Efeito imediato de exercício inspiratório com exercitador e incentivador respiratório em mulheres sem queixas vocais / Immediate effect of inspiratory exercise with exerciser and respiratory encourager in women without vocal complaints

RESUMO Objetivo Avaliar o efeito imediato do exercício inspiratório com incentivador e exercitador respiratório na voz de mulheres sem queixas vocais. Método Participaram 25 mulheres sem queixas vocais, entre 18 e 34 anos, com pontuação 1 no Índice de Triagem para Distúrbio Vocal (ITDV). A coleta de dados foi realizada nos momentos antes e após realização de exercício inspiratório e consistiu na gravação de vogal sustentada /a/, fala encadeada e tempos máximos fonatórios (TMF) de vogais, fonemas fricativos e contagem de números. No julgamento perceptivo-auditivo foi utilizada a Escala de Desvio Vocal (EDV) para verificar o grau geral do desvio vocal. Avaliação acústica foi feita no software PRAAT e foram extraídos os parâmetros frequência fundamental (f0), jitter, shimmer, proporção harmônico -ruído (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) e Acoustic Breathiness Index (ABI). Para mensuração das medidas aerodinâmicas, o tempo de emissão foi extraído no programa Audacity. Para comparar os resultados utilizou-se o teste paramétrico t de Student para amostras dependentes na análise das variáveis com distribuição normal e o teste de Wilcoxon para variáveis com distribuição não normal. Resultados Não houve diferenças entre os resultados do JPA e das medidas acústicas, nos momentos pré e pós exercício inspiratório. Quanto às medidas aerodinâmicas foi possível observar aumento significativo no valor do TMF /s/ (p=0,008). Conclusão Não houve modificação na qualidade vocal após o exercício inspiratório com incentivador e exercitador respiratório, porém foi observado aumento do TMF do fonema /s/ após a realização do exercício.

ABSTRACT Purpose To evaluate the immediate effect of the inspiratory exercise with a booster and a respiratory exerciser on the voice of women without vocal complaints. Methods 25 women with no vocal complaints, between 18 and 34 years old, with a score of 1 on the Vocal Disorder Screening Index (ITDV) participated. Data collection was performed before and after performing the inspiratory exercise and consisted of recording the sustained vowel /a/, connected speech and maximum phonatory times (MPT) of vowels, fricative phonemes and counting numbers. In the auditory-perceptual judgment, the Vocal Deviation Scale (VSD) was used to verify the general degree of vocal deviation. Acoustic evaluation was performed using the PRAAT software and the parameters fundamental frequency (f0), jitter, shimmer, harmonium-to-noise ratio (HNR), Cepstral Peak Prominence Smoothed (CPPS), Acoustic Voice Quality Index (AVQI) and Acoustic Breathiness Index (ABI). To measure the aerodynamic measurements, the time of each emission was extracted in the Audacity program. Data were statistically analyzed using the Statistica for Windows software and normality was tested using the Shapiro-Wilk test. To compare the results, Student's and Wilcoxon's t tests were applied, adopting a significance level of 5%. Results There were no significant differences between the results of the JPA and the acoustic measures, in the pre and post inspiratory exercise moments. As for the aerodynamic measures, it was possible to observe a significant increase in the value of the TMF /s/ (p=0.008). Conclusion There was no change in vocal quality after the inspiratory exercise with stimulator and respiratory exerciser, but an increase in the MPT of the phoneme /s/ was observed after the exercise.

Cepstral Peak Prominence Smoothed - CPPS e Acoustic Voice Quality Index - AVQI em vozes infantis saudáveis e alteradas: comparação, relação com julgamento perceptivo-auditivo e pontos de corte / Cepstral Peak Prominence Smoothed - CPPS and Acoustic Voice Quality Index - AVQI in healthy and altered children's voices: comparation, relationship with auditory-perceptual judgment and cut-off points

RESUMO Objetivo Comparar as medidas acústicas de Cepstral Peak Prominence Smoothed (CPPS) e Acoustic Voice Quality Index (AVQI) de crianças com vozes normais e alteradas, relacionar com o julgamento perceptivo-auditivo (JPA) da voz e estabelecer pontos de corte. Método Gravações vocais das tarefas de vogal sustentada e contagem de números de 185 crianças foram selecionadas em um banco de dados e submetidas a análise acústica com extração das medidas de CPPS e AVQI, e ao JPA. O JPA foi realizado individualmente para cada tarefa e as amostras foram classificadas posteriormente como normal ou alterada, e para as tarefas em conjunto definindo-se se a criança passaria ou falharia em uma situação de triagem vocal. Resultados Crianças com JPA alterado e que falharam na triagem apresentaram valores menores de CPPS e maiores de AVQI, do que as com JPA normal e que passaram na triagem. O JPA da tarefa de vogal sustentada se relacionou ao CPPS e AVQI, e da tarefa de contagem de números relacionou-se apenas ao AVQI e CPPS números. Os pontos de corte que diferenciam crianças com e sem desvio vocal são 14,07 para o CPPS vogal, 7,62 para o CPPS números e 2,01 para o AVQI. Conclusão Crianças com JPA alterado apresentaram maiores valores de AVQI e menores valores de CPPs. O JPA da tarefa de vogal previu todas as medidas acústicas, porém, de contagem previu apenas as medidas extraídas dela. As três medidas foram semelhantes na identificação de vozes sem desvio e vozes disfônicas.

ABSTRACT Purpose To compare the acoustic measurements of Cepstral Peak Prominence Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) of children with normal and altered voices, to relationship with auditory-perceptual judgment (APJ) and to establish cut-off points. Methods Vocal recordings of the sustained vowel and number counting tasks of 185 children were selected from a database and submitted to acoustic analysis with extraction of CPPS and AVQI measurements, and to APJ. The APJ was performed individually for each task, classified as normal or altered, and for the tasks together defining whether the child would pass or fail in a situation of vocal screening. Results Children with altered APJ and who failed the screening had lower CPPS values and higher AVQI values, than those with normal APJ and who passed the screening. The APJ of the sustained vowel task was related to CPPS and AVQI, and APJ of the number counting task was related only to AVQI and CPPS numbers. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the vowel CPPS, 7.62 for the CPPS numbers and 2.01 for the AVQI. Conclusion Children with altered voices, have higher AVQI values and lower CPPS values, when detected in children with voices within the normal range. The acoustic measurements were related to the auditory perceptual judgment of vocal quality in the sustained vowel task, however, the number counting task was related only to the AVQI and CPPS. The cut-off points that differentiate children with and without vocal deviation are 14.07 for the CPPS vowel, 7.62 for the CPPS numbers and 2.01 for the AVQI. The three measures were similar in identifying voices without deviation and dysphonic voices.

Aspectos oromiofuncionais e fatores associados à autopercepção sobre a qualidade do sono em indivíduos com queixa de ronco / Oromyofunctional aspects and factors associated with self-perception of sleep quality in individuals with snoring complaints / Aspectos oromiofuncionales y factores asociados a la autopercepción de la calidad del sueño en individuos con quejas de ronquidos

Introdução: O sono é uma função vital e essencial para a sobrevivência humana e tem por objetivo favorecer o reparo corporal e mental. Objetivo: Investigar os fatores associados à autopercepção sobre a qualidade do sono, bem como possíveis alterações das estruturas orofaciais e funções estomatognáticas em indivíduos com queixa de ronco. Material e Método: Trata-se de estudo observacional, analítico e transversal, realizado com 30 indivíduos adultos com queixa de ronco durante o sono, com idade média de 45 anos e 5 meses. Para a avaliação de motricidade oromiofuncional foi utilizado o protocolo AMIOFE. Foram aplicados questionários para investigação do ronco e qualidade de sono dos participantes: Questionário de Berlin, Escala de Sonolência de Epworth e Questionário de qualidade de sono de Pittsburgh. Resultados: Os resultados do questionário de Pittsburgh indicaram disfunção na qualidade do sono em 66,67% dos participantes. A sonolência diurna foi evidenciada em 33,33%, por meio da Escala de Epworth. 60% dos participantes apresentaram alto risco para AOS, por meio dos escores obtidos no instrumento de Berlin. Indivíduos que não praticam exercício físico e com posição habitual de língua no assoalho bucal apresentaram maiores escores no questionário de Berlin. Houve correlação positiva estatisticamente significante e moderada entre as variáveis Índice de massa corporal (IMC) e os escores do Questionário de Berlin. Conclusão: Indivíduos com queixa de ronco apresentam dificuldades relacionadas à qualidade do sono. A autopercepção negativa de qualidade do sono teve relação com dados de motricidade orofacial, hábitos alimentares, composição corporal e hábitos de estilo de vida. (AU)

Introduction: Sleep is a vital and essential function for human survival and aims to promote bodily and mental repair. Objective: To investigate factors associated with self-perception of sleep quality, as well as possible alterations in orofacial structures and stomatognathic functions in individuals with snoring complaints. Material and Method: Observational, analytical and cross-sectional study, conducted with 30 adult individuals complaining of snoring during sleep, with a mean age of 45 years and 5 months. For the evaluation of orofacial myofunctional motricity, the (AMIOFE) was used. Questionnaires were applied to investigate the snoring and sleep quality of the participants: Berlin Questionnaire, Epworth Sleepiness Scale and Pittsburg Sleep Quality Index Questionnaire. Results: The Pittsburgh questionnaire results indicated sleep quality dysfunction in 66.67% of participants. Daytime sleepiness was evidenced in 33.33%, using the Epworth Scale. 60% of the participants presented high risk for obstructive sleep apnea syndrome (OSA), through the scores obtained in the Berlin questionnaire. Individuals who do not practice physical exercise and with usual tongue position on the oral floor presented higher scores in the Berlin questionnaire. There was a statistically significant and moderate positive correlation between the variables Body Mass Index (BMI) and the Berlin questionnaire scores. Conclusion: Individuals complaining of snoring self-reported difficulties related to sleep quality. The sleep quality difficulties self-reported were related to data on orofacial motricity, eating habits, body composition and lifestyle habits. (AU)

Introducción: El sueño es uma función vital y essencial para la supervivência human, tien como objetivo promover la reparación corporal y mental. Objetivo: Investigar los factores asociados con la autopercepción de la calidad del sueño, así como posibles alteraciones en las estructuras orofaciales y funciones estomatognáticas en individuos con quejas de ronquidos. Metodo: Se trata de estudio observacional, analítico, transversal, realizado con 30 individuos adultos con queja de ronquidos durante el sueño y edad media de 45 años y 5 meses. Para la evaluación de la motricidad oromiofuncional se utilizó el protocolo (AMIOFE/OMES). Se aplicaron cuestionarios para investigar el ronquido y la calidad de sueño de los participantes: Cuestionario de Berlín; Escala de Somnolencia de Epworth; Cuestionario de Calidad del Sueño de Pittsburgh. Resultados: Los resultados del cuestionario de Pittsburgh indicaron disfunción en la calidad del sueño en 66,67%. La Escala de Epworth evidenció somnolencia diurna en 33,33%. El 60% presentaron alto riesgo de AOS, conforme las puntuaciones obtenidas en el instrumento de Berlín. Los que no practican ejercicio físico y que tienen la posición habitual de la lengua en el piso de la boca obtuvieron puntuaciones más altas en el cuestionario de Berlín. Hubo correlación positiva estadísticamente significativa y moderada entre las variables del IMC y las puntuaciones del Cuestionario de Berlín. Conclusión: Individuos con quejas de ronquidos refieren dificultades relacionadas con la calidad del sueño. Las dificultades estuvieron relacionadas con datos de motricidad orofacial, hábitos alimentarios, composición corporal y los hábitos de estilo de vida. (AU)

Neuroregeneration and immune response after neurorrhaphy are improved with the use of heterologous fibrin biopolymer in addition to suture repair alone.

INTRODUCTION/AIMS: Peripheral nerve injuries result in impaired neuromuscular interactions, leading to morphological and functional alterations. Adjuvant suture repair methods have been used to improve nerve regeneration and modulate the immune response. Heterologous fibrin biopolymer (HFB), a scaffold with adhesive properties, plays a critical role in tissue repair. The aim of this study is to evaluate neuroregeneration and immune response focusing on neuromuscular recovery, using suture-associated HFB for sciatic nerve repair. METHODS: Forty adult male Wistar rats were distributed into four groups (n = 10): C (control), only sciatic nerve location; D (denervated), neurotmesis and 6-mm gap removal and fixation stumps in subcutaneous tissue; S (suture), neurotmesis followed by suture; and SB (suture + HFB), neurotmesis followed by suture and HFB. Analysis of M2 macrophages (CD206+ ), as well as the morphology and morphometry of nerves, soleus muscle, and neuromuscular junctions (NMJs), were performed at 7 and 30 days after surgery. RESULTS: The SB group had the highest M2 macrophage area in both periods. After 7 days, SB was the only group similar to the C group regarding the number of axons; furthermore, after 30 days, the SB group was closer to the C group concerning blood vessel and central myonuclear numbers, NMJ angle, and connective tissue volume. After 7 days, increases in nerve area, as well as the number and area of blood vessels, were also observed in SB. DISCUSSION: HFB potentiates the immune response, increases axonal regeneration, induces angiogenesis, prevents severe muscle degeneration, and assists in NMJ recovery. In conclusion, suture-associated HFB has major implications for improved peripheral nerve repair.

Acetylcholine receptors of the neuromuscular junctions present normal distribution after peripheral nerve injury and repair through nerve guidance associated with fibrin biopolymer.

Peripheral nerve injuries (PNI) lead to alterations in the Agrin-LRP4-MuSK pathway. This results in disaggregation of AChRs and change from epsilon (mature, innervated) to gamma (immature, denervated) subunit. Tubulization technique has been shown to be effective for PNI repair and it also allows the use of adjuvants, such as fibrin biopolymer (FB). This study evaluated the effect of the association of tubulization with FB after PNI on AChRs and associated proteins. Fifty-two adults male Wistar rats were used, distributed in 4 experimental groups: Sham Control (S), Denervated Control (D); Tubulization (TB) and Tubulization + Fibrin Biopolymer (TB+FB). Catwalk was performed every 15 days. Ninety days after surgery the right soleus muscles and ischiatic nerves were submitted to the following analyses: (a) morphological and morphometric analysis of AChRs by confocal microscopy; (b) morphological and morphometric analysis of the ischiatic nerve; (c) protein quantification of AChRs: alpha, gama, and epsilon, of Schwann cells, agrin, LRP4, MuSK, rapsyn, MMP3, MyoD, myogenin, MURF1 and atrogin-1. The main results were about the NMJs that in the TB+FB group presented morphological and morphometric approximation (compactness index; area of the AChRs and motor plate) to the S group. In addition, there were also an increase of S100 and AChRε protein expression and a decrease of MyoD. These positive association resulted in AChRs stabilization that potentiate the neuromuscular regeneration, which strengthens the use of TB for severe injuries repair and the beneficial effect of FB, along with tubulization technique.

Medidas acústicas de CPPS e AVQI pré e pós terapia fonoaudiológica / Acoustic measurements of CPPS and AVQI pre and post speech therapy

RESUMO Objetivo Comparar as medidas acústicas de Proeminência do Pico Cepstral Suavizado (CPPS) e Acoustic Voice Quality Index (AVQI) nos momentos pré e pós-terapia Vocal. Método Trata-se de estudo de intervenção antes e após, com coleta de dados retrospectiva. Participaram do estudo 22 sujeitos com média de idade de 49,9 anos. A terapia vocal ocorreu entre os anos de 2016 a 2019 em uma clínica-escola, sendo que antes e após os processos terapêuticos, os sujeitos tiveram amostras vocais coletadas. Foram realizadas as extrações dos dados de CPPS e AVQI nos momentos pré e pós-terapia. A fim de caracterizar a amostra, foi realizado julgamento perceptivo-auditivo (JPA) referente ao grau geral do desvio vocal nos momentos pré e pós-terapia. Os dados foram analisados estatisticamente. Resultados Os dados do JPA indicaram diminuição nos valores medianos de grau geral do desvio vocal no momento pós-terapia, tanto para a amostra de vogal (p=0,00) quanto de números (p=0,00). A média do CPPS para a vogal foi de 14,53 pré-terapia e 16,37 pós-terapia (p= 0,01) e na emissão dos números foi de 8,22 pré-terapia e 9,06 pós-terapia (p=0,02), houve diferença no CPPS da vogal e dos números indicando melhora vocal pós-terapia. A média do AVQI foi de 2,27 pré-terapia e 1,54 pós-terapia (p= 0,05), houve melhora nos resultados do AVQI, com valor de p limítrofe. Conclusão A terapia vocal produziu modificações no grau geral do desvio vocal e nas medidas de CPPS e AVQI, sendo que no momento pós terapia os resultados são semelhantes aos apresentados por indivíduos vocalmente saudáveis.

ABSTRACT Purpose To compare the acoustic measurements of Cepstral Peak Prominence-Smoothed (CPPS) and Acoustic Voice Quality Index (AVQI) at pre- and post-voice therapy times. Methods This is a before and after intervention study, with retrospective data collection. Twenty-two subjects with a mean age of 49.9 years participated in the study. The vocal therapy occurred between the years 2016 to 2019 in a teaching clinic, and the subjects had vocal samples collected before and after the therapeutic processes. CPPS and AVQI data extractions were performed during pre- and post-therapy. In order to characterize the sample, auditory-perceptual evaluation (APE) regarding the overall degree of vocal deviation at pre- and post-therapy moments was performed. The data were analyzed statistically. Results The APE data indicated a decrease in the median values of overall vocal deviation degree at the post-therapy stage for both the vowel (p=0.00) and number (p=0.00) samples. The average CPPS for the vowel was 14.53 pre-therapy and 16.37 post-therapy (p=0.01); for the number emission, it was 8.22 pre-therapy and 9.06 post-therapy (p=0.02), there was a difference in the CPPS of the vowel and numbers indicating vocal improvement at post-therapy. The average AVQI was 2.27 pre-therapy and 1.54 post-therapy (p=0.05). There was an improvement in the AVQI results, with borderline p-value. Conclusion Vocal therapy produced changes in the general degree of vocal deviation, as well as in CPPS and AVQI measurements, and the results at the post-therapy moment are similar to those of vocally healthy individuals.

Futuros professores e a autopercepção de sintomas vocais e conhecimento em saúde e higiene vocal / Future teachers and the self-perception of vocal symptoms and knowledge about vocal health and hygiene

RESUMO Objetivo Analisar respostas de futuros professores quanto à autopercepção de sintomas vocais e conhecimento sobre saúde vocal e higiene vocal, relacionando-os às variáveis sociodemográficas, ocupacionais e conhecimento prévio sobre voz. Método Estudo observacional, analítico e transversal. Participaram 264 alunos de licenciatura, foram aplicados Questionário de Saúde e Higiene Vocal (QSHV), Escala de Sintomas Vocais (ESV) e questionário com perguntas sociodemográficas, ocupacionais e vocais. Os dados foram analisados estatisticamente considerando nível de significância 5%. Resultados QSHV de futuros professores apresentou escore médio total de 21,89, sugestivo de conhecimento insuficiente sobre saúde e higiene vocal. Resultados da ESV estão acima da nota de corte do instrumento, nos três domínios e no escore total, observou-se maior sintomatologia em estudantes do primeiro ano quando comparados aos demais estudantes, nos domínios emocional, limitação e total. Houve diferença na comparação do QSHV com o ano da graduação (p=0,001), em que alunos dos terceiros e quartos anos obtiveram pontuações maiores. Observou-se correlação positiva entre escore total do QSHV e variável idade (p=0,019). Conclusão Futuros professores apresentam sintomatologia vocal importante, compatível aos indivíduos disfônicos, e possuem conhecimento insuficiente sobre saúde e higiene vocal. O conhecimento é ainda menor em alunos dos anos de graduação iniciais e com menor idade. Futuros professores com mais idade demonstram ter mais conhecimento sobre saúde e higiene vocal. Faz-se necessária a proposição de ações preventivas à essa população, ainda no período da graduação, visando à diminuição dos riscos ao desenvolvimento de problemas vocais em médio ou longo prazo durante a docência.

ABSTRACT Purpose To analyze responses of future teachers regarding the self-perception of vocal symptoms and knowledge about vocal health and vocal hygiene, relating them to sociodemographic and occupational variables and previous knowledge about voice. Methods Observational, analytical and cross-sectional study. A total of 264 undergraduate students participated and the Vocal Health and Hygiene Questionnaire (QSHV), Vocal Symptoms Scale (ESV) and a questionnaire with sociodemographic, occupational and vocal questions were applied. Data were statistically analyzed considering a 5% significance level. Results QSHV of future teachers had a total mean score of 21.89, suggestive of lack of knowledge about vocal health and hygiene. The results of the ESV are above the instrument's cutoff score, in each of the three domains and in the total score, there was greater symptomatology in first-year students when compared to other students, in the emotional, limitation and total domains. There was a difference when comparing the QSHV with the year of graduation (p=0.001), in which third and fourth year students obtained higher scores. A positive correlation was observed between the total QSHV score and the age variable (p=0.019). Conclusion Future teachers present important vocal symptomatology, compatible with dysphonic individuals, and have insufficient knowledge about vocal health and hygiene. Knowledge is even lower among students in the early undergraduate years and at a younger age. Older future teachers demonstrate more knowledge about vocal health and hygiene. It is necessary to propose preventive actions with this population, even during the graduation period, aiming to reduce the risks of developing vocal problems in the medium or long term during teaching.

Avaliação perceptivo-auditiva da voz: comparação de diferentes tarefas de fala na identificação de crianças com e sem lesões laríngeas / Auditory-perceptual evaluation of voice: comparing different speech tasks to identify children with and without laryngeal lesions

RESUMO Objetivo comparar as tarefas de emissão de vogal e de contagem de números na diferenciação perceptivo-auditiva de crianças com e sem lesão laríngea. Método Estudo observacional, analítico, transversal. Utilizou-se banco de dados de uma pesquisa de doutorado, com resultados de avaliações laringológicas e gravação de amostras vocais de 44 crianças que se dividiram em: Grupo sem lesão laríngea (GSLL), com 33 crianças; e grupo com lesão laríngea (GCLL), com 11 crianças. Para a avaliação perceptivo-auditiva, as amostras vocais foram separadas de acordo com o tipo de tarefa e analisadas separadamente por uma juíza, que analisou o grau geral do desvio vocal e informou se, diante de uma situação de triagem, a criança passaria ou falharia. Resultados Houve diferença entre os grupos GSLL e GCLL quanto ao grau geral do desvio vocal para tarefa de emissão de números, com predomínio de desvios discretos no GSLL e moderados no GCLL. Quanto à triagem, houve diferença entre os grupos para a tarefa de contagem, com mais falhas no GCLL. Os grupos foram semelhantes na tarefa de vogal, tanto no que se refere à intensidade do desvio quanto ao resultado da triagem. A maior parte das crianças do GCLL falhou em ambas as tarefas na situação de triagem vocal, com diferença em relação às crianças do GSLL que, em geral, falharam em apenas uma tarefa. Conclusão A tarefa de contagem de números contribui para a diferenciação auditiva de crianças com e sem lesão laríngea, por identificar desvios de maior intensidade em crianças com lesão.

ABSTRACT Purpose To compare the vowel emission and number counting tasks in perceptual-auditory differentiation among children with and without laryngeal lesions. Methods Observational, analytical, and cross-sectional methods were used. Medical records of 44 children were selected from a database of an otorhinolaryngology service at a University Hospital and they were divided into groups: without laryngeal lesion (WOLL), and with laryngeal lesion (WLL), with 33 and 11 children. For the auditory-perceptual evaluation, the vocal samples were separated according to the type of task. They were analyzed separately by a judge who analyzed the general degree of vocal deviation and assessed whether the child would pass or fail in the face of a screening situation. Results There was a difference between the WOLL and WLL groups in terms of the overall degree of vocal deviation for the task of number counting, with a predominance of mild deviations in WOLL and moderate in WLL. In the screening, there was a difference between the groups during the number counting task, with more failures in the WLL. The groups were similar in the sustained vowel task, both in terms of the overall degree of vocal deviation and the vocal screening. Most children in the WLL failed in both tasks during vocal screening compared to the children in the WOLL who, in general, failed in only one task. Conclusion The task of number counting contributes to the auditory differentiation in children with and without laryngeal lesion, by identifying deviations of greater intensity in children with laryngeal lesion.

Aberrant paracrine signalling for bone remodelling underlies the mutant histone-driven giant cell tumour of bone.

Oncohistones represent compelling evidence for a causative role of epigenetic perturbations in cancer. Giant cell tumours of bone (GCTs) are characterised by a mutated histone H3.3 as the sole genetic driver present in bone-forming osteoprogenitor cells but absent from abnormally large bone-resorbing osteoclasts which represent the hallmark of these neoplasms. While these striking features imply a pathogenic interaction between mesenchymal and myelomonocytic lineages during GCT development, the underlying mechanisms remain unknown. We show that the changes in the transcriptome and epigenome in the mesenchymal cells caused by the H3.3-G34W mutation contribute to increase osteoclast recruitment in part via reduced expression of the TGFß-like soluble factor, SCUBE3. Transcriptional changes in SCUBE3 are associated with altered histone marks and H3.3G34W enrichment at its enhancer regions. In turn, osteoclasts secrete unregulated amounts of SEMA4D which enhances proliferation of mutated osteoprogenitors arresting their maturation. These findings provide a mechanism by which GCTs undergo differentiation in response to denosumab, a drug that depletes the tumour of osteoclasts. In contrast, hTERT alterations, commonly found in malignant GCT, result in the histone-mutated neoplastic cells being independent of osteoclasts for their proliferation, predicting unresponsiveness to denosumab. We provide a mechanism for the initiation of GCT, the basis of which is dysfunctional cross-talk between bone-forming and bone-resorbing cells. The findings highlight the role of tumour/microenvironment bidirectional interactions in tumorigenesis and how this is exploited in the treatment of GCT.

Impacto da pandemia da Covid-19 na autopercepção vocal e fatores preditivos em professores / Impact of the COVID-19 pandemic on vocal self-perception and predictive factors in teachers

RESUMO Objetivo Analisar a autopercepção de esforço vocal, sinais e sintomas vocais e fadiga vocal em professores antes e durante a pandemia da COVID-19; e os fatores relacionados a dados sociodemograficos e ocupacionais que pudessem prever a autopercepção durante a pandemia. Métodos Participaram do estudo 263 professores brasileiros que estavam trabalhando em home office durante a pandemia. Eles responderam um questionário sobre dados sociodemográficos e ocupacionais, escala de Borg CR10-BR adaptada para classificação de esforço vocal, Lista de Sinais e Sintomas Vocais e Índice de Fadiga Vocal. Os questionários de autoavaliação vocal foram respondidos duas vezes, considerando antes e durante a pandemia. Resultados A autopercepção de esforço vocal, sinais e sintomas vocais e fadiga vocal durante a pandemia em professores foi menor do que antes da pandemia. Na comparação dos desfechos por queixa vocal, os professores sem queixa vocal apresentaram valores menores do que aqueles com queixa vocal. Professores com queixas vocais durante a pandemia apresentaram maior autopercepção de fadiga vocal. Professores de educação infantil, ensino fundamental e ensino médio relataram mais sinais e sintomas vocais antes do que durante a pandemia. Conclusão Em geral, os professores relatam diminuição do esforço vocal e dos sinais e sintomas vocais durante a pandemia de COVID-19. Professores com queixas vocais apresentam maior percepção de esforço vocal, sinais e sintomas vocais e fadiga vocal. A presença de queixas vocais e as variáveis relacionadas à demanda vocal durante a pandemia estão relacionadas à percepção de esforço vocal, sinais e sintomas vocais e fadiga vocal.

ABSTRACT Purpose This study aims to analyze the self-perception of vocal effort, vocal signs and symptoms, and vocal fatigue in teachers before and during the COVID-19 pandemic; and factors related to sociodemographic and occupational data that could predict self-perception during the pandemic Methods Participants were 263 Brazilian teachers working from in-home office during the pandemic. They answered a questionnaire on sociodemographic and occupational data, adapted Borg CR10-BR for vocal effort ratings, Vocal Signs and Symptoms List, and Vocal Fatigue Index. The vocal self-assessment questionnaires were answered twice, considering the period before and during the pandemic. Results The self-perception of vocal effort, vocal signs and symptoms, and vocal fatigue during the pandemic in teachers was lower than before the pandemic. In comparing outcomes due to vocal complaints, teachers with no vocal complaints presented lower values than those with vocal complaints. Teachers with vocal complaints during the pandemic showed greater self-perception of vocal fatigue. Teachers at early education, elementary, and high schools self-reported more vocal signs and symptoms before than during the pandemic. Conclusion In general, teachers report decreased vocal effort and vocal signs and symptoms during the COVID-19 pandemic. Teachers with vocal complaints have a higher perception of vocal effort, vocal signs and symptoms, and vocal fatigue. The presence of vocal complaints and the variables related to vocal demand during the pandemic are related to the perception of vocal effort, vocal signs and symptoms, and vocal fatigue.

Profile and Migration of Members of Residency Programs in Family Medicine / Perfil e migração de membros dos Programas de Residência em Medicina de Família e Comunidade

ABSTRACT OBJECTIVE To describe the sociodemographic profile and analyze the migratory characteristics of the members of the Residency Programs in Family Medicine in 2020 in Brazil. METHODS The study follows a cross-sectional observational design of a quantitative nature from the perspective of the members of the Residency Programs in Family Medicine. Questionnaires adapted for each participating group were developed, applied through an online platform. RESULTS Most participants are female and white. Most supervisors and preceptors were residents of Residency Programs in Family Medicine, however, there are some who are not specialists in the field. Most participants are based in capitals or metropolitan regions. In relation to retention, 41.1% of supervisors and 73.1% of preceptors are affiliated to a program in the same municipality where they lived. For most resident physicians, the place of residence coincides with the place of birth and/or graduation (57.4%), and 48.5% are in the same place of graduation. CONCLUSIONS The research reinforces the need for policies to promote the migration of residents to Residency Programs in Family Medicine outside capital cities and metropolitan regions, as well as encouraging the retention of graduates trained outside large urban centers so that they can contribute to distribution and provision of doctors where they are still needed.

RESUMO OBJETIVO Caracterizar o perfil sociodemográfico e analisar as características migratórias dos integrantes dos Programas de Residência em Medicina de Família e Comunidade em 2020 no Brasil. MÉTODOS O estudo segue um delineamento observacional transversal de natureza quantitativa a partir da perspectiva dos integrantes dos Programas de Residência em Medicina de Família e Comunidade. Foram desenvolvidos questionários adaptados para cada grupo participante, aplicados por meio de plataforma on-line. RESULTADOS A maioria dos participantes é do sexo feminino e de cor branca. A maioria dos supervisores e preceptores foi residente de Programas de Residência em Medicina de Família e Comunidade, contudo, há alguns que não são especialistas na área. A maior parte dos participantes está vinculada às capitais ou regiões metropolitanas. Em relação à fixação, 41,1% dos supervisores e 73,1% dos preceptores estão vinculados a um programa no mesmo município onde foram residentes. Para a maioria dos médicos residentes, o local da residência coincide com o local de nascimento e/ou graduação (57,4%), sendo que 48,5% estão no mesmo local de graduação. CONCLUSÕES A pesquisa reforça a necessidade de políticas de promoção da migração de residentes para Programas de Residência em Medicina de Família e Comunidade fora das capitais e regiões metropolitanas, bem como estimula a fixação dos egressos formados fora dos grandes centros urbanos para que eles possam contribuir com a distribuição e com o provimento de médicos onde ainda é necessário.

Ocupar-se de fumar: sentidos e significados atribuídos por pessoas em tratamento do tabagismo / Smoking as an occupation: functions and meanings attributed by people undergoing smoking cessation treatment

Resumo Objetivo Este estudo buscou compreender as ocupações de pessoas em tratamento para deixar de fumar. As motivações para tal pesquisa surgiram durante a prática como profissional residente em um Programa de Controle do Tabagismo. A fim de compreender as ocupações das pessoas participantes desse programa, utilizou-se uma perspectiva teórica sobre os sentidos e significados ocupacionais desenvolvida no contexto da Ciência Ocupacional. Método Trata-se de uma pesquisa qualitativa realizada em setembro e outubro de 2020 com quatro participantes que estavam em tratamento do tabagismo. Os dados foram analisados a partir da Análise de Conteúdo. Resultados Foi possível identificar e discutir sobre fumar como ocupação e os sentidos que levaram os participantes a fumar e deixar de fumar. Esses sentidos estão relacionados à cultura, contexto e fatores psicoemocionais, adoecimento e autopercepção de saúde. Além disso, os participantes identificaram o espaço de tratamento como um suporte para o momento de transição ocupacional. Conclusão Fumar é uma ocupação que precisa ser considerada no tratamento do tabagismo, pois a maneira como se lida com a transição ocupacional pode interferir na adesão ao tratamento.

Abstract Objective This study sought to understand the occupations of people undergoing smoking cessation treatment. The motivations for this research emerged during a resident professional practice in a Tobacco Control Program. A theoretical perspective on the functions and meanings of occupations in the context of Occupational Science was used to understand the occupations of the participants of this program. Method This is a qualitative study carried out with four people undergoing smoking cessation treatment from September to October 2020. Data were analyzed by Content Analysis. Results It was possible to identify and discuss smoking as an occupation and the meanings that have led the participants to smoke and stop smoking. These meanings are related to culture, psycho-emotional context and factors, illness, and self-perception of health. In addition, the participants identified the treatment space as a support for the moment of occupational transition. Conclusion Smoking is an occupation that needs to be considered during smoking cessation treatment, as how the occupational transition is addressed can interfere with treatment adherence.

Vocal Signs and Symptoms Related to COVID-19 and Risk Factors for their Persistence.

OBJECTIVE: To compare the occurrence of vocal signs and symptoms before, during, and after coronavirus disease (COVID-19) and analyze possible risk factors for the persistence of these signs and symptoms after disease resolution. METHODS: This was an observational, analytical, and cross-sectional study. The participants were 45 individuals of both sexes, with a mean age of 44 years, who were previously affected by COVID-19. All participants answered a questionnaire about sociodemographic data, smoking history, disease course, vocal complaints, and the vocal signs and symptoms list (SSL), referring to three timepoints (before, during, and after COVID-19). RESULTS: The most commonly reported vocal signs and symptoms before COVID-19 were phlegm (26.67%; n=12) and dry throat (24.44%; n=11). During COVID-19, the most frequent vocal signs and symptoms were tired voice after short-term use (73.33%; n=33) and dry throat (71.11%; n=32). After the disease, the most reported vocal signs and symptoms were dry throat (57.78%; n=26) and phlegm (53.33; n=24). The self-perception of vocal signs and symptoms before COVID-19 was lower than that during and after COVID-19 (P < 0.001). Vocal complaints after COVID-19 and oxygen therapy were predictors of self-perception of vocal signs and symptoms after COVID-19. CONCLUSIONS: Individuals affected by COVID-19 had a higher frequency of vocal signs and symptoms during the disease. However, after remission, the frequency of vocal signs and symptoms was higher than that at baseline. The need for oxygen therapy may indicate a risk for a higher occurrence of vocal signs and symptoms after COVID-19.

Intratubular, Intracellular, and Mitochondrial Angiotensin II/AT1 (AT1a) Receptor/NHE3 Signaling Plays a Critical Role in Angiotensin II-Induced Hypertension and Kidney Injury.

Hypertension is well recognized to be the most important risk factor for cardiovascular diseases, stroke, and end-stage kidney failure. A quarter of the world's adult populations and 46% of the US adults develop hypertension and currently require antihypertensive treatments. Only 50% of hypertensive patients are responsive to current antihypertensive drugs, whereas remaining patients may continue to develop cardiovascular, stroke, and kidney diseases. The mechanisms underlying the poorly controlled hypertension remain incompletely understood. Recently, we have focused our efforts to uncover additional renal mechanisms, pathways, and therapeutic targets of poorly controlled hypertension and target organ injury using novel animal models or innovative experimental approaches. Specifically, we studied and elucidated the important roles of intratubular, intracellular, and mitochondrial angiotensin II (Ang II) system in the development of Ang II-dependent hypertension. The objectives of this invited article are to review and discuss our recent findings that (a) circulating and intratubular Ang II is taken up by the proximal tubules via the (AT1) AT1a receptor-dependent mechanism, (b) intracellular administration of Ang II in proximal tubule cells or adenovirus-mediated overexpression of an intracellular Ang II fusion protein selectively in the mitochonria of the proximal tubules induces blood pressure responses, and (c) genetic deletion of AT1 (AT1a) receptors or the Na+/H+ exchanger 3 selectively in the proximal tubules decreases basal blood pressure and attenuates Ang II-induced hypertension. These studies provide a new perspective into the important roles of the intratubular, intracellular, and mitochondrial angiotensin II/AT1 (AT1a) receptor signaling in Ang II-dependent hypertensive kidney diseases.

Residência em Medicina de Família e Comunidade para a formação de recursos humanos: o que pensam gestores municipais? / Family and Community Medicine Residency Programs for training the health workforce: what do municipal health managers think?

Resumo Treinamento especializado, provimento e fixação de profissionais na Atenção Primária à Saúde são desafios prementes no Brasil. A recente expansão dos Programas de Residência em Medicina de Família e Comunidade coexiste com lacunas na literatura sobre o efeito deste processo. O objetivo do trabalho é explorar a perspectiva do gestor municipal de saúde acerca das estratégias para o fortalecimento das residências e do papel destas na formação profissional e na qualificação da atenção. Trata-se de um estudo de análise quantitativa e qualitativa, com aplicação de questionário a gestores de municípios cenários destes programas. As respostas de 48 sujeitos foram submetidas a estatística descritiva e análise de conteúdo. Os resultados revelam um esforço em incorporar o Médico de Família e Comunidade na rede de atenção à saúde, uma percepção do potencial das residências no incremento da qualidade da atenção e da formação profissional e fragilidades nas ações para melhoria da estrutura e organização dos serviços com residentes. Vislumbra-se assim o potencial das residências para a superação de problemas históricos da Atenção Primária à Saúde brasileira, se atrelada a ações de fortalecimento do serviço, dos recursos humanos e do próprio programa.

Abstract The training, recruitment and retention of primary care professionals is a constant challenge in Brazil. The recent expansion of family and community medicine residency programs in the country coexists with gaps in the literature on the effects of this process. This article explores municipal health managers' understanding of these programs and the role they play in professional training and improving the quality of health care. We conducted a quantitative and qualitative analysis of the responses to questionnaires answered by 48 health managers working in municipal health services affiliated to residency programs. A descriptive statistical analysis of the quantitative data was performed and the qualitative data were analyzed using thematic analysis. The findings show that efforts were made to incorporate family and community doctors into the health care network and that managers recognized the potential residency program have to improve the quality of care and enhance professional training. Weaknesses were found in actions to improve infrastructure and facilities and the organization of the services affiliated to the programs. This study highlights the potential of residency programs for addressing longstanding problems in primary health care in Brazil when combined with actions to strengthen services, human resources and the programs.

Heterologous fibrin biopolymer associated to a single suture stitch enables the return of neuromuscular junction to its mature pattern after peripheral nerve injury.

Denervation leads to severe atrophy of neuromuscular junction (NMJ) structure including decrease of the expression of fundamental proteins. Up to now, conventional suture has been the gold standard method used to correct this injury. Fibrin sealant is one of the alternatives proposed to optimize this method. This study verified if the association of fibrin sealant - Heterologous Fibrin Biopolymer (HFB) and a single suture stitch promotes return of morphology and NMJ structure to mature pattern after peripheral nerve injury. Forty Wistar rats were distributed into 4 groups: Sham-Control (SC), Denervated-Control (DC), Suture-Lesion (SL) and Suture-Lesion + HFB (SFS). In SC group only the right sciatic nerve identification was done. In DC, SL and SFS groups fixation of nerve stumps on musculature immediately after neurotmesis was performed. After seven days, stump reconnection with 3 stitches in SL and a single stitch associated with HFB in SFS were done. After sixty days right soleus muscles were prepared for nicotinic acetylcholine receptors (nAChRs) and nerve terminal confocal analyses, and for nAChRs (α1, ε e γ), S100, Agrin, LRP-4, MMP-3, Rapsyn western blotting analyses. SC group presented normal morphology. In DC group it was observed flattening of NMJ, fragmentation of nAChRs and tangled nerve terminals. The majority of the parameters of SL and SFS groups presented values in between SC and DC groups. There was an increase of relative planar area in these groups (SL and SFS) highlighting that there was less nAChRs fragmentation and the values of protein expression showed return of nAChRs to mature pattern. Use of HFB associated with a single suture stitch decreased surgical time, minimized suture injuries, did not alter nerve regeneration and presented potential to reestablish the NMJ apparatus. These consolidated results encourage surgeons to develop future clinical trials to install definitively this new approach both for reconstructive surgery and neurosurgery.

Comparison of Sensitivity and Specificity of Structured and Narrative Reports of Transvaginal Ultrasonogaphy for Adenomyosis.

STUDY OBJECTIVE: To compare the sensitivity and specificity of the transvaginal ultrasonography (TVUS) narrative report with those of the structured report for the diagnosis of adenomyosis. DESIGN: Retrospective study. SETTING: A tertiary teaching hospital. PATIENTS: One hundred ninety-two patients (45 with adenomyosis and 147 controls) who underwent hysterectomy between 2012 and 2016 and were aged 30 years to 55 years, with available preoperative TVUS images, were included. INTERVENTIONS: To compare preoperative TVUS with histologic analysis of the uterus after hysterectomy for the diagnostic of adenomyosis. MEASUREMENTS AND MAIN RESULTS: Data regarding the presence of the ultrasonographic characteristics previously described for the diagnosis of adenomyosis were obtained from the original TVUS report (narrative report) and the structured report from 2 blinded radiologists (R1 and R2). Histologic analysis is defined as the gold standard for the diagnosis of adenomyosis. The mean age (45.4 ± 5.3 years vs 44.9 ± 4.8 years; p = .496) and clinical symptoms were similar between the adenomyosis and control groups, except for dyspareunia, which was more frequently reported in the patients with adenomyosis (25.6% vs 9.4%; p = .006). Most of TVUS characteristics were more frequently observed in the structured reports than in the narrative reports. The structured report presented higher sensitivity (R1: 84.4%, R2: 69.1%; narrative report: 31.1%; p <.05) and lower specificity (R1: 28.0%, R2: 31.2%; narrative report: 90.5%; p <.05) for adenomyosis. The structured report presented higher sensitivity and lower specificity for most of sonographic characteristics evaluated. After logistic regression analysis, no sonographic characteristics presented with statistical significance for the diagnosis of adenomyosis on R1's structured report, while globular uterus (odds ratio [OR] 0.276; p = .006; 95% CI, 0.11-0.697) and poorly defined junctional zone (OR 3.6; p = .007; 95% CI, 1.4-9.2) were significantly associated with adenomyosis. In the narrative report, a myometrial cyst was associated with a higher risk of adenomyosis (odds ratio 9.486, p =.002; CI, 2.359-38.149). CONCLUSION: The narrative reports were more specific, whereas the structured reports were more sensitive for the diagnosis of adenomyosis. In addition, the sensitivity of most of sonographic feature of adenomyosis was higher and the specificity was lower in the structured report. Future prospective studies comparing both reports are needed to validate the current findings.

Glomerular filtration rate and its relationship with visceral and subcutaneous adiposity: a study with patients from Northeast Brazil / Tasa de filtración glomerular y su relación con la adiposidad visceral y subcutánea: un estudio con pacientes del noreste brasileño

ABSTRACT Objective: evaluate the relationship between visceral/subcutaneous adipose tissue (VAT/SAT) and glomerular filtration rate (GFR). Methods: A case series study was conducted with 146 male and female adult outpatients at a hospital in Northeast Brazil. VAT and SAT were quantified using computed tomography and GFR was estimated using the formula proposed by the CKD Epidemiology Collaboration. The conceptual model also considered socio-demographic, clinical, anthropometric and lifestyle variables. Results: Females accounted for 71.9% of the sample and mean age was 52.5±13.2 years. Mean body mass index indicated obesity in both sexes (men:30.4±5.9 kg/m2; women: 31.6±6.1 kg/m2). For the same mean age and BMI, men had more VAT and a higher VAT/SAT ratio. Mean GFR was similar between sexes and within the normal range. Simple linear regression analysis revealed that 21.8% of the reduction in GFR in males could be explained by the VAT/SAT ratio (p=0.002). Among females, both VAT alone and the VAT/SAT ratio were predictors of GFR reduction (r2=4.8%, p=0.025 and r2=5.3%, p=0.019, respectively). Conclusion: Mean VAT and VAT/SAT ratio were compatible with abdominal obesity in both sexes and were related to a reduction in GFR.

RESUMEN Objetivo: Evaluar la relación entre el tejido adiposo visceral (TAV) y subcutáneo (TAS) con la tasa de filtración glomerular. Métodos: Estudio tipo serie de casos, en 146 pacientes adultos de ambos sexos, atendidos en un ambulatorio de un hospital de referencia en el Nordeste brasileño. El TAV y el TAS se cuantificaron por tomografía computadorizada y la tasa de filtración glomerular (TFG) estimada por la fórmula del grupo Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). El modelo conceptual también consideró variables sociodemográficas, clínicas, antropométricas y de estilo de vida. Resultados: Pacientes con edad promedio de 52,5 ± 13,2 años y el 71,9% de sexo femenino. El promedio del IMC en ambos sexos se encuentra en el rango de obesidad (hombres= 30,4 ± 5,9 kg/m2 vs mujeres= 31,6 ± 6,1 kg/m2). Para un mismo promedio de edad e IMC, los hombres presentaron mayor TAV y mayor razón TAV/TAS que las mujeres. El promedio de la TFG fue similar entre los sexos y se encuentra en el rango normal. A través de regresión lineal simple, se evidenció que, en el sexo masculino, la disminución de la TFG puede explicarse en el 21,8% por la razón TAV/TAS (p=0,002). En el sexo femenino, tanto el TAV aislado como la razón TAV/TAS fueron predictores de disminución de la TFG (r2= 4,8%; p=0,025 e r2= 5,3%; p=0,019), respectivamente. Conclusión: Se evidenciaron valores muy elevados de los parámetros antropométricos de obesidad abdominal y promedio de TAV y de la razón TAV/TAS compatible con obesidad visceral en ambos sexos, siendo que estos dos últimos parámetros estuvieron relacionados al descenso de la TFG.

Autoavaliação de sintomas vocais e desconforto no trato vocal em indivíduos com diabetes mellitus tipo 1 / Self-assessment of vocal symptoms and vocal tract discomfort in individuals with type 1 diabetes mellitus

RESUMO Objetivo Analisar a autoavaliação de sintomas vocais e do desconforto no trato vocal em indivíduos com e sem diabetes mellitus tipo 1 e analisar a influência do tempo de diagnóstico da doença e da forma de administração de insulinoterapia na autoavaliação. Métodos Participaram 60 indivíduos, divididos em dois grupos: Grupo I (G1) - 30 indivíduos com diagnóstico de diabetes mellitus tipo 1; Grupo II (G2) - 30 indivíduos sem a doença. Para avaliação dos desfechos, os participantes responderam às questões da Escala de Sintomas Vocais e da Escala de Desconforto no Trato Vocal. Os participantes do G1 responderam também a um questionário sobre o diagnóstico e do tratamento médico da diabetes mellitus tipo 1. Os dados foram analisados por meio de estatística descritiva e inferencial. Resultados não houve diferença entre os grupos para a autoavaliação de sintomas vocais e desconforto no trato vocal. Em indivíduos do G1, foi encontrada correlação positiva moderada entre o tempo de diagnóstico e as variáveis frequência de queimação, intensidade de queimação e frequência de garganta sensível. Além disso, houve valores significativamente maiores de frequência e intensidade de garganta sensível e irritada em indivíduos que referiram realizar insulinoterapia utilizando bomba de infusão, em relação aos que mencionaram aplicações ao longo do dia. Conclusão indivíduos com diabetes mellitus tipo 1apresentam baixa sintomatologia vocal e desconforto no trato vocal. Porém, as características da doença referentes ao tempo de diagnóstico e a forma de administração de insulinoterapia influenciam a percepção da frequência e da intensidade de desconforto no trato vocal.

ABSTRACT Purpose To analyze the self-assessment of voice symptoms and vocal tract discomfort in individuals with and without Type 1 Diabetes Mellitus (T1D) and to analyze the influence of the time of diagnosis and the type of insulin therapy in the self-assessment. Methods Sixty individuals participated, divided into two groups: Group I (G1) - 30 individuals with T1D; Group II (G2) - 30 individuals without T1D. The participants responded to the Voice Symptom Scale (VoiSS) and Vocal Tract Discomfort Scale (VTD). G1 participants also answered to a questionnaire to obtain data of the diagnosis and medical treatment of T1D. The data were analyzed using descriptive and inferential statistics. Results There was no difference between groups for self-assessment of voice symptoms and vocal tract discomfort. In G1, a moderate positive correlation was found between time of diagnosis and the variables: burning frequency, burning intensity and frequency of soreness. In addition, there were significantly higher values of frequency and intensity of soreness and irritated throat in individuals who reported performing insulin therapy using an infusion pumps compared to those who realize multiple daily injections. Conclusion Individuals with T1D have few vocal symptoms and vocal tract discomfort; they are not different from the control group. However, characteristics of the disease such as time of diagnosis and type of insulin therapy have influence in the perception of the frequency and intensity of some vocal tract discomfort.

Fadiga vocal em professores universitários no início e ao final do ano letivo / Vocal fatigue in professors at the beginning and end of the school year

RESUMO Objetivo Caracterizar e comparar a percepção de fadiga vocal em professores universitários no início e ao final do ano letivo. Método Estudo observacional, analítico, de coorte prospectivo. Participaram 115 professores universitários, idade média de 40 anos, sendo 71 mulheres e 44 homens, funcionários de 28 instituições de ensino superior das regiões sul e sudeste do Brasil. Todos responderam ao Índice de Fadiga Vocal (IFV) no início (fevereiro ou março) e ao final (outubro ou novembro) do ano letivo. Resultados Os resultados obtidos no IFV nos dois momentos foram comparados estatisticamente (p<0,05). Resultados: Os escores médios obtidos nos domínios fadiga e restrição vocal (p<0,001) e recuperação com repouso vocal (p=0,001) dos professores universitários aumentaram ao final do ano letivo. Conclusão Professores universitários referiram maior percepção de fadiga vocal ao final do ano letivo, o que influenciou na restrição vocal e na recuperação com repouso vocal.

ABSTRACT Purpose To characterize and to compare the perception of vocal fatigue in professors at the beginning and at the end of the school year. Methods Observational, analytical, prospective cohort study was carried out. A total of 115 professors participated with a mean age of 40 years old, 71 women and 44 men, employees of 28 higher education institutions in the south and southeast regions of Brazil. All answered to the Vocal Fatigue Index (VFI) at the beginning (February or March) and at the end (October or November) of the Brazilian school year. The VFI results for both assessed moments were statistically compared (p<0.05). Results The professors' mean scores obtained in the factors of tiredness of voice and avoidance of voice use (p<0.001) and improvement of symptoms with rest (p=0.001) increased at the end of the school year. Conclusion Professors reported higher perception of vocal fatigue at the end of the school year, which influenced the avoidance of voice use and improvement of symptoms with the rest.