Mental illness affects 18% of American adults and 8.0% of American children. Untreated mental illness can increase mortality, influence treatment of other conditions, and impose unnecessary burdens on individuals, families, and communities. Despite the prevalence and burdens of untreated mental illness, there are still numerous financial, social, and organizational barriers to the availability, utilization and quality of mental health services. In the last two decades, many efforts have been made to improve healthcare access through legal and regulatory overhauls, health insurance reform, electronic health system infrastructure expansion, and development of new models of care. These efforts are perhaps most easily observed through the implementation of telehealth and telemedicine. Telehealth is an umbrella term indicating the use of technology for the provision of healthcare, health administration, and health education while telemedicine is a more specific term referring to the use of technology for the delivery of healthcare across distances. While telemedicine is used in almost all subspecialties, implementation and research are more developed in some specialties than in others. Research on telepsychiatry shows that 1) telepsychiatry can be used to effectively diagnose and treat a variety of mental illnesses in a number of populations in many locations; 2) telepsychiatry has the potential to be a cost effective alternative to treatment as usual for patients, providers, and communities; 3) telemental health can function successfully within the legal and regulatory landscape in United States; 4) the technology for telemental health is already available and continually improving; 5) There are resources available to facilitate the use of telemental health by patients, providers and healthcare organizations. Telepsychiatry has the potential to improve access to mental health services by connecting patients with the right providers, reducing the costs of receiving and providing mental healthcare, lowering social barriers that prevent individuals from seeking and providers from offering care, and facilitating organizational practices and goals. This paper summarizes published data concerning the clinical, financial, legal and regulatory, and technological aspects of telepsychiatry and explores how telepsychiatry might be used to improve the availability, utilization, and quality of mental health services in the United States.

Submitted by Fernanda Martins Viana (femartinsviana@gmail.com) on 2015-02-10T16:56:06Z No. of bitstreams: 1 DISSERTAÇÃO FINAL.pdf: 933814 bytes, checksum: 967aaf9a4084b104a7423ede82dd16b5 (MD5) / Approved for entry into archive by PAMELA BELTRAN TONSA (pamela.tonsa@fgv.br) on 2015-02-10T16:59:00Z (GMT) No. of bitstreams: 1 DISSERTAÇÃO FINAL.pdf: 933814 bytes, checksum: 967aaf9a4084b104a7423ede82dd16b5 (MD5) / Made available in DSpace on 2015-02-10T17:05:23Z (GMT). No. of bitstreams: 1 DISSERTAÇÃO FINAL.pdf: 933814 bytes, checksum: 967aaf9a4084b104a7423ede82dd16b5 (MD5) Previous issue date: 2015-01-28 / O objetivo da presente dissertação é analisar a telemedicina como ferramenta para ampliar o acesso à assistência em saúde no Brasil, dentro do contexto do Sistema Único de Saúde (SUS). Atualmente, a dificuldade de acesso à assistência constitui um grande problema para sistemas de saúde e países no mundo todo. Foi utilizada metodologia qualitativa analítica do tipo “Theory Building from Cases”, envolvendo o estudo de dois casos: a Rede de Teleassistência de Minas Gerais e a Rede de Telessaúde do Canadá, buscando fornecer argumentos positivos para a incorporação da telessaúde em estratégias e políticas de saúde pública no Brasil. Os resultados mostraram que a telemedicina ampliou o acesso à assistência em áreas remotas e rurais, proporcionou economia de recursos devido à redução de deslocamentos de pacientes, possibilitou a educação à distância de profissionais de saúde e, com isso, melhorou a qualidade da atenção prestada. Assim, a conclusão da pesquisa foi que a telemedicina é uma ferramenta eficiente para ampliar o acesso à assistência em saúde no Brasil, colaborando para o cumprimento dos princípios do SUS de universalidade, integralidade, equidade e resolutividade. A incorporação da telessaúde dentro das políticas de saúde com financiamento integrado no orçamento público é fundamental para o sucesso desta ferramenta.

Made available in DSpace on 2015-07-22T20:50:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-07-29 / Objetivos: Avaliar a concordância no diagnóstico das lesões cutâneas pigmentadas por meio do exame dermatoscópico presencial e a distância. Analisar a concordância diagnóstica da teledermatoscopia e do exame dermatoscópico presencial em relação ao resultado anatomopatológico. Verificar a acurácia, a sensibilidade e a especificidade da teledermatoscopia na detecção das lesões pigmentadas malignas. Métodos: Sessenta e quatro lesões cutâneas pigmentadas foram submetidas a exame clínico e dermatoscópico realizado presencialmente por dois examinadores com experiência em dermatoscopia, durante o ano de 2005, no ambulatório de dermatoscopia do Departamento de Dermatologia da Universidade Federal de São Paulo (UNIFESP). Após dois anos, imagens digitais clínicas e dermatoscópicas destes casos foram reexaminadas pelos mesmos especialistas por meio da transmissão de imagens e de dados clínicos via web. Resultados: Observou-se boa concordância diagnóstica entre o exame presencial e a teledermatoscopia com valor de Kappa de 0,698 (IC a 95% - [0,575; 0,821]). Verificou-se também boa concordância entre o exame presencial e a teledermatoscopia com o resultado anatomopatológico (padrão ouro) com valores de Kappa de 0,728 (IC a 95% - [0,608; 0,848]) e 0,656 (IC a 95% - [0,526; 0,785]), respectivamente. Constatou-se 84% de acurácia, 93% de sensibilidade e 78% de especificidade na detecção das lesões pigmentadas malignas no exame dermatoscópico a distância. Dois casos falsos negativos foram observados pela teledermatoscopia. Não houve diferença estatisticamente significante entre a sensibilidade, a especificidade e a acurácia das duas modalidades diagnósticas. Conclusões: O exame dermatoscópico a distância pela transmissão de imagens digitais e de dados clínicos proporcionou acurácia diagnóstica, sensibilidade e especificidade comparáveis ao exame convencional. A teledermatoscopia mostrou ser método eficaz e confiável na detecção das lesões malignas constituindo ferramenta importante na triagem das lesões pigmentadas. A boa concordância diagnóstica entre a avaliação via web e o exame presencial destaca a aplicabilidade da teledermatoscopia como instrumento de assistência especializada em regiões de difícil acesso ou carentes no setor de saúde. / Objectives: To evaluate agreement in diagnosis of pigmented skin lesions through presential or remote dermoscopic examination. To analyze diagnosis agreement of teledermoscopy and presential dermoscopic examination regarding pathological findings. To verify accuracy, sensibility and specificity of teledermoscopy in detection of malignant pigmented lesions. Methods: A total of 64 pigmented skin lesions were submitted to clinical and dermoscopic examinations performed presentially by two examiners experienced in dermoscopy, at the Dermoscopy Outpatient’s Clinic, Department of Dermatology, Universidade Federal de São Paulo (UNIFESP), in 2005. Two years later, the digital clinical and dermoscopic images of these cases were re-examined by the same specialists through transmission of images and clinical data via web. Agreement between presential diagnosis and telediagnosis was assessed by the Kappa (κ) statistic calculation and its respective 95% confidence interval (95% CI). Through this calculation, the agreement between presential presumptive diagnoses and telediagnoses with pathological findings was analyzed. Sensitivity, specificity and accuracy of two diagnostic modalities were obtained using the pathological examination as the gold standard. The respective 95% confidence interval (95% CI) was calculated for each diagnostic measurement. Results: Good diagnostic agreement was observed between presential examination and teledermoscopy, with a Kappa value of 0.698 (95% CI - [0.575; 0.821]). Good agreement was also found between conventional examination and teledermoscopy, and the pathological findings (gold standard) had Kappa values of 0.728 (95% CI - [0.608; 0.848]) and 0.656 (95% CI - [0.526; 0.785]), respectively. Accuracy of 84%, sensitivity of 93% and specificity of 78% were observed in detecting malignant pigmented lesions by remote dermoscopic examination. Two false negative cases were observed through teledermoscopy. There was no statistically significant difference in sensitivity, specificity and accuracy of both diagnostic methods. Conclusions: Remote dermoscopic examination by means of digital image transmission and of clinical data provided diagnostic accuracy, sensitivity and specificity comparable to conventional examination. Teledermoscopy proved to be an efficient and reliable method to detect malignant lesions, representing an important tool to screen pigmented lesions. The good diagnostic agreement between assessment via web and conventional examination highlights the applicability of teledermoscopy as a specialized assistance tool in regions that are difficult to reach or lack health resources. / TEDE / BV UNIFESP: Teses e dissertações

Introdução: A Telessaúde caracteriza-se pelo uso da tecnologia de informação e comunicação na área da saúde. Na Fonoaudiologia, o uso desta ferramenta por meio da Teleducação e Teleassistência se caracteriza como uma importante estratégia que leva a informação para alunos, profissionais, pacientes e comunidade em geral. Esse fator, aliado à grande extensão geográfica do Brasil e a distribuição heterogênea dos profissionais da saúde, vem ao encontro da necessidade de atendimento especializado para pacientes e descentralização do conhecimento para profissionais. Neste contexto, o uso da Teleducação emerge como uma proposta para minimizar as dificuldades encontradas pelo paciente, no processo de adaptação do aparelho de amplificação sonora individual (AASI), na qual muitos materiais educacionais são produzidos com o intuito de orientar e facilitar a adaptação do indivíduo deficiente auditivo, à sua nova realidade. Objetivo: Este projeto tem por objetivo elaborar um programa de capacitação por meio da Teleducação Interativa, sobre o aparelho de amplificação sonora individual, e analisar a eficácia do mesmo, quanto ao aprendizado e motivação dos profissionais. Resultados: A primeira etapa compreendeu a elaboração do programa de capacitação, na qual foi desenvolvido um cybertutor sobre o tema AASI e as ferramentas fórum de discussão e web conferência, com o intuito de complementar o aprendizado. Na segunda etapa, referente à análise do programa, verificou-se que não houve significância estatística no aspecto relacionado ao aprendizado do conteúdo, na avaliação pré e pós teste. Em relação à motivação dos profissionais, o estudo obteve resultado positivo, sendo avaliado como curso impressionante. Discussão: O programa de capacitação foi desenvolvido, respaldado em estudos voltados para elaboração de materiais didáticos à distância. No que se referem aos resultados da avaliação, todas as dificuldades encontradas neste aspecto corroboraram com a literatura. Conclusão: A elaboração do Programa de Capacitação por meio da Teleducação Interativa sobre o tema aparelho de amplificação sonora individual (AASI) foi realizada satisfatoriamente, alcançando um índice de motivação em relação à participação altamente positivo, porém os resultados da comparação da avaliação da situação problema pré e pós teste não foram estatisticamente significantes. / Introduction: Telehealth is characterized by the use of information technology and communication in healthcare. In audiology, the use of this tool through Telecare and Tele-education is characterized as an important strategy that leads the information for students, professionals, patients and the general community. This factor, combined with the large geographical extent of Brazil and the heterogeneous distribution of health professionals, meets the need of specialized care for patients and decentralization of knowledge for professionals. In this context, the use of Tele-education has emerged as a proposal to minimize the difficulties encountered by the patient in the process of adaptation of a hearing aids (HA), in which many educational materials are produced in order to guide and facilitate the adaptation HA to their new reality. Objective: This project aims to develop a training program through the Interactive Tele-education on the individual sound amplification devices, and analyze the effectiveness of the same as learning and motivation. Results: The first stage of the preparation of the training program, which was developed on the theme Cybertutor hearing aids and tools discussion forum and web conferencing in order to supplement learning. In the second stage, regarding the analysis of the program, it was found that there was no statistical significance in the learning aspect of the content, in the pre and post test. Regarding the motivation of staff, the study was positive, which was assessed as \"impressive progress\". Discussion: The training program was developed, backed up by studies aimed at developing distance learning materials. In that refer to results of the evaluation, all difficulties found in this aspect corroborated with the literature. Conclusion: The development of the Training Program through the Interactive Tele-education on the subject of HA was performed satisfactorily, reaching a level of motivation in relation to participation highly positive, but the comparison results of the evaluation of the problem situation pre and post-test were not statistically significant.

Introdução: A comunicação é o processo pelo qual ocorrem compreensão e compartilhamento de mensagens enviadas e recebidas, sendo que o conteúdo destas mensagens exerce influência no comportamento das pessoas envolvidas. Atualmente, a área da saúde tem utilizado ferramentas de cuidado à distância para prestar assistência aos pacientes em diversos contextos - a chamada Telessaúde. A influência desta modalidade de cuidado sobre a natureza e o conteúdo da comunicação deve ser muito bem compreendida, visto que o processo de comunicação humana adequado é essencial na assistência à saúde com qualidade. Objetivos: avaliar a percepção do profissional da saúde referente a elementos de Comunicação Humana no cuidado por Telessaúde. Os objetivos específicos foram: verificar que elementos de Comunicação Humana o enfermeiro e o médico identificam no cuidado por Telessaúde, e discutir, por meio dos achados, em que aspectos essa modalidade de cuidado pode impactar na comunicação interpessoal entre os profissionais de saúde e, consequentemente, na assistência aos pacientes. Método: pesquisa descritiva, com abordagem qualitativa, realizada com 20 profissionais que atuam em telessaúde no Brasil. Os dados foram coletados com médicos e enfermeiros por meio de sistema de vídeo ou áudio, no período de junho a outubro de 2014. O número de participantes foi determinado pela saturação de dados, conforme metodologia adotada. Os dados foram analisados pela proposta de análise de conteúdo de Bardin. Resultados: Dos discursos emergiram quatro categorias principais, sendo a maioria composta de subcategorias: Entendendo a importância da comunicação (Comunicação adequada é fundamental, pois interfere na conduta; Identificando as barreiras de comunicação); O relacionamento interpessoal interferindo na comunicação; Comunicando-se por meio da tecnologia (Tecnologia facilita a prática; Entendendo os fatores que dificultam a comunicação à distância; Identificar o não verbal por telessaúde é mais difícil) e Aprendendo o processo de comunicação (Não há dificuldades em comunicar-se; Importância do aprendizado da comunicação verbal e não verbal; Importância do aprendizado da telessaúde). Conclusão: Concluímos com este estudo que a comunicação interpessoal adequada na área da saúde é considerada primordial por médicos e enfermeiros que atuam em Telessaúde no Brasil porque acreditam interferir em sua conduta profissional. O relacionamento interpessoal é o principal fator de interferência nesse processo. A tecnologia tem facilitado a prática profissional, porém, do ponto de vista comunicacional, o cuidado à distância apresenta nuances que dificultam o processo de comunicação, principalmente devido à dificuldade de percepção do não verbal na assistência por telessaúde. Para superar estas dificuldades, médicos e enfermeiros concordam que a comunicação é uma competência que deve ser lecionada aos profissionais durante sua formação e, especificamente para atuação à distância, esta habilidade deve ser ensinada considerando as nuances que a distância pode trazer no processo comunicacional entre as pessoas. / Introduction: Communication is the process through which understanding and sharing of sent and received messages occur, considering that the content of these messages influences the behaviour of people involved. Nowadays, the health care segment has used distance care tools to serve patients in different contexts - the so-called Telehealth. The influence of this type of care on the nature and content of communication must be well understood, since the adequate process of human communication is essential in quality health assistance. Objectives: evaluate the perception of the health care professional regarding Human Communication elements in Telehealth care. The specific objectives were: verifying which elements of Human Communication the nurse and the doctor identify in Telehealth care, and dissussing, through findings, in which aspects this type of care can impact the interpersonal communication among health care professionals and, consequently, patients care. Method: descriptive research, with qualitative approach, performed with 20 professionals who work in Telehealth in Brazil. Data were collected from doctors and nurses through audio or video system, from June to October 2014. The number of participants was determined by saturation of data, according to adopted methodology. Data were analyzed by the content analysis proposal of Bardin. Results: From the discourses, four main categories emerged, and most are composed of subcategories: understanding the importance of communication (dequate communication is fundamental, because it interferes in behaviour; Identifying the limitations of communication); The interpersonal relationship interfering in the communication; Communicating through technology (Technologies facilitates practice; Understanding the factors that make distance communication difficult; Identifying the non-verbal through Telehealth is more difficult) and Learning the process of communication (There are no difficulties in communicating; The Importance of learnig verbal and non-verbal communication; The importance of Telehealth learning). Conclusion: We have concluded in this study that adequate interpersonal communication in health care is considered fundamental by doctors and nurses that work in Telehealth in Brazil because it is believed that it interferes with their professional behaviour. Interpersonal relationship is the main factor of interference in this process. Technology has facilitated professional practice, however, from a communicational perspective, distance health care presents nuances that make the process of communication difficult , maily due to the difficulty of perception of non-verbal aspects in Telehealth care. To overcome these difficulties, doctors and nurses agree that communication is a competence that must be taught to professionals during their professional education and, especifically to work at distance, this ability must be taught taking into consideration the nuances that distance may bring in the communication process among people.

Os websites são um dos principais e mais ágeis veículos para difusão e busca por informação na área da saúde, apresentando um grande potencial para o estabelecimento de ações educativas distância. Este estudo descreve o desenvolvimento e avaliação da qualidade técnica e de conteúdo da Seção Odontologia do website Portal dos Bebês. A definição dos conteúdos a serem abordados nesta seção do website se deu a partir da revisão da literatura e dos resultados de uma avaliação diagnóstica, a respeito da higiene e cuidado com a saúde bucal do bebê, realizada com 60 pais de crianças entre 0 e 36 meses de idade. Aceitaram o convite para participar da avaliação do website 49 cirurgiões dentistas (10 homens e 29 mulheres, com idade média de 27,34 anos) e 41 pais (02 homens e 39 mulheres, com idade média de 34,20 anos). Os participantes preencheram anonimamente um formulário online com perguntas sobre dados demográficos, uso da internet e sobre a qualidade técnica (cirurgiões dentistas) e do conteúdo do website (cirurgiões dentistas e pais). A qualidade técnica pautou-se no questionário Emory, compreendendo as subescalas precisão, autores, atualizações, público, navegação, links e estrutura. A maioria dos consideram os aspectos técnicos como excelente (40%) ou adequado (57%). A média da pontuação total do questionário Emory foi igual a 88%. Houve diferença significativa entre as subescalas do Emory, sendo de particular importância a menor pontuação obtida na subescala precisão. A média da pontuação do conteúdo foi igual a 4,5 (máximo de 5 pontos). Houve diferença pequena, porém significativa, entre a pontuação do conteúdo higiene bucal do bebê e cárie precoce da infância. A avaliação do conteúdo estava relacionada ao tempo de atuação profissional. Os pais avaliaram seu conhecimento prévio sobre a saúde e higiene bucal do bebê como sendo bom (56%) ou muito bom (22%). A pontuação média total do conteúdo foi 4,2. Embora com diferença pequena, a pontuação do conteúdo alimentação foi significativamente menor do que os conteúdos primeira visita ao dentista, higiene bucal e cárie precoce da infância. Os pais estavam satisfeitos (60%) ou muito satisfeitos (34%) com o website, sendo que esta satisfação estava relacionada à idade de seus filhos. Todos os pais indicariam o website a outros pais. É necessária a adequação de alguns conteúdos do website de forma melhor atingir as necessidades do público alvo. A Seção Odontologia do Portal dos Bebês apresenta pode ser utilizada como instrumento para educação aos pais quanto a saúde bucal na primeira infância. / The websites are the fastest main diffusion and information search media in health area, presenting a great potential to establish educational actions at distance. This study describes the development and evaluation of the technical quality and content of Dentistry Section of Portal dos Bebes website. The content definition to be addressed on this section was based on a literature review and on the outcomes of a diagnostic assessment regarding to oral hygiene and care conducted with sixty parents and/or caregivers of babies aged from 0 to 36 months. Forty-nine dentists (10 men and 29 women; mean age of 27.34 years old) accepted to evaluate the website and 41 parents (2 men and 39 women; mean age of 34.2 years old) participated in the research. The participants anonymously fulfilled an online form containing questions on the demographical area, internet use, technical quality (dentists) and website content (dentists and parents).The technical quality based on Emory questionnaire regarding accuracy, authorship, updates, public, navigation, links and structure of the website were assessed. Most of the participants considered technical aspects as either excellent (40%) or adequate (57%). The total average score of Emory questionnaire achieved 88%. There was statistical significance among Emory subscales, highlighting the lowest score obtained by accuracy item. The average of content score was 4.5 (5.0 was considered the highest score). There was a small but significant difference between the content score baby oral hygiene and early caries childhood. The content evaluation was related to professional acting time. The parents assessed their previous knowledge on oral health and hygiene which was considered as either good (56%) or very good (22%). The total mean average was 4.2. Although with a low difference, the score relating to feeding was significant lower than that related to oral hygiene and early caries childhood. The parents were either satisfied (60%) or very satisfied (34%) with the website which had been related with the age of their children. Furthermore, all parentswould refer the website to other parents. It is necessary a better adequacy concerning some website contents aiming to reach the needs of the targeted public. The Dentistry section of Portal dos Bebes website may be a tool for the learning of parents concerning oral health at the early childhood.

Para analisar a efetividade da teledermatologia assistencial a partir de fotografias digitais de lesões, avaliou-se a sistematização de aspectos técnicos, morfológicos (maculoso, relevo e palpatório) e de representatividade clínica (típico, moderado e atípico). Verificou-se que o comprometimento da qualidade técnica, a morfologia palpatória e menor tipicidade clínica devem ser suplementados pela descrição das lesões e pelas informações clínicas para aumentar sua acurácia diagnóstica. Desenvolveu-se um sistema de interconsulta dermatológica à distância e constatou-se que seu desempenho diagnóstico foi comparável à consulta presencial, devendo ser consideradas todas as hipóteses diagnósticas elaboradas, além da principal / To analyze the effectiveness of a teledermatology system, the systematization of digital photographs from cutaneous lesions on technical quality, morphologic and clinical aspects was performed. The study showed that unsatisfactory technical quality, palpatory morphology and less typical lesions should be supplemented by clinical description of the lesions and patient information to increase diagnostic accuracy. The dermatologic Internet-based teleconsultation system has diagnostic performance comparable to face-to-face consultation, and all the hypotheses, not only first one, should be considered at virtual diagnostic evaluation

Apesar dos avanços tecnológicos voltados para o uso das Tecnologias da Informação e Comunicação em Saúde, vários aspectos normativos ainda estão sendo discutidos em âmbito nacional para o estabelecimento de uma legislação específica para a área de telemedicina. As normativas mais utilizadas como referência para definição do escopo de atuação profissional em telemedicina são: a RESOLUÇÃO CFM nº 1.643/2002, que define e disciplina a prestação de serviços através da Telemedicina e a RESOLUÇÃO CFM nº 2.107/2014, que define e normatiza a Telerradiologia e revoga a RESOLUÇÃO CFM nº 1890/09. Essa dissertação apresenta um estudo retrospectivo, quantitativo, descritivo, baseado em levantamento bibliográfico que tem como proposta verificar a conformidade das formas de uso da telemedicina e da telessaúde, nos contextos nacional e internacional, em relação ao modelo proposto para essa atividade pelo CFM, representado pelas resoluções 1.643/2002 e 2.107/2014. O levantamento bibliográfico foi feito no período de 2009 a 2015, nas bases de dados Scielo, PubMed e IEEE, com base nas palavras chaves videoconferencing, webconferencing, VTC, meeting, telemedicine e telehealth e suas combinações. Foram encontrados, incialmente, 2352 artigos que foram reduzidos para 572 após a leitura de seus resumos e, novamente reduzidos para 115, após a leitura parcial dos artigos. Os 115 artigos selecionados foram lidos na íntegra. Os resultados obtidos mostraram que o uso da telemedicina pode ampliar consideravelmente a área de atendimento especializado dos grandes centros médicos, o que deve ser incentivado, principalmente em países com menores recursos financeiros, ou com poucos especialistas, ou extremamente extensos, como no caso do Brasil / Despite technological advances aiming the best use of Information and Communication Technology in Healthcare, several normative aspects are still being discussed in national scope, in order to establish a specific legislation for telemedicine area. There are some specifically normative aspects for professional orientation in telemedicine as follows: CFM no. 1.643/2002 that define disciplines and services provided by telemedicine, and CFM no. 2.107/2014 that define and guide the teleradiology services. This work was a retrospective, quantitative and descriptive study based on bibliographic surveying, in order to verify the conformity of the use of telemedicine and telehealth in both national and international contexts, according to the CFM proposed model for this activity, represented by CFM resolutions no. 1.643/2002 and no. 2.107/2014. The bibliographic surveying between 2009 and 2015 used Scielo, PubMed, and IEEE databases, and the key words: videoconferencing, webconferencing, VTC, meeting, telemedicine, and telehealth plus their combinations. We found 2352 articles, reduced to 572 after reading their abstracts. One hundred and fifteen potentially relevant articles were selected after partial reading of the articles. After that, the 115 selected articles were fully read. The results showed that the use of telemedicine could considerably increase the area of specialized attending crew on important medical facilities, what should be encouraged mainly in countries with few or no financial resources, or the small number of specialists, or extensive areas such as Brazil

Philosophiae Doctor - PhD / Background: Teledentistry is the use of information and communications technology (ICT) to provide oral health care services and enhance oral health care delivery to communities in geographically challenged areas. The public health services in South Africa needs to be overhauled to address the inadequacies in the current system. As an attempt to minimise or repair the inadequacies in the public health sector, South Africa has identified the use of ICT’s as a potential tool in improving the delivery of health care. However, although SA has recognised telemedicine as a potential solution to improve access to health care, teledentistry does not feature at all in the dental public health sector. Teledentistry and mobile health has the potential to eliminate or minimise the oral health disparities that exist in South Africa with the use of health information systems. Teledentistry can be initiated in an incremental approach by 'piggy-backing' on existing telemedicine sites, thus reducing ICT costs for the public health sector. Stake holders and government officials need to embrace technology to address some of the challenges that exist in the South African public health sector. This study could aid in providing evidence-based information to assist in the introduction of teledentistry in South Africa as an innovative dental screening and management tool. The most recent SA National Oral Health Survey showed that at least 80% of dental caries in children is untreated (Department of Health, 2003) and this poses a significant public health problem. To reduce the double burden of dental caries in children and human resource shortages in the public sector, the use of teledentistry as a school screening tool has been recommended. Teledentistry screening has the potential to improve access and delivery of oral health care to children in underserved and the rural areas. The aim of the study is to compare traditional dental screening versus teledentistry screening for dental caries in children. Methodology: This study consists of two parts: the first part a concordance study and the second part the determination of user satisfaction with regards to the technology used. The concordance study assessed the diagnostic agreement between traditional and teledentistry screening of dental caries in school children aged between 6-8 years old. The methodology included traditional face-to-face dental screening by two trained and calibrated evaluators, and the teledentistry screening method included the same two evaluators together with two trained and calibrated teledentistry assistants (who were of non-dental background). For the traditional face-to-face dental screenings the two evaluators examined 233 children at selected rural primary schools and scored them for DMFT. For the teledentistry screening method the teledentistry assistants captured intraoral images of the same children and web-based stored the images in corresponding eFiles. After a two week wash out period these intraoral images were then examined by the same two evaluators and scored for DMFT. To determine concordance across methods, Kappa Statistics was applied to the data and this revealed intra-examiner reliability. To determine user satisfaction levels, close-ended questionnaires were designed based on the role of the evaluators and TAs in the teledentistry screening process. Results: The intra-rater agreement and reliability across methods for evaluator one was 98.30%, and for evaluator two it revealed a result of 95.09%. Kappa statistics thus revealed that both evaluators were in agreement between a range of 95%-98.30% of the classifications, or 92.79% of the way between random agreement and perfect agreement (p=0.000). The high concordance level indicated that there was no statistical difference between the traditional dental screening method and the teledentistry screening method (intra-rater reliability), thus suggesting that the teledentistry screening method is a reliable alternative to the traditional dental screening method. For the user satisfaction part, both of the evaluators agreed with 8 of the 13 statements (62%). The statements that were agreed upon related mainly to user satisfaction on the technology which included accessing the intraoral images for screening and the ease of scoring decayed and missing teeth off the images; time and technology suggested the screening process of the images saved time; and indicated teledentistry as being an innovative and easy system to use that will save clinical time for dental professionals. The statements they disagreed with related to the clarity of the images, scoring interproximal caries off the images, and the dental screening method of choice. Both of the TAs agreed with 7 of the 11 statements (64%). They agreed upon statements related mainly to perception of children’s attitudes & behaviour which suggested the children were comfortable during the imaging process and in addition they were excited to see pictures of their teeth; they found teledentistry to be an innovative and easy system to use; they found teledentistry to be a sterile process and hence they were happy with infection control. Both TAs disagreed with the statement that suggested clear images could be captured irrespective of poor lighting. Discordant statements related mainly to user satisfaction on technology which related to ease of using the intraoral camera, ease of storing the captured images into the eFiles and ease of deleting unwanted images. Conclusion: The key findings of this study highlights the reliability of utilising teledentistry as a dental screening and diagnostic tool which can be valuable in the delivery of oral health care in South Africa. This research study further revealed valuable data on user satisfaction levels of the evaluators and TAs, and has an impact on the utilisation of the teledentistry screening system. To ensure adoption and adaptation of the screening process all users must be satisfied with the ICTs used in the teledentistry system. User friendliness can impact negatively on the adoption of teledentistry.

In March 2020, COVID-19 was announced as a pandemic, and the whole world was affected. Lockdown and restrictions happened in several nations, and populations were told to keep their distance and avoid public places such as clinics and hospitals. Nation after nation started to implement or increase telemedicine usage to continue providing healthcare. In South Korea, telemedicine was prohibited before the pandemic but is now temporarily allowed. In the USA, telemedicine has increased its usage by 4000% at NYU Langone Health. However, there have been benefits such as easy accessibility, cost-effectiveness, efficiency, and barriers such as technical issues, limited access, and low experience with technology. It has affected several populations such as the elderly, younger, low-income, and people living in rural areas. In this scoping review, COVID-19s impact telemedicine usage will be investigated as well as its benefits and barriers.