Effect of Tinnitus on Sleep Quality and Insomnia

Abstract Introduction Tinnitus is a conscious perception of a sound resulting from abnormal activity within the nervous system. A relevant percentage of tinnitus patients report symptoms severe enough to significantly affect quality of life, including sleep disorders. Objectives To analyze the sleep quality, insomnia, daytime sleepiness, and risk of obstructive sleep apnea (OSA) in participants with tinnitus. Methods The sample comprised 18 adults and older adults aged between 18 and 85 years old (mean age = 58.7 ± 17.5 years old), females and males, with complaint of continuous tinnitus for > 1 month. The instruments used were the Tinnitus Handicap Inventory (THI) questionnaire, the Insomnia Severity Index, the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, and the STOP-Bang questionnaire. Results By means of the THI questionnaire, the tinnitus severity degree reported by most participants was mild (27.8%) and moderate (27.8%), having a positive (r = 0.582) and significant (0.011) correlation to sleep quality, measured by means of the Pittsburgh questionnaire. There was a positive correlation between the Insomnia Severity Index and tinnitus handicap (r = 0.499; p = 0.035). A total of 72.2% of the participants self-assessed their sleep quality as poor, in addition to moderate insomnia (27.8%), although there is low risk of OSA (66.7%), without complaints of excessive daytime sleepiness (72.2%). Conclusion Subjects with tinnitus complaint self-rated their sleep quality as poor. Moreover, the higher the reported tinnitus handicap, the greater the symptoms of insomnia. There was no influence of tinnitus in relation to daytime sleepiness and no relationship between the severity of tinnitus and the risk of OSA.

Tradução, adaptação e validação transcultural para o português brasileiro do questionário de Avaliação da Proteção Auditiva (APA) / Translation, adaptation, and cross-cultural validation into Brazilian portuguese of the hearing protection assessment questionnaire (HPA)

RESUMO Objetivo O objetivo do presente estudo foi traduzir, adaptar e validar transculturalmente a versão para língua portuguesa brasileira do questionário Hearing Protection Assessment Questionnaire (HPA). Método O instrumento original, desenvolvido na língua inglesa, buscou avaliar as barreiras e suportes relacionados ao uso dos dispositivos de proteção auditiva (DPA), assim como o conhecimento, hábitos e atitudes dos trabalhadores frente ao ruído ocupacional. A tradução, adaptação e validação transcultural do questionário foi composta de cinco etapas: Tradução do questionário do inglês para o português; 2) Processo inverso de tradução do português para o inglês; 3) Análise do instrumento por três especialistas na área; 4) Pré-teste do questionário com 10 trabalhadores; 5) Aplicação do instrumento em 509 trabalhadores de uma indústria frigorífica após o exame admissional. Resultados os resultados indicam a validade de construção e conteúdo da versão em Português Brasileiro para o seu uso com uma população trabalhadora e a consistência interna do mesmo. Conclusão Este estudo resultou na tradução, na adaptação cultural e validação do questionário Hearing Protection Assessment Questionnaire (HPA) com a finalidade de ser usado para avaliar o uso de proteção auditiva individual em âmbito ocupacional, denominado Questionário de Avaliação da Proteção Auditiva (APA).

ABSTRACT Purpose The aim of the present study is to translate, adapt, and cross-culturally validate the Brazilian Portuguese version of the questionnaire Hearing Protection Assessment Questionnaire (HPA). Methods The original instrument, developed in English, seeks to assess barriers and supports related to the use of hearing protection devices (HPD), as well as workers' knowledge, habits and attitudes towards occupational noise. The translation, adaptation, and cross-cultural validation of the questionnaire consisted of five steps: Translation of the questionnaire from English to Portuguese; 2) Reverse translation from Portuguese to English; 3) Analysis of the instrument by three experts in the field; 4) Pre-test of the questionnaire with ten workers; 5) Application of the instrument to 509 workers in a meatpacking industry after the pre-employment medical exam. Results The results indicate the construction and content validity of the Brazilian Portuguese version for use with a working population and its internal consistency. Conclusion This study resulted in the translation, cultural adaptation, and validation of the Hearing Protection Assessment Questionnaire (HPA), in order to be used to assess the use of individual hearing protection in the occupational field, called Hearing Protection Assessment Questionnaire (HPA).

Achados audiológicos de agricultores familiares paranaenses expostos a agrotóxicos / Audiological findings of family farmers exposed to pesticides

RESUMO Objetivo Analisar as possíveis diferenças na audição de agricultores e suas famílias em comparação com população não exposta aos agrotóxicos. Método Estudo transversal, com 70 participantes (grupo pesquisa), com média de idade de 39,7 anos, de ambos os sexos, proprietários de pequenos estabelecimentos agrícolas vinculados a agricultura familiar e tempo de exposição médio aos agrotóxicos de 23,7 anos. Um grupo controle com 71 participantes de ambos os sexos, sem exposição a ruído e agentes químicos, com idade média de 39,5 anos, foi incluído para a comparação dos resultados. Na etapa 1, ambos os grupos foram submetidos a audiometria convencional e de altas frequências e imitanciometria. Na etapa 2, somente os normoouvintes foram submetidos as emissões otoacústicas evocadas e efeito de supressão das emissões otoacústicas transientes. Resultados Observou-se diferenças significativas entre os grupos para audiometria tonal convencional e de altas frequências, e no reflexo acústico. As frequências mais afetadas na audiometria tonal convencional foram 3 a 6kHz e na audiometria de altas frequências foram as frequências de 9.000 e 11.200 Hz. Nas emissões otoacusticas transientes, observou-se no efeito de supressão piores resultados no grupo de pesquisa. Conclusão Conclui-se que houve diferenças na audição dos agricultores familiares em comparação com o grupo controle. Os limiares auditivos convencionais estão relacionados em função do grupo, idade e gênero. O trabalho na agricultura está associado com o comprometimento na região basal da cóclea, à ausência de reflexo acústico, à redução da relação sinal/ruído das emissões otoacústicas transientes e à disfunção do sistema auditivo eferente olivococlear.

ABSTRACT Purpose To analyze the possible differences among the hearing of farmers and their families when compared to the population not exposed to pesticides. Methods Cross-sectional study with 70 smallholder family farmers (research group), with the mean age of 39.7 years, of both sexes and a mean of 23.7 years of exposure to pesticides. We included a control group with 71 participants of both sexes with the mean age of 39.5 years, not exposed to either noise or chemical substances, to compare the results. In stage 1, both groups were submitted to conventional and high-frequency audiometry, and acoustic immittance. In stage 2, only people with normal hearing were submitted to the evoked otoacoustic emissions and suppression effect on transient otoacoustic emissions. Results Significant differences were observed between the groups in the conventional pure-tone and in the high-frequency audiometry, as well as in the acoustic reflex. The most affected frequencies in the conventional pure-tone audiometry ranged from 3 to 6 kHz and, in the high-frequency audiometry, from 9000 to 11200 Hz. As for the transient otoacoustic emissions, the worse suppression effect results were found in the research group. Conclusion There were differences among the hearing of family farmers and the control group. The conventional auditory thresholds are related to the group, age and sex. Farming is associated with impairments in the basal region of the cochlea, absence of acoustic reflex, reduced signal-to-noise ratio of the transient otoacoustic emissions, and dysfunction in the olivocochlear efferents of the auditory system.

Dispensação de medicamentos na atenção primária do Sistema Único de Saúde / The dispensation of drugs in the primary health care of the Single Health System

Objetivo:analisar a dispensação de medicamentos na atenção primária do Sistema Único de Saúde em um município do Estado de São Paulo. Metodologia:realizou-se análise documental dos boletins de movimentação de medicamentos das farmácias das 19 Unidades Básicas de Saúde do município de Araçatuba-SP, sede do Departamento Regional de Saúde II-SP, durante 12 meses. Os medicamentos foram agregados segundo o sistema de classificação Anatomical Therapeutic Chemicale ação farmacológica. Analisou-se o total de medicamentos dispensados e o saldo final dos principais tipos de fármacos. Resultados:foram dispensados 60.479.959 medicamentos, sendo 53,10% antibióticos, 15,42% anti-hipertensivos, 5,09% antidepressivos, 4,81% hipoglicemiantes, 3,16% ansiolíticos, 2,82% complexos vitamínicos e minerais, 2,17% antipsicóticos, 1,99% analgésicos, dentre outros tipos (11,45%). Permaneceram disponíveis 8.778.863medicamentos, sendo os anti-hipertensivos, antidepressivos e ansiolíticos os que representam a maior proporção entre estes. Os antibióticos apresentaram a menor proporção de unidades disponíveis, com aproximadamente 2%. Os hipoglicemiantes apresentaram maior diversidade de fármacos sem unidades disponíveis para dispensação. Conclusão:os principais tipos de medicamentos dispensados foram antibióticos, anti-hipertensivos, antidepressivos e hipoglicemiantes. A dispensação de medicamentos foi satisfatória, considerando que mesmo os medicamentos que não apresentaram saldo residual positivo foram substituídos por outros de propriedades farmacológicas similares

Objective: to analyze the dispensation of drugs in the primary health care of the Single Health System in a city in the State of São Paulo.Methodology: a document analysis was carried out in the reports of how the movement of drugs took place in the 19 Primary Health Care Units in the city of Araçatuba-SP, head office of the Regional Health Department II-SP, for 12 months. The medications were classified according with the Anatomical Therapeutic Chemical system and with their pharmacological action. The total number of drugs dispensed and the remaining amount of the main types of drugs were analyzed.Results: 60,479,959 medications were dispensed, among which 53.10% were antibiotics, 15.42% antihypertensive, 5.09% antidepressant, 4.81% hypoglycemic, 3.16% anxiolytic, 2.82% vitamin and mineral complexes, 2.17% antipsychotics, 1.99% analgesics, among others (11.45%). 8,778,863 drugs were still available, among which the most numerous were hypertensive, antidepressants, and anxiolytics. Antibiotics represented the lowest percentage of available units, with approximately 2%. Hypoglycemic drugs were the ones that showed that highest diversity of unavailable medications.Conclusion: the main types of medications dispensed were antibiotics, antihypertensives, antidepressants, and hypoglycemic drugs. Drug dispensation was satisfactory,considering that even medications that did not have a positive residual supply were replaced by drugs with similar pharmacological properties

Challenges to access health faced by rural population and their perception regarding healthcare

The Brazilian nation has rich population diversity, and this makes it responsible for guaranteeing the social rights of all. In this perspective, this research seeks to categorize which are the main challenges in access to health that the rural populations face and to understand how the execution of this health care is carried out by professionals from the perspective of rural people. This is a cross-sectional study with a qualitative approach, carried out at the Nossa Senhora Aparecida Settlement, located in the municipality of Pesqueira (Pernambuco state) in 2018. The results demonstrate that the challenges facedby settled families are due to the difficulty of access to health services. In view of this, the rural population chooses to keep their cultural practices focused on their health alive. Therefore, it is common to use herbal medicines and mystics related to religious beliefs in self-care practices. It was concluded that the current public policies have gaps in their implementation, especially in terms of accessibility, security, health education, equity and respect for cultural differences. In addition, there is precariousness at the national level of studies focused on the health determinants and determinants of the rural population, which makes it necessary that more research be carried out so that new public policies can emerge.

Carotid Intima and Media Thickness Correlation with Central Blood Pressure Measurements by Tonometric and Oscillometric Methods: A Proof of Concept

Abstract Background The early detection of vascular damage in subclinical stages of hypertensive disease may be the key point in the prevention of cardiovascular outcomes. Objectives to correlate parameters of structural vascular damage (measurement of the carotid intima-media thickness) with parameters of functional vascular damage (central hemodynamic measurements) in pre-hypertensive and hypertensive patients taking up to two classes of anti-hypertensive drugs. Methods This was a cross-sectional descriptive study conducted with a convenience sample of patients attending the Liga de Hipertensão Arterial , a multidisciplinary program for the diagnosis and treatment of systemic hypertension, of the Federal university of Goias. Patients with arrythmia, diabetes, previous cardiovascular or cerebrovascular diseases, and end-stage diseases were excluded. Carotid Doppler test, measurements of peripheral and central blood pressure by applanation tonometry (Sphygmocor®) and oscillometry (Mobil-O-Graph®) were performed. The t-test was used for comparisons and the Pearson correlation test for correlations, considering a p<0.05 statistically significant. Results twenty patients (12 women) were evaluated, mean age 53.8 ± 14.3 years. Higher values of central pulse pressure (42.9±13.9 vs. 34.7±9.6, p=0.01) and pulse wave velocity (PWV) (9.0±1.9 vs. 7.9±1.5, p=0.01) were obtained by applanation tonometry compared with oscillometry. No difference between the methods was observed for the other measures. A significant correlation was found between carotid artery intima-media thickness (CA-IMT) and PWV (r=0.659; p=0.002) by the oscillometric test, but not with applanation tonometry. No correlation was found between central hemodynamic variables and the presence of carotid artery plaques. Conclusion PWV, estimated by oscillometry, was the only central hemodynamic parameter that correlated significantly with CA-IMT in pre-hypertensive and hypertensive patients at low cardiovascular risk. International Journal of Cardiovascular Sciences. 2020; [online].ahead print, PP.0-0

SARS-CoV-2 reinfection in a healthcare professional in inner Sao Paulo during the first wave of COVID-19 in Brazil

Coronavirus Disease 2019 pandemic remains a threat to public health. We report 2 cases of Coronavirus Disease 2019 infection in the same healthcare professional in Brazil. Genomic analysis identified that primoinfection was caused by the endemic lineage B.1.1.33 while reinfection by the lineage B.1.1.44, a lineage with an additional V1176F mutation in S protein.

COVID-19 laboratory diagnosis: comparative analysis of different RNA extraction methods for SARS-CoV-2 detection by two amplification protocols

The gold standard for the laboratory diagnosis of COVID-19 is the reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) assay, which searches for SARS­CoV-2 target genes in nasopharyngeal/oropharyngeal (NP/OP) samples, and its performance depends on the quantity and quality of the RNA input. This study compared the performance and cost-effectiveness of three different kits/reagents for RNA extraction used in COVID-19 diagnosis in Sao Paulo, Brazil. A total of 300 NP/OP samples belonging to suspected cases of COVID-19 stored in a biorepository were randomly selected, and RNA was extracted using (i) automated extraction (Loccus, Extracta Kit FAST), (ii) manual extraction (BioGene Kit, Bioclin, Quibasa), and (iii) quick extraction methods (Lucigen, Quick DNA Extract Kit). Next, the samples were tested using RT-qPCR for SARS-CoV-2 with the Allplex 2019-nCoV modified assay and the Charité-Berlin protocol. All assays/kits were used according to the manufacturer's instructions. For the Allplex kit, the sensitivity in detecting SARS-CoV-2 with previously extracted RNA by different procedures was 100.0% for Loccus, 100.0% for BioGene and 91.9% for Quick. Using the Charité-Berlin protocol, the sensitivities were 81.4% for Loccus, 81.2% for BioGene and 60.7% for Quick. The least sensitive target gene and the gene most affected by RNA extraction procedures was the RNA-dependent RNA polymerase gene (Charité-Berlin protocol). No false-positive SARS-CoV-2 results were detected using RNA obtained from any of the different protocols. In conclusion, Loccus and BioGene RNA extractions were efficient for RT-qPCR assays, and although the BioGene procedure is less expensive, Loccus is the best choice because it allows the rapid handling of hundreds or thousands of samples, a desirable feature during pandemics. Although less sensitive, the Quick extraction is useful during outbreaks coupled with the Allplex amplification kit for SARS-CoV-2 diagnosis (κ = 0.925).

Frenotomy: from assessment to surgical intervention / Frenotomia: da avaliação à intervenção cirúrgica

ABSTRACT The objective of this study was to demonstrate that frenotomy can help improve breastfeeding, tongue movement, and the mother's comfort, if the assessment criteria are respected and the infant's function and age are observed. Frenotomy was performed on two babies with breastfeeding difficulties who came to CEPAE - Center for Research and Dental Care, in 2018, as part of the course on Early Childhood Interdisciplinary Preventive Care at a Dental School. After anamnesis and clinical examination, the lingual frenulum assessment protocol for babies was applied. The necessary frenotomies were performed with topical anesthesia, scissors, and groove director. The babies were reassessed in follow-up visits 7 days after the procedure. The babies had gained weight and the mothers had found greater comfort and easiness when breastfeeding, after the procedure. It is concluded that the less time it takes from ankyloglossia diagnosis to intervention, the easier it is to resume breastfeeding. Also, the identification of ankyloglossia is more effective, and its intervention more efficient, through an interdisciplinary assessment.

RESUMO O objetivo do estudo foi mostrar que a frenotomia pode contribuir para a melhora da amamentação, movimentação lingual e desconforto materno se respeitados os critérios de avaliação, observando a função e idade do lactente. Foram realizadas frenotomias em dois bebês com dificuldade de amamentação que compareceram ao Cepae - Centro de Pesquisa e Atendimento Odontológico, no curso de Atendimento Interdisciplinar Preventivo na Primeira Infância de uma Faculdade de Odontologia, no ano de 2018. Após anamnese e exame clínico foi aplicado o protocolo de avaliação de frênulo lingual para bebês, sendo realizadas as frenotomias necessárias, com a utilização de anestésico tópico, tesoura e tentacânula. Os bebês retornaram para reavaliação após 7 dias do procedimento. Foram observados ganho de peso dos bebês e maior conforto e facilidade das mães durante a amamentação após os procedimentos. Conclui-se que quanto menor o tempo entre o diagnóstico e a intervenção na anquiloglossia, mais fácil se dá o retorno à amamentação, e que a avaliação interdisciplinar torna a identificação mais eficaz e a intervenção da anquiloglossia mais eficiente.

Tonometric and Oscillometric Methods for Measurement of Central Blood Pressure Parameters: a Comparison in Patients with Borderline Hypertension or Stage 1 Hypertension

Abstract Background Changes in arterial compliance are among the first changes detectable in hypertensive syndrome. Methods with good reproducibility as compared with the gold standard for identifying such changes are desirable in clinical practice. Objectives To compare central pressure measurements and arterial stiffness obtained by two non-invasive methods (tonometry and oscillometry). Methods This was a descriptive, cross-sectional study with a convenience sample of patients with borderline hypertension or stage 1 hypertension. Peripheral and central blood pressure measurements were obtained by tonometry (SphygmoCor®), considered the gold standard, and oscillometry (Mobil O´graph®). Comparisons of results were made by unpaired t-test, and p values < 0.05 were considered statistically significant. Results No difference was found in central pressure measurements obtained by SphygmoCor® (117 x 80.1 mmHg) compared with Mobil O'graph (112 x 81.4 mmHg). Mean augmentation index (AIx) was 26.1% and 21.3%, and mean pulse pressure (PP) amplification 10.7 mmHg and 10.0 mmHg by Sphygmocor® and Mobil O´graph®, respectively (p > 0.05). Mean pressure wave velocity (PWV), 8.4 m/s vs. 7.4 m/s (p = 0.013) and mean central pulse pressure, 37.7 mmmHg and 30.9 mmHg (p = 0.013) were significantly higher by SphygmoCor® than Mobil O´graph®. Conclusion Values of central systolic blood pressure, AIx and pulse pressure amplification obtained by oscillometry were not statistically different compared with tonometry; values of PWV and cPP, however, were underestimated by oscillometry. (Int J Cardiovasc Sci. 2020; 33(2):145-150)

Importation and early local transmission of COVID-19 in Brazil, 2020

We conducted the genome sequencing and analysis of the first confirmed COVID-19 infections in Brazil. Rapid sequencing coupled with phylogenetic analyses in the context of travel history corroborate multiple independent importations from Italy and local spread during the initial stage of COVID-19 transmission in Brazil. (AU)

Prevalência de oclusopatias em jovens de 12 anos de idade: impactos físicos, sociais e emocionais / Prevalence of malocclusions in 12-year-olds: physical, social and emotional impacts

As oclusopatias representam um importante problema de saúde pública por apresentarem alta prevalência, possibilidade de prevenção, tratamento e promoverem prejuízos significantes na qualidade de vida dos indivíduos acometidos. Assim, torna-se fundamental a realização de estudos que investiguem a distribuição, a severidade e as consequências das oclusopatias em diferentes populações, visando contribuir para o desenvolvimento de estratégias e políticas públicas que minimizem a instalação e o agravamento das oclusopatias. Entretanto, nota-se que não há consenso sobre qual índice de oclusopatias melhor se adequa para a realização de estudos epidemiológicos, oferecendo critérios completos para classificar a presença, severidade e a necessidade de tratamento ortodôntico. Nesse contexto, a presente pesquisa teve como objetivos: realizar uma revisão de literatura sobre os índices de oclusopatias e analisar suas aplicações na saúde pública; e investigar a prevalência, severidade e necessidade de tratamento das oclusopatias e seus impactos na qualidade de vida relacionada à saúde bucal em adolescentes de 12 anos de idade. A revisão incluiu trabalhos nacionais e internacionais publicados nas bases de dados Pubmed, SciELO, Web of Science, Scopus, Bireme e Embase. A busca nas bases de dados considerou o período de 1899 a 2019 e utilizou os seguintes termos: saúde pública, métodos epidemiológicos, índices, levantamentos epidemiológicos, odontologia preventiva, maloclusão, oclusopatias e ortodontia. Foram incluídas publicações sobre o desenvolvimento e uso de índices de oclusopatias em estudos clínicos e epidemiológicos, sem restrições de metodologia e linguagem. Os títulos e resumos dos artigos encontrados foram avaliados e as versões completas das publicações elegíveis foram obtidas para leitura e análise. Cinquenta e dois índices e suas variações foram identificados e, desses, a maioria destinava-se a avaliações individuais, portanto sua utilização em saúde pública foi dificultada pelos requisitos de sua aplicação, como a necessidade de especialistas, análise de modelos de gesso, exames complementares como radiografias cefalométricas e fotografias, equipamentos específicos, necessidade de acompanhamento longitudinal dos casos, e avaliações exclusivamente objetivas ou subjetivas. Os índices apresentaram aspectos positivos ao analisarem parcialmente as condições físicas, funcionais, psicológicas e sociais, entretanto, ainda é um desafio encontrar um índice unânime para avaliação da necessidade de tratamento ortodôntico e os impactos das oclusopatias sobre a qualidade de vida dos indivíduos, com aplicabilidade em saúde pública. A segunda etapa desta pesquisa consistiu em um estudo observacional, transversal, analítico, do tipo inquérito, realizado com 453 adolescentes de 12 anos, matriculados em escolas públicas do município de Araçatuba-SP. A oclusão foi avaliada por meio do Índice de Estética Dental (DAI), enquanto o Child Perceptions Questionnaire11-14 (CPQ11-14) foi utilizado para avaliar a qualidade de vida relacionada à saúde bucal. Os escores do CPQ11-14 foram comparados de acordo com o sexo e presença de oclusopatia por meio do teste de Mann-Whitney. A análise segundo a severidade da oclusopatia foi realizada por meio do teste de Kruskal-Wallis. A correlação entre a severidade da oclusopatia e a qualidade de vida relacionada à saúde bucal foi avaliada com base nos resultados dos escores do DAI e do CPQ11-14 por meio do teste de correlação de Spearman. A prevalência de oclusopatia definida ou superior foi de 53,86%, enquanto a oclusopatia muito grave ou incapacitante foi observada em 18,76% dos adolescentes. Houve correlação positiva significativa (r = 0,7006; p <0,0001) entre os escores do DAI e do CPQ11-14. Adolescentes com oclusopatias apresentaram escores totais do CPQ11-14, assim como escores dos domínios bem-estar emocional e social, significativamente maiores (p <0,05) comparados àqueles sem oclusopatia. O escore total do CPQ11-14 foi significativamente maior (p = 0,0251) nos adolescentes do sexo feminino (16,91 + 10,52) em relação aos do sexo masculino (14,61 + 9,70). A presença de oclusopatias foi elevada, com predomínio de oclusopatias classificadas como definidas, e com necessidade de tratamento eletivo. Essa condição impactou negativamente a qualidade de vida relacionada à saúde bucal dos adolescentes, principalmente os aspectos emocionais e sociais. O impacto das oclusopatias em diferentes aspectos da qualidade de vida deve ser considerado na elaboração de estratégias de diagnóstico e tratamento(AU)

Malocclusion represents an important public health problem because it has a high prevalence, possibility of prevention, treatment and promotes significant losses in the life of affected individuals. Thus, it is essential to carry out studies that investigate the distribution, severity and consequences of malocclusions in different populations, aiming to contribute to the development of strategies and public policies that minimize the installation and aggravation of malocclusions. However, it is noted that there is no consensus on which rate of malocclusion is best suited to carry out epidemiological studies, offering complete criteria to classify the presence, severity, and the need for orthodontic treatment. In this context, the present research had as objectives: to carry out a literature review on the rates of malocclusion and to analyze its applications in public health; and to investigate the prevalence, severity and need for treatment of malocclusions and their impact on oral health-related quality of life in 12-year-old adolescents. The review included national and international works published in the databases Pubmed, SciELO, Web of Science, Scopus, Bireme and Embase. The search in the databases considered the period from 1899 to 2019 and used the following terms: public health, epidemiological methods, indexes, epidemiological surveys, preventive dentistry, malocclusion, and orthodontics. Publications on the development and use of malocclusion indexes were included in clinical and epidemiological studies, without restrictions on methodology and language. The titles and abstracts of the articles found were evaluated and the full versions of the eligible publications were obtained for reading and analysis. Fifty-two indices and their variations were identified and, of these, most were intended for individual evaluations, therefore their use in public health was hampered by the requirements of their application, such as the need for specialists, analysis of plaster models, complementary exams such as cephalometric radiographs and photographs, specific equipment, the need for longitudinal monitoring of cases, and exclusively objective or subjective evaluations. The indices showed positive aspects when partially analyzing physical, functional, psychological and social conditions, however, it is still a challenge to find a unanimous index to assess the need for orthodontic treatment and the impacts of malocclusions on the quality of life of individuals, with applicability in public health. The second stage of this research consisted of an observational, cross-sectional, analytical, survey-type study carried out with 453 12- year-old adolescents enrolled in public schools in the city of Araçatuba-SP. Occlusion was assessed using the Dental Aesthetics Index (DAI), while the Child Perceptions Questionnaire11-14 (CPQ11-14) was used to assess oral health-related quality of life. The scores of CPQ11-14 were compared according to gender and presence of malocclusion using the Mann-Whitney test. The analysis according to the severity of the malocclusion was performed using the Kruskal-Wallis test. The correlation between the severity of malocclusion and oral health-related quality of life was assessed based on the results of the DAI and CPQ11-14 scores using the Spearman correlation test. The prevalence of defined or higher malocclusion was 53.86%, while very severe or disabling malocclusion was observed in 18.76% of adolescents. There was a significant positive correlation (r = 0.7006; p <0.0001) between the DAI and CPQ11-14 scores. Adolescents with malocclusions had total CPQ11-14 scores, as well as scores in the emotional and social well-being domains, significantly higher (p <0.05) compared to those without malocclusion. The total score of CPQ11-14 was significantly higher (p = 0.0251) in female adolescents (16.91 + 10.52) compared to male adolescents (14.61 + 9.70). The presence of malocclusions was high, with a predominance of malocclusions classified as defined, and in need of elective treatment. This condition had a negative impact on the quality of life related to the adolescents' oral health, especially the emotional and social aspects. The impact of malocclusions on different aspects of quality of life must be considered when developing diagnostic and treatment strategies(AU)

Study on hearing loss and its relationship with work in pesticide-exposed tobacco growers / Estudo da perda auditiva e a sua relação com o trabalho em fumicultores expostos a agrotóxicos

ABSTRACT The Purpose of this case report is to present four cases of tobacco growers with hearing loss due to occupational exposure to pesticides. A qualitative case study comprising three cases of sensorineural hearing loss with causal nexus (Cases 1, 2 and 4), and one (Case 3) of sensorineural hearing loss compatible with ototoxicity by pesticides, with causal nexus mainly based on minor neuropsychiatric disorders. The sample was composed of rural workers with health problems, in working age, having started working early in life, exposed to various pesticides, including organophosphates. The auditory and neurovegetative symptoms reported were noise discomfort (n = 2), speech perception difficulty (n = 3), dizziness (n = 2), and imbalance (n = 2). The pure-tone audiometry revealed a sensorineural hearing loss in one or more high frequencies, and one of the cases presented alteration in the brainstem auditory evoked potentials. There is evidence, in this study, of an association between hearing loss and work in tobacco growers exposed to pesticides, with peripheral auditory damage in four cases, and central damage in one of them. Thus, the need for a complete audiological evaluation of pesticide-exposed populations is highlighted.

RESUMO O objetivo desse relato de casos clínicos é apresentar quatro casos de fumicultores com perda auditiva devida à exposição laboral a agrotóxicos. Trata-se de um estudo de caso qualitativo, incluindo 3 casos de perda auditiva sensório-neural com nexo causal (Casos 1, 2 e 4) e um caso (Caso 3) de perda auditiva sensório-neural compatível com ototoxidade por agrotóxicos, com nexo baseado, sobretudo, nos transtornos neuropsiquiátricos menores. A casuística foi constituída por trabalhadores rurais com problemas de saúde, em idade produtiva, com início de atividade laboral precoce, expostos a múltiplos agrotóxicos, incluindo os organofosforados. Os sintomas auditivos e neurovegetativos relatados foram: desconforto a sons (n=2), dificuldade de compreender a fala (n=3), tontura (n=2) e desequilíbrio (n=2). A audiometria tonal revelou perda auditiva sensório-neural em uma ou mais frequências altas e um dos casos apresentou alteração no Potencial Evocado Auditivo de Tronco Encefálico. Foi evidenciada associação entre perda auditiva e o trabalho nos fumicultores expostos a agrotóxicos, com danos auditivos periféricos nos quatro casos e dano central em um dos casos, demonstrando a necessidade da avaliação audiológica completa para populações expostas a agrotóxicos.

Hearing prevention program: how speech-language pathologists and audiologists work in the occupational health area / Programa de preservação auditiva: como atuam os fonoaudiólogos da área da saúde do trabalhador

ABSTRACT Objective: to characterize speech-language pathologists/audiologists and their interventions in the occupational health area, regarding the Hearing Prevention Program (HPP). Methods: a cross-sectional, quantitative study with 74 speech-language pathologists/audiologists from several regions of Brazil, working in the areas of Occupational Health and Audiology. The participants answered a questionnaire on their professional and educational profile, as well as on their work related to the HCP components. For data analysis, statistical procedures were used (Chi-Square Test and the test of difference in proportions, at the significance level of 0.05 - 5%), in relation to the variables of gender, age, job position, time since their graduation and academic training in occupational safety and health. Results: the speech-language pathologists/audiologists, mostly women, who reported performing the HPP, were older than 30 years, had specific postgraduate courses, but still had doubts about the Program implementation, they worked for companies with over 1,000 employees, disregarding their employment status, performing interventions, such as: hearing management and guidance on the correct use of ear protectors. Conclusion: a high number of speech-language pathologists in the Occupational Health area have not developed a complete hearing conservation program to this date.

RESUMO Objetivo: caracterizar os fonoaudiólogos e as ações que desenvolvem na área da saúde do trabalhador com relação ao Programa de Preservação Auditiva (PPA). Métodos: estudo quantitativo, transversal, com 74 fonoaudiólogos de diversas regiões do Brasil que trabalham em Saúde do Trabalhador e Audiologia. Os participantes responderam a um questionário sobre seu perfil profissional, formação e atuação em relação aos componentes do PPA. Para a análise dos dados utilizou-se procedimentos estatísticos (teste Qui-Quadrado e o teste de diferença de proporções, ao nível de significância 0,05 - 5%) em relação às variáveis sexo, idade, função, tempo de formado e formação acadêmica em saúde e segurança do trabalho. Resultados: os fonoaudiólogos, a maioria mulheres, que relataram realizar o PPA, tinham idade superior a 30 anos; fizeram cursos de pós-graduação específica, mas ainda apresentavam dúvidas em relação à implantação do Programa; estavam em empresas com mais de 1000 funcionários, independentemente de seu regime de trabalho, realizando ações como: gerenciamento auditivo e orientação sobre utilização correta de protetores auriculares. Conclusão: há ainda um número elevado de fonoaudiólogos na área de Saúde do Trabalhador que não desenvolvem um programa de preservação auditiva na íntegra.

Brainstem Auditory Evoked Potentials in infants aged 1 to 24 months during a hearing health care service

OBJECTIVES: Assessing infants' hearing is of utmost importance, as hearing at this phase is required for the development of oral language. Through hearing, human beings are capable of developing communication. The Brainstem Auditory Evoked Potentials are an indispensable test to diagnose deafness in infants. This study aimed to analyze the results of the Brainstem Auditory Evoked Potentials in children with risk factors for hearing loss. METHODS: This cross-sectional study analyzed the Brainstem Auditory Evoked Potentials in 123 infants aged 1 to 24 months at a hearing health care service. The Vivosonic Integrity V500 equipment, which enabled the child to be awake while the testing was carried out, was used in this study. The data were compared by gestational age and sex, according to the standards suggested in the equipment handbook. RESULTS: A significant difference was verified for age ranges 4 to 6 months, 13 to 15 months (waves I and V), and 7 to 9 months (wave V). The lower values in absolute wave latencies were comparable to data from the equipment handbook, justifying the need for standardization of the screening process. CONCLUSION: There are some differences between the standards in the equipment handbook and those observed in our study. These results will serve as a reference for the standardization of the equipment used in the hearing health care service.

A retomada do processo de implementação da Política Nacional de Educação Permanente em Saúde no Brasil / The resumption of the implementation process of the National Permanent Health Education Policy in Brazil

RESUMO Este trabalho teve por objetivos descrever e analisar as mais recentes iniciativas realizadas, no âmbito da gestão federal, para a implementação e fortalecimento da Política Nacional de Educação Permanente em Saúde (PNEPS). Toma como referencial o ciclo da política pública de Kingdon, descrevendo como se deu a inclusão desse tema na agenda governamental, em 2003, e analisa o conteúdo dos documentos que materializam as propostas da Política. Em seguida, concentra-se na descrição e análise do movimento desencadeado em 2017-2018, com a realização de uma série de eventos regionais, dos quais resultaram a identificação das fragilidades enfrentadas nesse processo de implementação da PNEPS, subsidiando um conjunto de propostas, que referenciam as iniciativas desencadeadas, visando à efetiva implementação da PNEPS no âmbito do Sistema Único de Saúde.

ABSTRACT This work aimed to describe and to analyze the most recent initiatives carried out, within the scope of federal management, for the implementation of the National Permanent Health Education Policy (PNEPS). It takes as reference the Kingdon public policy cycle, describing how the topic was included in the government agenda in 2003, and analyzes the content of the documents that materialize the proposals of the Policy. Subsequently, it focuses on the description and analysis of the movement triggered in 2017-2018, with the accomplishment of a series of regional events, which resulted in the identification of the weaknesses faced in the implementation process of the PNEPS, subsidizing a set of proposals that referenced the initiatives triggered, aiming at the effective implementation of the PNEPS in the scope of the Unified Health System (SUS).

Integralidade do cuidado na atenção à saúde auditiva do adulto no SUS: acesso à reabilitação / Care integrality in adult hearing health service in the Unified Health System: access to rehabilitation

RESUMO Objetivo Caracterizar a indicação e analisar a percepção dos usuários quanto a queixas e benefícios do uso de próteses auditivas concedidas pelo Sistema Único de Saúde (SUS). Métodos Estudo transversal, quantitativo, que analisou 100 usuários de próteses auditivas no retorno inicial após adaptação, em um serviço de média e alta complexidade em saúde auditiva. Foram coletados dados dos prontuários relativos às características da perda auditiva, da seleção e adaptação da prótese auditiva, e do tempo de uso. Foi realizada entrevista para investigar a percepção de queixas e benefícios com o uso da prótese auditiva. Resultados Houve predomínio dos seguintes aspectos: a faixa etária de 66 a 90 anos; Ensino Fundamental incompleto; perda auditiva sensorioneural de graus leve e moderado; ligeira/discreta dificuldade de compreensão da fala. Foram adaptadas 184 próteses, sendo a maioria retroauricular e de Tipo A; o tempo de espera entre a indicação e a adaptação foi entre 33 e 88 dias; o principal benefício da prótese auditiva foi a melhora da compreensão/interação social, e a queixa principal referiu-se a problemas de regulagem. Conclusão A maior parte dos usuários relatou benefícios com a utilização da prótese para a compreensão de fala e a interação social, e a queixa mais referida foi a regulagem.

ABSTRACTPurpose: To characterize the referral and analyze the perception of the users regarding the complaints and benefits of the use of hearing aids granted by the Unified Health System. Methods A cross-sectional, quantitative study that analyzed 100 users of hearing aids in the initial visit after fitting, in a service of medium and high complexity in hearing health. Data were collected from the medical records and analyzed the characteristics of the hearing loss, the selection and fitting of hearing aids and the length of time using them. An interview was carried out to investigate the perception of complaints and benefits with the use of hearing aids. Results Among the users of hearing aids, the age range of 66-90 years was predominant; schooling, incomplete middle school prevailed; mild to moderate sensorineural hearing loss, slight / discreet difficulty understanding speech; 184 prostheses were adapted, the majority of those were retroauricular and Type A; the waiting time between the referral and fitting was between 33-88 days, the main benefit of the hearing aid was the improvement of social understanding / interaction and the main complaint referred to problems of adjustment. Conclusion Most users reported benefits with prosthesis use for speech comprehension and social interaction; the most mentioned complaint was adjustment.

Hearing assessment of neonates at risk for hearing loss at a hearing health high complexity service: an electrophysiological assessment

Introduction: Hearing is the main sensory access in the first years of life. Therefore, early detection and intervention of hearing impairment must begin before the first year of age. Objective: To analyze the results of the electrophysiological hearing assessment of children at risk for hearing loss as part of the newborn hearing screening (NHS). Methods: This is a cross-sectional study held at a hearing health public service clinic located in Brazil, with 104 babies at risks factors for hearing loss referred by public hospitals. A questionnaire was applied to parents, and the auditory brainstem response (ABR) test was held, identifying those with alterations in the results. The outcome of the NHS was also analyzed regarding risk factor, gestational age and gender. Results: Among the 104 subjects,most of them weremale (53.85%), and the main risk factor found was the admission to the neonatal intensive care unit (NICU) for a period longer than 5 days (50.93%). Eighty-five (81.73%) subjects were screened by NHS at the maternity and 40% of them failed the test. Through the ABR test, 6 (5.77%) infants evidenced sensorineural hearing loss, 4 of them being diagnosed at 4months, and 2 at 6 months of age; all of them failed the NHS and had family history and admission atNICU for over 5 days as themost prevalent hearing risks; in addition, familymembers ofall children perceived their hearing impairment. Conclusion: Advances could be observed regarding the age of the diagnosis after the implementation of the NHS held at the analyzed public service clinic (AU)

Hearing risk in motorcycle taxi drivers of a Southern Brazilian city / Risco auditivo em mototaxistas de uma cidade do sul do Brasil

ABSTRACT Objective: to characterize the hearing profile of motorcycle taxi drivers and analyze the risk of their exposure to noise. Methods: a cross-sectional study with 17 motorcycle taxi drivers of a city on the Southern coast of Brazil, in 2008. Noise was measured at workplace and during a standard route. The dose of exposure to noise was calculated, a questionnaire on the perception of auditory and extra-auditory effects was applied and an auditory hearing assessment through threshold tonal audiometry was performed. Results: at workplace, noise was around 73dBA (decibels, A scale), and while commuting, noise was above 100% for a 12-hour working day. Strain and stress/fatigue after work were reported by 58.8% of the subjects and 52.9% of them showed hearing losses, five presenting characteristic noise-induced hearing losses (NIHL). However, the motorcycle taxi drivers did not associate the adverse health effects to the continuous exposure to noise. Conclusion: the motorcycle taxi drivers presented hearing risk, 29% of them presenting hearing alterations with characteristics suggestive of noise-induced hearing loss, which makes the implementation of auditory conservation programs of extremely importance for this class of workers.

RESUMO Objetivo: caracterizar o perfil audiológico de mototaxistas e analisar o risco de suas exposições ao ruído. Métodos: estudo transversal, com 17 mototaxistas de uma cidade no litoral do Sul do Brasil, 2008. Realizou-se a avaliação do ruído no posto de trabalho e durante um trajeto padrão. Calculou-se a dose de exposição ao ruído, aplicou-se um questionário sobre a percepção de efeitos auditivos e extra-auditivos e realizou-se avaliação auditiva por audiometria tonal limiar. Resultados: no posto de trabalho o ruído esteve em torno de 73 dBA (decibéis, escala A) e no trajeto, apresentou dose de ruído superior a 100% para uma jornada de trabalho de 12 horas. A irritabilidade e a fadiga/estresse após o trabalho foi relatada por 58,8% dos sujeitos e 52,9% deles apresentaram perdas auditivas destes, cinco com características de PAIR. Porém, os mototaxistas não relacionaram as consequências à saúde com a exposição contínua ao ruído. Conclusão: os mototaxistas apresentaram risco auditivo e 29% do total pesquisado, alterações auditivas com características sugestivas de perda induzida pelo ruído, o que torna a implantação de Programas de Conservação auditiva de grande valia para esta classe de trabalhadores.

Intervenções educativas voltadas à prevenção de perda auditiva no trabalho: uma revisão integrativa / Educational interventions on prevention of hearing loss at work: an integrative review

Resumo Objetivo: analisar a produção científica sobre intervenções educativas desenvolvidas para a prevenção auditiva de trabalhadores expostos ao ruído. Método: revisão integrativa, descritiva e analítica de produções científicas publicadas no período 2005-2016, em idioma inglês e português, disponíveis nas bases de dados LILACS, MEDLINE, PubMed, SciELO e Google Scholar. Resultados: inicialmente foram identificados 137 artigos e após aplicação dos critérios de inclusão e exclusão, 16 artigos foram selecionados (9 internacionais, 7 nacionais) para análise. As categorias profissionais nos estudos foram: mineiros, operários da construção civil, bombeiros, operários de empresa de equipamentos eletrônicos, agricultores, trabalhadores de frigorífico, teleoperadores, trabalhadores de universidade, pescadores industriais e trabalhadores de empresa alimentícia. A maioria dos estudos visava a mudança de atitude em relação aos protetores auriculares. Os estudos internacionais basearam-se em teoria comportamental e pretendiam aumentar a intenção de uso e a utilização de protetores auriculares; apenas um deles visou a redução do nível de ruído no ambiente de trabalho. Dos estudos nacionais, 3 utilizaram abordagens comportamentais e 4 desenvolveram ações educativas, mas somente 1 referiu metodologia participativa. Conclusão: intervenções educativas focadas apenas na utilização de protetores auriculares mostraram-se insuficientes, indicando a necessidade de ações educativas mais abrangentes e participativas, associadas a medidas de controle ambiental.

Abstract Objective: to analyze the scientific production about educational interventions aimed at prevention of Noise-Induced Hearing Loss at work. Method: descriptive and analytical integrative review of scientific literature published between 2005-2016, in English and Portuguese, available in LILACS, MEDLINE, SciELO, PubMed and Google Scholar. Results: initially, 137 articles were identified; after application of inclusion and exclusion criteria, 16 articles (9 international, 7 national) were selected for analysis. The occupational categories included in the studies were: miners, firefighters, telemarketers, farmers, industrial fishermen, and workers of universities, electronic equipment industry, construction, meat processing, and food companies. Most studies aimed at changing the attitude towards hearing protectors. The international investigations were based on behavioral approaches and had the purpose of increasing intent of use and use of hearing protectors; only one of them was aimed at reducing noise level in the work environment. Among the national studies, three adopted behavioral approaches, and four developed educational activities, but only one mentioned a participatory methodology. Conclusion: educational interventions, which were only focused on the use of hearing protectors, were insufficient, indicating that they must be more comprehensive and participatory, as well as associated with environmental control measures.