O Marco Legal de Ciência, Tecnologia e Inovação e seu papel na transformação digital do Sistema Único de Saúde

What Is Driving the Legal Interest in Hepatic Encephalopathy?

Brand inequity in access to COVID-19 vaccines

In times of converging and diversifying audiovisual (AV) industries, digitising health sector and the increasing phenomenon of cross-sectoral innovation, the question arises about the state of affairs between the health and AV sectors. The chapter aims to explore what the main modes of cross-sectoral cooperation between the health and AV sectors are and what supports and hinders the emergence of a related cross-innovation system. The chapter introduces two case studies carried out in Estonia and the wider Aarhus region (Midtjylland) in Denmark. At each site representatives of the main stakeholders of both sectors were interviewed – policy makers, entrepreneurs, educators and professionals. The results demonstrate the crucial role of path-dependencies – in terms of both hindering and enabling cross-sectoral dialogues – and also the importance of effective coordination in supporting cross-innovation. Keywords Cross-sectoral dialogues Path-dependence Health sector Audiovisual media industries Cross-innovation Innovation systems Citation Tafel-Viia, K. (2019), "Health and Audiovisual Sector: A Meso-analysis of How Systemic Coordination of Sectoral Cooperation Leads to Convergence", Ibrus, I. (Ed.) Emergence of Cross-innovation Systems, Emerald Publishing Limited, Bingley, pp. 121-144. https://doi.org/10.1108/978-1-78769-977-920191015 Publisher: Emerald Publishing Limited Copyright © 2019, Külliki Tafel-Viia. Published by Emerald Publishing Limited License This chapter is published under the Creative Commons Attribution (CC BY 4.0) licence. Anyone may reproduce, distribute, translate and create derivative works of this chapter (for both commercial and non-commercial purposes), subject to full attribution to the original publication and authors. The full terms of this licence may be seen at http://creativecommons.org/licences/by/4.0/legalcode Introduction In this chapter, we introduce developments in the field of cross-sectoral dialogues between the health and audiovisual (AV) media sectors. We use Estonia and the Aarhus region in Denmark (Midtjylland) as case studies. We chose these cases as our observations identified that amongst the six countries we studied at the initial phase of the study, the manifestations of these sectors’ convergence in these two countries was most visible and/or offered the most interesting initiatives to explore. In Aarhus, we observed the emergence of new convergent enterprises, and in Estonia, the overall systemic development of information and communication technology (ICT) infrastructures and e-governance systems offered a promising starting-point for cross-innovations. The empirical study consisted of 36 interviews with sectoral entrepreneurs, professionals and policy makers of both countries. We start the chapter with an overview of the sectors’ development stage where we outline the main changes that influence the sectors’ current and future development and their overall readiness to adapt to these changes. Thereafter, we describe the current institutional landscape that supports the sectors’ cooperation. In the second part, we continue with the sectors’ general openness to cooperation and describe the common modes and peculiarities of cross-sectoral dialogues. The chapter ends with challenges for policy makers by outlining the main shortcomings that policy could address to better support cross-boundary innovation between the health and AV media sectors. The Changing Face of the AV Media and Health Sectors AV Media Sector The interviews revealed the changing nature of the AV sector – this applies to both Estonia and the Aarhus region. In Aarhus, the AV content and services sector has a rather strong position (2nd place in Denmark after Copenhagen) with a large-scale concentration of AV industries, which are divided into four main categories: films and animation, video games, television production and production of commercials. In Estonia, the main hub of the AV sector is the capital Tallinn. Estonian interviewees were troubled in defining the scope and borders of the AV sector, which demonstrates that sectoral identities remain an important issue. Different opinions existed in terms of what to consider as part of the AV sector and what not, including whether video games are part of the larger AV sector and what fractions of the IT sector should be included. These discussions reflect well both the overall mediatisation trend and convergent processes (discussed in Chapter 1) which have given to the increase in the AV modes used in different sectors and to the borders between different media and creative sectors becoming blurred. Estonian and Danish interviewees acknowledged that the AV sector is growing and expanding. Growth is particularly noticeable in certain subfields of the AV sector, for example, animation, games, etc., which have gone through a tremendous change from a marginalised sector to a globally ascendant industry. However, micro and small-sized companies (one man to 20–25 employees) still dominate in this sector. The growth of this sector is also reflected in its internationalisation. In particular, the Danish interviewees stated that the sector has heavily internationalised during the last decade. On the one hand, there are increasing numbers of expatriates working in AV companies and, on the other hand, the majority of local companies have ties with big international corporations. The growth of the sector also means that the amount of AV content is increasing. The interviewees (in particular, the representatives of the AV sector) highlighted the belief that the importance of AV content and tools will continue to grow – thus, the interviewees pointed to the mediatisation trend. The other important key characteristic of the AV sector is, paradoxically, its both converging and diversifying nature – the multi-directionality of convergence, that Ibrus discusses in Chapter 1; the borders between different sub-sectors are blurring and the intra-sectoral convergence of the AV sector can be observed; the amount of different kinds of cross-, trans- etc. type of content is increasing, the channels and formats have changed, the business models have altered (e.g. emergence of VOD providers as crucial players in the industry), technologies are used more mixedly, the audiences are changing and attracting their attention is becoming more challenging. In addition, the AV sector is also converging with other fields. The importance of augmented reality (AR) and virtual reality (VR) is expected to increase. The interviewees emphasised that the technology is still rather immature; there are plenty of unused opportunities and less successful solutions. However, quite unanimously, the interviewees argued that the technology will become cheaper and more user-friendly. VR and AR were also seen as engaging technologies that will blur the borders between different AV subfields. As the head of a Danish AV incubator described: VR and AR call for people from both worlds […] we work with these new technologies in an engaging way. That’s why we work with the term ‘digital experiences’ instead of ‘films’ or ‘games’ or ‘audio’. As flexibility and fast learning ability were seen as main keywords to adapt to the changes in the future, we may argue that social capacities were considered important in coping with (technological) changes. In the light of those changes, the orientation towards constant product and service innovation was also rather obvious. The interviewees highlighted the fact that innovation process is a daily practice. One Estonian AV company CEO discussed that almost everything they do is experimental. He considered this a challenge, because trying out new things is always money- and time-consuming. Although the interviews pointed to innovation examples across the sector (across companies of different development stages), still, in case of Estonia, we can see that innovativeness, especially innovating in new convergent areas, is more common among younger companies. More traditional and long-term AV companies, including production companies, are somewhat more reserved when it comes to innovation in terms of entering new fields. The matured content production companies also did not consider themselves to be innovative. An owner of a company producing films and commercials explained: ‘the answer to that, how we feel, we do not feel that we are innovative […] the [audio-visual] sector is not innovative’. Several Estonian AV sector interviewees argued that innovativeness (in Estonia) is first and foremost associated with the ICT sector and with the start-up world. Quoting the owner of an Estonian AV company: At the moment in Estonia, there is a hype that all IT and start-ups are innovative and awesome […] How are feature films related to innovation? If you don’t come up with a new ID card or Skype, then you are just doing your movies […] despite the fact that, in my opinion, it is innovative to create a world-class film and bring out a new story and thought. These attitudes reflect that AV media companies, especially those working on film production, often find it difficult to think beyond their traditional practices. The novelty they work towards is usually their next film, but not a new type of cooperation or cross-innovation initiative outside the AV sector. Awareness of development opportunities that cooperation with other sectors would offer is low. Estonian public sector and sectoral umbrella organisations’ representatives also stated that the older companies are in something of a comfort zone and do not see the ultimate need for innovation. As the representative from the Estonian Ministry of Culture remarked: ‘the situation [is] not bad enough that something new should be developed’. The situation is somewhat different with broadcasting companies. The focus on cross-media output was obvious in the case of large Danish broadcasters. To quote the programme manager of a Danish TV production company: They’re also looking for unique formats, unique content, produced straight for the big internationals – Facebook, YouTube, stuff like that, but also for their own digital platforms. Two of the major broadcasters in Denmark have their own digital platforms, where they put all the flow TV, but they want unique content there as well. They want new ideas and the stuff that’s produced directly for their own platforms as well. The public media and broadcasting sector has also become more interactive in Estonia; producing content for different platforms has become an everyday practice. The Health Sector The health sector in Estonia and the Aarhus/Midtjylland region is predominantly public. The share of private sector involvement in the health sector is growing, particularly in Denmark. Differently from the AV sector, which was seen as rather progressive, the health sector was often described as old-fashioned and slow to respond to changes. However, the interviewees stressed that a certain shift has already occurred and the health sector is becoming more open, including in terms of its readiness to cooperate with other sectors. The topic that the interviewees very often addressed was the need to change current medicine education. The interviewees emphasised the need to make it more interdisciplinary and facilitate the connections between students of different fields already during the studies that would facilitate their cooperation in the future. As to the trends, both Danish and Estonian interviewees highlighted several changes that significantly influence the sector’s future development, including those that may also facilitate the emergence of cross-innovations between the health and AV sectors. One of them is the overall change towards a user-centred approach in health care: to put the patient at the centre of the health care system and increase the responsibility of the user for his/her health. Several interviewees also talked about the need to refocus the patient–doctor relationship. The doctor needs to ask the patient what she/he needs (not to define patient’s needs by him-/herself). This in turn presumes that the patient should be ready to take active position about her/his health behavior, including to answer about his/her needs, goals in life, etc. Related to that, the interviewees referred to the necessity for new types of personal assistants and new types of ‘help-desks’ that will change the communication between the patient and the doctor. The CEO and founder of Danish AV + health company remarked: the trend is maybe that […] actually resonates with people. So building feelings into the product, building personality, building character into the product […]. We don’t have an avatar that speaks to you, but we do have character. The trend that is already happening in the health sector is the strategic refocusing towards rehabilitation and prevention. As most of the cooperation with the AV sector predominantly happens in this field of the health sector then this can be seen as a good precondition for cross-innovations to emerge. Another trend that is expected to positively influence cooperation between the AV media and health sectors lies in the generational shift. Future patients are also expected to be more prone for gamified solutions. The changing technology was also seen as the main trend influencing the sector’s development. The driver is the sensed feeling that as technologies evolve one needs to keep up to stay relevant in the marketplace. But the new technologies were also seen as offering opportunities for solutions that were not possible before. Especially, health sector representatives emphasised that the sector’s innovativeness lies primarily in the usage of new cutting-edge technology and related infrastructure. Technology-centeredness in innovation (or technological innovation) was explicitly brought out by Estonian interviewees, but it was highlighted also in Aarhus. As part of technological change, the interviewees also discussed more personalised patient information systems and software developments. Cooperation with the technology-intense AV sector would amplify the technological shaping of the health sector. Health sector representatives also expressed the expectation that the world would become more diverse when the sectors’ borders become more blurred and the mixture of different competences, including social and technological competences, are highly valued. Institutional Landscape for Cross-sectoral Dialogues The current supportive institutional attitudes towards cooperation between the health and AV sectors in Aarhus and Estonia reflect several understandings in contemporary innovation theories. On the one hand, we can notice developments expressed in contemporary cluster-development theories that focus on cross-sectoral cooperation and social and interaction processes that support it (Granovetter, 1985; Harrison, 1992). On the other hand, for policy developers also, the stream of innovation studies that focus on space and proximity issues has been relevant as they attempt to understand how innovations emerge and develop in particular places (e.g. Asheim, 2012; Florida, 1995; Hassink & Klaerding, 2012; Healy & Morgan, 2012). As demonstrated below, the institutional landscape supporting the sectors’ cross-innovation in both studied cases is not limited to the narrow models of ‘innovation system’ (Edquist, 1997; Nelson, 1993), but also encompasses actors other than research institutions and firms. However, it is interesting to point out that research institutions may not be part of the landscape when it comes to the Estonian case. We shall now describe the institutional landscape of cooperation in more detail, starting with Aarhus. As to Aarhus, the key players of the supportive institutional landscape are: (a) higher education institutions (HEIs) as regional sectoral hubs, (b) private sector organisations and community-based initiatives specially targeted to foster intersectoral cooperation and (c) public sector measures that facilitate cooperation and partnerships. HEIs have had a special role to play in supporting the clustering of the AV sector and being the central hub that attracts different actors into the region. Quoting the interviewee from one Danish production company: Because we have the school in Viborg, the animation school, and they have this environment around school with the companies […]. People graduating from schools, […] some people coming back to Viborg starting [their own business]. Because it’s very convenient to be very close to truly educated animators and have access to them. The main ways that private sector organisations and community-based initiatives support the sectors’ cooperation are via creation of physical environments that include (a) labs, incubators, etc., and (b) the organisation of events that aim to bring actors physically close and support face-to-face meetings of different actors. One example here is Interactive Denmark, which is a non-profit organisation. Its mission is to accelerate, coordinate and support the development of the Danish game and interactive cluster by focusing (among others) on the interaction between what they call Digital Visual Industry (DVI) and health. 1 The other example relevant to highlight is the Filmby Aarhus Incubator located in Aarhus, which is a new incubator for start-up companies working within DVI and is aimed at matching them with companies from other sectors and public organisations that have specific challenges for which they need digital visual solutions. The importance of these kinds of initiatives and physical environments, in particular, were highly emphasised both by companies and policy and sector representatives. Quoting the CEO and founder of the Danish AV + health company: We are there [in IdeaLab] because we want to be a part of something bigger. There’s several considerations in it. One is like it’s awesome to go to work and there’s more people than us. So it is nice to have a lot of people to talk to, but it’s also a part of our identity that we are at a place with people who build digital experiences. So that works really well, just the story about it. […] And then we use people sometimes – […] [when] we are testing the product. We have a few conversations with some of the game developers about technical stuff or sometimes they look at it and comment on what we’re doing. So, basically, it’s really, really good to have this option of talking to other people about what we do. In Aarhus, the AV sector is the active player in pursuing cross-sectoral cooperation; AV sector organisations build the partnerships and find ways to facilitate cooperation with other sectors, including the health sector. One of the latest examples is the creation of the Vision Denmark alliance, 2 which has been established by seven AV sector organisations and actors, and is to support the growth of digital visual Quoting the representative of a Danish AV sector umbrella Vision Denmark […] the aim of this is to focus on how we can develop the between the sectors. We call them the Digital Visual […] both […] their but also with other industries – for […] software for or VR for in other sectors. Danish interviews highlighted several relevant innovation support but also targeted sectoral including AV from which the companies can for One of the central health sector initiatives is the Innovation which was in in to from and companies in the Denmark region as part of the business development private sector for example, the and the have had a special role to play in supporting cooperation between the health and AV sectors, as they support different cooperation it comes to support for the health and AV sectors’ the general is that, to Aarhus, the support is more and the main is the public sector. of Estonia is the policy focus on support measures and of private sector The main actors in the cooperation are: public sector) sectoral cluster organisations and public sector measures that facilitate cooperation and partnerships. As to the clustering the is put on the AV sector. Estonia supports creative industries development the development of different and in the AV sector that to the sector in include an incubator for AV sector start-ups in and an often highlighted as a good example that cooperation between the AV and technology fields. As to the health sector, a new has been – an innovation – to better and support innovative solutions in the health sector. In to Denmark, in Estonia the active who cooperation with other sectors are health sector the Health by public Estonia has also a support for creative industries cooperation which aims at supporting the growth of to other sectors through the development of business and by building on the specific and from the creative that this has not on there has not been enough initiatives to make use of the The fact that institutions do not play an important role in the cooperation landscape to argue that this could be one of the why cooperation between the health and AV sectors has rather in to and and as discussed in Chapter systems play a crucial role in the of innovation systems and are among the first of intersectoral to that, to to the in the institutional landscape is important from the point of we may that the of actors in the institutional landscape has been the hindering of sectors’ cooperation in Estonia and will also slow changes in the future. In addition, when about public sector we may argue that, despite the creative policy in Estonia for more than the of its policy has including to to other industries and and growth in them. We may argue that the development of cross-sectoral that are associated with creative industries policy by & have not become common practice. and of Cross-sectoral Dialogues This the different modes of dialogues and cooperation between the health and AV media sectors. We start with the sectors’ general openness towards cooperation and describe the main challenges that cross-sectoral which also the peculiarities of sectoral innovation practices. for and Sectoral In contemporary innovation innovation is as an interactive process and interactive learning (Edquist, 1997; is considered an important for innovation. study, highlighted certain of sectors’ capacities and readiness to At first the results of the study that, in both sectors are to cooperation with other sectors. The of cooperation both In particular, Danish AV and health sector companies that, as a are to them to cooperation. One Danish production company representative remarked: actually like of the it’s the people come to However, in the case of Estonia, the question about cooperation with other sectors to AV companies or related sector organisations and public sector representatives usually to an answer about cooperation with other creative industries sectors. The answer was for that films and games need and actors. after did a about cooperation with other sectors creative is, to consider these kinds of cooperation was somewhat with The for cooperation are very both in Estonia and in the Aarhus it is a of certain type of some cross-sectoral for with technology is term the work on innovative out new from other sectors. The study also demonstrated that the of cooperation is by the stage of development of the companies. are more active in looking for cooperation and trying it out in convergent and than more matured companies. As described by an interviewee a start-up working on a VR in we have to make some on the just the to see they have some in This especially applies to companies that are active in convergent fields and that still have to their and find their place in the The in convergent health gamified also create the need for new type of interdisciplinary and new type of cooperation Quoting the CEO of a Danish VR company that for the health care don’t really have a in related But in each that we there’s a very big on a […] it was an in the case of a it was a […] and in the case of these it was some people that care of the at the […] As to the health sector, the interviewees about its – the of very strong of the sector as described in Chapter The results of the interviews that the health sector to have its own & that do not sectoral and that be by from other sectors. The interviewees expressed rather explicitly that it is to to do you do not have connections within the health sector. The is by the fact that different do not understand each other As described by a Danish health sector organisation have to be very in how you to close to especially the Because you don’t their you don’t what understand what you Estonian interviewees that – those who do not have or in the health sector – have to the health sector to new solutions. The crucial that the sectors’ cooperation is a with a health sector in the development Quoting an Estonian health sector umbrella organisation innovation a technology an then and in the of sector. But an is in cooperation with health sector, then you don’t need the works […] it is that one of the for health sector start-ups is whether a health sector is or not in your have to be a they may also be a or in field […] as it is […] a not from we may that the health and AV sectors have to become important to each they still have to as the two sectors have not The study results also demonstrate that dialogues across sectoral are as the sectors are still learning to each their needs and practices. that, we may the for cross-innovations is This from by Ibrus in Chapter that the more the – as the health sector and AV are – the the innovation may be when these up in a of Cross-sectoral Dialogues The study results demonstrate that between the AV and health sectors do not the of

Digital dentistry has transformed oral healthcare processes, introducing technological innovations such as teledentistry, mobile applications, remote diagnosis, and digital workflows. In the context of the Brazilian Unified Health System (SUS), these technologies represent an opportunity to expand access, improve the quality of care, and overcome historical structural limitations. Thus, this study aimed to conduct an integrative literature review to answer the guiding question: what are the advances and challenges of digital dentistry within the SUS? The search was carried out in PubMed, SciELO, Virtual Health Library (VHL), and gray literature using DeCs/MeSH terms such as Unified Health System, Oral Health, and Digital Technology. Articles published between 2020 and 2025 addressing digital dentistry in the SUS context were included. Initially, 244 articles were retrieved. Duplicates and studies outside the scope were excluded. After applying eligibility criteria, 9 studies composed the final sample. The results indicate significant benefits of digitalization, such as strengthening primary care, expanding access to vulnerable populations, improving the skills of oral health teams, and ensuring continuity of care in challenging contexts such as the COVID-19 pandemic. However, the studies also highlight challenges, including regional inequalities in access to technological infrastructure, insufficient training of professionals in emerging technologies, and difficulties in integrating digital systems into public health service routines. In conclusion, digital dentistry within the SUS shows promising advances that may improve access and the quality of oral healthcare. Nevertheless, for its full incorporation, it is essential to address remaining structural challenges. Investments in technological infrastructure, professional training, and integrated public policies are crucial to promoting equity and effectiveness in oral healthcare.

Visando dar subsídios à análise do trabalho do fonoaudiólogo na Atenção Básica, mais especificamente nos Núcleos de Apoio à Saúde da Família (NASF), este artigo realizou revisão da literatura sobre o tema abordado usando ferramentas de busca do Medline, SciELO e o LILACS, por intermédio da pesquisa avançada simultânea de base de dados da Biblioteca Virtual em Saúde (BVS), da Bireme. Procurou-se resgatar um pouco da história da Fonoaudiologia no SUS e dar ênfase à importância da Estratégia de Saúde da Família relacionada ao serviço de Fonoaudiologia nos NASFs. A pesquisa realizada aponta que a atuação da Fonoaudiologia dentro do sistema de saúde é bastante extensa, perpassando diferentes níveis de assistência, o que requer o desenvolvimento de distintas tecnologias de trabalho em saúde. As ações desenvolvidas pelos NASFs exigem, necessariamente, a atuação de equipes interdisciplinares, implicadas em processos de trabalho transdisciplinar e na criação/invenção de dispositivos terapêuticos. A análise das experiências de atuação da Fonoaudiologia na Atenção Básica, na Saúde da Família e, mais recentemente, nos NASFs, merece ser acompanhada e avaliada de perto para que se possa avançar na produção e sistematização de práticas de cuidado à saúde que respondam às necessidades da população e que sejam capazes de enfrentar os graves efeitos dos distúrbios de linguagem, voz, motricidade oral e audição. Desta forma conclui-se que se faz necessário o monitoramento e sistematização dos limites e potencialidades deste modelo, visando seu aprimoramento e apropriação do mesmo, como estratégia de atenção integral, de inserção da Fonoaudiologia no SUS.

Kidney Transplantation in the Setting of Prolonged Dialysis Vintage: It’s About Time

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Objective: To evaluate the profile and professional trajectory of medical graduates in Brazil. Methodology: An Integrative Literature Review was used as a methodology, using the articles in full, available in the Virtual Health Library, Google Scholar, Scientific Electronic Library Online and National Center for Biotechnology Information, U.S. National Library of Medicine. The Health Sciences Descriptors selected were: physicians, Brazil, “medical education” and “professional practice”. The Boolean operators “AND” and “OR” were adopted. After applying the inclusion and exclusion criteria, 11 articles were selected for review. Results: When talking about sociodemographic profile, it was evidenced that in the country there are inequalities among graduates of the medical course. According to the survey, it was possible to verify a greater female participation in recent years, but in some specialties, there is still a male predominance. Conclusion: Regarding the professional trajectory, it was noticed that most graduates followed their professional journey in their own state, in macro-regional and micro-regional poles and working in the Unified Health System as generalists.

Objective: The objective of the study was to understand the role of health managers in primary care, using validated quality tools, created and implemented within the Unified Health System (SUS). Method: This is a bibliographical review, of an exploratory and descriptive nature, developed using the qualitative method, through published scientific articles and literary works, without a time frame, in the Portuguese language. The Virtual Health Library (VHL) databases were used, specifically LILACS and MEDLINE, and BDTD, Google Scholar, SciELO and CAPES journals. Results and conclusion: The literature review identified that the quality tools validated in the SUS can be used by health managers to improve primary care, helping them to develop strategies to improve the provision of care to users. Among the tools identified, the PCATool-Brasil instrument was considered the most complete, as it evaluates primary care in several aspects, such as organization, access, care process, effectiveness and user satisfaction. Research implications: The research results indicate that quality tools validated in the SUS can be an important tool for health managers in improving primary care. However, it is important that managers adapt the tools to their local reality, taking into account the most relevant indicators for their population. Originality/value: The study is original because it presents a bibliographical review that addresses the role of health managers in primary care, using quality tools validated in the SUS. The study is also relevant for identifying that the PCATool-Brasil instrument is a complete tool that can be used by health managers to improve primary care.

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