Popular Health, Environmental and Occupational Surveillance: an integrative literature review. / Vigilância Popular da Saúde, Ambiente e Trabalho (VPSAT): uma revisão integrativa da literatura.

The objective is to identify concepts, experiences, methods, and techniques in Popular Health, Environmental and Occupational Surveillance (VPSAT). This is an integrative review that used the descriptors: Community Participation, Public Health Surveillance, Environmental Health, and Occupational Health, using five databases: Virtual Health Library, EBSCOhost, Embase, Scopus and Web of Science. The review selected 15 studies, based on the inclusion criteria: surveillance experiences with community protagonism; and exclusion criteria: research without primary data and developed only by the health service. The theoretical and methodological bases of the studies were identified as citizen science, popular education, and environmental justice; experiences such as participatory mapping and monitoring; methods such as action research, 'do-it-yourself', and community-based research; and techniques such as "Photovoice" and Community Journal. Low-income urban communities, indigenous peoples, young individuals, and workers stand out as the protagonists. The recognition of the VPSAT as an important source of data and intervention by public health systems and academia contributes to making health surveillance more dialogic and effective.

Objetiva-se identificar concepções, experiências, métodos e técnicas em Vigilância Popular da Saúde, Ambiente e Trabalho (VPSAT). Trata-se de uma revisão integrativa com os descritores: participação da comunidade, vigilância em saúde, vigilância da saúde, saúde ambiental e saúde do trabalhador, envolvendo cinco bancos de dados: Biblioteca Virtual da Saúde, EBSCOhost, Embase, Scopus e Web Of Science. A revisão selecionou 15 estudos, a partir dos critérios de inclusão: experiências de vigilância com protagonismo comunitário; e exclusão: pesquisas sem dados primários e desenvolvidas apenas pelo serviço de saúde. Identificaram-se como bases teóricas e metodológicas dos estudos a ciência cidadã, educação popular e justiça ambiental; e experiências como mapeamentos e monitoramentos participativos; métodos como pesquisa-ação, "faça você mesmo" e investigação baseada na comunidade; e técnicas como "Photovoice" e Jornal Comunitário. Destacam-se as comunidades urbanas de baixa renda, indígenas, jovens e trabalhadores como protagonistas. O reconhecimento da VPSAT como importante fonte de dados e de intervenção pelos sistemas de saúde públicos e pela academia contribui para que a vigilância em saúde seja mais dialógica e efetiva.

Vigilância Popular da Saúde, Ambiente e Trabalho (VPSAT): uma revisão integrativa da literatura / Popular Health, Environmental and Occupational Surveillance: an integrative literature review

Resumo Objetiva-se identificar concepções, experiências, métodos e técnicas em Vigilância Popular da Saúde, Ambiente e Trabalho (VPSAT). Trata-se de uma revisão integrativa com os descritores: participação da comunidade, vigilância em saúde, vigilância da saúde, saúde ambiental e saúde do trabalhador, envolvendo cinco bancos de dados: Biblioteca Virtual da Saúde, EBSCOhost, Embase, Scopus e Web Of Science. A revisão selecionou 15 estudos, a partir dos critérios de inclusão: experiências de vigilância com protagonismo comunitário; e exclusão: pesquisas sem dados primários e desenvolvidas apenas pelo serviço de saúde. Identificaram-se como bases teóricas e metodológicas dos estudos a ciência cidadã, educação popular e justiça ambiental; e experiências como mapeamentos e monitoramentos participativos; métodos como pesquisa-ação, "faça você mesmo" e investigação baseada na comunidade; e técnicas como "Photovoice" e Jornal Comunitário. Destacam-se as comunidades urbanas de baixa renda, indígenas, jovens e trabalhadores como protagonistas. O reconhecimento da VPSAT como importante fonte de dados e de intervenção pelos sistemas de saúde públicos e pela academia contribui para que a vigilância em saúde seja mais dialógica e efetiva.

Abstract The objective is to identify concepts, experiences, methods, and techniques in Popular Health, Environmental and Occupational Surveillance (VPSAT). This is an integrative review that used the descriptors: Community Participation, Public Health Surveillance, Environmental Health, and Occupational Health, using five databases: Virtual Health Library, EBSCOhost, Embase, Scopus and Web of Science. The review selected 15 studies, based on the inclusion criteria: surveillance experiences with community protagonism; and exclusion criteria: research without primary data and developed only by the health service. The theoretical and methodological bases of the studies were identified as citizen science, popular education, and environmental justice; experiences such as participatory mapping and monitoring; methods such as action research, 'do-it-yourself', and community-based research; and techniques such as "Photovoice" and Community Journal. Low-income urban communities, indigenous peoples, young individuals, and workers stand out as the protagonists. The recognition of the VPSAT as an important source of data and intervention by public health systems and academia contributes to making health surveillance more dialogic and effective.

Trajetórias e aprendizados do curso de educação popular e promoção de territórios saudáveis na convivência com o semiárido / Trajectories and lessons learned from the popular education course and the promotion of healthy territories in coexistence with the semiarid

A obra: "TRAJETÓRIAS E APRENDIZADOS DO CURSO DE EDUCAÇÃO POPULAR E PROMOÇÃO DE TERRITÓRIOS SAUDÁVEIS NA CONVIVÊNCIA COM O SEMIÁRIDO" apresenta a sistematização do processo e percurso pedagógico vivenciado no "Curso de Especialização e Aperfeiçoamento em Educação Popular e Promoção de Territórios Saudáveis na Convivência com o Semiárido". Uma das inovações produzidas como dispositivo de implementação da Política Nacional de Educação Popular em Saúde reconhecida institucionalmente no Sistema Único de Saúde (SUS) através da Portaria 2.761 de 19 de novembro de 2013, que tem na sua essência o diálogo, a amorosidade, a problematização, a construção compartilhada do conhecimento, a emancipação e o compromisso com o Projeto Democrático e Popular de sociedade como princípios fundamentais (BRASIL, 2013). Desse processo essencialmente inovador surgem três obras, em que se apresentam os saberes e aprendizados que emergiram do vivenciado no Curso e no que o conjunto de suas singularidades político-pedagógicas possibilitaram fazer, sentir, experienciar e criar de novos conceitos, reflexões e conhecimentos. Esta primeira reflete o percurso desse processo, sua construção, a proposta pedagógica e como foi sendo desenvolvido enquanto dinâmica formativa essencialmente comprometida, engajada e implicada nos territórios com seus atores e atrizes! Expressa a força e a potência da Sistematização de Experiências na produção de conhecimentos, pesquisas, saberes e sabores emergentes no cotidiano dos serviços, das organizações sociais e populares, do Esperançar de vida e saúde vivido no Ceará e Rio Grande do Norte e agora compartilhado com quem deseja construir processos nessa perspectiva dialógica e emancipatória.

Are reduced internal nasal dimensions a risk factor for obstructive sleep apnea syndrome? / Dimensões internas nasais reduzidas constituem fator de risco para síndrome da apneia obstrutiva do sono?

Abstract Introduction Obstructive sleep apnea syndrome is a high-prevalence disorder found in the population. Studies have shown a possible association between nasal obstruction and obstructive sleep apnea syndrome, but the existence of a association between the degree of nasal obstruction and obstructive sleep apnea syndrome severity has not yet been proven. Objective To evaluate the internal nasal dimensions of adults with primary snoring and obstructive sleep apnea syndrome by acoustic rhinometry and to correlate the findings with obstructive sleep apnea severity. Methods Twenty-one male Caucasian subjects with complaints of snoring and/or respiratory pauses during sleep, aged between 18 and 60 years of age, were evaluated. After clinical evaluation, otorhinolaryngological examination and flexible nasopharyngolaryngoscopy, all patients underwent type III polysomnography. The participants were divided into two groups according to symptom severity: group 1, primary snoring and/or mild obstructive sleep apnea syndrome(n = 9) and group 2, moderate/severe obstructive sleep apnea syndrome (n = 12). Internal nasal dimensions were measured by acoustic rhinometry, analyzing minimum cross sectional area (CSA) and three nasal segment volumes. Results The respiratory event index corresponded to 8.1 ± 4.0 in group 1 and 47.5 ± 19.1 in group 2. In group 1, the cross-sectional areas values, in cm2, corresponded to: CSA 1 = 1.1 ± 0.4; CSA 2 = 2.1 ± 0.9; CSA 3 = 3.5 ± 1.8 and, in group 2: CSA 1 = 1.2 ± 0.3, CSA 2 = 2.0 ± 0.5; CSA 3 = 2.8 ± 0.7. In group 1, volumes (V), in cm3, corresponded to: V1 = 3.5 ± 1.0; V2 = 9.3 ± 5.0; V3 = 40.2 ± 21.5 and in group 2 a: V1 = 3.6 ± 0.5; V2 = 7.6 ± 1.5; V3 = 31.5 ± 6.7. Cross-sectional area and volume ​​did not differ between groups. Conclusion There were no significant differences in the cross-sectional areas and nasal volumes between individuals with primary snoring-mild obstructive sleep apnea syndrome and moderate-severe obstructive sleep apnea syndrome. Differently to the raised hypothesis, our results suggest that there is no association between internal nasal dimensions and severity of obstructive sleep apnea syndrome.

Resumo Introdução A síndrome da apneia obstrutiva do sono é uma desordem de elevada prevalência na população. Estudos constataram possível associação entre obstrução nasal e síndrome da apneia obstrutiva do sono, porém a existência de uma relação entre a intensidade da obstrução nasal e a gravidade da síndrome da apneia obstrutiva do sono ainda não foi comprovada. Objetivo Avaliar as dimensões internas nasais de adultos com ronco primário e síndrome da apneia obstrutiva do sono por meio de rinometria acústica e correlacionar os achados com a gravidade da síndrome da apneia obstrutiva do sono. Método Foram avaliados 21 indivíduos com queixas de ronco e/ou pausas respiratórias durante o sono, gênero masculino, entre 18 e 60 anos, brancos. Após avaliação clínica, exame físico otorrinolaringológico e nasofaringolaringoscopia flexível, todos foram submetidos à polissonografia tipo III. Os participantes foram divididos em dois grupos de acordo com a gravidade dos sintomas: grupo 1, ronco primário e/ou síndrome da apneia obstrutiva do sono leve (n = 9) e grupo 2, síndrome da apneia obstrutiva do sono moderada/grave (n = 12). Dimensões internas nasais foram aferidas por rinometria acústica, foram consideradas para análise as áreas de secção transversa mínima e os volumes de três diferentes segmentos nasais. Resultados O índice de eventos respiratórios correspondeu a 8,1 ± 4,0 no grupo 1 e 47,5 ± 19,1 no grupo 2. No grupo 1, os valores de área de secção transversa, em cm2, corresponderam a: área de secção transversa 1 = 1,1 ± 0,4; área de secção transversa 2 = 2,1 ± 0,9; área de secção transversa 3 = 3,5 ± 1,8. No grupo 2: área de secção transversa 1 = 1,2 ± 0,3, área de secção transversa 2 = 2,0 ± 0,5; áre de secção transversa 3 = 2,8 ± 0,7. No grupo 1 os valores do volume, em cm3, corresponderam a: volume 1 = 3,5 ± 1,0; volume 2 = 9,3 ± 5,0; volume 3 = 40,2 ± 21,5 e no grupo 2 a: volume 1 = 3,6 ± 0,5; V2 = 7,6 ± 1,5; volume 3 = 31,5 ± 6,7. Os valores de área de secção transversa e volume não diferiram entre os grupos. Conclusão Não foram demonstradas diferenças significantes quanto às áreas seccionais transversas e os volumes nasais entre indivíduos com ronco primário e síndrome da apneia obstrutiva do sono leve e síndrome da apneia obstrutiva do sono moderada-grave. Contrariamente à hipótese levantada, os resultados sugerem não existir relação entre as dimensões internas nasais e o nível de gravidade da síndrome da apneia obstrutiva do sono.

Are reduced internal nasal dimensions a risk factor for obstructive sleep apnea syndrome?

INTRODUCTION: Obstructive sleep apnea syndrome is a high-prevalence disorder found in the population. Studies have shown a possible association between nasal obstruction and obstructive sleep apnea syndrome, but the existence of a association between the degree of nasal obstruction and obstructive sleep apnea syndrome severity has not yet been proven. OBJECTIVE: To evaluate the internal nasal dimensions of adults with primary snoring and obstructive sleep apnea syndrome by acoustic rhinometry and to correlate the findings with obstructive sleep apnea severity. METHODS: Twenty-one male Caucasian subjects with complaints of snoring and/or respiratory pauses during sleep, aged between 18 and 60 years of age, were evaluated. After clinical evaluation, otorhinolaryngological examination and flexible nasopharyngolaryngoscopy, all patients underwent type III polysomnography. The participants were divided into two groups according to symptom severity: group 1, primary snoring and/or mild obstructive sleep apnea syndrome(n = 9) and group 2, moderate/severe obstructive sleep apnea syndrome (n = 12). Internal nasal dimensions were measured by acoustic rhinometry, analyzing minimum cross sectional area (CSA) and three nasal segment volumes. RESULTS: The respiratory event index corresponded to 8.1 ±â€¯4.0 in group 1 and 47.5 ±â€¯19.1 in group 2. In group 1, the cross-sectional areas values, in cm2, corresponded to: CSA 1 = 1.1 ±â€¯0.4; CSA 2 = 2.1 ±â€¯0.9; CSA 3 = 3.5 ±â€¯1.8 and, in group 2: CSA 1 = 1.2 ±â€¯0.3, CSA 2 = 2.0 ±â€¯0.5; CSA 3 = 2.8 ±â€¯0.7. In group 1, volumes (V), in cm3, corresponded to: V1 = 3.5 ±â€¯1.0; V2 = 9.3 ±â€¯5.0; V3 = 40.2 ±â€¯21.5 and in group 2 a: V1 = 3.6 ±â€¯0.5; V2 = 7.6 ±â€¯1.5; V3 = 31.5 ±â€¯6.7. Cross-sectional area and volume ​​did not differ between groups. CONCLUSION: There were no significant differences in the cross-sectional areas and nasal volumes between individuals with primary snoring-mild obstructive sleep apnea syndrome and moderate-severe obstructive sleep apnea syndrome. Differently to the raised hypothesis, our results suggest that there is no association between internal nasal dimensions and severity of obstructive sleep apnea syndrome.

NASF-AB no campo e nas águas: o cuidado em torno do trabalho, ambiente e saúde de famílias agricultoras e pescadoras / NASF-AB in the field and in the waters: the care around work, environment and health of farming and fishing families / NASF-AB en el campo y en las aguas: el cuidado acerca del trabajo, el medio ambiente y la salud de las familias campesinas y pesqueras

Resumo O Núcleo Ampliado de Saúde da Família e Atenção Básica foi criado no Brasil para apoiar e ampliar a atenção e a gestão na Saúde da Família. Analisa-se a sua atuação quanto à saúde do trabalhador e saúde e ambiente em territórios do campo e das águas com as famílias que vivem da pesca artesanal e da agricultura camponesa. Pesquisa qualitativa que se ancorou em referenciais da Sociologia das Ausências e da Saúde Coletiva, na abordagem particular que esta faz das relações entre saúde, ambiente e trabalho. A pesquisa valeu-se do emprego de grupos focais na produção de narrativas de profissionais do Núcleo Ampliado de Saúde da Família e Atenção Básica em municípios do semiárido e do litoral do Nordeste. Evidenciaram-se singularidades socioeconômicas e culturais das populações do campo e das águas; invisibilidades e potencialidades sobre seus modos de vida e trabalho; cargas e doenças relacionadas ao trabalho; e aspectos da atuação do Núcleo Ampliado de Saúde da Família e Atenção Básica mediante interações com o trabalho e o ambiente nesses territórios. Os cuidados oferecidos a estas populações consideram parcialmente suas especificidades socioculturais, produtivas, ambientais e de saúde, sendo preciso ampliar o reconhecimento de seus modos de vida e trabalho visando intervenções mais exitosas sobre os problemas e necessidades de saúde - o que aponta desafios à formação em saúde para o Sistema Único de Saúde.

Abstract The Extended Family Health and Primary Care Center (Núcleo Ampliado de Saúde da Família e Atenção Básica - NASF-AB) was created in Brazil to support and expand Family Health care and management. Its performance regarding workers' health and health and environment in rural and water territories is analyzed with families that live from artisanal fishing and peasant agriculture. This is a qualitative research that was anchored in references from the Sociology of Absences and Collective Health, in the latter's particular approach to the relations between health, environment, and work. The research used focus groups to produce narratives of professionals from the Extended Center for Family Health and Primary Care in municipalities in the semiarid and coastal regions of the Northeast. The socioeconomic and cultural singularities of the rural and water populations were evidenced; invisibilities and potentialities about their ways of life and work; work-related burdens and diseases; and aspects of the performance of the Extended Family Health Center and Primary Care through interactions with work and the environment in these territories. The care offered to these populations partially considers their sociocultural, productive, environmental, and health specificities, and it is necessary to expand the recognition of their ways of life and work, aiming at more successful interventions on health problems and needs; which poses challenges to health education for the Unified Health System.

Resumen El Núcleo Ampliado de Salud de la Familia y Atención Básica fue creado en Brasil para apoyar y ampliar la atención y gestión en Salud de la Familia. Se analiza su desempeño en materia de salud de los trabajadores y salud y medio ambiente en territorios del campo y de las aguas con las familias que viven de la pesca artesanal y de la agricultura campesina. Investigación cualitativa que se basó en referentes de la Sociología de las Ausencias y de la Salud Colectiva, en el particular abordaje que esta hace de la relación entre salud, medio ambiente y trabajo. La investigación se basó en la utilización de grupos focales en la producción de narrativas por parte de profesionales del Núcleo Ampliado de Salud de la Familia y Atención Básica en municipios de la región semiárida y del litoral del Nordeste. Se evidenciaron singularidades socioeconómicas y culturales de las poblaciones del campo y de las aguas; invisibilidades y potencialidades sobre sus formas de vida y trabajo; cargas y enfermedades relacionadas con el trabajo; y aspectos de la actuación del Núcleo Ampliado de Salud de la Familia y Atención Primaria a través de interacciones con el trabajo y el medio ambiente en estos territorios. La atención ofrecida a estas poblaciones considera parcialmente sus especificidades socioculturales, productivas, ambientales y de salud, siendo necesario ampliar el reconocimiento de sus modos de vida y de trabajo, visando intervenciones más exitosas sobre los problemas y necesidades de salud; lo que apunta desafíos a la formación en salud para el Sistema Único de Salud.

Normative nasalance scores in the production of words and syllables for Brazilian Portuguese speakers.

The objective of this study was to determine normative nasalance scores for non-cleft children, adolescents and adults, native speakers of Brazilian Portuguese, during the production of words and syllables, for cross-linguistic comparisons in populations with and without cleft palate. Nasalance was assessed in 62 individuals, aged 6-10 years (n = 20), 11-17 years (n = 20) and 18-35 years (n = 22), using a nasometer II model 6450 (KayPENTAX), during production of one sequence of nine oral words (pipa, bis, burro, tatu, pilha, cuca, gui, fila, luz) and of sequences of isolated syllables (e.g. pa, pa, pa, pa, pa, pa) composed of plosive, fricative, liquid and nasal consonants with high and low vowels. In order to validate the new nasalance stimuli, nasalance scores for traditional oral and nasal stimuli were also obtained. Differences were analyzed at a significance level of 0.01. Mean nasalance scores (±SD) during the production of the sequence of words were 18 ± 5% (children), 18 ± 7% (adolescents) and 21 ± 5% (adults). Differences between age groups were not significant. During the production of syllables, adults had the highest mean nasalance scores (except for syllable /mi/); significant differences between age groups were observed only for /pa/ ,/sa/ and /la/. Nasalance scores were significantly higher in oral and nasal syllables with high vowels than with low vowels, and in nasal syllables than in oral syllables with high and low vowels. The nasalance scores obtained for the sentences were comparable to previously established norms. In conclusion, the nasalance scores defined for Brazilian Portuguese speakers, in different stimuli, may be adopted as normative values for local and cross-language comparisons in the identification of hypernasality related to conditions such as cleft palate, neurogenic disorders and syndromes.

Nasalance scores of Brazilian Portuguese speakers at 5 years of age. / Escores de nasalância de falantes do Português Brasileiro aos cinco anos de idade.

PURPOSE: To determine nasalance scores of Brazilian Portuguese speaking children without evident speech disorders, language delay and orofacial deformities, at age 5 years, and analyze differences between types of speech samples and genders. METHODS: Twenty children were analyzed, 11 males, age ranging from 4 years and 10 months to 5 years and 11 months. The Nasometer II 6450 (KayPENTAX) was used for nasalance assessment. Speech samples were eight consonant-vowel syllables and one sequence of nine words. The significance of differences between speech samples and genders were assessed by the Tukey test and Mann-Whitney test, respectively, at a significance level of 5%. RESULTS: Mean nasalance scores were: /pa/= 10±4%, /pi/= 22±7%, /sa/= 11±5%, /si/= 24±11%, /ma/= 57±11%, /mi/= 73±13%, /la/= 14±9%, /li/= 25±11%, words (pipa, bis, burro, tatu, pilha, cuca, gui, fila, luz)= 20±6%. Nasalance scores of nasal syllables were significantly higher than those of oral syllables (with high or neutral vowels) and nasalance scores of oral syllables with high vowels were significantly higher than those of oral syllables with neutral vowels, for the majority of comparisons. There was no difference between genders. CONCLUSION: Normative nasalance scores for 5-year-old Brazilian children were determined. The methodology can serve as a standard for the early diagnosis of nasality deviations, such as hypernasality observed in cleft palate speech.

Escores de nasalância de falantes do Português Brasileiro aos cinco anos de idade / Nasalance scores of Brazilian Portuguese speakers at 5 years of age

RESUMO Objetivo Determinar valores de nasalância de crianças falantes do Português Brasileiro sem alterações na produção da fala, atraso de linguagem e deformidades dentofaciais evidentes, aos 5 anos de idade, e verificar as diferenças entre tipos de emissão e entre gêneros. Método A nasalância foi determinada em 20 crianças, 11 do gênero masculino e idade entre 4 anos e 10 meses e 5 anos e 11 meses, utilizando um nasômetro II 6450 (KayPENTAX), na produção de oito sílabas tipo consoante-vogal e uma sequência de nove vocábulos. A significância das diferenças entre os tipos de emissões foi verificada pelo Teste de Tukey e, entre os gêneros, pelo teste de Mann-Whitney, para um nível de 5%. Resultados Os valores médios de nasalância foram os seguintes: /pa/= 10±4%, /pi/= 22±7%, /sa/= 11±5%, /si/= 24±11%, /ma/= 57±11%, /mi/= 73±13%, /la/= 14±9%, /li/= 25±11%, vocábulos (pipa, bis, burro, tatu, pilha, cuca, gui, fila, luz)= 20±6%. Na maioria das comparações, os valores de nasalância das sílabas nasais foram significantemente maiores do que os das sílabas orais (com vogal alta ou neutra) e os valores das sílabas orais com vogal alta foram significativamente maiores que os das sílabas orais com vogal neutra. Não houve diferença significante entre os gêneros. Conclusão Foram definidos valores normais de nasalância de crianças falantes do Português Brasileiro, de 5 anos de idade, sendo que a metodologia empregada pode servir de padrão para o diagnóstico precoce de desvios de nasalidade, como a hipernasalidade observada na fala de crianças com fissura palatina.

ABSTRACT Purpose To determine nasalance scores of Brazilian Portuguese speaking children without evident speech disorders, language delay and orofacial deformities, at age 5 years, and analyze differences between types of speech samples and genders. Methods Twenty children were analyzed, 11 males, age ranging from 4 years and 10 months to 5 years and 11 months. The Nasometer II 6450 (KayPENTAX) was used for nasalance assessment. Speech samples were eight consonant-vowel syllables and one sequence of nine words. The significance of differences between speech samples and genders were assessed by the Tukey test and Mann-Whitney test, respectively, at a significance level of 5%. Results Mean nasalance scores were: /pa/= 10±4%, /pi/= 22±7%, /sa/= 11±5%, /si/= 24±11%, /ma/= 57±11%, /mi/= 73±13%, /la/= 14±9%, /li/= 25±11%, words (pipa, bis, burro, tatu, pilha, cuca, gui, fila, luz)= 20±6%. Nasalance scores of nasal syllables were significantly higher than those of oral syllables (with high or neutral vowels) and nasalance scores of oral syllables with high vowels were significantly higher than those of oral syllables with neutral vowels, for the majority of comparisons. There was no difference between genders. Conclusion Normative nasalance scores for 5-year-old Brazilian children were determined. The methodology can serve as a standard for the early diagnosis of nasality deviations, such as hypernasality observed in cleft palate speech.

Obstructive Sleep Apnea Following Pharyngeal Flap Surgery for Velopharyngeal Insufficiency: A Prospective Polysomnographic and Aerodynamic Study in Middle-Aged Adults.

OBJECTIVE: To compare the frequency and severity of obstructive sleep apnea (OSA) in middle-aged adults who underwent pharyngeal flap surgery for velopharyngeal insufficiency (VPI) with matched subjects who did not undergo pharyngeal flap surgery and to verify the relationship between OSA severity and internal pharyngeal dimensions. SETTING: National referral care center for cleft lip and palate. METHOD: Prospective study on 42 nonsyndromic subjects with repaired cleft palate with flap (F group, n = 22) and without flap (NF group, n = 20), aged 40 to 58 years. The main outcome measure was the apnea-hypopnea index (AHI), measured by in-lab nocturnal polysomnography (PSG). The OSA-related symptoms were investigated by Pittsburgh, Epworth, and Berlin questionnaires. The nasopharyngeal or velopharyngeal (NP/VP) cross-sectional area was measured by modified anterior rhinomanometry in subgroups of the F (n = 14) and NF (n = 10) groups at rest and during speech. Differences were considered significant at P < .05. RESULTS: Questionnaire scores and frequency of self-reported symptoms of snoring, nasal obstruction, and breathing interruptions during sleep did not differ between groups. OSA was diagnosed by PSG in 60% and 77% of the NF and F subjects, respectively. The difference was not significant. No cases of severe OSA were observed. There was no correlation between AHI and NP/VP area. CONCLUSION: A significant number of middle-aged adults with repaired cleft palate had OSA and related symptoms, regardless of the presence of a pharyngeal flap. Results suggest that VPI treatment with a flap may not cause sleep-disordered breathing in the cleft population. Besides advancing age, congenital upper airway abnormalities may be involved.

Rapid Maxillary Expansion Increases Internal Nasal Dimensions of Children With Bilateral Cleft Lip and Palate.

OBJECTIVE: The transverse maxillary deficiency frequently observed in patients with cleft lip and palate (CLP) is usually treated by rapid maxillary expansion (RME). Considering that RME causes a significant increase of the internal nasal dimensions in children with unilateral CLP (UCLP), this study aimed to characterize the internal nasal geometry of children with bilateral CLP (BCLP) and transverse maxillary deficiency using acoustic rhinometry. The study also aimed to analyze changes caused by RME. DESIGN: Cross-sectional prospective study. SETTING: Laboratory of Physiology, Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Bauru, SP, Brazil. PARTICIPANTS: Fifteen children with repaired BCLP of both genders, aged 8 to 15 years, referred for RME, were prospectively analyzed. INTERVENTIONS: Subjects underwent acoustic rhinometry before the expander installation and after the active phase of expansion. Cross-sectional areas (CSA) and volumes (V) of the nasal valve regions (CSA1 and V1) and turbinates (CSA2, CSA3, and V2), were measured after nasal decongestion. MAIN OUTCOME MEASURES: In the majority of the subjects, an increase of internal nasal dimensions was observed. RESULTS: Percent changes of CSA1, CSA2, CSA3, V1, and V2 were: +25%, +11%, +9%, 20%, and +12%, respectively. Differences were significant for all variables studied, except CSA3 (P < .05). CONCLUSIONS: RME promotes an increase in the internal nasal dimensions of children with BCLP, suggesting that RME is capable of substantially improving nasal patency in this population.

Velar activity in individuals with velopharyngeal insufficiency assessed by acoustic rhinometry.

UNLABELLED: Acoustic rhinometry is routinely used for the evaluation of nasal patency. OBJECTIVE: To investigate whether the technique is able to identify the impairment of velopharyngeal (VP) activity in individuals with clinical diagnosis of velopharyngeal insufficiency (VPI). METHODS: Twenty subjects with repaired cleft palate and inadequate velopharyngeal function (IVF) and 18 non-cleft controls with adequate velopharyngeal function (AVF), adults, of both genders, were evaluated. Area-distance curves were obtained during VP rest and speech activity, using an Eccovision Acoustic Rhinometry system. Volume was determined by integrating the area under the curve at the segment corresponding to the nasopharynx. VP activity (ΔV) was estimated by the absolute and relative differences between nasopharyngeal volume at rest (Vr) and during an unreleased/k/ production (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. RESULTS: Mean Vk and Vr values (± SD) obtained were: 23.2 ± 3.6 cm3 and 15.9 ± 3.8 cm3 (AVF group), and 22.7 ± 7.9 cm3 and 20.7 ± 7.4 cm3 (IVF group), corresponding to a mean ΔV decay of 7.3 cm3 (31%) for the AVF group and a significantly smaller ΔV decay of 2.0 cm3 (9%) for the IVF group (p < 0.05). Seventy percent of the IVF individuals showed a ΔV suggesting impaired VP function (below the cutoff score of 3.0 cm3 which maximized both sensitivity and specificity of the test), confirming clinical diagnosis. CONCLUSION: Acoustic rhinometry was able to identify, with a good discriminatory power, the impairment of VP activity which characterizes VPI.

Velar activity in individuals with velopharyngeal insufficiency assessed by acoustic rhinometry

Acoustic rhinometry is routinely used for the evaluation of nasal patency. Objective: To investigate whether the technique is able to identify the impairment of velopharyngeal (VP) activity in individuals with clinical diagnosis of velopharyngeal insufficiency (VPI). Methods: Twenty subjects with repaired cleft palate and inadequate velopharyngeal function (IVF) and 18 non-cleft controls with adequate velopharyngeal function (AVF), adults, of both genders, were evaluated. Area-distance curves were obtained during VP rest and speech activity, using an Eccovision Acoustic Rhinometry system. Volume was determined by integrating the area under the curve at the segment corresponding to the nasopharynx. VP activity (ΔV) was estimated by the absolute and relative differences between nasopharyngeal volume at rest (Vr) and during an unreleased /k/ production (Vk). The efficiency of the technique to discriminate IVF and AVF was assessed by a ROC curve. Results: Mean Vk and Vr values (±SD) obtained were: 23.2±3.6 cm3 and 15.9±3.8 cm3 (AVF group), and 22.7±7.9 cm3 and 20.7±7.4 cm3 (IVF group), corresponding to a mean ΔV decay of 7.3 cm3 (31%) for the AVF group and a significantly smaller ΔV decay of 2.0 cm3 (9%) for the IVF group (p<0.05). Seventy percent of the IVF individuals showed a ΔV suggesting impaired VP function (below the cutoff score of 3.0 cm3 which maximized both sensitivity and specificity of the test), confirming clinical diagnosis. Conclusion: Acoustic rhinometry was able to identify, with a good discriminatory power, the impairment of VP activity which characterizes VPI. .

Prevalência de síndrome metabólica em mulheres acima de 40 anos de Divinópolis-MG / Prevalence of metabolic syndrome in women aged 40-59 years using two international criteria Prevalencia del síndrome metabólico en las mujeres de 40-59 años utilizando 2 criterios internacionales

Avaliar prevalência da síndrome metabólica (SM) em mulheres comparando critérios internacionais. Métodos: Estudo descritivo transversal envolvendo 93 mulheres, com idade entre 40 a 59 anos, acompanhadas em Unidades Básicas eProgramas de Saúde da Família de Divinópolis-MG. Foram realizadas avaliações clínicas, antropométricas e bioquímicas. Para o diagnóstico de SM foram empregados critérios internacionais: Adult Treatment Panel IIIof the National Cholesterol Education Program (NCEP/ATP III) e International Diabetes Federation (IDF), que utilizam a presença de três ou mais dos seguintes parâmetros alterados: circunferência da cintura (CC), triglicerídeos (TG), HDL,pressão arterial e glicemia. Resultados: 54 mulheres entre 40 a 49 anos (58,7%) e 39 entre 50 a 59 anos (41,3%). Parâmetro individual mais alterado foi CC para ambos os critérios. De acordo com NCEP/ATP III, 40,8% das participantes foram diagnosticadas com SM e 53,7% pelo IDF. Faixa etária de 50-59 apresentou maior prevalência de SM para ambos critérios. Demonstrou-se aumento de risco para SM com tabagismo, diabetes e hipertensão em ambos os critérios. Boa concordância entre os critérios da NCEP ATP III e IDF (k=0,74). Conclusão: IDF foi o critério com maior prevalência para SM e a faixa etária de 50-59 foi a mais crítica...

To evaluate the prevalence of metabolic syndrome (MS) in women compared to international criteria. Methods: Crosssectional descriptive study involving 93 women, aged 40 to 59 years, accompanied in Basic Units and Family HealthPrograms in Divinópolis-MG. Clinical, anthropometric and biochemical assessments were performed. Two International criteria were employedfor the diagnosis of MS: Adult Treatment Panel III of the National Cholesterol Education Program(NCEP/ATP III) and International Diabetes Federation (IDF), which use the presence of three or more of the following altered parameters: waist circumference (WC), triglycerides (TG), HDL, blood pressure and blood glucose. Results: 54women aged 40-49 years (58.7%) and 39 aged 50-59 (41.3%). The most altered individual parameter was the WC for both criteria. According to NCEP/ATP III, 40.8% of participants were diagnosed with MS and 53.7% by IDF. The age group 50-59 showed a higher prevalence of MS for both criteria. Increased risk for MS was demonstrated with smoking, diabetes and hypertension in both criteria. There was agreement between the criteria of NCEP/ATP III and IDF (k = 0.74). Conclusion: IDF criteria was most prevalent for SM and the age group of 50-59 was the most critical...

Evaluar la prevalencia de síndrome metabólico (SM) en las mujeres en comparación con los criterios internacionales. Métodos: estudio descriptivo transversal que involucró a 93 mujeres, entre 40 a 59 años, acompañadas por las UnidadesBásicas y Programas de Salud de la Familia de Divinópolis-MG. Se realizaron evaluaciones clínicas, antropométricas ybioquímicas. Para el diagnóstico de SM criterios internacionales se emplearon: del Programa National de Education porCholesterol - Panel de Tratamiento de Adultos III (NCEP/ATP III) y Federación Internacional de Diabetes (IDF), que utilizan la presencia de tres o más de los siguientes parámetros cambiados: circunferencia de la cintura (CC), triglicéridos (TG), HDL, presión arterial y glucosa enla sangre. Resultados: 54 mujeres de 40-49 años (58,7%) y 39 entre los 50 a 59 años (41,3%). Parámetroindividual más alterado fue CC en ambos criterios. Según NCEP/ATP III, el 40,8% de las participantes fueron diagnosticadas con SM y el 53,7% por IDF. Grupo de edadde 50-59 mostraronmayor prevalencia de SM por ambos criterios. Se demostrómayor riesgo de SM con el tabaquismo, la diabetes y la hipertensión arterial en ambos criterios.Hubo bastante concordancia entre los criterios del NCEP/ATP III y IDF (k = 0,74). Conclusión: criterios de IDF fueron más frecuentes para SM y el grupo de edad de 50 a 59 fue el más crítico...

Internal nasal dimensions of adults with nasal obstruction.

UNLABELLED: Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency. OBJECTIVE: To characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry. METHOD: This prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA1, CSA2, CSA3), the distance between them and the nostrils (dCSA1, dCSA2, dCSA3), and the volumes of segments 1.0-3.2 cm (V1), 3.3-6.4 cm (V2), and 7.0-12.0 cm (V3) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated. RESULTS: Mean values (standard deviation) before ND were: 0.83 ± 0.23 (CSA1), 1.66 ± 0.52 (CSA2), and 2.36 ± 0.77 (CSA3) cm2; 2.19 ± 0.20 (dCSA1), 4.01 ± 0.33 (dCSA2), and 5.85 ± 0.37 (dCSA3) cm; 2.77 ± 0.51 (V1), 6.52 ± 1.99 (V2), and 26.00 ± 9.62 (V3) cm3; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction. CONCLUSION: Most patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry.

Dimensoes internas nasais de adultos com obstrucao nasal / Internal nasal dimensions of adults with nasal obstruction

O desvio septal (DS) e a hipertrofia de conchas (HC) aumentam a resistência ao fluxo aéreo respiratório, podendo prejudicar a patência nasal. OBJETIVO: Caracterizar a geometria nasal de indivíduos com obstrução nasal (ON) por DS e/ou HC usando rinometria acústica. Forma de estudo: Clínico prospectivo. MÉTODO: Foram avaliados 30 adultos com queixa de ON e DS+HC (n = 24), DS (n = 5) ou HC (n = 1) ao exame clínico e determinadas as áreas seccionais transversas em três principais deflexões do rinograma (AST1, AST2, AST3), suas distâncias relativamente às narinas (dAST1, dAST2, dAST3) e os volumes dos segmentos 1,0-3,2 cm (V1), 3,3-6,4 cm (V2) e 7,0-12,0 cm (V3), pré e pós-descongestão nasal (DN). Foram consideradas, para análise, as somas de AST e V das cavidades direita e esquerda e a média de dAST. RESULTADOS: Os valores médios (± DP) pré-DN corresponderam a 0,83 ± 0,23 (AST1), 1,66 ± 0,52 (AST2) e 2,36 ± 0,77 (AST3) cm2, 2,19 ± 0,20 (dAST1), 4,01 ± 0,33 (dAST2) e 5,85 ± 0,37 (dAST3) cm, 2,77 ± 0,51 (V1), 6,52 ± 1,99 (V2), 26,00 ± 9,62 (V3) cm3, todos menores (p < 0,05) que valores de referência do laboratório. A DN causou aumentos proporcionalmente maiores neste grupo ON, sugerindo componente funcional associado. A análise individual mostrou 12 casos com resultados normais, apesar da ON. CONCLUSÃO: A maioria dos pacientes com ON estrutural apresentou resultados sugestivos de comprometimento da patência nasal ao exame rinométrico. .

Nasal septum deviation (SD) and turbinate hypertrophy (TH) increase the resistance to respiratory airflow and may impair nasal patency. OBJECTIVE: To characterize the nasal geometry of individuals with nasal obstruction secondary to SD and/or TH by means of acoustic rhinometry. METHOD: This prospective study included 30 adults with complaints of nasal obstruction (NO) and SD + TH (n = 24), SD (n = 5) or TH (n = 1) seen by clinical examination. The cross-sectional areas of the three main dips of the rhinogram (CSA1, CSA2, CSA3), the distance between them and the nostrils (dCSA1, dCSA2, dCSA3), and the volumes of segments 1.0-3.2 cm (V1), 3.3-6.4 cm (V2), and 7.0-12.0 cm (V3) were measured before and after nasal decongestion (DN). For analysis, right and left cross-sectional areas and volumes were added and mean dCSA was calculated. RESULTS: Mean values (standard deviation) before ND were: 0.83 ± 0.23 (CSA1), 1.66 ± 0.52 (CSA2), and 2.36 ± 0.77 (CSA3) cm2; 2.19 ± 0.20 (dCSA1), 4.01 ± 0.33 (dCSA2), and 5.85 ± 0.37 (dCSA3) cm; 2.77 ± 0.51 (V1), 6.52 ± 1.99 (V2), and 26.00 ± 9.62 (V3) cm3; all values were lower than laboratory reference values (p < 0.05). ND led to proportionally greater increases of sectional areas and volumes in the NO group, suggesting an associated functional component. Individual analysis revealed 12 cases with normal results despite nasal obstruction. CONCLUSION: Most patients with structural nasal obstruction had results suggestive of nasal patency impairment in acoustic rhinometry. .

Sentidos e métodos de territorialização na atenção primária à saúde / Meanings and methods of territorialization in primary health care

Metodologias analíticas participativas de base territorial são essenciais para a atuação da Atenção Primária à Saúde (APS) considerando a questão ambiental e o trabalho. Este estudo, realizado em município cearense com modelo de produção agroexportador, analisou os processos no território da APS relacionados ao ambiente/trabalho e as repercussões sobre a saúde da comunidade e dos trabalhadores, com vistas à reapropriação do território e proposição de ações focadas nas necessidades de saúde, pelos sujeitos sociais, a partir da elaboração dos mapas: social, ambiental e do trabalho em oficinas conduzidas em pesquisa-ação. A problematização na perspectiva crítica, embasada na participação social e na determinação social do processo saúde-doença referente às relações produção-ambiente-saúde foi etapa fundamental no mapeamento participativo, tendo sido o material qualitativo interpretado à luz da análise do discurso. O processo favoreceu a identificação das necessidades de saúde, a reapropriação do território reforçando a atuação intersetorial, fortalecendo a interlocução entre a saúde ambiental e do trabalhador, avançando na superação dos processos contribuintes para a insuficiência das práticas da APS.

Territorially-based participative analytical methodologies taking the environmental question and work into consideration are essential for effective primary health care. The study analyzed work and environment-related processes in the primary health care area and their repercussions on the health of workers and the community in a rural city in Ceará, whose economy is based on agriculture for export,. It sought to redeem the area and the proposal of actions focused on health needs by the social subjects through the making of social, environmental and work-related maps in workshops within the framework of action research. Examining the situation from a critical perspective, based on social participation and social determination of the health-disease process with regard to the relations between production, environment and health, was the most important step in the participative map-making process, with the qualitative material interpreted in light of discourse analysis. The process helped identify the health needs, the redemption of the area, strengthened the cooperation between sectors and the tie between the health of the worker and that of the environment, and represented an advance towards the eradication of the causes of poor primary health care services.

[Meanings and methods of territorialization in primary health care]. / Sentidos e métodos de territorialização na atenção primária à saúde.

Territorially-based participative analytical methodologies taking the environmental question and work into consideration are essential for effective primary health care. The study analyzed work and environment-related processes in the primary health care area and their repercussions on the health of workers and the community in a rural city in Ceará, whose economy is based on agriculture for export,. It sought to redeem the area and the proposal of actions focused on health needs by the social subjects through the making of social, environmental and work-related maps in workshops within the framework of action research. Examining the situation from a critical perspective, based on social participation and social determination of the health-disease process with regard to the relations between production, environment and health, was the most important step in the participative map-making process, with the qualitative material interpreted in light of discourse analysis. The process helped identify the health needs, the redemption of the area, strengthened the cooperation between sectors and the tie between the health of the worker and that of the environment, and represented an advance towards the eradication of the causes of poor primary health care services.

[The green rural economy: challenges to research and to public health policies posed by agricultural modernization]. / O verde da economia no campo: desafios à pesquisa e às políticas públicas para a promoção da saúde no avanço da modernização agrícola.

In this paper, we ask ourselves who should, can and has the will to promote health in the rural zone today. The fields of science and public policy were chosen as our primary focus of dialogue conducted from the perspective of the right to health and a healthy environment. Seven lessons emerged: (1) in addition to the surveillance of isolated chemical risks, the relation between agrochemicals and health should be investigated in the context of conservative agricultural modernization; (2) it is mandatory and urgent to discover the health problems related to the use of agrochemicals; (3) the State has been successful in its support of agribusiness, but highly inefficient at enforcing policies to safeguard social rights; (4) sectors of society linked to rural organizations have played an important role in the public policies combating agrochemicals and protecting health; (5) studies must help deconstruct the myths surrounding the Green Revolution model; (6) we are faced with the challenge of contributing to the construction of an emerging scientific paradigm founded on an ethical-political commitment to the most vulnerable social elements; (7) rural communities are creating agro-ecological alternatives for life in semiarid areas.

O verde da economia no campo: desafios à pesquisa e às políticas públicas para a promoção da saúde no avanço da modernização agrícola / The green rural economy: challenges to research and to public health policies posed by agricultural modernization

Neste ensaio, é feita a pergunta de quem deve, pode e quer promover a saúde no campo hoje. Foi eleito, prioritariamente, o campo da ciência e o das políticas públicas como foco de diálogo. Configurou-se oito lições aprendidas sob a perspectiva dos direitos à saúde a um ambiente saudável, aqui compartilhadas: (1) para além de um risco químico isolado, a relação entre agrotóxicos e saúde deve ser estudada no contexto da modernização agrícola conservadora; (2) é necessário e urgente que se proceda ao desvelamento dos agravos à saúde relacionados aos agrotóxicos; (3) o Estado tem tido significativa eficácia no apoio ao agronegócio e significativa ineficácia nas políticas sociais de garantia de direitos dos trabalhadores e da população; (4) setores da sociedade ligados às organizações do campo vêm desempenhando importante papel na política pública de combate aos agrotóxicos e de proteção da saúde; (5) é importante que os estudos contribuam para a desconstrução dos mitos que sustentam o modelo da Revolução Verde; (6) se está diante do desafio de contribuir na construção de um paradigma emergente de ciência, fundado no compromisso ético-político com os mais vulneráveis; (7) comunidades camponesas vêm construindo alternativas agroecológicas de vida no semiárido.

In this paper, we ask ourselves who should, can and has the will to promote health in the rural zone today. The fields of science and public policy were chosen as our primary focus of dialogue conducted from the perspective of the right to health and a healthy environment. Seven lessons emerged: (1) in addition to the surveillance of isolated chemical risks, the relation between agrochemicals and health should be investigated in the context of conservative agricultural modernization; (2) it is mandatory and urgent to discover the health problems related to the use of agrochemicals; (3) the State has been successful in its support of agribusiness, but highly inefficient at enforcing policies to safeguard social rights; (4) sectors of society linked to rural organizations have played an important role in the public policies combating agrochemicals and protecting health; (5) studies must help deconstruct the myths surrounding the Green Revolution model; (6) we are faced with the challenge of contributing to the construction of an emerging scientific paradigm founded on an ethical-political commitment to the most vulnerable social elements; (7) rural communities are creating agro-ecological alternatives for life in semiarid areas.