Introdução: a amamentação traz benefícios para a mãe e para o bebê. Esta afirmativa se torna primordial para a mulher, dentre outros aspectos, pelo estabelecimento de estratégias de prevenção do câncer de mama, caracterizadas pelo incentivo a prática da amamentação. Já para o bebê, o aleitamento materno é de extrema importância no desenvolvimento e preparo das condições neuromusculares das estruturas orais. Nesse contexto, se faz importante a disseminação de todo esse conhecimento para que a amamentação natural seja respeitada e encorajada. A criação de um programa de educação em saúde, prepara jovens do ensino médio para se tornarem disseminadores do conhecimento, contribuindo para o desenvolvimento social. Objetivo: criar uma Rede de Aprendizagem Colaborativa sobre o tema Os Benefícios da Amamentação e a Prevenção de Doenças. Desenvolver e validar um Modelo de Educação em Saúde por meio da Teleducação Interativa. Método: participaram desse estudo 190 estudantes de ensino médio de quatro escolas públicas. O Grupo Padrão Ouro (GPO) foi formado por 14 alunos, receberam informações por meio do método convencional de ensino da escola e responderam ao Questionário de Impacto (QI), após quatro meses. O Projeto Jovem Doutor capacitou 36 alunos, Grupo Jovem Doutor (GJD), por meio do Kit Cultural Interativo, composto por aulas presenciais, à distância, atividade prática e ação social. Todo material utilizado nesta capacitação foi desenvolvido pela pesquisadora e avaliado por 14 profissionais por meio do Questionário de Avaliação do Conteúdo pelos Juízes (QJ). O GJD respondeu à ficha de Pesquisa Motivacional (FPM), com o propósito de avaliação do ambiente virtual de aprendizagem, ao Questionário de Investigação de Nível de conhecimento I e II (QINC I e II), em dois momentos, pré e pós-capacitação, e ao QI após quatro meses. Como estratégia de multiplicação do conhecimento, o GJD criou o Kit Cultural Interativo Móvel e transmitiu o conhecimento sobre o tema para mais 140 alunos, denominado Grupo Disseminadores (GD), responsável pela criação dos Espaços Culturais em Saúde expostos nas escolas. O GD respondeu aos QINC I e II e ao QI quatro meses após a intervenção. Resultados: o QJ possibilitou a validação de conteúdo. A validação de construto foi possível por meio da análise dos resultados do QINC I e II, a qual mostrou um crescimento significativo no nível de conhecimento tanto do GJD como do GD. A validação de critério ocorreu com a comparação dos resultados do QI entre o GPO e o GJD, onde os resultados apresentados demonstraram melhor desempenho para o GJD. Conclusão: Modelo de Educação em Saúde sobre o tema em questão, através do Projeto Jovem Doutor, propôs um programa inovador. A multiplicação do conhecimento foi certificada pela criação de uma Rede de Aprendizagem Colaborativa, onde os alunos do ensino médio, graduação e pós-graduação puderam ampliar seus conhecimentos sobre a importância do tema. / Introduction: breastfeeding can provide benefits to both mother and baby. For women, the prevention of breast cancer stands out as an incentive for breastfeeding. For the baby, breastfeeding is important in the development and preparation of the neuromuscular conditions of oral structures. Therefore, it is important to disseminate knowledge of these benefits to the population, so that natural breastfeeding may be respected and encouraged. The creation of a health education program on the benefits of breastfeeding and the prevention of diseases has prepared high school students to become disseminators of knowledge, contributing to social development. Objective: create a Collaborative Learning Network on The Benefits of Breastfeeding and Disease Prevention. Develop and validate a Health Educational Model through Interactive Teleducation on the topic of breastfeeding. Methods: 190 high school students from four public schools participated in the project. Initially, fourteen students, designated the Gold Standard Group (GSG), received information through the schools conventional method of teaching and answered the Impact Questionnaire (IQ) four months later. The Young Doctor Project trained thirty-six students, designated the Young Doctor Group (YDG), through the Interactive Cultural Kit, consisting of face-to-face classes, distance learning, activities and social action. All materials used in this training were developed by the researcher and evaluated by fourteen professionals through the Judges Evaluation Questionnaire (JQ). The YDG answered a Motivational Research Sheet (MRS) for evaluation of the virtual learning environment, a Knowledge Questionnaire I and II (KQ I and II) pre and post training, and the IQ four months later. As a strategy for disseminating knowledge, the YDG created the Interactive Cultural Mobile Kit and transmitted knowledge on the topic to 140 students, designated the Disseminators Group (DG), who created the Cultural Spaces in Health exhibited across the schools. The DG answered the KQ I and II and the IQ four months after the intervention. Results: the JQ achieved the content validity. The construct validity was achieved through the evaluation of the results of KQ I and II which showed a significant growth in the level of knowledge in both YDG and DG. The criterion validity was achieved through the comparison of the IQ results between the GSG and YDG, where the results presented showed better performance by the YDG. Conclusion: The Health Educational Model on the topic of the benefits of breastfeeding and the prevention of diseases, through the Young Doctor Project, proposed an innovative program. The dissemination of knowledge was evidenced by the creation of a Collaborative Learning Network, where high school, graduate and post-graduate students were able to increase their knowledge on the importance of natural breastfeeding.

Tendo em vista a alta incidência da perda auditiva de grau leve, dificuldades comunicativas que acarreta, sobretudo em situações acústicas adversas, e inconsistência da literatura quanto ao benefício obtido com o aparelho de amplificação sonora individual (AASI) para esta população, os dispositivos com tecnologia de microfone remoto, como o sistema de frequência modulada (FM), são considerados. Tais dispositivos são de alto custo e sua dispensação pelo Sistema Único de Saúde é voltada para indivíduos entre 5 a 17 anos de idade. O aplicativo gratuito, para smartphone, Mobile Based Assistive Listening System (MoBALS) funciona como microfone remoto, sendo de importância sua avaliação. Esta pesquisa foi organizada em dois estudos. Estudo 1: realizou-se a adaptação do teste do nível de ruído aceitável (ANL) para o português brasileiro. Um discurso contínuo em português (falante masculino) foi apresentado com ruído de 12 falantes (em inglês), em campo livre. A intensidade de ruído que o indivíduo consegue aceitar enquanto escuta o discurso (ANL) foi mensurada em 36 indivíduos com audição normal (GTA) e 20 com perda auditiva sensorioneural de grau leve (GDA). Os valores do ANL para o GTA e GDA foram menores do que os reportados em literatura. Não houve diferença significativa do ANL quando comparado os estímulos de fala (inglês x português), gênero do ouvinte e grupos. Não houve correlação do ANL com a idade ou dados audiométricos dos participantes. Estudo 2: avaliou-se o desempenho na percepção da fala no ruído e impressões quanto à utilização do MoBALS, em comparação ao FM e AASI. Analisou-se a relação entre o ANL e benefício obtido na percepção de fala no ruído, uso e benefício em vida diária com um ou mais destes dispositivos. Participaram 40 adultos e idosos, sendo 20 com audição normal (Controle - GC) e 20 com perda sensorioneural leve bilateral, simétrica (Experimental - GE). Foram aplicados os testes nível de ruído aceitável (ANL), avaliação do esforço auditivo (escala SSQ) e percepção da fala no ruído (HINT-Brasil) nas condições sem dispositivo, MoBALS, FM e AASI (a última apenas para o GE). O inventário internacional de resultados com AASI (IOI-HA) foi aplicado e as horas diárias de uso do AASI foram mensuradas (apenas GE). A média da pontuação do IOI-HA foi alta sugerindo benefício e satisfação com o AASI em vida diária. A média de horas de uso do AASI relatada (6,8) foi significativamente maior do que a observada no datalogging dos dispositivos (4,3). O GE reportou esforço auditivo significativamente maior do que o GC. Na comparação intragrupo para o HINT-Brasil, a relação sinal/ruído (S/R) obtida com o MoBALS foi significamente maior (GC) ou similar (GE) à obtida com o FM. Tanto o FM como o MoBALS proporcionaram menores relações S/R (melhor desempenho) do que as condições sem dispositivo (GC e GE) e AASI (GE). Não houve diferença da relação S/R entre as condições sem dispositivo e AASI (GE). O benefício na percepção da fala obtido com o MoBALS foi igual para o GC e GE. Correlações fracas e não significativas foram observadas entre o ANL e todas as demais variáveis - exceto para o GE, onde houve correlação fraca significativa entre ANL e a relação S/R obtida com o FM. A maioria dos participantes consideraram o MoBALS de fácil manuseio, avaliaram positivamente sua qualidade sonora, assim como utilizariam em vida diária. Conclui-se que: (a) a versão do ANL em português produziu resultados equivalentes ao teste original inglês; (b) indivíduos com perda leve enfrentam maior esforço auditivo no seu dia a dia do que seus pares ouvintes; (c) o AASI fornece benefício em vida diária para indivíduos com perda leve, embora tais benefícios não sejam refletidos na avaliação clínica da percepção da fala no ruído; (d) o ANL não influenciou os resultados de percepção de fala, uso ou benefício em vida diária obtidos com os dispositivos avaliados e (e) o MoBALS pode ser considerado como alternativa na reabilitação de indivíduos com perda auditiva leve. / Considering the high incidence of mild hearing loss, communicative difficulties, especially in adverse acoustic situations, and inconsistency of the literature regarding the hearing aid (HA) benefit obtained for this population, devices with remote microphone technology, such as the frequency modulated (FM) system, are considered. Such devices are of high cost and their dispensation by the Unified Health System is aimed at individuals between 5 and 17 years of age. The Mobile Based Assistive Listening System (MoBALS) free smartphone application functions as a remote microphone, being of importance its evaluation. This research was organized in the form of two studies. Study 1: the adaptation of the Acceptable Noise Level (ANL) test to Brazilian Portuguese was performed. A continuous discourse in Portuguese (male speaker) was presented with a 12-speaker babble noise (in English), in calibrated free field. The noise intensity that the individual can accept while listening to the speech (ANL) was measured in 36 individuals with normal hearing (GTA) and 20 with mild sensorineural hearing loss (GDA). The ANL values for GTA and GDA were lower than those reported in the literature. No significant difference for ANL was found when comparing Portuguese and English speech stimulus, listener genre and groups. There was no correlation between the ANL and the participants\' age or audiometric data. Study 2: we evaluated the speech perception in noise performance, as well as impressions regarding the use of the MoBALS application, when compared to hearing aids and an FM system. It was also analyzed whether the ANL was related to the benefit obtained with such devices in a speech in noise test, as well as hearing aid use and benefit in daily life. A total of 40 individuals (adults and elderly) took part of this study, being 20 with normal hearing (Control - CG) and 20 with mild sensorineural loss (Experimental - EG). Accepted noise levels (ANL), auditory effort assessment (three questions from the SSQ scale) and speech perception in noise (HINT-Brazil) in the unaided, MoBALS-only, FM-only and HA-only (the later just for the EG) were measured. For the EG, the International Outcome Inventory for Hearing Aids (IOI-HA) was administered and the number of daily hours of HA use was measured (GE only). Mean IOI scores were high (around 4 points) suggesting benefit and satisfaction with HAI in daily life. Mean self-reported HA use (6.8 hs) was significantly higher than that observed in the devices\' datalogging (4.3 hs). The EG reported significantly greater auditory effort than the GC. In the HINT-Brazil test, for intra-group comparison, the signal-to-noise ratio (S/N) obtained with MoBALS was significantly higher (CG) or similar (EG) than that obtained with the FM. Both FM and MoBALS provided lower S/R ratios (better performance) than the unaided (CG and EG) and HA-only conditions (EG). There was no difference in the S/R ratio between the unaided and HA-only conditions (EG). In between-groups comparison, no difference was found for speech in noise benefit obtained with MoBALS. Weak and non-significant correlations were observed between ANL and the other variables - except for the EG, where weak significant correlation between ANL and S/N ratio with FM was observed. Most participants considered the MoBALS easy to handle, positively evaluated their sound quality and would use it in daily life. This research concluded: (a) the ANL version in Brazilian Portuguese produced results equivalent to the original English test; (b) individuals with mild hearing loss face more day-to-day auditory effort than individuals with normal hearing; (c) HA provides benefit in daily life for individuals with mild loss, although such benefits are not reflected in the clinical assessment of speech perception in noise; (d) the ANL did not influence the results of speech perception, use or benefit in daily life obtained with the evaluated devices and (e) MoBALS can be considered as an alternative for auditory rehabilitation for individuals with mild hearing loss.

Introdução: a amamentação traz benefícios para a mãe e para o bebê. Esta afirmativa se torna primordial para a mulher, dentre outros aspectos, pelo estabelecimento de estratégias de prevenção do câncer de mama, caracterizadas pelo incentivo a prática da amamentação. Já para o bebê, o aleitamento materno é de extrema importância no desenvolvimento e preparo das condições neuromusculares das estruturas orais. Nesse contexto, se faz importante a disseminação de todo esse conhecimento para que a amamentação natural seja respeitada e encorajada. A criação de um programa de educação em saúde, prepara jovens do ensino médio para se tornarem disseminadores do conhecimento, contribuindo para o desenvolvimento social. Objetivo: criar uma Rede de Aprendizagem Colaborativa sobre o tema Os Benefícios da Amamentação e a Prevenção de Doenças. Desenvolver e validar um Modelo de Educação em Saúde por meio da Teleducação Interativa. Método: participaram desse estudo 190 estudantes de ensino médio de quatro escolas públicas. O Grupo Padrão Ouro (GPO) foi formado por 14 alunos, receberam informações por meio do método convencional de ensino da escola e responderam ao Questionário de Impacto (QI), após quatro meses. O Projeto Jovem Doutor capacitou 36 alunos, Grupo Jovem Doutor (GJD), por meio do Kit Cultural Interativo, composto por aulas presenciais, à distância, atividade prática e ação social. Todo material utilizado nesta capacitação foi desenvolvido pela pesquisadora e avaliado por 14 profissionais por meio do Questionário de Avaliação do Conteúdo pelos Juízes (QJ). O GJD respondeu à ficha de Pesquisa Motivacional (FPM), com o propósito de avaliação do ambiente virtual de aprendizagem, ao Questionário de Investigação de Nível de conhecimento I e II (QINC I e II), em dois momentos, pré e pós-capacitação, e ao QI após quatro meses. Como estratégia de multiplicação do conhecimento, o GJD criou o Kit Cultural Interativo Móvel e transmitiu o conhecimento sobre o tema para mais 140 alunos, denominado Grupo Disseminadores (GD), responsável pela criação dos Espaços Culturais em Saúde expostos nas escolas. O GD respondeu aos QINC I e II e ao QI quatro meses após a intervenção. Resultados: o QJ possibilitou a validação de conteúdo. A validação de construto foi possível por meio da análise dos resultados do QINC I e II, a qual mostrou um crescimento significativo no nível de conhecimento tanto do GJD como do GD. A validação de critério ocorreu com a comparação dos resultados do QI entre o GPO e o GJD, onde os resultados apresentados demonstraram melhor desempenho para o GJD. Conclusão: Modelo de Educação em Saúde sobre o tema em questão, através do Projeto Jovem Doutor, propôs um programa inovador. A multiplicação do conhecimento foi certificada pela criação de uma Rede de Aprendizagem Colaborativa, onde os alunos do ensino médio, graduação e pós-graduação puderam ampliar seus conhecimentos sobre a importância do tema. / Introduction: breastfeeding can provide benefits to both mother and baby. For women, the prevention of breast cancer stands out as an incentive for breastfeeding. For the baby, breastfeeding is important in the development and preparation of the neuromuscular conditions of oral structures. Therefore, it is important to disseminate knowledge of these benefits to the population, so that natural breastfeeding may be respected and encouraged. The creation of a health education program on the benefits of breastfeeding and the prevention of diseases has prepared high school students to become disseminators of knowledge, contributing to social development. Objective: create a Collaborative Learning Network on The Benefits of Breastfeeding and Disease Prevention. Develop and validate a Health Educational Model through Interactive Teleducation on the topic of breastfeeding. Methods: 190 high school students from four public schools participated in the project. Initially, fourteen students, designated the Gold Standard Group (GSG), received information through the schools conventional method of teaching and answered the Impact Questionnaire (IQ) four months later. The Young Doctor Project trained thirty-six students, designated the Young Doctor Group (YDG), through the Interactive Cultural Kit, consisting of face-to-face classes, distance learning, activities and social action. All materials used in this training were developed by the researcher and evaluated by fourteen professionals through the Judges Evaluation Questionnaire (JQ). The YDG answered a Motivational Research Sheet (MRS) for evaluation of the virtual learning environment, a Knowledge Questionnaire I and II (KQ I and II) pre and post training, and the IQ four months later. As a strategy for disseminating knowledge, the YDG created the Interactive Cultural Mobile Kit and transmitted knowledge on the topic to 140 students, designated the Disseminators Group (DG), who created the Cultural Spaces in Health exhibited across the schools. The DG answered the KQ I and II and the IQ four months after the intervention. Results: the JQ achieved the content validity. The construct validity was achieved through the evaluation of the results of KQ I and II which showed a significant growth in the level of knowledge in both YDG and DG. The criterion validity was achieved through the comparison of the IQ results between the GSG and YDG, where the results presented showed better performance by the YDG. Conclusion: The Health Educational Model on the topic of the benefits of breastfeeding and the prevention of diseases, through the Young Doctor Project, proposed an innovative program. The dissemination of knowledge was evidenced by the creation of a Collaborative Learning Network, where high school, graduate and post-graduate students were able to increase their knowledge on the importance of natural breastfeeding.

Para que os pais consigam dar o suporte necessário à criança com deficiência auditiva, é preciso que estes lidem com sentimentos e situações novas, dúvidas e expectativas, as quais podem gerar estresse. A participação em grupos de pais pode possibilitar apoio a estes indivíduos. Neste estudo clínico randomizado controlado, foi criada a rede social online Portal dos Bebês para pais e/ou cuidadores de crianças com deficiência auditiva, candidatas ao implante coclear, sendo avaliada sua eficácia como apoio a estes pais. Participaram 22 mães, com idades entre 18 e 39 anos, residindo nas regiões Sudeste (n=10), Sul (n=5), Centro Oeste (n=3), Norte (2) e Nordeste (2) do país, as quais foram divididas randomicamente em grupos experimental (n=11) e controle (n=11). As participantes preencheram um formulário online com perguntas sobre dados demográficos, uso da internet e o Índice de Estresse Parental versão reduzida (PSI-SF). O PSI-SF avalia o estresse geral a partir de um modelo com três fatores (subescalas): Sofrimento Parental, Criança Difícil e Interações Disfuncionais Pais-Criança. Apenas o grupo experimental teve acesso à rede social online. Ambos os grupos preencheram novamente o PSI-SF, três meses após a primeira aplicação, sendo que grupo experimental também respondeu questões sobre a avaliação de uso e participação na rede social. As postagens na rede social foram classificadas por dois juízes independentes com relação aos temas e mecanismos de auto-ajuda. Verificou-se que 72% das participantes acessavam a internet várias vezes na semana, sendo o acesso realizado majoritariamente em seus domicílios. Na primeira aplicação, o grupo experimental apresentou escores médios menores do que o grupo controle em todas as subescalas e na pontuação total do PSI-SF, contudo, tais diferenças entre os grupos não foram significativas. Em média, os níveis de estresse, para ambos os grupos, foram similares aos encontrados na literatura para pais de crianças com desenvolvimento típico e sem queixas auditivas. No entanto, para 22% dos participantes os níveis de estresse encontrados foram altos, sugerindo necessidade de intervenção. O mesmo padrão de resultados foi obtido na segunda aplicação do PSI-SF. A análise intra-grupos mostrou que não houve diferença nos resultados totais e das subescalas do PSI-SF entre as duas aplicações, para ambos os grupos, com exceção da subescala Resposta Defensiva em que houve diminuição da pontuação para o grupo controle - no entanto, esta diferença não foi clinicamente significante. Um coeficiente Kappa de 0,89 foi obtido entre as análise das postagens realizadas pelos juízes. Os temas mais frequentes das postagens foram relacionados à dimensão outros comentários (43,8%), com informações pessoais e expressões de crença em Deus, seguidos da experiência com a deficiência auditiva (39,6%), sobretudo em relação aos dispositivos utilizados pela criança. Quanto aos mecanismos de auto-ajuda, observou-se maior frequência de postagens com trocas de experiências (29,2%) e expressão de gratidão (18,6%). Embora tenham sido observadas postagens frequentes com informações de saúde, estas não foram imprecisas ou de natureza negativa. Os participantes do grupo experimental relataram que gostariam de ter participado mais da rede social, pois consideram este tipo de ferramenta importante pela possibilidade troca de informações e experiências com outras mães e profissionais da saúde. A pouca disponibilidade de tempo foi o fator mais apontado como obstáculo para participação. Os tipos de participação preferenciais foram escrever sobre o assunto em discussão e observar o que as outras pessoas escreviam. A participação na rede social Portal dos Bebês não diminuiu o estresse parental geral. Contudo, o teor das postagens e a avaliação dos participantes indicaram o potencial desta rede para fornecimento de apoio aos pais de crianças deficientes auditivas candidatas ao implante coclear. Outros estudos com um maior número de participantes e que avaliem o efeito de participação na rede social online sobre o estresse contextualmente relacionado à deficiência auditiva são necessários. / For parents to be able to provide the necessary assistance for their hearing impaired children, they must deal with new situations and feelings, doubts and expectations, which in turn can create stress. Participation in parent groups can propitiate support for these individuals. In this randomized controlled trial, the online social network \"Babies\' Portal\" was created for parents or caregivers of hearing impaired children, cochlear implant candidates, and its efficacy in supporting theses parents was evaluated. Participants were 22 mothers, aged between 18 and 39 years, residing in the Southeast (n=10), South (n=5), Midwest (n=3), North (n=2) and Northeast (n=2) of the country, which were randomly divided into experimental (n=11) and control (n=11) groups. The participants filled out an online form with questions about demographics, Internet usage and the Parental Stress Index short form (PSI-SF). The PSI-SF assesses the parental general stress from a model with three factors (subscales): Parental Distress, Difficult Child and Parent-Child Dysfunctional Interactions. Only the experimental group had access to the online social network. Both groups filled the PSI-SF a second time, three months after the first application, and the experimental group also answered questions evaluating utility and participation in the social network. The posts on the social network were rated by two independent judges regarding general themes and mechanisms of self-help. It was found that 72% of participants accessed the internet several times a week, with access done mostly in their homes. In the first application, the experimental group had lower mean PSI-SF scores than the control group, however, such differences between groups were not significant. On average, the stress levels for both groups were similar to those found in the literature for parents of children with typical development and normal hearing. However, for 22% of the participants stress levels were high, suggesting the need for intervention. The same pattern of results was obtained in the second application of the PSI-SF. The intra-group analysis showed no difference in total scores and subscales of the PSI-SF between the two applications, for both groups, except for the subscale \"Defensive Response\" in which there was a decrease in score for the control group. However, this difference was not clinically significant. A Kappa coefficient of 0.89 was obtained from the analysis of the postings made by judges indicating high concordance between them. The most frequent posts themes was related to dimension \"other commnets\" (43.8%), with personal information and expressions of belief in God, followed by experience with hearing loss (39.6%), especially in relation to devices used by the child. Regarding the mechanisms of self-help, it was observed a higher frequency of posts with exchanges of experiences (29.2%) and expression of gratitude (18.6%). Although there were many postings with health related information these were not imprecise or of negative nature. Participants in the experimental group reported that they would like to have a greater participation in the social network since they considered it an important mean of exchanging information and experiences with other parents and health professionals. The limited availability of time was often cited as an obstacle to participation. The preferred types of participation were writing about the subject under discussion and reading other people\'s postings. Participation in social networking \"Babies` Portal\" did not diminish the overall parental stress. However, the content of posts and evaluation of participants indicated the potential of this network to provide support for parents of hearing impaired children cochlear implant candidates. Further studies with a larger number of participants, assessing the effects of social networks on the stress contextually related to hearing impairment are needed.

The primary purpose of this study was to craft and validate a set of core competencies necessary for an e-Helper to possess. A review of the literature guided the creation of the initial competencies. Following expert review, the competencies were revised and formatted into an online survey which was sent to respondents in four target groups: (a) school administrators who had adopted telepractice as a service delivery model; (b) SLPs experienced in telepractice within a school setting; (c) current e-Helpers, and (d) scholars experienced in telepractice. Sixty percent (21 out of 35) of the competencies were rated as “important” by 76-100% of respondents. The remaining competencies could be more or less important dependent on workplace requirements.

Orientador: Ana Silvia Sartori Barraviera Seabra Ferreira / Resumo: De acordo com a OMS o termo Telemedicina pode ser definido como “a oferta de serviços ligados aos cuidados com a saúde, nos casos em que a distância é um fator crítico”. Ela pode ser utilizada em várias áreas como dermatologia, cardiologia, trauma, emergência, patologia, cirurgia, psiquiatria, radiologia. Já a Telessaúde é um termo mais amplo, envolvendo diferentes profissionais de saúde de áreas como enfermagem, fisioterapia, nutrição, psicologia. Devido à atual crise financeira do país, as características geográficas e dimensões territoriais, contrastes sociais, econômicos e culturais, existência de milhares de pessoas que vivem em locais de difícil acesso e distantes de unidades de saúde especializadas, o uso da tecnologia nas áreas da Telemedicina e Telessaúde mostra-se muito eficaz para a aproximação das populações localizadas em lugares remotos; integração de profissionais e pesquisadores; melhorias na gestão dos serviços de saúde e economia de gastos públicos. Assim, este estudo teve como objetivo descrever, por meio de um ebook, as ações das atividades e serviços de Telemedicina e Telessaúde desenvolvidas no Hospital das Clínicas e na Faculdade de Medicina de Botucatu da UNESP entre os anos de 2017 e 2018. Desta forma, este o estudo foi retrospectivo, caracterizando-se pela investigação e análise de atividades e serviços acontecidos entre os anos de 2017 e 2018, além de abranger reflexões e discussões sobre atividades e planejamentos futuros e desenvolvimento de dossi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: According to WHO the term telemedicine can be defined as "the provision of health care services in cases where distance is a critical factor." It can be used in several areas such as dermatology, cardiology, trauma, emergency, pathology, surgery, psychiatry, radiology. Telehealth is a broader term, involving different health professionals in areas such as nursing, physiotherapy, nutrition, psychology. Due to the country's current financial crisis, geographical characteristics and territorial dimensions, social, economic and cultural contrasts, existence of thousands of people living in difficult to reach places and away from specialized health units, the use of technology in the areas of telemedicine and telehealth are very effective for the approximation of populations located in remote places; integration of professionals and researchers; improvements in the management of health services and savings in public spending. The purpose of this study was to describe, through an ebook, the actions of the telemedicine and telehealth services and activities developed at the Hospital das Clínicas and at the Botucatu Medical School of UNESP between 2017 and 2018. Thus, this study was retrospective and characterized by the investigation and analysis of activities and services that took place between the years 2017 and 2018, as well as reflections and discussions on future activities and planning and development of dossier with the information and data raised during the research . Thus,... (Complete abstract click electronic access below) / Mestre

Critical Access Hospitals (CAHs) – the predominant type of hospital operating in rural areas – play an integral role in the US healthcare system, providing care for over 7 million rural residents each year who might otherwise have no local access to urgent care or inpatient services. This dissertation examines three aspects of care delivery in CAHs – effectiveness, cost/efficiency, and access – each of which has separate implications for policy and practice. The first study addresses effectiveness and evaluates the performance of CAHs on specific patient safety indicators compared to small Prospective Payment System (PPS) hospitals. A total of 35,674 discharges from 136 non-federal general hospitals with fewer than 50 beds were included in the analyses: 14,296 from 100 CAHs and 21,378 from 36 PPS hospitals. Outcome measures included six bivariate indicators of adverse events of surgical care that were developed from Agency for Healthcare Research and Quality Patient Safety Indicators. Multiple logistic regression models were developed to examine the relationship between hospital adverse events and CAH status. The results indicated that compared to PPS hospitals, CAHs are less likely to have any observed (unadjusted) adverse event on all six indicators, four of which are statistically significant. After adjusting for patient mix and hospital characteristics, CAHs perform better on three of the six indicators. Accounting for the number of discharges eliminated the differences between CAHs and PPS hospitals in the likelihood of adverse events across all indicators except one. Tele-emergency (tele-ED) services can address several challenges facing emergency departments (EDs) in rural areas. The second study investigates access and characterizes the impact of a rural-ED-based telemedicine program on discharge disposition in terms of patient transfer, local hospital admission, and routine discharge. This study tests the hypothesis that telemedicine enhances access by allowing patients to receive care in the local community, and does so by looking at the probability of transfer and local admissions before and after telemedicine was implemented in CAHs. The results indicate that in the post-telemedicine period, patients were 38% less likely to be admitted to the local inpatient facility than to be routinely discharged [aOR=0.62, 95%CI=(0.57,0.67)] after adjusting for age, sex, race, time of visit, clinical diagnosis, CPT code, number of diagnoses, and admitting hospital. The third study addresses cost and efficiency by modeling the financial implications of using the same telemedicine program to avoid transfers and estimating the costs and benefits associated with tele-ED implementation in CAHs. Analysis is based on 9,048 tele-ED encounters generated by the Avera eEmergency program in 85 rural hospitals across seven states between October 2009 and February 2014. For each non-transfer patient, physicians indicated whether the transfer was avoided because of tele-ED activation. The cost-benefit analysis is conducted from the hospital, patient, and societal perspectives, and includes technology costs, local hospital revenues, and patient-associated savings. The results show that 1,175 avoided transfers could be attributed to tele-ED. From a rural hospital perspective, tele-ED costs around $1,739 to avoid a single transfer but saves approximately $5,563 in avoided transportation and indirect patient costs. From a societal perspective, tele-ED results in a net savings of $3,823 per avoided transfer while accounting for tele-ED technology costs, hospital revenues, and patient-associated savings. This study highlights various stakeholder perspectives on the financial impact of tele-ED in avoiding patient transfers in rural EDs. Telemedicine has the potential to reduce the number of transfers of ED patients and generate some revenue for rural hospitals despite associated technology costs, while incurring substantial patient savings.

隨著少子化、老年化的時代來臨，以「銀髮族」為目標客戶的產業前景看好。全世界已開發國家人口老化日趨嚴重，社會醫療成為各國財政越來越沈重的包袱，於是以提升高齡者自立能力、降低醫療負擔，提高生活品質為目的的「遠距照護產業」備受重視。相較於其它先進國家，我國遠距照護產業發展較晚。衛生署主導的「遠距照護試辦計畫」第一階試辦已完成，目前進入第二階段擴大推廣。因而，本論文探討的核心問題，在於如何建立成功的遠距照護產業營運模式。 本論文選擇遠距照護應用中的「遠距心電圖監測」作為研究標的，乃因心電圖監測技術已有成熟發展，且全世界心臟病人口日益增加，值得投資。本論文修改技術與市場二分法的研究模式，除了「產業環境」與「營運模式分析」，更將「專利」與「查驗登記制度」納入研究環節。技術、專利與查驗登記制度雖非傳統營運模式分析的重要核心，但對於發展此產品、服務，有一定的影響。由於美國遠距心電圖產監測業發展較我國成熟，本論文比較美國與台灣發展現況，並選擇兩家於美國提供遠距心電圖監測服務的LifeWatch AG與CardioNet, Inc.作為個案研究的對象。 研究結果發現，遠距心電圖監測服務在美國主要用於輔助醫師診斷心臟疾病。不受限於環境，長期連續不間斷監測心電圖的特性，使其市場表現快速成長。美國成功建構產業的關鍵在於完善的商業機制。此外，亦發現美國針對六十五歲以上高齡人口的政府保險Medicare，其給付金額對市場發產有舉足輕重的影響，值得我國政府借鏡。建議台灣應該在保護民眾生命財產安全，以及發展產業之間取得平衡，建構一個適合發展創新技術、創新服務的產業環境。 此外，研究結果發現，台灣尚未能成功發展遠距心電圖監測服務的關鍵，並非技術，而是商業模式。台灣以保守的醫院為服務窗口的營運策略，是衛生署比擬全民健保機制，推動年長者長期健康照護制度的產物，屬於社會福利的性質，與發展產業的概念背道而馳，而且成本過高。另一方面，民眾沒有長期測量生理參數的習慣，拓展市場不易，此二者為台灣長期推動服務失敗的主要原因。因此，本研究最後建議，應捨棄以醫院為中心的服務模式，設計一套能夠被民眾廣為接受的營運模式，提供彈性的價格與服務，搭配適當的宣傳，方能突破現狀。 / Population aging is getting more and more serious among developed countries, as well as the extremely heavy medical treatment budgets. Consequently, governments start to think about how to make medical service more efficient by means of information technology; businessmen start to provide telemedicine service, in order to let the elder live more independently and healthier. A pilot remote health care project, held by the Department of Health, is moving to the second stage this year. Many telemedicine service centers had been built in the hospitals at the first stage, and now government is seeking for more hospitals and companies setting up more service centers in Taiwan. This is time to check weather it is a good business model worthy of working on, or there is a better way to develop telemedicine business. Remote ECG monitoring is one of the typical telemedicine services. Many people are suffering from cardiac disease in developed countries, and there are already some successful business models in the U.S. This is the reason why this studies focuses on remote ECG monitoring. This study takes into account technology, patent, FDA regulations, markets, and industrial environment aspects. Usually, only markets and industrial environment would be taken into account in this kinds of theses. Technology, patents, and FDA regulations, however, may have significant impact on business. The purpose of this essay is to advice to Taiwan, by comparing the difference between the U.S. model and Taiwan model, and analyzing two cases, LifeWatch AG and CardioNet, Inc.. According to the above surveys, remote ECG monitoring is mostly used for diagnosis. The key factor is the well-built U.S. medical system. The U.S. governmental health insurance, the Medicare, has huge influence on remote the ECG monitoring industry. The medical treatment system is open and well-governed, and suits for incubating new products. Although the medical system is relatively conservative in Taiwan, it is recommended that the Taiwan government should create some mechanisms that will encourage innovative telemedicine services. There are two reasons that make remote ECG monitoring services in Taiwan is not as successful as those in the U.S. Firstly, the services are provided by hospitals. Hospitals are conservative, and services doctors are expensive. So, there are less innovative business models, and the costs rocket high. Monitoring centers should be set outside the hospitals. Secondly, patients don’t “feel” the benefit from monitoring ECG constantly, so usually they quit the services in the second month. Therefore, marketing and promotion should be taking place. Services and prices should be more flexible and cost-effective as well. At this moment, the biggest challenge of remote ECG monitoring is business model, not technology, FDA regulations, or even patents

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The growing development and use of pervasive systems, equipped with increasingly sophisticated functionalities and communication means, offer fantastic potentialities of services, particularly in the eHealth and Telemedicine domains, for the benifit of each citizen, patient or healthcare professional. One of the current societal challenges is to enable a better exploitation of the available services for all actors involved in a given domain. Nevertheless, the multiplicity of the offered services, the systems functional variety, and the heterogeneity of the needs require the development of knowledge models of these services, systems functions, and needs. In addition, the distributed computing environments heterogeneity, the availability and potential capabilities of various human and material resources (devices, services, data sources, etc.) required by the different tasks and processes, the variety of services providing users with data, the interoperability conflicts between schemas and data sources are all issues that we have to consider in our research works. Our contribution aims to empower the intelligent exploitation of ubiquitous resources and to optimize the quality of service in ambient environment. For this, we propose a knowledge meta-model of the main concepts of a pervasive environment, such as Actor, Task, Resource, Object, Service, Location, Organization, etc. This knowledge meta-model is based on ontologies describing the different aforementioned entities from a given domain and their interrelationships. We have then formalized it by using a standard language for knowledge description. After that, we have designed an architectural framework called ONOF-PAS (ONtology Oriented Framework for Pervasive Applications and Services) mainly based on ontological models, a set of rules, an inference engine, and object oriented components for tasks management and resources processing. Being generic, extensible, and applicable in different domains, ONOF-PAS has the ability to perform rule-based reasoning to handle various contexts of use and enable decision making in dynamic and heterogeneous environments while taking into account the availability and capabilities of the human and material resources required by the multiples tasks and processes executed by pervasive systems. Finally, we have instantiated ONOF-PAS in the telemedicine domain to handle the scenario of the transfer of persons victim of health problems during their presence in hostile environments such as high mountains resorts or geographically isolated areas. A prototype implementing this scenario, called T-TROIE (Telemedicine Tasks and Resources Ontologies for Inimical Environments), has been developed to validate our approach and the proposed ONOF-PAS framework.