Background The prevalence and burden of musculoskeletal (MSK) conditions are growing around the world, and low back pain (LBP) is the most significant of the five defined MSK disorders in the Global Burden of Disease (GBD) study. LBP has been the leading cause of non-fatal health loss for the last three decades. The objective of this study is to describe the current status and trends of the burden due to LBP in Brazil based on information drawn from the GBD 2017 study. Methods We estimated prevalence and years lived with disability (YLDs) for LBP by Brazilian federative units, sex, age group, and age-standardized between 1990 and 2017 and conducted a decomposition analysis of changes in age- and sex-specific YLD rates attributable to total population growth and population ageing for the purpose of understanding the drivers of changes in LBP YLDs rates in Brazil. Furthermore, we analyzed the changes in disability-adjusted life years (DALYs) rankings for this disease over the period. Results The results show high prevalence and burden of LBP in Brazil. LBP prevalence increased 26.83% (95% UI 23.08 to 30.41) from 1990 to 2017. This MSK condition represents the most important cause of YLDs in Brazil, where the increase in burden is mainly related to increase in population size and ageing. The LBP age-standardized YLDs rate are similar among Brazilian federative units. LBP ranks in the top three causes of DALYs in Brazil, even though it does not contribute to mortality. Conclusions Findings from this study show LBP to be the most important cause of YLDs and the 3rd leading cause of DALYs in Brazil. The Brazilian population is ageing, and the country has been experiencing a rapid epidemiological transition, which generates an increasing number of people who need chronic care. In this scenario, more attention should be paid to the burden of non-fatal health conditions.

To determine whether teleophthalmology can help physicians in assessing and managing eye conditions and to ascertain which clinical conditions can be addressed by teleophthalmology in primary care setting. Methods We evaluated the resolution capacity of TeleOftalmo, strategy implemented in the public health system of southern Brazil. Resolution capacity was defined as the ability to fully address patients' eye complaints in primary care with remote assistance from ophthalmologists. Data from tele-eye reports were collected over 14 months. Resolution capacity was compared across different age groups and different ocular conditions. Results Overall, 8,142 patients had a tele-eye report issued in the study period. Resolution capacity was achieved in 5,748 (70.6%) patients. When stratified into age groups, the lowest capacity was 43.1% among subjects aged �65 years, while the highest was 89.7% among subjects aged 13-17 years (p<0.001). Refractive error (70.3%) and presbyopia (56.3%) were the most prevalent conditions followed by cataract (12.4%) and suspected glaucoma (7.6%). Resolution capacity was higher in cases of refractive error, presbyopia, spasm of accommodation and lid disorders than in patients diagnosed with other condition (p<0.001).

T he coronavirus disease (COVID-19) pandemic has spread worldwide (1). The rapid transmission of the causative agent, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has produced a high death toll, threatening health systems and creating huge challenges for governments and societies.Until advances in the development and distribution of vaccines or treatments reduce the risk for COVID-19 complications to levels permitting nearnormal day-to-day functioning, societies continue to require simple public health approaches to control pandemic spread, including mask use and social distancing. Several cohort studies in hospital settings have shown benefi ts of both interventions (2). However, in community settings, where these approaches have the greatest potential to limit viral spread and halt the pandemic, documented support for their use comes mostly from ecologic studies and, indirectly, from fi ndings related to previous pandemics of other coronaviruses. Only a few studies (3), including a retrospective case-control study of asymptomatic contacts (4), a randomized trial (5), and a study at sea (6), have evaluated their effectiveness against community transmission of SARS-CoV-2 on the basis of individual-level exposure and outcome measurements. Their relevance remains embroiled in controversy. To help close this gap, we evaluated the association of mask use and social distancing with incident, symptomatic, laboratory-confi rmed SARS-CoV-2 infection in a population-based case-control study. MethodsWe conducted a population-based, case-control study in Porto Alegre, the capital of Rio Grande do Sul State, Brazil, which has an estimated population of 1,483,771 (7). The ethics committee of the Hospital de Clínicas de Porto Alegre approved our study (approval no. 31499420.5.0000.5327), and the Brazilian National Ethics Committee (approval no. 30415520.2.0000.5313) approved the accompanying

Resumo Este estudo avaliou o custo de um serviço público de telediagnóstico em oftalmologia. O método de custeio baseado em atividades e tempo (TDABC) foi adotado para examinar os componentes de custos relacionados à teleoftalmologia. Com este método, também foi possível estabelecer o custo unitário padrão que o telediagnóstico deveria ter, dada a capacidade instalada e utilização de profissionais. Dados de um ano de telediagnósticos foram considerados, e avaliou-se a mudança do custo por telediagnóstico ao longo do período de adaptação da tecnologia no sistema. O custo padrão calculado por diagnóstico oftalmológico a distância foi de R$ 119, considerando a emissão de 1.080 laudos de telediagnóstico oftalmológico por mês. Foi identificado um desequilíbrio entre as atividades que sugere a capacidade do método TDABC orientar ações de gestão e melhoria na alocação dos recursos. Ao longo de um ano, o custo unitário real passou de R$ 783 para R$ 283, ainda havendo espaço para se aproximar do custo padrão estimado. Avaliações econômicas parciais possuem importante aporte para subsidiar a incorporação de novas tecnologias. O TDABC merece destaque nesse sentido, pois permite obter informações mais precisas sobre custo da tecnologia, melhorando a capacidade de dimensionamento e gerenciamento da organização de saúde.

Resumo O SARS-CoV-2, vírus causador da Covid-19, é o terceiro coronavírus a causar doença grave em humanos e que apresentou disseminação global nas duas últimas décadas. Nesse contexto, diversos departamentos nacionais de saúde pública, entre eles o Ministério da Saúde do Brasil, trouxeram destaque àquilo que era, até então, considerado um serviço de apoio ao sistema de saúde: a telessaúde e a telemedicina. Pretendemos apresentar as ações realizadas por um serviço nacional de telessaúde no Brasil, tanto no suporte aos profissionais de saúde da Atenção Primária à Saúde quanto a pacientes, além de discutir o potencial de reorganizar um sistema de saúde. Estudo de prevalência que sumariza as ações de telemedicina adotadas pelo TelessaúdeRS-UFRGS no período da 9ª à 27ª semana epidemiológica de 2020 para apoio aos serviços de saúde do Sistema Único de Saúde (SUS). Houve aumento de 76,8% da demanda de teleconsultorias telefônicas no período avaliado em comparação com o mesmo período em 2019, sendo 28,8% dessa demanda total decorrente de dúvidas relacionada à Covid-19. A pandemia por Covid-19 demandou rápida resposta com a organização de materiais sobre a doença, uma nova equipe para execução das atividades de telemonitoramento e teleconsultas, além da elaboração de um manual para teleconsultas na Atenção Primária à Saúde.

Objectives This study evaluates the quality of ophthalmic images acquired by a nurse technician trained in teleophthalmology as compared with images acquired by an ophthalmologist, in order to provide a better understanding of the workforce necessary to operate remote care programs. Methods A cross-sectional study was performed on 2044 images obtained from 118 participants of the TeleOftalmo project, in Brazil. Fundus and slit-lamp photography were performed on site by an ophthalmologist and by a nurse technician under the supervision of a remote ophthalmologist. Image quality was then evaluated by masked ophthalmologists. Proportion of suitable images in each group was compared. Results The proportion of concordant classification regarding quality was 94.8%, with a corrected kappa agreement of 0.94. When analyzing each type of photo separately, there was no significant difference in the proportion of suitable images between on-site ophthalmologist and nurse technician with remote ophthalmologist assistance for the following: slit-lamp views of the anterior segment and anterior chamber periphery, and fundus photographs centered on the macula and on the optic disc (P = 0.825, P = 0.997, P = 0.194, and P = 0.449, respectively). For slit-lamp views of the lens, the proportion of suitable images was higher among those obtained by an ophthalmologist (99.6%) than by a technician (93.8%, P < 0.01). Conclusions Ophthalmic photographs acquired by a trained technician consistently achieved >90% adequacy for remote reading. Compared with ophthalmologist-acquired photos, the proportion of images deemed suitable achieved a high overall agreement. These findings provide favorable evidence of the adequacy of teleophthalmological imaging by nurse technicians.

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