Speech-language therapy offer and primary health care in Brazil: an analysis based on socioeconomic development / Oferta de fonoaudiologia e atenção primária em saúde no Brasil: uma análise baseada no desenvolvimento socioeconômico

ABSTRACT Purpose To describe the presence of speech-language therapists (SLT) in the primary health care (PHC) in Brazil and its association with socioeconomic inequalities. Methods Cross-sectional study with 17,157 PHC services in all Brazilian states. Based on the NASF External Assessment Questionnaire sub-item "speech-language therapist", which was used to answer the question "What NASF professionals support your PHC service?", in addition to contextual data (regional population, number of registered SLP, speech therapy college courses, city HDI and Gini Index). Results From all the PHC services supported by NASF, 50.8% (8713/17,157) has SLPs as part of the team. Brazil's Southeast region has the higher prevalence of SLP at the team (57.4%; 5,575). South Region has the lower prevalence (28.9%; 625). The presence of SLP support is directly proportional to HDI stratum and Gini Index (average and high). Conclusion There is an important limitation of public care to treat communication and swallowing disorders in Brazil.

RESUMO Objetivo Descrever a presença de fonoaudiólogos na atenção primária à saúde (APS) no Brasil e sua associação com desigualdades socioeconômicas. Método Estudo transversal com 17.157 serviços de APS em todos os estados brasileiros. Com base no Questionário de Avaliação Externa do NASF utilizou-se o subitem "fonoaudiólogo" para a resposta à pergunta "Que profissionais do NASF apóiam seu serviço de APS?", além disso utilizou-se dados contextuais (população regional, número de fonoaudiólogos registrados, número de faculdades de fonoaudiologia, IDH da cidade e Índice Gini). Resultados De todos os serviços de APS apoiados pelo NASF, 50,8% (871.317.157) tem o fonoaudiólogo como parte da equipe. A região Sudeste do Brasil tem a maior prevalência de fonoaudiólogo na equipe (57,4%; 5.575). A região Sul tem a menor prevalência (28,9%; 625). A presença do suporte fonoaudiológico é diretamente proporcional ao estrato IDH e ao índice de Gini (médio e alto). Conclusão Existe uma importante limitação na oferta dos serviços fonoaudiológicos públicos no Brasil.

Voice challenge in transgender women: trans women self-perception of voice handicap as compared to gender perception of naïve listeners / O desafio da voz na mulher transgênero: autopercepção de desvantagem vocal em mulheres trans em comparação à percepção de gênero por ouvintes leigos

ABSTRACT Purpose: to analyze the self-perception of transgender women's voice handicap in comparison to the voices' gender perception by naïve listeners. Methods: 31 transgender women, who were first submitted to vocal acoustic assessment and had their voices recorded to measure fundamental frequency and standard deviations, were eligible to the study. Next, they answered to the Voice Handicap Index protocol, from which, at the end of data collection, the most suited questions to the daily demands of this population were selected. Subsequently, 50 naïve blindfolded listeners were exposed to the recordings and had to identify the voices as males, females or undefined. Descriptive statistics were applied to speakers' characteristics and the Spearman's correlation coefficient was applied to the protocol scores and the speaker's voice identifications. Results: the mean fundamental frequency found was 172.40 Hz (SD=4.8Hz) and one third of the transgender women reported being satisfied with their voices. A moderate positive significant correlation was found in voices considered as males, and strongly significant and negative in voices considered as females. For the voices considered undefined, however, no significant correlation was found. Conclusion: transgender women's self-perception of voice handicap is directly related to naïve listeners' perception of their voice gender.

RESUMO Objetivo: analisar a autopercepção de desvantagem vocal de mulheres transgêneros em comparação à percepção de gênero das vozes por ouvintes leigos. Métodos: foram eleitas para o estudo 31 mulheres transgêneros. Todas foram submetidas à análise acústica vocal para mensuração da frequência fundamental e desvio padrão. Após, responderam ao protocolo Índice em Desvantagem Vocal, do qual, ao final da coleta de todos os dados, foram selecionadas as questões consideradas mais afeitas às demandas diárias desta população. Subsequentemente, 50 ouvintes leigos foram cegamente expostos às vozes e tiveram de identificar as vozes como sendo masculinas, femininas ou indefinidas. Estatística descritiva foi aplicada para as características das transgêneros e correlação de Spearman para as pontuações do protocolo e a identificação de gênero pelos ouvintes leigos. Resultados: a frequência fundamental média encontrada foi de 172,40 Hz (DP=4,8 Hz) e um terço das transgêneros relatou satisfação com a própria voz. Foi encontrada correlação moderadamente significante e positiva nas vozes consideradas masculinas (rs=0,584; p=0,001) e fortemente significante e negativa nas femininas (rs= -0,605; p<0,001). Não houve correlação significativa com o IDV para as vozes consideradas indefinidas (rs=0,320; p=0,079). Conclusão: a autopercepção de desvantagem vocal em mulheres trans está diretamente relacionada à percepção de gênero por ouvintes leigos.

Dental status, oral prosthesis and chewing ability in an adult and elderly population in southern Brazil

OBJECTIVE: The objective of this study was to explore the factors associated with inadequate chewing in an adult and elderly population of a city in the southern region of Brazil. METHODS: This was a cross-sectional study based on a population home-based inquiry (DCH-POP) in southern Brazil. Individuals were interviewed by trained interviewers to create a standardized procedure. In a pilot study, the Questionnaire of Human Communication Disorders (DCH-POP) was created and validated to identify self-reported speech and language, swallowing and hearing disorders. The outcome was dichotomized into either having adequate chewing or not, as assessed by a series of questions about chewing ability. Analyses of absolute and relative frequencies were measured according to the studied variables. A Poisson regression was applied at a significance level of 5%. RESULTS: A total of 1,246 people were interviewed. Inadequate chewing was found in 52 (5.6%) individuals, with a higher prevalence in the elderly (11.8%) than in adults (5.2%). In the final model, the following factors were associated with inadequate chewing: being 61 years of age or older (prevalence ratio or PR=9.03; 95% CI: 1.20-67.91), loss of teeth and use of unadjusted prosthesis (PR=3.50; 95% CI: 1.54-7.95), preference for foods of soft consistency (PR=9.34; 95% CI:4.66-8.70) and difficulty in nasal breathing (PR=2.82; 95% CI: 1.31-6.06). CONCLUSION: Age, oral health status through dental prosthesis, preference for foods of soft consistency and difficulty breathing through the nose were factors associated with chewing inability in adults and the elderly.