Cheeks appearance as a novel predictor of obstructive sleep apnea: the CASA score study.

STUDY OBJECTIVES: Four well-established predictors of obstructive sleep apnea risk are body mass index, age, gender, and neck circumference. We have previously reported cheeks appearance as an OSA predictor, which may represent a combination of such predictors in a single readily available feature. This study sought to answer the question: Is cheeks appearance an OSA risk predictor? METHODS: A prospective cross-sectional diagnostic accuracy study based on STARD. Patients undergoing polysomnography to investigate sleep complaints at a sleep clinic affiliated to a university hospital were assessed using cheeks appearance scored 0-3 for volume from and 0-3 for flaccidity to create the cheeks appearance for sleep apnea (CASA) score ranging from 0-6. Appearance was judged by three blinded and independent evaluators. RESULTS: Among 265 patients evaluated, 248 were included. Fifty-seven patients had a CASA score of 0, 191 had a CASA score between 1-6. Polysomnography diagnosed 177 of the individuals with OSA; of these 167 had altered CASA score. Sensitivity was 87%, specificity 82%, positive predictive value 94%, negative predictive value 66%, accuracy 86%. CONCLUSIONS: Our results suggest that combining volume and flaccidity of cheeks appearance in a single index may constitute a reliable OSA predictor. CASA score is a novel predictor of obstructive sleep apnea with internal validity in sleep laboratory adult population. Our findings support further studies to confirm external validity of this practical diagnostic tool. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Title: Cheeks Appearance as a Novel Predictor of Obstructive Sleep Apnea: The CASA Score Study (CASA); Identifier: NCT04980586; URL: https://clinicaltrials.gov/study/NCT04980586.

Choking, gagging and complementary feeding methods in the first year of life: a randomized clinical trial.

OBJECTIVE: Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. METHODS: Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) - group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05). RESULTS: 130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). CONCLUSION: Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.

Marcadores de consumo alimentar e diversidade alimentar mínima em diferentes métodos de introdução alimentar: um ensaio clínico randomizado / Food consumption markers and minimum dietary diversity in different complementary feeding methods: a randomized clinical trial

Objetivo: Avaliar os marcadores de consumo alimentar e a diversidade alimentar mínima em lactentes de 12 meses de vida expostos a diferentes métodos de introdução alimentar. Métodos: Ensaio clínico randomizado com pares mãe-lactente submetidos à intervenção sobre introdução alimentar em três métodos: Método tradicional (MT), Baby-led Introduction to SolidS (BLISS) e misto (combinação das duas técnicas). Os marcadores de consumo alimentar foram avaliados por questionário online aos 12 meses com base nos alimentos consumidos no dia anterior, utilizando os marcadores de consumo alimentar para menores de 2 anos do Sistema de Vigilância Alimentar e Nutricional. O estudo foi aprovado no comitê de ética. Resultados: Aos 12 meses foram avaliadas 136 crianças: 45 alocadas no MT, 48 no BLISS e 43 no misto. Os alimentos com maior prevalência de consumo foram: leite materno103 (75,7%), frutas, legumes e verduras 122 (89,7%), carnes ou ovos 135 (99,3%), feijão 115 (84,6%), cereais ou tubérculos 135 (99,3%). Alimentos ultraprocessados que estiveram presentes na dieta dos lactentes foram hambúrguer ou salsichas 3 (2,2%), bebidas açucaradas 2 (1,5%), macarrão instantâneo 4 (2,9%) e biscoito recheado 2 (1,5%).Não foram encontradas diferenças entre os métodos de introdução da alimentação complementar. A diversidade alimentar mínima esteve presente na alimentação de 22 lactentes (16,2%), sendo: 6 (13,3%) no MT, 8 (16,7%) no BLISS e 8 (18,6%) no misto (p=0,793). Conclusão: Leite materno,frutas, legumes e verduras, carne, feijão e arroz estiveram presentes na alimentação da maioria dos lactentes; no entanto, a prevalência de diversidade alimentar mínima foi baixa.O consumo de alimentos ultraprocessados também esteve presente na alimentação dos lactentes. Registro Brasileiro de Ensaios Clínicos (ReBEC) identificação RBR-229scm.

Objective: To evaluate food consumption markers and minimum dietary diversity in 12-month-old infants exposed to different methods of food introduction. Methods: A randomized clinical trial with mother-infant pairs undergoing intervention on food introduction in three methods: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), and mixed (combination of the two techniques). Food consumption markers were evaluated by an online questionnaire at 12 months based on food consumed the previous day, using food consumption markers for children under 2 years of the Food and Nutrition Surveillance System. The study was approved by the ethics committee. Results: At 12 months, 136 children were evaluated: 45 allocated to PLW, 48 to BLISS, and 43 to mixed. The foods with the highest prevalence of consumption were breast milk 103 (75.7%), vegetables 122 (89.7%), meat 135 (99.3%), beans 115 (84.6%), rice, potatoes, or yam 135 (99.3%). Ultra-processed foods were present in the diet of infants, including hamburgers or sausages 3 (2.2%), sweetened beverages 2 (1.5%), instant noodles 4 (2.9%), and sandwich cookies 2 (1.5 %). No differences were found between the methods of introducing complementary feeding. The minimum dietary diversity was present in the diet of 22 infants (16.2%), being: 6 (13.3%) in the PLW, 8 (16.7%) in the BLISS, and 8 (18.6%) in the mixed (p=0.793). Conclusion: Breast milk, vegetables, meat, beans, and rice were present in the diet of most infants; however, the prevalence of minimal dietary diversity was low. The consumption of ultra-processed foods was also present in the diet of infants. Brazilian Registry of Clinical Trials (ReBEC) identification RBR-229scm.

Abordagem interdisciplinar no tratamento da macroglossia na síndrome de Beckwith-Wiedemann: relato de caso / Interdisciplinary approach in the treatment of macroglossia in Beckwith-Wiedemann syndrome: case report

RESUMO O objetivo deste estudo foi relatar a abordagem interdisciplinar no manejo da macroglossia em um caso de paciente com síndrome de Beckwith-Wiedemann, no período de dez anos. O acompanhamento iniciou pela equipe de Cirurgia Bucomaxilofacial, seguido da Fonoaudiologia, em função de dificuldades alimentares. Após avaliação clínica e instrumental, aos 8 meses de idade, iniciou-se a intervenção fonoaudiológica com foco na disfagia orofaríngea e na terapia miofuncional orofacial. Foi verificado, com 1 ano e 11 meses, ausência de sinais de alteração de deglutição em fase faríngea e melhora na postura de lábios e língua. Aos 3 anos, foram iniciados estímulos para retirada dos hábitos orais e o treino da função mastigatória. O tratamento ortodôntico para correção de mordida aberta anterior e mordida cruzada posterior unilateral iniciou-se aos 6 anos. Aos 7 anos e 5 meses de idade, constatou-se estabilidade do modo respiratório nasal e adequação da postura de repouso de lábios e língua. Aos 9 anos, em função de recidiva das alterações oclusais, optou-se pela redução cirúrgica da língua seguida de terapia miofuncional orofacial, retomada aos 9 anos e 3 meses. O resultado foi a correção da postura da língua na deglutição e a adequação da fala. A associação dos tratamentos, envolvendo Fonoaudiologia, Ortodontia e Cirurgia Bucomaxilofacial foi considerada efetiva no manejo da macroglossia, resultando na adequação e equilíbrio das funções orofaciais.

ABSTRACT This study aims to report the interdisciplinary management of macroglossia in a Beckwith-Wiedemann syndrome patient during ten years. Clinical follow-up started by the Oral and Maxillofacial Surgery team, followed by Speech Therapy due to feeding difficulties. After clinical and instrumental evaluation, at 8 months old, the speech therapy intervention was indicated, focusing on oropharyngeal dysphagia and orofacial myofunctional therapy. At 1 year and 11 months, no signs of swallowing alteration in the pharyngeal phase and improvement in the posture of the lips and tongue were found. At the age of 3, stimulation to remove oral habits and train masticatory function were initiated. Orthodontic treatment to correct anterior open bite and unilateral posterior crossbite started at age 6. At 7 years and 5 months, there was stability in the nasal breathing mode and adequacy of resting posture of lips and tongue. At the age of 9, due to relapse of the occlusal alterations, surgical reduction of the tongue was indicated, followed by orofacial myofunctional therapy, restarted at the age of 9 years and 3 months. The result was the correction of the posture of the tongue during swallowing and speech adequacy. The association of treatments involving Speech Therapy, Orthodontics and Oral and Maxillofacial Surgery was considered effective in the management of the macroglossia. It resulted in the adequacy and equilibrium of orofacial functions.

Choking, gagging and complementary feeding methods in the first year of life: a randomized clinical trial

Abstract Objective: Compare the occurrence of choking and gagging in infants subjected to three complementary feeding (CF) methods. Methods: Randomized clinical trial with mother-infant pairs, allocated according to the following methods of CF: a) Parent-Led Weaning (PLW) — group control, b) Baby-Led Introduction to SolidS (BLISS), and c) mixed (initially BLISS and if the infant presents a lack of interest or dissatisfaction, PLW), with the last two methods guided by the infant. Mothers received nutritional intervention on CF and prevention of choking and gagging according to the method at 5.5 months of age and remained in follow-up until 12 months. Frequencies of choking and gagging were collected by questionnaire at nine and 12 months. The comparison between groups was performed using the analysis of variance test (p < 0.05). Results: 130 infants were followed, and 34 (26.2%) children presented choking between six and 12 months of age, 13 (30.2%) in PLW, 10 (22.2%) BLISS, and 11 (26.2%) mixed method, no significative difference between methods (p > 0.05). The choking was caused mainly by the semi-solid/solid consistency. Moreover, 100 (80%) infants aged from six to 12 months presented gagging and their characteristics were not statistically different among groups (p > 0.05). Conclusion: Infants following a baby-led feeding method that includes advice on minimizing choking risk do not seem more likely to choke than infants following traditional feeding practice that includes advice on minimizing choking risk.

Diagnostic procedures in infrared thermography for the human face: a scoping review protocol / Procedimentos diagnósticos em termografia infravermelha para a face humana: um protocolo de revisão de escopo

ABSTRACT Purpose: to present the scoping review protocol that will describe the diagnostic procedures used in infrared thermography to evaluate the human face. Methods: based on the Joanna Briggs Institute and PRISMA-ScR checklist, with the mnemonic: population (P) - human face, concept (C) - infrared thermography, and context (C) - diagnostic procedures in infrared thermography for the human face. The methodological structure will have six stages. The PubMed, LILACS, SciELO, BBO, Web of Science, EMBASE, Scopus, Cochrane Library, and Grey Literature Report databases will be searched, with no restriction on time or language. The review will include qualitative and quantitative studies. Two reviewers will independently select studies and extract data. Results will be analyzed using a variable approach. Conclusion: this scoping review protocol followed the methodological precepts and is apt to be carried out. It will serve as the basis for other scoping reviews. Conducting a scoping review is important and the prior publication of the scoping review protocol is essential to make the review process transparent.

RESUMO Objetivo: apresentar um protocolo de revisão de escopo para identificar os procedimentos diagnósticos utilizados na termografia infravermelha para a avaliação da face humana. Métodos: baseado no The Joanna Briggs Institute e no checklist PRISMA-ScR, com o mnemônico: população (P) - face humana, conceito (C) - termografia infravermelha e contexto (C) - procedimentos diagnósticos na termografia infravermelha para a região da face humana. A estrutura metodológica consistirá em seis etapas. As bases de dados consultadas serão o PubMed, LILACS, SciELO, BBO, Web of Science, Embase, Scopus, Cochrane Library e Grey Literature Report. A busca será realizada sem delimitação temporal ou restrição de idioma. A revisão incluirá estudos qualitativos e quantitativos. Dois revisores selecionarão os estudos independentemente e extrairão os dados. Os resultados serão analisados utilizando uma abordagem variável. Conclusão: este protocolo de revisão de escopo seguiu os preceitos metodológicos e se encontra em condições de execução, servindo também como base para outras revisões de escopo. A realização de uma revisão de escopo é importante e a prévia publicação do protocolo de revisão de escopo fundamental, pois tem a finalidade de trazer transparência ao processo a ser realizado.

Adherence to different methods for introducing complementary food to 7-month-old babies: a randomized clinical trial / Adesão a diferentes métodos de introdução da alimentação complementar aos 7 meses de vida: um ensaio clínico randomizado

Abstract Objective: To assess the adherence to three methods of food introduction for 7-month-old babies. Methods: This is a randomized clinical trial conducted with mother-infant pairs, submitted to the intervention with five and a half months of age and three different methods for food introduction according to randomization: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), or mixed (specially developed for this study). Adherence to the method was assessed at the seventh month of age, via telephone call to the caregiver by a researcher blinded to the method. The analyses were performed using the Chi-Square test and data are presented in absolute numbers and percentages. Results: A total of 139 mother-infant pairs were evaluated; 46 of them were allocated to the PLW method; 47, to the BLISS; and 46, to the mixed. At seven months of age, 60 (43.2%) mothers reported that the infants were following the proposed feeding method. When analyzing each approach, the mixed method showed a higher likelihood of adherence (71.7%, n=33), followed by the PLW method (39.1%, n=18) and by the BLISS (19.2%, n=9) (p<0.001). Among the sample that did not follow the proposed method, those that had been randomized to the PLW and BLISS methods mostly migrated to the mixed method (92.9%; n=26 and 92.1%; n=35, respectively) (p<0.001). Conclusions: Complementary feeding in a mixed approach obtained greater adherence in 7-month-old babies.

RESUMO Objetivo: Avaliar a adesão a três métodos de introdução alimentar aos 7 meses de vida. Métodos: Ensaio clínico randomizado com pares mães-lactentes submetidos à intervenção aos 5 meses e meio de vida sobre três diferentes métodos de introdução alimentar, conforme randomização: tradicional, Baby-Led Introduction to SolidS (introdução de sólidos guiada pelo bebê, em português) ou misto (criado especialmente para este estudo). A adesão ao método foi avaliada aos 7 meses em ligação telefônica feita para o cuidador por pesquisador cego em relação ao método. As análises foram realizadas por teste do qui-quadrado e os dados apresentados em número absoluto e percentual. Resultados: Foram avaliados 139 pares mães-lactentes, 46 alocados no método tradicional, 47 no Baby-Led Introduction to SolidS e 46 no misto. Aos 7 meses, 60 (43,2%) mães relataram que seus lactentes seguiam o método alimentar proposto. Analisando-se cada abordagem, o método misto apresentou maior probabilidade de adesão (71,7%, n=33), seguido do tradicional (39,1%, n=18) e de introdução de sólidos guiada pelo bebê (19,2%, n=9) (p<0,001). Da amostra que não seguiu o método proposto, aqueles que haviam sido randomizados para os métodos tradicional e de introdução de sólidos guiada pelo bebê migraram majoritariamente para o misto (92,9%; n=26 e 92,1%; n=35, respectivamente) (p<0,001). Conclusões: A alimentação complementar em abordagem mista obteve maior adesão aos 7 meses de idade.

Complementary feeding methods and introduction of ultra-processed foods: A randomized clinical trial.

Introduction: Complementary feeding (CF) is defined as a period when foods, other than milk, are introduced to the infant's diet. Unfortunately, frequent consumption of ultra-processed foods (UPF) has become highly prevalent early in an infant's life. The aim was to verify the association of CF methods with the introduction of UPF in early childhood. Methods: This randomized clinical trial involved pairs of mother-infants, allocated in groups receiving different CF interventions: strict Parent-Led Weaning (PLW); strict Baby-Led Introduction to SolidS (BLISS), or mixed-method. The intervention consisted of a counseling session on healthy eating at the child's 5.5 months of age. A structured questionnaire was created based on the NOVA classification for the definition of UPF and applied at 9 and 12 months. The effect of the CF method intervention was measured by a survival curve for UPF offered for the first time in early childhood between groups. Cox regression was used to estimate its magnitude. The primary analysis was done in three groups (PLW, BLISS, and Mixed) and the secondary analysis was done in two groups (PLW, and BLISS + Mixed). Results: A total of 139 mother-infant pairs were eligible and 129 followed the study. The prevalence of infants who were exposed to UPF in early childhood was 58.9% (n = 76), being 71.4% in the PLW group, 53.3% in the BLISS group, and 52.4% in the Mixed group, without differences between them (p = 0.133). The PLW group intervention had a greater chance of exposure to ice cream or popsicles (p = 0.032) and sweet crackers (p = 0.009), compared with the other two CF groups. The Cox regression did not find significant differences between the three groups. However, the regression with two groups estimated a 38% reduction in the offer of UPF in the BLISS + Mixed group intervention (p = 0.049). Discussion: The CF intervention promoting greater infant autonomy (BLISS and Mixed) was associated with a reduction in the offer of UPF in early childhood. This knowledge may contribute to supporting strategies aimed at reducing UPF consumption by the young infant. Brazilian registry of clinical trials ReBEC: [https://ensaiosclinicos.gov.br/rg/RBR-229scm], identifier [RBR-229scm U1111-1226-9516].

Adherence to different methods for introducing complementary food to 7-month-old babies: a randomized clinical trial.

OBJECTIVE: To assess the adherence to three methods of food introduction for 7-month-old babies. METHODS: This is a randomized clinical trial conducted with mother-infant pairs, submitted to the intervention with five and a half months of age and three different methods for food introduction according to randomization: Parent-Led Weaning (PLW), Baby-Led Introduction to SolidS (BLISS), or mixed (specially developed for this study). Adherence to the method was assessed at the seventh month of age, via telephone call to the caregiver by a researcher blinded to the method. The analyses were performed using the Chi-Square test and data are presented in absolute numbers and percentages. RESULTS: A total of 139 mother-infant pairs were evaluated; 46 of them were allocated to the PLW method; 47, to the BLISS; and 46, to the mixed. At seven months of age, 60 (43.2%) mothers reported that the infants were following the proposed feeding method. When analyzing each approach, the mixed method showed a higher likelihood of adherence (71.7%, n=33), followed by the PLW method (39.1%, n=18) and by the BLISS (19.2%, n=9) (p<0.001). Among the sample that did not follow the proposed method, those that had been randomized to the PLW and BLISS methods mostly migrated to the mixed method (92.9%; n=26 and 92.1%; n=35, respectively) (p<0.001). CONCLUSIONS: Complementary feeding in a mixed approach obtained greater adherence in 7-month-old babies.

The Effectiveness of Lingual Frenectomy and Myofunctional Therapy for Children: A Randomized Controlled Clinical Trial.

Purpose: To evaluate the effectiveness of lingual frenectomy, as a standalone treatment or in association with myofunctional therapy, on the general and functional aspects of six- to 12-year-old children with anomalies in the lingual frenulum.
Methods: This randomized controlled clinical trial involved 40 children diagnosed with altered lingual frenulum. Children who received a frenectomy were evaluated 15 and 30 days after the procedure. After 15 days, the children were randomized into two groups: a group that received isotonic tongue exercises (Study Group [SG]) and a group that did not receive isotonic tongue exercises (Control Group [CG]). The outcome evaluator was blinded to group assignment. Statistical tests were used to compare between and within groups (P <0.05).
Results: There were 20 children in each group. SG children improved significantly when compared to CG subjects regarding tongue mobility (P =0.016), maximum mouth opening (MMO; P =0.024), and MMO with the tip of the tongue touching the incisive papilla (P =0.026).
Conclusion: Frenectomy associated with myofunctional therapy benefitted tongue mobility.

Metodologias aplicadas no ensino de Ética, Bioética e Deontologia da Saúde durante a última década: uma revisão integrativa / Metodologías aplicadas en la enseñanza de la Ética, Bioética y Deontología de la Salud durante la última década: una revisión integradora / Methodologies applied in the teaching of Ethics, Bioethics and Deontology during the last decade: an integrative review

Esta revisão integrativa realiza um mapeamento da produção científica da última década com vistas às metodologias aplicadas no ensino de Ética, Bioética e Deontologia, objetivando categorizá-las e descrevê-las. Na busca pelos descritores "ensino" and "saúde" and "ética" or "bioética" or "deontologia", nas bases de Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Educational Resources Information Centre (ERIC), Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO) e Google Acadêmico, foram encontrados 34 artigos. As metodologias foram organizadas em: metodologias ativas e modelo tradicional. A síntese desta revisão afirma que as metodologias ativas oferecem aprendizagens mais significativas se comparadas ao modelo tradicional, sobretudo associadas ao uso da tecnologia. Além disso, pressupostos teóricos transversais e interdisciplinares também foram associados à aplicabilidade metodológica no ensino das temáticas em questão. (AU)

Esta revisión integradora realiza un mapeo de la producción científica de la última década, con relación a las metodologías aplicadas en la enseñanza de la Ética, Bioética y Deontología, con el objetivo de caracterizarlas y describirlas. En la búsqueda por los descriptores "enseñanza" and "salud" and "ética" or "bioética" or "deontología" en las bases Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS), Educational Resources Information Centre (ERIC), Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO) y Google Académico se encontraron treinta y cuatro artículos. Las metodologías se organizaron en: metodologías activas y modelo tradicional. La síntesis de esta revisión afirma que las metodologías activas ofrecen aprendizajes más significativos si comparadas al modelo tradicional, principalmente asociadas al uso de la tecnología. Además, presuposiciones teóricas transversales e interdisciplinarias también se asociaron a la aplicabilidad metodológica en la enseñanza de las temáticas en cuestión. (AU)

This integrative review maps out the scientific production of the last decade focusing on methodologies applied in teaching Ethics, Bioethics and Deontology, aiming to categorize and describe them. The review found thirty-four articles searching the keywords "teaching" and "health" and "ethics" or "bioethics" or "deontology" in the bases Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Educational Resources Information Centre (ERIC), Medical Literature Analysis and Retrieval System Online (MEDLINE), Scientific Electronic Library Online (SciELO) and Google Scholar. The methodologies were organized into: active methodologies and traditional model. The synthesis of this review states that active methodologies offer more significant learning, when compared to the traditional model, especially due to technology. Moreover, transversal and interdisciplinary theoretical assumptions were also associated with methodological applicability in the teaching of the themes in question. (AU)

Aspectos anatômicos e funcionais da língua após frenectomia em gemelares: relato de casos clínicos / Anatomic and functional aspects of the tongue after frenectomy in twin: clinical cases report

Objetivo: Relatar dois casos clínicos de alteração de frênulo lingual em gemelares, com 10 anos de idade, ambas do sexo feminino, avaliadas nos aspectos anatômicos e funcionais da língua antes e 15 dias após a frenectomia. Relato de casos: Inicialmente, o odontopediatra realizou a anamnese com a mãe. Em seguida, as participantes foram submetidas à avaliação clínica odontológica e, posteriormente, foi realizada a avaliação fonoaudiológica do frênulo lingual. A avaliação fonoaudiológica foi realizada por meio do Protocolo de Avaliação do Frênulo da Língua, que foi aplicado antes e 15 dias após a frenectomia. As duas participantes apresentaram melhor desempenho em provas anatômicas após o procedimento cirúrgico. Entretanto, algumas alterações, principalmente ao elevar a língua, continuaram sendo observadas em uma das pacientes 15 dias após a frenectomia. Ademais, as duas participantes passaram a executar a maioria dos movimentos de língua com maior precisão. No que se refere à fala, somente a participante que apresentava um maior número de alterações fonéticas anteriores, permaneceu com algumas alterações na fala decorridos 15 dias da cirurgia. Discussão: Algumas dificuldades envolvendo mobilidade da língua e alterações na fala podem persistir após a realização da cirurgia, indicando a necessidade de intervenção fonoaudiológica específica. Conclusão: Ambos os casos apresentaram melhora no desempenho tanto nas provas anatômicas quanto funcionais após a frenectomia.

Aim: to report two clinical cases of alteration of the lingual frenulum in twins, aged 10 years, both female, evaluated in the anatomical and functional aspects of the tongue before and 15 days after the frenectomy. Case reports: Initially, the paediatric dentistry performed the anamnesis with the mother. Then, the participants were submitted to a dental clinical evaluation and, sub-sequently, the speech language pathologist evaluation of the lingual frenulum was performed. The speech language pathologist assessment was performed using the Tongue Frenulum Evaluation Protocol, which was applied before and 15 days after the frenectomy. Both participants performed better in anatomical tests after the surgical procedure. However, some changes, especially when elevating the tongue, continued to be observed in one of the patients 15 days after the frenectomy. In addition, the two participants started to perform most of the tongue movements with greater precision. About speech, only the participant who had a greater number of previous phonetic changes, remained with some speech disorders after 15 days of surgery. Discussion: Some di-fficulties involving mobility of the tongue and changes in speech may persist after surgery, indicating the need for specific speech therapy intervention. Conclusion:Both cases showed improvement in performance both in anatomical and functional tests after frenectomy

Complementary feeding methods in the first year of life: a study protocol for a randomized clinical trial.

BACKGROUND: The traditional spoon-feeding approach to introduction of solid foods during the complementary feeding period is supported by consensus in the scientific literature. However, a method called Baby-Led Introduction to SolidS (BLISS) has been proposed as an alternative, allowing infants to self-feed with no adult interference. To date, there have been no trials in the Brazilian population to evaluate the effectiveness of BLISS in comparison to the traditional approach. METHODS/DESIGN: To evaluate and compare three different complementary feeding methods. Data on 144 mother-child pairs will be randomized into intervention groups by methods: (A) strict Parent-Led Weaning; (B) strict Baby-Led Introduction to SolidS; and (C) a mixed method. Prospective participants from Porto Alegre, Brazil, and nearby cities will be recruited through the Internet. The interventions will be performed by nutritionists and speech therapists, at 5.5 months of age of the child, at a private nutrition office equipped with a test kitchen where meals will be prepared according to the randomized method. The pairs will be followed up at 7, 9, and 12 months of age. Data will be collected through questionnaires designed especially for this study, which will include a 24h child food recall, questionnaires on the child's and parents' eating behavior, oral habits, eating difficulties, and choking prevalence. At 12 months of age, children will undergo blood collection to measure hemoglobin, ferritin, and C-reactive protein, saliva collection for analysis of genetic polymorphisms, and oral examination. Anthropometric parameters (child and maternal) will be measured at the baseline intervention, at a 9 month home visit, and at the end-of-study visit at the hospital. The primary outcome will be child growth and nutritional status z-scores at 12 months; secondary outcomes will include iron status, feeding behavior, acceptability of the methods, dietary variety, choking, eating behaviors, food preferences, acceptance of bitter and sweet flavors, suction, oral habits, oral hygiene behavior, dental caries, gingival health status, and functional constipation. DISCUSSION: The trial intends to ascertain whether there are potential advantages to the BLISS complementary feeding method in this specific population, generating data to support families and healthcare providers. TRIAL REGISTRATION: Brazilian Clinical Trials Registry (ReBEC): RBR- 229scm number U1111-1226-9516 . Registered on September 24, 2019.

Covid-19: o que dizem os códigos de ética profissional? / Covid-19: what do the codes of professional ethics say? / Covid-19: ¿qué dicen los códigos de ética profesional?

Resumo O novo coronavírus (Sars-CoV-2) chegou ao Brasil em fevereiro de 2020, com alta taxa de transmissibilidade e letalidade. Diante de tal situação, o Ministério da Saúde emitiu a Portaria 639/2020, que instituiu a ação "O Brasil Conta Comigo: Profissionais da Saúde", com o fim de cadastrar e capacitar profissionais para o combate à pandemia. Esta pesquisa visa identificar, dentre as profissões elencadas pela mencionada portaria, aquelas que trazem orientações aplicáveis à atual situação em seus códigos de ética. Trata-se de pesquisa documental, exploratória, descritiva e qualiquantitativa, que utiliza como método a análise estatística e de conteúdo. Os textos dos códigos de ética foram processados pelo software Iramuteq e passaram por análises de especificidades e similitudes. Das profissões analisadas, sete apresentaram em seu código de ética conteúdo que pode ser relacionado à pandemia de covid-19: enfermagem, farmácia, fonoaudiologia, fisioterapia, psicologia, serviço social e terapia ocupacional. As orientações, no entanto, apresentaram pouca conexão com o código como um todo, o que indica limitações nos documentos deontológicos analisados.

Abstract The new coronavirus arrived in Brazil in February 2020, with a high rate of transmissibility and lethality. In view of this situation, the Ministry of Health issued Ordinance 639/2020, legitimizing the action "Brazil counts on me - health professionals," to train and register professionals. In order to identify which professions, listed by the Ordinance, have in their Codes of Professional Ethics guidelines for the current situation and analyze the content found, this documentary research has an exploratory, descriptive nature and qualitative and quantitative character, presenting statistical and content analysis. The data were processed using specificity and similarity analysis techniques, using the Iramuteq software. Of the professions analyzed, presented in their code of ethics content related to covid-19: nursing, pharmacy, speech therapy, physiotherapy, psychology, social services and occupational therapy. The existing guidelines have little connection with the text of the committees, indicating deontological insufficiency.

Resumen El nuevo coronavirus (Sars-CoV-2) se identificó en Brasil en febrero de 2020, con una alta tasa de transmisibilidad y letalidad. Ante esta situación, el Ministerio de Salud emitió la Ordenanza 639/2020, legitimando la acción "Brasil Cuenta Conmigo: Profesionales de la Salud", para formar y registrar profesionales en la pandemia. Esta investigación tuvo como objetivo identificar qué profesiones, enumeradas por la Ordenanza, tienen en sus Códigos de Ética Profesional directrices para afrontar la situación actual. Esta es una investigación documental, con carácter exploratorio, descriptivo y cualicuantitativo, que utilizó como método el análisis estadístico y de contenido. Los datos de los mencionados códigos se procesaron mediante técnicas de análisis de especificidad y similitud, utilizando el software Iramuteq. De las profesiones analizadas, siete presentaron en su código de ética contenidos que pueden estar relacionados con la covid-19: enfermería, farmacia, logopedia, fisioterapia, psicología, trabajo social y terapia ocupacional. Las directrices, sin embargo, mostraron poca conexión con el código en su conjunto, lo que indica limitaciones en los documentos deontológicos analizados.

All day-long pacifier use and intelligence quotient in childhood: A birth cohort study.

BACKGROUND: Literature on pacifier use remains controversial, but mostly suggests an inverse association with childhood intelligence. OBJECTIVES: The objective of this study was to assess the association between pacifier use and intelligence quotient (IQ) in six-year-old children from a birth cohort. METHODS: Data from 3532 children from the 2004 Pelotas (Brazil) Birth Cohort were analysed. Children were recruited and assessed at birth and followed up at 3 months, and 1, 2, 4, and 6 years. Data on pacifier use duration and intensity were obtained via interviews with mothers in all six follow-up visits. IQ was estimated at 6 years using the Wechsler Intelligence Scale for Children and standardised for the analyses. Crude and adjusted coefficients were calculated (linear regression) for all the data collected in follow-up assessments for pacifier use. RESULTS: IQ was inversely associated with all pacifier use indicators. Children who used a pacifier all day long (ADL) at any follow-up showed an IQ 0.18 (95% confidence interval [CI] 0.11, 0.24) standard deviations below those who never used it ADL, after adjusting for confounders. The strength of association increased with number of assessments reporting ADL pacifier use, from a reduction in IQ of 0.13 (95% CI 0.06, 0.21) to 0.34 (95% CI 0.15, 0.52) standard deviations for ADL use in one and in all four follow-up visits, respectively. CONCLUSIONS: We found a strong association between intense pacifier use up to 4 years of age and lower IQ at 6 years. A dose-response gradient was observed, with greater IQ deficits in children who used a ADL pacifier for longer durations. The mechanisms underlying this association need to be clarified. One hypothesis is that children using a pacifier, especially those who use it more intensely, are less stimulated.

Influence of pacifier use on the association between duration of breastfeeding and anterior open bite in primary dentition.

BACKGROUND: The literature is controversial with regard to the association between longer breastfeeding duration and lower prevalence of anterior open bite. Pacifier use may be involved in this controversy. Thus, the objective of the study was to assess the influence of pacifier use and its duration on the association between longer breastfeeding duration and lower prevalence of anterior open bite in children with primary dentition. METHODS: This was a cross-sectional study nested in a cohort study involving 153 infants recruited at a maternity hospital in the municipality of Porto Alegre, southern Brazil. The study outcome (anterior open bite) was assessed when the children were between 3 and 5 years old. Data on breastfeeding and pacifier use were collected at 7, 30, 60, 120, and 180 days of life and on the date of the evaluation here described. Poisson regression with robust variance was used to analyze the association between the prevalence of anterior open bite and breastfeeding duration, expressed in months. RESULTS: The univariate analysis showed a protective effect of breastfeeding against anterior open bite (prevalence ratio [PR] 0.96; 95% confidence interval [95%CI] 0.95-0.98). This effect remained significant after adjustment for pacifier use at any time between birth and the date of dental assessment (PR0.98; 95%CI; 0.96-0.99), i.e., there was a reduction of 2% in the prevalence of anterior open bite for each month of breastfeeding. However, this effect lost significance when pacifier use duration was included in the multivariate analysis (PR1.00; 95%CI; 0.99-1.01). CONCLUSIONS: Pacifier use duration influences the association between longer breastfeeding duration and lower prevalence of anterior open bite. It is likely that prolonged pacifier use reduces the magnitude of this association.

Influencia de los hábitos orales en el perfil miofuncional orofacial de niños de tres a cinco años / Influência dos hábitos orais no perfil miofuncional orofacial de crianças de três a cinco anos / Influence of oral habits on the myofunctional orofacial profile of children aged three to five years-old

Objetivo: Investigar la influencia de los hábitos orales en el perfil miofuncional de los niños de tres a cinco años. Material y métodos: Estudio transversal con 73 niños a través del protocolo de aplicación validado para la evaluación de los aspectos miofuncional orofacial y el cuestionario sobre los hábitos orales. Para el análisis de las variables, el nivel de significación fue del 5%. Resultados: La suma total de protocolo de Evaluación Miofuncional Orofacial con Valores (AMIOFE) fue de 91,6 ± 5,4 puntos (IC del 95%: 90,3 92,9), con un mínimo de 75 y un máximo de 100 puntos. Se observó relación significativa entre: la alimentación con biberón (p=0,014) y chupetes (p <0,001) con los aspectos y las posiciones de los articuladores; el uso del chupete y la función respiratoria (p=0,04) y la deglución (p=0,006); el uso de objetos en la boca y la función de masticación (p=0,001); la respiración oronasal y los aspectos y las posiciones de los articuladores (p <0,001) y la función de deglución (p=0,002). Además, la lactancia materna prolongada influyó positivamente el aspecto y la posición de los articuladores (p=0,001) y la función respiratoria (p=0,005). Conclusiones: Los hábitos de alimentación con biberón, los objetos en la boca, los chupetes y la respiración oronasal se relacionaron con cambios en los aspectos y posturas de los articuladores y las funciones estomatognáticas.

Objetivo: Verificar a influência dos hábitos orais no perfil miofuncional orofacial de crianças de três a cinco anos. Material e métodos: Estudo transversal, realizado com 73 crianças por meio da aplicação de protocolo validado para avaliação do aspecto miofuncional orofacial e o questionário sobre os hábitos orais. Para a análise entre as variáveis, o nível de significância utilizado foi de 5%. Resultados: A soma total do protocolo Avaliação Miofuncional Orofacial com Escores (AMIOFE) foi de 91,6+5,4 pontos (IC95%= 90,3 ­ 92,9), com o mínimo de 75 e máximo de 100 pontos. Foi observada relação significativa entre: o uso da mamadeira (p=0,014) e chupeta (p<0,001) com os aspectos e posturas dos órgãos fonoarticulatórios; uso da chupeta e as funções de respiração (p=0,04) e deglutição (p=0,006); o uso de objetos na boca e a função de mastigação (p=0,001); respiração oronasal e aspectos e posturas dos órgãos fonoarticulatórios (p<0,001) e função de deglutição (p=0,002). Também, ter recebido aleitamento materno por mais tempo influenciou positivamente o aspecto e postura dos órgãos fonoarticulatórios (p=0,001) e a função de respiração (p=0,005). Conclusão: Os hábitos de mamadeira, objetos, chupeta e respiração oral estiveram relacionados a alterações nos aspectos e posturas dos órgãos fonoarticulatórios e nas funções estomatognáticas.

Objective: Verify the influence of oral habits on miofunctional orofacial profile of children aged three to five yearsold. Material and methods: This cross sectional study included 73 children which underwent the application of validated protocol for evaluation of their myofunctional orofacial functions and a questionnaire about their oral habits. A significance level of 5% was set for the statistical analysis. Results: The Orofacial Myofunctional Evaluation with Scores (OMES) total sum was 91.6+5.4 points (CI95%= 90.3 ­ 92.9), with a minimum of 75 and maximum of 100 points. A significant association was identified between bottlefeeding (p=0.014) and pacifier (p<0.001) with respect to phonoarticulatory organs' appearance and posture, pacifier use and breathing (p=0.04) and swallowing functions (p=0.006); the use of objects in the mouth and the chewing function (p=0.001); oral breathing, phonoarticulatory organs' appearance and posture (p<0.001) and swallowing function (p=0.002). Besides, being breastfed for a longer time modified phonoarticulatory organs' appearance and posture (p=0.001) and breathing function (p=0.005). Conclusion: Feeding habits, plying with solid external objects in the mouth, pacifier use and mouth breathing were associated with changes in articulatory organs' appearance and posture, as well as, stomatognathic functions.

O ensino de fonoaudiologia no brasil: retrato dos cursos de graduação / The teaching of speech therapy in brazil: a portrait of the undergraduate courses / La enseñanza de fonoaudiologia en brasil: retrato de los cursos de graduación

Resumo O presente estudo foi realizado em setembro de 2018, e teve como objetivo verificar o estado atual do ensino de fonoaudiologia no Brasil, por meio da caracterização de seus cursos de graduação. Para tal, foi realizada uma pesquisa documental e descritiva, de abordagem quantitativa e qualitativa. O levantamento de dados ocorreu no portal do Ministério da Educação. Analisaram-se 87 cursos de fonoaudiologia vinculados a instituições de ensino superior públicas (27,6%) e privadas (72,4%), num total de 7.044 vagas anuais ofertadas, com carga horária média de 3.681 horas, num prazo de integralização entre oito e dez semestres. Os cursos estavam distribuídos em 23 estados brasileiros, com maior concentração na região Sudeste. A maioria dos cursos teve nota três nos indicadores de qualidade propostos pelo Ministério da Educação. Concluiu-se que o ensino da fonoaudiologia no Brasil é fundamentalmente presencial, privado, distribuído pelo país, com baixa ocupação de vagas - aspecto inferido pelo número pequeno de concluintes quando comparado ao número de vagas ofertadas, carga horária mínima maior nas instituições de ensino superior públicas, cumprida entre oito e dez semestres, bem como apresenta indicadores de qualidade satisfatórios.

Abstract The present study was conducted in September 2018, and had the goal of checking the current state of the teaching of speech therapy in Brazil through a characterization of its undergraduate courses. In order to do so, a documentary and descriptive research was conducted with a quantitative and qualitative approach. Data collection was made through the website of the Brazilian Ministry of Education. We analyzed 87 speech therapy undergraduate courses linked to public (27.6%) and private (72.4%) higher education institutions, totaling 7,044 slots offered annually, with an average of 3,681 credit hours, and a period of integralization ranging from eight to ten semesters. The courses were distributed among 23 Brazilian states, with a higher concentration in the Southern region of the country. Most courses were graded 3 regarding the indicators of quality proposed by the Ministry of Education. We concluded that the teaching of speech therapy in Brazil is fundamentally in-person, private, distributed throughout the country, with a low rate of students taking the slots, an aspect deduced by the small number of graduates compared with the amount of slots offered, higher credit hours in the public higher education institutions, concluded between eight and ten semesters, and it presents satisfactory quality indicators.

Resumen El estudio fue realizado en septiembre de 2018, y tuvo como objetivo verificar el estado actual de la enseñanza de fonoaudiología en Brasil, por medio de la caracterización de sus cursos de graduación. Para ello, fue realizada una búsqueda documental y descriptiva, de abordaje cuantitativo y cualitativo. El relevamiento de datos se realizó en el portal del Ministerio de Educación Brasileño. Se analizaron 87 cursos de fonoaudiología vinculados a instituciones de enseñanza superior públicas (27,6%) y privadas (72,4%), en un total de 7.044 vacantes anuales ofertadas, con carga horaria promedio de 3.681 horas, en un plazo de integralización entre ocho y diez semestres. Los cursos estaban distribuidos en 23 estados brasileños, con mayor concentración en la región Sudeste. La mayoría de los cursos tuvo nota tres en los indicadores de calidad propuestos por el Ministerio de Educación. Se concluyó que la enseñanza de la fonoaudiología en Brasil es fundamentalmente presencial, privado, distribuido por el país, con baja ocupación de vacantes - aspecto inferido por el número pequeño de concluyentes cuando es comparado al número de vacantes ofertadas, carga horaria mínima mayor en las instituciones de enseñanza superior públicas, cumplida entre ocho y diez semestres, así como presenta indicadores de calidad satisfactorios.

Diagnostic performance of cheeks appearance in sleep apnea.

OBJECTIVE: Obstructive sleep apnea (OSA) is a common, potentially life-threatening, but underdiagnosed condition. The study aimed to test the role of facial myofunctional alterations in OSA screening. METHOD: Sixty-one individuals with sleep complaints were evaluated by the Orofacial Myofunctional Evaluation with Scores (OMES) protocol before undergoing polysomnography. The performance of each of the protocol scores in OSA screening was tested. RESULTS: The nonparametric correlation of the apnea-hypopnea index (AHI) was significant for 18 of the 41 variables of the OMES protocol. Cheeks appearance had the best performance, increasing five times the odds for AHI ≥ 15. Its sensitivity was 66%; specificity, 72%; the area under the ROC curve, 0.69; positive and negative likelihood ratios, respectively, 2.38 and 0.47. DISCUSSION: Cheeks appearance may be an instantly visible surrogate of tongue and pharyngeal fat deposition and of muscle function in OSA screening. Adding the item "cheeks appearance" to OSA screening tools and questionnaires may be useful for the identification of OSA risk.