Use of Auditory Feedback Amplifier in Women Without Voice Complaints: A Comparison of Acoustic Measures, Self-Rated Vocal Effort, and Voice Intensity.

OBJECTIVE: To compare the immediate effects of using MindVox in women without voice complaints for 1, 3, 5, and 7 minutes of reading tasks, on acoustic measurements of the vocal signal in low, medium, and strong intensity emissions; on self-rated effort vocal, and on the intensity of voice reception and production. METHODS: Participants read one text using MindVox for 1, 3, 5, and 7 minutes. After each time, measures of self-rated vocal effort were collected (BORG CR10-BR Scale), as well as samples of the vowel /e/ at low (>70 dB), moderate (≥70 dB and ≤80 dB), and high intensities (>80 dB). Acoustic measurements (F0, short-term acoustic measurements, and cepstral peak prominence measurements) were also collected before and after the procedure and subsequently analyzed in the CTS 5.0 Vox-Metria Program. Voice reception and production intensities were captured during the reading task using two decibel meters. One decibel meter was installed near the ear (average intensity received by the ear (EAVG)) and the other near the lips (average intensity captured near the lips (LAVG)), and the data were submitted for analysis. RESULTS: The Cepstral Peak Prominence-Smoothed increased in the first minute, the Cepstral Peak Prominence increased in the third minute, and the jitter decreased from the first minute. All these changes were observed at low intensity and were maintained at the other time points. For every 5 dB of amplification (EAVG), there was a 1 dB decrease in voice production (LAVG). CONCLUSION: Using MindVox in women without voice complaints brings positive immediate effects in cepstral measures and jitter at low intensity. There is a connection between the intensity of the voice received by the ear and the intensity of voice production.

Modificações do feedback auditivo e seus efeitos sobre a voz de indivíduos adultos: uma revisão de escopo / Modifications of auditory feedback and its effects on the voice of adult subjects: a scoping review

RESUMO Introdução A percepção auditiva da voz e sua produção envolvem o feedback auditivo, as pistas cinestésicas e o sistema de feedforward, os quais produzem efeitos distintos para a voz. Os efeitos Lombard, Sidetone e o Pitch-Shift-Reflex são os mais estudados. O mapeamento de experimentos científicos sobre as modificações do feedback auditivo para o controle motor da voz possibilita examinar a literatura existente sobre o fenômeno e pode contribuir para o treinamento ou terapias da voz. Objetivo Mapear os experimentos e resultados das pesquisas com manipulação do feedback auditivo para o controle motor da voz de indivíduos adultos. Método Revisão de escopo seguindo o Checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA-ScR) para responder à pergunta: "Quais os métodos de investigação e principais achados das pesquisas sobre a manipulação do feedback auditivo no automonitoramento da voz de indivíduos adultos?". O protocolo de busca foi baseado na estratégia mnemônica População, Conceito e Contexto (PCC). A população são os indivíduos adultos; o conceito é a manipulação do feedback auditivo e o contexto é o controle motor da voz. Os artigos foram pesquisados nas bases de dados: BVS/ Biblioteca Virtual em Saúde, MEDLINE/Medical Literature Analysis and Retrieval Sistem on-line, COCHRANE, CINAHL/Cumulative Index to Nursing and Allied Health Literature, SCOPUS e WEB OF SCIENCE. Resultados Foram encontrados 60 artigos, sendo 19 da temática do Efeito Lombard, 25 do efeito Pitch-shift-reflex, 12 do efeito Sidetone e quatro sobre o efeito Sidetone/Lombard. Os estudos são concordantes que a inserção de um ruído que mascara o feedback auditivo provoca um aumento na intensidade de fala do indivíduo e que a amplificação do feedback auditivo promove a redução do nível de pressão sonora na produção da voz. Observa-se uma resposta reflexa à mudança de tom no feedback auditivo, porém, com características individuais em cada estudo. Conclusão O material e método dos experimentos são distintos, não há padronizações nas tarefas, as amostras são variadas, muitas vezes reduzidas. A diversidade metodológica dificulta a generalização dos resultados. Os principais achados das pesquisas a respeito o feedback auditivo sobre o controle motor da voz confirmam que, na supressão do feedback auditivo, o indivíduo tende a aumentar a intensidade da voz. Na amplificação do feedback auditivo, o indivíduo diminui a intensidade e tem maior controle sobre a frequência fundamental e, nas manipulações da frequência, o indivíduo tende a corrigir a manipulação. Os poucos estudos com sujeitos disfônicos mostram que eles se comportam diferentemente dos não disfônicos.

ABSTRACT Introduction The auditory perception of voice and its production involve auditory feedback, kinesthetic cues and the feedforward system that produce different effects for the voice. The Lombard, Sidetone and Pitch-Shift-Reflex effects are the most studied. The mapping of scientific experiments on changes in auditory feedback for voice motor control makes it possible to examine the existing literature on the phenomenon and may contribute to voice training or therapies. Purpose To map experiments and research results with manipulation of auditory feedback for voice motor control in adults. Method Scope review following the Checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA-ScR) to answer the question: "What are the investigation methods and main research findings on the manipulation of auditory feedback in voice self-monitoring of adults?". The search protocol was based on the Population, Concept, and Context (PCC) mnemonic strategy, in which the population is adult individuals, the concept is the manipulation of auditory feedback and the context is on motor voice control. Articles were searched in the databases: BVS/Virtual Health Library, MEDLINE/Medical Literature Analysis and Retrieval System online, COCHRANE, CINAHL/Cumulative Index to Nursing and Allied Health Literature, SCOPUS and WEB OF SCIENCE. Results 60 articles were found, 19 on the Lombard Effect, 25 on the Pitch-shift-reflex effect, 12 on the Sidetone effect and four on the Sidetone/Lombard effect. The studies are in agreement that the insertion of a noise that masks the auditory feedback causes an increase in the individual's speech intensity and that the amplification of the auditory feedback promotes the reduction of the sound pressure level in the voice production. A reflex response to the change in pitch is observed in the auditory feedback, however, with particular characteristics in each study. Conclusion The material and method of the experiments are different, there are no standardizations in the tasks, the samples are varied and often reduced. The methodological diversity makes it difficult to generalize the results. The main findings of research on auditory feedback on voice motor control confirm that in the suppression of auditory feedback, the individual tends to increase the intensity of the voice. In auditory feedback amplification, the individual decreases the intensity and has greater control over the fundamental frequency, and in frequency manipulations, the individual tends to correct the manipulation. The few studies with dysphonic individuals show that they behave differently from non-dysphonic individuals.

Association Between Vocal Symptoms, Communication, Work Environment, and Sense of Coherence in Hospital Health Professionals.

OBJECTIVE: This study aimed to associate the presence of vocal symptoms with sociodemographic and occupational data, work environment self-perception, oral communication wearing a face mask, and the sense of coherence (SOC). METHOD: This cross-sectional analytical observational study included 66 health professionals from a Brazilian hospital. They answered an online questionnaire on sociodemographic aspects, self-perception of the physical work environment, and oral communication at work. The Voice Symptom Scale (VoiSS) and Sense of Coherence Scale (SOC-13) were also applied. The significance level was set at 5% for the statistical analysis. RESULTS: The self-perception of vocal symptoms was 62%. Professionals who considered the noise in their work environment unsatisfactory had more vocal symptoms (P = 0.005), especially in the limitation (P = 0.013) and physical (P = 0.028) domains of the VoiSS. Professionals with higher self-perceived vocal symptoms also reported incoordination between breathing, speech, and articulation (P = 0.041) and self-perceived difficulty being heard with a protective mask (P = 0.033). Professionals with a higher self-perceived score in the limitation domain of the VoiSS also had a higher self-perceived effort to speak with a mask (P = 0.035) and a higher self-perception that other people find it difficult to hear them with a face mask (P = 0.050). There was a weak negative correlation between VoiSS and SOC (P < 0.05) and between its domains (P < 0.05). CONCLUSION: Self-perception of voice symptoms is high among health professionals in a Brazilian public hospital. The presence of these symptoms is related to the perception of a noisy work environment and communication difficulties due to the use of a face mask. The lower the ability to cope with stressful situations, the larger the presence of voice symptoms among health professionals.

Modifications of auditory feedback and its effects on the voice of adult subjects: a scoping review. / Modificações do feedback auditivo e seus efeitos sobre a voz de indivíduos adultos: uma revisão de escopo.

INTRODUCTION: The auditory perception of voice and its production involve auditory feedback, kinesthetic cues and the feedforward system that produce different effects for the voice. The Lombard, Sidetone and Pitch-Shift-Reflex effects are the most studied. The mapping of scientific experiments on changes in auditory feedback for voice motor control makes it possible to examine the existing literature on the phenomenon and may contribute to voice training or therapies. PURPOSE: To map experiments and research results with manipulation of auditory feedback for voice motor control in adults. METHOD: Scope review following the Checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA-ScR) to answer the question: "What are the investigation methods and main research findings on the manipulation of auditory feedback in voice self-monitoring of adults?". The search protocol was based on the Population, Concept, and Context (PCC) mnemonic strategy, in which the population is adult individuals, the concept is the manipulation of auditory feedback and the context is on motor voice control. Articles were searched in the databases: BVS/Virtual Health Library, MEDLINE/Medical Literature Analysis and Retrieval System online, COCHRANE, CINAHL/Cumulative Index to Nursing and Allied Health Literature, SCOPUS and WEB OF SCIENCE. RESULTS: 60 articles were found, 19 on the Lombard Effect, 25 on the Pitch-shift-reflex effect, 12 on the Sidetone effect and four on the Sidetone/Lombard effect. The studies are in agreement that the insertion of a noise that masks the auditory feedback causes an increase in the individual's speech intensity and that the amplification of the auditory feedback promotes the reduction of the sound pressure level in the voice production. A reflex response to the change in pitch is observed in the auditory feedback, however, with particular characteristics in each study. CONCLUSION: The material and method of the experiments are different, there are no standardizations in the tasks, the samples are varied and often reduced. The methodological diversity makes it difficult to generalize the results. The main findings of research on auditory feedback on voice motor control confirm that in the suppression of auditory feedback, the individual tends to increase the intensity of the voice. In auditory feedback amplification, the individual decreases the intensity and has greater control over the fundamental frequency, and in frequency manipulations, the individual tends to correct the manipulation. The few studies with dysphonic individuals show that they behave differently from non-dysphonic individuals.

INTRODUçÃO: A percepção auditiva da voz e sua produção envolvem o feedback auditivo, as pistas cinestésicas e o sistema de feedforward, os quais produzem efeitos distintos para a voz. Os efeitos Lombard, Sidetone e o Pitch-Shift-Reflex são os mais estudados. O mapeamento de experimentos científicos sobre as modificações do feedback auditivo para o controle motor da voz possibilita examinar a literatura existente sobre o fenômeno e pode contribuir para o treinamento ou terapias da voz. OBJETIVO: Mapear os experimentos e resultados das pesquisas com manipulação do feedback auditivo para o controle motor da voz de indivíduos adultos. MÉTODO: Revisão de escopo seguindo o Checklist Preferred Reporting Items for Systematic reviews and Meta-Analyses extension (PRISMA-ScR) para responder à pergunta: "Quais os métodos de investigação e principais achados das pesquisas sobre a manipulação do feedback auditivo no automonitoramento da voz de indivíduos adultos?". O protocolo de busca foi baseado na estratégia mnemônica População, Conceito e Contexto (PCC). A população são os indivíduos adultos; o conceito é a manipulação do feedback auditivo e o contexto é o controle motor da voz. Os artigos foram pesquisados nas bases de dados: BVS/ Biblioteca Virtual em Saúde, MEDLINE/Medical Literature Analysis and Retrieval Sistem on-line, COCHRANE, CINAHL/Cumulative Index to Nursing and Allied Health Literature, SCOPUS e WEB OF SCIENCE. RESULTADOS: Foram encontrados 60 artigos, sendo 19 da temática do Efeito Lombard, 25 do efeito Pitch-shift-reflex, 12 do efeito Sidetone e quatro sobre o efeito Sidetone/Lombard. Os estudos são concordantes que a inserção de um ruído que mascara o feedback auditivo provoca um aumento na intensidade de fala do indivíduo e que a amplificação do feedback auditivo promove a redução do nível de pressão sonora na produção da voz. Observa-se uma resposta reflexa à mudança de tom no feedback auditivo, porém, com características individuais em cada estudo. CONCLUSÃO: O material e método dos experimentos são distintos, não há padronizações nas tarefas, as amostras são variadas, muitas vezes reduzidas. A diversidade metodológica dificulta a generalização dos resultados. Os principais achados das pesquisas a respeito o feedback auditivo sobre o controle motor da voz confirmam que, na supressão do feedback auditivo, o indivíduo tende a aumentar a intensidade da voz. Na amplificação do feedback auditivo, o indivíduo diminui a intensidade e tem maior controle sobre a frequência fundamental e, nas manipulações da frequência, o indivíduo tende a corrigir a manipulação. Os poucos estudos com sujeitos disfônicos mostram que eles se comportam diferentemente dos não disfônicos.

Comparison of different methods of analysis of maxillary sinus volume and validation of a new proposal using cone beam computed tomography.

PURPOSE: develop and validate a formula, through a discriminant analysis of sex estimation, evaluating maxillary sinus in cone beam computed tomography scans in a Brazilian population, comparing this formula with two other existing ones. METHODS: 190 cone beam CT scans of Brazilian adults were retrospectively evaluated by an independent examiner. Measurements were performed in the right and left MS region: height, width, length, distance between the breasts, distance between infraorbital foramina, and volume in the ITK software. The sample was divided into female and male. T test, ANOVA, Tukey test and the ROC Curve was performed (p > 0,05). RESULTS: statistically significant differences were found in relation to the maximum height of the MS both right (p = 0,001) and left (p = 0,026) between sexes and the maximum length in the right MS (p = 0,01). Regarding the comparison of MS volume according to the different analysis methods, statistically significant differences were found between sexes for the right MS when using the method by Bangi et al. (p = 0,012) and the volume of the left MS in females (p < 0,001). Comparing the three classification models, statistically significant differences were found between the proposed method and the classification by Bangi et al. (p < 0.007). The ROC curve showed greater accuracy in the classification proposed in this work. CONCLUSION: the new proposed formula obtained better predictions of sexual dimorphism, when compared to classifications already described in the literature.

University Professors' Communicative Competence and Its Relationship With Interpersonal Communication and Voice Symptoms.

OBJECTIVE: To analyze the association between communicative competence self-assessment and interpersonal communication self-perception and voice symptoms in university professors. METHOD: Cross-sectional, analytical, observational study in 322 professors, who answered sociodemographic and occupational questions and three self-perception protocols: Self-Assessment of Communication Competence (SACCom), Interpersonal Communication Competence Scale (ICCS), and Voice Symptom Scale (VoiSS). The dependent variable was SACCom's yes/no answers. Univariate and multivariate descriptive and inferential data analyses were performed through logistic regression. RESULTS: Most professors were females (55.3%), worked 40 hours (96.6%), and self-reported voice symptoms (72.7%). The largest portion had been in the career for 11-22 years (38.2%). The final multivariate model demonstrated that better self-assessed communicative competence among professors (SACCom) is related to an absence of voice complaints (odds ratio (OR) = 2.17; 95% confidence interval (CI) 1.29-3.65) and better self-perceived interpersonal communication (ICCS) (OR = 1.05; 95% CI 1.02-1.08). The older the professor (OR = 1.03; 95% CI 1.01-1.06), the better their communicative competence (SACCom). CONCLUSIONS: Study professors' self-assessed communicative competence is predominantly high. Those with a better communicative competence self-assessment are older and vocally healthy and self-perceive greater interpersonal communication skills.

Prevalence, morphology, and morphometry of anatomical variations of the clivus: a cone beam computed tomographic study.

The purpose of this study was to evaluate the prevalence and characteristics of 3 anatomical variations of the clivus: fossa navicularis magna (FNM), canalis basilaris medianus (CBM), and craniopharyngeal canal (CPC). Findings were correlated with sex, age, and facial skeletal pattern. A total of 602 cone beam computed tomography scans of Brazilian adults were retrospectively evaluated by 2 independent examiners. The presence of an FNM, CBM, or CPC was recorded, and length, depth, and width were measured. The CBM was classified according to type (3 complete and 3 incomplete varieties). All data were correlated with sex, age, and facial skeletal pattern. Results were tested using chi-square, Mann-Whitney U, and Kruskal-Wallis tests (P < 0.05). The prevalence rates for FNM, CBM, and CPC were 15.78% (n = 95), 6.64% (n = 40), and 0.17% (n = 1), respectively. No significant differences in the prevalence of the variations were found based on sex or facial skeletal patterns (P > 0.05). The median length, depth, and width of FNM were 5.55, 1.83, and 4.81 mm, respectively, with no significant differences (P > 0.05) between the variables. The prevalence of FNM was significantly higher in patients aged 18 to 33 years than in those aged 34 and older (P < 0.001). An incomplete variant of the CBM, presenting as an inferior recess, was more common (32.5%). The FNM is the most prevalent anatomical variation of the clivus, especially in young adults. The sex and facial skeletal pattern of the individual do not affect the frequency of FNM, CBM, or CPC. Because of their clinical relevance, recognition of these anatomical variations is essential, as they can be misdiagnosed as pathologies.

Relationships Between Sense of Coherence, Self-perception of Voice and Work Environment Among Teachers.

OBJECTIVE: to analyze the relationship between sense of coherence and sociodemographic data, remote physical work environment, and self-perception of symptoms, vocal handicap and vocal fatigue in teachers. METHODS: Seventy eight teachers pertaining to the municipal education network of a Brazilian capital city participated in the study, during the period of social isolation by COVID-19. An online questionnaire was applied with sociodemographic and physical remote work environment questions, the Sense of Coherence Scale (SOC-13), the Brazilian Dysphonia Screening Tool (Br-DST), the Vocal Fatigue Index (VFI), and the Vocal Handicap Index (VHI-10). Descriptive analysis, bivariate and multivariate Logistic regression models were performed to check the proportion of teachers with high and low SOC among the different categories of independent variables. Student's t test and Mann Whitney test were used to compare SOC, IDV, and VFI scores between the groups, and Hedge's g test was used to access the effect size. The total scores of SOC, VHI and VFI were correlated using Pearson's Correlation Coefficient. All tests adopted a 5% significance level. RESULTS: Male teachers and those over 45 years old were, respectively, 6.79 (95%CI = 1.16-39.58) and 5.27 (95%CI = 1.40-19.76) times more likely to present a high SOC. The variables associated with a lower chance of presenting high SOC were vocal restriction (OR = 0.21; 95%CI = 0.06-0.79) and voice-related physical discomfort (OR = 0.13; 95%CI = 0.02-0.78). Regarding the remote work environment, in bivariate analysis, teachers who were dissatisfied with air quality (OR = 0.08; 95%CI = 0.01-0.65), temperature (OR = 0.11; 95%CI = 0.01-0.92), and noise (OR = 0.25; 95%CI = 0.61-0.99) were less likely to have high SOC. Higher values of SOC are associated with lower self-perception of vocal fatigue and voice handicap (P < 0,001). CONCLUSION: The way individuals face stressful situations interferes with the self-perception of their voice and their work environment. The relationship between the sense of coherence and voice perception is relevant to favor programs to promote vocal health and stress management in teachers.

The Usability and Acceptability of the mHealth "Health and Voice" for Promoting Teachers' Vocal Health.

OBJECTIVE: To evaluate the usability and acceptability of "Health and Voice" for the promotion of vocal health, and to analyze the same with sociodemographic data, work data, self-knowledge data on vocal care, voice disadvantage, and vocal fatigue symptoms in elementary school teachers. MATERIAL AND METHODS: A cross-sectional observational study, with a sample of 277 elementary school teachers from a Brazilian capital. Teachers were invited to access, interact and evaluate the mHealth: "Health and Voice". The evaluation instruments were the questionnaire with information on socio-demographic and work data, the System Usability Scale (SUS), the questionnaire with questions about acceptability, the Voice Handicap Index Protocol (VHI-10), and the Vocal Fatigue Index Protocol (VFI). Descriptive and association analyses were performed by the Chi-square, Fisher exact, Mann-Whitney, and Wilcoxon tests (P ≤ 0.05) RESULTS: the mean SUS score was 81.9 points; the mean of the acceptability questions was 17.24; the VHI-10 was 6.96 points; the VFI was 21.11 points. Most participants rated the acceptability of mHealth as high. There was an association between acceptability and working in two shifts (P = 0.019); between acceptability and usability (P < 0.001); and between usability and self-perception of knowledge about voice care after using mHealth (P = 0.000). The activity perceived as most important was guidance on voice care. CONCLUSION: "Health and Voice" is a vocal guidance tool for teachers that promotes vocal health. It has high usability and acceptability by elementary school teachers. Self-reported knowledge about vocal care increases after its use and those who evaluate the technology with high acceptability are 3.6 times more likely to also classify it with high usability.

Common Mental Disorders and Self-Perceived Interpersonal Communication and Vocal Symptoms in University Professors.

OBJECTIVE: To determine the prevalence of common mental disorders in university professors and to analyze the same with sociodemographic and occupational data, self-perceived interpersonal communication, and vocal symptoms. METHODS: A Cross-sectional analytical observational quantitative study with 322 university professors. Four assessment instruments: the Sociodemographic and Work Information Questionnaire, the Self-Report Questionnaire, the Brazilian Dysphonia Screening Tool, the Interpersonal Communication Competence Scale, and the Voice Symptom Scale. The study performed descriptive and association analyses. The measure of association was the prevalence ratio, estimated with Poisson regression with robust invariance, considering common mental disorders as a dependent variable. RESULTS: The prevalence of common mental disorders in university professors was 27.6%. There was a significant association between such disorders and self-perceived vocal complaints, the suspicion of dysphonia, and self-perceived difficulties in regards to being heard with a mask (sometimes/always). The higher the score in the self-disclosure domain of the Interpersonal Communication Competence Scale the higher the prevalence of common mental disorders in university professors. CONCLUSION: The prevalence of common mental disorders in university professors is high and influences their self-perception of vocal symptoms and interpersonal relationships. Hence, it reinforces the need for measures to maintain university professors' vocal and mental health.

Antileishmania and immunomodulatory potential of cashew nut shell liquid and cardanol.

Conventional treatments for leishmaniasis have caused serious adverse effects, poor tolerance, development of resistant strains. Natural products have been investigated as potential therapeutic alternatives. The cashew nut shell liquid (CNSL) is a natural source of phenolic compounds with several biological activities, where cardanol (CN) is considered one of the most important and promising compounds. This study aimed to evaluate antileishmanial, cytotoxic and immunomodulatory activities of CNSL and CN. Both showed antileishmanial potential, with IC50 for CNSL and CN against Leishmania infantum: 148.12 and 56.74 µg/mL; against Leishmania braziliensis: 85.71 and 64.28 µg/mL; against Leishmania major: 153.56 and 122.31 µg/mL, respectively. The mean cytotoxic concentrations (CC50) of CNSL and CN were 37.51 and 31.44 µg/mL, respectively. CNSL and CN significantly reduced the percentage of infected macrophages, with a selectivity index (SI) >20 for CN. CNSL and cardanol caused an increase in phagocytic capacity and lysosomal volume. Survival rates of Zophobas morio larvae at doses of 3; 30 and 300 mg/kg were: 85%, 75% and 60% in contact with CNSL and 85%, 60% and 40% in contact with CN, respectively. There was a significant difference between the survival curves of larvae when treated with CN, demonstrating a significant acute toxicity for this substance. Additional investigations are needed to evaluate these substances in the in vivo experimental infection model.

Fatores de risco correlacionados à alopecia frontal fibrosante em Criciúma, Santa Catarina: estudo caso-controle / Risk factors correlated with frontal fibrosing alopecia in Criciuma, Santa Catarina: case-control study

Introdução: A alopecia frontal fibrosante (AFF) é uma forma de alopecia cicatricial, em que os pacientes apresentam perda irreversível dos folículos pilosos, principalmente em região frontal e tempoparietal. Sua etiopatogenia não está totalmente elucidada, embora hipóteses sobre fatores genéticos, hormonais e comportamentais, como o uso de filtro solar e hidratante facial, já tenham sido descritas. Métodos: estudo de caso-controle, realizado com aplicação de um questionário objetivo com 33 perguntas. Foram avaliadas 60 pacientes do sexo feminino, 30 diagnosticadas com AFF e 30 não acometidas pela doença. Resultados: a média de idade da amostra foi de 64 anos (± 10,37 para casos e ± 9,40 para os controles). 76,7% das pacientes com AFF e 23,3% dos controles faziam uso de filtro solar, sendo a diferença estatisticamente significativa (p<0,001). Além disso, o uso de hidratante facial mostrou-se significativamente maior nas pacientes com alopecia (63,3%) quando comparadas aos controles (33,3%; p=0,038). Notou-se a frequência de uso de sabonete comum na face significativamente menor nas pacientes com AFF (46,7%), quando comparada ao grupo controle (83,3%; p=0,006). Conclusão: nossos resultados sugerem uma possível associação entre AFF e uso de produtos faciais, como filtro solar e hidratante. Todas as pacientes eram menopausadas, reforçando a relação hormonal com a doença

Introduction: Fibrosing Frontal Alopecia (FFA) is a form of scarring alopecia, in which patients have an irreversible loss of hair follicles, especially in the frontal and temporoparietal regions. The etiopathogenesis is not fully understood, although hypotheses about genetic, hormonal, and behavioral factors, such as the use of sunscreen and facial moisturizers, have already been described. Methods: A case-control study was conducted using an objective questionnaire with 33 questions. Sixty women were evaluated, 30 diagnosed with FFA, and 30 not affected by the disease. Results: The mean age of the sample was 64 years old. 76.7% of patients with FFA and 23.3% of controls used facial sunscreen and the difference was statistically significant (p<0.001). Also, the use of facial moisturizer was significantly higher in patients with alopecia (63.3%) when compared to controls (33.3%; p=0.038). The frequency of use of regular soap on the face was significantly lower in patients with FFA (46.7%) when compared to the control group (83.3%; p=0.006). Conclusion: Results suggest a possible association between FFA and the use of facial products, such as sunscreen and moisturizer, in this population. All patients were menopausal, reinforcing the hormonal relationship with the disease.

Free thyroxine but not TSH levels are associated with decline in functional status in a cohort of geriatric outpatients.

PURPOSE: To assess the associations between TSH and free thyroxine (FT4) levels and decline in functional status in euthyroid older patients at risk of frailty. DESIGN: Longitudinal prospective study. METHODS: Participants from the geriatric outpatient clinic of a university hospital, who fulfilled the criteria for frailty or were at risk of frailty, were recruited. Only those euthyroid, defined by age-specific reference range of TSH, were included. Serum was collected during enrollment and at the third and sixth years of follow-up to assess the mean value of all follow-up levels of serum TSH and FT4. Functional status assessing activities of daily living (ADL) and instrumental ADL were evaluated using the Katz Index and the Health Assessment Questionnaire, respectively. Functional decline was defined by a positive variation in any of the applied scales in the absence of disagreement between the scales or if the patient was institutionalized. RESULTS: Of the 273 participants (72.5% females) enrolled (mean age 80 years old), 48 died and 102 presented functional decline at the end of follow-up (mean 3.6 ± 1.7 years). Each 0.1 ng/dL increase in baseline and mean follow-up serum FT4 levels increased the risk of functional decline by 14.1% and 7.7%, respectively. The risk of functional decline was 9 times greater with baseline FT4 levels in the fourth and fifth quintiles (p = 0.049) and 50% lower with baseline FT4 levels in the first quintile (p = 0.046). No association between TSH and the outcome was found. CONCLUSIONS: Higher and lower FT4 levels were, respectively, a risk and a protective factor for the decline in functional status in a cohort of euthyroid older adults at risk of frailty.

Sense of Coherence and Coping Strategies in Patients With Dysphonia.

AIM: To analyze sense of coherence (SOC) of dysphonic individuals considering the type and degree of dysphonia, coping strategies, and sociodemographic variables. METHODS: This cross-sectional study was performed with 50 dysphonic individuals under follow-up at a Brazilian Speech-Language Pathology Clinic. They answered a questionnaire with sociodemographic information, the PEED-10 (Brazilian Voice Disability Coping Questionnaire) and the Brazilian version of Sense of Coherence scale. The SOC was categorized as high or low using Cluster analysis. After descriptive analysis, data were analyzed through both the bivariate and multivariate logistic regression model method and the Spearman's correlation test (P< 0.05). RESULTS: Most individuals presented a high SOC (60%). Individuals with mild dysphonia were 7.00 times more likely to present high SOC (95% CI = 1.24-39.38).  Individuals between 45 and 70 years old were 5.03 times more likely to present high SOC (95% CI = 1.25-20.28). In addition, the higher SOC, as well as the scores of manageability domain, the lower the use of strategies focused on emotion. CONCLUSION: Patients with mild dysphonia are more likely to have a high SOC. The same goes for individuals over the fourth decade of life. Also, the greater the SOC, the fewer emotional strategies are used to cope with dysphonia.

Instrumentos de avaliação e autoavaliação da fala em público: uma revisão integrativa da literatura / Public speaking assessment and self-assessment instruments: an integrative literature review

RESUMO Objetivo revisar e descrever os estudos que utilizaram instrumentos para avaliar e autoavaliar a fala em público de indivíduos adultos, no período de 2011 a 2020. Estratégia de pesquisa trata-se de uma revisão integrativa da literatura. A busca dos estudos ocorreu nas bases de dados SciELO, PubMed e Biblioteca Virtual em Saúde, que abrange as bases de dados MEDLINE e LILACS. A questão norteadora desta revisão foi: "Quais os tipos, aspectos avaliados e categorias de resposta dos instrumentos que avaliaram a fala em público de indivíduos adultos nos últimos dez anos?". Critérios de seleção Foram selecionados artigos originais, disponíveis na íntegra, publicados nos últimos dez anos, nos idiomas português, inglês ou espanhol, que apresentassem instrumentos de avaliação da fala em público, em adultos. Foram excluídos da revisão teses, dissertações, monografias, anais de congressos, estudos com análise do discurso e artigos de revisão de literatura. Resultados foram localizados 2539 artigos, dos quais 21 foram incluídos nesta revisão. A maioria dos estudos foi desenvolvida no Brasil, realizada com universitários e utilizou instrumentos de autoavaliação para investigar a fala em público. Conclusão os instrumentos de investigação para avaliação da fala em público são distintos e não há padronização conceitual dos aspectos avaliativos e das categorias de respostas. Nos instrumentos de autoavaliação, os aspectos mais avaliados são ansiedade ao falar em público, voz, velocidade de fala, competência comunicativa, pitch, articulação e loudness. Nos instrumentos de avaliação, os aspectos avaliativos mais abordados são voz, velocidade de fala, articulação, pausas, loudness, pitch e gestos.

ABSTRACT Purpose To review and describe studies that used assessment and selfassessment instruments, investigating public speaking by adults from 2011 to 2020. Research strategy: This was an integrative literature review. Studies were searched on SciELO, PubMed and Virtual Health Library databases, which included databases from MEDLINE and LILACS. This study proposed to answer the following question: What kind of instruments assessed public speaking by adults over the last 10 years? Selection criteria Original articles that presented instruments for assessing public speaking by adults were selected. The articles were available in full format and published over the last 10 years in English, Portuguese, or Spanish. Theses, dissertations, monographs, conference proceedings, studies with discourse analysis and literature review articles were excluded from the review. Results A total of 2,539 articles were found, of which 21 were included in this review. Most of the studies were from Brazil carried out by college students. Studies included self-assessment instruments to investigate public speaking. Conclusion The investigation instruments used to assess public speaking were all different (from each other) and there was no assessment or conceptual response category standardization. The most self-assessed aspects were public speaking anxiety, voice, speech rate, communicative competence, pitch, articulation, and loudness. The most addressed aspects in the assessment instruments were voice, speech rate, articulation, pauses, loudness, pitch, and gestures.

Usabilidade e aceitabilidade de atividades digitais para o ensino da voz em Fonoaudiologia / Usability and acceptability of digital activities for voice teaching in Speech-Language Pathology and Audiology / Usabilidad y aceptabilidad de actividades digitales para la enseñanza de la voz en Fonoaudiologia

Introdução: O uso das Tecnologias de Informação e Comunicação está em expansão na educação superior. Na área da saúde, os avanços tecnológicos agregam novas formas de aprendizado ao ensino. Uma plataforma, denominada ObservaVoz foi criada com objetivo de divulgar informação e oferecer estratégias para o ensino da voz, e, desse ambiente virtual, duas atividades digitais foram testadas. Objetivo: Descrever a satisfação com a usabilidade de atividades digitais para o ensino da voz e analisar sua associação com dados sociodemográficos e de aceitabilidade por graduandos de Fonoaudiologia. Método: Participaram do estudo 122 alunos do curso de Fonoaudiologia de uma universidade pública brasileira. Eles foram convidados a utilizar e avaliar duas atividades digitais para o ensino da voz. Para a coleta de dados e avaliação das atividades, foi utilizado um questionário on-line, dividido em informações sociodemográficas, escala numérica de usabilidade System Usability Scale e Questionário de Aceitabilidade das Atividades. Os dados descritivos foram analisados por meio da distribuição de frequência das variáveis categóricas e análise das medidas de tendência central e de dispersão das variáveis. Resultados: A maioria dos participantes avaliou a usabilidade das atividades digitais como boa. A aceitabilidade foi considerada satisfatória. Houve associação entre a usabilidade com as variáveis sexo, contribuição para o aprendizado, layout das ferramentas, apreciação positiva e possibilidade de revisão de conteúdos. Conclusão: As atividades digitais "Qual é a Patologia?" e "Histolobby" apresentam boas características de usabilidade e aceitabilidade de acordo com a avaliação de graduandos de Fonoaudiologia.

Introduction: The use of Communication and Information Technologies is expanding in higher education. In health area, technological advances add new forms of learning. The ObservaVoz platform was created to disseminate information and offer strategies of voice teaching. Two digital activities from this virtual environment were evaluated. Objective: To describe the satisfaction of the usability of digital activities and to analyze its association with sociodemographic and acceptability data by Speech Therapy students. Methods: 122 Speech Therapy students of a Brazilian public university participated of the study. They were invited to use and evaluate two digital activities of voice teaching. An online questionnaire in a self-applicable Google Docs format was used for data collection and evaluation of the activities. It was divided into sociodemographic information, System Usability Scale and Activity Acceptability Questionnaire. Descriptive data were analyzed through the frequency distribution of categorical variables and analysis of measures of central tendency and dispersion of variables. Results: Most participants rated the usability of the digital activities as good. Acceptability was considered satisfactory. There was an association between the System Usability Scale with the variables gender, contribution to learning, layout of the tools, positive appreciation and revising content possibility. Conclusion: The "ObservaVoz" digital activities "What is the Pathology?" and "Histolobby" present good characteristics of usability and acceptability according to the evaluation of Speech Therapy students.

Introducction: El uso de tecnologías de la información y la comunicación se está expandiendo en la educación superior. En el área de la salud, los avances tecnológicos agregan nuevas formas de aprendizaje a la enseñanza. La plataforma ObservaVoz fue creada para difundir información y ofrecer estrategias para la enseñanza de la voz. Se evaluaron dos actividades digitales de este entorno virtual. Objetivo: Describir la satisfacción con la usabilidad de las actividades digitales para la enseñanza de la voz y analizar su asociación con datos sociodemográficos y de aceptabilidad por parte de los estudiantes de Fonoaudiología. Metodos: En el estudio participaron 122 estudiante del curso de Fonoaudiología de una Universidad pública brasileña. Seles pidió que utilizaran y evaluaran dos actividades digitales para la enseñanza de la voz. Para la recogida de datos y evaluación de las actividades se utilizó un cuestionario online, con información sociodemográfica, System Usability Scale y Cuestionario de Aceptabilidad de Actividad. Los datos descriptivos se analizaron mediante distribución de frecuencia de variables categóricas y análisis de medidas de tendencia central y dispersión de variables. Resultados: La mayoría de los participantes calificaron la usabilidad de las actividades digitales como buena. La aceptabilidad se consideró satisfactoria. Hubo asociación entre la usabilidad de la Sistem Usability Scale y las variables género, contribución al aprendizaje, disposición de las herramientas valoración positive y posibilidad de revisión de contenidos. Conclusión: Las actividades digitales "Qual é a Patogia?" e "Histolobby" presentan buenas características de usabilidad y aceptabilidad según la evaluación de los estudiantes de Fonoaudiología.

Academic path and professional competencies seen through the perception of speech therapy alumni. / Percurso acadêmico e competências profissionais na percepção de egressos de Fonoaudiologia.

PURPOSE: To analyze the factors associated with the professional insertion of Speech Therapy graduates. METHODS: Observational analytical cross-sectional study, with a non-probabilistic sample, composed of 245 graduates from a Speech Therapy course in Brazil. The research applied a questionnaire containing objective and open questions, segmented into six axes. Bivariate and multivariate analysis of the data were performed. RESULTS: There was an association between working as a speech therapist with the variables, gender (p=0.031), age (p≤0.001), initiative (p=0.001), leadership ability (p=0.001), decision making ability (p=0.001), teamwork ability (p=0.001), managerial skills (p=0.034), interest in new knowledge (p≤0.001), pride in the profession (p=0.001), network of contacts (p=0.001) and participation in outreach projects (p≤0.001). There was a higher chance of entering the job market as a speech therapist for those graduates who acquired network contacts during an undergraduate course (3.3 times more); were interested in knowledge (3.2 times more); develop leadership skills (2.6 times more); younger than 29 years old (0.3 times more) and carried out outreach projects during graduation (0.2 times more). CONCLUSION: Graduates in Speech Therapy who develop a network of contacts, have an interest in knowledge, develop leadership skills and participate in outreach projects during graduation have enlarged possibilities of entering the job market as speech therapists.

OBJETIVO: Analisar os fatores associados à inserção profissional de egressos de Fonoaudiologia. MÉTODO: Estudo observacional analítico de delineamento transversal, com amostra não probabilística, composta por 245 egressos de um curso de Fonoaudiologia no Brasil. Aplicou-se um questionário com questões objetivas e abertas, segmentadas em seis eixos e foi realizada análise bivariada e multivariada dos dados. RESULTADOS: Houve associação entre egressos que trabalham como fonoaudiólogos e as variáveis, sexo (p=0,031), idade (p≤0,001), iniciativa (p=0,001), capacidade de liderança (p=0,001), capacidade de tomar decisões (p=0,001), capacidade de trabalhar em equipe (p=0,001), competências gerenciais (p=0,034), interesse por novos conhecimentos (p≤0,001), orgulho pela profissão (p=0,001), rede de contatos (p=0,001) e participação em projetos de extensão (p≤0,001). A chance de estar inserido do mercado de trabalho como fonoaudiólogo foi maior para os egressos que adquiriram rede de contatos durante a graduação (3,3 vezes mais); tinham interesse pelo conhecimento (3,2 vezes mais); desenvolveram capacidade de liderança (2,6 vezes mais); tinham idade até 29 anos (0,3 vezes mais) e realizaram projetos de extensão durante a graduação (0,2 vezes mais). CONCLUSÃO: Egressos de Fonoaudiologia que desenvolvem rede de contatos, têm interesse pelo conhecimento, desenvolvem capacidade de liderança e participam de projetos de extensão durante a graduação têm mais chances de inserção no mercado de trabalho como fonoaudiólogos.

Risk factors and detection of brucella ovis in naturally infected rams and ewes / Fatores de risco e detecção de brucella ovis em carneiros e ovelhas naturalmente infectados

The objective of this study was to verify the occurrence of ovine brucellosis using Agar Gel Immunodiffusion (AGID) and Polymerase Chain Reaction (PCR) techniques, as well as to identify the main risk factors associated with infection in sheep flocks belonging to municipalities in the microregion from Teresina, PI, Brazil. A total of 100 urine and blood samples were collected from sheep aged 6 months or older. The urine samples were submitted to conventional PCR and the blood samples were examined by the AGID technique. Of the 100 blood samples, 17 (17%) were reactive to the AGID test. In conventional PCR of 100 urine samples, six (6%) were positive. Risk factors associated to infection by B. ovis included the rearing system (OR=0.19), feed management (OR=0.05), presence of dystotic births (OR=4.50), miscarriages (OR=3.75) and source of water offered to the animals (OR=0.19). Thus, it was concluded that it is possible to detect the occurrence of animals with ovine brucellosis since PCR is a reliable method to confirm infection. Furthermore, there are risk factors associated to infection by B. ovis in the municipalities studied.

Objetivou-se verificar a ocorrência da brucelose ovina através das técnicas de Imunodifusão em Gel de Ágar (IDGA) e Reação em Cadeia da Polimerase (PCR), bem como identificar os principais fatores de risco associados à infecção nos rebanhos ovinos pertencentes a municípios da microrregião de Teresina, PI, Brasil. Foram colhidas 100 amostras de urina e de sangue de ovinos com idade superior ou igual a seis meses. As amostras de urina foram submetidas a PCR convencional e as amostras de sangue à técnica de IDGA. Das 100 amostras de sangue 17 (17%) foram reagentes ao teste de IDGA. Já na PCR convencional das 100 amostras de urina, seis (6%) foram positivas. Ressalta-se que três animais foram positivos em ambos os testes. Como fatores associados à infecção por B. ovis, observou-se o tipo de sistema de criação (OR=0,19), o manejo alimentar (OR=0,05), presença de partos distócicos (OR=4,50), abortamentos (OR=3,75) e a fonte de água fornecida aos animais (OR=0,19). Assim, conclui-se que foi possível detectar a ocorrência de animais com brucelose ovina, uma vez que a PCR é um método confirmatório. Além disso, há fatores de risco associados à infecção por B. ovis nos municípios estudados.

Risk factors and detection of brucella ovis in naturally infected rams and ewes / Fatores de risco e detecção de brucella ovis em carneiros e ovelhas naturalmente infectados

The objective of this study was to verify the occurrence of ovine brucellosis using Agar Gel Immunodiffusion (AGID) and Polymerase Chain Reaction (PCR) techniques, as well as to identify the main risk factors associated with infection in sheep flocks belonging to municipalities in the microregion from Teresina, PI, Brazil. A total of 100 urine and blood samples were collected from sheep aged 6 months or older. The urine samples were submitted to conventional PCR and the blood samples were examined by the AGID technique. Of the 100 blood samples, 17 (17%) were reactive to the AGID test. In conventional PCR of 100 urine samples, six (6%) were positive. Risk factors associated to infection by B. ovis included the rearing system (OR=0.19), feed management (OR=0.05), presence of dystotic births (OR=4.50), miscarriages (OR=3.75) and source of water offered to the animals (OR=0.19). Thus, it was concluded that it is possible to detect the occurrence of animals with ovine brucellosis since PCR is a reliable method to confirm infection. Furthermore, there are risk factors associated to infection by B. ovis in the municipalities studied.

Objetivou-se verificar a ocorrência da brucelose ovina através das técnicas de Imunodifusão em Gel de Ágar (IDGA) e Reação em Cadeia da Polimerase (PCR), bem como identificar os principais fatores de risco associados à infecção nos rebanhos ovinos pertencentes a municípios da microrregião de Teresina, PI, Brasil. Foram colhidas 100 amostras de urina e de sangue de ovinos com idade superior ou igual a seis meses. As amostras de urina foram submetidas a PCR convencional e as amostras de sangue à técnica de IDGA. Das 100 amostras de sangue 17 (17%) foram reagentes ao teste de IDGA. Já na PCR convencional das 100 amostras de urina, seis (6%) foram positivas. Ressalta-se que três animais foram positivos em ambos os testes. Como fatores associados à infecção por B. ovis, observou-se o tipo de sistema de criação (OR=0,19), o manejo alimentar (OR=0,05), presença de partos distócicos (OR=4,50), abortamentos (OR=3,75) e a fonte de água fornecida aos animais (OR=0,19). Assim, conclui-se que foi possível detectar a ocorrência de animais com brucelose ovina, uma vez que a PCR é um método confirmatório. Além disso, há fatores de risco associados à infecção por B. ovis nos municípios estudados.

Sense of Coherence and the fear of public speaking in university students. / Senso de Coerência e o medo de falar em público em universitários.

PURPOSE: To test the association between the Sense of Coherence (SOC) and the fear of public speaking in university students. METHOD: Cross-sectional study was carried out with a sample of 1124 undergraduate students of a Brazilian public university. An online questionnaire was used divided into three blocks: the first evaluated the sociodemographic data and the somatic symptoms of the fear of public speaking; the second evaluated the SOC, through the SOC-13 questionnaire; and the third was composed by the Scale for Self-Assessment in Public Speaking (SSPS), with questions that point out cognitive aspects of this activity. The students were divided into two groups (high SOC and low SOC) through the Two-step Cluster analysis. Data were analyzed descriptively and by the Mann-Whitney test and bi and multivariate logistic regression models, with significance set at 5%. RESULTS: The students who reported not being afraid to speak in public were more likely to belong to the high SOC group (OR = 3.19, 95% CI = 2.30-4.42). Students from the high SOC group self-assessed more positively on the SSPS scale (p <0.001). CONCLUSION: College students over 30 years old, on the second half of graduation, with breathing discomfort, who do not report fear of public speaking and who perceive themselves more positively for public speaking, they have the highest SOC. Thus, it is observed the importance of considering the SOC as an important coping resource, given the great interference of emotional aspects in public speech.

OBJETIVO: Testar a associação entre o Senso de Coerência (SOC) e o medo de falar em público em universitários. MÉTODO: Estudo transversal, com amostra de 1.124 estudantes de cursos de graduação de uma universidade pública brasileira. Foi utilizado questionário online dividido em três blocos: o primeiro avaliou os dados sociodemográficos e os sintomas somáticos do medo de falar em público; o segundo avaliou o SOC, por meio do questionário SOC-13; e o terceiro foi composto pela Escala para Autoavaliação ao Falar em Público (SSPS), que norteia aspectos cognitivos dessa atividade. Os universitários foram divididos em dois grupos (SOC alto e SOC baixo) por meio da análise de Cluster de dois passos. Os dados foram analisados de forma descritiva e por meio do teste de Mann-Whitney e modelos de regressão logística bi e multivariado, com significância de 5%. RESULTADOS: Os universitários que relataram não ter medo de falar em público apresentaram mais chance de pertencer ao grupo SOC alto (OR=3,19, IC95%=2,30-4,42). Os universitários do grupo SOC alto se autoavaliaram mais positivamente na escala SSPS (p<0.001). CONCLUSÃO: Universitários com mais de 30 anos, na segunda metade da graduação, das áreas da Saúde e Exatas, com sintoma de respiração ofegante, que não relatam medo de falar em público e que se autopercebem mais positivamente para falar em público, apresentam o SOC mais alto. Diante do estudo, observa-se a importância de se considerar o SOC como um recurso de enfrentamento importante, tendo em vista a grande interferência dos aspectos emocionais na fala em público.