Challenges in operationalizing conceptual models in aetiological research.

Conceptual or theoretical models are crucial in developing causal hypotheses and interpreting study findings, but they have been underused and misused in aetiological research, particularly in dentistry and oral epidemiology. Good models should incorporate updated evidence and clarify knowledge gaps to derive logical hypotheses. Developing models and deriving testable hypotheses in operational models can be challenging, as seen in the four examples referred to in this commentary. One challenge concerns the theoretical validity of the model, while another relates to difficulties in operationalizing abstract concepts. A third challenge refers to the lack of sufficient information in the dataset to test partially or even the whole model. Finally, a common challenge is the application of a conceptual model to different contexts. Among the existing methodological approaches to operationalize conceptual models, causal graphs may be helpful, especially when combined with approaches from diverse disciplinary fields via triangulation.

Self-reported discrimination against adults with hearing loss in Brazilian health services: results of the National Health Survey. / Discriminação social em adultos com deficiência auditiva nos serviços de saúde brasileiro: resultados da Pesquisa Nacional de Saúde.

This article aims to estimate the prevalence of self-reported discrimination against people with hearing loss in Brazilian health services and analyze associated factors. We conducted a cross-sectional population-based study using data from the 2013 National Health Survey. The final study sample comprised 1,464 individuals with self-reported hearing loss. Poisson regression was used to calculate crude and adjusted prevalence ratios (PR) and respective 95% confidence intervals. The overall prevalence of discrimination was 15%. Prevalence was higher among black people and respondents who reported experiencing limitations in activities of daily living. Prevalence of discrimination in Brazilian health services was highest in black people with limitations in activities of daily living. The implementation of policies and actions to address this problem is recommended, including strategies during the education and training of health professionals.

O artigo tem como objetivo estimar a prevalência de discriminação social autorreferida em pessoas com deficiência auditiva nos serviços de saúde brasileiros, verificando fatores associados à discriminação. Estudo transversal de base populacional, com dados de um inquérito epidemiológico domiciliar realizado ponderadamente em todo o território brasileiro no ano de 2013. A amostra final deste estudo compreendeu 1.464 adultos com perda auditiva autorreferida. Utilizou-se regressão de Poisson com variância robusta para cálculo de razões de prevalência (RP) brutas e ajustadas para a investigação das prevalências de discriminação autorreferida nos serviços de saúde e seus respectivos intervalos de confiança de 95%. A prevalência de discriminação em adultos com deficiência auditiva nos serviços de saúde brasileiros foi de 15%. Indivíduos de cor/raça preta e que relataram que a perda auditiva limita as suas atividades de vida diária apresentaram maior associação com discriminação. Pessoas com deficiência auditiva de cor/raça preta e que apresentam limitação nas atividades da vida diária em decorrência da perda auditiva relataram maior discriminação nos serviços de saúde. Estratégias de enfrentamento à discriminação de profissionais da área da saúde devem ser implementadas para que esse cenário seja modificado.

Discriminação social em adultos com deficiência auditiva nos serviços de saúde brasileiro: resultados da Pesquisa Nacional de Saúde / Self-reported discrimination against adults with hearing loss in Brazilian health services: results of the National Health Survey

Resumo O artigo tem como objetivo estimar a prevalência de discriminação social autorreferida em pessoas com deficiência auditiva nos serviços de saúde brasileiros, verificando fatores associados à discriminação. Estudo transversal de base populacional, com dados de um inquérito epidemiológico domiciliar realizado ponderadamente em todo o território brasileiro no ano de 2013. A amostra final deste estudo compreendeu 1.464 adultos com perda auditiva autorreferida. Utilizou-se regressão de Poisson com variância robusta para cálculo de razões de prevalência (RP) brutas e ajustadas para a investigação das prevalências de discriminação autorreferida nos serviços de saúde e seus respectivos intervalos de confiança de 95%. A prevalência de discriminação em adultos com deficiência auditiva nos serviços de saúde brasileiros foi de 15%. Indivíduos de cor/raça preta e que relataram que a perda auditiva limita as suas atividades de vida diária apresentaram maior associação com discriminação. Pessoas com deficiência auditiva de cor/raça preta e que apresentam limitação nas atividades da vida diária em decorrência da perda auditiva relataram maior discriminação nos serviços de saúde. Estratégias de enfrentamento à discriminação de profissionais da área da saúde devem ser implementadas para que esse cenário seja modificado.

Abstract This article aims to estimate the prevalence of self-reported discrimination against people with hearing loss in Brazilian health services and analyze associated factors. We conducted a cross-sectional population-based study using data from the 2013 National Health Survey. The final study sample comprised 1,464 individuals with self-reported hearing loss. Poisson regression was used to calculate crude and adjusted prevalence ratios (PR) and respective 95% confidence intervals. The overall prevalence of discrimination was 15%. Prevalence was higher among black people and respondents who reported experiencing limitations in activities of daily living. Prevalence of discrimination in Brazilian health services was highest in black people with limitations in activities of daily living. The implementation of policies and actions to address this problem is recommended, including strategies during the education and training of health professionals.

Dysarthria in hereditary spastic paraplegia type 4.

OBJECTIVE: To describe the speech pattern of patients with hereditary Spastic Paraplegia type 4 (SPG4) and correlated it with their clinical data. METHODS: Cross-sectional study was carried out in two university hospitals in Brazil. Two groups participated in the study: the case group (n = 28) with a confirmed genetic diagnosis for SPG4 and a control group (n = 17) matched for sex and age. The speech assessment of both groups included: speech task recording, acoustic analysis, and auditory-perceptual analysis. In addition, disease severity was assessed with the Spastic Paraplegia Rating Scale (SPRS). RESULTS: In the auditory-perceptual analysis, 53.5% (n = 15) of individuals with SPG4 were dysarthric, with mild to moderate changes in the subsystems of phonation and articulation. On acoustic analysis, SPG4 subjects' performances were worse in measurements related to breathing (maximum phonation time) and articulation (speech rate, articulation rate). The articulation variables (speech rate, articulation rate) are related to the age of onset of the first motor symptom. CONCLUSION: Dysarthria in SPG4 is frequent and mild, and it did not evolve in conjunction with more advanced motor diseases. This data suggest that diagnosed patients should be screened and referred for speech therapy evaluation and those pathophysiological mechanisms of speech involvement may differ from the length-dependent degeneration of the corticospinal tract.

Dysarthria in hereditary spastic paraplegia type 4

Abstract Objective: To describe the speech pattern of patients with hereditary Spastic Paraplegia type 4 (SPG4) and correlated it with their clinical data. Methods: Cross-sectional study was carried out in two university hospitals in Brazil. Two groups participated in the study: the case group (n = 28) with a confirmed genetic diagnosis for SPG4 and a control group (n = 17) matched for sex and age. The speech assessment of both groups included: speech task recording, acoustic analysis, and auditory-perceptual analysis. In addition, disease severity was assessed with the Spastic Paraplegia Rating Scale (SPRS). Results: In the auditory-perceptual analysis, 53.5% (n = 15) of individuals with SPG4 were dysarthric, with mild to moderate changes in the subsystems of phonation and articulation. On acoustic analysis, SPG4 subjects' performances were worse in measurements related to breathing (maximum phonation time) and articulation (speech rate, articulation rate). The articulation variables (speech rate, articulation rate) are related to the age of onset of the first motor symptom. Conclusion: Dysarthria in SPG4 is frequent and mild, and it did not evolve in conjunction with more advanced motor diseases. This data suggest that diagnosed patients should be screened and referred for speech therapy evaluation and those pathophysiological mechanisms of speech involvement may differ from the length-dependent degeneration of the corticospinal tract.

Relato da experiência da atuação fonoaudiológica em telessaúde em pacientes neurológicos com disfagia e disartria durante a pandemia de Covid-19 / Experience report of speech therapy in telehealth with neurological patients with dysphagia and dysarthria during the Covid-19 pandemic / Reporte de experiencia de desempeño logopédico en telesalud en pacientes neurológicos con disfagia y disartria durante la pandemia de Covid-19

Introdução: Devido à COVID-19, os pacientes com doenças neurológicas deixaram de frequentar presencialmente as consultas fonoaudiológicas em ambulatórios. Objetivo: Descrever o relato da experiência fonoaudiológica em pacientes com doença neurológica com disartria e/ou disfagia durante a pandemia da COVID-19 através da telessaúde. Método: Trata-se de um relato de experiência. Foram incluídos pacientes do ambulatório de fonoaudiologia de um hospital universitário, que ficaram privados do acompanhamento fonoaudiológico em período pandêmico e que tinham diagnóstico de disfagia e/ou disartria (prévios à pandemia). No total, 43 pacientes foram convidados a participar do estudo. Os indivíduos foram separados de acordo com seu diagnóstico fonoaudiológico: disfagia, disartria e disfagia/disartria. No início, todos foram reavaliados em videochamadas: disfagia (Northwestern dysphagia patient check sheet, Escala Funcional de Ingestão Via Oral e Instrumento de Autoavaliação da Alimentação); disartria (coleta de fala e questionário de autopercepção Radbould Oral Inventory Motor for Parkinson's disease). Após, os pacientes foram alocados aleatoriamente: teleatendimento fonoaudiológico por quatro semanas consecutivas, sendo o outro grupo controle, sem intervenções e/ou orientações. Todos foram reavaliados para a comparação pré e pós-acompanhamento fonoaudiológico. Resultados: Nove participantes concluíram todas as etapas do estudo, sendo 6 (66,66%) homens. A média de idade foi de 60,44 anos (±16,13). Os participantes possuíam diagnóstico médico de doença neurológica, sendo 2 neurogenética (22,22%), 5 neurodegenerativa (55,5%) e 2 neurológicas (22,22%). Não foram observadas diferenças descritivas entre os grupos nas avaliações pré e pós-intervenção. A perda na amostra aconteceu devido à falta de dispositivos tecnológicos e à sobrecarga dos cuidadores. Conclusões: A experiência em tele fonoaudiologia, apesar de ter sido positiva, revelou a dificuldade da sua implementação em pacientes neurológicos de baixa condições sócio financeiras e educacional.

Introduction: Due to COVID-19, patients with neurological disease no longer attend face-to-face speech therapy consultations in outpatient clinics. Objective: To describe the report of the speech therapy experience patients with neurological disease with dysarthria and/or dysphagia during the COVID-19 pandemic through telehealth. Method: This is an experience report. Patients from the speech therapy outpatient clinic of a university hospital who were deprived of speech therapy during a pandemic period and had a diagnosis of dysphagia and/or dysarthria (prior to the pandemic) were included. In total, 43 patients were invited to participate in the study. Individuals were separated according to their speech-language diagnosis: dysphagia, dysarthria, and dysphagia/dysarthria. In the beginning, all were reassessed in video calls: dysphagia (Northwestern dysphagia patient check sheet, Functional Oral Intake Scale, and Food Self-Assessment Instrument); dysarthria (speech collection and self-perception questionnaire Radbould Oral Motor Inventory for Parkinson's disease). Afterward, the patients were randomly allocated: speech therapy telecare for four consecutive weeks, with the other being a control group, without interventions and/or guidance. All were reassessed for comparison before and after speech therapy follow-up. Results:Nine participants completed all stages of the study, 6 (66.66%) men. The mean age was 60.44 years (±16.13). Participants had a medical diagnosis of neurological disease, 2 of which were neurogenetic (22.22%), five neurodegenerative (55.5%), and two neurologic (22.22%). No descriptive differences were observed between groups in pre- and post-intervention assessments. The loss in the sample happened due to the lack of technological devices and the overload of caregivers. Conclusions: The experience in telehealth was positive, revealing the difficulty of its implementation in neurological patients with low socio-financial and educational conditions.

Introducción: Debido al COVID-19, los pacientes con enfermedades neurologicas ya no asisten a consultas de logopedia presenciales en consultas externas. Objetivo: Describir el relato de la experiencia fonoaudiológica en pacientes con enfermedades neurologicas con disartria y/o disfagia durante la pandemia de COVID-19 a través de telesalud. Método: Este es un relato de experiencia. Se incluyeron pacientes de la consulta externa de logopedia de un hospital universitario, que fueron privados de logopedia durante un período de pandemia y que tenían diagnóstico de disfagia y/o disartria (previo a la pandemia). En total, 43 pacientes fueron invitados a participar en el estudio. Los individuos se separaron según su diagnóstico del habla y el lenguaje: disfagia, disartria y disfagia/disartria. Al principio, todos fueron reevaluados en videollamadas: disfagia (Northwestern dysphagia patient check sheet), Escala de ingesta oral funcional e Instrumento de autoevaluación de alimentos); disartria (cuestionario de recogida de voz y autopercepción Radbould Oral Motor Inventory for Parkinson's disease). Posteriormente, los pacientes fueron asignados aleatoriamente: teleasistencia logopédica durante cuatro semanas consecutivas, siendo el otro grupo control, sin intervenciones y/u orientaciones. Todos fueron reevaluados para compararlos antes y después del seguimiento con logopedia. Resultados: Nueve participantes completaron todas las etapas del estudio, 6 (66,66%) hombres. La edad media fue de 60,44 años (±16,13). Los participantes tenían diagnóstico médico de enfermedad neurológica, 2 de ellas neurogenéticas (22,22%), 5 neurodegenerativas (55,5%) y 2 neurológica (22,22%). No se observaron diferencias descriptivas entre los grupos en las evaluaciones previas y posteriores a la intervención. La pérdida en la muestra ocurrió por la falta de dispositivos tecnológicos y la sobrecarga de cuidadores. Conclusiones: La experiencia en telefonoaudiología, a pesar de ser positiva, reveló la dificultad de su implementación en pacientes neurológicos de baja condición socioeconómica y educativa.

Frequency and associated factors for swallowing impairment in community-dwelling older persons: a systematic review and meta-analysis.

INTRODUCTION: Swallowing impairment (SI) is an underdiagnosed dysfunction frequently seen as an expected condition of aging. However, SI can lead to health complications and considerable social impact. METHODS: The objective of this systematic review with meta-analysis was to evaluate the frequency and associated factors with SI in community-dwelling older persons. Searches were performed in 13 electronic databases including MEDLINE and EMBASE (from inception to September 18, 2021). Data extraction and methodological quality assessment of included studies were performed by two independent reviewers. Meta-analysis of proportions with 95% confidence interval (CI) and prediction interval (PI) was used to pool estimates. Subgroup analysis by Country and Assessment Method was performed. General meta-analysis was used to pool measures of association between potential risk factors and SI occurrence (odds ratio [OR] or prevalence ratio [PR]). RESULTS: The worldwide estimated frequency of SI in community-dwelling older persons was 20.35% (95%CI 16.61-24.68%, 95%PI 4.79-56.45, I2 99%, n = 33,291). This estimation varied across assessment methods and by country. The main factors associated with SI were a dry mouth (OR 8.1, 95%CI 4.9-13.4), oral diadochokinesis (OR 5.3, 95%CI 1.0-27.3), ≥ 80 years old (OR 4.9, 95%CI 2.6-9.2), genetic factor (SNPrs17601696) (OR 4.8, 95%CI 2.7-8.3), and partial dependence (OR 4.3, 95%CI 2.0-9.3). And the main factors associated with SI estimated by PR were dry mouth sensation (PR 4.1, 95%CI 2.6-6.5), oral sensorimotor alteration (PR 2.6, 95%CI 1.4-4.9), osteoporosis (PR 2.51, 95%CI 1.2-5.3), and heart diseases (PR 2.31, 95%CI 1.1-5.0). CONCLUSION: One in five older adults worldwide are expected to experience SI and factors associated with this underdiagnosed dysfunction included biological and physiological changes related to aging, physical and psychological conditions, and poor oral health. Early assessment is paramount for the prevention of future clinical complications and should be a high priority in health care practices.

Factors associated with frailty in patients with neurodegenerative diseases. / Fatores associados a fragilidade em pacientes com doenças neurodegenerativas.

PURPOSE: To identify the factors associated with frailty in patients with neurodegenerative diseases. METHODS: Cross-sectional study, whose sample consisted of 150 patients diagnosed with neurodegenerative diseases seen at a speech-language therapy clinic in a reference hospital in southern Brazil. A secondary exploratory analysis of the medical records of patients treated at this clinic between April 2016 and May 2019 was performed. The information collected was sex, age, education, type of neurodegenerative disease, time of disease, frailty (Edmonton Frail Scale-EFS), swallowing (Northwestern Dysphagia Patient CheckSheet-NDPCS, Eating Assessment Tool-EAT 10), and cognition (Mini-Mental State Examination-MMSE and Montreal Cognitive Assessment-MoCA). Continuous quantitative variables were analyzed using mean and standard deviation and categorical quantitative variables from absolute and relative frequency, as well as their association with the outcome using the Chi-square test. Crude and adjusted Prevalence Ratios were assessed using Poisson regression with robust variance. All statistical tests were considered significant at a level of 5%. RESULTS: The significant factors associated with frailty were the presence of oropharyngeal dysphagia and altered cognitive performance. Individuals with frailty have a higher prevalence of oropharyngeal dysphagia (PR= 1.772(1.094-2.872)), while cognition alteration presented a lower prevalence (PR= 0.335(0.128-0.873). CONCLUSION: Oropharyngeal dysphagia can be an important clinical predictive factor for consideration in cases of frailty in patients with neurodegenerative diseases.

OBJETIVO: Identificar os fatores associados à fragilidade em pacientes com doenças neurodegenerativas. MÉTODO: Estudo transversal, cuja amostra foi composta por 150 pacientes com diagnóstico de doenças neurodegenerativas atendidos em um ambulatório de Fonoaudiologia de um hospital de referência no sul do Brasil. Foi realizada análise secundária exploratória dos prontuários dos pacientes atendidos neste ambulatório entre o período de abril de 2016 e maio de 2019. As informações coletadas foram: sexo, idade, escolaridade, tipo de doença neurodegenerativa, tempo de doença, fragilidade (Edmonton Frail Scale - EFS), deglutição (Northwestern Dysphagia Patient CheckSheet- NDPCS, Eating Assessment Tool-EAT 10) e cognição (Mini-Mental State Examination-MMSE e Montreal Cognitive Assessment-MoCA). As variáveis quantitativas contínuas foram analisadas a partir de média e desvio padrão e as quantitativas categóricas a partir de frequência absoluta e relativa, assim como analisou-se a associação destas com o desfecho pelo teste Qui-Quadrado. As Razões de Prevalência brutas e ajustadas foram avaliadas a partir da Regressão de Poisson com variância robusta. Todos os testes estatísticos foram considerados significativos a um nível de 5%. RESULTADOS: Os fatores significativos associados à fragilidade foram à presença de disfagia orofaríngea e desempenho cognitivo alterado. Indivíduos com a fragilidade apresentam maior prevalência de disfagia orofaríngea (RP=1,772(1,094-2,872)), enquanto a cognição alterada está associada a menor prevalência de fragilidade (RP=0,335(0,128-0,873). CONCLUSÃO: A disfagia orofaríngea pode ser um importante fator clínico preditivo a ser considerado em casos de fragilidade em pacientes com doenças neurodegenerativas.

Grupos de cessação de tabaco: série histórica de um serviço de atenção primária à saúde no sul do Brasil / Tobacco cessation groups: historical series of a primary health care at the south of Brazil

Resumo Introdução O tabagismo é uma das principais causas evitáveis de doenças e um grande desafio para a saúde pública, sendo a Atenção Primária à Saúde (APS) o nível de atenção à saúde com maior potencial de manejo da cessação de uso de tabaco. Objetivo O objetivo foi descrever os resultados de cessação de tabaco em grupos inseridos em um programa público de tratamento do tabagismo ao longo de 11 anos. Método Estudo retrospectivo do tipo série histórica dos grupos de tabagismo desenvolvido no período de 2006 a 2016 nas 12 unidades de saúde do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição (GHC), Porto Alegre-RS. Os dados foram coletados nos Relatórios Anuais de Indicadores de Saúde e no Sistema de Informações do GHC. Análises descritivas foram realizadas por meio de frequências absolutas e relativas. Resultados Dos 2.691 tabagistas acompanhados, 1.273 (47%) deixaram de fumar até a quarta sessão do grupo. Discussão A cessação de tabaco em grupos contribuiu para que mais da metade dos participantes conseguisse parar de fumar ao longo do período de 4 semanas de tratamento em grupo. Esta é uma importante estratégia terapêutica acessível e eficiente para auxiliar e oportunizar um atendimento integral aos usuários tabagistas no contexto da APS.

Abstract Background Smoking is one of the main preventable causes of diseases and a major challenge for public health. Primary Health Care (PHC) is the level of health care with the greatest potential for managing tobacco cessation. Objective The objective was to describe the results of smoking cessation in groups included in a public smoking treatment program over 11 years. Methods Retrospective study of the historical series type of smoking groups developed between 2006 and 2016 in the 12 health units of the Community Health Service of Grupo Hospitalar Conceição (GHC), Porto Alegre-RS. Data were collected in the Annual Health Indicator Reports and the GHC Information System. Descriptive analyzes were performed using absolute and relative frequencies. Results Of the 2,691 smokers monitored, 1,273 (47%) quit smoking until the fourth session of the group. Discussion Smoking cessation in groups contributed to more than half of the participants being able to quit smoking over 4 weeks of treatment groups. This is an important accessible and efficient therapeutic strategy to assist and provide comprehensive care to smokers in the context of PHC.

Speech and swallowing characteristics in patients with facioscapulohumeral muscular dystrophy / Caracterização da fala e da deglutição em pacientes com distrofia muscular facioescapuloumeral

ABSTRACT Background: Although facial muscle weakness is common in patients with Facioscapulohumeral Muscular Dystrophy (FSHD), the literature is scarce on the speech and swallowing aspects. Objective: To investigate speech and swallowing patterns in FSHD and assess the correlation with clinical data. Methods: A cross-sectional study was conducted. Patients with clinical confirmation of FSHD and aged above 18 years were included and paired with healthy control individuals by age and gender. Individuals who had neurological conditions that could interfere with test results were excluded. The following assessments were applied: speech tests (acoustic and auditory-perceptual analysis); swallowing tests with the Northwestern Dysphagia Patient Check Sheet (NDPCS), the Eat Assessment Tool (EAT-10), the Speech Therapy Protocol for Dysphagia Risk (PARD), and the Functional Oral Intake Scale (FOIS); disease staging using the modified Gardner-Medwin-Walton scale (GMWS); and quality of life with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The correlation between test results and clinical data was verified by non-parametric statistics. Results: Thirteen individuals with FSHD and 10 healthy controls were evaluated. The groups presented significant differences in the motor bases of phonation and breathing. Regarding swallowing, two (15%) individuals presented mild dysphagia and seven (53.8%) showed reduced facial muscles strength. These results were not correlated with duration of the disease, age at symptoms onset, and quality of life. Dysphagia was related to worsening disease severity. Conclusions: FSHD patients presented mild dysarthria and dysphagia. Frequent monitoring of these symptoms could be an important way to provide early rehabilitation and better quality of life.

RESUMO Antecedentes: Embora haja predomínio de fraqueza muscular facial na distrofia facioescapuloumeral (FSHD), é escassa a literatura sobre aspectos de fala e deglutição. Objetivo: Investigar os padrões de fala e deglutição na FSHD e correlacioná-los com dados clínicos da doença. Métodos: Estudo transversal. Pacientes com confirmação clínica de FSHD e idade acima de 18 anos foram incluídos e pareados por idade e sexo com controles saudáveis. Foram excluídos indivíduos que apresentassem condições neurológicas que pudessem interferir nos resultados dos testes. Aplicaram-se as seguintes avaliações: fala (análise acústica e perceptivo-auditiva); deglutição, por meio do Northwestern Dysphagia Patient Check Sheet (NDPCS), Eat Assessment Tool (EAT-10), Protocolo de Avaliação para Risco de Disfagia (PARD) e Functional Oral Intake Scale (FOIS); estadiamento da doença, por meio da Gardner-Medwin-Walton scale (GMWS); e qualidade de vida, com o Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Resultados de fala e deglutição foram correlacionados com dados clínicos da doença por teste não paramétrico. Resultados: Foram avaliados 13 indivíduos com FSHD e dez controles saudáveis. Houve diferença significativa entre os grupos nas bases motoras fonação e respiração. Na deglutição, dois (15%) indivíduos apresentaram disfagia leve e sete (53,8%), força reduzida da musculatura da face. Esses resultados não foram correlacionados com tempo de doença, idade de início dos sintomas e qualidade de vida. A disfagia esteve relacionada com a gravidade da doença. Conclusões: Pacientes com FSHD apresentaram disartria e disfagia leves. O monitoramento frequente desses sintomas pode ser uma forma importante de proporcionar reabilitação precoce e melhor qualidade de vida.

Speech and swallowing characteristics in patients with facioscapulohumeral muscular dystrophy.

BACKGROUND: Although facial muscle weakness is common in patients with Facioscapulohumeral Muscular Dystrophy (FSHD), the literature is scarce on the speech and swallowing aspects. OBJECTIVE: To investigate speech and swallowing patterns in FSHD and assess the correlation with clinical data. METHODS: A cross-sectional study was conducted. Patients with clinical confirmation of FSHD and aged above 18 years were included and paired with healthy control individuals by age and gender. Individuals who had neurological conditions that could interfere with test results were excluded. The following assessments were applied: speech tests (acoustic and auditory-perceptual analysis); swallowing tests with the Northwestern Dysphagia Patient Check Sheet (NDPCS), the Eat Assessment Tool (EAT-10), the Speech Therapy Protocol for Dysphagia Risk (PARD), and the Functional Oral Intake Scale (FOIS); disease staging using the modified Gardner-Medwin-Walton scale (GMWS); and quality of life with the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). The correlation between test results and clinical data was verified by non-parametric statistics. RESULTS: Thirteen individuals with FSHD and 10 healthy controls were evaluated. The groups presented significant differences in the motor bases of phonation and breathing. Regarding swallowing, two (15%) individuals presented mild dysphagia and seven (53.8%) showed reduced facial muscles strength. These results were not correlated with duration of the disease, age at symptoms onset, and quality of life. Dysphagia was related to worsening disease severity. CONCLUSIONS: FSHD patients presented mild dysarthria and dysphagia. Frequent monitoring of these symptoms could be an important way to provide early rehabilitation and better quality of life.

Using Voice Change as an Indicator of Dysphagia: A Systematic Review.

Voice change post-swallow, observed during a clinical swallow examination, is often used as a clinical indicator of dysphagia risk. However, there has been limited research that evaluated the level of agreement between voice change and swallow dysfunction reported to date. This systematic review aims to investigate existing evidence relating to the relationship between vocal change post-swallow and swallow deficits identified on a Videofluoroscopic Swallow Study (VFSS). The studies were selected by two independent evaluators for inclusion, without restriction on language or date of publication and the methodological quality and the risk of bias were assessed using QUADAS-2. Following the PRISMA recommendation, 271 articles were analyzed, of which 17 were included in the study. Of these, the methodology described in five studies employed voice analyses using only acoustic methods, seven others conducted only auditory-perceptual analyses, and five other studies used both. Across the studies there was no homogeneity in the voice quality parameters assessed, analytic methods used, and results obtained. Forty seven per cent of the studies presented a high risk of bias in the analysis of vocal quality due to lack of clarity and blinding of VFSS. There was no homogeneity in the choice of consistencies evaluated during swallowing, as well as standardization of the outcome investigated in VFSS without a vocal parameter attributable to accurate detection in each outcome. It is not possible to obtain a consensus regarding the recommendation of the use of vocal evaluation as an accurate method for identifying swallowing alterations due to heterogeneity of the vocal evaluation methods, the outcomes evaluated in the VFSS examination, heterogeneity in food and liquid consistencies, and the methodological quality of the studies.

Speech characteristics in individuals with myasthenia gravis: a case control study.

INTRODUCTION: Myasthenia Gravis (MG) is an autoimmune disease. The characteristic symptoms of the disease are muscle weakness and fatigue. These symptoms affect de oral muscles causing dysarthria, affecting about 60% of patients with disease progression. PURPOSE: Describe the speech pattern of patients with MG and comparing with healthy controls (HC). MATERIAL AND METHODS: Case-control study. Participants were divided in MG group (MGG) with 38 patients MG diagnosed and HC with 18 individuals matched for age and sex. MGG was evaluated with clinical and motor scales and answered self-perceived questionnaires. Speech assessment of both groups included: recording of speech tasks, acoustic and auditory-perceptual analysis. RESULTS: In the MGG, 68.24% of the patients were female, with average age of 50.21 years old (±16.47), 14.18 years (±9.52) of disease duration and a motor scale of 11.19 points (±8.79). The auditory-perceptual analysis verified that 47.36% (n = 18) participants in MGG presented mild dysarthria, 10.52% (n = 4) moderate dysarthria, with a high percentage of alterations in phonation (95.2%) and breathing (52.63%). The acoustic analysis verified a change in phonation, with significantly higher shimmer values in the MGG compared to the HC and articulation with a significant difference between the groups for the first formant of the /iu/ (p = <.001). No correlation was found between the diagnosis of speech disorder and the dysarthria self-perception questionnaire. CONCLUSION: We found dysarthria mild in MG patients with changes in the motor bases phonation and breathing, with no correlation with severity and disease duration.

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

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

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

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

Prevalence of malocclusion in early childhood and its associated factors in a primary care service in Brazil / Prevalência de maloclusões na primeira infância e fatores associados em um serviço de atenção primária no Brasil

ABSTRACT Purpose to evaluate the prevalence of malocclusion and its associated factors of children cared for by a PHC Service in Porto Alegre, Brazil. Methods a cross-sectional study nested in a cohort, carried out in 12 Health Care Practices. Of the 414 children in the cohort examined, 268 were assessed for malocclusion. The presence of anterior open bite, posterior and anterior crossbite was evaluated by the criteria of Foster and Hamilton. Socioeconomic variables, breastfeeding habits and pacifier use information were collected through a standardized questionnaire. Data analysis was performed using a hierarchical approach by Poisson Regression with robust variance. Results out of the total 268 evaluated, 135 (50.4%) were boys, and the average age was 28.6 (± 11.9) months. Out of the 143 (53.4%) cases of malocclusion, 113 were anterior open bite, 16 were anterior crossbite, 27 were posterior crossbite, and 38 had increased overjet. In the final analysis, it was observed that there was a higher prevalence of malocclusion in children who never breastfed (PR = 1.44; 95%CI 1.00-2.08) and who always used a pacifier to sleep (PR = 1.81; 95%CI 1.14-2.86). Conclusion the prevalence of malocclusion in this population was high and was associated with behavioral habits, such as the use of pacifier and not breastfeeding.

RESUMO Objetivo avaliar a prevalência de maloclusões e seus fatores associados em crianças atendidas em um Serviço de APS de Porto Alegre, Brasil. Método estudo transversal aninhado a uma coorte, realizado em 12 Unidades de Saúde. Das 414 crianças da coorte examinadas, 268 foram examinadas para maloclusão. A presença de mordida aberta anterior, mordida cruzada posterior e anterior foi avaliada pelos critérios de Foster e Hamilton. Variáveis socioeconômicas, hábitos de amamentação e informações sobre o uso de chupeta foram coletados por meio de questionário padronizado. A análise dos dados foi realizada por meio de uma abordagem hierárquica por Regressão de Poisson com variância robusta. Resultados do total de 268 avaliados, 135 (50,4%) eram meninos e a média de idade foi de 28,6 (± 11,9) meses. Dos 143 (53,4%) casos de maloclusão, 113 eram mordida aberta anterior, 16 eram mordida cruzada anterior, 27 eram mordida cruzada posterior e 38 tinham overjet acentuado. Na análise final, observou-se que houve maior prevalência de maloclusões em crianças que nunca foram amamentadas (RP = 1,44; IC95% 1,00-2,08) e que sempre usaram chupeta para dormir (RP = 1,81; IC95% 1,14 -2,86). Conclusão a prevalência de maloclusões nesta população foi elevada e esteve associada a hábitos comportamentais, como o uso de chupeta e a não amamentação.

Fatores associados a fragilidade em pacientes com doenças neurodegenerativas / Factors associated with frailty in patients with neurodegenerative diseases

RESUMO Objetivo Identificar os fatores associados à fragilidade em pacientes com doenças neurodegenerativas. Método Estudo transversal, cuja amostra foi composta por 150 pacientes com diagnóstico de doenças neurodegenerativas atendidos em um ambulatório de Fonoaudiologia de um hospital de referência no sul do Brasil. Foi realizada análise secundária exploratória dos prontuários dos pacientes atendidos neste ambulatório entre o período de abril de 2016 e maio de 2019. As informações coletadas foram: sexo, idade, escolaridade, tipo de doença neurodegenerativa, tempo de doença, fragilidade (Edmonton Frail Scale - EFS), deglutição (Northwestern Dysphagia Patient CheckSheet- NDPCS, Eating Assessment Tool-EAT 10) e cognição (Mini-Mental State Examination-MMSE e Montreal Cognitive Assessment-MoCA). As variáveis quantitativas contínuas foram analisadas a partir de média e desvio padrão e as quantitativas categóricas a partir de frequência absoluta e relativa, assim como analisou-se a associação destas com o desfecho pelo teste Qui-Quadrado. As Razões de Prevalência brutas e ajustadas foram avaliadas a partir da Regressão de Poisson com variância robusta. Todos os testes estatísticos foram considerados significativos a um nível de 5%. Resultados Os fatores significativos associados à fragilidade foram à presença de disfagia orofaríngea e desempenho cognitivo alterado. Indivíduos com a fragilidade apresentam maior prevalência de disfagia orofaríngea (RP=1,772(1,094-2,872)), enquanto a cognição alterada está associada a menor prevalência de fragilidade (RP=0,335(0,128-0,873). Conclusão A disfagia orofaríngea pode ser um importante fator clínico preditivo a ser considerado em casos de fragilidade em pacientes com doenças neurodegenerativas.

ABSTRACT Purpose To identify the factors associated with frailty in patients with neurodegenerative diseases. Methods Cross-sectional study, whose sample consisted of 150 patients diagnosed with neurodegenerative diseases seen at a speech-language therapy clinic in a reference hospital in southern Brazil. A secondary exploratory analysis of the medical records of patients treated at this clinic between April 2016 and May 2019 was performed. The information collected was sex, age, education, type of neurodegenerative disease, time of disease, frailty (Edmonton Frail Scale-EFS), swallowing (Northwestern Dysphagia Patient CheckSheet-NDPCS, Eating Assessment Tool-EAT 10), and cognition (Mini-Mental State Examination-MMSE and Montreal Cognitive Assessment-MoCA). Continuous quantitative variables were analyzed using mean and standard deviation and categorical quantitative variables from absolute and relative frequency, as well as their association with the outcome using the Chi-square test. Crude and adjusted Prevalence Ratios were assessed using Poisson regression with robust variance. All statistical tests were considered significant at a level of 5%. Results The significant factors associated with frailty were the presence of oropharyngeal dysphagia and altered cognitive performance. Individuals with frailty have a higher prevalence of oropharyngeal dysphagia (PR= 1.772(1.094-2.872)), while cognition alteration presented a lower prevalence (PR= 0.335(0.128-0.873). Conclusion Oropharyngeal dysphagia can be an important clinical predictive factor for consideration in cases of frailty in patients with neurodegenerative diseases.

Influência da intubação orotraqueal nas alterações miofuncionais orofaciais em lactentes / Influencia de la intubación orotraqueal sobre los cambios miofuncionales orofaciales en lactantes / Influence of orotracheal intubation on orofacial myofuncional changes in infants

Introdução: As alterações da deglutição pós-extubação são amplamente identificadas e estudadas, nas quais a disfagia é identificada nas fases oral e faríngea, acompanhada de penetração laríngea e aspiração traqueal. Entretanto, as alterações miofuncionais orofaciais em pacientes pós-extubação ainda não estão bem descritas em Pediatria. Objetivo: Verificar a influência da intubação orotraqueal (IOT) nas alterações miofuncionais orofaciais do lactente. Método: Estudo transversal, realizado em uma Unidade de Terapia Intensiva Pediátrica no período entre novembro de 2015 a setembro de 2016. Os participantes foram divididos em dois grupos: grupo estudo, com diagnóstico médico de cardiopatia congênita, pós-operatório de cirurgia cardíaca, em IOT por no mínimo 6 horas, e grupo controle composto por lactentes de 0 a 6 meses, previamente saudáveis, que não tiveram histórico de qualquer IOT anterior. Após a seleção, ambos os grupos foram submetidos ao Protocolo de Avaliação de Disfagia Pediátrica. Resultados: Postura e tônus labial, postura de língua, palato e qualidade vocal estiveram significativamente associados ao uso de IOT, pressão intraoral e padrão de sucção. Ao analisar a distribuição de frequência da comparação com e sem IOT, observa-se que não há um padrão específico que indique se a associação é prejudicial, protetora ou não interfere no padrão das características miofuncionais nesses casos. Conclusão: A influência da IOT foi encontrada nas estruturas miofuncionais orofaciais de bebês, quando comparados a bebês não intubados.

Introduction: Post-extubation swallowing changes are widely identified and studied, in which dysphagia is identified in the oral and pharyngeal phases, accompanied by laryngeal penetration and aspiration. However, orofacial myofunctional changes in post-extubation patients are still not well described in pediatrics. Objective: Verify the influence of orotracheal intubation on orofacial myofunctional changes in lactates. Methods: Cross-sectional study, performed in a Pediatric Intensive Care Unit from November 2015 to September 2016. Participants were divided into two groups: study group, with medical diagnosis of congenital heart disease, post-cardiac surgery, undergoing OTI for at least 6 hours, and the control group was composed of infants aged 0 to 6 months, previously healthy, who did not have any previous IOT. After selection, babies from both groups were submitted to the same assessment protocols. The clinical evaluation of the child's orofacial myofunctional structures was performed using the Pediatric Dysphagia Assessment Protocol. Results: Lip posture, lip tone, tongue posture, palate, and vocal quality were significantly associated with the use of OIT, intraoral pressure and suction pattern. When analyzing the frequency distribution of the comparison with and without OIT, it is observed that there is no specific pattern that indicates whether the association is harmful, protective or does not interfere in the pattern of myofunctional characteristics in these cases. Conclusion: OIT influence was found in orofacial myofunctional structures in infants, when compared to babies who were not intubated.

Introducción: Los cambios en la deglución post-extubación están ampliamente identificados y estudiados, en los que se identifica disfagia en las fases oral y faríngea, acompañada de penetración y aspiración laríngea. Sin embargo, los cambios miofuncionales orofaciales en pacientes post-extubación todavía no están bien descritos en pediatría. Objetivo: Verificar la influencia de la intubación orotraqueal sobre los cambios miofuncionales orofaciales en lactatos. Metodos: estudio transversal, realizado en una Unidad de Cuidados Intensivos Pediátricos desde noviembre de 2015 hasta septiembre de 2016. Los participantes se dividieron en dos grupos: grupo de estudio, con diagnóstico médico de cardiopatía congénita, postoperatorio cardíaco, sometidos a IOT durante al menos 6 horas y el grupo control, compuesto por lactantes de 0 a 6 meses, previamente sanos, que no tiene alguna IOT anterior. Después de la selección, los bebés de ambos grupos fueron sometidos a los mismos protocolos de evaluación. La evaluación clínica de las estructuras miofuncionales orofaciales del niño se realizó mediante el Protocolo de Evaluación de Disfagia Pediátrica. Resultados: La postura de los labios, el tono de los labios, la postura de la lengua, el paladar, la calidad vocal se asociaron significativamente con el uso de ITO, la presión intraoral y el patrón de succión. Al analizar la distribución de frecuencias de la comparación con y sin ITO, se observa que no existe un patrón específico que indique si la asociación es dañina, protectora o no interfiere en el patrón de características miofuncionales en estos casos. Conclusión: la influencia de la ITO se encontró en las estructuras miofuncionales orofaciales en los bebés, en comparación con los bebés que no fueron intubados.

Eficácia de terapia de fala em grupo para pacientes com a doença de Machado Joseph: uma série de casos / Effectiveness of group speech therapy for patients with Machado Joseph Disease: a series of cases / Eficiencia de la terapia del habla en grupo para pacientes con Enfermedad de Machado Joseph: una serie de casos

Objetivo: Verificar o benefício de terapia fonoaudiológica em grupo na inteligibilidade de fala de pacientes com Doença de Machado Joseph (DMJ). Método: Realizou-se uma série de casos, com pacientes atendidos em um ambulatório de fonoaudiologia para adultos neurodegenerativos em um hospital de referência no sul do Brasil. Foram incluídos pacientes com o diagnóstico molecular de DMJ. Realizaram-se coletas de fala pré e pós-intervenção. Posteriormente, os trechos de fala passaram por análise perceptiva-auditiva por 3 fonoaudiólogas treinadas e calibradas a um índice Kappa ≥ 0.90, cegas às coletas de fala e por análise acústica no software Praat. A terapia fonoaudiológica foi realizada em grupo, composta por quatro sessões semanais de cinquenta minutos. Cada sessão foi dividida entre exercícios de fala e orientação sobre estratégias para otimizar a comunicação. Resultados: A amostra foi composta por 5 pacientes com média de idade de 39,8 anos (±16,51) e tempo de doença de 10 anos (±8,15). Quatro (80%) participantes receberam diagnóstico fonoaudiológico inicial de disartria leve e um (20%) de disartria moderada. Após a intervenção, não houve melhora no diagnóstico de disartria, contudo verificou-se que 60% (n=3) dos participantes apresentaram melhora na articulação, 40% (n=2) na prosódia e ressonância e 40% (n=2) apresentaram piora na respiração. Na análise acústica observou-se melhora no tempo máximo de fonação (TMF) em 3 (60%) dos 5 pacientes. Conclusão: Verificou-se melhora na funcionalidade da fala através da análise perceptiva auditiva, porém com pouca melhora em parâmetros específicos da análise acústica.

Objective: To verify the benefit of group speech therapy in speech intelligibility of patients with Machado Joseph's disease (MJD). Methods: A series of cases was carried out, with patients seen in a speech therapy clinic for neurodegenerative adults in a referral hospital in southern Brazil. Patients with the molecular diagnosis of MJD were included. Speech recordings were performed before and after the intervention. Subsequently, the speech excerpts underwent auditory-perceptual analysis by 3 trained speech therapists and calibrated to a Kappa index ≥ 0.90, blind to speech collections and acoustic analysis in the Praat software. Speech therapy was performed in a group, consisting of four weekly sessions of fifty minutes. Each session was divided between speech exercises and guidance on strategies to optimize communication. Results: The sample consisted of 5 patients with a mean age of 39.8 years (± 16.51) and disease duration of 10 years (± 8.15). Four (80%) participants received an initial speech therapy diagnosis of mild dysarthria and one (20%) of moderate dysarthria. After the intervention, there was no improvement in the diagnosis of dysarthria, however it was found that 60% (n = 3) of the participants showed improvement in the speech motor bases: articulation, 40% (n = 2), prosody and resonance and 40% (n = 2) worsened in breathing. The acoustic analysis showed an improvement in maximum phonation time (MPT) in 3 (60%) of the 5 patients. Conclusion: Despite the little improvement in specific parameters of the acoustic analysis, there was an improvement in speech functionality from the auditory perceptual analysis, improving the speech intelligibility of this sample.

Objetivo: Verificar el beneficio de la logopedia grupal en la inteligibilidad del habla de pacientes con enfermedad de Machado Joseph (EMJ). Metodos: Se realizó una serie de casos, con pacientes atendidos en una clínica de logopedia para adultos neurodegenerativos en un hospital de referencia en el sur de Brasil. Se incluyeron pacientes con diagnóstico molecular de EMJ. Se realizaron grabación del habla antes y después de la intervención. Posteriormente, los extractos del habla se sometieron a un análisis auditivo-perceptivo por 3 logopedas capacitados y calibrados con un índice Kappa ≥ 0,90, ciegos a las grabación del habla y al análisis acústico en el software Praat. La logopedia se realizó en grupo, consistente en cuatro sesiones semanales de cincuenta minutos. Cada sesión se dividió entre ejercicios de habla y orientación sobre estrategias para optimizar la comunicación. Resultados: La muestra estuvo formada por 5 pacientes con una edad media de 39,8 años (± 16,51) y una duración de la enfermedad de 10 años (± 8,15). Cuatro (80%) participantes recibieron un diagnóstico inicial de terapia del habla de disartria leve y uno (20%) de disartria moderada. Tras la intervención, no hubo mejoría en el diagnóstico de disartria, sin embargo se encontró que el 60% (n = 3) de los participantes mostró mejoría en las bases motoras del habla: articulación, 40% (n = 2), prosodia y resonancia. y el 40% (n = 2) empeoró en la respiración. El análisis acústico mostró una mejora en el tiempo máximo de fonación (TMF) en 3 (60%) de los 5 pacientes. Conclusion: A pesar de la pequeña mejora en los parámetros específicos del análisis acústico, hubo una mejora en la funcionalidad del habla a partir del análisis de percepción auditiva, mejorando la inteligibilidad del habla de esta muestra.

Cognitive profile of patients with facioscapulohumeral muscular dystrophy / Perfil cognitivo de pacientes com distrofia muscular facioescapuloumeral

ABSTRACT Although it is predominantly a muscular disease, impairments in the central nervous system in patients with facioscapulohumeral muscular dystrophy (FSHD) have been described in the literature. Objective: To describe the cognitive profile of patients with FSHD and to correlate the impairments found with clinical variables and quality of life. Methods: Cross-sectional and case-control study that evaluated FSHD patients using a series of cognitive assessments (Mini-Mental State Examination — MMSE, Montreal Cognitive Assessment — MoCA, verbal fluency with phonological restriction — FAS, categorical verbal fluency — FAS-cat, trail-making test — TMT, and Rey's Verbal Auditory Learning Test); a neurological severity scale (Gardner-Medwin-Walton — GMWS); and a quality of life measurement tool (Medical Outcomes Study 36-Item Short-Form Health Survey). Results: Individuals with FSHD (13) and healthy controls (26) were paired by gender and age. Significant differences between case and control groups were found in MMSE, TMT A, and A7 (p≤0.05) and MOCA (p≤0.001) performances. A positive correlation was verified in long-term memory impairments and the age in which symptoms appear (r=-0.593, p=0.033). Regarding quality of life assessment, the emotional domain correlated to MEEM (r=0.657, p=0.015), TMT A (r=-0.601, p=0.030), and A7 (r=0.617, p=0.025) performances. Conclusions: Individuals with FSHD presented mild impairments in the performance of tasks that involve attention, planning, and long-term memory functions. Those impairments were associated neither with the disease duration nor with its neurological severity.

RESUMO Embora seja uma doença predominantemente muscular, alterações no sistema nervoso central em pacientes com Distrofia Facioescapuloumeral (FSHD) têm sido descritas na literatura. Objetivo: Caracterizar o perfil cognitivo de pacientes com FSHD e correlacionar as alterações encontradas com variáveis clínicas e qualidade de vida. Métodos: Estudo transversal, caso-controle que avaliou pacientes com FSHD por meio de uma série de avaliações cognitivas (Mini Exame do Estado Mental — MEEM; Montreal Cognitive Assessment — MoCA; fluência verbal com restrição fonológica — FAS; fluência verbal categórica — FAS-cat; Trail Making Test — TMT; e Rey's Verbal Auditory Learning Test — RAVLT); uma escala de gravidade neurológica (Gardner-Medwin-Walton — GMWS); e um questionário (Medical Outcomes Study 36-Item Short-Form Health Survey — SF-36). Resultados: A amostra foi composta por 13 indivíduos com FSHD e 26 controles saudáveis, pareados por sexo e idade. A análise comparativa entre os grupos FSHD e controle mostrou diferenças significativas no desempenho cognitivo dos testes MEEM, TMT A e A7 (p≤0.05) e no MoCA (p≤0,001). Verificou-se uma correlação positiva com a idade de início dos sintomas e o prejuízo na memória de longo prazo (r=-0,593, p=0,033). Em relação à qualidade de vida, observou-se uma correlação entre o domínio de limitação emocional e os testes MEEM (r=0,657, p=0,015), TMT A (r=-0,601, p=0,030) e A7 (r=0,617, p=0,025). Conclusões: Pacientes com FSHD apresentaram alterações leves na realização de tarefas que envolvem as funções de atenção, planejamento e memória de longo prazo. Essas alterações não tiveram associação com o tempo de doença nem com sua gravidade neurológica.

Factors Associated with Tobacco Cessation in Primary Health Care.

Introduction Cigarettes are the main cause of preventable death in the world, and primary health care services can contribute to the management of this habit. Objective To describe and analyze the factors associated with tobacco cessation in groups of smokers in primary health care. Methods The present is a cross-sectional study conducted in 12 primary health care units from July 2016 to May 2017. We investigated sociodemographic and health variables, as well as smoking characteristics and different interventions for tobacco cessation, with the outcome being studied and analyzed after the fourth group care session. Results We evaluated 329 smokers, of which 182 quit smoking after the fourth interview. Most of the individuals who quit smoking were women ( n = 121, 66.5%), with a monthly income of 2 to 5 minimum wages ( n = 88, 77.9%). After the multivariable analysis, we observed that tobacco cessation was significantly associated with depression (prevalence ratio [PR] = 1.11; 95% confidence interval [95%CI] = 1.02 to 1.22), as well as with belonging to the groups which used as approaches motivational interviewing (PR = 1.21; 95%CI = 1.13 to 2.01), patches (PR = 1.36; 95%CI = 1.24 to 1.48), and bupropion (PR = 1.16; 95%CI = 1.03 to 1.31). Conclusion Primary health care is the ideal site for the reduction of smoking rates, given that different technologies may be applicable and useful for tobacco cessation. The comprehensiveness and longitudinal care offered in primary care may provide opportunities for health professionals to understand which is the best technology for each health system user, thus contributing to personalized care.