Uso das Tecnologias de Informação e Comunicação por Professores da Área da Saúde da Universidade Federal de São Paulo / Use of Information and Communication Technologies by Teachers of the Health Area of the Universidade Federal de São Paulo

RESUMO Objetivo Investigar o uso das Tecnologias de Informação e Comunicação (TIC) por professores da Unifesp. Métodos Estudo observacional descritivo do tipo transversal, baseado em amostra aleatória simples composta por 191 respondentes. Estudou-se a associação do número total de 27 TIC com as variáveis idade, sexo, titulação, lecionar em dois ou mais cursos e participação em curso preparatório para docência no ensino superior. Resultados A idade média foi de 49 anos, 60,7% do sexo feminino, 72,8% em nível de doutorado e 33,0% lecionavam em dois ou mais cursos. Observou-se associação negativa entre quantidade de TIC e idade, e associação direta entre titulação e realização de curso para docência. Conclusão A quantidade de instrumentos utilizados diminuiu 1,2 a cada dez anos, aumentou 1,8 com a participação do docente em curso preparatório e 1 a cada titulação obtida.

ABSTRACT Objective To investigate the use of Information and Communication Technologies (ICT) by UNIFESP professors. Methods Descriptive cross-sectional observational study based on simple random sample of 191 respondents. We studied the association of a total of 27 ICT to the age, sex, academic qualification, status of teaching in two or more courses and involvement in preparatory course for teaching in higher education. Results The mean age was 49 years, 60.7% female, 72.8% at the doctoral level and 33.0% teaching on two or more courses. We observed a negative association between the amount of ICT and age, and a direct association between academic qualification and having completed teacher training. Conclusion The amount of instruments used fell by 1.2 every 10 years, and increased by 1.8 with the participation of professors in preparatory courses and by 1 for each academic title obtained.

Web-based auditory self-training system for adult and elderly users of hearing aids.

INTRODUCTION: Adults and elderly users of hearing aids suffer psychosocial reactions as a result of hearing loss. Auditory rehabilitation is typically carried out with support from a speech therapist, usually in a clinical center. For these cases, there is a lack of computer-based self-training tools for minimizing the psychosocial impact of hearing deficiency. OBJECTIVE: To develop and evaluate a web-based auditory self-training system for adult and elderly users of hearing aids. METHODS: Two modules were developed for the web system: an information module based on guidelines for using hearing aids; and an auditory training module presenting a sequence of training exercises for auditory abilities along the lines of the auditory skill steps within auditory processing. We built aweb system using PHP programming language and a MySQL database .from requirements surveyed through focus groups that were conducted by healthcare information technology experts. The web system was evaluated by speech therapists and hearing aid users. An initial sample of 150 patients at DSA/HRAC/USP was defined to apply the system with the inclusion criteria that: the individuals should be over the age of 25 years, presently have hearing impairment, be a hearing aid user, have a computer and have internet experience. They were divided into two groups: a control group (G1) and an experimental group (G2). These patients were evaluated clinically using the HHIE for adults and HHIA for elderly people, before and after system implementation. A third web group was formed with users who were invited through social networks for their opinions on using the system. A questionnaire evaluating hearing complaints was given to all three groups. The study hypothesis considered that G2 would present greater auditory perception, higher satisfaction and fewer complaints than G1 after the auditory training. It was expected that G3 would have fewer complaints regarding use and acceptance of the system. RESULTS: The web system, which was named SisTHA portal, was finalized, rated by experts and hearing aid users and approved for use. The system comprised auditory skills training along five lines: discrimination; recognition; comprehension and temporal sequencing; auditory closure; and cognitive-linguistic and communication strategies. Users needed to undergo auditory training over a minimum period of 1 month: 5 times a week for 30 minutes a day. Comparisons were made between G1 and G2 and web system use by G3. CONCLUSION: The web system developed was approved for release to hearing aid users. It is expected that the self-training will help improve effective use of hearing aids, thereby decreasing their rejection.

Hope matters to the glycemic control of adolescents and young adults with type 1 diabetes.

This study investigated the association of hope and its factors with depression and glycemic control in adolescents and young adults with type 1 diabetes. A total of 113 patients were invited to participate. Significant negative correlations were found between hope and HbA1c and also between hope and depression. Hope showed a significant association with HbA1c and depression in the stepwise regression model. Among the hope factors, "inner positive expectancy" was significantly associated with HbA1c and depression. This study supports that hope matters to glycemic control and depression. Intervention strategies focusing on hope should be further explored.

The impact of knowledge about diabetes, resilience and depression on glycemic control: a cross-sectional study among adolescents and young adults with type 1 diabetes.

BACKGROUND: The purpose of this study is to evaluate the relationship between glycemic control and the factors of knowledge about diabetes, resilience, depression and anxiety among Brazilian adolescents and young adults with type 1 diabetes. METHODS: This cross-sectional study included 85 adolescents and young adults with type 1 diabetes, aged between 11-22 years, with an average age of 17.7 ± 3.72 years. Glycemic control degree was evaluated through HbA1c. To assess psychosocial factors, the following questionnaires were used: resilience (Resilience Scale, RS) and anxiety and depression (Hospital Anxiety and Depression Scale, HADS). The Diabetes Knowledge Assessment Scale (DKNA) was used to assess knowledge about diabetes. RESULTS: Significant correlations were found between HbA1c and resilience, anxiety and depression. Multiple linear regression analysis revealed that the only variable which presented significant association with the value of HbA1c was depression. CONCLUSIONS: Depression has a significant association with higher HbA1c levels, as demonstrated in a regression analysis. The results suggest that depression, anxiety and resilience should be considered in the design of a multidisciplinary approach to type 1 diabetes, as these factors were significantly correlated with glycemic control. Glycemic control was not correlated with knowledge of diabetes, suggesting that theoretical or practical understanding of this disease is not by itself significantly associated with appropriate glycemic control (HbA1c = 7.5%).

A aprendizagem humana: cada pessoa com seu estilo / The human learning: each person with his/her style

O modo como as pessoas sentem e pensam os desafios, isto é, como manejam e buscam a solução, é diferente de uma para outra. Adotar determinada estratégia, optar por certo caminho e decidir entre uma ou outra alternativa evidencia um jeito próprio e singular de lidar com as informações. Como se dá a aprendizagem humana, compreender como as pessoas elaboram e processam as informações é uma das possibilidades de conhecer como ela aprende. Diferentes pressupostos teóricos podem explicar o fenômeno da aprendizagem humana, como a Teoria das Inteligências Múltiplas, a Teoria dos Estilos Cognitivos, bem como a Teoria dos Estilos de Aprendizagem. Com o objetivo de relacionar os conceitos de estilos cognitivos, de inteligências múltiplas e de estilos de aprendizagem com o modo de aprender das pessoas, buscamos na literatura a fundamentação que esclarecesse os conceitos citados.(AU)

How people feel and think of challenges, each person manages and searches for a solution in a personal way. Applying a strategy, choosing a specific way, deciding between two alternatives indicate a personal and unique approach to deal with information. How do human beings learn? Understanding how people elaborate and process information is one way of getting to know how a human being learns in both systems, formal and distance learning. Different theoretical assumptions, among others, may explain this phenomenon as the Theory of Multiple Intelligence, the Theory of Cognitive Styles and also the Theory of Learning Styles. Aiming at making the connection among the concepts cognitive styles, multiple intelligence and learning styles, we have searched in the literature the reasoning to clarify the concepts mentioned which could be the reason to review the teaching and learning processes.(AU)

A aprendizagem humana: cada pessoa com seu estilo / The human learning: each person with his/her style

O modo como as pessoas sentem e pensam os desafios, isto é, como manejam e buscam a solução, é diferente de uma para outra. Adotar determinada estratégia, optar por certo caminho e decidir entre uma ou outra alternativa evidencia um jeito próprio e singular de lidar com as informações. Como se dá a aprendizagem humana, compreender como as pessoas elaboram e processam as informações é uma das possibilidades de conhecer como ela aprende. Diferentes pressupostos teóricos podem explicar o fenômeno da aprendizagem humana, como a Teoria das Inteligências Múltiplas, a Teoria dos Estilos Cognitivos, bem como a Teoria dos Estilos de Aprendizagem. Com o objetivo de relacionar os conceitos de estilos cognitivos, de inteligências múltiplas e de estilos de aprendizagem com o modo de aprender das pessoas, buscamos na literatura a fundamentação que esclarecesse os conceitos citados.

How people feel and think of challenges, each person manages and searches for a solution in a personal way. Applying a strategy, choosing a specific way, deciding between two alternatives indicate a personal and unique approach to deal with information. How do human beings learn? Understanding how people elaborate and process information is one way of getting to know how a human being learns in both systems, formal and distance learning. Different theoretical assumptions, among others, may explain this phenomenon as the Theory of Multiple Intelligence, the Theory of Cognitive Styles and also the Theory of Learning Styles. Aiming at making the connection among the concepts cognitive styles, multiple intelligence and learning styles, we have searched in the literature the reasoning to clarify the concepts mentioned which could be the reason to review the teaching and learning processes.

Digital inclusion and functional capacity of older adults living in Florianópolis, Santa Catarina, Brazil (EpiFloripa 2009-2010).

OBJECTIVE: To study the relationship between digital inclusion, represented by the exchange of online messages, and functional capacity of older adults living in Florianópolis, Santa Catarina, Brazil. METHODS: Data were from EpiFloripa Idoso, a cross-sectional household-based survey conducted between 2009 and 2010 with older adults (60+ years). Functional capacity was represented by the inability / difficulty to perform basic / instrumental activities of daily living, and formed the outcome variable called functional dependence. The main independent variable was self-reported ability to send and receive online messages using the computer. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were estimated with multivariable Poisson regression models. RESULTS: The sample consisted of 1,656 older adults between 60 and 102 years old with a mean age of 70.39 years (SD = 7.79). Older adults who could send and receive online messages without difficulty demonstrated a significant lower prevalence of moderate / severe functional dependence (PR = 0.61; 95%CI: 0.40 - 0.94) after adjustment for demographic, socioeconomic, health and behavioral factors. CONCLUSIONS: The exchange of online messages has a strong association with functional independence. The causality of this association cannot be determined. Studies support the hypothesis that the exchange of online messages and functional independence have a bidirectional, additive and synergistic association. Longitudinal studies could elucidate the mechanisms involved in this association, in order to support digital inclusion policies for older adults, and to identify the profile of older adults who would benefit the most from digital inclusion.

Categorização automática de conteúdos web de saúde em português brasileiro com classificador bayesiano / Automatic categorization of health-related web content in brazilian portuguese language with bayesian classifier / Categorización automática de contenidos web sobre salud en portugués de Brasil con elclasificador bayesiano

Objetivo: Investigar aplicação de diferentes métodos de representação de textos por vetores de pesos com classificador bayesiano para classificação automática de conteúdos web de saúde em português. Métodos: Foi utilizado conjunto de 3.702 páginas web de saúde em português dividido em 19 categorias provenientes do Open Directory Project. Foram comparados desempenho de 4 métodos de representação de textos por vetores de pesos utilizados com o classificador Naive Bayes, medidos por revocação, precisão e F2, considerando da primeira à quinta posições dos rankings de relevância de categorias. Resultados: A representação dos textos por ocorrência dos termos utilizada com o classificador Naive Bayes (nb-to) atingiu 0,91 de revocação, precisão e F2 para a primeira posição do ranking de relevância de categorias; para a quinta posição os valores foram 0,98; 0,20 e 0,54, respectivamente. Estes valores colocam nb-to como o melhor classificador dos investigados para a base de dados utilizada, com diferença estatística entre este e todos os demais classificadores. Conclusão: Métodos de recuperação de informação baseados no Naive Bayes podem ser utilizados com sucesso para categorizar conteúdo web de saúde em idioma português, sendo que o classificador nb-to atingiu o melhor desempenho na tarefa de classificação.

Objective: To investigate the application of different methods of text representation by weighting vectors with a Bayesian classifier to automatically categorize health-related web pages in Brazilian Portuguese language. Methods: We used a set of 3,702 health-related web pages in Brazilian Portuguese language, separated in 19 categories, from Open Directory Project. We compared the effectiveness of 4 different methods of text representation by weighting vectors used with the Naive Bayes classifier, according to recall, precision and F2 measures and considering from the first to the fifth positions of category relevance ranking produced by the classifiers. Results: The text representation by counting the term occurrence with the Naive Bayes classifier (nb-to) reached 0.91 of recall, precision and F2 to the first position of the category relevance ranking, while to the fifth position the values were 0.98, 0.20, and 0.54, respectively. These results place nb-to as the best classifier to the database used in this work, with statistical differences between this classifier and all other. Conclusion: The information retrieval methods based on Naïve Bayes can be successfully used to categorize health-related web content in Brazilian Portuguese language and the nb-to classifier achieved the best performance at classification.

Objetivo: Investigar aplicación de diferentes métodos de representación de textos con un clasificador bayesiano para clasificación automática de contenidos web sobre salud en portugués de Brasil. Métodos: Se utilizó un conjunto de 3.702 páginas web sobre salud en portugués de Brasil, en 19 categorías y provenientes del Open Directory Project. Se comparó el desempeño de 4 métodos de representación de textos por vector de pesos utilizados con el clasificador Naive Bayes, medidos por recall, precisión y F2, considerándose de la primera a la quinta posición en los rankings de relevancia de categorías. Resultados: El clasificador Naive Bayes (nb-to) alcanzó 0,91 de recall, precisión y F2 para la primera posición en el ranking de relevancia de categorías, mientras que para la quinta posición, los valores fueron de 0,98, 0,20 y 0,54, respectivamente. Estos valores colocan el nb-to como el mejor clasificador para la base de datos utilizado, con diferencia estadística entre éste y todos los clasificadores testados. Conclusión: Los métodos de recuperación de información basados en el Naive Bayes pueden ser utilizados con éxito para categorizar contenidos web sobre salud en el idioma portugués de Brasil, pero el clasificador nb-to alcanzó el mejor desempeño al ejecutar la tarea de clasificación.

Inclusão digital e capacidade funcional de idosos residentes em Florianópolis, Santa Catarina, Brasil (EpiFloripa 2009-2010) / Digital inclusion and functional capacity of older adults living in Florianópolis, Santa Catarina, Brazil (EpiFloripa 2009-2010)

OBJETIVO: Estudar a relação entre inclusão digital, na forma de troca de mensagens pela Internet, e capacidade funcional de idosos residentes em Florianópolis, Santa Catarina, Brasil. MÉTODOS: Utilizaram-se dados do EpiFloripa Idoso, um estudo transversal de base populacional com idosos (60+ anos) realizado entre 2009 e 2010. A capacidade funcional foi representada pela dificuldade ou incapacidade na realização de atividades básicas ou instrumentais da vida diária, e constituiu a variável dependente denominada dependência funcional. A variável independente principal foi a capacidade autorreferida de enviar e receber mensagens pela Internet usando um computador. Razões de prevalência (PR) e intervalos de confiança de 95 por cento (IC95 por cento) foram estimados em modelo multivariável por regressão de Poisson. RESULTADOS: A amostra compreendeu 1.656 idosos entre 60 e 102 anos com idade média de 70,39 anos (DP = 7,79). Os idosos que conseguiam enviar e receber mensagens pela Internet sem dificuldade apresentaram prevalência significativamente menor de dependência funcional moderada/grave (RP = 0,61; IC95 por cento: 0,40 - 0,94) após ajuste para fatores demográficos, socioeconômicos, de saúde e comportamentais. CONCLUSÕES: A troca de mensagens pela Internet possui forte associação com independência funcional. Não é possível inferir a relação de causalidade dessa associação. Estudos alicerçam a hipótese de que a troca de mensagens pela Internet e a independência funcional tenham uma associação bidirecional, aditiva e sinérgica. Estudos longitudinais poderiam investigar os mecanismos envolvidos nessa associação, para fundamentar políticas de inclusão digital de idosos e para identificar qual o perfil de idosos que mais se beneficiaria com essa inclusão.

OBJECTIVE: To study the relationship between digital inclusion, represented by the exchange of online messages, and functional capacity of older adults living in Florianópolis, Santa Catarina, Brazil. METHODS: Data were from EpiFloripa Idoso, a cross-sectional household-based survey conducted between 2009 and 2010 with older adults (60+ years). Functional capacity was represented by the inability / difficulty to perform basic / instrumental activities of daily living, and formed the outcome variable called functional dependence. The main independent variable was self-reported ability to send and receive online messages using the computer. Prevalence ratios (PR) and 95 percent confidence intervals (95 percentCI) were estimated with multivariable Poisson regression models. RESULTS: The sample consisted of 1,656 older adults between 60 and 102 years old with a mean age of 70.39 years (SD = 7.79). Older adults who could send and receive online messages without difficulty demonstrated a significant lower prevalence of moderate / severe functional dependence (PR = 0.61; 95 percentCI: 0.40 - 0.94) after adjustment for demographic, socioeconomic, health and behavioral factors. CONCLUSIONS: The exchange of online messages has a strong association with functional independence. The causality of this association cannot be determined. Studies support the hypothesis that the exchange of online messages and functional independence have a bidirectional, additive and synergistic association. Longitudinal studies could elucidate the mechanisms involved in this association, in order to support digital inclusion policies for older adults, and to identify the profile of older adults who would benefit the most from digital inclusion.

Results of a randomized controlled trial to assess the effects of a mobile SMS-based intervention on treatment adherence in HIV/AIDS-infected Brazilian women and impressions and satisfaction with respect to incoming messages.

OBJECTIVE: To assess whether a warning system based on mobile SMS messages increases the adherence of HIV-infected Brazilian women to antiretroviral drug-based treatment regimens and their impressions and satisfaction with respect to incoming messages. DESIGN: A randomized controlled trial was conducted from May 2009 to April 2010 with HIV-infected Brazilian women. All participants (n=21) had a monthly multidisciplinary attendance; each participant was followed over a 4-month period, when adherence measures were obtained. Participants in the intervention group (n=8) received SMS messages 30 min before their last scheduled time for a dose of medicine during the day. The messages were sent every Saturday and Sunday and on alternate days during the working week. Participants in the control group (n=13) did not receive messages. MEASUREMENTS: Self-reported adherence, pill counting, microelectronic monitors (MEMS) and an interview about the impressions and satisfaction with respect to incoming messages. RESULTS: The HIV Alert System (HIVAS) was developed over 7 months during 2008 and 2009. After the study period, self-reported adherence indicated that 11 participants (84.62%) remained compliant in the control group (adherence exceeding 95%), whereas all 8 participants in the intervention group (100.00%) remained compliant. In contrast, the counting pills method indicated that the number of compliant participants was 5 (38.46%) for the control group and 4 (50.00%) for the intervention group. Microelectronic monitoring indicated that 6 participants in the control group (46.15%) were adherent during the entire 4-month period compared to 6 participants in the intervention group (75.00%). According to the feedback of the 8 participants who completed the research in the intervention group, along with the feedback of 3 patients who received SMS for less than 4 months, that is, did not complete the study, 9 (81.81%) believed that the SMS messages aided them in treatment adherence, and 10 (90.90%) responded that they would like to continue receiving SMS messages. CONCLUSION: SMS messaging can help Brazilian women living with HIV/AIDS to adhere to antiretroviral therapy for a period of at least 4 months. In general, the results are encouraging because the SMS messages stimulated more participants in the intervention group to be adherent to their treatment, and the patients were satisfied with the messages received, which were seen as reminders, incentives and signs of affection by the health clinic for a marginalized population.

Sistemas de apoio à decisão baseados em diretrizes interpretadas por computador: um breve histórico e outros tópicos / Clinical decision support systems based on computer-interpretable guideline: a brief history and others topics / Sistemas de soporte a la decisión sobre la base de guías interpretadas por un ordenador: una breve historia yotros temas

Este artigo aborda aspectos sobre a construção de sistemas de apoio à decisão clínica (SADC) e relata o desenvolvimento histórico de sistemas que utilizam bases de conhecimento (BC) de forma a armazenar diretrizes digitais em saúde, ou seja, diretrizes interpretadas por computador (DIC). Também são apresentados os principais requisitos que definem um SADC.

The present paper focuses on the construction of Clinical Decision Support Systems (CDSS) and recounts the chronological development of systems that use Knowledge Bases (KB) in order to store digital guidelines, i.e. Computer-Interpretable Guidelines (CIG). We also present the main requirements that define a CDSS.

Este artículo se centra en la construcción de sistemas de apoyo de decisiones clínicas (SADC) y se relaciona con el desarrollo histórico de los sistemas que utilizan las bases de conocimiento para almacenar las directrices digitales de la salud, es decir, directrices interpretado por ordenador. También se presentan los principales requisitos que definen a un SADC.

Análise da percepção de usuários sobre a qualidade de websites em saúde comparada com os critérios de adequação da HON / Analysis of user perception regarding the quality of health websites compared to HON suitability criteria / Análisis de la percepción de usuários acerca de la calidad de los sitios web de salud en comparación con loscriterios de adecuación de la HON

Objetivos: Neste trabalho foi comparada a percepção de usuários sobre a qualidade de conteúdos de websites da área da saúde e suas respectivas avaliações sobre a adequação destes websites aos critérios éticos propostos pela HON. Métodos: Uma interface web foi desenvolvida com tecnologias Web 2.0 para a avaliação dos critérios de adequação e da percepção de qualidade. Estudantes da área de informática em saúde foram selecionados para determinar a percepção de qualidade e adequação de conteúdos de 50 websites no domínio da saúde. Resultados: Participaram deste estudo 352 estudantes, que realizaram 2.277 avaliações. Cada website foi avaliado em média 36,83 vezes, e os websites avaliados tiveram uma média de adequação de 50,11% e a pontuação da percepção de qualidade foi de 49,06 em uma escala de 0 a 100. Diante dos 12 critérios propostos, apenas 3 apresentaram correlação estatisticamente significante se comparado com a percepção dos usuários sobre a qualidade do conteúdo de websites de saúde. Conclusão: Diante das análises foi possível identificar que os websites apresentaram poucos indícios de adequação (50,11) e na visão dos avaliadores mesmo com pouca adequação, os websites foram considerados bons.

Objectives: This study compared the user quality perception of health content regarding their assessments of the adequacy of the criteria for websites based on HON code recommendations. Methods: A web interface was developed with Web 2.0 technologies for this assessment of adequacy criteria. Students of health domain voted their quality perception and adequacy of content for 50 websites in the health domain, based on the criteria of adequacy defined by the HON code. Results: This study included 352 students and showed that the average adequacy assessed for the websites were 50.11 and 49.06 of perception, in a range from 0 to 100. Given the 12 criteria, only 3 showed a statistically significant correlation compared with the users? perception about the quality of health websites content. Conclusion: Against the analysis it was found that the websites showed little evidence of adequacy (50.11) and in view of the evaluators even in low adequacy, the websites were considered good.

Objetivos: Este estudio comparó la percepción de calidad de contenido del dominio de salud por usuarios com su evaluación de la adecuación dos sítios web con los criterios de recomendaciones basados en código HON. Métodos: Una interfaz web fue desarrollado con las tecnologías Web 2.0 para la evaluación de los criterios de adecuación. Estudiantes de área de salud determina su percepción de la calidad y de la adecuación de contenidos para 50 sitios web en el ámbito de la salud, con base en los criterios de adecuacion definidos por el código HON. Resultados: Este estudio incluyó 352 estudiantes que mostraron la media de la evaluación de adecuación para los sitios web de 50,11 y 49,06 de la percepción, en un rango de 0 a 100. Teniendo en cuenta los 12 criterios, sólo 3 mostraron una correlación estadísticamente significativa en comparación con la percepción de los usuarios sobre la calidad de los contenidos en sitios web en salud. Conclusión: Diante de los análisis se encontró que los sitios web mostraron pocas pruebas de adecuación (50,11) y, en opinión de los evaluadores, incluso en la aptitud baja, los sitios web se considera buenos.

[BabyCare: decision support system for primary child care using personal digital assistant]. / BabyCare: apoio à decisão na atenção primária materno-infantil com computadores de mão.

The purpose of this work was to develop a digital device - referred as BabyCare System - for the collection, storage, and decision support for healthcare professionals and other concerned people, in order to assist patients in primary child care in deprived communities. This system is based on handheld device technologies to be used locally in basic healthcare units in deprived communities, whether assisted or not by the Family Health Program/Strategy (PSF), as well as in ambulatory facilities and hospitals. Java was used as programming language. Evaluations have been conducted regarding 62 users at São Paulo city including volunteers from the Pastoral da Criança, an ecumenical institution for children. The applied questionnaires resulted in a high level of general acceptance (98.3%); the on-site training was considered as appropriate (91.9%); a perception of routine improvement and decrease in the time of consultation (100.0%), and a decrease in the volume of paperwork (96.7%). The prototype has proven to be robust and effective for the use in deprived communities with precarious computer and telecommunication infrastructure.

BabyCare: apoio à decisão na atenção primária materno-infantil com computadores de mão / BabyCare: decision support system for primary child care using personal digital assistant

O objetivo desta pesquisa foi desenvolver um instrumento digital - aqui denominado Sistema BabyCare - para coleta, armazenamento e apoio à decisão dos profissionais de saúde e demais envolvidos na assistência primária infantil em comunidades carentes. Esse sistema baseia-se em tecnologias de dispositivos móveis para utilização local em unidades básicas de saúde em comunidades carentes, assistidos ou não pelo Programa/Estratégia Saúde da Família (PSF), organizações não governamentais, ambulatórios e hospitais. Utilizou-se Java como linguagem de programação. Foram realizadas avaliações sobre o uso do sistema na cidade de São Paulo, envolvendo 62 usuários com diferentes formações, incluindo voluntários da Pastoral da Criança e do PSF. Os questionários aplicados resultam em alto índice de aceitação geral (98,3 por cento); treinamento in loco considerado adequado (91,9 por cento); percepção na melhoria na rotina e na redução de tempo da consulta (100,0 por cento) e na redução no volume de documentos (96,7 por cento). Conclusão: o protótipo apresentou-se robusto e eficiente para uso em comunidades carentes com infraestrutura precária de informática e telecomunicação.

The purpose of this work was to develop a digital device - referred as BabyCare System - for the collection, storage, and decision support for healthcare professionals and other concerned people, in order to assist patients in primary child care in deprived communities. This system is based on handheld device technologies to be used locally in basic healthcare units in deprived communities, whether assisted or not by the Family Health Program/Strategy (PSF), as well as in ambulatory facilities and hospitals. Java was used as programming language. Evaluations have been conducted regarding 62 users at São Paulo city including volunteers from the Pastoral da Criança, an ecumenical institution for children. The applied questionnaires resulted in a high level of general acceptance (98.3 percent); the on-site training was considered as appropriate (91.9 percent); a perception of routine improvement and decrease in the time of consultation (100.0 percent), and a decrease in the volume of paperwork (96.7 percent). The prototype has proven to be robust and effective for the use in deprived communities with precarious computer and telecommunication infrastructure.

Recuperação de informações em campos de texto livres de prontuários eletrônicos do paciente baseada em semelhança semântica e ortográfica / Information retrieval from free text s of electronic patient records, based on semantic and orthographic portuguese similarity

A maior parte da informação médica em forma digital se encontra na forma de textos livres como nos sites de medicina e saúde, artigos científicos em banco de dados da literatura biomédica e em prontuários eletrônicos do paciente (PEP). Muitos problemas podem ocorrer em sistemas de recuperação de informações médicas como o uso de sinonímia, erros de digitação e variações semânticas na linguagem médica. Para analisar a quantidade de informações que são perdidas em sistemas de busca tradicionais, que fazem um busca do termo exato, foram selecionados 34 termos médicos de duas bases de dados de PEPs e pesquisados com um algoritmo tradicional de busca direta embutido em um PEP chamado Clinic ManagerÒ e um sistema desenvolvido batizado SIRIMED que embutiu algoritmos de semelhança semântica (incorporação de sinônimos) e semelhança ortográfica (edit distance+stemming).Os resultados mostram que a recuperação dos termos aumenta em cerca de 30% em relação à busca tradicional, com uma quantidade de falsos positivos baixa (menos de 1%), o que mostra que muitas informações são perdidas normalmente.

Most medical information in digital form occurs in internet health sites, biomedical literature databases and electronic patient record (EPR). Many problems can be found in medical information retrieval systems like problems of synonyms, mistakes on typing and semantic variations in medical language. To analyse the amount of lost infomation in traditional information retrieval systems which use exact string matching, 34 medical terms were selected from two databases of EPRs and they were analysed with traditional search found in EPR System called Clinic Manager and a new system called Sirimed developed by autor which was added algorithms to semantic approximate (synonymous) and approximate string matching (edit distance + stemming). The results show that information retrieval was improved in 30% in compare with the traditional search, with little amopunt of false positives (less 1%), that show a lot of lost informations.

Educação médica continuada online: potencial e desafios no cenário brasileiro / Online continuing medical education: potential and challenges in the Brazilian context

Com a intensa produção e veiculação de informações científicas, tornou-se difícil para o profissional médico manter-se atualizado com os recursos habituais. A necessidade de conhecer e de participar de processos de formação continuada se impõe. Entre outras iniciativas, a Associação Médica Brasileira e o Conselho Federal de Medicina lançaram o Programa Nacional de Educação Continuada a Distância para médicos, buscando divulgar o conhecimento produzido nos grandes centros para profissionais de áreas mais remotas ou com reduzida disponibilidade de tempo. Tendo como pressu posto que a Sociedade do Conhecimento requer a formação inicial e continuada de profissionais e de cidadãos com um novo conjunto de competências para atuar com eficiência e responsabilidade, esses programas devem ser desenvolvidos com base em abordagens pedagógicas que efetivamente valorizem, além dos conteúdos de ensino, a disposição para a pesquisa, a autonomia na busca da informação, o espírito colaborativo e a postura ética, entre outras. No intuito de contribuir para essa reflexão, este texto tem por objetivos retomar o processo de formalização da educação médica continuada a distância no Brasil em termos didático-pedagógicos e analisar perspectivas dessas ações educativas.

With the intense production and publication of scientific information, it has become difficult for medical professionals to keep up-to-date using only the traditional resources. It is urgent to be come familiar with and participate in continuing training processes. Among other initiatives, the Brazilian Medical Association and the National Medical Board launched the National Program for Online Continuing Medical Education, seeking to disseminate the knowledge produced in large cities to profes sionals in the more remote areas of the country or those with less available time. Based on the assumption that the Knowledge Society requires initial and on-going training for professionals and citizens with a new set of skills to act efficiently and responsibly, these programs should be developed through pedagogical approaches that effectively value, beyond content delivery, a willingness to engage in research, autonomy in the search for information, collaborative spirit, and an ethical stance. To contribute to this discussion, the current article aims to resume the process of formal organization of online continuing medical education in Brazil in didactic and pedagogical terms and to analyze the perspectives of distance education programs.

Time orientation and executive functions in the prediction of mortality in the elderly: Epidoso study.

OBJECTIVE: To analyze the predictive ability of a functional cognitive index of mortality in the elderly. METHODS: Cohort study performed with 1,667 elderly individuals aged more than 65 years and living in the city of São Paulo, Southeastern Brazil, between 1991 and 2001. Functional cognitive index was constructed from time orientation and executive functions (going shopping and taking medication), controlled by sociodemographic variables, life habits, morbidity, self-perception of health, hospitalization, edentulism and social support. Deaths occurred during this period were analyzed with family members in home interviews, notary public offices and records from the Fundação Seade (State System of Data Analysis Foundation), until 2003. Crude and adjusted relative risks were calculated with their respective 95% confidence intervals, using bivariate and multiple analysis with Poisson regression and p<0.05. RESULTS: In the final multivariate model, the following independent risk factors were identified by the index: partial loss of time orientation or executive functions (RR=1.37; 95% CI: 1.03;1.83); total loss of orientation and partial loss of functions (RR=1.71; 95% CI: 1.24;2.37); partial loss of orientation and total loss of functions (RR=1.76; 95% CI: 1.35;2.28); and total loss of orientation and functions (RR=1.64; 95% CI: 1.30;2.06). As regards health conditions, the following were observed: hospitalization (RR=1.45; 95% CI: 1.22;1.73); diabetes (RR=1.20; 95% CI: 1.00;1.44); and total edentulism (RR=1.34; 95% CI: 1.09;1.66). Monthly contact with relatives was identified as a protective factor (RR=0.83; 95% CI: 0.69;1.00). CONCLUSIONS: The Functional Cognitive Index can help clinicians and health planners to make decisions on strategies for follow-up and prevention of treatable causes of cognitive deficit and functional loss to reduce mortality in the elderly.

Orientação temporal e funções executivas na predição de mortalidade entre idosos: estudo Epidoso / Time orientation and executive functions in the prediction of mortality in the elderly: Epidoso study

OBJETIVO: Analisar a capacidade preditiva de índice cognitivo funcional para mortalidade entre idosos. MÉTODOS: Estudo de coorte realizado com 1.667 idosos acima de 65 anos residentes no município de São Paulo, SP, no período 1991-2001. O índice cognitivo funcional foi construído a partir da orientação temporal e funções executivas (fazer compras e tomar medicação), controlado por variáveis sociodemográficas, hábitos de vida, morbidade, autopercepção de saúde, internação, edentulismo e suporte social. Os óbitos ocorridos no período foram investigados com familiares em entrevistas domiciliares, em cartórios e registros da Fundação Seade (até 2003). Foram calculados riscos relativos brutos e ajustados com respectivos intervalos com 95 por cento de confiança por meio de análise bivariada e múltipla com regressão de Poisson, adotando-se p<0,05. RESULTADOS: No modelo multivariado final os fatores de risco independentes identificados pelo índice foram: perda parcial da orientação temporal ou funções executivas (RR=1,37; IC 95 por cento: 1,03;1,83); perda total da orientação e parcial das funções (RR=1,71; IC 95 por cento: 1,24;2,37); perda parcial da orientação e total das funções (RR=1,76; IC 95 por cento: 1,35;2,28); perda total da orientação e das funções (RR=1,64; IC 95 por cento: 1,30;2,06), Quanto às condições de saúde: internação (RR=1,45; IC 95 por cento: 1,22;1,73); diabetes (RR=1,20; IC 95 por cento: 1,00;1,44); edentulismo total (RR=1,34; IC 95 por cento: 1,09;1,66). Relacionamento mensal com parentes foi identificado como fator protetor (RR=0,83; IC 95 por cento: 0,69;1,00). CONCLUSÕES: O Índice Cognitivo Funcional pode auxiliar clínicos e planejadores em decisões sobre estratégias de seguimento e prevenção de causas tratáveis de déficit cognitivo e perda funcional para diminuir a mortalidade entre os idosos.

OBJECTIVE: To analyze the predictive ability of a functional cognitive index of mortality in the elderly. METHODS: Cohort study performed with 1,667 elderly individuals aged more than 65 years and living in the city of São Paulo, Southeastern Brazil, between 1991 and 2001. Functional cognitive index was constructed from time orientation and executive functions (going shopping and taking medication), controlled by sociodemographic variables, life habits, morbidity, self-perception of health, hospitalization, edentulism and social support. Deaths occurred during this period were analyzed with family members in home interviews, notary public offices and records from the Fundação Seade (State System of Data Analysis Foundation), until 2003. Crude and adjusted relative risks were calculated with their respective 95 percent confidence intervals, using bivariate and multiple analysis with Poisson regression and p<0.05. RESULTS: In the final multivariate model, the following independent risk factors were identified by the index: partial loss of time orientation or executive functions (RR=1.37; 95 percent CI: 1.03;1.83); total loss of orientation and partial loss of functions (RR=1.71; 95 percent CI: 1.24;2.37); partial loss of orientation and total loss of functions (RR=1.76; 95 percent CI: 1.35;2.28); and total loss of orientation and functions (RR=1.64; 95 percent CI: 1.30;2.06). As regards health conditions, the following were observed: hospitalization (RR=1.45; 95 percent CI: 1.22;1.73); diabetes (RR=1.20; 95 percent CI: 1.00;1.44); and total edentulism (RR=1.34; 95 percent CI: 1.09;1.66). Monthly contact with relatives was identified as a protective factor (RR=0.83; 95 percent CI: 0.69;1.00). CONCLUSIONS: The Functional Cognitive Index can help clinicians and health planners to make decisions on strategies for follow-up and prevention of treatable causes of cognitive deficit and functional loss to reduce mortality in the elderly.

The impact of short message service text messages sent as appointment reminders to patients' cell phones at outpatient clinics in São Paulo, Brazil.

OBJECTIVE: Nonattendance for appointments remains a challenge to health care managers and providers. The objective of this article is to present the results of a study on the impact of appointment reminders sent as short message service text messages to patients' cell phones on nonattendance rates at outpatient clinics in São Paulo, Brazil. DESIGN: Data were collected on scheduled appointments in four medical clinics using Clinic Manager or Clinic Web systems that can send automated messages to patients. Data on appointment attendance were collected from these systems. MEASUREMENTS: More than 29,000 appointments were scheduled between July 1, 2007, and May 31, 2008, and for 7890 of them a text message reminder was sent to the patient's cell phone. The rates of nonattendance were compared between those who were sent and those who were not sent a text message as an appointment reminder. RESULTS: The nonattendance reduction rates for appointments at the four outpatient clinics studied were 0.82% (p= .590), 3.55% (p= .009), 5.75% (p= .022), and 14.49% (p= < .001). CONCLUSION: The study results indicate that sending appointment reminders as text messages to patients' cell phones is an effective strategy to reduce nonattendance rates. When patients attend their appointments, the facility providing care and the patients receiving uninterrupted care benefit.