Neurocognitive function in children with cochlear implants and hearing aids: a systematic review.

Purpose: To systematically review the existing literature that examines the relationship between cognition, hearing, and language in children using cochlear implants and hearing aids. Method: The review has been registered in Prospero (Registration: CRD 42020203974). The review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and examined the scientific literature in VHL, MEDLINE, CINAHL, Scopus, WOS, and Embase. It included original observational studies in children using hearing aids and/or cochlear implants who underwent cognitive and auditory and/or language tests. Data were extracted from the studies and their level of evidence was graded with the Oxford Center for Evidence-Based Medicine: Levels of Evidence. Meta-analysis could not be performed due to data heterogeneity. Outcomes are described in narrative and tables synthesis. Results: The systematic search and subsequent full-text evaluation identified 21 studies, conducted in 10 different countries. Altogether, their samples comprised 1,098 individuals, aged 0.16-12.6 years. The studies assessed the following cognitive domains: memory, nonverbal cognition, reasoning, attention, executive functions, language, perceptual-motor function, visuoconstructive ability, processing speed, and phonological processing/phonological memory. Children with hearing loss using cochlear implants and hearing aids scored significantly lower in many cognitive functions than normal hearing (NH) children. Neurocognitive functions were correlated with hearing and language outcomes. Conclusion: Many cognitive tools were used to assess cognitive function in children with hearing devices. Results suggest that children with cochlear implants and hearing aids have cognitive deficits; these outcomes are mainly correlated with vocabulary. This study highlights the need to understand children's cognitive function and increase the knowledge of the relationship between cognition, language, and hearing in children using cochlear implants and hearing aids.

Beginner's Intelligibility Test (BIT): translation, cultural adaptation to Brazilian Portuguese and validation.

OBJECTIVE: Translate and validate the Beginner's Intelligibility Test (BIT) speech intelligibility assessment instrument into Brazilian Portuguese. METHOD: Study developed in two stages: 1st translation and cross-cultural adaptation of the Beginner's Intelligibility Test instrument into Brazilian Portuguese; 2nd application of the instrument. The second stage of the study involved 20 children using cochlear implants, aged between 4 and 11 years old, enrolled in the Cochlear Implant Program at Hospital das Clínicas de Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo. All data collection procedures were video, and audio recorded for analysis by judges. After orthographic transcription of each sentence repeated by the child, the judge was asked to score the participant's speech intelligibility and classify it according to criteria established in the literature. RESULTS: The translation stage took place for the four lists and 40 sentences of the Beginner's Intelligibility Test (BIT) instrument into Brazilian Portuguese, the semantic, idiomatic, experimental and conceptual equivalences were considered, and it took place without any difficulties identified by the translators. The terms used in the Portuguese language were similar and those that presented differences among the translators did not bring significant divergences to its understanding. In the inter-evaluator analysis, there was reliability between the classification and the score obtained. Different judges evaluated the same children and a concordance was observed in classification and scoring. CONCLUSIONS: Face validity of the BIT was confirmed through the understanding of each sentence of the four lists by the majority of children using cochlear implants participating in the pre-test phase. The content validity among experts was unanimous for the four lists of sentences. The Brazilian Portuguese adapted version maintained the semantic, idiomatic, conceptual, and cultural equivalence, according to the evaluation of the expert committee. EVIDENCE LEVEL: 02.

Beginner's Intelligibility Test (BIT): translation, cultural adaptation to Brazilian Portuguese and validation

Abstract Objective: Translate and validate the Beginner's Intelligibility Test (BIT) speech intelligibility assessment instrument into Brazilian Portuguese. Method: Study developed in two stages: 1st translation and cross-cultural adaptation of the Beginner's Intelligibility Test instrument into Brazilian Portuguese; 2nd application of the instrument. The second stage of the study involved 20 children using cochlear implants, aged between 4 and 11 years old, enrolled in the Cochlear Implant Program at Hospital das Clínicas de Ribeirão Preto, Faculty of Medicine of Ribeirão Preto, University of São Paulo. All data collection procedures were video, and audio recorded for analysis by judges. After orthographic transcription of each sentence repeated by the child, the judge was asked to score the participant's speech intelligibility and classify it according to criteria established in the literature. Results: The translation stage took place for the four lists and 40 sentences of the Beginner's Intelligibility Test (BIT) instrument into Brazilian Portuguese, the semantic, idiomatic, experimental and conceptual equivalences were considered, and it took place without any difficulties identified by the translators. The terms used in the Portuguese language were similar and those that presented differences among the translators did not bring significant divergences to its understanding. In the inter-evaluator analysis, there was reliability between the classification and the score obtained. Different judges evaluated the same children and a concordance was observed in classification and scoring. Conclusions: Face validity of the BIT was confirmed through the understanding of each sentence of the four lists by the majority of children using cochlear implants participating in the pretest phase. The content validity among experts was unanimous for the four lists of sentences. The Brazilian Portuguese adapted version maintained the semantic, idiomatic, conceptual, and cultural equivalence, according to the evaluation of the expert committee. Evidence level: 02.

Effectiveness of the speech language intervention on the communicative behavior in groups of individuals diagnosed with schizophrenia. / A efetividade da intervenção fonoaudiológica grupal no comportamento comunicativo de indivíduos com diagnóstico de esquizofrenia.

PURPOSE: To verify the effectiveness of the speech language intervention in the communicative behavior in group of individuals diagnosed with schizophrenia. METHODS: This is a semi-experimental, quantitative analytical-exploratory study. Users of a Psychosocial Care Center III (CAPS III) with a diagnosis of schizophrenia were included, divided into 2 groups: Experimental Group (EG), comprising the Speech Therapy Intervention Group (STIG) and Control Group (CG). The communicative behavior was evaluated through the Brief MAC Battery. The STIG was performed in 2 weekly sessions, during 12 weeks, totalizing 24 sessions. After this period, individuals were reassessed. Data were analyzed through Mann Whitney non-parametric Test, and Pearson's Correlation Test. RESULTS: A total of 19 individuals of both sexes participated, who are between 19 and 59 years old with a minimum schooling of 5 years, 14 participating in EG and 5 in CG. In the EG, it was possible to observe that there was improvement in the communicative behavior after the speech language intervention in all the tasks evaluated, except in the writing task. In CG, no significant changes were observed comparing evaluation and reevaluation after 12 weeks. CONCLUSION: The speech-language intervention in group was effective as a socialization tool and contributing to the improvement of the living conditions of these people with schizophrenia.

OBJETIVO: Verificar a efetividade da intervenção fonoaudiológica grupal no comportamento comunicativo de indivíduos com diagnóstico de esquizofrenia. MÉTODO: Trata-se de um estudo quase experimental, quantitativo analítico-exploratório. Foram incluídos usuários de um Centro de Atenção Psicossocial III (CAPS III) com diagnóstico de esquizofrenia, divididos em 2 grupos: Grupo Experimental (GE), compondo o Grupo de Intervenção Fonoaudiológica (GIF) e Grupo Controle (GC). O comportamento comunicativo foi avaliado através da Bateria MAC Breve. O GIF foi realizado em 2 sessões semanais, totalizando 24 sessões. Após esse período, os indivíduos foram reavaliados. A análise ocorreu por meio dos Testes não paramétricos de Mann Whitney e o Teste de Correlação de Pearson. RESULTADOS: Participaram 19 indivíduos, de ambos os sexos, com idade entre 19 e 59 anos, escolaridade mínima de 5 anos, sendo que 14 participaram do GE e 5 do GC. No GE, foi possível observar que houve melhora no comportamento comunicativo após a intervenção fonoaudiológica em todas as tarefas avaliadas, exceto na tarefa de Escrita. Já no GC, não foram observadas alterações significativas comparando a avaliação e a reavaliação após 12 semanas. CONCLUSÃO: A intervenção fonoaudiológica grupal foi efetiva, utilizando a comunicação como instrumento de socialização e contribuindo para a melhoria das condições de vida de indivíduos com diagnóstico de esquizofrenia.

Influence of different types of noise on sentence recognition in normally hearing adults / A influência de diferentes tipos de ruídos no reconhecimento de sentenças em adultos normo-ouvintes

ABSTRACT Objective: to analyze speech perception in normally hearing adults when listening in silence and with different types of noise. Methods: 40 individuals of both sexes, aged 18 to 45 years, participated in the study. Speech perception was assessed with the Lists of Sentences in Portuguese test, without a competing noise and with speech-spectrum, babble, and cocktail party noise. A mixed-effects linear regression model and the 95% confidence interval were used. Results: the subjects' performance was worse in the three types of noise than in silence. When comparing the types of noise, differences were found in all combinations (speech-spectrum X babble, speech-spectrum X cocktail party, and babble X cocktail party), with a worse performance in babble, noise, followed by cocktail party. Conclusion: all noises negatively influenced speech perception, with a worse performance in babble, followed by cocktail party and speech-spectrum.

RESUMO Objetivo: analisar a percepção da fala em adultos normo-ouvintes na situação de escuta no silêncio e com diferentes tipos de ruídos. Métodos: participaram 40 indivíduos de ambos os gêneros, de 18 a 45 anos. Foi realizada a avaliação da percepção de fala com o teste Lista de Sentenças para o Português, sem ruído competitivo e com os ruídos: espectro de fala, babble e cocktail party. Foi utilizado modelo de regressão linear com efeitos mistos e adotado intervalo de confiança de 95%. Resultados: houve pior desempenho dos indivíduos com todos os ruídos em comparação a situação de escuta no silêncio. Na comparação entre os tipos de ruídos, também foi constatado diferença em todas as combinações (espectro de fala X babble, espectro de fala X cocktail party e babble X cocktail party), com pior desempenho dos indivíduos com os ruídos babble e cocktail party, respectivamente. Conclusão: todos os ruídos influenciaram negativamente a percepção de fala, com pior desempenho quando utilizado o ruído babble, seguido pelo cocktail party e espectro de fala.

Association between the Unterberger-Fukuda test and vectoelectronystagmography / Associação entre a prova de Unterberger-Fukuda e o exame de vectoeletronistagmografia

ABSTRACT Purpose: to study and characterize anteroposterior and angular deviations in the Unterberger-Fukuda Test (UFT) in relation to the results of the caloric tests in patients complaining of dizziness or vertigo. Methods: 44 subjects-men and women between 20 and 79 years of age-who had symptoms of vertigo or dizziness and had been referred for vectoelectronystagmography were examined. The exclusion criteria were gait difficulties arising from orthopedic and/or spinal disorders, and syndromes or neurological diseases that affect balance. Two procedures were performed: vectoelectronystagmography and UFT. Results: the caloric test showed that 25.00% of the patients had hyporeflexia-the most frequent result. In the open-eyes UFT, only 2.30% presented altered results in anteroposterior displacement. In the closed-eyes test, the equivalent value was 31.80%. Anteroposterior deviation showed a greater correlation with age than the angular one. Abnormal results in the caloric test were associated with the UFT. Conclusion: the results of the closed-eyes UFT were associated with the caloric test. Anteroposterior deviation was correlated with age, while angular deviation was not.

RESUMO Objetivo: estudar e caracterizar os desvios anteroposteriores e angulares da Prova de Unterberger-Fukuda (PUF) em função do resultado da prova calórica, em sujeitos com queixa de tontura e ou vertigem. Métodos: foram avaliados 44 sujeitos, de ambos os sexos, com idade entre 20 a 79 anos, com queixa de vertigem e ou tontura, encaminhados para exame de vectoeletronistagmografia. Os critérios de exclusão foram a identificação de dificuldades de marcha decorrentes de alterações ortopédicas e ou de coluna, assim como síndromes e doenças neurológicas que afetam o equilíbrio. Foram realizados dois procedimentos, a PUF e o exame de vectonistagmografia. Resultados: na prova calórica o tipo de alteração mais frequente foi a hiporreflexia 25,00%, da casuística total. Para o resultado da PUF apenas 2,30% apresentou resultados alterados no deslocamento anteroposterior, de olhos abertos, na etapa de olhos fechados o mesmo tipo de ocorrência foi de 31,80%. O desvio anteroposterior mostrou maior correlação com o aumento da idade, em relação ao do tipo angular. Houve associação entre os resultados alterados na prova calórica e a PUF. Conclusão: os resultados da PUF de olhos fechados apresentaram associação com a prova calórica, o desvio do tipo anteroposterior esteve correlacionado ao aumento da idade, o angular não.

Teste de percepção de fala com figuras: aplicabilidade em crianças com deficiência auditiva / Speech perception test with pictures: applicability in children with hearing impairment

RESUMO Objetivo: verificar a aplicabilidade do teste de percepção de fala com figuras, desenvolvido por Souza e Reis (2015), em crianças com deficiência auditiva. Métodos: estudo descritivo exploratório. Participaram 40 crianças, de ambos os sexos, na faixa etária entre 2 e 11 anos, sendo 20 normo ouvintes (GC) e 20 com deficiência auditiva (GE), equiparadas por tempo de estimulação sensorial auditiva com audição normal. Os grupos foram subdivididos de acordo com tempo de estimulação sensorial auditiva, sendo GC1 (2 anos de idade), GC2 (3 anos de idade), GC3 (4 anos de idade), GE1 (2 anos de estimulação auditiva), GE2 (3 anos de estimulação auditiva), GE3 (4 anos de estimulação auditiva). Resultados: os grupos apresentaram as seguintes porcentagens de acertos: GC1 87.33%, GC2 85.6% e GC3 98.67%. O grupo estudo, composto pelas crianças com deficiência auditiva, os resultados foram, GE1 61.33%, GE2 76.8% e GE3 88% de acertos. Houve diferença significante para seis das 25 palavras (gelo, faca, rato, trem, cão, flor), quando associados acertos e erros. Conclusão: o teste é viável para a avaliação e monitoramento da percepção de fala em crianças com deficiência auditiva, independente da capacidade de verbalização das mesmas.

ABSTRACT Purpose: to verify the applicability of speech perception test with figures, developed by Souza and Reis (2015), in children with hearing loss. Methods: an exploratory descriptive study. A total of 40 children, both sexes, aged between 2 and 11 years, 20 normal hearing (CG) and 20 hearing impaired (SG), matched by time of sensorial auditory stimulation with normal hearing. The groups were subdivided according to time of sensorial auditory stimulation, being CG1 (2 years of age), CG2 (3 years of age), CG3 (4 years of age), SG1 (2 years of auditory stimulation), SG2 (3 years of auditory stimulation), SG3 (4 years of auditory stimulation). Results: the groups presented the following percentages of correct answers: CG1 87.33%, CG2 85.6% and CG3 98.67%. For the study group, composed of children with hearing loss, the results were, SG1 61.33%, SG2 76.8% and SG3 88% of correct answers. There were significant differences for six of the 25 words (ice, knife, rat, train, dog, flower), when associated with correct and incorrect answers. Conclusion: the test is feasible for the evaluation and monitoring of speech perception in children with hearing impairment, regardless of their verbal ability.

Preparation and applicability of a test of speech perception with pictures. / Construção e aplicabilidade de um teste de percepção de fala com figuras.

PURPOSE: To prepare and apply support material for responses to the Speech Recognition Percentage Index (SRPI) test in children. METHODS: This is a descriptive, exploratory study conducted in two phases: in the first phase, 31 speech-language pathologists (referees) prepared material composed of regular, frequently used monosyllabic and disyllabic words belonging to the vocabulary of children and figures that could represent these words; the second phase consisted in the application of this material to 30 normal-hearing children aged 2 to 4 years and 11 months. RESULTS: The material consisted of 25 words and six boards with six figures each. The word selection criterion adopted by the referees included the initial phoneme and real, colorful figures familiar to the children. The mean scores of the children in the SRPI test were 93% (SD ± 8%) with the support of figures and 64% (SD ± 25%) without figure support. Comparison between the results obtained with and without the support of figures showed significant difference for 15 of the 25 test words, with higher scores with the use of supporting figures. Comparison between correct and incorrect responses using the support of figures showed significant difference only for the word "dog" ("cão") (p=0.0079). CONCLUSION: There was agreement among the referees with respect to the words and figures. The SRPI test can be rapidly and easily applied, allowing evaluation and systematic monitoring of speech perception ability regardless of child verbalization capacity.

Construção e aplicabilidade de um teste de percepção de fala com figuras / Preparation and applicability of a test of speech perception with pictures

RESUMO Objetivo construir e aplicar um material de apoio para respostas ao teste do índice percentual de reconhecimento de fala em crianças. Método estudo descritivo exploratório. A primeira etapa, elaboração de um material, foi realizada pela avaliação de 31 fonoaudiólogos (juízes), com palavras monossílabas e dissílabas, regulares e frequentes, que pertencem ao vocabulário das crianças e figuras que pudessem representar essas palavras. A segunda etapa constituiu-se da aplicabilidade do material em 30 crianças na faixa etária de 2 a 4 anos e 11 meses, com audição normal. Resultados o material foi constituído por 25 palavras e seis pranchas com seis figuras. As palavras selecionadas pelos fonoaudiólogos tiveram como critério o fonema inicial e figuras reais, coloridas e próximas do cotidiano das crianças. A média de acertos apresentada pelas crianças no índice percentual de reconhecimento de fala com apoio das figuras foi de 93% (± 8% desvio padrão) e sem, de 64% (± 25% desvio padrão). Ao comparar os resultados obtidos com e sem o apoio das figuras, observou-se diferença significativa para 15 das 25 palavras do teste, sendo maior o número de acertos quando se utilizou com apoio de figuras. Na comparação entre os acertos e erros obtidos no teste, utilizando as figuras como apoio, houve diferença significativa apenas para a palavra “cão” (p=0,0079). Conclusão houve concordância entre os juízes em relação às palavras e figuras; a aplicação foi rápida e fácil, possibilitando a avaliação e o monitoramento sistematizado da habilidade de percepção de fala independentemente da capacidade de verbalização da criança.

ABSTRACT Purpose To prepare and apply support material for responses to the Speech Recognition Percentage Index (SRPI) test in children. Methods This is a descriptive, exploratory study conducted in two phases: in the first phase, 31 speech-language pathologists (referees) prepared material composed of regular, frequently used monosyllabic and disyllabic words belonging to the vocabulary of children and figures that could represent these words; the second phase consisted in the application of this material to 30 normal-hearing children aged 2 to 4 years and 11 months. Results The material consisted of 25 words and six boards with six figures each. The word selection criterion adopted by the referees included the initial phoneme and real, colorful figures familiar to the children. The mean scores of the children in the SRPI test were 93% (SD ± 8%) with the support of figures and 64% (SD ± 25%) without figure support. Comparison between the results obtained with and without the support of figures showed significant difference for 15 of the 25 test words, with higher scores with the use of supporting figures. Comparison between correct and incorrect responses using the support of figures showed significant difference only for the word “dog” (“cão”) (p=0.0079). Conclusion There was agreement among the referees with respect to the words and figures. The SRPI test can be rapidly and easily applied, allowing evaluation and systematic monitoring of speech perception ability regardless of child verbalization capacity.

Comportamento comunicativo de indivíduos com diagnóstico de esquizofrenia / Communicative behavior of individuals with a diagnosis of schizophrenia

Objetivo descrever o comportamento comunicativo de indivíduos com diagnóstico de esquizofrenia em processo de reabilitação psicossocial. Métodos estudo descritivo-exploratório, com amostra por conveniência de recorte transversal. Participaram 50 indivíduos com diagnóstico de esquizofrenia, de ambos os sexos, com faixa etária entre 19 e 75 anos, usuários de um Núcleo de Saúde Mental de uma cidade do interior do estado de São Paulo, Brasil. Foi realizado levantamento nos prontuários para obter dados pessoais e o subtipo da esquizofrenia. Para avaliar o comportamento comunicativo utilizou-se a Bateria Montreal de Avaliação da Comunicação (Bateria MAC), constituída por 14 tarefas que avaliam os aspectos discursivo, pragmático inferencial, léxico-semântico e prosódico da linguagem. Resultados os indivíduos, em sua maioria, eram do sexo masculino, com baixa escolaridade, praticantes do catolicismo e com esquizofrenia do subtipo paranoide. A avaliação pela Bateria MAC apontou alterações em todas as tarefas avaliadas e a maioria dos participantes respondeu que é consciente da dificuldade comunicativa. As maiores alterações ocorreram nas tarefas de evocação lexical com critério semântico, atos de fala indiretos, discurso conversacional e discurso narrativo, e, as menores alterações, ocorreram nos componentes prosódicos no nível de compreensão, destacando-se que, o nível da produção nos aspectos linguísticos e emocionais da prosódia, também apresentou alteração considerável. Conclusão todas as tarefas avaliadas apresentaram alterações. Os aspectos mais prejudicados foram o discurso e a pragmática, que não devem ser relacionados somente aos aspectos linguísticos, ...

Purpose to describe the communicative behavior of individuals diagnosed with schizophrenia in psychosocial rehabilitation. Methods a descriptive and exploratory study with a convenience, cross-sectional sample. 50 individuals diagnosed with schizophrenia, of both sexes, aged between 19 and 75 years, users of a mental health unit in the interior of the state of São Paulo, Brasil participated in the study. Survey was conducted in the medical records for personal data and subtype of schizophrenia. To evaluate the communicative behavior, the instrument Montreal Battery of Evaluation of Communication (Drums MAC) was used, which is consisted of 14 tasks that assess discursive aspects: pragmatic-inferential, lexical-semantic and prosodic language. Results most participants were males, with low education, Catholics, with schizophrenia paranoid type. The assessment through Battery MAC showed changes in all tasks evaluated and most participants said they were aware of the difficulty related to communication. The biggest changes occurred in the tasks of lexical evocation with semantic criteria, indirect speech acts, conversational discourse and narrative discourse, and the smallest changes occurred in the prosodic components related to understanding, highlighting that the level of production related to linguistic and emotional aspects of prosody also showed considerable change. Conclusion all tasks evaluated presented changes. The most affected aspects were the discourse and pragmatics, which should not only be related to linguistic aspects, but also the characteristics of changes in thought and cognition, the affective blunting and social issues of this disorder. .

Clinical validation of the Preterm Oral Feeding Readiness Assessment Scale.

INTRODUCTION: Health professionals have great difficulties to establish the adequate and safe time to start breast feeding in preterm infants. There is a need to develop a standardized tool to help health professionals to comprehensively evaluate preterm infant readiness to transition preterm infants' feeding from gastric to oral, and encourage breast feeding practice in neonatal units. AIMS: To clinical validate the accuracy of a Preterm Oral Feeding Readiness Assessment Scale with 60 clinically stable preterm infants. METHODS: Global accuracy, sensitivity and specificity of Preterm Oral Feeding Readiness Assessment Scale cut-offs, compared to milk intake through translactation, were estimated through ROC curves (Receiver Operating Characteristic Curves). RESULTS: The global accuracy of Preterm Oral Feeding Readiness Assessment Scale was 74.38%. The highest sensitivity and specificity were obtained for three cut-offs: 28, 29 and 30. Since higher specificity (75.68%) for the Preterm Oral Feeding Readiness Assessment Scale was found at a score cut-off=of 30 showed higher specificity (75.68%), it should be used as a cut-off score to select initiate breastfeeding the preterm newborns' oral feeding readiness. CONCLUSION: The Preterm Oral Feeding Readiness Assessment Scale is considered valid to assist health professionals to initiate preterm feeding in view of promoting safe and objective breastfeeding.

Clinical validation of the Preterm Oral Feeding Readiness Assessment Scale / Validação clínica do Instrumento de Avaliação da Prontidão do Prematuro para Início da Alimentação Oral / La validación clínica del Instrumento de Evaluación de la Prontitud de los Prematuros para Iniciación de la Alimentación por Vía Oral

INTRODUCTION: Health professionals have great difficulties to establish the adequate and safe time to start breast feeding in preterm infants. There is a need to develop a standardized tool to help health professionals to comprehensively evaluate preterm infant readiness to transition preterm infants´ feeding from gastric to oral, and encourage breast feeding practice in neonatal units. Aims: To clinical validate the accuracy of a Preterm Oral Feeding Readiness Assessment Scale with 60 clinically stable preterm infants. METHODS: Global accuracy, sensitivity and specificity of Preterm Oral Feeding Readiness Assessment Scale cut-offs, compared to milk intake through translactation, were estimated through ROC curves (Receiver Operating Characteristic Curves). RESULTS: The global accuracy of Preterm Oral Feeding Readiness Assessment Scale was 74.38%. The highest sensitivity and specificity were obtained for three cut-offs: 28, 29 and 30. Since higher specificity (75.68%) for the Preterm Oral Feeding Readiness Assessment Scale was found at a score cut-off=of 30 showed higher specificity (75.68%), it should be used as a cut-off score to select initiate breastfeeding the preterm newborns' oral feeding readiness. CONCLUSION: The Preterm Oral Feeding Readiness Assessment Scale is considered valid to assist health professionals to initiate preterm feeding in view of promoting safe and objective breastfeeding.

INTRODUÇÃO: profissionais de saúde têm grande dificuldade para estabelecer o momento adequado e seguro para iniciar a amamentação em prematuros. Há necessidade de desenvolver um instrumento padronizado para auxiliar esses profissionais, na transição da alimentação gástrica para via oral do prematuro, incentivando a prática da amamentação nas unidades neonatais. Objetivo: avaliar a acurácia do Instrumento de Avaliação da Prontidão do Prematuro para Início da Alimentação Oral. MÉTODO: participaram do estudo 60 prematuros clinicamente estáveis e que não haviam recebido alimentação oral. A acurácia global, sensibilidade e especificidade do instrumento, em comparação à ingestão de leite por meio da translactação, foram estimadas através de curvas ROC (Receiver Operating Characteristic Curves). RESULTADOS: a acurácia global do instrumento foi de 74,38%. A maior sensibilidade e especificidade foram obtidas para três pontos de corte: 28, 29 e 30. Como o ponto de corte=30 do instrumento apresentou maior especificidade (75,68%), sugere-se, aqui, que deverá ser usado para selecionar os prematuros com prontidão para início da alimentação oral. CONCLUSÃO: o Instrumento de Avaliação da Prontidão do Prematuro para Início da Alimentação Oral está validado para assistir os profissionais de saúde a iniciar a alimentação do prematuro, com vistas ao aleitamento materno, de forma segura e objetiva.

INTRODUCCIÓN: Profesionales de la salud tienen grandes dificultades para establecer el momento adecuado y seguro para iniciar la lactancia en prematuros. Hay una necesidad de se desarrollar un instrumento para ayudar a estos profesionales en la transición de la alimentación gástrica para oral en prematuros mediante el fomento de la lactancia en las unidades neonatales. Objetivo: Evaluar la precisión de el Instrumento de Evaluación de la Prontitud de los Prematuros para Iniciación de la Alimentación por Vía Oral. MÉTODO: Participaron 60 prematuros clínicamente estables y que no recibieron alimentación oral. La precisión global, la sensibilidad y la especificidad del instrumento, en comparación con la ingestión de leche por translactancia se estimaron mediante curvas ROC. RESULTADOS: La precisión global del instrumento fue del 74,38%. La mayor sensibilidad y especificidad se obtuvieron para tres puntos de corte: 28, 29 y 30. Como el punto de corte=30 del instrumento mostró mayor especificidad (75,68%), sugerimos que debe utilizarse para seleccionar los prematuros con prontitud para la alimentación oral. CONCLUSIÓN: El Instrumento se valida para ayudar a los profesionales de la salud en la iniciación de la alimentación en los prematuros, con vistas a la lactancia de manera segura y objetiva.

Impact of a participatory program to reduce noise in a neonatal unit.

This study evaluated the impact of a participatory program to reduce noise in a neonatal intermediate care unit of a university hospital. A time-series quasi-experimental design was used, in which sound pressure levels were measured before and after the intervention was implemented using the Quest-400 dosimeter. Non-parametric statistical tests were used to compare noise with the level of significance fixed at 5%. Results showed significant reduction of sound pressure levels in the neonatal unit after the intervention program was implemented (p<0.0001). The average Leq before the intervention was 62.5dBA and was reduced to 58.8dBA after the intervention. A reduction of 7.1dBA in the average Lmax(from 104.8 to 87.7dBA) and of 30.6dBA in the average Lpeak(from 138.1 to 107.5dBA) was observed. The program was proven to be effective in significantly reducing noise levels in the neonatal unit, although levels were still more intense than recommended.

Impact of a participatory program to reduce noise in a Neonatal Unit / Impacto de um programa participativo de redução do ruído em unidade neonatal / Impacto de un programa participativo de reducción de ruido en una unidad neonatal

This study evaluated the impact of a participatory program to reduce noise in a neonatal intermediate care unit of a university hospital. A time-series quasi-experimental design was used, in which sound pressure levels were measured before and after the intervention was implemented using the Quest-400 dosimeter. Non-parametric statistical tests were used to compare noise with the level of significance fixed at 5%. Results showed significant reduction of sound pressure levels in the neonatal unit after the intervention program was implemented (p<0.0001). The average Leq before the intervention was 62.5dBA and was reduced to 58.8dBA after the intervention. A reduction of 7.1dBA in the average Lmax(from 104.8 to 87.7dBA) and of 30.6dBA in the average Lpeak(from 138.1 to 107.5dBA) was observed. The program was proven to be effective in significantly reducing noise levels in the neonatal unit, although levels were still more intense than recommended.

O objetivo deste estudo foi avaliar o impacto de um programa participativo na redução do ruído ambiente em uma unidade neonatal, de um hospital universitário. Utilizou-se delineamento quase-experimental do tipo tempo-série, no qual os níveis de pressão sonora foram dimensionados antes e após a implantação do programa de intervenção, utilizando o dosímetro Quest-400. Para a análise comparativa do ruído, utilizaram-se os testes estatísticos não-paramétricos (α=0,05). Constatou-se redução significativa dos níveis de pressão sonora da unidade neonatal, após a implantação do programa de intervenção (p<0,0001). O Leq médio foi de 62,5dBA antes da intervenção e reduziu para 58,8dBA após a intervenção. Houve redução de 7,1dBA no Lmax médio (de 104,8 para 87,7dBA) e de 30,6dBA no Lpeak médio (de 138,1 para 107,5dBA). Concluiu-se que o programa foi efetivo na redução do nível sonoro da unidade neonatal, embora ainda se mantenha mais intenso que o recomendável.

El objetivo fue evaluar el impacto de un programa participativo en la reducción del ruido ambiente en una unidad neonatal de un hospital universitario. Se utilizó delineamiento casi-experimental del tipo tiempo-serie, en el cual los niveles de presión sonora fueron mensurados antes y después de la implantación del programa de intervención, utilizando el dosímetro Quest-400. Para el análisis comparativo del ruido, se utilizaron las pruebas estadísticas no paramétricas (α=0,05). Se constató reducción significativa de los niveles de presión sonora de la unidad neonatal después de la implantación del programa de intervención (p<0,0001). El Leq medio fue de 62,5dBA antes de la intervención y se redujo para 58,8dBA después de la intervención. Hubo reducción de 7,1dBA en el Lmax medio (de 104,8 para 87,7dBA) y de 30,6dBA en el Lpeak medio (de 138,1 para 107,5dBA). Se concluye que el programa fue efectivo en la reducción del nivel sonoro de la unidad neonatal, a pesar de que todavía se mantiene más intenso que lo recomendable.

Percepção da equipe multiprofissional sobre ruído em unidade de cuidado intermediário neonatal / Perception of the multidisciplinary team about noise in neonatal intermediate care units

OBJETIVO: Descrever a percepção da equipe multiprofissional sobre ruído ambiente em uma unidade de cuidado intermediário neonatal. MÉTODOS: Estudo descritivo com delineamento qualitativo. Realizaram-se entrevistas abertas com 43 profissionais que atuavam na unidade de cuidado intermediário neonatal. As entrevistas gravadas foram transcritas e realizou-se a análise temática. RESULTADOS: Apreenderam-se quatro núcleos temáticos: Como a equipe percebe o ruído na unidade; O que gera ruído na unidade; Os efeitos do ruído nos bebês, trabalhadores, familiares e acompanhantes; Como reduzir o ruído na unidade. CONCLUSÃO: A equipe tem conhecimento sobre o ruído na unidade, apontando possibilidades e limitações para sua redução.

OBJECTIVE: To describe the perception of the multidisciplinary team on ambient noise in a neonatal intermediate care unit. METHODS: Descriptive study with qualitative design. Open-ended interviews were conducted with 43 professionals working in the neonatal intermediate care unit. The taped interviews were transcribed and underwent thematic analysis. RESULTS: Four thematic topics arose: how the team perceived the noise in the unit; what generated noise in the unit; the effects of noise on babies, workers, relatives and associates; and, how to reduce noise in the unit. CONCLUSION: The staff was knowledgeable about the noise in the unit, pointing out possibilities and limitations for its reduction.

OBJETIVO: Describir la percepción del equipo multiprofesional sobre el ruido del ambiente en una unidad de cuidado intermedio neonatal. MÉTODOS: Se trata de un estudio descriptivo con abordaje cualitativo. Se realizaron entrevistas abiertas con 43 profesionales que trabajaban en una unidad de cuidado intermedio neonatal. Las entrevistas grabadas fueron transcritas realizándose el análisis temático. RESULTADOS: Se elaboraron cuatro núcleos temáticos: Cómo percibe el equipo el ruido en la unidad; Qué genera ruido en la unidad; Los efectos del ruido en los bebés, trabajadores, familiares y acompañantes; Cómo reducir el ruido en la unidad. CONCLUSIÓN: El equipo tiene conocimiento sobre el ruido en la unidad, apuntando posibilidades y limitaciones para su reducción.