A contribuição do governo digital e da transformação digital para as políticas públicas de saúde / The contribution of digital government and digital transformation to public health policies

A transformação digital na saúde é um reflexo das mudanças complexas e intensas de uma sociedade cada vez mais digital. Essas mudanças são ocasionadas pela conectividade e inovações disruptivas, que levam as organizações públicas, privadas e pessoas, a enfrentarem o desafio de integrar novas tecnologias digitais. Nesse sentido, esta pesquisa tem por objetivo propor um modelo conceitual para a transformação digital na saúde, que possibilite a integração do governo digital na oferta dos serviços públicos de saúde e seus sistemas de informação, com a finalidade de mitigar a sobreposição de tarefas, a fragmentação de esforços e o desperdício de recursos públicos. A pesquisa é classificada como exploratória com abordagem qualitativa e foi dividida em duas etapas: a primeira, conceitual, e a segunda, analítica. Na etapa conceitual, a pesquisa foi orientada pela análise documental e pelo levantamento bibliográfico da literatura entre os anos 2001 e 2021, por meio das publicações indexadas nas bases de dados Scopus, PubMed e Web of Science. Na etapa analítica, o estudo considerou os resultados encontrados na etapa conceitual e buscou identificar um estágio mais avançado da pesquisa, por meio de uma revisão sistemática de literatura. Nessa revisão sistemática, com recorte temporal de 2001 a fevereiro de 2023, foram selecionados 542 artigos nas mesmas bases da etapa conceitual. Foi utilizada a plataforma Rayyan para os revisores, e no final foram selecionados 41 artigos que atenderam aos critérios e temáticas estabelecidos pelo pesquisador. Como resultado, foi apresentado o modelo conceitual para a transformação digital para a saúde, com seus atributos, cenários, pilares e propostas. As políticas públicas de saúde são uma das áreas mais afetadas pela transformação digital. Isso ocorre porque as novas tecnologias digitais estão gerando uma quantidade de dados incomparável com as décadas anteriores. As tecnologias de informação e comunicação ­ como big data, internet das coisas, inteligência artificial, mídias sociais ­ têm o potencial de mudar a forma como as políticas públicas de saúde podem ser formuladas, implementadas e avaliadas. (AU)

The digital transformation in health is a reflection of the complex and intense changes in an increasingly digital society. These changes are caused by connectivity and disruptive innovations, which lead public and private organizations, as well as individuals, to face the challenge of integrating new digital technologies. In this sense, this research aims to propose a conceptual model for digital transformation in health, which enables the integration of digital government in the provision of public health services and their information systems in order to mitigate the overlapping of tasks, fragmentation of efforts and waste of public resources. The research is classified as exploratory with a qualitative approach and was divided into two stages: the first, conceptual, and the second, analytical. In the conceptual stage, the research was guided by documentary analysis and a bibliographic survey of the literature between 2001 and 2021, through publications indexed in the Scopus, PubMed, and Web of Science databases. In the analytical stage, the research considered the results found in the conceptual stage and sought to identify a more advanced stage of research through a systematic literature review. In this systematic review from 2001 to February 2023, 542 articles were selected from the same databases as the conceptual stage. The Rayyan platform was used for the reviewers, and, in the end, 41 articles were selected that met the criteria and themes established by the researcher. The result is a conceptual model for the digital transformation of health, with its attributes, scenarios, pillars, and proposals. Public health policies are one of the most affected areas by the digital transformation, due to the new digital technologies which are generating an amount of data that is incomparable to previous decades. Information and communication technologies, such as big data, the internet of things, artificial intelligence, and social media, have the potential to change the way public health policies can be formulated, implemented, and evaluated. (AU)

Lockdown as an Intervention Measure to Mitigate the Spread of COVID-19: a modeling study

Abstract INTRODUCTION: This work aims to develop a biomathematical transmission model of COVID-19, in the State of Sergipe, Brazil, to estimate the distribution of cases over time and project the impact on the spread of the epidemic outbreak due to interventions and control measures over the local population. METHODS: This is an epidemiological mathematical modeling study conducted to analyze the dynamics of the accumulated cases of COVID-19, which used a logistic growth model that adds a term of withdrawal of individuals as a control measure. Three possible COVID-19 propagation scenarios were simulated based on three different rates of withdrawal of individuals. They were adjusted with real data of the infected and measures of control over the population. RESULTS: The lockdown would be the best scenario, with a lower incidence of infected people, when compared to the other measures. The number of infected people would grow slowly over the months, and the number of symptomatic individuals in this scenario would be 40,265 cases. We noticed that the State of Sergipe is still in the initial stage of the disease in the scenarios. It was possible to observe that the peak of cases and the equilibrium, in the current situation of social isolation, will occur when reaching the new support capacity, at the end of August in approximately 1,171,353 infected individuals. CONCLUSIONS: We established that lockdown is the intervention with the highest ability to mitigate the spread of the virus among the population.

Vitamin E for prevention of oxaliplatin-induced peripheral neuropathy: a pilot randomized clinical trial / Vitamina E na prevenção de neuropatia periférica induzida pela oxaliplatina: estudo clínico piloto randomizado

Oxaliplatin is one of the chemotherapy regimens most used for treating colorectal cancer. One of the main limitations to its use is induction of peripheral neuropathy. Previous studies have shown that vitamin E can reduce the incidence of peripheral neuropathy by 50%. This study aimed to assess the effectiveness of vitamin E for prevention of oxaliplatin-induced peripheral neuropathy.

Prospective, phase II, randomized pilot study developed at a university hospital in the Greater ABC region.

Patients were randomized five days before starting oxaliplatin treatment, to receive either vitamin E or placebo until the end of the chemotherapy regimen. The outcome was evaluated using the Common Terminology Criteria for Adverse Events (CTCAE), version 3, and specific gradation scales for oxaliplatin-induced peripheral neuropathy. Patients with colorectal and gastric cancer who had been scheduled to receive oxaliplatin-based chemotherapy were included. Both groups received calcium and magnesium supplementation before and after oxaliplatin infusions.

Eighteen patients were randomized to the vitamin E group and 16 to the placebo group. Cumulative incidence of 83% with peripheral neuropathy grades 1/2 was observed in the vitamin E group, versus 68% in the placebo group (P = 0.45). A trend towards more diarrhea was observed among patients who received vitamin E (55.6% vs. 18.8%; P = 0.06). There were no other significant differences in toxicity between the groups.

No significant decrease in the incidence of acute oxaliplatin-induced peripheral neuropathy was demonstrated through vitamin E use.

A oxaliplatina é um dos quimioterápicos mais utilizados no tratamento do câncer colorretal, sendo a indução da neuropatia periférica (NP) uma das principais limitações para o seu uso. Trabalhos anteriores demonstraram que a vitamina E poderia reduzir a incidência dessa neuropatia em 50%. Este estudo teve como objetivo avaliar a efetividade da vitamina E na prevenção da NP induzida pela oxaliplatina.

Estudo piloto prospectivo e randomizado de fase II desenvolvido em hospital universitário do Grande ABC.

Os pacientes foram randomizados para receber vitamina E ou placebo por cinco dias antes do início do tratamento com oxaliplatina e até o término do regime quimioterápico. O desfecho foi avaliado através dos Critérios Comuns de Toxicidade do Câncer versão 3 (CTCAE) e escalas específicas de gradação da NP induzida por oxaliplatina. Foram incluídos pacientes com câncer colorretal e gástrico programado para receber quimioterapia baseada em oxaliplatina. Ambos os grupos receberam suplementação de cálcio e magnésio antes e depois das infusões de oxaliplatina.

Dezoito pacientes foram randomizados para grupo da vitamina E e 16 para o grupo placebo. Observou-se incidência cumulativa de 83% das classes I/II de neuropatia periférica no grupo da vitamina E, contra 68% no grupo placebo (P = 0,45). Observou-se maior tendência à diarreia em pacientes que receberam vitamina E (55,6% versus 18,8%, P = 0,06). Não houve outras diferenças significativas quanto às toxicidades entre os grupos. ...