What is the future of the Brazilian Public Health System?

Pasternak, Jacyr

doi:10.31744/einstein_journal/2018ed4811

Cited by 7 publications

(9 citation statements)

References 4 publications

(5 reference statements)

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“…A review of false negatives did not reveal any case of severe NPDR or proliferative DR. We believe that high sensitivity and the setting of mtmDR as the cutoff point allows safe use in a screening strategy (Figure 3); the sensitivity reached by the current algorithm compares well with previous reports. 4,13,14 Implementation and maintenance of DR screening programs worldwide are challenged by financial and workforce constraints; 6 under-resourced health systems, particularly in low-to middle-income countries that face severe worker and infrastructure shortages, 15,16 need rational and cost-effective strategies to deal with the increasing demand brought by growing global prevalence of diabetes mellitus and to overcome social and economic barriers; telemedicine and AI have been established as successful and cost-effective strategies for DR screening, 6,17 helping increase program coverage and assisting in the detection of vtDR. 15 The high sensitivity found in the present study also allows for a semiautomated strategy, with algorithmic assistance increasing efficiency of non-specialist clinicians to diagnose at scale and reducing the workload of the specialist in a high burden setting, as it directs attention to concerning features consistently across large data sets, for example, through heatmaps (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera

Malerbi

Andrade

Morales

et al. 2021

J Diabetes Sci Technol

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Background: Portable retinal cameras and deep learning (DL) algorithms are novel tools adopted by diabetic retinopathy (DR) screening programs. Our objective is to evaluate the diagnostic accuracy of a DL algorithm and the performance of portable handheld retinal cameras in the detection of DR in a large and heterogenous type 2 diabetes population in a real-world, high burden setting. Method: Participants underwent fundus photographs of both eyes with a portable retinal camera (Phelcom Eyer). Classification of DR was performed by human reading and a DL algorithm (PhelcomNet), consisting of a convolutional neural network trained on a dataset of fundus images captured exclusively with the portable device; both methods were compared. We calculated the area under the curve (AUC), sensitivity, and specificity for more than mild DR. Results: A total of 824 individuals with type 2 diabetes were enrolled at Itabuna Diabetes Campaign, a subset of 679 (82.4%) of whom could be fully assessed. The algorithm sensitivity/specificity was 97.8 % (95% CI 96.7-98.9)/61.4 % (95% CI 57.7-65.1); AUC was 0·89. All false negative cases were classified as moderate non-proliferative diabetic retinopathy (NPDR) by human grading. Conclusions: The DL algorithm reached a good diagnostic accuracy for more than mild DR in a real-world, high burden setting. The performance of the handheld portable retinal camera was adequate, with over 80% of individuals presenting with images of sufficient quality. Portable devices and artificial intelligence tools may increase coverage of DR screening programs.

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Section: Discussionmentioning

confidence: 99%

Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera

Malerbi

Andrade

Morales

et al. 2021

J Diabetes Sci Technol

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“…Of note is the previous lack of experience of the trained team, as previous reports have presented high-quality rates obtained with experienced personnel [1,15,16]. The sustainability and cost-effectiveness of screening programs are also fundamental for its implementation and success; to the best of our knowledge, ours is the first report on the performance of low-cost, portable handheld devices for DR screening in an urban setting in Brazil, a continent-sized country with very heterogeneous socioeconomic realities and an uneven distribution of ophthalmologists [17], home to the fifth biggest diabetic population in the world [18] and also to the largest public free and chronically underfinanced healthcare system [19]. Multiple socioeconomic barriers prevent access to eye examination in the poor regions of Brazil [3].…”

Section: Discussionmentioning

confidence: 97%

Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera

Queiroz

Carvalho²,

Bortoto

et al. 2020

Acta Diabetol

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Aims To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary healthcare setting and to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience in retinal imaging. Methods This was a prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback given by a retina specialist during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classified according to the need of referral. Results A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years, diabetes duration 10.7 ± 8.2 years and HbA1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher HbA1c was associated with referable DR. Conclusions A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of COVID-19 pandemic. This article belongs to the topical collection Eye Complications of Diabetes, managed by Giuseppe Querques.

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“…8 No Brasil, o custo em saúde por pessoa é de 947,00 dólares. 9,16 A grande diferença entre os sistemas é a forte presença do investimento privado português, especialmente por meio de copagamentos dos pacientes com medicamentos, exames e consultas (quase 25% dos gastos do SNS). 8 Essas taxas moderadoras são pagamentos complementares e estão isentas para até 60% da população, contanto que os pacientes apresentem justificativas, como desemprego ou gravidez.…”

Section: B) Eixos Estruturantes E a Importância Da Atenção Primária à Saúdeunclassified

“…8 No SUS, apesar do PIB investido em saúde, apenas 47% é direcionado ao setor público. 16,17 Essa alocação de recursos deficiente contribui com a existência de serviços públicos insatisfatórios. Assim, as famílias procuram serviços privados de forma complementar ao SUS, gerando importantes despesas financeiras.…”

Section: Fragilidadesunclassified

Intercâmbio internacional na era COVID-19

Silva

Filho

2021

Rev Bras Med Fam Comunidade

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Problema: O intercâmbio internacional é um excelente instrumento de formação para estudantes e Portugal apresenta diversas vantagens para os alunos brasileiros. No entanto, a literatura brasileira carece de relatos de experiência sobre tais atividades e os estudantes frequentemente encontram- se preocupados sobre quais atividades serão desenvolvidas, sobre que tipo de sistema de saúde encontrarão e, recentemente, sobre como a pandemia se desenrolou no país de destino. Métodos: Trata-se de um estudo descritivo, do tipo relato de experiência, referente a um estágio internacional na área da saúde, realizado por um acadêmico brasileiro em Portugal. O trabalho foi elaborado a partir de pesquisas bibliográficas e resgate mnemônico da experiência. Resultados: O sistema de saúde português funciona de forma semelhante ao brasileiro, baseado na atenção primária à saúde e na descentralização, e apresentou bom desempenho em relação à pandemia da COVID-19. O intercâmbio foi realizado na área de medicina geral e familiar e de medicina de emergência pela Universidade de Lisboa, no início de 2020, e foi composto por uma vasta gama de atividades desenvolvidas, principalmente o acompanhamento de consultas. Os aprendizados do estágio incluem os conteúdos técnicos das consultas acompanhadas, os conhecimentos não científicos ensinados durante a rotina e as experiências sociais vivenciadas na viagem. Conclusão: Os estudantes brasileiros encontrarão familiaridades e diferenças positivas no sistema de saúde português e observarão excelentes números em relação ao controle da pandemia da COVID-19. O intercâmbio em Portugal possibilitou o crescimento profissional e pessoal do estudante e é recomendado para os estudantes brasileiros da área da saúde interessados em uma experiência transcultural.

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What is the future of the Brazilian Public Health System?

Cited by 7 publications

References 4 publications

Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera

Diabetic Retinopathy Screening Using Artificial Intelligence and Handheld Smartphone-Based Retinal Camera

Diabetic retinopathy screening in urban primary care setting with a handheld smartphone-based retinal camera

Intercâmbio internacional na era COVID-19

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