Marcela Guimarães Côrtes

Análise espectrográfica da voz: efeito do treinamento visual na confiabilidade da avaliação

OBJETIVO: Verificar se o treinamento visual melhora a concordância inter e intra-avaliadores da interpretacao da analise acustica espectrografica. METODOS: Trata-se de um estudo experimental longitudinal que utilizou espectrogramas coletados em um banco de dados de consultorio particular, referentes a vozes de homens e mulheres analisadas pelo programa Gram 5.0 em escala de 60 dB, em display scroll, paleta BW, com analise de frequencias em escala linear, banda estreita, FFT 1024 e resolucao 5.4 Hz. Vinte sujeitos, estudantes de Fonoaudiologia, avaliaram 25 espectrogramas, sendo cinco destes repetidos para avaliar a concordância intra-sujeitos, antes e apos um treinamento de analise de espectrogramas. Os parâmetros analisados foram: forma do tracado espectrografico, grau de escurecimento dos harmonicos, estabilidade do tracado espectrografico, presenca de ruido, presenca de sub-harmonicos e definicao dos harmonicos. O treinamento teve a duracao total de quatro horas. Utilizou-se a estatistica Kappa para avaliar a concordância intrassujeitos e o teste Qui-quadrado de ajuste para a concordância intersujeitos. RESULTADOS: Em relacao a concordância intra-sujeitos, os aspectos escurecimento do tracado, estabilidade do tracado, presenca de sub-harmonicos, e definicao de harmonicos obtiveram melhora desta e os demais aspectos mantiveram concordância quase perfeita depois do treinamento. Quanto a concordância intersujeitos, os aspectos de estabilidade do tracado e presenca de sub-harmonicos obtiveram melhora, e o aspecto presenca de ruido obteve piora apos o treinamento. CONCLUSAO: O treinamento visual melhorou a confiabilidade inter e intra-avaliadores na interpretacao de espectrogramas.

Análise visual de parâmetros espectrográficos pré e pós-fonoterapia para disfonias

OBJETIVO: Avaliar os efeitos da fonoterapia nos disturbios da voz por meio de diferentes parâmetros acusticos pre e pos-fonoterapia. METODOS: Trata-se de estudo experimental retrospectivo no qual se analisou as gravacoes de vozes de 67 individuos submetidos a reabilitacao vocal. Os espectrogramas pre e pos-terapia fonoaudiologica foram julgados por quatro fonoaudiologas. Os parâmetros para analise foram: forma do tracado, grau de escurecimento dos harmonicos, estabilidade do tracado dos harmonicos, presenca de ruido, presenca de harmonicos e de sub-harmonicos. Os dados obtidos foram submetidos a analise estatistica, em que tambem se buscou observar a eventual diferenca de padroes entre generos e diagnosticos. RESULTADOS: Nao houve diferenca estatisticamente significante entre a forma do tracado espectrografico nas condicoes pre e pos-fonoterapia, porem a maioria dos pacientes (58%) obteve melhora. O grau de escurecimento manteve-se estavel nas condicoes pre e pos-fonoterapia (p=0,000). Houve significativa melhora espectrografica, apos a fonoterapia, para os parâmetros de estabilidade do tracado (p=0,006), presenca de ruido (p=0,007), harmonicos (p=0,000) e sub-harmonicos (p=0,001). Nao houve relacao entre o genero do paciente e o grau de melhora espectrografica. Em relacao ao diagnostico, apenas o parâmetro forma do tracado apresentou diferencas significativas. CONCLUSAO: Apesar de nao terem sido encontradas mudancas significativas em todos os parâmetros avaliados, a espectrografia acustica demonstrou ser um instrumento eficaz para avaliar a evolucao da voz do paciente no processo terapeutico, sendo complementar a avaliacao perceptivo-auditiva e fazendo parte de um protocolo multidimensional.

Estudo do efeito do apoio visual do traçado espectrográfico na confiabilidade da análise perceptivo-auditiva

OBJETIVO: avaliar a concordância intra e inter-sujeitos na avaliacao perceptivo-auditiva realizada de forma isolada e simultaneamente a apresentacao do tracado espectrografico correspondente, a fim de verificar se a apresentacao simultânea dos estimulos vocais e espectrograficos aumenta a concordância da avaliacao perceptivo-auditiva da voz. METODOS: trata-se de um estudo longitudinal, em que seis fonoaudiologas avaliaram, em dois momentos distintos, 105 vozes disfonicas e nao disfonicas, de forma perceptivo-auditiva: primeiramente sem e posteriormente com a apresentacao dos espectrogramas correspondentes. Vinte por cento das vozes foram repetidas aleatoriamente nos dois momentos, a fim de se analisar as concordâncias intra-avaliadoras. Utilizou-se a escala GRBASI para realizacao da avaliacao vocal. Para analise da concordância inter-avaliadores, foi utilizado o indice estatistico Kappa Fleiss e, para calculo da concordância intra-avaliador, foi utilizado o coeficiente de correlacao de Spearman. RESULTADOS: nao houve diferenca estatisticamente significante entre as avaliacoes perceptivo-auditivas inter-sujeitos com e sem a leitura espectrografica, porem houve aumento da concordância entre os avaliadores para as variaveis G, R, B e S. Nao houve diferenca estatisticamente significante entre as avaliacoes perceptivo-auditivas intra-sujeitos sem e com o apoio visual do espectrograma, entretanto, houve aumento da concordância intra-avaliadores apos a apresentacao do estimulo visual, para as variaveis G, B e I. CONCLUSAO: o apoio visual do espectrograma nao aumenta significativamente a confiabilidade da avaliacao perceptivo-auditiva da voz, mas a auxilia, uma vez que promove um aumento da concordância inter e intra-avaliadores.

Preterm newborn readiness for oral feeding: systematic review and meta-analysis

PURPOSE To identify and systematize the main studies on the transition from enteral to oral feeding in preterm infants. RESEARCH STRATEGY Articles that describe the transition from oral to enteral feeding in preterm infants were located in MEDLINE, LILACS, and SciELO databases. SELECTION CRITERIA Original studies, with available abstract, published in the last 10 years were included. DATA ANALYSIS Analysis of the methodology and the main results of the studies, and meta-analysis of the effects of sensory-motor-oral stimulation at the time of transition to full oral feeding and duration of hospitalization were conducted. RESULTS Twenty-nine national and international publications were considered. Most studies were clinical trials (44.8%) and did not use rating scales to start the transition process (82.7%). In the meta-analysis, positive effect of stimulation of the sensory-motor-oral system was observed with respect to the transition time to oral diet (p=0.0000), but not in relation to the length of hospital stay (p=0.09). However, heterogeneity between studies was found both in the analysis of the transition time to full oral feeding (I2=93.98) and in the length of hospital stay (I2=82.30). CONCLUSION The transition to oral feeding is an important moment, and various physical and clinical characteristics of preterm infants have been used to describe this process. Despite the impossibility of generalizing the results due to the heterogeneity of the studies, we have noted the importance of strategies for stimulation of sensory-motor-oral system to decrease the period of transition to full oral feeding system.

O uso de escalas de silhuetas na avaliação da satisfação corporal de adolescentes: revisão sistemática da literatura

O objetivo deste artigo e descrever as recentes mudancas na epidemiologia da pertussis e as politicas de vacinacao voltadas a prevencao da coqueluche para profissionais de saude. Os autores fizeram um levantamento dos artigos publicados no PubMed, SciELO e paginas da Internet da Organizacao Mundial da Saude, Organizacao Pan-Americana da Saude, Centers for Disease Control and Prevention (Estados Unidos) e do Ministerio da Saude usando as palavras-chave: pertussis, vacinas e profissionais de saude. A vacinacao de profissionais de saude contra coqueluche e recomendada pela OMS, OPAS, CDC, e autoridades de saude de nove paises europeus, da Australia, Hong Kong, Cingapura, Costa Rica, Argentina e Uruguai, e em alguns paises e compulsoria. No Brasil, identificamos apenas um artigo abordando a vacinacao de profissionais de saude contra coqueluche, mas considerando a reemergencia da doenca com grande numero de hospitalizacoes e mortes em 2011, consideramos necessario rediscutir as politicas publicas envolvendo a vacinacao dos profissionais de saude, particularmente daqueles que tem contato frequente com lactentes jovens.The aim of this study was to describe recent changes in the epidemiology of pertussis and existing policies regarding recommended and mandatory occupational vaccinations for healthcare professionals (HCPs). The authors carried out an extensive review of references on the PubMed and SciELO databases and the official sites of the World Health Organization, Pan American Health Organization, Centers for Disease Control and Prevention, and Brazilian Ministry of Health, using the keywords pertussis, vaccines and healthcare professionals. Vaccination against pertussis is recommended for HCPs in the United States, Canada, nine European countries, Australia, Hong Kong, Singapore, Costa Rica, Argentina and Uruguay, and in some countries it is compulsory. In Brazil, only one publication discussing the risk of pertussis among HCPs was found. Considering the reemergence of pertussis and the great number of associated hospitalizations and deaths registered in 2011, it is necessary to review public policies regarding HCP pertussis vaccination, particularly among workers in frequent contact with young babies.

Características individuais associadas à autopercepção da extensão territorial da vizinhança

There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual’s definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study’s results can help produce more significant neighborhood definitions that are more consistent with residents’ own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.

Weight excess in adolescents in Belo Horizonte? population-based household survey

Introduction: Weight excess rates have had an alarming growth among adolescents. Of complex and multifactor origins, weight excess is influenced by genetic and contextual factors. Objective: To assess individual factors related to weight excess among adolescents in a large urban center. Methods: A cross-sectional study with data from a population-based household survey conducted in two districts of Belo Horizonte, between 2008 and 2009. Data were collected through confidential self-administered questionnaires and anthropometric measurements. The final sample consisted of 1,030 adolescents aged 11-17 years. We evaluated excess weight, as defined by body mass index, and its association with sociodemographic variables, habits and lifestyles, body satisfaction and self-rated health. Descriptive analysis of the data, including frequency distributions and differences between proportions and means with the Pearson chi-square test were conducted. Results: 21.9% of adolescents were overweight, with a higher prevalence among females (54.2%, p <0.05). The following aspects were significantly associated with weight excess: not eating breakfast, body dissatisfaction and worse self-rated health status. Males were more active compared to females, however without significant differences in nutritional status classifications. Conclusion: This study reinforces the multifactor aspects of exWeight excess in adolescents in Belo Horizonte? population-based household survey Stephanie Bispo1, Adriana Lúcia Meireles2, Marcela Guimarães Côrtes3, César Coelho Xavier4, Fernando Augusto Proietti5, Waleska Teixeira Caiaffa6 1 Nutricionista. Mestranda em Ciências da Saúde: Saúde da Criança e do Adolescente – Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG). Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. 2 Nutricionista. Doutoranda em Saúde Pública – Faculdade de Medicina da UFMG. Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. 3 Fonoaudióloga. Doutoranda em Saúde Pública – Faculdade de Medicina da UFMG. Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. 4 Médico. Professor Associado do Departamento de Pediatria da Faculdade de Medicina da UFMG. Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. Professor da Faculdade de Saúde e Ecologia Humana (FASEH). Vespasiano, MG – Brasil 5 Médico. Professor Associado do Departamento de Medicina Preventiva e Social da Faculdade de Medicina da UFMG. Observatório de Saúde Urbana, Belo Horizonte, MG – Brasil. Professor da Faculdade de Saúde e Ecologia Humana (FASEH). Vespasiano, MG – Brasil 6 Médica. Professora Titular de Epidemiologia – Departamento de Medicina Preventiva da Faculdade de Medicina da UFMG. Observatório de Saúde Urbana. Belo Horizonte, MG – Brasil. Excesso de peso em adolescentes de Belo Horizonte: inquérito domiciliar de base populacional DOI: 10.5935/2238-3182.20130003

Individual characteristics associated with perception of the local neighborhood’s territory

There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual’s definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study’s results can help produce more significant neighborhood definitions that are more consistent with residents’ own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.

Las características individuales asociadas con la percepción de la extensión territorial del vecindario

There is a growing interest in evaluating the impact of neighborhood characteristics on health. The definition of neighborhood involves two main strategies, one using artificial boundaries, usually created for administrative purposes, and the other based on the individual’s definition, namely the perceived neighborhood. The aim of this study was to identify factors associated with heterogeneity in the perceived neighborhood among participants in a health survey in Belo Horizonte, Minas Gerais State, Brazil. Ordinal logistic regression was used to determine and quantify this association. Larger size of the perceived neighborhood was associated with better socioeconomic status, positive employment status, positive assessment of aesthetic aspects and mobility within the neighborhood, active identification of problems in the neighborhood, less involvement in sports/leisure activities, and knowing more neighbors. The study’s results can help produce more significant neighborhood definitions that are more consistent with residents’ own perceptions, thereby favoring more accurate estimates of neighborhood impact on health.

Well-being of children and adolescents: a multidimensional construct

Objectives: To review the literature on the well-being of children and adolescents from a multidimensional perspective. Methods: A narrative review was conducted and articles from the PubMed database, from publications of national and international institutions, dissertations and theses were selected. Results: The production of articles on the wellbeing of children and adolescents still cannot be considered significant when compared to other themes in the scientific production involving individuals in this age group. These findings highlight the importance of a targeted approach to this issue. It is clear that the term well-being, despite being commonly used, is inconsistently defined. A single domain is unable to encompass all the complexity involved in this concept , as attested by the extensive list of studies and reports monitoring well-being throughout the world. Analysis based on data from the Health Beaga Study reveals the existence of important intra-urban differences in the various domains of well-being of adolescents living in Belo Horizonte, a large urban center in Brazil, reinforcing the importance of studying well-being from a multidimensional perspective, one that can visualize is as a potential indicator of social inequities. Conclusion: We found that well-being is influenced not only by individual attributes but also by contextual factors such as family, neighborhood, and country characteristics.