Pediatric Dysphonia and the Access to Voice Therapy: A Study in Speech Therapy Services Available in a Capital City in the Northeast of Brazil.

OBJECTIVES: Defining the laryngeal and vocal alterations in the pediatric group studied in private speech therapy facilities; and estimating the time period between the problem being identified by the parents and the access to the proper provided services. METHODS: A cross-sectional analytical observational research with data collected from medical records by the speech therapist of each private facility. A written form was prepared and sent to the speech therapists of the 40 existing facilities. We received 124 of them from the pediatric group being assisted in 15 of the facilities. The form included questions about gender, age, vocal complaints; general degree of dysphonia; otorhinolaryngological diagnosis of vocal fold alterations; the age that the problem was identified by the parents and the beginning of speech therapy. The larynx was examined by videonasopharyngolaryngoscopy, and voice quality by auditory-perceptual assessment. RESULTS: The time period between the identification of the participant's dysphonia by the parents and the start of speech therapy was considered long (3.5years). The group showed variance in the proportion of nodule and cyst between genders. The highest prevalence of nodules occurred in boys; and the cyst in girls. Moderate general dysphonia occurred between 4 and 17years old, average age of 7years and 7months, with greater distribution between 5 and 10years of age. CONCLUSIONS: The average time delay until the start of speech therapy was 3.5years, more frequently in the 5-10years group and due to nodules in boys and cysts in girls.

Descripción clínica y epidemiológica de los pacientes con colitis ulcerativa en un hospital universitario de Colombia / Clinical and epidemiological description of patients with ulcerative colitis in a university hospital in Colombia

Introducción y objetivo: La colitis ulcerativa (CU) es una enfermedad inflamatoria intes-tinal crónica limitada a la mucosa del colon, caracterizada por ser difusa y continua. El objetivo es identificar las principales características de los pacientes con diagnóstico de CU. Métodos: Estudio observacional, descriptivo, de corte transversal retrospectivo. La población de estudio fueron pacientes del hospital universitario. Resultados: Un total de 30 pacientes fueron analizados. El promedio de edad fue de 53,86 años. El 46,7% fueron hombres. Los pacientes presentaron diarrea (90%), hematoquecia (86,7%), dolor abdominal (83,3%), fiebre (26,7%), astenia y adinamia (26,7%), pérdida de peso (16,7%). En un paciente se asoció a espondilitis anquilosante y otro a colangitis esclerosante primaria.

Autoavaliação da comunicação em promotores de justiça em um estado do nordeste, Brasil / Communication self-assessment by public prosecutors in a north-eastern Brazilian state

RESUMO Objetivo Descrever a autoavaliação do promotor de justiça quanto à sua comunicação e reação do ouvinte e analisar a relação com o gênero, idade e anos de trabalho. Método Desenho descritivo, transversal. Foi elaborado um questionário e enviado aos 126 promotores, sendo devolvidos 33 questionários preenchidos. As variáveis independentes foram o gênero, idade e anos do exercício profissional. As variáveis dependentes foram a autoavaliação da comunicação ao longo dos anos de trabalho, os parâmetros de comunicação utilizados e a reação do ouvinte. Foi realizada análise descritiva e o Teste Exato de Fisher. Resultados A amostra foi constituída por ambos os gêneros, mediana de 43 anos de idade e 20 anos de trabalho. A maioria dos respondentes referiu que ao falar em público sente desmotivação, insegurança, tensão e dificuldade de persuadir o ouvinte. Houve maior proporção em mulheres de piora da comunicação ao longo dos anos de trabalho que em homens. Todas as mulheres relataram insegurança ao falar em público. Um terço dos promotores referiu alteração de voz. Os respondentes com mais de 43 anos de idade tiveram maior proporção de voz alterada que aqueles com idade menor. A maioria dos promotores com mais de 20 anos de trabalho revelou insegurança ao falar em público comparado com aqueles com idade menor. Conclusão Os promotores identificam seus parâmetros fortes e fracos da comunicação. O gênero, idade e tempo de profissão influenciam o desempenho comunicativo.

ABSTRACT Purpose To describe how public prosecutors self-assess their communication approaches and how listeners react to them; to analyze how this relates to gender, age, and work experience. Methods Descriptive, transversal study. A questionnaire was developed and sent to 126 public prosecutors for completion. Thirty-three completed questionnaires were sent back. The independent variables were gender, age, and number of years of professional experience. The dependent variables were communication self-assessment throughout the years of work, communication parameters used, and listeners’ reactions. A descriptive analyzis and Fisher’s Exact Test was carried out. Results the sample contained both male and female participants with a median age of 43 years and an average of 20 years of professional experience. Most of the respondents claimed they had experienced demotivation, insecurity, tension, and difficulty when trying to convince listeners. More women than men reported they felt that their communication had worsened throughout their careers. All the women reported they experienced insecurity when speaking in public. One third of the public prosecutors stated they suffered from disorders on their voice. Those respondents aged over 43, experienced greater proportion on voice change than younger ones. In contrast to their younger colleagues, the majority of public prosecutors with more than 20 years of professional experience revealed that they felt insecure when speaking in public. Conclusion the public prosecutors identified their strong and weak communication parameters. Gender, age, and work experience affect communicative performance.

Communication self-assessment by public prosecutors in a north-eastern Brazilian state. / Autoavaliação da comunicação em promotores de justiça em um estado do nordeste, Brasil.

PURPOSE: To describe how public prosecutors self-assess their communication approaches and how listeners react to them; to analyze how this relates to gender, age, and work experience. METHODS: Descriptive, transversal study. A questionnaire was developed and sent to 126 public prosecutors for completion. Thirty-three completed questionnaires were sent back. The independent variables were gender, age, and number of years of professional experience. The dependent variables were communication self-assessment throughout the years of work, communication parameters used, and listeners' reactions. A descriptive analyzis and Fisher's Exact Test was carried out. RESULTS: the sample contained both male and female participants with a median age of 43 years and an average of 20 years of professional experience. Most of the respondents claimed they had experienced demotivation, insecurity, tension, and difficulty when trying to convince listeners. More women than men reported they felt that their communication had worsened throughout their careers. All the women reported they experienced insecurity when speaking in public. One third of the public prosecutors stated they suffered from disorders on their voice. Those respondents aged over 43, experienced greater proportion on voice change than younger ones. In contrast to their younger colleagues, the majority of public prosecutors with more than 20 years of professional experience revealed that they felt insecure when speaking in public. CONCLUSION: the public prosecutors identified their strong and weak communication parameters. Gender, age, and work experience affect communicative performance.

Ações de graduandos de Fonoaudiologia em Centro de Referência em Educação Especial do Nordeste / Speech Language Pathology under graduates Interventions in a SpecialEducation Reference Center from Brazilian Northeast / Acciones de graduandos em Fonoaudiología en el Centro de Referencia en Educación Especial del Nordeste

O objetivo desta comunicação é descrever ações de fonoaudiologia no Centro de Referência em Educação Especial, junto aos usuários e familiares, realizadas por graduandos de uma universidade do Nordeste do Brasil. Trata-se de estudo longitudinal aprovado pelo CEP(Conselho de Ensino e Pesquisa). Os dados foram coletados em prontuários e em relatos de pais e discentes e as ações ocorreram no único Centro de Referência em Educação Especial do Estado. Foram realizadas ações fonoaudiológicas individuais e grupais pelos discentes sob supervisão, encaminhando a esse Centro 47 escolares provenientes de serviços de Saúde e de Educação, de diferentes municípios, com queixas de dificuldades de linguagem/ aprendizagem. A amostra final constituiu-se de 27 usuários, 19 (70%) meninos e 23 (85%) inseridos em ensino regular. Os usuários foram organizados em oito grupos, participando de cinco oficinas de linguagem conduzidas por duplas de graduandos sob supervisão docente. Os pais participaram de dois encontros. Após as oficinas, observou-se favorecimento dos aspectos linguístico-cognitivos e de interação do grupo estudado, além de se ter propiciado espaço de escuta para os responsáveis. Os resultados evidenciam a eficácia das ações a partir da evolução das crianças e dos adolescentes e também a partir dos depoimentos dos familiares e dos graduandos. Os usuários foram encaminhados para atendimento fonoaudiológico na Clínica-Escola da Universidade, considerando-se o sistema de referência e contrarreferência entre os serviços. Os futuros profissionais tiveram a oportunidade de experienciar ações de fonoaudiologia norteadas pela Promoção da Saúde, no âmbito da educação inclusiva, contribuindo para o desenvolvimento do grupo estudado com repercussão em seu processo de inclusão sócio educacional.

The aim is to describe SLP activities carried out by undergraduates of a university in the Northeast of Brazil at a Reference Center for Special Education. It?s a longitudinal study approved by CEP. Data was collected from records and statements made by users? parents and the SLP students. The activities took place at the only Reference Center in the state and included supervised SLP individuals and groups activities carried out by the undergraduates. Among the students referred to the center were 47 with speech and language/learning problems, beneficiaries of other public services from different municipalities. The sample group was made up of 27 participants, 19 (70%) boys and 23 (85%) coming from mainstreameducation. The participants were allocated to eight groups and took part in five language workshops, run by two undergraduates and supervised by a tutor, while the participants? parents were invited to two meetings. Apart from giving the parents the opportunity to receive advice, the workshops proved to favour linguistic-cognitive abilities and to improve the interaction in the researched group. For further SLP treatment, the participants were referred to the school clinic of the university, considering the reference and counter-reference system between services. Both, the development the users underwent and the parents? and undergraduate students? testemonies show that activities were effective. The future professionals had the opportunity to experience SLP activities aiming to promote health in the areaof inclusive education, besides made a contribution to the further development and process of socioeducational inclusion of the researched group.

El objetivo de esta comunicación es describir acciones de fonoaudiología en el Centro de Referencia en Educación Especial junto a usuarios y sus familiares, realizadas por graduandos de una universidad delnordeste de Brasil. Es un estudio longitudinal aprobado por el Consejo de Enseñanza e Investigación de una universidad. Los datos fueron recolectados por medio de informes y del relato de padres y discentes.Las acciones ocurrieron en el único Centro de Referencia en Educación Especial del estado. Los discentes realizaron acciones fonoaudiológicas individuales y en grupobajo supervisión y direccionaron a eseCentro 47 estudiantes de servicios de Salud y de Educación, de distintos municipios, con dificultades de lenguaje/aprendizaje. La muestra final constó de 27 usuarios, de los cuales 19(70%)eran niños y 23(85%) estaban inseridos en la enseñanza regular. Los usuarios fueron divididos en ocho grupos y participaron de cinco talleres de lenguaje, conducidos por parejas de graduandos bajo supervisión docente. Los padres participaron de dos encuentros. Tras los talleres, se observó una mejora en los aspectos lingüístico-cognitivos y de interacción del grupoestudiado, además de haberse propiciado espacio para escuchar a losresponsables por los niños. Los resultados demuestran la eficacia de las acciones a partir de la evolución de losniños y de los adolescentes y también por los testimonios de familiares y graduandos. Los usuarios fueron dirigidos a la Clínica-Escuela de la Universidad para recibir atención fonoaudiológica, gracias a un convenio entre los sistemas de educación y salud. Los futuros profesionales tuvieron la oportunidad de experimentar acciones fonoaudiológicas para la Promoción de la Salud en el ámbito de la educación inclusiva, lo que contribuyó con el desarrollo del grupo e influyó en su proceso de inclusión socio educacional.

Vocal function and vocal discomfort in sheltered and non-sheltered 7- to 10-year-old school children in Aracaju, Brazil.

OBJECTIVE: To compare vocal function, school performance, and vocal discomfort between sheltered and nonsheltered school children in Aracaju, Brazil. METHODS: A controlled cross-sectional study was carried out on 7- to 10-year-old children who attended school regularly. Two groups of children were studied: the study group (SG), with children who lived in a shelter, and the control group (CG) containing children who lived with their families. We interviewed 44 children for the SG and 15 (34%) revealed vocal discomfort (SG = 15). Concomitantly, we interviewed 400 regular school children from the same geographical area and 45 (11.25%) were selected for the control group (CG). They were paired by sex and age with the sheltered children using a 3:1 ratio. Both groups were interviewed about school performance and vocal discomfort and were evaluated using perceptual and acoustic measurements for the voice and larynx. RESULTS: Children from both groups had started public school late. There were more individuals with vocal discomfort in the SG and individuals in this group also had a slower speech rate and inadequate pneumophonic coordination compared with the CG. The Dysphonia Severity Index (DSI) revealed mild-moderate deviation for both groups. Upper harmonics and palatal tonsil hypertrophy were higher in the CG, whereas laryngeal constriction was more common in the SG. CONCLUSION: All the SG children revealed mild-moderate deviance on the DSI, a higher level of vocal discomfort, a slow speech rate, inadequate pneumophonic coordination, and laryngeal constriction. The results here presented suggest that social conditions are important for voice behavior in children.

Estimating the number of street children and adolescents in two cities of Brazil using capture-recapture.

AIM: To use the capture-recapture method to estimate the number of street children and adolescents in Maceió and Arapiraca, north-east Brazil, and describe the characteristics of the two populations. METHODS: The number of children and adolescents on the street in Maceió and Arapiraca was estimated using the multi-list capture-recapture method. Two street surveys and an official list from the social services department were compared. The characteristics of the children were recorded during the street surveys using a questionnaire. RESULTS: The estimated number of street children and adolescents was 5225 in Maceió and 1191 in Arapiraca. According to the official records, the population registered was 565 and 157, respectively. Most individuals were male (71.4% and 71.8%, respectively). They still maintain contact with their families (85.5% in Maceió and 89.6% in Arapiraca) and attend school regularly (43.4% and 49.7%). Drug use was admitted by 46.9% of the individuals in Maceió and by 26.9% in Arapiraca. In both cities, glue inhalation, associated or not with other drugs, was most frequently cited. CONCLUSIONS: Children and adolescents on the streets are a common and underestimated occurrence in Maceió and Arapiraca. They have similar characteristics to street children from other countries and other cities in Brazil. The method of capture-recapture seems to be suited to study populations such as street children.

[Corneal thickness progression from the thinnest point to the limbus: study based on a normal and a keratoconus population to create reference values]. / Progressão da espessura corneana do ponto mais fino em direção ao limbo: estudo de uma população normal e de portadores de ceratocone para criação de valores de referência.

PURPOSE: To study the variation and progression of the pachymetric values from the thinnest point towards the limbus in normal and keratoconic corneas; to establish reference curves for this parameter. METHODS: One hundred eyes with normal corneas and twenty-five eyes with mild keratoconus (stages I and II - Krumeich) were analyzed using the Orbscan. Concentric circles were drawn on the thinnest point of the cornea with increasing radii from 1 to 7 mm. The average results of each circle were calculated and inserted in an Excel table in order to arrange a progression chart for each case starting on the thinnest point. The SPSS software was also used for statistical analysis. Student's t test was then used to compare the found values. RESULTS: The average values on the thinnest point in normal patients was 511.6 microm (standard deviation 30.6). The average values of the thinnest point in patients with keratoconus was 424.4 microm (standard deviation 56.57). Statistically significant different values were reported (p<0.01) for all circles, and for 6 and 7 mm radii p=0.01. CONCLUSION: There is a greater pachymetric variability in patients with keratoconus. Keratoconic corneas also have a faster progression of pachymetric values than healthy eyes. Pachymetric progression complements traditional single point evaluation of corneal thickness and must be considered for the screening at refractive candidates. This parameter may represent an indirect index of the biomechanics of corneal tissue but this hypothesis still needs further studies.

Progressão da espessura corneana do ponto mais fino em direção ao limbo: estudo de uma população normal e de portadores de ceratocone para criação de valores de referência / Corneal thickness progression from the thinnest point to the limbus: study based on a normal and a keratoconus population to create reference values

OBJETIVO: Estudar a variação e a progressão dos valores paquimétricos, a partir do ponto mais fino da córnea em direção ao limbo em pacientes normais e com ceratocone; elaborar curvas de referência para esse parâmetro. MÉTODOS: Utilizando-se o mapa paquimétrico numérico do Orbscan, 100 olhos considerados normais e 25 olhos com diagnóstico de ceratocone estágios I e II (Krumeich) foram analisados. Foram demarcadas circunferências concêntricas no ponto mais fino da córnea, com raios crescentes de 1 a 7 mm. As médias dos pontos de cada circunferência foram calculadas para cada raio e inseridas numa planilha Excel, de modo a possibilitar a criação de um gráfico de progressão para cada caso, a partir do ponto mais fino. O software SPSS foi utilizado para estudos estatísticos. Utilizou-se o teste t de Student como ferramenta para comparação dos valores encontrados. RESULTADOS: A média dos valores no ponto mais fino dos pacientes normais foi igual a 511,60 µm (desvio padrão de 30,60). A média dos valores do ponto mais fino dos pacientes portadores de ceratocone foi 424,48 µm (desvio padrão de 56,57). Observaram-se diferenças estatisticamente significativas na comparação dos valores médios de todas as circunferências (p<0,01), sendo que para os valores de 6 mm e 7 mm, observou-se p=0,01. CONCLUSÃO: Há maior variabilidade de valores paquimétricos nas córneas com ceratocone, bem como há progressão mais acentuada que em olhos normais. A progressão paquimétrica representa uma complementação à propedêutica tradicional da paquimetria pontual central que deve ser considerada no pré-operatório de cirurgias refrativas. Pode também representar índice indireto da biomecância do tecido corneano, sendo que essa hipótese merece mais estudos futuros.

PURPOSE: To study the variation and progression of the pachymetric values from the thinnest point towards the limbus in normal and keratoconic corneas; to establish reference curves for this parameter. METHODS: One hundred eyes with normal corneas and twenty-five eyes with mild keratoconus (stages I and II - Krumeich) were analyzed using the Orbscan. Concentric circles were drawn on the thinnest point of the cornea with increasing radii from 1 to 7 mm. The average results of each circle were calculated and inserted in an Excel table in order to arrange a progression chart for each case starting on the thinnest point. The SPSS software was also used for statistical analysis. Student's t test was then used to compare the found values. RESULTS: The average values on the thinnest point in normal patients was 511.6 µm (standard deviation 30.6). The average values of the thinnest point in patients with keratoconus was 424.4 µm (standard deviation 56.57). Statistically significant different values were reported (p<0.01) for all circles, and for 6 and 7 mm radii p=0.01. CONCLUSION: There is a greater pachymetric variability in patients with keratoconus. Keratoconic corneas also have a faster progression of pachymetric values than healthy eyes. Pachymetric progression complements traditional single point evaluation of corneal thickness and must be considered for the screening at refractive candidates. This parameter may represent an indirect index of the biomechanics of corneal tissue but this hypothesis still needs further studies.

Distribuição espacial do baixo peso ao nascer em Sergipe, Brasil, 1995/1998 / Space distribution of low birth weight in Sergipe, Brazil, 1995/1998

O estudo analisa a distribuição espacial do baixo peso ao nascer em Sergipe, Brasil, avaliando o evento como indicador de saúde. A análise foi feita a partir de 166.312 nascimentos vivos dos 75 municípios, numa abordagem ecológica. Foram utilizados quatro métodos: clusters analysis, análise de correlação, análise de regressão múltipla e multiple comparisons (Tukey). O estudo evidencia homogeneidade interna dos municípios nos distritos de saúde e nos grupos resultantes do dendrograma. Considerando 10,00 por cento de perda de informação, identifica-se a presença de sete grupos, sendo dois resíduos (Aracaju e Porto da Folha). A evolução do baixo peso ao nascer, em Sergipe, é declinante (média de 6,97 por cento no período) e reflete tímida melhoria da qualidade de vida. As suas causas indicam relações com o ambiente e são influenciadas pelos padrões de ocupação do espaço. O percentual do baixo peso ao nascer é útil como indicador de risco individual, porém, como indicador coletivo de saúde, não parece ser capaz de expressar diferenças entre regiões que não apresentam variabilidade acentuada entre si.

[Space distribution of low birth weight in Sergipe, Brazil, 1995/1998]. / Distribuição espacial do baixo peso ao nascer em Sergipe, Brasil, 1995/1998.

This study analyzes the spatial distribution of low birth weight (LBW) in the State of Sergipe, Brazil, evaluating the event as a health indicator. The analysis was based on 166,312 live births in the 75 municipalities in the State, using an ecological approach. Four methods were used: cluster analysis, correlation analysis, multiple regression analysis, and multiple comparisons (Tukey). The study shows internal homogeneity in the municipalities' health districts and in the groups resulting from the cluster analysis. Considering a 10% loss of information, seven groups were identified, two of which were residues (Aracaju and Porto da Folha). There is a downward trend in LBW in Sergipe (with a mean of 6.97% during the period), reflecting a slight improvement in quality of life. The causes suggest relations with the environment and are influenced by spatial occupation patterns. The percentage of LBW is a useful indicator of individual risk, but as a collective health indicator it does not appear capable of expressing differences between regions that do not display strong inter-variability.