Lentivirus Susceptibility in Brazilian and US Sheep with TMEM154 Mutations.

Small ruminant lentiviruses (SRLVs) affect sheep and goats worldwide. The major gene related to SRLV infections is the Transmembrane Protein Gene 154 (TMEM154). We estimated the haplotype frequencies of TMEM154 in the USA (USDA-ARS) and Brazil (Embrapa) Gene Banks by using two different SNP genotyping methodologies, FluidigmTM and KASPTM. We also genotyped the ZNF389_ss748775100 deletion variant in Brazilian flocks. A total of 1040 blood samples and 112 semen samples from 15 Brazilian breeds were genotyped with Fluidigm for the SNP ZNF389_ss748775100 and 12 TMEM154 SNPs. A total of 484 blood samples from the Santa Inês breed and 188 semen samples from 14 North American sheep breeds were genotyped with KASP for 6 TMEM154 SNPs. All the Brazilian samples had the "I/I" genotype for the ZNF389_ss748775100 mutation. There were 25 TMEM154 haplotypes distributed across the Brazilian breeds, and 4 haplotypes in the US breeds. Haplotypes associated with susceptibility were present in almost all breeds, which suggests that genetic testing can help to improve herd health and productivity by selecting non-susceptible animals as founders of the next generations. Fluidigm and KASP are reliable assays when compared with Beadchip arrays. Further studies are necessary to understand the unknown role of TMEM154 mutations, host-pathogen interaction and new genes associated with the clinical condition.

PEC e-SUS APS online appointment scheduling system: a tool to facilitate access to Primary Care in Brazil. / Sistema de agendamento online: uma ferramenta do PEC e-SUS APS para facilitar o acesso à Atenção Primária no Brasil.

Barriers faced by health services providing scheduled care result in high no-show rates. This article describes the main characteristics of an online appointment scheduling system incorporated into the citizens' electronic health record system (PEC e-SUS APS). Developed by the Bridge Laboratory, Federal University of Santa Catarina, which also developed the PEC e-SUS APS, the system allows patients to schedule appointments using the national patient communications hub, Conecte SUS Cidadão. The PEC e-SUS APS includes a professional's agenda module that allows patients to view available time slots and book and cancel appointments. Unfortunately, despite the benefits of online scheduling systems, their potential has been poorly exploited in Brazil. The main reasons for this include lack of information and training of health professionals on how to use the system and its potential benefits for Primary Health Care (PHC) services. Wider dissemination is needed to improve the adoption of the system and promote the routine use of this tool in health services in order to facilitate access to primary health care.

A existência de barreiras nos serviços de demanda agendada resulta no elevado índice de absenteísmo. O objetivo deste manuscrito é apresentar as principais características do Sistema de Agendamento Online da estratégia e-SUS APS no Brasil. O Sistema de Agendamento Online desenvolvido pelo Laboratório Bridge da Universidade Federal de Santa Catarina, o qual também desenvolve o sistema de Prontuário Eletrônico do Cidadão (PEC e-SUS APS), e permite o agendamento de consultas através do aplicativo Conecte SUS Cidadão. O PEC e-SUS APS possui, entre outros, o módulo de agenda do profissional onde são realizadas as marcações e cancelamentos de consultas, permitindo a visualização de seus horários e disponibilidades. Embora o uso de sistemas de agendamento online seja capaz de fornecer benefícios, infelizmente eles têm sido pouco explorados na APS. Os principais motivos estão relacionados com a falta de informação e capacitação dos profissionais sobre o sistema e os impactos nos serviços prestados pelos estabelecimentos de saúde da APS. A fim de garantir a maior adoção e utilização do Sistema de Agendamento Online, é necessário ampliar a divulgação do sistema de modo a instituí-lo na rotina dos serviços como um instrumento facilitador do acesso à APS.

Sistema de agendamento online: uma ferramenta do PEC e-SUS APS para facilitar o acesso à Atenção Primária no Brasil / PEC e-SUS APS online appointment scheduling system: a tool to facilitate access to Primary Care in Brazil

Resumo A existência de barreiras nos serviços de demanda agendada resulta no elevado índice de absenteísmo. O objetivo deste manuscrito é apresentar as principais características do Sistema de Agendamento Online da estratégia e-SUS APS no Brasil. O Sistema de Agendamento Online desenvolvido pelo Laboratório Bridge da Universidade Federal de Santa Catarina, o qual também desenvolve o sistema de Prontuário Eletrônico do Cidadão (PEC e-SUS APS), e permite o agendamento de consultas através do aplicativo Conecte SUS Cidadão. O PEC e-SUS APS possui, entre outros, o módulo de agenda do profissional onde são realizadas as marcações e cancelamentos de consultas, permitindo a visualização de seus horários e disponibilidades. Embora o uso de sistemas de agendamento online seja capaz de fornecer benefícios, infelizmente eles têm sido pouco explorados na APS. Os principais motivos estão relacionados com a falta de informação e capacitação dos profissionais sobre o sistema e os impactos nos serviços prestados pelos estabelecimentos de saúde da APS. A fim de garantir a maior adoção e utilização do Sistema de Agendamento Online, é necessário ampliar a divulgação do sistema de modo a instituí-lo na rotina dos serviços como um instrumento facilitador do acesso à APS.

Abstract Barriers faced by health services providing scheduled care result in high no-show rates. This article describes the main characteristics of an online appointment scheduling system incorporated into the citizens' electronic health record system (PEC e-SUS APS). Developed by the Bridge Laboratory, Federal University of Santa Catarina, which also developed the PEC e-SUS APS, the system allows patients to schedule appointments using the national patient communications hub, Conecte SUS Cidadão. The PEC e-SUS APS includes a professional's agenda module that allows patients to view available time slots and book and cancel appointments. Unfortunately, despite the benefits of online scheduling systems, their potential has been poorly exploited in Brazil. The main reasons for this include lack of information and training of health professionals on how to use the system and its potential benefits for Primary Health Care (PHC) services. Wider dissemination is needed to improve the adoption of the system and promote the routine use of this tool in health services in order to facilitate access to primary health care.

e-SUS APS strategy: Case of success on Primary Care informatization in Brazil / Estratégia e-SUS APS: Um Caso de sucesso na informatização da Atenção Primária no Brasil / Estrategia e-SUS APS: Caso de éxito de informatización de Atención Primaria en Brasil

Objectives: To present the main actions of the Brazilian government that led to the successful implementation of the strategy for the computerization of Primary Care, e-SUS APS, throughout the whole country, as well as the difficulties in implementing such a national health information system (NHIS). Methods: Report on the experience of implementing an NHIS in Brazilian Primary Care, identifying the actions taken by the government to mitigate the risks and overcome difficulties. Results: The e-SUS Primary Care strategy (e-SUS APS) initiated the restructuring of the health information system at the national level. This action focused on the effective management of information, considered essential to increase the quality of care. This strategy aims to create different realities of technological infrastructure and allow all cities to interconnect with an NHIS across the country. Since e-SUS AB was implemented, more than 3 billion records of Primary Health Care (PHC) from all regions of the country have been received by the government. Today, even cities with weak technological infrastructure are able to transmit their data to NHIS, which manages all information. Conclusion: The implementation of the new strategy for primary care at almost 100% of Brazilian municipalities has been a success due to a number of factors. However, efforts must be maintained to ensure the success of its implementation.

Objetivos: Apresentar as principais ações do governo brasileiro que levaram ao sucesso da implantação da estratégia da informatização da Atenção Primária, e-SUS APS, em todo o país, bem como as dificuldades para se implantar um sistema nacional de informações em saúde (NHIS). Métodos: Relato da experiência da implantação de um NHIS na Atenção Primária brasileira, identificando as ações adotadas pelo governo para mitigar os riscos e superar as suas dificuldades. Resultados: A estratégia e-SUS Atenção Básica (e-SUS APS) iniciou a reestruturação do sistema de informação em saúde em nível nacional. Essa ação se concentrou no gerenciamento eficaz das informações, considerado como essencial para aumentar a qualidade do atendimento. Essa estratégia foi construída com o intuito de criar diferentes realidades de infraestrutura tecnológica e permitir que todas as cidades se interconectem com um NHIS em todo o país. Desde que o e-SUS APS foi implantado, mais de 3 bilhões de registros de atenção primária à saúde (APS) de todas as regiões do país, foram recebidos pelo governo. Hoje, mesmo cidades com fraca infraestrutura tecnológica são capazes de transmitir seus dados ao NHIS, que gerencia todas as informações. Conclusão: A implantação da nova estratégia para atenção primária em quase 100% do território brasileiro vem sendo um sucesso devido a uma série de fatores. No entanto, os esforços devem ser mantidos para garantir o sucesso de sua implementação.

Objetivos: Presentar las principales acciones del gobierno brasileño que llevaron a la implementación exitosa de la estrategia de informatización de atención primaria, e-SUS APS, en todo el país, así como las dificultades para implementar un sistema nacional de información de salud (NHIS). Métodos: Informe sobre la experiencia de implementar un NHIS en Atención Primaria brasileña, identificando las acciones tomadas por el gobierno para mitigar riesgos y superar sus dificultades. Resultados: La estrategia de atención primaria de e-SUS (e-SUS APS) inició la reestructuración del sistema de información de salud a nivel nacional. Esta acción se centró en el manejo efectivo de la información, considerada esencial para aumentar la calidad de la atención. Esta estrategia fue construida con el objetivo de crear diferentes realidades de infraestructura tecnológica y permitir que todas las ciudades se interconecten con un NHIS en todo el país. Desde que se implementó el e-SUS APS, el gobierno ha recibido más de 3 mil millones de registros de atención primaria de salud (APS) de todas las regiones del país. Hoy, incluso las ciudades con infraestructura tecnológica débil pueden transmitir sus datos a NHIS, que administra toda la información. Conclusión: La implementación de la nueva estrategia de atención primaria en casi 100% del territorio brasileño ha sido un éxito debido a una serie de factores. Sin embargo, se deben mantener los esfuerzos para garantizar el éxito de su implementación.

An overview of the results of hysterosonography prior to in vitro fertilization.

OBJECTIVE: This study aimed to analyze the results of hysterosonography performed prior to in vitro fertilization (IVF) and to correlate anomalous findings with hysteroscopy. METHODS: Findings from 197 hysterosonograms of patients examined in an assisted reproduction clinic between January 2012 and August 2014 were included. Enrollment criteria: patients in preparation for IVF not recently submitted to uterine examination through hysterosalpingography or hysteroscopy referred to hysterosonography. Uterine cavity evaluation was considered anomalous when one or more of the following were found: polyps, submucous myomas, uterine synechiae, Müllerian duct anomalies. Individuals with cavity abnormalities that might interfere with IVF results were referred to hysteroscopy. RESULTS: Normal test results were seen in 170/197 of the cases (86.3%). Eighteen of the 197 cases (9.1%) were suspected for polyps, two (1%) for submucous myoma, six (3.5%) for synechiae, and one (0.5%) for Müllerian duct anomalies. Sixteen of the patients diagnosed with abnormalities underwent hysteroscopy to confirm or treat the suspected pathology. In only two cases there was no agreement between tests: one patient suspected for synechiae and another for polyps were not confirmed; another individual suspected for polyps was found to have focal endometrial thickening in hysteroscopy. The positive predictive value (PPV) in our study was 93.7%. CONCLUSION: In most cases, the diagnoses obtained by hysterosonography showed normal uterine cavities. The most common anomalous findings were polyps, followed by synechiae, submucous myoma, and Müllerian duct anomalies. Hysterosonography is a good option for evaluating the uterus and offers a high positive predictive value, while hysteroscopy stands as the gold standard.

Does the use of structured reporting improve usability? A comparative evaluation of the usability of two approaches for findings reporting in a large-scale telecardiology context.

One of the main reasons that leads to a low adoption rate of telemedicine systems is poor usability. An aspect that influences usability during the reporting of findings is the input mode, e.g., if a free-text (FT) or a structured report (SR) interface is employed. The objective of our study is to compare the usability of FT and ST telemedicine systems, specifically in terms of user satisfaction, efficiency and general usability. We comparatively evaluate the usability of these two input modes in a telecardiology system for issuing electrocardiography reports in the context of a statewide telemedicine system in Brazil with more than 350.000 performed tele-electrocardiography examinations. We adopted a multiple method research strategy, applying three different kinds of usability evaluations: user satisfaction was evaluated through interviews with seven medical professionals using the System Usability Scale (SUS) questionnaire and specific questions related to adequacy and user experience. Efficiency was evaluated by estimating execution time using the Keystroke-Level Model (KLM). General usability was assessed based on the conformity of the systems to a set of e-health specific usability heuristics. The results of this comparison provide a first indication that a structured report (SR) input mode for such a system is more satisfactory and efficient with a larger conformity to usability heuristics than free-text (FT) input. User satisfaction using the SUS questionnaire has been scored in average with 58.8 and 77.5 points for the FT and SR system, respectively, which means that the SR system was rated 18.65 points higher than the FT system. In terms of efficiency, the completion of a findings report using the SR mode is estimated to take 8.5s, 3.74 times faster than using the FT system (31.8s). The SR system also demonstrated less violations to usability heuristics (8 points) in comparison to 14 points observed in the FT system. These results provide a first indication that the usage of structured reporting as an input mode in telecardiology systems may enhance usability. This also seems to confirm the advantages of the usage of structured reporting, as already described in the literature for other areas such as teleradiology.

Molecular and pedigree analysis applied to conservation of animal genetic resources: the case of Brazilian Somali hair sheep.

The first registers of Somali sheep in Brazil are from the beginning of the 1900s. This breed, adapted to the dry climate and scarce food supply, is restricted in the northeast region of the country. Molecular marker technologies, especially those based on genotyping microsatellite and mtDNA loci, can be used in conjunction with breeding (pedigree analysis) and consequently the maintenance of genetic variation in herds. Animals from the Brazilian Somali Conservation Nuclei from Embrapa Sheep and Goats in Ceará State were used to validate genetic monitoring by traditional pedigree methods and molecular markers. Nineteen microsatellite markers and 404 base pairs from the control region of mtDNA were used. For total herd diversity, an average 5.32 alleles were found, with expected heterozygosity of 0.5896, observed heterozygosity of 0.6451, 0.4126 for molecular coancestrality, and coefficient of inbreeding (F (IS)) was -0.095. Comparing molecular coancestrality means over the years, there was a consistent increase in this parameter within the herd, increasing from 0.4157 to 0.4769 in 2 years (approx. 12% variation). Sixteen mtDNA haplotypes were identified. Inbreeding and other estimates from genealogical analyses confirm the results from molecular markers. From these results, it is possible to state that microsatellites are useful tools in genetic management of herds, especially when routine herd recording is not carried out, or there were gaps in recent generations. As well as pedigree control, genetic diversity can be optimized. Based on the results, and despite herd recording in the herd of Brazilian Somali of Embrapa Sheep and Goats, additional management measures need to be carried out in this herd to reduce inbreeding and optimize genetic variation.