Daniela Regina Molini-Avejonas

Fonoaudiologia e Núcleos de Apoio à Saúde da Família: conceitos e referências

ABSTRACT In order to provide subsidies to the analysis of the speech-language and hearing pathologist work in Primary Care, specifically in the Nucleus of Support for Family Health (NASF), this study conducted a literature review on the subject using the search tools of Medline, SciELO and LILACS, through the simultaneous advanced database search of the Virtual Health Library – Bireme. The study briefly recovered the history of Speech-Language and Hearing Pathology on the Brazilian’s national health system (Unified Health System – SUS), and emphasized the importance of the Family Health Strategy related to Speech-Language and Hearing Pathology services in the NASFs. The literature review indicates that the performance of Speech-Language and Hearing Pathology within the health system is quite extensive, spanning different levels of assistance, which requires the development of different technologies of health work. Actions developed by NASFs necessarily require the performance of interdisciplinary teams, involved in interdisciplinary work processes and in the creation/invention of therapeutic strategies. The analysis of Speech-Language and Hearing Pathology’s experiences in Primary Health Care, in Family Health Care and, more recently, in NASFs, deserves to be closely monitored and evaluated, so the production and systematization of health care practices can advance to attend the population needs, and can be able to face the serious effects of language, voice, oral motor and hearing disorders. Thus, it is necessary to monitor and to systematize the limits and potentials of this model, aiming its improvement and ownership as a strategy for the integration of Speech-Language and Hearing Pathology in the SUS.

A systematic review of the use of telehealth in speech, language and hearing sciences

Introduction We conducted a systematic literature review to investigate the domain of speech-language and hearing sciences (SLHS) in telehealth. Methods The databases used for the literature search were Web of Knowledge, Pubmed, Scopus, Embase and Scielo. The inclusion criteria consisted of papers published up to August 2014. Papers without peer-review evaluation, and those without abstracts or available full texts were excluded. Results A total of 103 papers were selected. The selected studies have focused primarily on hearing (32.1%), followed by speech (19.4%), language (16.5%), voice (8.7%), swallowing (5.8%), multiple areas (13.6%) and others (3.9%). The majority of the studies focused on assessment (36.9%) or intervention (36.9%). The use of telehealth in SLHS has been increasing in many countries, especially in the last 5 years. The country with the largest number of published studies was the United States of America (32.03%), followed by Australia (29.12%). The remaining studies were distributed in lower numbers among other countries. Discussion The advancement of information and communication technologies provides more favourable conditions for providing distance care in several areas. Most of studies concluded that the telehealth procedure had advantages over the non-telehealth alternative approach (85.5%); however, 13.6% reported that it was unclear whether the telehealth procedure had advantages. Some barriers still need to be overcome, such as technology, training, regulation, acceptance and recognition of the benefits of this practice by the public and professionals. The need for speech-language pathologists and audiologists to adapt to this new health care modality is evident.

Orientação a mães de crianças do espectro autístico a respeito da comunicação e linguagem

Purpose: To verify the results obtained by ten sessions of specific instruction about language and communi cation to mothers of children of the autistic spectrum. Methods: Subjects were 26 mother-child dyads. The children attended language therapy in a specialized service. Five pre-planned instruction sessions and five accompanying sessions to small groups of mothers parallel to the children’s language therapy were conducted. Results: The focus directed to the child’s communication allowed the identification of essential elements to the determination of successful interactive situation as joint attention, latency to answers and child’s individual interests. The individualized analysis has shown that all subjects presented progress at least in one of the assessed areas. Conclusion: There was a positive impact of the systematic orientations to mothers about language and communication, conducted at the same time as language therapy (and not alternatively). The formal planning and recording were flexible enough to allow adjustments to group specific needs and demands.

Fatores intervenientes na terapia fonoaudiológica de crianças autistas

Recent studies state that the incidence of autism spectrum disorders is 1% of the infantile population. It implies the need of urgent identification of efficient intervention proposals as well as of the factors that may intervene in these processes. The aim of this study is to describe three years of language therapy processes of three children diagnosed within the autism spectrum with different developmental characteristics and different responses to the therapeutic process. All the children were attending a specialized ambulatory program once a week. The language therapists were post-graduate students in the field and the therapeutic intervention started approximately six months prior to the beginning of the study. The children presented evidence of the diversity of the autism phenotype. Although it was not the purpose of this study, the reference to the three different features of the autism spectrum is clear. This way, the intervention processes received subtle adjustments to each childs specific needs and possibilities. All children had significant progress in their manifestations. The longitudinal individual analysis of therapeutic intervention processes allows the identification of associate process that might be determinant to the results and that demand consistent approaches.

Speech-Language Intervention for Children with Autism Spectrum Disorder in Brazil.

Brazil has more than 200 million inhabitants living in an area of more than 8.5 million km2 (Ministério da Saúde, Brasil, 2013a,b). Granting access to health and educational services for populations in such different environments clearly demands different actions and resources. Official policies regarding rehabilitation services and education to children and adolescents with autism spectrum disorders (ASDs) are being gradually defined and implemented. This article aims to present an overview of the Brazilian health system that considers health as a universal right and a states duty. Some of the strategies created to provide services to persons with different needs living in different environments are outlined. Specifically in what refers to persons with ASD, there are laws, bills of rights, and guidelines, but their implementation is gradual and uneven. More developed regions provide more comprehensive support to these persons and their families, but some initiatives of outreach are being implemented. Speech–language pathology services are integrated to the health system and present their own challenges. Undergraduate programs for speech–language pathology include ASD as part of the mandatory training, and there are postgraduate studies in the field. Some challenges are being met by several initiatives by different groups as parents, scientific associations, and universities. Issues such as tests and protocols that can be used to Portuguese-speaking children and the identification of efficient methods that can be applied in different situations and orientation to parents and families have been object of research for some decades. There are still many challenges that must be addressed to provide adequate health and educational services to children with ASD and their families in Brazil.

Referred speech-language and hearing complaints in the western region of São Paulo, Brazil

OBJECTIVE: The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of São Paulo, Brazil, highlighting referred speech-language and hearing complaints. METHOD: This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions. RESULTS: Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment. CONCLUSIONS: The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of São Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders.

Prevalência de alterações fonoaudiológicas na infância na região oeste de São Paulo

PURPOSE To establish the speech-language disorders in children living in the western region of São Paulo; to assess associations between diagnosis hypotheses (DH) and the age, gender and origin of referral; and to investigate the degree of agreement between the complaint and the DH at the moment of speech-language screening. METHODS Observational epidemiological study conducted at a laboratory of Primary Health Care. A survey of 525 medical records of children between 2002 and 2011 was conducted. The following variables were analyzed: gender and age of the child; origin of referral, complaint reported by parents, diagnosis hypothesis and referrals. RESULTS There was a predominance of male children (68.3%) and of the age group between 3 and 5 years and 11 months (48.7%), referred by a health professional (51.9%) and with more than one complaint reported by parents (26.1%). The most frequent DH were Phonological Disorder (22.9%) and more than one Diagnosis Hypothesis (19.4%). Most children were referred to a clinic-school where screening was performed (77.9%). There was an association between DH and the variables age (p <0.001*), gender (p = 0.008*) and origin of referrals (p <0.001). The degree of agreement between complaints and DHs was moderate. CONCLUSION It has been proven that there are different DHs according to age, gender and origin of referrals. The use of speech-language screening with the information provided by parents for tracking of speech pathology is recommended.PURPOSE To establish the speech-language disorders in children living in the western region of Sao Paulo; to assess associations between diagnosis hypotheses (DH) and the age, gender and origin of referral; and to investigate the degree of agreement between the complaint and the DH at the moment of speech-language screening. METHODS Observational epidemiological study conducted at a laboratory of Primary Health Care. A survey of 525 medical records of children between 2002 and 2011 was conducted. The following variables were analyzed: gender and age of the child; origin of referral, complaint reported by parents, diagnosis hypothesis and referrals. RESULTS There was a predominance of male children (68.3%) and of the age group between 3 and 5 years and 11 months (48.7%), referred by a health professional (51.9%) and with more than one complaint reported by parents (26.1%). The most frequent DH were Phonological Disorder (22.9%) and more than one Diagnosis Hypothesis (19.4%). Most children were referred to a clinic-school where screening was performed (77.9%). There was an association between DH and the variables age (p <0.001*), gender (p = 0.008*) and origin of referrals (p <0.001). The degree of agreement between complaints and DHs was moderate. CONCLUSION It has been proven that there are different DHs according to age, gender and origin of referrals. The use of speech-language screening with the information provided by parents for tracking of speech pathology is recommended.

Association between language and hearing disorders – risk identification

OBJECTIVE: To identify children at risk for hearing and/or language disorders and to investigate the association between these risks by conducting pre-validated hearing and language screenings. METHODS: The study was conducted during a polio vaccination campaign in August of 2013 in basic health units in western São Paulo. Parents of children between 2 and 5 years of age were asked to complete two screening tools: a hearing questionnaire (regarding hearing development) and a language production and comprehension scale (including the major language development milestones). The screening tools were administered by different researchers. We compared the risk of having language disorders among children at risk for hearing loss versus children not at risk, as well as the attributable risk and odds ratios. Chi-squared tests and logistic regression analyses were used. RESULTS: The study included 479 children with a mean age of three and one-half years, of whom 26.9% were identified as at risk for deficits in language production, 8.6% were at risk for deficits in language comprehension and 14% were at risk for hearing disorders. The children at risk for hearing disorders were twice as likely as those not at risk to exhibit language production and comprehension deficits. CONCLUSION: The results of this study highlight the importance of establishing and adopting low-cost procedures such as screenings to identify children at risk of developing language and/or hearing disorders in early childhood.

Addressing Communication Difficulties of Parents of Children of the Autism Spectrum

However, a recent literature review [1] about the papers published in three of the most im‐ portant journals with specific focus on autism revealed a different reality. Only 0.7% of the papers published between 2005 and 2009 referred to studies about families with ASD chil‐ dren, comprising a total of 4883 participants. It is interesting to note that more than half of the papers about families with children of the autism spectrum were published in the last 18 months of the considered period. The themes of those studies involved issues about stress and emotional problems (13 papers); support groups and quality of life (7 papers); charac‐ terization of the families and their members (7 papers); intervention processes and their re‐

Avaliação da atenção primária em saúde por usuários com e sem deficiência

PURPOSE To evaluate the core (First Contact, Longitudinality, Comprehensiveness, and Coordination of Services) and derivative (Family Orientation, Community Orientation) attributes of primary health care (PHC) from the perspective of users with and without disabilities. METHODS Observational, cross-sectional study using the Primary Care Assessment Tool (PCAT) with users with and without disabilities of five basic health units (BHU) in a municipality where 55% of the population depends on the Brazilian Unified Health System (SUS). Scores were assigned to the responses given to each of the PHC attributes evaluated. RESULTS Study participants were 93 (67 physically disabled and 26 without disabilities) PHC users. No statistically significant differences were observed for any attribute on the comparison between the populations. For both groups, the attributes Degree of Affiliation, First Contact - Utilization, Longitudinality, and Coordination of Services - Information System received satisfactory (above cutoff) scores, whereas the attributes First Contact - Accessibility, Coordination of Services - Care Integration, Comprehensiveness, Family Orientation, and Community Orientation received unsatisfactory (below cutoff) scores. Users reported that the health teams are able to satisfactorily identify mobility issues, but there are failures in the recognition of problems of hearing, voice/speech and vision, and in the orientation of services available and services provided. CONCLUSION Users with and without disabilities evaluated the health care received similarly, indicating fragilities on the recognition of specific demands. Structural and work process changes should be conducted to ensure Accessibility, Comprehensiveness, and Family and Community Orientation, and thus increase the quality of PHC.PURPOSE To evaluate the core (First Contact, Longitudinality, Comprehensiveness, and Coordination of Services) and derivative (Family Orientation, Community Orientation) attributes of primary health care (PHC) from the perspective of users with and without disabilities. METHODS Observational, cross-sectional study using the Primary Care Assessment Tool (PCAT) with users with and without disabilities of five basic health units (BHU) in a municipality where 55% of the population depends on the Brazilian Unified Health System (SUS). Scores were assigned to the responses given to each of the PHC attributes evaluated. RESULTS Study participants were 93 (67 physically disabled and 26 without disabilities) PHC users. No statistically significant differences were observed for any attribute on the comparison between the populations. For both groups, the attributes Degree of Affiliation, First Contact - Utilization, Longitudinality, and Coordination of Services - Information System received satisfactory (above cutoff) scores, whereas the attributes First Contact - Accessibility, Coordination of Services - Care Integration, Comprehensiveness, Family Orientation, and Community Orientation received unsatisfactory (below cutoff) scores. Users reported that the health teams are able to satisfactorily identify mobility issues, but there are failures in the recognition of problems of hearing, voice/speech and vision, and in the orientation of services available and services provided. CONCLUSION Users with and without disabilities evaluated the health care received similarly, indicating fragilities on the recognition of specific demands. Structural and work process changes should be conducted to ensure Accessibility, Comprehensiveness, and Family and Community Orientation, and thus increase the quality of PHC.