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

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

Relationship between microcephaly and indicators of social inequality in the state of Paraíba, Brazil.

OBJECTIVE: • Seventy-four (33.18%) municipalities in the state of Paraíba registered live births with microcephaly. • The highest proportion of cases (23.03%) was concentrated in the capital, João Pessoa. • Number of inhabitants, number of cases of Zika virus, water supply, and average household income were associated with a higher proportion of new cases. To analyze the relationship between microcephaly and social inequality indicators in the state of Paraíba during the biennium January 2015 and December 2016. METHODS: Ecological study with data from newborn microcephaly records and municipal socioeconomic, environmental, and demographic indicators was conducted using two health information systems from the Brazilian Ministry of Health (SINASC and SINAN) and the Brazilian Institute of Geography and Statistics. A Poisson multiple regression model was applied with a significance level of 5%. RESULTS: Among 223 municipalities in Paraíba, 74 registered new cases of microcephaly. The number of Zika virus cases, number of inhabitants, number of households without adequate water supply, and household income were predictor variables of the number of new cases of microcephaly in Paraíba. CONCLUSION: Microcephaly is associated with indicators of social inequality in Paraíba. Zika virus cases, water supply, and family income are the indicators that best explain the increase in microcephaly cases. Therefore, these variables must be monitored by health professionals and authorities.

Effects of low-level laser photobiomodulation on the masticatory function and mandibular movements in adults with temporomandibular disorder: a systematic review with meta-analysis. / Fotobiomodulação com laser de baixa potência na função mastigatória e nos movimentos mandibulares em adultos com disfunção temporomandibular: revisão sistemática com metanálise.

PURPOSE: To review the effects of low-level laser photobiomodulation on masticatory function and mandibular movements in adults with temporomandibular disorder. RESEARCH STRATEGIES: Search in PubMed, Web of Science, Scopus, EMBASE, Cochrane, LILACS, ScienceDirect, and Google Scholar, using the following descriptors: "temporomandibular joint disorders", "low-level light therapy", "low-level laser therapy", "mastication", and "mandible". SELECTION CRITERIA: Randomized clinical trials in adults with temporomandibular disorder, using low-level laser and assessing the mastication and mandibular movements. DATA ANALYSIS: Firstly, the titles and abstracts of all retrieved studies were read. Then, only the studies selected in the first stage were read in full and assessed regarding eligibility. After the selection, the characteristics, methodological quality, and quality of evidence of the studies included in the review were analyzed. In the meta-analysis, the mean amplitude of mouth opening was considered as a measure of intervention effect. RESULTS: The 10 articles included in the review had quite different results one from the other, especially regarding the amplitude of mouth opening, while the mastication was assessed in only one of them. Most studies had a high risk of bias, demonstrating a low methodological quality. Significantly higher results for photobiomodulation were identified in the six studies included in the meta-analysis. CONCLUSION: Due to the scarcity in the literature, there is not enough evidence of the effects of low-level laser photobiomodulation on mastication. As for the mandibular movements, this intervention presented significant results, particularly in the amplitude of mouth opening.

OBJETIVO: Revisar os efeitos da Fotobiomodulação com Laser de Baixa Potência na função mastigatória e nos movimentos mandibulares, em adultos com Disfunção Temporomandibular. ESTRATÉGIA DE PESQUISA: Busca nas bases de dados PubMed, Web of Science, Scopus, Embase, Cochrane, Lilacs, Science Direct e Google Scholar, utilizando os descritores: "temporomandibular joint disorders", "low level light therapy", "low level laser therapy", "mastication" e "mandible". CRITÉRIOS DE SELEÇÃO: Ensaios clínicos randomizados envolvendo adultos com Disfunção Temporomandibular, que utilizaram laser de baixa potência e avaliaram a mastigação e os movimentos mandibulares. ANÁLISE DOS DADOS: Inicialmente realizou-se a leitura dos títulos e resumos de todos os estudos encontrados. Em seguida, apenas os estudos selecionados na primeira etapa foram lidos na íntegra e avaliados quanto à elegibilidade. Após a seleção, foram analisadas as características dos estudos incluídos, bem como a sua qualidade metodológica e da evidência. Na metanálise, a média da amplitude de abertura de boca foi considerada como medida de efeito da intervenção. RESULTADOS: Verificou-se que os dez artigos incluídos apresentaram resultados muito distintos entre si, principalmente com relação à amplitude de abertura de boca, sendo a mastigação avaliada em apenas um deles. A maioria dos estudos apresentou alto risco de viés, demonstrando uma baixa qualidade metodológica. Considerando os seis estudos incluídos na metanálise, foram identificados resultados significativamente superiores para a fotobiomodulação. CONCLUSÃO: Devido à escassez na literatura, não há evidências suficientes para os efeitos da fotobiomodulação com laser de baixa potência na mastigação. Já nos movimentos mandibulares, notou-se que essa intervenção apresentou resultados significativos, principalmente para o desfecho de amplitude de abertura de boca.

Predictive Factors of Listeners' Attitudes Related to Dysphonic Voices in Native Brazilian Portuguese.

OBJECTIVES: To verify whether there are differences in the judgments of listeners' attitudes as a function of the presence, severity, and type of vocal deviation, and to identify the predictive factors of listeners' attitudes toward dysphonic voices in Brazilian Portuguese speakers. METHODS: A sample of CAPE-V sentences was used from 44 subjects of both genders. The samples presented different severities of vocal deviation (general grade - GG) (healthy, mild, moderate, and severe) and different degrees of roughness (GR), breathiness (GB), and strain (GS), characterized by a perceptual-auditory judgment performed by speech therapists. The samples were presented to 152 listeners of both genders who performed the judgment of 12 attitudes inserted in a semantic differential scale previously validated for this study. Here, we used a Logistic Regression Model. RESULTS: There was no association between listener's gender and the judgment of attitudes. Subjects with vocal quality deviation were judged more negatively in relation to vocally healthy individuals. We observed that higher the GG, higher the negative judgment of listeners in relation to the speakers. Listeners judged breathy and strained voices as more negative. In the general model for female and male voices, the increase in GB and GG reduced the chance of a voice being evaluated positively by 16 and 20%, respectively. For female voices, GB and GS reduced the chance of a female voice being evaluated positively by 36 and 19%, respectively. GG reduces the chance of a male voice being evaluated positively by 46%, while GR increases the chance of a male voice being judged positively by 62 %. CONCLUSIONS: There is an association between the presence, severity, and type of vocal deviation and listeners' attitudes. We identified a predictive model of listeners' attitudes related to dysphonic voices among Brazilian Portuguese speakers. In general, GG and GB were predictors of negative attitudes toward listeners. GB and GS were predictors of negative attitudes toward female voices. The GG is a predictor of negative attitudes toward male voices, while the GR increases the chance of positive judgments.

Effects of photobiomodulation combined with orofacial myofunctional therapy on the quality of life of individuals with temporomandibular disorder. / Efeitos da fotobiomodulação associada a terapia miofuncional orofacial na qualidade de vida de indivíduos com disfunção temporomandibular.

PURPOSE: To analyze the impact of photobiomodulation combined with orofacial myofunctional therapy (OMT) on the oral health quality of life (OHQOL) of individuals with temporomandibular disorder, before and after the treatment. METHODS: Blind, controlled, randomized clinical trial with 34 volunteers randomly distributed into two groups: G1, who received OMT combined with photobiomodulation, and G2, treated with OMT combined with inactive laser. The subjects were first assessed with a visual analog scale (VAS) to classify them according to the degree of orofacial pain and with the Oral Health Impact Profile - Short Form (OHIP-14) regarding the impact on the OHQOL. The resulting data were statistically analyzed. The significance level was set at 0.05 (95%). RESULTS: "Physical pain", "psychological discomfort", "physical disability", and "psychological disability" were the aspects with the greatest impact on the OHQOL. The G1 subjects responded positively to their treatment, as well as G2 to theirs. There was a strong positive correlation between VAS and total OHIP-14 score in both groups after the treatment. However, the functional recovery in the control group individuals (G2) was the most perceived positive change in the OHQOL in comparison with the experimental group (G1). CONCLUSION: The people who received photobiomodulation combined with OMT perceived an improvement in the OHQOL, as well as those treated with placebo laser. There was a strong positive correlation in both groups in the improvement of the degree of pain and self-perception of the OHQOL.

OBJETIVO: Analisar o impacto na qualidade de vida relacionada à saúde oral de indivíduos com disfunção temporomandibular, antes e após o tratamento de fotobiomodulação associada a terapia miofuncional orofacial. MÉTODO: Estudo do tipo ensaio clínico randomizado, controlado e cego, com 34 voluntários distribuídos aleatoriamente em dois grupos: G1, que recebeu a Terapia Miofuncional Orofacial (TMO) associada a fotobiomodulação e o G2, tratado pela TMO associada ao laser inativo. Os indivíduos foram submetidos, primeiramente, à avaliação para serem classificados de acordo com o grau da dor orofacial pela Escala Visual Analógica (EVA) e também quanto ao impacto da qualidade de vida relacionada a saúde oral (QVRSO) pelo questionário Oral Health Impact Profile ­ Short form (OHIP-14). Os dados obtidos foram analisados estatisticamente. Foi adotado o nível de significância de 0,05 (95%). RESULTADOS: "Dor física", "desconforto psicológico", "limitação física" e "limitação psicológica" foram os aspectos mais impactantes na QVRSO. O G1 apresentou respostas positivas para o respectivo tratamento, assim como o G2. Observou-se correlação positiva e de grau forte para EVA e escore total do OHIP-14 em ambos os grupos após tratamento. Porém, os indivíduos do grupo controle (G2) evidenciaram que a recuperação funcional foi o aspecto que mais se percebeu de mudança positiva na QVRSO em comparação ao grupo experimental (G1). CONCLUSÃO: As pessoas que receberam fotobiomodulação associada a TMO-perceberam melhora da QVRSO, assim como as tratadas com o laser placebo. Houve correlação positiva e forte em ambos os grupos na melhora do grau da dor e autopercepção da QVRSO.

Coreferential processing in elderly with and without Alzheimer's disease. / Processamento correferencial em idosos com e sem doença de Alzheimer.

PURPOSE: To compare coreferential processing in elderly people with and without Alzheimer's disease in Brazilian Portuguese. METHODS: Twelve elderly people without Alzheimer's (EA) and six elderly people with Alzheimer's disease (EWA) participated in the study. The Mini-Mental State Examination was used for cognitive screening of participants. Two experiments were performed using the self-monitored reading technique to analyze coreference processing. Each contained eight experimental phrases and 24 distracting phrases, one of them using repeated pronouns and names and the other using hyponyms and hypernyms. After reading, questions were asked related to the content of the sentences. The main variable of interest was reading time, measured after the presentation of anaphoric resuming. RESULTS: In the first experiment, there were statistically significant results. The EA group processed the pronouns more quickly than repeated names. The volunteers of the EWA group were quicker in resuming repeated names. In the second experiment, the results show that the EA group showed preference for hypernyms in anaphoric resumption, whereas the EWA group did not present significant differences between conditions. CONCLUSION: Elderly people without pathology processed pronouns and hypernyms more quickly compared to retrievals with repeated names and hyponyms, respectively, due to the smaller amount of semantic traits necessary to identify the antecedents in those conditions, as well as syntactic and discursive prominence. Elderly people with AD read names more readily than pronouns. There was no difference in anaphoric processing involving hyponyms and hypernyms, which may result from impaired working memory.

OBJETIVO: Comparar o processamento correferencial, em idosos com e sem a Doença de Alzheimer, no Português Brasileiro. MÉTODO: Participaram 12 idosos sem Alzheimer (ISA), e 06 idosos com a Doença de Alzheimer (IDA). O Mini-Exame do Estado Mental foi utilizado para triagem cognitiva dos participantes. Dois experimentos foram realizados utilizando a técnica de leitura automonitorada para analisar o processamento da correferência, cada um contendo oito frases experimentais e 24 frases distratoras, um deles utilizou pronomes e nomes repetidos, já o outro utilizou hipônimos e hiperônimos. Após a leitura, foram realizadas perguntas relacionadas ao conteúdo das frases. A principal variável de interesse foi o tempo de leitura aferido após a apresentação das retomadas anafóricas. RESULTADOS: No primeiro experimento, foram encontrados resultados estatisticamente significantes, no grupo ISA os pronomes foram processados mais rapidamente do que nomes repetidos, e no grupo IDA, os voluntários foram mais rápidos na retomada do nome repetido. No segundo experimento, os resultados demonstraram que o grupo ISA apresentou preferência, na retomada anafórica, pelos hiperônimos, já o grupo IDA não apresentou diferenças significativas entre as condições. CONCLUSÃO: Os idosos sem patologia processaram mais rapidamente pronomes e hiperônimos, quando comparados a retomadas com nomes repetidos e hipônimos, respectivamente, pela menor quantidade de traços semânticos necessários para identificar os antecedentes naquelas condições, assim como pela proeminência sintática e discursiva. Nos idosos com DA, os nomes foram lidos mais prontamente que pronomes, e não houve diferença no processamento anafórico envolvendo hipônimos e hiperônimos, podendo decorrer do comprometimento na memória de trabalho.

Effects of photobiomodulation associated with orofacial myofactional therapy on temporomandibular joint dysfunction. / Efeitos da fotobiomodulação associada à terapia miofuncional orofacial na disfunção temporomandibular muscular.

PURPOSE: To investigate the influence of photobiomodulation associated with orofacial myofunctional therapy (OMT) in patients with temporomandibular muscle disorders (TMD). METHODS: Randomized, blinded trial clinical study with a sample of eleven women with muscle TMD divided into two groups. The experimental group (EG) consisted of five women submitted to orofacial myofunctional therapy associated with photobiomodulation, and the control group (CG) consisted of six women submitted to orofacial myofunctional therapy associated with inactive photobiomodulation (placebo). The intervention was performed in the following twelve sessions: one evaluation, ten speech therapy sessions associated with photobiomodulation, and one reevaluation. For outcomes, investigation on pain perception using the visual analogue scale (VAS), investigation of palpation sensitivity with the research diagnostic criteria for temporomandibular disorders (RDC/TMD), and quality of life (QOL) verification through oral health impact profile - short form (OHIP-14) were considered. RESULTS: The EG increased measurements of mandibular movements of opening and protrusion and improved in the evaluation of QOL. CONCLUSION: Orofacial myofunctional therapy, when associated with photobiomodulation, contributed to increase the range of mandibular movements, with important improvements in the perception of quality of life and with significant improvement in the painful conditions of volunteers with TMD.

OBJETIVO: Investigar a influência da fotobiomodulação associada à terapia miofuncional orofacial (TMO) em pacientes com disfunção temporomandibular muscular (DTM). MÉTODO: Trata-se de uma pesquisa do tipo ensaio-clínico randomizado e cego, com uma amostra de 11 mulheres com DTM muscular, dividida em dois grupos. O Grupo Experimental (GE) composto por 05 voluntárias submetidas à TMO associada à fotobiomodulação, e o Grupo Controle Positivo (GC) composto por 06 mulheres submetidas à TMO associada à fotobimodulação inativa (placebo). A intervenção foi realizada em 12 sessões: uma avaliação, 10 sessões de fonoterapia associada à fotobiomodulação, e uma reavaliação. Para os desfechos foram consideradas a investigação da percepção de dor, com a Escala Visual Analógica (EVA), a investigação da sensibilidade à palpação com o protocolo Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), e a verificação da qualidade de vida (QV) por meio do protocolo Oral Health Impact Profle ­ short form (OHIP-14). RESULTADOS: o GE teve aumento nas medidas dos movimentos de abertura e de protrusão mandibular, e evidenciou melhora na avaliação da QV. CONCLUSÃO: A TMO quando associada à fotobiomodulação contribuiu no aumento da amplitude dos movimentos mandibulares e com ganhos importantes na percepção da qualidade de vida, e com melhora significativa nos quadros dolorosos das voluntárias com DTM.

Intervention plan in vocabulary, working memory, and syntactic awareness for adolescents and young adults with trisomy 21: Content development and validation / Plano de intervenção em vocabulário, memória de trabalho e consciência sintática para adolescentes e jovens adultos com trissomia do 21: desenvolvimento e validação do conteúdo

ABSTRACT Purpose: to develop and validate the content of an intervention plan for adolescents and young adults with Trisomy 21, focusing on vocabulary, working memory, and syntactic awareness. Methods: a methodological study with validation stages for the proposed intervention, which was assessed by ten judges. The content validity index was used to evaluate the content, quantitatively. Results: most judges had a doctoral degree. All propositions reached the minimum score. The oral language intervention plan focusing on vocabulary, working memory, and syntactic awareness was designed for adolescents and young adults aged 13 to 25 years and 11 months. The proposal included fifteen 40-minute weekly sessions. Conclusion: the study presented the process of developing and validating the Oral Language Therapy Plan, focusing on vocabulary, working memory, and syntactic awareness for people presented with trisomy 21, with the judges' agreement.

RESUMO Objetivo: elaborar e validar o conteúdo de um plano de intervenção para adolescentes e jovens adultos com Trissomia do 21 focado em vocabulário, memória de trabalho e consciência sintática. Métodos: estudo metodológico, com etapas de validação de proposta de intervenção. Foi realizada avaliação com um grupo de dez juízes. Para avaliação do conteúdo de forma quantitativa, foi utilizado o Índice de Validade de Conteúdo. Resultados: a maior parte dos juízes apresenta doutorado. Em todas as proposições, o escore mínimo foi atingido. O plano de intervenção em linguagem oral com foco em vocabulário, memória de trabalho e consciência sintática foi elaborado para adolescentes e jovens adultos entre 13 e 25 anos e 11 meses. A proposta contempla 15 sessões de 40 minutos, semanalmente. Conclusão: foi possível apresentar o processo de desenvolvimento e validação do Plano Terapêutico em Linguagem Oral com foco em Vocabulário, Memória de Trabalho e Consciência Sintática para pessoas com Trissomia do 21 com a concordância dos juízes.

Characterization of linguistic development of children affected by congenital Zika virus syndrome as compared to typically developing peers / Caracterização do desenvolvimento infantil e linguístico de crianças acometidas da Síndrome Congênita do Zika Vírus comparadas com crianças de desenvolvimento típico

ABSTRACT Purpose: to describe the development, focusing on language, of children affected by congenital Zika syndrome and compare it with that of typically developing children. Methods: a quantitative, observational, cross-sectional, case-control study. Data from the group of children with congenital Zika virus syndrome (case) were matched for sex and age with data from the group of typically developing children without comorbidities (control). The research included 20 parents/guardians of the children in the case group and 20 parents/guardians of the children in the control group, using interview as an adapted instrument. The data underwent descriptive and inferential statistical analysis, through association tests and comparison of means, with the significance level set at 5%. Results: there was a statistical difference in motor, auditory, and language development between the groups, according to the parents' perception. Conclusion: Based on the caregivers' reports, most of the case group communicated non-verbally through babbling, shouting, and eye contact, whereas the minority communicated through dialogue, understood simple orders, and performed imitative behaviors, symbolic play, and shared attention. On the other hand, the control group communicated through complex sentences constructed into narratives.

RESUMO Objetivo: descrever o desenvolvimento infantil, com enfoque na linguagem, de crianças acometidas da síndrome congênita do Zika e compará-lo com o de crianças com desenvolvimento típico. Métodos: trata-se de um estudo observacional, transversal, do tipo caso-controle, e de natureza quantitativa. Os dados do grupo de crianças com Síndrome Congênita do Zika vírus (caso) foram pareados por sexo e idade com os dados do grupo de crianças sem comorbidades e desenvolvimento típico (controle). Participaram da pesquisa, 20 responsáveis pelas crianças do grupo caso e 20 pelas crianças do grupo controle e o instrumento utilizado foi uma entrevista adaptada. Os dados foram examinados por meio de uma análise estatística descritiva e inferencial por meio de testes de associação e de comparação de médias, com nível de significância de 5%. Resultados: foi observada diferença estatística entre os grupos estudados, referente ao desenvolvimento infantil, no âmbito motor, auditivo e de linguagem, com base na percepção dos pais. Conclusão: diante das informações dos cuidadores, a comunicação da maioria do grupo caso ocorre de forma não verbal por meio de gorjeios, gritos e contato visual; e a minoria comunica-se por diálogo, compreende ordens simples, realiza condutas imitativas, brincar simbólico e tem atenção compartilhada. Diferentemente, o grupo controle comunica-se por meio de frases complexas presentes em narrativas.

Contributions of speech-language therapy to the integration of individuals with Down syndrome in the workplace. / Contribuições da Fonoaudiologia na inserção de pessoas com síndrome de Down no mercado de trabalho.

PURPOSE: To analyze the contributions of speech-language therapy in the integration of young individuals with Down syndrome (DS) into the workplace, with reference to their professionalization. METHODS: A questionnaire was distributed to eight undergraduate students (tutors) who participated in a project with individuals with DS, five mothers of individuals with DS, and five employees from the institution in which the present study was conducted. The questionnaire assessed the communication, memory, behavior, social interaction, autonomy and independence of the participants with DS, called "trainees". The trainees were employed in one of five routine work sectors at the university that conducted the present study. The data collected in this descriptive and cross-sectional study were analyzed quantitatively and qualitatively. The Research Ethics Committee of the affiliated institute approved the project. RESULTS: Mothers and tutors rated the trainees' language skills as "good". However, their ratings differed from those of the participating employees. After the trainees with DS were placed in a work environment, significant changes were observed in their communication and autonomy. There was no improvement in the trainees' independence, but after training noticeable changes were observed in their social behavior and autonomy. CONCLUSION: Speech-language therapy during vocational training led to positive changes in the social behavior of individuals with DS, as evidenced by an increase in their autonomy and communication.

OBJETIVO: Analisar as contribuições da Fonoaudiologia no processo de inserção no ambiente laboral de jovens com síndrome de Down (SD), tendo em vista sua profissionalização. MÉTODO: Foi aplicado um questionário em oito alunos de graduação, que fazem parte de um projeto de extensão com pessoas com síndrome de Down, cinco mães das pessoas com SD e quatro funcionários da instituição onde são realizados os estágios. As temáticas exploradas nas questões envolviam aspectos da comunicação, comportamento, interação social, autonomia e independência dos estagiários com síndrome de Down. Os jovens participantes do projeto com SD, denominados estagiários, passaram a fazer parte da rotina de trabalho de cinco setores da universidade em que se realizou a pesquisa. O estudo se caracteriza como descritivo e transversal e os dados foram analisados quanti e qualitativamente, e foi aprovada pelo comitê de ética em pesquisa da instituição de origem. RESULTADOS: Segundo os dados pesquisados as habilidades de linguagem das pessoas com SD foram consideradas boas, no entanto as mesmas não estavam efetivas para o mercado de trabalho. Após a inserção em um ambiente de trabalho, foi visto que houve mudanças significativas tanto na comunicação como na autonomia dos sujeitos do estudo. Os mesmos, não são independentes, mas após o estágio também foram perceptíveis mudanças no comportamento social, bem como na sua autonomia. CONCLUSÃO: Houve mudanças no comportamento social, maior uso da autonomia e ganhos na comunicação, contribuindo no empoderamento dos jovens com síndrome de Down.

Performance of the phonatory deviation diagram in the evaluation of rough and breathy synthesized voices.

INTRODUCTION: Voice disorders alter the sound signal in several ways, combining several types of vocal emission disturbances and noise. The phonatory deviation diagram is a two-dimensional chart that allows the evaluation of the vocal signal based on the combination of periodicity (jitter, shimmer, and correlation coefficient) and noise (Glottal to Noise Excitation) measurements. The use of synthesized signals, where one has a greater control and knowledge of the production conditions, may allow a better understanding of the physiological and acoustic mechanisms underlying the vocal emission and its main perceptual-auditory correlates regarding the intensity of the deviation and types of vocal quality. OBJECTIVE: To analyze the performance of the phonatory deviation diagram in the discrimination of the presence and degree of roughness and breathiness in synthesized voices. METHODS: 871 synthesized vocal signals were used corresponding to the vowel /ɛ/. The perceptual-auditory analysis of the degree of roughness and breathiness of the synthesized signals was performed using visual analogue scale. Subsequently, the signals were categorized regarding the presence/absence of these parameters based on the visual analogue scale cutoff values. Acoustic analysis was performed by assessing the distribution of vocal signals according to the phonatory deviation diagram area, quadrant, shape, and density. The equality of proportions and the chi-square tests were performed to compare the variables. RESULTS: Rough and breathy vocal signals were located predominantly outside the normal range and in the lower right quadrant of the phonatory deviation diagram. Voices with higher degrees of roughness and breathiness were located outside the area of normality in the lower right quadrant and had concentrated density. CONCLUSION: The normality area and the phonatory deviation diagram quadrant can discriminate healthy voices from rough and breathy ones. Voices with higher degrees of roughness and breathiness are proportionally located outside the area of normality, in the lower right quadrant and with concentrated density.

Feeding development of children with microcephaly: a descriptive study / Desenvolvimento alimentar de crianças com microcefalia: estudo descritivo

ABSTRACT Purpose: to describe feeding characteristics of children with microcephaly, encompassing the feeding route, food consistencies, and utensils used to feed them. Methods: a descriptive study approved by the Research Ethics Committee, including 34 caregivers of children diagnosed with microcephaly. They answered a structured interview on the children's feeding route, breastfeeding, utensils used to feed them, and the food consistencies, besides sociodemographic and overall development data. Descriptive statistical analyses were performed, presenting absolute and percentage frequencies and measures of central tendency and dispersion. Results: the 34 caregivers in the sample were responsible for 34 children born between 2015 and 2018, diagnosed with microcephaly, due to various causes. Of these, 33 (97.02%) were on oral feeding in their first year of life - 26 (76.44%) on breastfeeding, nine of which (26.46%) exclusively so until 6 months old. The children were served food in baby bottles, cups, spoons, and syringes. Pureed food was the consistency most accepted by the children. Conclusions: there was a low prevalence of exclusive breastfeeding until they were 6 months old, delayed progress of consistencies, use of utensils inadequate to their age, and necessary adaptations to feed children, orally.

RESUMO Objetivo: descrever características relacionadas à alimentação de crianças com microcefalia, considerando via de alimentação, consistência e utensílios utilizados. Métodos: estudo descritivo, aprovado pelo Comitê de Ética em Pesquisa. Participaram 34 cuidadores de crianças com diagnóstico de microcefalia. Foi realizada entrevista estruturada com os cuidadores quanto à via de alimentação, amamentação, utensílios para oferta e consistência do alimento, além de aspectos sociodemográficos e de desenvolvimento global. Foi realizada análise estatística descritiva, apresentada por meio de frequências absoluta e percentual, e medidas de posição e dispersão. Resultados: os 34 cuidadores que compuseram a amostra eram responsáveis por 34 crianças nascidas entre os anos de 2015 e 2018 com diagnóstico de microcefalia de causas diversas. Dessas, 33 (97,02%) alimentaram-se por via oral durante o primeiro ano de vida, sendo que 26 (76,44%) foram amamentadas, nove delas (26,46%) de forma exclusiva até o sexto mês. Para oferta do alimento foram utilizados mamadeira, copo, colher e seringa. A consistência alimentar mais aceita pelas crianças foi a pastosa. Conclusões: observa-se baixa prevalência de aleitamento materno exclusivo até o sexto mês, atraso na progressão de consistências, uso de utensílios inadequados para a idade e necessidade de adaptações para as crianças que se mantiveram em alimentação por via oral.

Speech-language-hearing therapists' perception of orofacial myofunctional changes in subjects with congenital Zika syndrome / Percepção dos fonoaudiólogos sobre alterações miofuncionais orofaciais em sujeitos com Síndrome Congênita pelo Zika Vírus

ABSTRACT Purpose: to investigate the profile of speech-language-hearing therapists from Northeastern Brazil assisting children presented with congenital Zika syndrome and their perception of these children's orofacial myofunctional aspects and speech-language-hearing intervention procedures. Methods: a cross-sectional observational study with quantitative/qualitative analysis. The data collection instrument was an online questionnaire with 34 items on the speech-language-hearing therapists' sociodemographic information and perception of the study topic. The sample comprised 23 speech-language-hearing therapists from the nine Northeastern states. Results: altogether, 96% of the sample were females. Most professionals had more than 3 years of experience with congenital Zika syndrome. Concerning stomatognathic system characterization, the professionals described a greater degree of change in aspects of orofacial muscle posture and mobility. Regarding oral functions, they perceived greater changes in speech and swallowing liquids and solid foods. There was a greater degree of change in masticating solids than in swallowing liquids. Conclusion: most speech-language-hearing therapists in the research had a specialization degree, especially in dysphagia and oral-motor control. Most of them had more than 3 years of experience following up with children with congenital Zika syndrome, which indicates a satisfactory time working with this population to help identify orofacial myofunctional changes in them. The professionals stated that orofacial muscle posture and mobility, speech, and swallowing liquids and solid foods were the most changed aspects.

RESUMO Objetivo: investigar o perfil e a percepção de fonoaudiólogos do Nordeste do Brasil, que atuam com crianças com Síndrome Congênita pelo Zika vírus, quanto aos aspectos miofuncionais orofaciais e aos procedimentos de intervenção fonoaudiológica. Métodos: trata-se de estudo transversal, observacional, com análise quanti-qualitativa. O instrumento de coleta de dados tratou-se de um questionárioon-line, que continha 34 questões abrangendo: dados sociodemográficos e questões voltadas para a percepção de fonoaudiólogos no que se refere ao assunto estudado. A amostra foi composta por 23 fonoaudiólogos dos nove estados do Nordeste. Resultados: da amostra, 96% foram mulheres. A maioria dos profissionais apresentava mais de 3 anos de experiência com a Síndrome Congênita pelo Zika Vírus. Na caracterização do sistema estomatognático, os profissionais descreveram maior grau de alteração nos aspectos de postura e mobilidade da musculatura orofacial. Em relação às funções, observou-se maior percepção de alteração na fala e deglutição para líquido e sólido. Conclusão: a maioria dos fonoaudiólogos da pesquisa possuem especialização, com destaque nas áreas de Disfagia e Motricidade Orofacial. Os profissionais afirmaram que a postura e mobilidade da musculatura orofacial são os aspectos mais alterados, assim como as funções de fala e deglutição de sólido e líquido.

Relationship between microcephaly and indicators of social inequality in the state of Paraíba, Brazil

ABSTRACT Objective To analyze the relationship between microcephaly and social inequality indicators in the state of Paraíba during the biennium January 2015 and December 2016. Methods Ecological study with data from newborn microcephaly records and municipal socioeconomic, environmental, and demographic indicators was conducted using two health information systems from the Brazilian Ministry of Health (SINASC and SINAN) and the Brazilian Institute of Geography and Statistics. A Poisson multiple regression model was applied with a significance level of 5%. Results Among 223 municipalities in Paraíba, 74 registered new cases of microcephaly. The number of Zika virus cases, number of inhabitants, number of households without adequate water supply, and household income were predictor variables of the number of new cases of microcephaly in Paraíba. Conclusion Microcephaly is associated with indicators of social inequality in Paraíba. Zika virus cases, water supply, and family income are the indicators that best explain the increase in microcephaly cases. Therefore, these variables must be monitored by health professionals and authorities.

Effects of electrostimulation associated with masticatory training in individuals with down syndrome. / Efeitos da eletroestimulação associada ao treino mastigatório em pessoas com síndrome de down.

Purpose Investigate and measure the effects of electrostimulation on the orofacial musculature and on the chewing, breathing and swallowing functions of individuals with Down syndrome. Methods Study participants were 16 individuals with Down syndrome (six males and 10 females) from an institutional extension project aged nine to 25 years. Speech-language pathology assessment was performed using the protocol of Orofacial Myofunctional Evaluation with Scores (OMES) pre- and post-intervention. This protocol comprised eight weekly electrostimulation sessions. Functional Electrical Stimulation (FES) current was used at a frequency of 10Hz in warm-up and 30Hz in application, intermittent stimulation (cycling pulses) with ON-time of 5s and OFF-time of 10s common to both stages, and pulse width of 200µs in warm-up and 250µs in application. Results Significant differences were observed between pre- and post-application of FES regarding cheek appearance (flaccidity and arching), tongue mobility (right and left laterality), and musculature behavior during performance of functions of the stomatognathic system: respiration, deglutition (lip behavior), and mastication (bite and trituration). Conclusion Effects of electrostimulation associated with masticatory training of the masseter muscles were statistically identified, with functional gains in chewing, breathing and swallowing performance in individuals with Down syndrome.

Fotobiomodulação com laser de baixa potência na função mastigatória e nos movimentos mandibulares em adultos com disfunção temporomandibular: revisão sistemática com metanálise / Effects of low-level laser photobiomodulation on the masticatory function and mandibular movements in adults with temporomandibular disorder: a systematic review with meta-analysis

RESUMO Objetivo Revisar os efeitos da Fotobiomodulação com Laser de Baixa Potência na função mastigatória e nos movimentos mandibulares, em adultos com Disfunção Temporomandibular. Estratégia de pesquisa Busca nas bases de dados PubMed, Web of Science, Scopus, Embase, Cochrane, Lilacs, Science Direct e Google Scholar, utilizando os descritores: "temporomandibular joint disorders", "low level light therapy", "low level laser therapy", "mastication" e "mandible". Critérios de seleção Ensaios clínicos randomizados envolvendo adultos com Disfunção Temporomandibular, que utilizaram laser de baixa potência e avaliaram a mastigação e os movimentos mandibulares. Análise dos dados Inicialmente realizou-se a leitura dos títulos e resumos de todos os estudos encontrados. Em seguida, apenas os estudos selecionados na primeira etapa foram lidos na íntegra e avaliados quanto à elegibilidade. Após a seleção, foram analisadas as características dos estudos incluídos, bem como a sua qualidade metodológica e da evidência. Na metanálise, a média da amplitude de abertura de boca foi considerada como medida de efeito da intervenção. Resultados Verificou-se que os dez artigos incluídos apresentaram resultados muito distintos entre si, principalmente com relação à amplitude de abertura de boca, sendo a mastigação avaliada em apenas um deles. A maioria dos estudos apresentou alto risco de viés, demonstrando uma baixa qualidade metodológica. Considerando os seis estudos incluídos na metanálise, foram identificados resultados significativamente superiores para a fotobiomodulação. Conclusão Devido à escassez na literatura, não há evidências suficientes para os efeitos da fotobiomodulação com laser de baixa potência na mastigação. Já nos movimentos mandibulares, notou-se que essa intervenção apresentou resultados significativos, principalmente para o desfecho de amplitude de abertura de boca.

ABSTRACT Purpose To review the effects of low-level laser photobiomodulation on masticatory function and mandibular movements in adults with temporomandibular disorder. Research strategies Search in PubMed, Web of Science, Scopus, EMBASE, Cochrane, LILACS, ScienceDirect, and Google Scholar, using the following descriptors: "temporomandibular joint disorders", "low-level light therapy", "low-level laser therapy", "mastication", and "mandible". Selection criteria Randomized clinical trials in adults with temporomandibular disorder, using low-level laser and assessing the mastication and mandibular movements. Data analysis Firstly, the titles and abstracts of all retrieved studies were read. Then, only the studies selected in the first stage were read in full and assessed regarding eligibility. After the selection, the characteristics, methodological quality, and quality of evidence of the studies included in the review were analyzed. In the meta-analysis, the mean amplitude of mouth opening was considered as a measure of intervention effect. Results The 10 articles included in the review had quite different results one from the other, especially regarding the amplitude of mouth opening, while the mastication was assessed in only one of them. Most studies had a high risk of bias, demonstrating a low methodological quality. Significantly higher results for photobiomodulation were identified in the six studies included in the meta-analysis. Conclusion Due to the scarcity in the literature, there is not enough evidence of the effects of low-level laser photobiomodulation on mastication. As for the mandibular movements, this intervention presented significant results, particularly in the amplitude of mouth opening.

Effectiveness of nonsurgical treatments for trigeminal neuralgia: an overview protocol / A efetividade dos tratamentos não cirúrgicos na neuralgia do trigêmeo: um protocolo de overview

ABSTRACT Purpose: to present an overview protocol for systematic reviews to synthesize and describe available evidence on the effectiveness of nonsurgical treatments for trigeminal neuralgia. Methods: the protocol follows the method proposed by PRISMA-P guidelines for protocol reports. The search will be made in MEDLINE, EMBASE, LILACS, Cochrane, Web of Science, Scopus, SpeechBITE, PeDRO, and the grey literature (Google Scholar and ProQuest Dissertations and Theses), with no restriction on language or time of publication. A search strategy developed for MEDLINE will be adapted for each database. Two independent reviewers will screen the articles by title and abstract. Then, they will read the full texts of included articles, following the eligibility criteria. In case of disagreements, a third reviewer will come to a consensus. The data will be extracted with a standardized form. Information on the risk of bias and GRADE assessment will be recorded. AMSTAR-2 will assess the overall result reliability of the systematic reviews. Results will be presented in a flowchart, tables, and a narrative description. Final Considerations: once carried out, this protocol will describe the current body of research on the topic and identify existing gaps on the basis of evidence.

RESUMO Objetivo: apresentar um protocolo de Overview das revisões sistemáticas (RSs) para sintetizar e descrever evidências disponíveis sobre a efetividade dos tratamentos não cirúrgicos na neuralgia do trigêmeo. Métodos: o protocolo seguirá o método proposto pelas diretrizes do PRISMA-P para relato de protocolos. A busca será realizada nas bases de dados eletrônicas: MEDLINE, EMBASE, Lilacs, COCHRANE, Web of Science, Scopus, SpeechBITE, PeDRO, além de consulta à literatura cinzenta (Google Scholar e ProQuest Dissertations and Theses), sem restrições de idioma ou período de publicação. Uma estratégia de busca foi desenvolvida para MEDLINE e será adaptada para cada base de dados. O rastreio dos artigos pelo título e resumo será realizado por dois revisores independentes. Em seguida, farão leitura dos textos completos dos artigos incluídos, conforme os critérios de elegibilidade. Em discordância, um terceiro revisor fará o consenso. Os dados serão extraídos por meio de um formulário padronizado. Serão registradas informações de risco de viés e avaliação do GRADE. A ferramenta AMSTAR II avaliará a confiança geral dos resultados das RSs. Os resultados serão apresentados em um fluxograma, tabelas e descrição narrativa. Considerações Finais: a execução deste protocolo descreverá o corpo atual de pesquisa sobre o tema e identificará lacunas existentes na base de evidências.

Nocebo effect in health communication: how to minimize it? / Efeito nocebo na comunicação em saúde: como minimizá-lo?

ABSTRACT Purpose: to describe the strategies used to minimize the nocebo effect in health communication. Methods: an integrative review of the literature. The keywords "nocebo effect" and "health communication" and their combinations were used in English, Portuguese, and Spanish to search publications from 2011 to 2021 in MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library, EMBASE, and Web of Science/ISI. The following research question was used: "Which strategies have been used to minimize the nocebo effect in health communication?". Literature Review: altogether, 77 articles were found, although only six met the inclusion criteria and comprised the review sample. Their year of publication ranged from 2015 to 2021. Positive framing, assertive communication, and contextual factors were the strategies used to minimize the nocebo effect. Conclusion: the strategies used to minimize the nocebo effect were contextual factors, motivational talk, positive framing, assertive communication, and empathetic communication. These communication techniques are seemingly effective, though still little known by health professionals. This knowledge is important as it helps develop communicative skills aiming at humanized patient care.

RESUMO Objetivo: descrever as estratégias para minimizar o efeito nocebo na comunicação em saúde. Métodos: trata-se de uma revisão integrativa da literatura. Os descritores utilizados foram: "Efeito nocebo" e "comunicação em saúde", em inglês, português e espanhol e suas combinações, no período de 2011 a 2021, nas bases de dados da Medline, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cochrane Library, Embase e Web of Science/ISI. A pergunta de investigação para esse estudo foi: Quais as estratégias utilizadas para minimizar o efeito nocebo na comunicação em saúde? Revisão da Literatura: foram encontrados 77 artigos. Apenas seis preencheram os critérios de inclusão e compuseram a amostra da revisão. Os anos de publicação dos artigos variaram entre 2015 e 2021. As estratégias definidas para minimizar o efeito nocebo foram: enquadramento positivo, comunicação assertiva e utilização de fatores contextuais. Conclusão: as estratégias encontradas para minimizar o efeito nocebo foram fatores contextuais, conversa motivacional, enquadramento positivo, comunicação assertiva e comunicação empática. Essas técnicas de comunicação parecem ser efetivas, mas ainda são pouco conhecidas pelos profissionais em saúde. Esse conhecimento se faz importante, pois auxilia no desenvolvimento de habilidades comunicativas que visam à humanização do cuidado ao paciente.

Prevalence of kinesiophobia and catastrophizing in patients with temporomandibular disorders / Prevalência de cinesiofobia e catastrofização em pacientes com disfunção temporomandibular

ABSTRACT Purpose: to identify the frequency and levels of kinesiophobia and catastrophizing in patients with temporomandibular disorders who had been submitted to speech-language-hearing therapy. Methods: the sample comprised patients with myogenous (predominantly) and mixed temporomandibular disorders in the study group and healthy individuals in the control group. The instruments used were the Diagnostic Criteria for Temporomandibular Disorders, Tampa Scale for Kinesiophobia, and Pain Catastrophizing Scale. Statistical analyses were performed with the Mann-Whitney test (to compare the means on each scale between the groups) and the Spearman's correlation coefficient test (to analyze the correlation between the scales in each group and its significance). Results: the study group had a higher pain catastrophizing index than the control group. Likewise, the study group had greater kinesiophobia positive indices, whereas the control group had lower ones. A moderate positive correlation was also identified between kinesiophobia and catastrophizing in the study group. Conclusion: patients presented with temporomandibular disorders have higher levels of kinesiophobia and catastrophizing than subjects not diagnosed with the disorder.

RESUMO Objetivo: identificar a frequência e os níveis de cinesiofobia e catastrofização em pacientes com Disfunção Temporomandibular que realizaram terapia fonoaudiológica. Métodos: a amostra compreendeu pacientes com Disfunção Temporomandibular muscular e mista com predominância muscular, grupo de estudo e adultos saudáveis, o grupo controle. Os instrumentos utilizados foram: Diagnostic Criteria for Temporomandibular Disorders, Escala Tampa para Cinesiofobia e Escala de Catastrofização da Dor. A análise estatística foi composta do Teste de Mann-Whitney para comparar as médias entre os grupos de cada escala e o teste de Coeficiente de Correlação de Spearman para analisar a correlação entre as escalas em cada grupo e sua significância. Resultados: foi identificado um alto índice de catastrofização da dor no grupo de estudo em comparação ao grupo controle. Quanto à cinesiofobia, houve maior índice positivo para essa variável no grupo de estudo e menor para o grupo controle. Além disso, identificou-se correlação moderada e positiva entre a cinesiofobia e catastrofização no grupo de estudo. Conclusão: Pacientes com Disfunção Temporomandibular possuem níveis de cinesiofobia e catastrofização mais altos que pacientes que não foram diagnosticados com o distúrbio.