Brazilian Specialists Research Articles

Understanding Business Models in the Brazilian Context of Electric Mobility: A Proposed Framework

In the transition to electric mobility (EM), business model innovation plays a crucial role in expanding the use of electric vehicles and increasing acceptance of this technology. The transition pathways differ between countries in the largest economies and those in Latin America. Brazil presents a unique scenario, benefiting from an early start with biofuels, the production of flex-fuel vehicles, predominantly renewable electric energy generation (>80%), and the absence of a structured national policy aligned with local governments. This study introduces a framework that surveys and categorizes businesses in EM, relating them to sustainable development aspects and regulatory maturity. It builds a solid conceptual foundation, incorporating data from technical and commercial events, as well as interviews with Brazilian specialists for validation. The proposed framework aids in understanding the Brazilian context, identifying regulatory gaps, and developing a common language to advance studies on business model innovation, contributing to electromobility studies in Latin America. Additionally, it can guide the construction of regional and local public policies and help identify more sustainable projects.

Oral Health Education for Children: Development of a Serious Game with a User-Centered Design Approach.

Background: Children can learn efficiently with well-designed serious games. The use of applications to promote health has proliferated, but there is a lack of scientific studies on educational games in oral health. Materials and Methods: We developed the Brazilian version of a British and Jordanian oral health education game for children from the perspectives of Brazilian specialists and users. This descriptive study, with a qualitative and quantitative approach, comprised three phases: I-Experts' discussion of the appropriateness of the previous version of the game to Brazil; II-Development of the first Brazilian version of the game; and III-Evaluation of the first version with 15 children from 4 to 8 years of age. Results: In Phase I, the specialists agreed with the development of the Brazilian version of the game, with minor adjustments on: advice on eating; advice on oral hygiene habits, users' age group, game characters, and game purpose. Phase II: a version with a few changes in images and recommendations, written and spoken in Brazilian Portuguese. Phase III: The global average of correct answers in the game's tasks was 75.3%, ranging from 50.0% to 100%. Children reported having fun with the game, and most understood the content and its interface; their parents found the information relevant and enjoyed the gameplay with their children. Conclusions: The Oral Health Education Game offered basic information for preventing dental caries to Brazilian children aged 4-8 years old in an interactive and fun way; it could support professionals in improving oral health education.

Reflectance confocal microscopy - Consensus terminology glossary in Brazilian Portuguese for normal skin, melanocytic and non-melanocytic lesions

BackgroundCurrently, there is no uniform and official terminology in Portuguese for reflectance confocal microscopy analysis, despite the increasing number of Brazilian dermatologists using this new tool. ObjectiveTo present the terminology in Brazilian Portuguese for the description of reflectance confocal microscopy and establish the first Brazilian consensus on terms related to normal skin and cutaneous tumors. Methods10 Brazilian specialists from different institutions and states of Brazil were selected to evaluate the best corresponding terms in Portuguese for normal skin, melanocytic and non-melanocytic tumors. The terms used were translated from international consensuses in the English language. The modified Delphi method was used to create the consensus in 3 steps. ResultsThe terms considered the most appropriate in the Portuguese language to describe the findings of normal skin, melanocytic and non-melanocytic lesions in the reflectance confocal microscopy analysis were presented. Study limitationsThe limitations of the present study include the number of participants and limited regional representation (only two of the five Brazilian regions were represented). ConclusionThis Brazilian consensus represents an opportunity for dermatologists and physicians specializing in cutaneous oncology to become familiar with reflectance confocal microscopy, propagating the technique in clinical and research environments to stimulate national and international publications on this subject.

Brazilian guidelines for the pharmacological treatment of the pulmonary symptoms of cystic fibrosis. Official document of the Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Thoracic Association).

Cystic fibrosis (CF) is a genetic disease that results in dysfunction of the CF transmembrane conductance regulator (CFTR) protein, which is a chloride and bicarbonate channel expressed in the apical portion of epithelial cells of various organs. Dysfunction of that protein results in diverse clinical manifestations, primarily involving the respiratory and gastrointestinal systems, impairing quality of life and reducing life expectancy. Although CF is still an incurable pathology, the therapeutic and prognostic perspectives are now totally different and much more favorable. The purpose of these guidelines is to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of the pulmonary symptoms of CF in Brazil. Questions in the Patients of interest, Intervention to be studied, Comparison of interventions, and Outcome of interest (PICO) format were employed to address aspects related to the use of modulators of this protein (ivacaftor, lumacaftor+ivacaftor, and tezacaftor+ivacaftor), use of dornase alfa, eradication therapy and chronic suppression of Pseudomonas aeruginosa, and eradication of methicillin-resistant Staphylococcus aureus and Burkholderia cepacia complex. To formulate the PICO questions, a group of Brazilian specialists was assembled and a systematic review was carried out on the themes, with meta-analysis when applicable. The results obtained were analyzed in terms of the strength of the evidence compiled, the recommendations being devised by employing the GRADE approach. We believe that these guidelines represent a major advance to be incorporated into the approach to patients with CF, mainly aiming to favor the management of the disease, and could become an auxiliary tool in the definition of public policies related to CF.

Lean and Green Product Development in SMEs: A Comparative Study between Small- and Medium-Sized Brazilian and Japanese Enterprises

Facing the new challenges in production processes, companies should adopt lean and green practices in product development. In SMEs, the application of these practices is more complex. This work explores the maturity of lean–green methodologies in the product development process in Brazilian and Japanese SMEs. The methodology used is multicriteria, combining the analytic hierarchy process (AHP) and TOPSIS 2-tuple method, applied to four Japanese SMEs and four Brazilian SMEs in the metalworking sector. The criteria for evaluating SMEs are company flexibility, difficulties with NPD, innovation, limited resources, and personnel authority high. The TOPSIS method alternatives refer to 18 lean–green enablers. In the AHP method, the prioritisation of criteria between Japanese and Brazilian specialists presented divergences. In the Japanese context, the incidence of innovation is predominant, while in the Brazilian context, the most important is the limited resources. In the TOPSIS 2-tuple method, the results showed a higher level of maturity in lean–green methodologies in Japanese companies than in Brazilian ones. Lean practices are more evolved compared to sustainable practices in both countries. The study also addressed how open innovation adoption may contribute to innovation and NPD practices. Policymakers need to understand the heterogeneity of innovators within SMEs and how they differently innovate, developing distinct internal and external activities.

Avaliação de impacto à saúde no processo de implantação de usinas hidrelétricas: contribuições metodológicas

Abstract Health Impact Assessment (HIA) is defined by the World Health Organization as a methodology that encompasses the identification, prediction and evaluation of expected changes in health risks. Objective: to analyze the contributions of experts on the stages of HIA. Research was carried out with Brazilian specialists on the stages of HIA with regard to the areas where hydroelectric plants are located using an electronic platform. Eighteen specialists from eight higher education institutions in five Brazilian states participated in the study. They indicate that the following aspects must be observed in the HIA: the need to create interdisciplinary and multiprofessional teams; participation of the affected population at all stages; special attention to mental health; and consider the scientific evidence. These aspects contribute to qualify the HIA stages in the implementation and monitoring of new hydroelectric projects.

Adaptação Transcultural do Clinical Perfectionism Questionnaire (CPQ) para brasileiros

Abstract The goals of this paper are the cross-cultural adaptation and psychometric properties evaluation of the Brazilian version of the Clinical Perfectionism Questionnaire (CPQ), a scale that measures the tendency of a person to pursue self-demanding standards and the subjective consequences provided by achieving them or not. The original instrument was translated to Portuguese and back-translated to English. The preliminary version was judged by one of the authors of the instrument and by Brazilian specialists, producing content validity indicators. The final version was applied to a sample of 250 Brazilian undergraduate students, aged from 18 to 60 years old (M=24.9, SD=8.63), mostly female (76%). In the Exploratory Factor Analysis, data have revealed a bidimensional structure, and the other psychometric properties, such as internal consistency and validity regarding other variables, have shown adequate to the instrument. Additional analyses of unidimensional congruence reinforced the multidimensionality of the measure.

Brazilian guideline for pediatric cycloplegia and mydriasis.

Cycloplegia is crucial for reliable pediatric ophthalmology examinations. This document provides a re-commendation for pediatric cycloplegia and mydriasis for Brazilian ophthalmologists. This article was developed based on literature reviews; the clinical experience of Brazilian specialists, as obtained through questionnaires; and the consensus of the Expert Committee of the Brazilian Pediatric Ophthalmology Society. According to the best evidence and formulations available in Brazil, this committee recommends the use of one drop of 1% cyclopentolate plus one drop of 1% tropicamide in children older than 6 months and two drops of 1% tropicamide 0-5 minutes apart for those younger than 6 months. Mydriasis may be increased by a single drop of 2.5% phenylephrine. For retinopathy of prematurity screening, the recommendation is 0.5% or 1% tropicamide, administered two or three times, 5 minutes apart, and 2.5% phenylephrine, used preferably once. In all scenarios, we recommend the use of a prior drop of 0.5% proxymetacaine.

Combating Malnutrition Among Pregnant Women, Mothers and Babies in the Rural Amazonian Forest: What can Telehealth Do?

Purpose: Malnutrition is a current public health problem and a leading cause of childhood morbidity and mortality among the indigenous population in the Amazon forest. This may be related to the nutritional transition observed among indigenous women in Brazil. This research aims to empower health professionals to promote food and nutritional education for mothers and babies living in the forest of the Brazilian state of Amazonas and its Colombian border. We describe our experience using telehealth to combat malnutrition among pregnant women, mothers and babies in the rural Amazonian forest. Methods: This is a qualitative study that included three interventions: field visits, a scoping review, and online meetings. Data collect from field visits and the scoping review were used to identify demands and incorporate themes discussed in the virtual meetings held at telehealth units. Sessions used the web conferencing platform of the state of Amazonas and were facilitated by Brazilian specialists. Locations were selected according to existence of telehealth site. Results and Conclusions: Seven telehealth sessions were held between April and December in 2018 and three in 2019, including 14 different locations equipped with telehealth points, and lasted 120 minutes each. The main findings were that telehealth services can be an instrument to establish a knowledge exchange between health professionals and indigenous people. The participation of indigenous people in social media could be an instrument to maintain their culture and to promote their healthcare, especially traditional and healthy dietary patterns.

Percutaneous surgery practice in Brazil

Objective: The objective of this study was to evaluate current percutaneous foot surgery practice among Brazilian specialists. Methods: A cross-sectional observational study was conducted, surveying members of the Brazilian Foot and Ankle Society (ABTPé) by emailing electronic questionnaires in 2017 and 2019. The information requested included demographic data and the profile of their practice with relation to percutaneous foot surgery. A total of 74 participants completed the survey questionnaire in 2017 and 82 in 2019 (response rates of 15 and 14% respectively). Results: A total of 49 participants in 2017 (65.33%) and 57 in 2019 (69.51%) were performing percutaneous foot surgery. Among respondents who were not performing percutaneous foot surgery, 15 in 2017 (57.69%) and 10 in 2019 (40%) stated that they believed in the method, but had not been trained to perform it. Exclusively spinal anesthesia was used by 19 surgeons in 2017 (38.77%) and 23 in 2019 (40.35%). When correcting Hallux Valgus, 13 surgeons in 2017 (26.53%) and 3 in 2019 (5%) did not use any type of fixation. The most frequently reported complication was poor reduction in both periods, reported by 36 (73.46%) participants in 2017 and 39 (68.42%) in 2019. Conclusion: In Brazil, a lack of specific training is one factor that limits the practice of percutaneous foot surgery. The technique is used by a greater number of younger surgeons. The most frequent complication is poor reduction and there is a growing trend to employee fixation hardware. Level of Evidence V; Expert Opinion.

ADAPTATION OF THE FRAILTY INDEX FOR BRAZILIAN PORTUGUESE IN ADULT SPINE DEFORMITY SURGERY

ABSTRACT Objectives To adapt the adult spinal deformity frailty index (ASD-FI), which was presented as an instrument for stratification of risk of surgical complications, for application in the Brazilian population. Methods This is a consensus-building study, following the Delphi method, in which a team of six Brazilian spine surgery specialists worked alongside the International Spine Study Group (ISSG), the group responsible for preparing the original version of the ASD-FI, in order to adapt the index for the Brazilian population. The variables to be included in the new version, as well as the translation of the terminology into Portuguese, were evaluated and a consensus was considered to have been reached when all (100%) of the Brazilian experts were in agreement. Results A version of the ASD-FI was created, composed of 42 variables, with the inclusion of two new variables that were not included in the original version. The new version was then back translated into English and approved by the ISSG members, resulting in the adapted version of the ASD-FI for the Brazilian population. Conclusion This study presents an adapted version of the adult spinal deformity frailty index for the Brazilian population, for the purpose of risk stratification in the surgical treatment of these complex deformities. Level of evidence II; Study of adaptation of a valid score.

Fuzzy Model for the Priorization Analysis of Variable Quality Performance: An Approach in Shipbuilding

The shipbuilding industry has evolved in recent years. Some quantitative and qualitative factors influence competitiveness of shipyards. The development of shipbuilding processes depends on evolution of manufacturing techniques, planning, organization and external environment. In general, regarding performance, quantitative variables are analyzed through mathematical and linear models. However, the qualitative variables, due to its subjectivity because it deals with human perceptions, it is not common for organizations to work on the performance of these factors. Then, this is the objective of the research, to analyze qualitative factors in shipbuilding in context with the Brazilian industry. The chosen that compose the proposed model are technology and industrial location. This research presents a prioritizing evaluation model of qualitative performance variables. So, presents as original the treatment by the fuzzy sets of qualitative critical factors expressed in linguistic terms by specialists working in the Brazilian sector, resulting in the prioritization of these factors. After result, the model was applied at specific shipyard. The results converge Brazil's real scenario and show that the proposed fuzzy model might be a good qualitative performance factor evaluation tool. Finally, to identify real the distance of a specific shipyard for to this research's model prioritization pattern by brazilian specialists.

The role of governments in sustainable consumption: the perception of Brazilian experts

This article aimed to analyse the roles of governments to promote sustainable consumption in the perception of Brazilian specialists. As methodological procedures, a research was carried out among 40 Brazilian specialists on the topic, using the Policy Delphi to identify the papers' relevance identified in an extensive bibliographic survey of a national and international basis. The results point out the concern of specialists when it comes to issues related to environmental regulation and inspection as being the main aspects associated with structuring. That context being favourable to the sustainability of consumer practices, elements that should be linked to instruments that promote greater consumer awareness, and the use of public procurement as an example of sustainable practices for society. The technique was applied in two rounds, as the research participants maintained, in the second round, the relevance trend attributed to the sustainable consumption promotion papers obtained in the first round.

Brazilian guidelines for the pharmacological treatment of idiopathic pulmonary fibrosis. Official document of the Brazilian Thoracic Association based on the GRADE methodology.

ABSTRACTIdiopathic pulmonary fibrosis (IPF) is a form of chronic interstitial lung disease of unknown cause, which predominantly affects elderly men who are current or former smokers. Even though it is an uncommon disease, it is of great importance because of its severity and poor prognosis. In recent decades, several pharmacological treatment modalities have been investigated for the treatment of this disease, and the classic concepts have therefore been revised. The purpose of these guidelines was to define evidence-based recommendations regarding the use of pharmacological agents in the treatment of IPF in Brazil. We sought to provide guidance on the practical issues faced by clinicians in their daily lives. Patients of interest, Intervention to be studied, Comparison of intervention and Outcome of interest (PICO)-style questions were formulated to address aspects related to the use of corticosteroids, N-acetylcysteine, gastroesophageal reflux medications, endothelin-receptor antagonists, phosphodiesterase-5 inhibitors, pirfenidone, and nintedanib. To formulate the PICO questions, a group of Brazilian specialists working in the area was assembled and an extensive review of the literature on the subject was carried out. Previously published systematic reviews with meta-analyses were analyzed for the strength of the compiled evidence, and, on that basis, recommendations were developed by employing the Grading of Recommendations Assessment, Development and Evaluation approach. The authors believe that the present document represents an important advance to be incorporated in the approach to patients with IPF, aiming mainly to improve its management, and can become an auxiliary tool for defining public policies related to IPF.

The role of governments in sustainable consumption: the perception of Brazilian experts

This article aimed to analyse the roles of governments to promote sustainable consumption in the perception of Brazilian specialists. As methodological procedures, a research was carried out among ...

Surgical cancer care in the COVID-19 era: front line views and consensus.

to suggest a script for surgical oncology assistance in COVID-19 pandemic in Brazil. a narrative review and a "brainstorming" consensus were carried out after discussion with more than 350 Brazilian specialists and renowned surgeons from Portugal, France, Italy and United States of America. consensus on testing for COVID-19: 1- All patients to be operated should be tested between 24 and 48 before the procedure; 2- The team that has contact with sick or symptomatic patients should be tested; 3 - Chest tomography was suggested to investigate pulmonary changes. Consensus on protection of care teams: 1 - Use of surgical masks inside the hospitals. Use of N95 masks for all professionals in the operating room; 2 - Selection of cases for minimally invasive surgery and maximum pneumoperitoneal aspiration before removal of the surgical specimen; 2 - Optimization of the number of people in teams, with a minimum number of professionals, reducing their occupational exposure, the consumption of protective equipment and the circulation of people in the hospital environment; 3 - Isolation of contaminated patients. Priority consensus: 1- Construction of service priorities; 2 - Interdisciplinary discussion on minimally invasive or conventional pathways. the Brazilian Society of Surgical Oncology (BSSO) suggests a script for coping with oncological treatment, remembering that the impoundment in the assistance of these cases, can configure a new wave of overload in health systems.

Access to pain management for cancer patients treated under the Brazilian private healthcare system

Objective: To reflect about current pain management in cancer patients treated under the Brazilian Private Healthcare System, considering legal boundaries, access to essential drugs and involved ethical issues. Panelists aimed to reach a consensus about recommendations to increase access to proper analgesia for patients with cancer secondary pain. Methods: Four Brazilian specialists, being a radiation oncologist (and bioethicist), an oncologist, a pain specialist and a CEO of a private healthcare plan, met after the 2019 American Society of Clinical Oncology (ASCO) meeting, held in Chicago, and discussed the aforementioned subjects. A consensus was reached and is described below. Results: Cancer pain is prevailing in our country, probably undertreated, and may be a prevalent cause of medical services overuse, which may increase healthcare costs. Thus, there may be an opportunity to improve patient’s quality of life, with a positive budget impact for private healthcare plans, if this treatment becomes mandatorily reimbursed. There are several studies in the literature showing similar results, but this should be prospectively studied, preferable using real word evidence, at the Brazilian scenario. Cancer pain treatment protocols, designed by specialists, should be designed in agreement with all stakeholders. Conclusion: Panelists agreed that pain treatment, which must be considered a human right, is a clear priority in Brazil. All stakeholders should collaborate in designing protocols to improve patient’s quality of life, consequently improving health insurance’s budgets. If so, this would have clear consequences in access to innovative cancer treatments, as those discussed during the 2019 ASCO meeting.

Current Practices in Ocular Tuberculosis: A Survey of Brazilian Specialists

ABSTRACTPurpose: To describe the approach of Brazilian specialists in the diagnosis and treatment of tuberculosis-associated uveitis (TBU).Methods: Members of the Brazilian Uveitis Society received an electronic invitation to participate in an online questionnaire.Results: Of the 169 invited specialists, 78 answered the questionnaire. Specialists evaluated 5.6 patients with TBU annually. Tuberculin skin test (TST, 81%) was primarily used for diagnosis. Patients with presumed TBU should always be tested for syphilis and HIV according to 51 (88%) and 47 (81%) of respondents, respectively. Chest computed tomography (CT, 72%) was preferable to chest radiography (CXR) for diagnosis. A positive TST (81%) and CXR (60%) were the main indicators of anti-tuberculous therapy, with 34%, 39%, and 14% of specialists treating for 6, 9, and 12 months, respectively.Conclusions: TST remains the preferred method for TBU diagnosis and prompt treatment by Brazilian specialists, though there is no consensus regarding disease treatment and management.

Development and analysis of measurement properties of the “maternal perception of childbirth fatigue questionnaire” (MCFQ)

ObjectiveTo develop and analysis of measurement properties an instrument to assess maternal perception of fatigue during childbirth. MethodsThe study was developed in three steps: elaboration of the initial version of the questionnaire from literature review and semi-structured interviews of the health professionals and the women during labor; consultation of Brazilian specialists through a Delphi Study, to define the items that should compose the final version of the document; validation and factor analysis. ResultsA 51-item questionnaire, comprised of the perception of general health, physical, emotional and cognitive aspects of the parturient was composed through both literature search and the interview of health professionals and women during labor. The Delphi Study was composed of three rounds and the instrument was reduced to 12 questions by its end, involving the same aspects. Internal consistency testing resulted in a Cronbach's alpha of 0.56 in the 12 items. 8 more items were added in the last round of the Delphi study for a new evaluation. After the reevaluation, an acceptable Cronbach's alpha of 0.85 was obtained. The questionnaire showed three factors, the first being physical fatigue, then second with psychological fatigue and the third factor being emotional. ConclusionThe developed questionnaire is short, simple and easy to apply; it is clear and concise to evaluate the perception of fatigue in women during labor, showing adequate content, internal consistency and face validity.

New Challenges in Oncology for the Brazilian Private Health Sector: Specialists' Concerns After the ISPOR International Congress in Boston, Massachusetts, 2017

The congress of the International Society for Pharmacoeconomics and Outcomes Research is one of the main worldwide forums for the dissemination of research and knowledge on healthcare economics. Brazil is the largest country in Latin America, with a per-capita gross domestic product of $15 200 in 2017 and healthcare expenditure of the order of $1 318 per inhabitant. Brazilian specialists participated actively in the society’s latest congress, which took place in Boston, Massachusetts, from May 20 to 24, 2017. They met to discuss the main topics dealt with at the congress and their applicability to Brazilian realities. The topics chosen were precision medicine, new challenges for economic modeling within oncology and immuno-oncology, data to aid in managerial decision making (ie, data from real-world studies), and, lastly, strategies for accessing high-cost medications in Brazil. This opinion article sought to report the main conclusions and consensus reached by this group of specialists on the occasion of this discussion.