Tatiana Mendes de Melo

A avaliação de serviços em Audiologia: concepções e perspectivas

ABSTRACT The evaluation of services has played an important role in health planning and management, since an effective system may reorganize the accomplishment of actions and services to meet the needs of the target population and to optimize financial resources. Although there have been some international experiences in the assessment of hearing health services, their contribution is limited, due to the particularities of each country’s Hearing Health Attention Policies. In Brazil, integral assistance to the hearing impaired has been guaranteed by Portaria GM/MS number 2.073/04, with the purpose to organize a hierarchical and regionalized network, integrated in Primary-, Medium- and High-complexity Health Care Attention. The improvement of this Policy is a natural consequence, follo-wing its implantation, in order to constitute quality hearing health public services, not only upon its creation, but also and mainly in the constant maintenance and improvement of the process of assisting people with hearing impairment, assuring its effectiveness. Therefore, professional qualification and incentive of discussions regarding the evaluation of the quality of hearing health services provided by Brazil’s Unified Health System are indispensable.

Avaliação de serviços de saúde auditiva sob a perspectiva do usuário: proposta de instrumento

PURPOSE: To verify the applicability of a questionnaire for the assessment of hearing health services, under the perspective of the users. METHODS: The questionnaire was inspired on the study conducted by the Hearing and Communication Group, and presents 18 questions focused on the following dimensions: access to the service, hearing evaluation, personal attendance, family benefits, communication and information, and professional competence. Each question of this instrument was presented in a graduation scale of five points. The casuistic comprised 53 patients (or caregiver), that were invited, by the reception professionals, to answer to the questionnaire. Data were calculated in percentage, and the score for each domain and the total score were established. Inferential statistic tests were applied, adopting a significant level of 5%, in order to verify the influences of demographic characteristics on the total score. RESULTS: The score for the access domain was 62.25%, for hearing evaluation was 85.96%, for personal attendance was 82.05%, for family benefits was 68.57%, for the domain communication and information was 79.13%, for professional competence was 97.39%, and the total score was 70.65%. It was verified that patients with lower schooling levels, lesser time attending the service, and those that had already received the hearing aid obtained higher total scores on the questionnaire. CONCLUSION: The questionnaire used in the present study proved to be easily applicable in hearing health services; however, its application on national level is necessary, so that standardization and reliability and validity can be established.

Capacitação de agentes comunitários de saúde em saúde auditiva: efetividade da videoconferência

BACKGROUND: training of Community Health Agents on hearing health through videoconference. AIM: to verify the effectiveness of a training program for community health agents, through videoconference, on child hearing health. METHOD: participants of the study were 50 professionals who were randomly divided in two groups: 31 community health agents were physically present in the training program and 19 participated via videoconference. Training was provided in eight hours, through classes and using specific material adapted from the Primary ear and hearing care training resource - basic, intermediate and advanced levels for both groups, simultaneously. Training was organized and evaluated according to a previous study. RESULTS: both groups presented a statistically significant difference when comparing pre and post training performances. However, for the group of community health agents who were physically present during the training program, this difference was higher not only when considering the final total scores but also when looking at the individual topics. CONCLUSION: videoconference was effective as a learning tool for the training of community health agents on child hearing health. However, this instrument should be used as a complementary material to the traditional form of training.

Capacitação de profissionais da saúde na área de saúde auditiva: revisão sistemática

The aim of this study was to evaluate the training of health professionals regarding hearing health, through a systematic literature review. The bibliographic search was carried out in scientific database (Lilacs, SciELO, Medline, Scopus, Embase, Science Direct Online and Web of Science), online journals on audiology, proceedings from Brazilian conventions, and libraries from Brazilian universities, using specific keywords in order to find all the possible studies matching the proposed question. The studies that matched these criteria were selected and evaluated according to the following aspects: type of study, participants, intervention adopted and outcomes evaluation. After reading the selected manuscripts, they were summarized in a protocol and classified according to level of evidence and recommendation degree. Five studies were included in the systematic review. The results showed a shortage of researches that emphasize this topic, but the analysis of the articles demonstrated that the training of health professionals in hearing health is effective, increasing their knowledge on the theme and, consequently, enabling them to identify patients at risk for hearing loss and to refer these individuals to specific evaluation.

Contribuições para análise da política de saúde auditiva no Brasil

ABSTRACT Purpose: To quantity the procedures related to hearing aid fitting included in Hearing Health Care National Policy ( Tabela SUS ). Methods: Data about fitting procedures included in Tabela SUS were gathered in the website www.datasus.gov.br. After data col-lection, it was conducted the organization and descriptive analysis of the production of ambulatory consults registered by hearing health services in Brazil, during the period from November 2004 to July 2010. Data were statistically analyzed. Results: Regarding procedures related to dispensing hearing aids in national territory, in 2006, speech-language therapy exceeded the amount obtained by hearing aid fitting, and audiological follow-up was little frequent. Hearing aids with technologies B and C have been adapted more than hearing aids with technology A, and the use of measures with a real-ear measurement or 2cc coupler in the adaptation of hearing aids is uncommon, in comparison to functional gain measures. Conclusion: There has been great progresses in the area of hearing impaired attention in the country, but it is necessary to improve the audiological follow-up to hearing aid users, and to review procedures such as the real-ear measurement and technologies of hearing aids.

Opinião dos agentes comunitários de saúde sobre o uso da videoconferência na capacitação em saúde auditiva infantil

RESUMOObjetivo: avaliar a videoconferencia como ferramenta instrucional na capacitacao dos agentes comu-nitarios de saude, em saude auditiva infantil, sob a perspectiva destes profissionais. Metodologia: a casuistica foi composta por 50 agentes comunitarios de saude, divididos aleatoriamente em dois gru-pos de acordo com a metodologia de ensino: 31 profissionais participaram da capacitacao de forma presencial e 19 por meio de videoconferencia. A atividade ocorreu em um encontro de oito horas, por meio de aulas expositivas e utilizando material didatico adaptado e validado para o portugues pro-posto pela Organizacao Mundial da Saude de forma simultânea para ambos os grupos. A avaliacao da videoconferencia como ferramenta instrucional foi realizada por meio de questionario elaborado para o presente estudo. Resultados: a avaliacao da videoconferencia foi muito semelhante em ambos os grupos, sendo que a ferramenta de ensino foi considerada como de facil entendimento e permitindo a interacao com o ministrante. Conclusao: a videoconferencia foi uma ferramenta valida e aceita pelos profissionais estudados para ser utilizada em programas de capacitacao em saude auditiva infantil.DESCRITORES: Videoconferencia; Capacitacao; Saude da Familia; Perda Auditiva

Avaliação da produção de fala em crianças deficientes auditivas usuárias de Implante Coclear Multicanal

OBJETIVO: Comparar a producao de fala de criancas com deficiencia auditiva neurossensorial a de criancas com neuropatia auditiva/ dessincronia auditiva, ambas submetidas a cirurgia de implante coclear. METODOS: Participaram do estudo cinco criancas com deficiencia auditiva neurossensorial e cinco criancas com neuropatia auditiva/dessincronia auditiva; os dois grupos foram pareados segundo idade e tempo de uso do implante coclear, sendo utilizada uma amostra da fala durante as tarefas de nomeacao de figuras e discurso espontâneo. RESULTADOS: A media de acertos no grupo de criancas com neuropatia auditiva/dessincronia auditiva foi de 59,32%, contra 51,32% no grupo com deficiencia auditiva neurossensorial, nao apresentando diferenca estatisticamente significante. CONCLUSAO: O implante coclear demonstrou ser benefico na reabilitacao da neuropatia auditiva/dessincronia auditiva e, assim como na deficiencia auditiva neurossensorial, o tempo de privacao sensorial influenciou a producao de fala dessas criancas.

Percepção da fala de usuários de implante coclear com a estratégia HiRes 120: revisão sistemática

Despite technological advances employed in signal processing strategies, one of the remaining obstacles are spectral gap details on the information transmitted. Considering its importance in speech perception, researchers have investigated mechanisms to optimize spectral details through virtual spectral channels. The clinical application of this technique resulted in a new approach to signal processing - the HiRes 120. OBJECTIVE: To assess the auditory performance of cochlear implant users with the HiRes 120 strategy. METHODOLOGY: The literature review was conducted in an electronic database, with standard bibliographic search in the year 2011, using specific keywords. In order to select and evaluate the scientific studies found in the search, we setup search containing the following aspects: type of study, subjects, intervention used and evaluation of the results. CONCLUSION: Scientific evidence points to an improvement in hearing performance in noisy environments with the HiRes 120 strategy, but this does not occur in quiet situations. The optimization of speech perception with this strategy is closely related to the cochlear implant users age, to the time of sensory deprivation and the acclimatization time required to use the strategys spectral information.

Influence of signal processing strategy in auditory abilities

UNLABELLED The signal processing strategy is a parameter that may influence the auditory performance of cochlear implant and is important to optimize this parameter to provide better speech perception, especially in difficult listening situations. OBJECTIVE To evaluate the individuals auditory performance using two different signal processing strategy. METHOD Prospective study with 11 prelingually deafened children with open-set speech recognition. A within-subjects design was used to compare performance with standard HiRes and HiRes 120 in three different moments. During test sessions, subjects performance was evaluated by warble-tone sound-field thresholds, speech perception evaluation, in quiet and in noise. RESULTS In the silence, children S1, S4, S5, S7 showed better performance with the HiRes 120 strategy and children S2, S9, S11 showed better performance with the HiRes strategy. In the noise was also observed that some children performed better using the HiRes 120 strategy and other with HiRes. CONCLUSION Not all children presented the same pattern of response to the different strategies used in this study, which reinforces the need to look at optimizing cochlear implant clinical programming.

Evasão dos pacientes nos acompanhamentos nos serviços de saúde auditiva: identificação sobre o motivo e resultados pós-adaptação de aparelho de amplificação sonora individual

OBJETIVO: identificar o motivo da ausencia no acompanhamento audiologico dos usuarios de aparelhos de amplificacao sonora individual do Sistema Unico de Saude e analisar o resultado da adaptacao do dispositivo nesta populacao. METODO: entrevista com 27 pacientes faltosos, realizando questoes abertas sobre o motivo da ausencia no atendimento e aplicacao do Questionario Internacional de Aparelho de Amplificacao Sonora Individual, para avaliacao dos resultados pos-adaptacao. A comparacao dos resultados pos-adaptacao dos pacientes faltosos foi realizada a partir da selecao aleatoria de 30 questionarios, de pacientes que compareceram no acompanhamento audiologico da Instituicao, cadastrados em um banco de dados. Para analise dos resultados foi aplicada estatistica descritiva e inferencial. RESULTADOS: a maioria dos faltosos (25,92%) refere nao ter lembrado da data do retorno. Os resultados comparativos do questionario entre os grupos de faltosos e nao faltosos evidenciam diferencas estatisticamente significantes em quase todos os dominios do questionario de auto-avaliacao, exceto nos itens beneficio, restricao da participacao e qualidade de vida. CONCLUSAO: dentre os motivos do nao comparecimento ao servico, destacam-se: esquecimento do atendimento, problemas de saude e motivos de trabalho. Foi observado que os pacientes que nao compareceram ao acompanhamento audiologico apresentam resultados pos-adaptacao de aparelho de amplificacao sonora individual aquem aos resultados dos pacientes que compareceram ao acompanhamento, de forma estatisticamente significante.