Physical Exertion Recognition Using Surface Electromyography and Inertial Measurements for Occupational Ergonomics.

By observing the actions taken by operators, it is possible to determine the risk level of a work task. One method for achieving this is the recognition of human activity using biosignals and inertial measurements provided to a machine learning algorithm performing such recognition. The aim of this research is to propose a method to automatically recognize physical exertion and reduce noise as much as possible towards the automation of the Job Strain Index (JSI) assessment by using a motion capture wearable device (MindRove armband) and training a quadratic support vector machine (QSVM) model, which is responsible for predicting the exertion depending on the patterns identified. The highest accuracy of the QSVM model was 95.7%, which was achieved by filtering the data, removing outliers and offsets, and performing zero calibration; in addition, EMG signals were normalized. It was determined that, given the job strain index's purpose, physical exertion detection is crucial to computing its intensity in future work.

Biportal Endoscopic Spine Surgery: Clinical Results for 163 Patients.

BACKGROUND: Biportal endoscopy spine surgery is an endoscopic procedure that uses 2 portals, 1 for the endoscope and 1 for the instruments. It provides an excellent and very versatile field of view, with the advantage of another portal to approach the most common degenerative lumbar pathologies. METHODS: We evaluated a retrospective series of patients who underwent biportal endoscopy with ≥1 year of follow-up. Relevant epidemiological and clinical data, such as the Oswestry disability index and visual analog scale for pain, were also considered. Complications and the effects of the learning curve are also discussed. RESULTS: We included 163 patients treated within a 5-year period with ≥1 year of follow-up available. The main pathologies were disc herniation (53.4%), foraminal stenosis (19%), and central canal stenosis (16.6%). The outcomes regarding disability and pain scores after surgery were very good, with a redistribution of the patient sample to the mild categories of disability. Inferential analysis showed relative and absolute improvements for both disc herniation and canal stenosis in terms of the Oswestry disability index and visual analog scale for pain, especially for disc herniation. The incidence of complications was approximately 7%. The most common approach was interlaminar (89%), and the most common pathology was disc herniation (54.9%). The duration of surgery overall and for the different stages had improved at the end of the learning curve with a reduction of almost 58 minutes. CONCLUSIONS: Biportal endoscopy is a minimally invasive procedure that is safe and effective, with a low rate of complications. It has a reproducible learning curve and provides very good outcomes regarding functionality and pain scores.

Morbidity and Mortality Analysis in the Treatment of Intertrochanteric Hip Fracture with Two Fixation Systems: Dynamic Hip Screw (DHS) or Trochanteric Fixation Nail Advance (TFNA).

BACKGROUND: The aim of this study was to compare the clinical outcomes, complications, and mortality of patients with intertrochanteric hip fracture treated with dynamic hip screw (DHS) vs. trochanteric fixation nail advance (TFNA). METHODS: We evaluated 152 patients with intertrochanteric fractures concerning age, sex, comorbidity, Charlson Index, preoperative gait, OTA/AO classification, time from fracture to surgery, blood loss, amount of blood replacement, changes in gait, full weight-bearing at hospital discharge, complications, and mortality. The final indicators encompassed the adverse effects linked to implants, postoperative complications, clinical healing or bone healing duration, and functional score. RESULTS: The study included a total of 152 patients, out of which 78 (51%) received DHS treatment and 74 (49%) received TFNA treatment. The results of this study show that the TFNA group demonstrated superiority (p < 0.001). However, it should be noted that the TFNA group had a higher frequency of the most unstable fractures (AO 31 A3, p < 0.005). Full weight-bearing at discharge also decreased in patients with more unstable fractures (p = 0.005) and severe dementia (p = 0.027). Mortality was higher in the DHS group; however, a longer time from diagnosis to surgery was also observed in this group (p < 0.005). CONCLUSIONS: The TFNA group has shown a higher success rate in achieving full weight-bearing at hospital discharge when treating trochanteric hip fractures. This makes it the preferred choice for treating unstable fractures in this region of the hip. Additionally, it is important to note that a longer time to surgery is associated with increased mortality in patients with hip fractures.

Digital breast tomosynthesis compared to diagnostic mammographic projections (including magnification) among women recalled at screening mammography: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC).

BACKGROUND: Diagnostic mammography projections (DxMM) have been traditionally used in the assessment of women recalled after a suspicious screening mammogram. Digital breast tomosynthesis (DBT) reduces the tissue overlap effect, thus improving image assessment. Some studies have suggested DBT might replace DxMM with at least equivalent performance. OBJECTIVE: To evaluate the replacement of DxMM with DBT in women recalled at screening. METHODS: We searched PubMed, EMBASE, and the Cochrane Library databases to identify diagnostic paired cohort studies or RCTs comparing DBT vs DxMM, published in English that: reported accuracy outcomes, recruited women recalled for assessment at mammography screening, and included a reference standard. Subgroup analysis was performed over lesion characteristics. We provided pooled accuracy estimates and differences between tests using a quadrivariate model. We assessed the certainty of the evidence using the GRADE approach. RESULTS: We included ten studies that reported specificity and sensitivity. One study included 7060 women while the remaining included between 52 and 738 women. DBT compared with DxMM showed a pooled difference for the sensitivity of 2% (95% CI 1%-3%) and a pooled difference for the specificity of 6% (95%CI 2%-11%). Restricting the analysis to the six studies that included women with microcalcification lesions gave similar results. In the context of a prevalence of 21% of breast cancer (BC) in recalled women, DBT probably detects 4 (95% CI 2-6) more BC cases and has 47 (95%CI 16-87) fewer false-positive results per 1000 assessments. The certainty of the evidence was moderate due to risk of bias. CONCLUSION: The evidence in the assessment of screen-recalled findings with DBT is sparse and of moderate certainty. DBT probably has higher sensitivity and specificity than DxMM. Women, health care providers and policymakers might value as relevant the reduction of false-positive results and related fewer invasive diagnostic procedures with DBT, without missing BC cases.

A phase 2 trial of neoadjuvant metformin in combination with trastuzumab and chemotherapy in women with early HER2-positive breast cancer: the METTEN study.

The METTEN study assessed the efficacy, tolerability, and safety of adding metformin to neoadjuvant chemotherapy plus trastuzumab in early HER2-positive breast cancer (BC). Women with primary, non-metastatic HER2-positive BC were randomized (1:1) to receive metformin (850 mg twice-daily) for 24 weeks concurrently with 12 cycles of weekly paclitaxel plus trastuzumab, followed by four cycles of 3-weekly FE75C plus trastuzumab (arm A), or equivalent regimen without metformin (arm B), followed by surgery. Primary endpoint was the rate of pathological complete response (pCR) in the per-protocol efficacy population. pCR rate was numerically higher in the metformin-containing arm A (19 of 29 patients [65.5%, 95% CI: 47.3-80.1]) than in arm B (17 of 29 patients [58.6%, 95% CI: 40.7-74.5]; OR 1.34 [95% CI: 0.46-3.89], P = 0.589). The rate of breast-conserving surgery was 79.3% and 58.6% in arm A and B (P = 0.089), respectively. Blood metformin concentrations (6.2 µmol/L, 95% CI: 3.6-8.8) were within the therapeutic range. Seventy-six percent of patients completed the metformin-containing regimen; 13% of patients in arm A dropped out because of metformin-related gastrointestinal symptoms. The most common adverse events (AEs) of grade ≥3 were neutropenia in both arms and diarrhea in arm A. None of the serious AEs was deemed to be metformin-related. Addition of anti-diabetic doses of metformin to a complex neoadjuvant regimen was well tolerated and safe. Because the study was underpowered relative to its primary endpoint, the efficacy data should be interpreted with caution.

Protein Expression Profile of Twenty-Week-Old Diabetic db/db and Non-Diabetic Mice Livers: A Proteomic and Bioinformatic Analysis.

Type 2 diabetes mellitus is characterized by insulin resistance in the liver. Insulin is not only involved in carbohydrate metabolism, it also regulates protein synthesis. This work describes the expression of proteins in the liver of a diabetic mouse and identifies the metabolic pathways involved. Twenty-week-old diabetic db/db mice were hepatectomized, after which proteins were separated by 2D-Polyacrylamide Gel Electrophoresis (2D-PAGE). Spots varying in intensity were analyzed using mass spectrometry, and biological function was assigned by the Database for Annotation, Visualization and Integrated Discovery (DAVID) software. A differential expression of 26 proteins was identified; among these were arginase-1, pyruvate carboxylase, peroxiredoxin-1, regucalcin, and sorbitol dehydrogenase. Bioinformatics analysis indicated that many of these proteins are mitochondrial and participate in metabolic pathways, such as the citrate cycle, the fructose and mannose metabolism, and glycolysis or gluconeogenesis. In addition, these proteins are related to oxidation⁻reduction reactions and molecular function of vitamin binding and amino acid metabolism. In conclusion, the proteomic profile of the liver of diabetic mouse db/db exhibited mainly alterations in the metabolism of carbohydrates and nitrogen. These differences illustrate the heterogeneity of diabetes in its different stages and under different conditions and highlights the need to improve treatments for this disease.

Fistula aorto-esofágica en un paciente con cáncer de esófago / Aortoesophageal fistula in a patient with esophageal cancer

La fistula aorto-esofágica es una complicación infrecuente del cáncer de esófago, pero extremadamente agresiva. Se presenta un paciente fumador, bebedor ocasional, que ingresa por disnea intensa, tos con expectoración, disfagia y síntomas generales que llevan al diagnóstico de cáncer esofágico mediante esofagoscopia. El paciente fallece al séptimo día del ingreso por hematemesis masiva secundaria a fistula aorto-esofágica (AU)

Aortoesophageal fistula is an infrequent complication of esophageal cancer, but extremely aggressive. The study presents the case of a smoker and occasional drinker that was admitted for intense dyspnea, cough with expectoration, dysphagia and general symptoms that led to a diagnosis of esophageal cancer by esophagoscopy. The patient died at the seventh day of admission for massive hematemesis secondary to an aortoesophageal fistula (AU)

[Contributions of proteomics in the study of diabetes]. / Aportaciones de la proteómica en el estudio de la diabetes.

The incidence of type 2 diabetes mellitus (T2D) is growing rapidly due to aging, urbanization, changes in lifestyle, and increasing prevalence of obesity. In T2D, chronic hyperglycemia leads to macro and micro vascular complications, which currently are serious problem for health systems worldwide. The complexity of T2D and its complications requires study skills of high performance that provide important information in the understanding of the pathophysiology of the disease and biological pathways involved in development of T2D and its complications. In this work we describe the recent contributions of proteomics in the study of T2D and discuss its importance in the identification of therapeutic targets and biomarkers that help to improve the diagnosis of T2D, monitor the disease progression, and the development of new drugs to improve treatment and reduce its complications.

Imaging of breast implants-a pictorial review.

The number of women with breast implants is increasing. Radiologists must be familiar with the normal and abnormal findings of common implants. Implant rupture is a well-known complication after surgery and is the main cause of implant removal. Although mammography and ultrasonography are the standard first steps in the diagnostic workup, magnetic resonance imaging (MRI) is the most useful imaging modality for the characterisation of breast implants because of its high spatial resolution and contrast between implants and soft tissues and absence of ionising radiation. MRI has the highest sensitivity and specificity for implant rupture, thanks to its sequences that can suppress or emphasise the signal from silicone. Regardless of the technique used, the overall aim of imaging breast implants is to provide essential information about tissue and prosthesis integrity, detect implant abnormalities and detect breast diseases unrelated to implants, such as breast cancer.

Formas de diálogo entre actores-agentes del desarrollo territorial sobre políticas institucionales relacionadas con la pobreza / Ways of negotiation between actor-agents of territorial development about institutional policies realted with poverty / Formas de dialogo entre atores – agentes do desenvolvimento territorial sobre politicas institucionais relacionadas com a pobreza

Objetivo: evidenciar de qué manera los diferentes discursos del desarrollo y de la pobreza se encuentran y desencuentran según las percepciones de una lógica institucional y una racionalidad de las poblaciones pobres frente al orden configurado por el Estado. La investigación se realizó en Manizales, entre 2006 y 2009, frente al programa Confamilias Solidarias de la Caja de Compensación Familiar de Caldas, Confamiliares. Material y Método: el método utilizado, el estudio de caso, permitió el análisis de las lógicas familiares e institucionales frente a la pobreza. Resultados. Los resultados se dan en dos partes: una conceptual y otra social. Conceptualmente, se presenta la construcción de tres categorías de análisis para la comprensión del desarrollo, la pobreza, la apropiación del espacio y la racionalidad de los actores. Socialmente, se presentan las reflexiones de los discursos formales y no formales frente a las prácticas familiares e institucionales en la apropiación del territorio de un programa social. Conclusiones: se presenta la configuración de micro-ordenes (estilos de vida) no contemplados en los marcos normativos o esquemas formales que hacen cada vez más evidente el desarrollo desde abajo en el que el capital social y el capital humano siguen siendo retos en las agendas que pretenden lograr los objetivos del milenio.

Objective: The aim of this paper is to evidence how the different discourses of development and poverty meet and disagree depending on the perceptions of an institutional logic and a rationality of the poor population in view of the order set by the State. The study was carried out in Manizales between 2006 and 2009, within the program supportive Confamilias from the Caja de Compensación Familiar de Caldas, CONFAMILIARES. Material and Method: The method used, case study, allowed the analysis of the family and institutional logic in view to poverty. The results are given in two parts: a conceptual part and a social part. Conceptually the construction of three categories of analysis for the comprehension of development, poverty, appropriation of space and rationality of the actors is presented. Socially, the reflection of the formal and non-formal discourses in view to the family and institutional practices in the appropriation of the territory of a social program is presented. Conclusions: The configuration of microorders (life styles) not considered in the normative frameworks or formal schemas which make more and more evident the development seen from the bottom up where the social capital and the human capital continue being remains in the agendas which expect to fulfill the millennium objectives.

Objetivo: evidenciar de que maneira os diferentes discursos do desenvolvimento e da pobreza encontraram se e desencontram se conforme as percepções duma lógica institucional e uma racionalidade das povoações pobres frente à ordem configurada pelo Estado. A pesquisa realizou se em Manizales, entre 2006 e 2009, frente ao programa com famílias solidarias da Caixa de Compensação Familiar de Caldas, Confamiliares. Material e Método: familiares e institucionais frente á pobreza. Os resultados dão se em duas partes: uma conceptual e outra social. Conceitualmente, apresentam se a construção de três categorias de analise para a compreensão do desenvolvimento, a pobreza, a apropriação do espaço e a racionalidade dos atores. Socialmente, apresentam se as reflexões dos discursos formais e não formais frente às praticas familiares e institucionais na apropriação do território dum programa social. Conclusões: apresentam se a configuração de micro-ordens (estilos de vida) não contempladas nos marcos normativas ou esquemas formais que fazem cada vez mais evidente o desenvolvimento desde abaixo no que o capital social e o capital humano seguem sendo retos nas agendas que pretendam lograr os objetivos do milênio.

Diagnosis and screening for cytomegalovirus infection in pregnant women in Cuba as prognostic markers of congenital infection in newborns: 2007-2008.

BACKGROUND: Human cytomegalovirus (HCMV) has established itself as the most significant cause of congenital infection in the developed world. The objective of this research was prenatal identification of pregnant women at risk for developing active infection due to HCMV as well as to diagnose congenitally infected newborns. METHODS: A diagnostic algorithm based on specific immunoglobulin G (IgG), IgM, and, IgG avidity was used to screen serum from 1131 pregnant women enrolled prospectively from 3 municipalities from Havana City, Cuba during 2007-2008. Qualitative multiplex nested PCR and quantitative real time-based PCR testing for HCMV DNA were performed on urine and saliva specimens from women detected with active infection and from their newborns. RESULTS: Most women were seropositive to HCMV (92.7%), with 2.38% (27 women) having active infection. Primary infection was detected in 20 pregnant women (1.77%) while 7 patients (0.62%) had active nonprimary infection. HCMV DNA was detected in specimens from 9 of the 27 pregnant women by both PCR methods. HCMV congenital infection was diagnosed in 12 (1.06%) of the 26 live children born from 25 mothers with active infection, for a vertical transmission rate of 46.2%. Two fetal deaths were reported from 2 women with active infection; furthermore 2 newborns were symptomatic at birth and 2 showed sequelae during the follow-up done until 6 months age. CONCLUSIONS: Mothers with active infection during the pregnancy and with HCMV excretion had significant risks, RR = 1.16 and RR = 1.35, respectively, to have congenitally infected children.

Influence of using manual or automatic breast density information in a mass detection CAD system.

RATIONALE AND OBJECTIVES: The goal of this article is to analyze and compare the performance of a developed mass computer-aided detection (CAD) system that takes breast density information into account when using manual or automatic breast density annotations in the training step. The advantages of considering this breast density information will be highlighted. MATERIALS AND METHODS: The image database used in this article is 92 mediolateral oblique (MLO) and 92 craniocaudal (CC) mammograms obtained by a full-field digital mammographic unit. All mammograms contain at least one mass. The evaluation of the experiments is performed using free receiver operating characteristic analysis for evaluating the detection performance and pixel-based receiver operating characteristic analysis for evaluating the segmentation accuracy. In addition, the performance of the automatic breast density classifier is shown using confusion matrices. RESULTS: When the breast density information is not considered and at a specificity of two false positives per image, the sensitivity obtained by the CAD system is 0.747 for the CC views and 0.853 for the MLO views. Considering the breast density information, the sensitivity for CC and MLO mammograms increases to 0.800 and 0.893, respectively, using manual classification, and 0.827 and 0.907, respectively, using automatic estimation. The same trend is observed when evaluating the CAD segmentation accuracy for detected masses in terms of area under the curve values: without considering breast density, these are 0.920 +/- 0.057 and 0.917 +/- 0.072; using manual classification, 0.934 +/- 0.039 and 0.932 +/- 0.046; and using automatic estimation, 0.947 +/- 0.038 and 0.946 +/- 0.045 for CC and MLO views, respectively. CONCLUSIONS: The experiments showed improved results when breast density information was taken into account. Moreover, the results obtained when using automatic breast density estimation outperformed those based on the manual annotations provided by expert radiologists. In this sense, the experiments showed that breast density information can be beneficial for CAD systems, and this information can be estimated robustly by an automatic procedure, which reduces the inter- and intra-class variability of the radiologists.

A review of automatic mass detection and segmentation in mammographic images.

The aim of this paper is to review existing approaches to the automatic detection and segmentation of masses in mammographic images, highlighting the key-points and main differences between the used strategies. The key objective is to point out the advantages and disadvantages of the various approaches. In contrast with other reviews which only describe and compare different approaches qualitatively, this review also provides a quantitative comparison. The performance of seven mass detection methods is compared using two different mammographic databases: a public digitised database and a local full-field digital database. The results are given in terms of Receiver Operating Characteristic (ROC) and Free-response Receiver Operating Characteristic (FROC) analysis.

A statistical approach for breast density segmentation.

Studies reported in the literature indicate that the increase in the breast density is one of the strongest indicators of developing breast cancer. In this paper, we present an approach to automatically evaluate the density of a breast by segmenting its internal parenchyma in either fatty or dense class. Our approach is based on a statistical analysis of each pixel neighbourhood for modelling both tissue types. Therefore, we provide connected density clusters taking the spatial information of the breast into account. With the aim of showing the robustness of our approach, the experiments are performed using two different databases: the well-known Mammographic Image Analysis Society digitised database and a new full-field digital database of mammograms from which we have annotations provided by radiologists. Quantitative and qualitative results show that our approach is able to correctly detect dense breasts, segmenting the tissue type accordingly.

Eigendetection of masses considering false positive reduction and breast density information.

The purpose of this article is to present a novel algorithm for the detection of masses in mammographic computer-aided diagnosis systems. Four key points provide the novelty of our approach: (1) the use of eigenanalysis for describing variation in mass shape and size; (2) a Bayesian detection methodology providing a mathematical sound framework, flexible enough to include additional information; (3) the use of a two-dimensional principal components analysis approach to facilitate false positive reduction; and (4) the incorporation of breast density information, a parameter correlated with the performance of most mass detection algorithms and which is not considered in existing approaches. To study the performance of the system two experiments were carried out. The first is related to the ability of the system to detect masses, and thus, free-response receiver operating characteristic analysis was used, showing that the method is able to give high accuracy at a high specificity (80% detection at 1.40 false positives per image). Second, the ability of the system to highlight the pixels belonging to a mass is studied using receiver operating characteristic analysis, resulting in A(z) = 0.89 +/- 0.04. In addition, the robustness of the approach is demonstrated in an experiment where we used the Digital Database for Screening Mammography database for training and the Mammographic Image Analysis Society database for testing the algorithm.

Comunicación social en salud / Social communication in health

De un profesional de la salud se espera que sea un buen comunicador como parte de su diaria labor. Se realiza por ello una reflexión sobre el tema Comunicación en salud, en la que se tratan los principios de la comunicación, como el respeto al criterio ajeno, la comprensión como fin, la visión competitiva de la comunicación, así como la valoración de la cooperación comunicativa y la calidad del punto de vista personal e interactivo. Se realizan también un grupo de recomendaciones para una buena escucha y una buena emisión, y se explican cómo crear climas defensivos y de apoyo, así como la manera de dialogar en forma constructiva(AU)

Comunicación social en salud / Social communication in health

De un profesional de la salud se espera que sea un buen comunicador como parte de su diaria labor. Se realiza por ello una reflexión sobre el tema Comunicación en salud, en la que se tratan los principios de la comunicación, como el respeto al criterio ajeno, la comprensión como fin, la visión competitiva de la comunicación, así como la valoración de la cooperación comunicativa y la calidad del punto de vista personal e interactivo. Se realizan también un grupo de recomendaciones para una buena escucha y una buena emisión, y se explican cómo crear climas defensivos y de apoyo, así como la manera de dialogar en forma constructiva

Methods of the National Nutrition Survey 1999.

OBJECTIVE: To describe the methods and analyses of the 1999 National Nutrition Survey (NNS-99). MATERIAL AND METHODS: The 1999 National Nutrition Survey (NNS-99) is a probabilistic survey with nationwide representativity. The NNS-99 included four regions and urban and rural areas of Mexico. The last sampling units were households, selected through stratified cluster sampling. The study population consisted of children under five years of age, school-age children (6-11 years), and women of childbearing age (12-49 years). Data were collected on anthropometric measurements, hemoglobin levels, morbidity and its determinants, and socioeconomic and demographic characteristics. In addition, data on diet and micronutrients intakes (iron, zinc, vitamin A, folic acid, vitamin C, and iodine) were obtained in a sub-sample of subjects. RESULTS: The response rate for the NNS-99 was 82.3%; the non-response rate was 5.9% and the remaining did not participate due to uninhabited houses. CONCLUSIONS: This survey updates the information on nutritional status in Mexico and should serve as the basis for food and nutrition policy-making and priority program design. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

Methods of the National Nutrition Survey 1999

OBJETIVO: Describir la metodología y análisis de la Encuesta Nacional de Nutrición 1999 (ENN-99). MATERIAL Y MÉTODOS: La ENN-99 es probabilística, con representatividad nacional de cuatro regiones y estratos urbano/rural. Las unidades últimas de muestras son los hogares seleccionados por muestreo estratificado y por conglomerados. La población de estudio fueron los niños menores de cinco años de edad, los niños 6-11 años (escolares) y las mujeres de 12-49 años, en quienes se obtuvieron mediciones antropométricas, niveles de hemoglobina, información sobre morbilidad y sus determinantes, datos socieconómicos y demográficos, y en una submuestra se determinaron micronutrimentos (hierro, zinc, vitamina A, ácido fólico, vitamina C, yoduria) y se obtuvo información sobre dieta. RESULTADOS: La Encuesta obtuvo una tasa de respuesta de 82.3 por ciento, la no respuesta se asoció en 5.9 por ciento a no respuesta del informante y el resto fue ocasionado por no estar habitadas las viviendas seleccionadas. CONCLUSIONES: La información obtenida a través de esta encuesta actualiza la información existente en nuestro país y es la base para la formulación de políticas y programas prioritarios.

Prevención y control de desordenes de la voz en los docentes / Prevention and voice disorders control in teachers

La presencia de problemas en la voz es frecuente en docentes, debido a que ellos requieren para el desempeño de sus funciones un uso vocal continuo y la mayoría no han recibido información ni instrucción sobre la voz y el uso adecuado de la misma. Estos problemas se pueden prevenir si se realiza un efectivo control de los riesgos ocupacionales que pueden desencadenar desordenes de la voz. El control de estos riesgos es responsabilidad de docentes, Instituciones educativas a lo largo de su formación, empleadores y servicios de salud, y cada uno de estos grupos debe tomar conciencia sobre la importancia. En este artículo se resume los principales factores de riesgo para los profesores y las repercusiones que estos tienen sobre la voz; proporciona información sobre como detectar los primeros síntomas de un problema de voz y estar alerta para controlarlos a tiempo. La información presentada permite conocer las principales áreas de trabajo para llegar a optimizar el acto vocal y proporciona recomendaciones prácticas para los cuidados de la voz.