Telehealth is key to primary health care qualification. There is no knowledge about its use in the Mais Médicos Program. Here, we sought to analyze the use of Telehealth tools at Mais Médicos in Espírito Santo state in 2016. This is a cross-sectional study with a structured questionnaire applied to the total number of physicians present at regional telehealth seminars. The analysis included absolute and relative frequency and bivariate analysis with Fisher's exact test. As a result, 211 doctors (48.6% of the total number of professionals at Mais Médicos) participated. The majority were Cubans who worked in a large urban center with a specialization in Family and Community Medicine. Most (n=130, 61.9%) had already used some Telehealth service, but discontinuously, with Tele-education being the most used (n=101; 77.7%). Getting to know Telehealth and its tools and seeing them as relevant to improving the service were associated with greater use of technologies. The facility and type of device used to access the internet do not influence the use of the program. It is concluded that the knowledge and relevance given to Telehealth tools by professionals and their work context are more associated with their use than structural working conditions.

Telessaúde é uma das estratégias de qualificação da atenção primária. Não há trabalho que analise sua utilização no Programa Mais Médicos. Logo, buscou-se analisar a utilização das ferramentas de Telessaúde no Mais Médicos do estado Espírito Santo em 2016. Trata-se de um estudo transversal com aplicação de questionário estruturado ao total de médicos presentes em seminários regionais em Telessaúde. A análise incluiu frequência absoluta e relativa e análise bivariada com teste exato de Fisher. Como resultado, 211 médicos (48,6% do total de profissionais do Mais Médicos) participaram, sendo a maioria cubanos que atuavam em grande centro urbano com especialização em Medicina de Família e Comunidade. A maior parte (n=130, 61,9%) já havia utilizado algum serviço de Telessaúde, mas de forma descontínua, sendo a teleducação o mais utilizado (n=101; 77,7%). Conhecer o Telessaúde e suas ferramentas e vê-las como relevantes para a melhoria do serviço se associaram a maior uso das tecnologias. A facilidade e o tipo de dispositivo utilizado para acessar a internet não influenciam a utilização do programa. Conclui-se que o conhecimento e a relevância dada às ferramentas de Telessaúde pelos profissionais e seu entorno estão mais associadas a seu uso que as condições estruturais de trabalho.

Abstract Introduction Impairment of sleep quality directly increases the risk of heart attack, obesity, and stroke, among other conditions, which makes polysomnography (PSG) an important public health tool. However, the inherent problems with PSG render the correct diagnosis of sleep diseases a difficult task. As a novel alternative to the class II PSG system, this work presents a distributed system composed of three modules, which together are capable of the simultaneous monitoring of environmental variables and patient signals. This system could reduce the distress of a PSG exam in certain cases, dismiss the need for an overnight sleep in a healthcare/sleep centre, and facilitate self-setup and internet-based diagnosis. Methods Hardware and software capable of synchronously monitoring, processing and logging into a µSD card environmental parameters (temperature, humidity, visible light intensity and audible noise level) and directly measured patient signals (electrocardiogram, electrooculogram, and body and limb posture) were designed and implemented. Results A novel alternative to the class III PSG system was demonstrated with independent boards capable of operating for more than 16 hours powered by a 750 mAh/3.7 V battery with 0.003% data loss during preliminary PSG exams. Additionally, a computer-based library capable of reading, decoding, estimating respiration through ECG, and calculating the heart rate was developed and described. Conclusion This article contributes to PSG research through the development of a new PSG system and the improvement of patient comfort. All software and hardware developed are fully open source and available on GitHub.

Abstract Introduction This paper presents a complete approach for the automatic classification of heartbeats to assist experts in the diagnosis of typical arrhythmias, such as right bundle branch block, left bundle branch block, premature ventricular beats, premature atrial beats and paced beats. Methods A pre-processing step was performed on the electrocardiograms (ECG) for baseline removal. Next, a QRS complex detection algorithm was implemented to detect the heartbeats, which contain the primary information that is employed in the classification approach. Next, ECG segmentation was performed, by which a set of features based on the RR interval and the beat waveform morphology were extracted from the ECG signal. The size of the feature vector was reduced by principal component analysis. Finally, the reduced feature vector was employed as the input to an artificial neural network. Results Our approach was tested on the Massachusetts Institute of Technology arrhythmia database. The classification performance on a test set of 18 ECG records of 30 min each achieved an accuracy of 96.97%, a sensitivity of 95.05%, a specificity of 90.88%, a positive predictive value of 95.11%, and a negative predictive value of 92.7%. Conclusion The proposed approach achieved high accuracy for classifying ECG heartbeats and could be used to assist cardiologists in telecardiology services. The main contribution of our classification strategy is in the feature selection step, which reduced classification complexity without major changes in the performance.

Introduction Left ventricle hypertrophy (LVH) is an important risk factor for cardiovascular morbidity and mortality. It is characterized by a thickening of the walls of the left ventricle. The transthoracic echocardiogram is a very accurate method for LVH detection. However, the electrocardiogram (ECG) offers an alternative method in diagnosing LVH, besides being less expensive and easier to obtain. In this context, this study proposes an ECG based approach for left ventricle hypertrophy (LVH) classification. Methods According to the literature, several indexes have so far been proposed that suggest specific changes in cardiac structure, however, generally speaking there is no consensus about the best criteria. This way, instead of considering only one LVH criterion, a score derived from electrocardiographic traces was employed which explores the complementarity of the best criteria through a fusion strategy. The best criteria are those which discriminate normal and LVH ECGs. Results The experiments were performed in the Monica database with a group of fifty men. Half of the individuals had LVH diagnosed by calculating the left ventricular mass index measured by transthoracic echocardiography. The score fusion proposed achieved a sensitivity of 78.3% and specificity of 91.3%, outperforming all isolated LVH criteria. Discussion Unlike the other methods, our score must be estimated within a computer because of its high complexity. Even with this limitation it is much less expensive than using the echocardiography.

Este artigo descreve os exames clínicos realizados no Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Alguns deles (antropometria, pressão arterial e índice tornozelo-braquial) já têm uso clínico consolidado. Outros, como a velocidade de onda de pulso, variabilidade da frequência cardíaca e medida da espessura médio-intimal de carótidas, carecem de valor de referência na população brasileira não doente e podem constituir preditores importantes de desfechos cardiovasculares. A medida da pressão arterial após manobra postural foi incluída no ELSA-Brasil porque foi pouco testada em estudos epidemiológicos. O ELSA-Brasil inovou na realização do índice tornozelo-braquial, ao usar um aparelho automático em substituição à coluna de mercúrio na medida da pressão arterial, e também na medida do diâmetro ântero-posterior do lobo direito do fígado pela ultrassonografia, proposta para avaliação quantitativa da doença hepática gordurosa não-alcoólica. Os participantes são indivíduos mais jovens (a partir dos 35 anos) do que em outras coortes focadas no estudo da aterosclerose subclínica. A inclusão de indivíduos mais jovens e a diversidade dos exames realizados tornam o ELSA-Brasil um estudo relevante no contexto da epidemiologia brasileira e internacional.

The article describes assessments and measurements performed in the Brazilian Longitudinal Study for Adult Health (ELSA-Brasil). Some assessments including anthropometric assessment, casual blood pressure measurement, and ankle-brachial index have an established clinical application while others including pulse wave velocity, heart rate variability, and carotid intima-media thickness have no established application and do not have reference values for healthy Brazilian population but may be important predictors of cardiovascular outcomes. Blood pressure measurement following postural change maneuver was included in the ELSA-Brasil because it has not been much tested in epidemiological studies. Innovative approaches were developed for assessing the ankle-brachial index using an automatic device instead of the mercury column to measure blood pressure and for assessing the anterior-posterior diameter of the right lobe of the liver by ultrasound for quantitative assessment of nonalcoholic fatty liver disease. All ELSA-Brasil subjects were younger (35 years or more) than those included in other cohorts studying subclinical atherosclerosis. The inclusion of younger individuals and a variety of assessments make the ELSA-Brasil a relevant epidemiology study nationwide and worldwide.