Relationship Between Chloroquine or Hydroxychloroquine Use and Hearing Disorders: A Systematic Review and Meta-Analysis.

Background and Objectives: Chloroquine and its analog hydroxychloroquine are derivatives of 4-aminoquinoline and are regularly used in the treatment of malaria and autoimmune diseases. Among the side effects of these drugs, alterations associated with the auditory system are frequently mentioned. Thus, the aim of this systematic review is to systematically review publications on hearing disorders and chloroquine or hydroxychloroquine use. Materials and Methods: Inclusion criteria were observational or interventional studies on audiological assessment in participants who were using chloroquine or hydroxychloroquine. The methodological quality was independently assessed by two reviewers using the Meta-Analysis of Statistics: assessment and review Instrument. The certainty of the evidence was assessed using the GRADE tool. Results: A total of 1,372 non-duplicate papers were screened, out of which 17 were included in the final qualitative synthesis, and 5 studies in the meta-analysis. The odds ratio for the two subgroups evaluated did not show significance with no heterogeneity between the effects observed between the different diseases (I2=0%) and obtaining the global estimate of 0.76 (95% confidence interval [CI]=0.41-1.39; p>0.05). Despite the inclusion of papers with different disease samples, the heterogeneity observed in the analysis was low (I2= 0%) and prediction interval (95% PI=0.32-1.80; p>0.05) remained close to that estimated by the CI (95% CI=0.41-1.39; p>0.05). The certainty of the evidence assessed by the GRADE tool was considered very low due to the risk of bias, indirect evidence, and imprecision. Conclusions: The findings of this study suggest that the use of chloroquine/hydroxychloroquine is not associated with hearing disorders.

Impact of the COVID-19 pandemic on the sleep quality of students: A meta-analysis and meta-regression.

OBJECTIVE: The present systematic review aims to assess the impact of the COVID19 pandemic on the sleep quality of students. METHODS: An electronic search was performed in the databases and in gray literature for articles published up to January 2022. The results included observational studies that assessed sleep quality through validated questionnaires, comparing moments pre and postCOVID19 pandemic. The risk of bias was assessed using the Joanna Briggs Institute Critical Assessment Checklist. The Grading of Assessment, Development and Evaluation (GRADE) was used to assess the certainty of scientific evidence. Estimates of interest were calculated using random effects meta-analyses and possible confounding factors were meta-regressed. RESULTS: Eighteen studies were considered for qualitative synthesis and thirteen were considered for meta-analysis. Considering the comparison of means obtained by the Pittsburgh Sleep Quality Index, there was an increase in the scores obtained during the pandemic period [MD = -0.39; 95% CI = -0.72 - -0.07; I2 = 88.31%], thus evidencing a slight worsening in the sleep quality of these individuals. Risk of bias was considered low in nine studies, moderate in eight studies, and high in one study. The unemployment rate (%) in the country of origin of each included study partially explained the heterogeneity of analysis. GRADE analysis showed a very low certainty of scientific evidence. CONCLUSION: The COVID-19 pandemic may have a slight negative impact on the sleep quality of high school and college students, but the evidence is still uncertain. The socioeconomic reality must be considered when evaluating this outcome.

Accessibility to manage the obstructive sleep apnea within the Brazilian Unified Health System.

OBJECTIVE: To measure the average time for the diagnosis and for the therapeutic prescription of Continuous Positive Airway Pressure (CPAP) at a hospital in Botucatu Medical School - State University São Paulo, UNESP. METHOD: A retrospective observational study was carried out by collecting data from the electronic medical records of patients over 18-years of age, who had a diagnostic polysomnography testing scheduled between January and December 2017. RESULT: Of the 347 patients eligible for the study, 94 (27.1%) missed follow-up and 103 (29.7%) had a referral for CPAP use. Until February 2021, only 37 (35.9%) of these patients had already acquired and were using the device, the remaining 66 (64.1%) were waiting or gave up the therapy. The mean value of the waiting time interval between the referral of the diagnostic test and its performance was equivalent to 197 days (6.5 months). The mean time between diagnostic polysomnography and CPAP prescription was 440-days (14.5-months), with a total mean time of 624 days (21-months). CONCLUSION: As in other services, the diagnostic-therapeutic flow proved to be highly inefficient, with a long waiting period, difficult access to treatment and a high dropout rate. These findings highlight the need to establish new patient-centered strategies with measures that speed up the flow and facilitate access to CPAP, in order to reduce the morbidity and mortality associated with this condition. LEVEL OF EVIDENCE: Level 3 - Non-randomized controlled cohort/follow-up study Recommendation B.

Accessibility to manage the obstructive sleep apnea within the Brazilian Unified Health System

Abstract Objective To measure the average time for the diagnosis and for the therapeutic prescription of Continuous Positive Airway Pressure (CPAP) at a hospital in Botucatu Medical School - State University São Paulo, UNESP. Method A retrospective observational study was carried out by collecting data from the electronic medical records of patients over 18-years of age, who had a diagnostic polysomnography testing scheduled between January and December 2017. Result Of the 347 patients eligible for the study, 94 (27.1%) missed follow-up and 103 (29.7%) had a referral for CPAP use. Until February 2021, only 37 (35.9%) of these patients had already acquired and were using the device, the remaining 66 (64.1%) were waiting or gave up the therapy. The mean value of the waiting time interval between the referral of the diagnostic test and its performance was equivalent to 197 days (6.5 months). The mean time between diagnostic polysomnography and CPAP prescription was 440-days (14.5-months), with a total mean time of 624 days (21-months). Conclusion As in other services, the diagnostic-therapeutic flow proved to be highly inefficient, with a long waiting period, difficult access to treatment and a high dropout rate. These findings highlight the need to establish new patient-centered strategies with measures that speed up the flow and facilitate access to CPAP, in order to reduce the morbidity and mortality associated with this condition. Level of evidence Level 3 - Non-randomized controlled cohort/follow-up study Recommendation B.

Hábitos de sono e autoavaliação miofuncional orofacial de crianças com risco para distúrbios respiratórios do sono / Sleep habits and orofacial myofunctional self-assessment of children at risk for sleep breathing disorders

RESUMO Objetivo Identificar e correlacionar as queixas de alterações miofuncionais orofaciais e de risco para distúrbios respiratórios do sono com hábitos de sono na infância. Método Participaram 71 pais ou responsáveis de crianças de 6 a 11 anos, matriculadas em uma escola pública. Foi aplicado um formulário com questões semiestruturadas/anamnese e os protocolos Nordic Orofacial Test-Screening - entrevista, Pediatric Obstructive Sleep Apnea Screening Tool Questionnaire, e Children's Sleep Habits Questionnaire - todos em suas versões em português/Brasil no formato online. Para a análise estatística, realizou-se o teste de correlação de Spearman, considerando o nível de significância de 5%. Resultados 29 crianças eram do sexo feminino (40,8%) e 42 do sexo masculino (59,2%), com média de idade de 8,52 anos. As queixas miofuncionais orofaciais encontradas foram relacionadas às funções de respiração (35,2%), mastigação e deglutição (32,4%) e hábitos deletérios (33,8%). Todas as crianças apresentaram um baixo risco para distúrbios respiratórios do sono e quanto aos hábitos de sono, 23 crianças (32,39%) apresentaram uma somatória menor, enquanto que 48 crianças (67,61%) ultrapassaram 41 pontos. Conclusão Houve correlação entre risco para distúrbios respiratórios do sono em crianças com as queixas de alterações miofuncionais orofaciais e com a baixa qualidade/maus hábitos de sono.

ABSTRACT Purpose To identify orofacial myofunctional complaints and sleep-disordered breathing and correlate them with sleep habits in childhood. Methods The study included 71 parents/guardians of public school children aged 6 to 11 years. They answered a form with semi-structured medical history questions and the Nordic Orofacial Test-Screening - interview, the Pediatric Obstructive Sleep Apnea Screening Tool Questionnaire, and the Children's Sleep Habits Questionnaire - all of them in their Portuguese/Brazilian versions in an online format. Statistical analyses used Spearman's correlation, setting the significance level at 5%. Results There were 29 female children (40.8%) and 42 male ones (59.2%), with a mean age of 8.52 years. The study found orofacial myofunctional complaints related to breathing functions (35.2%), chewing and swallowing (32.4%), and deleterious habits (33.8%). All children were at a low risk of sleep-disordered breathing. As for sleep habits, 23 children (32.39%) had a lower total score, whereas 48 children (67.61%) exceeded 41 points. Conclusion There was a correlation between the risk of sleep-disordered breathing in children with complaints of orofacial myofunctional disorders and poor sleep quality/habits.

Sleep habits and orofacial myofunctional self-assessment of children at risk for sleep breathing disorders. / Hábitos de sono e autoavaliação miofuncional orofacial de crianças com risco para distúrbios respiratórios do sono.

PURPOSE: To identify orofacial myofunctional complaints and sleep-disordered breathing and correlate them with sleep habits in childhood. METHODS: The study included 71 parents/guardians of public school children aged 6 to 11 years. They answered a form with semi-structured medical history questions and the Nordic Orofacial Test-Screening - interview, the Pediatric Obstructive Sleep Apnea Screening Tool Questionnaire, and the Children's Sleep Habits Questionnaire - all of them in their Portuguese/Brazilian versions in an online format. Statistical analyses used Spearman's correlation, setting the significance level at 5%. RESULTS: There were 29 female children (40.8%) and 42 male ones (59.2%), with a mean age of 8.52 years. The study found orofacial myofunctional complaints related to breathing functions (35.2%), chewing and swallowing (32.4%), and deleterious habits (33.8%). All children were at a low risk of sleep-disordered breathing. As for sleep habits, 23 children (32.39%) had a lower total score, whereas 48 children (67.61%) exceeded 41 points. CONCLUSION: There was a correlation between the risk of sleep-disordered breathing in children with complaints of orofacial myofunctional disorders and poor sleep quality/habits.

OBJETIVO: Identificar e correlacionar as queixas de alterações miofuncionais orofaciais e de risco para distúrbios respiratórios do sono com hábitos de sono na infância. MÉTODO: Participaram 71 pais ou responsáveis de crianças de 6 a 11 anos, matriculadas em uma escola pública. Foi aplicado um formulário com questões semiestruturadas/anamnese e os protocolos Nordic Orofacial Test-Screening - entrevista, Pediatric Obstructive Sleep Apnea Screening Tool Questionnaire, e Children's Sleep Habits Questionnaire - todos em suas versões em português/Brasil no formato online. Para a análise estatística, realizou-se o teste de correlação de Spearman, considerando o nível de significância de 5%. RESULTADOS: 29 crianças eram do sexo feminino (40,8%) e 42 do sexo masculino (59,2%), com média de idade de 8,52 anos. As queixas miofuncionais orofaciais encontradas foram relacionadas às funções de respiração (35,2%), mastigação e deglutição (32,4%) e hábitos deletérios (33,8%). Todas as crianças apresentaram um baixo risco para distúrbios respiratórios do sono e quanto aos hábitos de sono, 23 crianças (32,39%) apresentaram uma somatória menor, enquanto que 48 crianças (67,61%) ultrapassaram 41 pontos. CONCLUSÃO: Houve correlação entre risco para distúrbios respiratórios do sono em crianças com as queixas de alterações miofuncionais orofaciais e com a baixa qualidade/maus hábitos de sono.

Impact of orthognathic surgery on voice and speech: a systematic review and meta-analysis.

BACKGROUND: Orthognathic surgical procedures, whether in one or both jaws, can affect structures regarding the articulation and resonance of voice and speech. OBJECTIVE: Evaluating the impact of orthognathic surgery on voice and speech performance in individuals with skeletal dentofacial disharmony. SEARCH METHODS: Word combinations and truncations were adapted for the following electronic databases: EMBASE, PubMed/Medline, Scopus, Web of Science, Cochrane Library, and Latin American and Caribbean Literature in Health Sciences (LILACS), and grey literature. SELECTION CRITERIA: The research included studies on nonsyndromic adults with skeletal dentofacial disharmony undergoing orthognathic surgery. These studies assessed patients before and after surgery or compared them with individuals with good facial harmony using voice and speech parameters through validated protocols. DATA COLLECTION AND ANALYSIS: Two independent reviewers performed all stages of the review. The Joanna Briggs Institute tool was used to assess risk of bias in the cohort studies, and ROBINS-I was used for nonrandomized clinical trials. The authors also performed a meta-analysis of random effects. RESULTS: A total of 1163 articles were retrieved after the last search, of which 23 were read in full. Of these, four were excluded, totalling 19 articles for quantitative synthesis. When comparing the pre- and postoperative periods, both for fundamental frequency, formants, and jitter and shimmer perturbation measures, orthognathic surgery did not affect vowel production. According to the articles, the main articulatory errors associated with skeletal dentofacial disharmonies prior to surgery were distortions of fricative sounds, mainly/s/ and/z/. CONCLUSIONS: Orthognathic surgery may have little or no impact on vocal characteristics during vowel production. However, due to the confounding factors involved, estimates are inconclusive. The most prevalent articulatory disorders in the preoperative period were distortion of the fricative phonemes/s/ and/z/. However, further studies must be carried out to ensure greater robustness to these findings. REGISTRATION: PROSPERO (CRD42022291113).

Ações socioeducativas em saúde auditiva para jovens utilizando educação híbrida / Social-educational hearing health activities based on blended learning / Actividades socioeducativas en salud auditiva basadas en la educación híbr

Introdução: O uso frequente de música amplificada pelos jovens traz a reflexão da importância de projetos de promoção de saúde auditiva, visando a conscientização dos jovens e mudança de comportamento. Objetivo: promover o aprendizado sobre o tema, avaliar o conhecimento sobre saúde auditiva e multiplicar o conhecimento adquirido junto à comunidade. Métodos: foi realizado uma ação socioeducativa em saúde auditiva com 12 alunos do sétimo ano do Ensino Fundamental II de uma Escola Publica no Sudeste do Brasil. A ação foi organizada com base em educação híbrida (encontros presenciais e uso do AIA), utilizando a metodologia do Projeto Jovem Doutor. Para a avaliação, os alunos responderam a um questionário sobre conhecimento prévio, comportamento auditivo e um questionário situação-problema. O AIA foi avaliado por meio da Ficha de Pesquisa Motivacional, foi realizada a análise do Impacto através de um questionário para os professores. Resultados: observou-se que houve mudança no comportamento dos alunos no que diz respeito ao tempo de uso e volume dos fones de ouvido, verificou-se que 100% melhoraram seu conhecimento sobre os riscos de altas intensidades sonoras para a audição. Ao avaliarmos o AIA, a análise descritiva evidenciou que os valores da média de melhor desempenho foram para as dimensões organizado e fácil de usar. Na última etapa, 802 pessoas foram envolvidas, nas atividades interativas em sala de aula e nos Espaços Culturais em saúde auditiva, criando uma cadeia produtiva em saúde. Conclusão: Por meio desta ação, foi possível atingir diretamente os jovens, promovendo o aprendizado, mudança de comportamento e melhora na qualidade de vida desses jovens. (AU)

Introduction: young people often listen to amplified music, which calls attention to the importance of projects to promote their hearing health, raise their awareness, and change their behaviors. Objective:to promote learning on the topic, assess knowledge on hearing health, and spread acquired knowledge to the community. Methods: a hearing health social-educational program was carried out with 12 seventh graders at a public school in Southeastern Brazil. The program was organized for blended learning (in-person meetings and virtual learning environment [VLE] activities), using the Young Doctor Project methodology. For the assessment, students answered a questionnaire on their previous knowledge and auditory behavior, as well as a problem-situation questionnaire. VLE was assessed with a motivational survey sheet, and the impact of the program was analyzed through a questionnaire administered to the teachers. Results: there were changes in the students' behaviors regarding the time and volume at which they used the earphones. Also, 100% of them improved their knowledge of the risks high sound levels pose to hearing. The VLE descriptive analysis indicated that the mean values of the "organized" and "easy to use" domains had the best performances. The last stage involved 802 people in the classroom interactive activities and hearing health cultural spaces, which created a health production chain.Conclusion: the program directly reached young people, promoting their learning, behavior changes, and improved quality of life. (AU)

Introducción: El uso frecuente de música amplificada por parte de los jóvenes, trae la reflexión sobre la importancia de los proyectos de promoción de la salud auditiva, orientados a la sensibilización de los jóvenes y al cambio de comportamiento. Objetivo: promover el aprendizaje sobre el tema de la salud auditiva, evaluar conocimientos y multiplicar los conocimientos adquiridos en la comunidade. Métodos: una acción socioeducativa en salud auditiva con 12 alumnos del séptimo año de la Escuela Primaria II de una escuela pública del sudeste de Brasil. La acción se organizó y basó en la educación híbrida (encuentros presenciales y uso del entorno de aprendizaje interactivo), utilizando la metodología del Proyecto Doctor Joven. Para la evaluación, los estudiantes respondieron un cuestionario sobre conocimientos previos, comportamiento auditivo y un cuestionario de situación problema. La entorno de aprendizaje interactivo se evaluó mediante el Formulario de Investigación Motivacional, el análisis de Impacto se realizó en un cuestionario para docentes. Resultados: se observó que hubo un cambio en el comportamiento de los estudiantes con respecto al tiempo de uso y volumen del audífono, se encontró que el 100% mejoró sus conocimientos sobre los riesgos de alta intensidad sonora para audiencia. Al evaluar el entorno de aprendizaje interactivo, el análisis descriptivo mostró que los valores del promedio de mejor desempeño fueron para las dimensiones organizadas y fáciles de usar. Durante la etapa final, 802 personas se involucraron en actividades interactivas en el aula y en los Espacios Culturales en salud auditiva, creando una cadena productiva en salud. Conclusión: A través de esta acción se logró llegar directamente a los jóvenes, promoviendo el aprendizaje, el cambio de comportamiento y mejorando la calidad de vida de estos jóvenes. (AU)

Technologies and Mental Health in University Students: An Unhealthy Combination

Abstract Introduction The exposure of medical students to a full-time schedule that includes classes, extracurricular activities, patients' lives responsibility, and great competition between classmates can interfere in emotional issues and in the sleep time. Objective The aim of the present study was to evaluate the sleep quality, and the incidence of anxiety and depression in medical school undergraduates as well as the relationship of these parameters with the intense use of technologies. Methods Fifty-five medical school undergraduates in their second year participated in the present study, answering questionnaires to evaluate sleep quality (Pittsburgh sleep quality index - PSQI), night-time use of technology (sleep time-related information and communication technology - STRICT), and signs of anxiety or depression (hospital anxiety and depression scale - HADS). Results The results showed 31 students (56.4%) with poor sleep quality (PSQI > 5). Based on the STRICT questionnaire, 36 (65.4%) of the participants referred to making use of technology at night-time; and 34 (61.8%) students had compatible anxiety score, while 14 (25.4%) had a compatible score for depression on the HADS questionnaire. There has been a correlation between poor sleep quality, the abuse of technologies before sleep time, and the presence of anxiety or depression. Conclusion The abuse of technology before sleep time reduced the sleep quality in the studied population, besides increasing the symptoms of anxiety and depression.

Effect of Tinnitus on Sleep Quality and Insomnia

Abstract Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objectives To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.

Effect of Tinnitus on Sleep Quality and Insomnia.

Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objective To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.

Technologies and Mental Health in University Students: An Unhealthy Combination.

Introduction The exposure of medical students to a full-time schedule that includes classes, extracurricular activities, patients' lives responsibility, and great competition between classmates can interfere in emotional issues and in the sleep time. Objective The aim of the present study was to evaluate the sleep quality, and the incidence of anxiety and depression in medical school undergraduates as well as the relationship of these parameters with the intense use of technologies. Methods Fifty-five medical school undergraduates in their second year participated in the present study, answering questionnaires to evaluate sleep quality (Pittsburgh sleep quality index - PSQI), night-time use of technology (sleep time-related information and communication technology - STRICT), and signs of anxiety or depression (hospital anxiety and depression scale - HADS). Results The results showed 31 students (56.4%) with poor sleep quality (PSQI > 5). Based on the STRICT questionnaire, 36 (65.4%) of the participants referred to making use of technology at night-time; and 34 (61.8%) students had compatible anxiety score, while 14 (25.4%) had a compatible score for depression on the HADS questionnaire. There has been a correlation between poor sleep quality, the abuse of technologies before sleep time, and the presence of anxiety or depression. Conclusion The abuse of technology before sleep time reduced the sleep quality in the studied population, besides increasing the symptoms of anxiety and depression.

Worldwide prevalence and associated risk factors of obstructive sleep apnea: a meta-analysis and meta-regression.

PURPOSE: This study aimed to identify the prevalence of obstructive sleep apnea (OSA) and associated risk factors globally. METHODS: Six databases and registrations and three grey databases were explored for observational field research. Independently and impartially paired reviewers selected research, gathered data, and evaluated the methodological quality. Heterogeneity was investigated using subgroup analysis and meta-regression following the moderating variable in a meta-analysis of proportions with a random-effects model. The critical appraisal instrument developed by the Joanna Briggs Institute was used to evaluate the listed studies' methodology. The certainty of the evidence was evaluated using the GRADE tool. RESULTS: A total of 8236 articles were collected during the database search, resulting in 99 articles included for qualitative synthesis, and 98 articles were included for the meta-analysis. The estimated combined prevalence of OSA was 54% [CI 95% = 46-62%; I2 = 100%]. Mean age, percentage of moderate-severe cases, and the sample's body mass index (BMI) did not affect the heterogeneity that was already present when meta-regressed (p > 0.05). Ninety-one studies were deemed to have a low risk of bias, while eight were deemed to have a moderate risk. For OSA prevalence outcomes, the GRADE criteria were considered very low. CONCLUSION: Approximately half of the people worldwide have OSA. High BMI, increasing age, and male gender are described as risk factors in the literature, but these covariates do not affect pre-existing heterogeneity.

Babies With Pierre Robin Sequence: Neuropsychomotor Development.

BACKGROUND: The Pierre Robin Sequence presents heterogeneous symptoms, and each newborn can manifest from mild breathing and feeding difficulties to severe complications, as well as a predisposition to present changes in growth and neuropsychomotor development in the first years of life. OBJECTIVE: The aims were to evaluate and associate the neuropsychomotor development of zero- to 12-month-old children with Pierre Robin sequence (PRS) in the personal-social, fine motor-adaptive, language, and gross motor aspects. METHODS: The subjects of the study were 17 infants of both sexes with PRS admitted to the special care unit (SCU) of a reference hospital in the interior of the state of São Paulo, Brazil, in the age range of 20 days to 263 days. Developmental assessments were performed using the Denver Development Screening Test II. The evaluations were carried out in the SCU, with duration of 30 minutes each. Statistical analysis was descriptive using the Mann-Whitney test, two-proportion equality test, and Spearman correlation. The level of significance was set at 0.05. RESULTS: According to Denver Development Screening Test II, median 78.5 of the babies were at risk for developmental delay identified by the Denver II Test (n = 14, 82.4%). For the developmental areas analyzed by the test there was statistically significant difference in language area. CONCLUSION: The babies aged up to 12 months with PRS in this study presented risks for delay in neuropsychomotor development in language, gross motor, fine motor-adaptive, and personal-social aspects, and this finding should be considered to set goals in family orientation and intervention.

Hearing habits of young adolescent students from public and private schools in the Brazilian Federal District / Hábitos auditivos de jovens adolescentes escolares da rede pública e privada do Distrito Federal

ABSTRACT Purpose: to analyze the hearing habits of a group of students between public and private schools and compare the degree of exposure to sound stimuli via earphones. Methods: 1,085 public and private school students received a questionnaire on hearing habits and exposure to amplified music. Their answers to these questions were analyzed and compared between the groups of students. The chi-square test compared hearing habits between public and private schools, with the statistical significance level set at 5% (p < 0.05). Result: in general, most students (92%) reported hearing habits of exposure to amplified music. Questionnaire answers indicated a high prevalence of both earphone use (92%) and attendance at places with loud music (63.6%). Conclusion: private school students use earphones more often than those from public schools.

RESUMO Objetivo: analisar os hábitos auditivos de um grupo de alunos e comparar o grau de exposição ao estímulo sonoro via fones de ouvido entre escolas públicas e privadas. Métodos: foram distribuídos questionários contendo perguntas referentes a hábitos auditivos de exposição à música amplificada, aos 1085 alunos de escolas pública e privada. Em seguida, as respostas aos questionamentos foram analisadas e comparadas entre os grupos de alunos. Utilizou-se o teste Qui-quadrado com um nível de significância estatística estabelecido em 5% (p<0,05) para se comparar os hábitos auditivos entre as escolas públicas e privadas. Resultado: de modo geral, a maioria dos alunos (92%) respondeu que tem hábitos auditivos de exposição à música amplificada. Tanto o uso de fones de ouvido (92%) quanto as idas a lugares com música alta (63,6%) tiveram alta prevalência nas respostas aos questionários. Conclusão: alunos de escolas particulares utilizam mais fones de ouvido frequentemente comparados aos alunos de escolas públicas.

Assessment of websites on cleft lip and palate in Brazilian Portuguese

ABSTRACT Purpose: this study aimed at assessing the legibility, reliability, usability and coverage of websites on cleft lip and/or palate (CL/P) in Brazilian Portuguese and providing a global comparison. Methods: in order to evaluate the obtained data, four protocols were used, i.e., the Website Coverage Protocol, the legibility (by means of the COH METRIX PORT), the reliability (Discern Protocol), and the usability (by means of the System Usability Scale). Results: 98 websites were included with average legibility scoring of 31.6±11.7, rated as a hard readability level. Coverage average scoring was 19.9±3.79 from a total of 35 points. As for reliability, average scoring was 43.2±6.51 points, rated as acceptable. The usability scoring was 24.8±2.18 points, rated as the worst imaginable one. Conclusion: therefore, the assessed Brazilian websites on CL/P were rated difficult for legibility, requiring high-school level of education, restricted coverage and acceptable reliability, in addition to the low usability. The results were similar to those of websites from other countries, except for the legibility aspect, which was lower for Brazilian websites.

Brazilian Consensus on Sleep-Focused Speech-Language-Hearing Sciences - 2023 Brazilian Sleep Association.

Introduction This consensus aimed to develop a structured document presenting the role of sleep-focused Speech-Language-Hearing (SPH) Sciences (SPHS). The recommendations were based on the expertise of specialists and on evidence in the literature, aiming to guide the coverage of this area and the consequent improvement in the quality of the professionals' approach. Methods A Delphi method was conducted with 49 SLH pathologists (SLHP), four sleep physicians, one dentist, one physical therapist, and one methodologist. Four Delphi panel rounds were conducted in Google Forms. The items were analyzed based on the panelists' percentage of agreement; consensuses were reached when ⅔ (66.6%) of valid responses were on a same on a same answer (either "agree" or "disagree"). Results Participants voted on 102 items. The mean consensus rate was 89.9% ± 10.9%. The essential topics were the importance of professional training, the SLH diagnosis, and the SLH treatment of sleep disorders. It was verified that all fields of the SLHS are related to the area of sleep; that sleep-focused SLH pathologists (SLHP) are the responsible for assessing, indicating, and conducting specific orofacial myofunctional therapy for sleep-disordered breathing alone or in combination with other treatments; that SLHP are included in interdisciplinary teams in the area of sleep in public and private services. Discussion The Brazilian consensus on sleep-focused SLHS is a landmark in this area. This consensus described the scope of action of sleep-focused SLHP and systematized recommendations being useful as a reference for the professional practice in the area of sleep.

How the speech-language pathologist interacts with cystic fibrosis patients? a scoping review / Qual a relação da fonoaudiologia com a fibrose cística? uma revisão de escopo / ¿Cuál es la relación entre la logopedia y la fibrosis quís- tica? una revisión del alcance

Objective: The review describes the changes related to sleep-breathing disorders, com- munication and feeding processes in subjects with CF, through a scoping review. Meth- ods: A scoping review based on the PRISMA protocol was carried out in Pubmed, Lilacs and Scopus databases, to investigate the possibility of including SLP in the treatment of patients with CF. The inclusion criteria included studies that addressed communication and eating processes and disorders related to CF. Studies with a sample that presented other comorbidities that would justify the worsening of the condition, or secondary stud- ies, were excluded. There was no time or language delimitation. Results: The search found 1566 works, 27 Lilacs, 1009 Pubmed and 530 Scopus, by analysis of titles, abstract and reading in full. A total of 30 articles were selected for inclusion, 2 Lilacs, 22 Pubmed and 6 Scopus, all related to Speech-Language Pathology. Conclusion: It was observed that there is a poor sleep quality due to nocturnal desaturation, mild and moderate obstructive apnea. In studies related to hearing, individuals had sensorineural hearing loss. Speech-Language Pathology is of paramount importance in monitoring these sub- jects.

Objetivo: Descrever alterações relacionadas aos processos de distúrbios respiratórios do sono, comunicação e alimentação em sujeitos com FC, por meio de uma scoping review. Métodos: Foi realizada uma scoping review nas bases de dados Pubmed, Lilacs e Scopus, para investigar a possibilidade de incluir o fonoaudiólogo no tratamento de pacientes com FC, utilizando o checklist PRISMA. Os critérios de inclusão incluíram estudos que abor- dassem processos de comunicação e alimentação e distúrbios relacionados à FC. Foram excluídos estudos com amostra que apresentasse outras comorbidades que justificassem o agravamento do quadro, ou estudos secundários. Não houve delimitação de tempo ou idioma. Resultados: A busca encontrou 1566 trabalhos, sendo 27 Lilacs, 1009 Pubmed e 530 Scopus, por meio de análise de títulos, resumo e leitura na íntegra. Foram seleciona- dos para inclusão 30 artigos, sendo 2 Lilacs, 22 Pubmed e 6 Scopus, todos relacionados à Fonoaudiologia. Conclusão: Observou-se que há má qualidade do sono devido à dessa- turação noturna, apneia obstrutiva leve e moderada. Em estudos relacionados à audição, os indivíduos apresentaram perda auditiva neurossensorial. A Fonoaudiologia é de suma importância no acompanhamento desses sujeitos.

Objetivo: Describir las alteraciones relacionadas con los procesos de trastornos respira- torios del sueño, comunicación y alimentación en sujetos con FQ, a través de una revisión de alcance. Métodos: Se realizó una revisión de alcance en las bases de datos Pubmed, Lilacs y Scopus, para investigar la posibilidad de incluir al logopeda en el tratamiento de pacientes con FQ, utilizando la lista de verificación PRISMA. Los criterios de inclusión incluyeron estudios que abordaran los procesos de comunicación y alimentación y los trastornos relacionados con la FQ. Se excluyeron los estudios con una muestra que pre- sentaba otras comorbilidades que justificasen el empeoramiento del cuadro, o estudios secundarios. No había delimitación de tiempo ni de idioma. Resultados: La búsqueda en- contró 1566 trabajos, de los cuales 27 fueron Lilacs, 1009 Pubmed y 530 Scopus, me- diante análisis de títulos, resúmenes y lectura completa. Se seleccionaron 30 artículos para inclusión, 2 Lilacs, 22 Pubmed y 6 Scopus, todos relacionados con Logopedia. Con- clusión: Se observó que existe mala calidad del sueño por desaturación nocturna, apnea obstructiva leve y moderada. En estudios relacionados con la audición, los individuos tenían pérdida auditiva neurosensorial. La logopedia es de suma importancia en el segui- miento de estos sujetos.

Caracterização de traqueostomia em crianças e adolescentes em um serviço de atenção terciária / Characterization of tracheostomy in children and adolescents in a tertiary care service / Caracterización de la traqueotomía en niños y adolescentes en un servicio de tercer nivel de atención

Objetivo: descrever o perfil de indicações, comorbidades e complicações pós-operatórias precoces de crianças e adolescentes submetidos à traqueostomia em um hospital referência brasileiro. Método: estudo retrospectivo,transversale quantiativo, com análise de prontuários eletrônicos de crianças e adolescentes submetidos à traqueostomia em um hospital de Botucatu, São Paulo, Brasil, no periodo de 2013 a 2019. A amostra foi comparada mediante a divisão de presença e ausência de complicações pós-operatórias precoces, no que se refere ao sexo, idade, síndrome, óbito, caráter eletivo ou de urgência/emergência e peso ao nascer. Resultados: entre100 prontuários, 55% do sexo masculino, com média de 3,03±3,10 anos. Foram identificadas 12 diferentes síndromes em 16 pacientes. No que se refere às complicações pós-operatórias precoces, a rolha foi a mais frequente (13%), e esteve associada a presença de síndromes (p=0,01). O motivo mais identificado da traqueostomia foi a intubação orotraquealprolongada, enquanto 44% evoluíram a óbitodevido a gravidade da doença de base. Conclusão: a traqueostomia em crianças é um procedimento seguro, com indicação mais frequente por intubação prolongada, em portadores de síndromes genéticas menores de um ano de idade. Complicação como rolha é comum, associado a síndrome.

Objective: to describe the profile of indications, comorbidities and early postoperative complications of children and adolescents undergoing tracheostomy in a Brazilian referral hospital. Method: retrospective, cross-sectional and quantitative study, with analysis of electronic medical records of children and adolescents who underwent tracheostomy in a hospital in Botucatu, São Paulo, Brazil, from 2013 to 2019. The sample was compared by dividing the presence and absence of post-operative complications. early operative procedures, with regard to sex, age, syndrome, death, elective or urgency/emergency character and birth weight. Results:among 100 records, 55% were male, with an average of 3.03±3.10 years.Twelve different syndromes were identified in 16 patients. With regard to early postoperative complications, cork was the most frequent (13%) and was associated with the presence of syndromes (p=0.01). The most identified reason for tracheostomy was prolonged orotracheal intubation, while 44% died due to the severity of the underlying disease.Conclusion:pediatric tracheostomy is a safe procedure, more frequently realized due to failure of extubation, in genetic syndrome children younger than one year old. Cork is a frequent complication, associated to syndromes.

Objetivo:describirel perfil de indicaciones, comorbilidades y complicaciones postoperatorias tempranas de niños y adolescentes sometidos a traqueotomía en un hospital de referencia brasileño. Método: estudio retrospectivo, transversal y cuantitativo, con análisis de historias clínicas electrónicas de niños y adolescentes operados de traqueotomía en un hospital de Botucatu, São Paulo, Brasil, de 2013 a 2019. La muestra fue comparada dividiendo la presencia y ausencia de complicaciones postoperatorias. .procedimientos operatorios tempranos, con respecto al sexo, edad, síndrome, muerte, carácter electivo o urgencia/emergencia y peso al nacer. Resultados: entre 100 registros, 55% eran del sexo masculino, con una media de 3,03±3,10 años. Se identificaron 12 síndromes diferentes en 16 pacientes. En cuanto a las complicaciones postoperatorias tempranas, el corcho fue la más frecuente (13%) y se asoció a la presencia de síndromes (p=0,01). El motivo de traqueostomía más identificado fue la intubación orotraqueal prolongada, mientras que el 44% fallecieron debido a la gravedad de la enfermedad de base.Conclusión: la traqueotomía en niños es un procedimiento seguro, con indicación más frecuente de intubación prolongada, en pacientes con síndromes genéticos menores de un año. La complicación como el corcho es común, asociada con el síndrome.

Oral language skills in Brazilian children with obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea (OSA) is associated with a negative impact on neurocognitive development in children. Receptive/expressive oral language is a complex process, with limited investigations on the repercussion of OSA. This study aimed to analyze receptive and expressive oral language skills in children with obstructive sleep apnea (OSA). METHODOLOGY: This study included 52 children (27 females, 51.92 %) with a mean age of 7 ± 2 years (age range of 4-11 years), which underwent type 3 polysomnography (PSG). The participants were divided into N-OSA (n = 16) and OSA (n = 36) groups based on the apnea-hypopnea index. The speech-language therapist evaluated hearing and oral language for phonology, expressive semantics, syntax, receptive semantics (Peabody Image Vocabulary Test), pragmatics, and understanding of verbal instructions (Token Test). RESULTS: Oral language assessments showed a difference in the pragmatics subsystem (p = 0.047), with positive correlation between OSA severity and oral language functions such as pragmatics and syntax (desaturation index, p = 0.045). CONCLUSION: Obstructive sleep apnea (OSA) had a negative impact on oral language skills, including the syntax and pragmatics subsystems.