Brazilian Service Research Articles

Regulatory analysis of E-mobility for Brazil: A comparative review and outlook

The transport sector accounts for approximately 20% of the demand for primary energy resources. Also, the integration of energy generated by renewable sources in road transport has advanced mainly through the electrification of vehicles, supporting energy system flexibility. Sales of electric vehicles doubled in 2021 from the previous year to a new record of 6.6 million. Nearly 10% of global car sales were electric in 2021, four times the 2019 market share, bringing the total number of electric cars on the world's roads to about 16.5 million, triple the amount in 2018. Global sales of electric cars have kept rising strongly in 2022, with two million sold in the first quarter, up 75% from the same period in 2021. The behaviour of electric utilities is decisive for energy transition and sustainability success, considering the grid's adoption of energy storage system elements and electric vehicles. This study presents the obstacles of smart mobility, focusing on regulatory, governance, and acceptance challenges for electric mobility (e-mobility) services in Brazil. Regulatory systems for the expansion of e-mobility in different countries were considered from the perspective of electricity concessionaires. Ninety-three articles were selected through a systematic literature review and assessment. The research considers regulations from the reference countries, a preliminary evaluation of the feasibility of commercialising e-mobility in Brazil, and proposed incentive mechanisms for promoting e-mobility from an energy distribution perspective.

State transplant coordinators’ views on influencing factors of the performance of organ donation and transplantation services in Brazil: a qualitative study

State transplant coordinators’ views on influencing factors of the performance of organ donation and transplantation services in Brazil: a qualitative study

Telemedicine in Brazil: Teleconsultations at the Largest University Hospital in the Country.

The coronavirus disease (COVID-19) pandemic leveraged telemedicine worldwide mainly due to the need for social distancing, patient safety, and infection prevention. The Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) was a key reference site in the treatment of COVID-19 severe cases in the country. To continue patient's health care, it became necessary to increase the number of teleconsultations and standardize it institutionally. Herein, we briefly described how the HCFMUSP improved the teleconsultation health care service during the COVID-19 pandemic, highlighting the implementation of important innovations and the throughout standardization process, including patients and professional workflow. We also detailed the methodology used to implement or improve teleconsultation in a medical/multidisciplinary specialty at HCFMUSP. All these efforts made the HCFMUSP reach the goal of converting 15% of all face-to-face consultations into teleconsultations only in 2021. In addition, there were more than 370,000 teleconsultations until the end of 2022. Our experience has shown that having a supporting team, a digital certification process, and the data integration were key factors toward the successful implementation of the teleconsultation services. We believe that progressing toward teleconsultation will improve the population covered by health care services in Brazil, as well as contribute to a reduction of waiting time, and solving costs to health care institutions and patients. We expect this report of our experience in teleconsultation implementation could inspire and guide other health care institutions in the development of telemedicine.

HIGHER EDUCATION AND SOCIAL SERVICE IN BRAZIL: training projects in dispute

HIGHER EDUCATION AND SOCIAL SERVICE IN BRAZIL: training projects in dispute

Water and sanitation services in Brazil: evaluating the regulatory governance based on the institutional analysis and development framework

Abstract Brazilian's framework of water and sanitation services (WSS) is complex, with several actors from different legal natures and varied rules. The new Brazilian sanitation law aims to achieve universal access to WSS and effective provision of services, encouraging more efficiency by promoting competitiveness. However, the regulatory governance of the sector poses a challenge to achieve these objectives. This article addresses identifying and analyzing the WSS structures based on the Institutional Analysis and Development (IAD) Framework, which provides a multidimensional conceptual map that combines levels of macro and micro situations. Databases from the National Sanitation Information System (SNIS) and the Brazilian Institute of Geography and Statistics (IBGE) were cross-referenced to evaluate the structures that exist in the provision of WSS, focusing on municipalities located in the metropolitan regions and urban agglomerations of Brazil. It is possible to conclude that the IAD Framework helps to clarify the actors, its functions, responsibilities, and the interactions between them, as well as the exogenous factors and how they influence the action arena, reaching recommendations, supported by a Delphi approach, such as to improve industry regulation in terms of governance and regulatory governance.

Trajectory of blood pressure levels and weight gain in pregnant women: A group-based approach

Background and objectivesMorbidities associated with increased blood pressure levels during pregnancy represent one of the main causes of maternal mortality. The objective was to identify patterns of systolic blood pressure (SPB) trajectory in pregnant women undergoing prenatal care at the Unified Health System, and associations with weight gain trajectory, demographic, obstetric, anthropometric data, and health related behaviors. Methods and resultsCohort study with pregnant women using the public health services in Brazil. Data were collected through questionnaires and medical records. Trajectory patterns of SBP and weight gain were identified by a group-based trajectory model. For trajectory analysis, 460 women had SBP information available, totaling 2839 measurements, with an average of 6.2 measurements during pregnancy. Three SBP trajectory patterns were identified and classified as “Group 1” (48.0%), with a mean of 103 mmHg (95% CI 102.5–103.7 mmHg), “Group 2” (42.7%) with a mean of 114 mmHg (95% CI 113.7–114.9 mmHg), and “Group 3” (9.1%) with the highest mean SBP value of 130 mmHg (95% CI 128.8–131.5 mmHg). It was observed that regardless of the weight gain trajectory group, women classified in the group with the highest SBP had the highest SBP levels. The probability of being classified in Group 3 was higher among women with higher education, who started pregnancy presenting obesity, and who were using antihypertensive drugs. ConclusionThe probability of belonging to groups with a greater trajectory of SBP during pregnancy was associated with obesity, education, and hypertension under treatment.

Cancer deaths in the state of Sao Paulo, Brazil: Is there a solution for disparities among private and public services?

e18677 Background: There is a notable discrepancy between resources available for the private and public health care services that care for Brazilian people living with cancer. Barretos Cancer Hospital (Barretos) is a Sao Paulo countryside public hospital that stands out in Brazil for its approach of supplementing government receipts with philanthropy and fundraising, allowing it to incorporate state-of-the-art technology in the prevention, screening, and treatment of cancer. However, the availability of systemic therapies in Barretos is still restricted to the list contemplated in the public health system procedures. Lack of access to innovative systemic therapies may hinder survival. As such we aimed to evaluate the outcomes of patients treated in Barretos compared to other public and private institutions in Sao Paulo, Brazil. Methods: We performed a retrospective analysis of the public database of the Fundação Oncocentro de São Paulo, including new patients diagnosed with cancer in the period from 2013 to 2017, assessing tumor type, clinical staging, cancer survival, and treatment site (private/public/Barretos). We used Cox proportional-hazards regression for survival data with R Statistical Software, taking Barretos as reference compared to private and public services (excluding Barretos). Results: We analyzed data from 133,868 patients with the most prevalent cancers in the state: breast (n = 45,402), prostate (n = 36,046), colorectal (n = 23,951), cervical (n = 13,801) and lung (n = 14,668). More than two thirds of patients (69.88%) received treatment in public services, 16.71% in private centers and 13.41% in Barretos. There were no significant differences in OS between private centers and Barretos for patients with cancer stages 0 and I (HR 1.1; p = .48; CI 95%). For patients with stage II breast, cervical and lung cancers, and for patients with stage III cervical and prostate tumors, there were no significant differences in OS between Barretos and private services. For all patients in stages 0-I, II and III, Barretos had better survival than other public centers (HR 2.8; 1.3; 1.3, respectively p < .001; CI 95%). In stage IV cancers, Barretos had worse survival than private institutions (HR 0.6; p < .001; CI 95%) and only patients with stage IV prostate and cervical cancers had better outcomes in Barretos than in other public services. Conclusions: Strategies for earlier incorporation of health technologies have the potential to decrease disparities between public and private services in Brazil. The lack of access to novel systemic therapies likely led to poorer outcomes for patients with metastatic disease in Barretos and other public services. These data indicate that greater government investment in early diagnosis and treatment programs are needed to improve outcomes in resource-limited settings.

Clinical-pathological characterization of patients with HER2 negative breast cancer submitted to adjuvant docetaxel/cyclophosphamide (TC), TC4 versus TC6.

e12530 Background: The optimal number of cycles of adjuvant docetaxel and cyclophosphamide (TC) in patients with HER2 negative breast cancer is unknown. The serious long-term adverse events associated with anthracyclines led researchers to question the risk-benefit ratio of anthracycline-based regimens, especially in those without axillary lymph node involvement, leading to an increasing trend to omit anthracyclines in adjuvant treatment. Therefore, we do not know for sure which clinical-pathological characteristics would favor the use of TC4 versus TC6. Objective: To evaluate the clinical-pathological characteristics of patients who received adjuvant treatment for invasive breast cancer, her2 negative, stage I-III with TC4 or TC6 in a Brazilian service. Methods: This is a retrospective observational cohort study of patients diagnosed with invasive breast cancer, her2 negative, stage I-III, who received adjuvant treatment with TC4 or TC6, between January 2010 and December 2022 at AC Camargo Cancer Center, São Paulo, Brazil. Results: We analyzed 186 patients, 98% female, 52.3% pre-menopausal, 68.7% had at least one comorbidity, 10% mutation in the BRCA1/2 gene, 5% had a previous history of DCis or IDC. 62.2% underwent breast-conserving surgery and 80% underwent sentinel lymph node (SL). Regarding the pathological characteristics of the tumor 82.9% invasive ductal carcinoma (IDC), 42.7% histological grade (HG) III, 90% were hormone receptor positive (HR+) and only 10% triple negative (TN), staging 66% pT1, 71% pN0, being grouped into 63.7% stage I, 34.6% stage II; 1.7% stage III. Only 9% underwent oncotype, 5% of them had some contraindication to anthracycline. Regarding treatment groups 72.4% received TC4 versus 27.6% TC6. There were no treatment-related deaths. Regarding the TC4 / TC6 groups (%) and clinical-pathological characteristics: pre-menopausal 60.5 / 49% ( p= 0.225), comorbidity 3 / 6% ( p= 0.400), contraindication to anthracycline 4.7 / 6% ( p= 0.714). Conservative surgery 61.5 / 64% ( p= 0.894), SL 81 / 78% ( p= 0.504), GH III 39.8 / 50% (p = 0.334), pT2 staging 26.4 / 40 % (p = 0.087), pN1 11.7/ 22% (p = 0.050), stage I 65.9/58%, II 33.3 / 38%, III 0.8 /4 % (p = 0.212). RH- 8.7 / 14% (p = 0.444). Did not complete treatment 3.2 / 12% (p = 0.033), toxicities G3/4 9.7 / 12.5% (p = 0.791), FN G3/4 3.8 / 4% (p = 1.00) and neuropathies 8.9 / 28.6% (p = 0.002). Late toxicities 5.7 / 18.4% (p = 0.018). Extended hormone therapy 35/ 50% (p = 0.142). Systemic recurrences 12.5% / 2% (p = 0.566). Conclusions: TC6 was more indicated in patients with GH III, pT2 and/or pN1, stage II and III, RH-, therefore patients who received TC6 had a lower chance of completing the treatment, as well as greater toxicities, mainly late peripheral neuropathy, and more indications of extended hormone therapy, however those who performed the TC6 had less chance of systemic recurrences.

AVALIAÇÃO DA ACURÁCIA DA TÉCNICA DE POSICIONAMENTO GNSS PPP-RTK COM O USO DO SERVIÇO DE CORREÇÃO TRIMBLE CENTERPOINT RTX

The use of only one receiver at the user level, together with the solution of phase ambiguities as integer values, are among the main advantages of the PPP-RTK GNSS Positioning Technique. However, it is necessary to have a Geodetic Network at a global level for the generation of products, such as precise orbits and satellite clocks. Furthermore, to accurately estimate geodetic coordinates, all errors involved with the propagation of GNSS signals and with ground stations must be properly modeled and treated. Thus, the main objective of this work is to evaluate the accuracy of the PPP-RTK Positioning Technique, using corrections from the Trimble Centerpoint RTX Service in Brazil. For this, GNSS surveys were carried out in all states of the Federation in Geodetic Stations belonging to the SGB, whose coordinates were considered as reference in the evaluation process. Student's t statistical tests were applied – to detect possible trends (systematic errors) in the data, and Chi-Square to assess the precision of the coordinates. Finally, the results show that the horizontal accuracy improves gradually with increasing convergence time, reaching 0.025m ± 0.018m (Trend and Precision) for 15 minutes of convergence.

Política de Saúde Bucal no Brasil: transformações e rupturas entre 2018-2021

Abstract This study analyzed the implementation of Brazil’s National Oral Health Policy during the period 2018-2021, covering institutional actions, implementation of public dental services, results achieved, and federal funding. We conducted a retrospective descriptive study using documentary analysis and secondary data obtained from institutional websites, government information systems, and reports published by dental organizations. The findings show a significant reduction in funding between 2020 and 2021 and declining performance against indicators since 2018, such as coverage of first dental appointments and group supervised tooth brushing, which stood at 1.8% and 0.02%, respectively, in 2021. Federal funding dropped in 2018 and 2019 (8.45%), followed by an increase in 2020 (59.53%) and decrease in 2021 (-5.18%). The study period was marked by economic and political crises aggravated by the COVID-19 pandemic. This context influenced the functioning of health services in Brazil. There was a sharp reduction in performance against oral health indicators, while performance in primary health care and specialized care services remained stable.

Digital platform for surveillance of COVID-19 in primary health care services in Brazil

Digital platform for surveillance of COVID-19 in primary health care services in Brazil

Net Promoter Score (NPS) in the primary health care services in Brazil

Net Promoter Score (NPS) in the primary health care services in Brazil

Health protection and risk reduction related to SARS-Cov-2 in health services in Brazil

Health protection and risk reduction related to SARS-Cov-2 in health services in Brazil

Evaluating User Experience With a Chatbot Designed as a Public Health Response to the COVID-19 Pandemic in Brazil: Mixed Methods Study.

The potential of chatbots for screening and monitoring COVID-19 was envisioned since the outbreak of the disease. Chatbots can help disseminate up-to-date and trustworthy information, promote healthy social behavior, and support the provision of health care services safely and at scale. In this scenario and in view of its far-reaching postpandemic impact, it is important to evaluate user experience with this kind of application. We aimed to evaluate the quality of user experience with a COVID-19 chatbot designed by a large telehealth service in Brazil, focusing on the usability of real users and the exploration of strengths and shortcomings of the chatbot, as revealed in reports by participants in simulated scenarios. We examined a chatbot developed by a multidisciplinary team and used it as a component within the workflow of a local public health care service. The chatbot had 2 core functionalities: assisting web-based screening of COVID-19 symptom severity and providing evidence-based information to the population. From October 2020 to January 2021, we conducted a mixed methods approach and performed a 2-fold evaluation of user experience with our chatbot by following 2 methods: a posttask usability Likert-scale survey presented to all users after concluding their interaction with the bot and an interview with volunteer participants who engaged in a simulated interaction with the bot guided by the interviewer. Usability assessment with 63 users revealed very good scores for chatbot usefulness (4.57), likelihood of being recommended (4.48), ease of use (4.44), and user satisfaction (4.38). Interviews with 15 volunteers provided insights into the strengths and shortcomings of our bot. Comments on the positive aspects and problems reported by users were analyzed in terms of recurrent themes. We identified 6 positive aspects and 15 issues organized in 2 categories: usability of the chatbot and health support offered by it, the former referring to usability of the chatbot and how users can interact with it and the latter referring to the chatbot's goal in supporting people during the pandemic through the screening process and education to users through informative content. We found 6 themes accounting for what people liked most about our chatbot and why they found it useful-3 themes pertaining to the usability domain and 3 themes regarding health support. Our findings also identified 15 types of problems producing a negative impact on users-10 of them related to the usability of the chatbot and 5 related to the health support it provides. Our results indicate that users had an overall positive experience with the chatbot and found the health support relevant. Nonetheless, qualitative evaluation of the chatbot indicated challenges and directions to be pursued in improving not only our COVID-19 chatbot but also health chatbots in general.

The use of dental services in the past year in the brazilian population: a systematic review with meta-analysis

The scope of this study was to analyze the factors associated with the use of dental services in Brazil. The review strategy included PubMed, SciELO, LILACS, BBO, EMBASE, Scopus, WOS and Google Scholar databases, in addition to repositories and databases of dissertations and theses. Studies were selected using the PEO (Population/Exposure/Outcomes) strategy. The outcome of this study was the use of dental services in the last year by the Brazilian population, treated as dichotomous variables for the following analyses: ≤ 1 year and > 1 year. Mantel-Haenszel random effect meta-analysis was performed, estimating Prevalence Ratios (PR) and 95% confidence intervals (95%CI). A total of 94 studies were selected. The majority (98%) had a cross-sectional design, with 63% derived from primary data. For the meta-analysis, 25 studies were included. The use of oral health services in the last year was associated with higher education (≥ 8 years of schooling) (PR = 0.49, (95%CI: 0.39-0.60)); higher family income (≥ 2 minimum wages) (RP = 0.79, (95%CI: 0.74-0.84)); and living in urban areas (RP = 0.79, (95%CI: 0.64-0.97)). The availability of dental services in the Unified Health System needs to be made readily accessible to people with lower income, less education and those living in rural areas.

Assessment of the quality of services of reception with risk classification in obstetrics: a scoping review protocol

IntroductionQuality assessment in the context of maternal health services in Brazil has been the object of study due to maternal mortality rates that remain high in the country, in addition...

Oral lichen planus: case series and experience in a tertiary dermatology service in Brazil

BackgroundLichen planus is an inflammatory disease that can affect both the skin and mucous membranes, including the oral mucosa. There is very little original Brazilian dermatology literature about oral lichen planus. ObjectiveTo describe the clinical, pathological, and treatment data of 201 patients diagnosed with oral lichen planus followed at the Stomatology Outpatient Clinic of Hospital das Clínicas, Universidade de São Paulo, from 2003 to 2021. MethodThe patients demographic profile, the morpho-topographic features of the lesions, the treatment employed, and the possible presence of squamous cell carcinoma were analyzed. ResultsThe disease was more common in women over 50 years of age, tending to be chronic, with a large number of cases showing cicatricial sequelae in the mucosa. Topical treatment with potent corticosteroids was shown to be effective in the vast majority of cases. Squamous cell carcinoma in oral lichen planus cicatricial sequelae was observed in eight cases. Study limitationsRetrospective study of medical records, with gaps regarding the filling out of data; unequal observation time among the studied cases. ConclusionsThis is the largest Brazilian dermatology series on oral lichen planus. The response to topical corticoid therapy was excellent in the vast majority of cases. The high prevalence of atrophic lesions, demonstrating the chronicity and tissue destruction potential of this disease, may explain the large number of cases of squamous cell carcinoma.

A model proposal for the technical assistance and rural extension service execution in Brazil

ABSTRACTThis study presents a proposal for a model for execution of Technical Assistance and Rural Extension (TARE) services in Brazil, presenting a flow of actions through methodological tools. For this purpose, the study used a mixed methodological approach, that is, it used the principles of data triangulation, which comprised a survey of qualitative primary data and secondary quantitative data to prove the evidence. In other words, this study raised, from semi-structured interviews with specialists in the execution of TARE, the main methodological tools used in the execution of that service. Based on the terms most frequently cited by the interviewees, a search syntax developed to carry out a systematic review of the literature to theoretically prove the tools raised. As a result of the verification, it was possible to identify a model based on six main TARE execution tools: awareness, diagnosis, individual service, collective service, reference unit and program. This article has as its main contribution the offer of a model validated in the literature. Proposes to standardize a model for the design of TARE notices, and execution plans to contribute with the maximum efficiency in offering the service to the beneficiaries.

Electronic sales made by micro and small enterprises to federal government: a critical analysis of the data on the breadth of processes

The creation of e-government, changes have occurred both in the products offered to citizens and in the work process. Among these changes were the purchases of goods and services, which began to be made via reverse auctions on the Internet, through electronic purchasing portals. The ease of the purchasing process, the low cost of participation, and the laws created have given Micro and Small Enterprises the opportunity to sell electronically to the Public Administration. Studies carried out by SEBRAE (Brazilian Service of Support to Micro and Small Enterprises) point to the growing trend of this activity as a differential, ensuring the continuity of the companies' activities. The present work aimed to present an analysis of electronic sales, by Micro and Small Enterprises, to the Federal Government, in the period from January to December 2013. To this end, it is performed quantitative exploratory research, using, as techniques for data collection, bibliographic and documentary research. The data were obtained through the Federal Government's purchasing statistics, disclosed on its purchasing portal. Thus, it was possible to know the participation of Micro and Small Enterprises in the electronic purchases of the Federal Government in the period from January to December 2013. The results show that 30% of the Federal Government's electronic purchases, representing R$ 14.1 billion, in the period from January to December 2013, were acquired from Micro and Small Enterprises, compared to the same period in 2012, showing an increase of 60% in the volume of sales by Micro and Small Enterprises.

The life path and activity of the Russian-Brazilian teacher and psychologist E.V. Antipova

Introduction. The relevance of the article is to reveal the positive influence of the Russian scientific school represented by E.V. Antipova on the development of psychology and pedagogy, as well as on the organization of psychological services in Brazil. The purpose of the article is to create a complete description of the activities of a prominent psychologist-practitioner and organizer of the psychological service Elena Vladimirovna Antipova. Materials and methods. Relying on the axiological methodological approach and biographical research method, as well as by including in the text of the article a number of scientific, including foreign, sources, little-known facts of the biography of E.V. Antipova are presented, her scientific connections with prominent foreign and Russian scientists are revealed, her contribution to the development of psychological services in Russia and Brazil is shown. The characteristic of the life and activity of E.V. Antipova in Russia is given in direct connection with the socio-political situation in those years in the country. Results. The article gives a detailed description of the main stages of E.V. Antipova's life: childhood in pre-October Russia, school years at the gymnasium of L.S. Tagantseva, study and work in England, France and Switzerland under the guidance of prominent foreign scientists such as E. Klapared. The author reveals the connections of E.V. Antipova with leading Russian psychologists and paedologists G.I. Chelpanov, K.N. Kornilov, P.O. Efrussi, Z.A. Luppova, V.A. Treiter, with whom she communicated and collaborated in Petrograd and Vyatka. The contribution of E.V. Antipova to the development of psychological service in Brazil in 1928- 1974 is shown. During this period, she actually acted as a kind of "goodwill ambassador" from Russia, establishing "a bridge of friendship" between our countries through her selfless work. She left a significant scientific and methodological legacy in five volumes of her writings.