RESUMO
El presente estudio explora evidencia sobre la evaluación de la deglución, usando la técnica de ultrasonido. En relación a la estrategia búsqueda, la revisión se desarrolló en PubMed y Scielo, utilizando una adaptación de las recomendaciones del manual Cochrane para revisiones sistemáticas. Se seleccionaron los términos "Deglutition" "Swallowing", "Ultrasonography" y "Ultrasound" en inglés y en español. Se incluyeron inicialmente estudios originales publicados entre enero del 2000 y enero del 2019. De acuerdo con los criterios de elegibilidad, se incluyeron 24 artículos originales sobre el uso de ultrasonido para evaluar algún aspecto de la deglución en las etapas oral y faríngeas. Los artículos seleccionados ofrecen datos cuantitativos de parámetros e indicadores de la deglución. A partir de estos estudios, se recogió información cualitativa y cuantitativa sobre la movilidad lingual, la elevación laríngea, la movilidad faríngea lateral, la movilidad del hioides, la movilidad del músculo genihioideo, la apertura del esfínter esofágico superior, el cierre glótico, además de estudios sobre la posibilidad de detectar episodios de penetración laríngea y aspiración. Los resultados sugieren que existe evidencia positiva sobre la utilidad del ultrasonido para evaluar la deglución, sin embargo, se requiere de más estudios que analicen la eficiencia diagnóstica en población con disfagia.
The present study explores evidence on swallowing assessment using ultrasound technique. Regarding the search strategy, the review was carried out in PubMed and Scielo, using an adaptation of the recommendations from the Cochrane manual for systematic reviews. The terms "Deglutition" "Swallowing", "Ultrasonography" and "Ultrasound" were selected in English and Spanish. Original studies published between January 2000 and January 2019 were initially selected. According to the elegibility criteria, 24 original studies dealing with the use of ultrasound to evaluate some aspect of swallowing in both oral and pharyngeal stages. Selected articles offer quantitative data on swallowing parameters and indicators. From these studies, qualitative and quantitative information on lingual mobility, laryngeal elevation, lateral pharyngeal mobility, hyoid mobility, genihyoid muscle mobility, upper esophageal sphincter opening, glotic closure was collected, in addition to studies on the possibility of detecting episodes of laryngeal penetration and aspiration. The results suggest that there is positive evidence on the usefulness of ultrasound to assess swallowing, however, more studies are required to analyze diagnostic efficiency in a population with dysphagia.
Assuntos
Ultrassonografia/métodos , Deglutição/fisiologiaRESUMO
Intensification of the use of natural resources is a world-wide trend driven by the increasing demand for water, food, fibre, minerals and energy. These demands are the result of a rising world population, increasing wealth and greater global focus on economic growth. Land use intensification, together with climate change, is also driving intensification of the global hydrological cycle. Both processes will have major socio-economic and ecological implications for global water availability. In this paper we focus on the implications of land use intensification for the conservation and management of freshwater ecosystems using Australia as an example. We consider this in the light of intensification of the hydrologic cycle due to climate change, and associated hydrological scenarios that include the occurrence of more intense hydrological events (extreme storms, larger floods and longer droughts). We highlight the importance of managing water quality, the value of providing environmental flows within a watershed framework and the critical role that innovative science and adaptive management must play in developing proactive and robust responses to intensification. We also suggest research priorities to support improved systemic governance, including adaptation planning and management to maximise freshwater biodiversity outcomes while supporting the socio-economic objectives driving land use intensification. Further research priorities include: i) determining the relative contributions of surface water and groundwater in supporting freshwater ecosystems; ii) identifying and protecting freshwater biodiversity hotspots and refugia; iii) improving our capacity to model hydro-ecological relationships and predict ecological outcomes from land use intensification and climate change; iv) developing an understanding of long term ecosystem behaviour; and v) exploring systemic approaches to enhancing governance systems, including planning and management systems affecting freshwater outcomes. A major policy challenge will be the integration of land and water management, which increasingly are being considered within different policy frameworks.
