Aptidão e conduta dos estudantes de odontologia sobre atendimento de pacientes com deficiência visual e auditiva / Aptitude and conduct of dental students on the care of patients with visual and hearing impairments

Avaliar a aptidão e conduta de estudantes de Odontologia sobre atendimento de pacientes com de deficiência visual e auditiva. Trata-se de um estudo observacional, do tipo transversal. A coleta de dados foi realizada a partir de um questionário estruturado e a amostra foi constituída por 88 estudantes do 5º, 7º e 9º período, matriculados em alguma disciplina clínica, do curso de Odontologia de uma instituição privada do estado de Pernambuco. Os dados coletados foram tabulados e analisados através de estatística descritiva e inferencial com um nível de significância de 5%. Menos da metade dos estudantes se sente aptos para atender pacientes com essas necessidades, independente do período avaliado. Uma pequena parcela tem algum tipo de contato social/familiar com deficientes visuais e auditivos, mas o fato de possuírem contato, não alterou significativamente a aptidão deste para realizar a consulta. Da mesma forma, possuir informação prévia sobre o tema não influenciou significativamente na aptidão dos estudantes durante o atendimento odontológico. A maioria dos estudantes não se sentem aptos e seguros ao atendimento de pacientes com deficiências visuais e auditivas e que o fato de possuir familiar e/ou parente com esse tipo de deficiência e ter recebido informação prévia sobre o tema não aumenta a segurança dos estudantes.

To evaluate the aptitude and conduct of dentistry students regarding the care of patients with visual and hearing impairments. This is an observational, cross-sectional study. Data collection was carried out using a structured questionnaire and the sample consisted of 88 students from the 5th, 7th and 9th period, enrolled in some clinical discipline, of the Dentistry course at a private institution in the state of Pernambuco. The collected data were tabulated and analyzed using descriptive and inferential statistics with a significance level of 5%. Less than half of the students feel able to care for patients with these needs, regardless of the period evaluated. A small portion has some kind of social/family contact with the visually and hearing impaired, but the fact that they have contact did not significantly change their ability to carry out the consultation. Likewise, having prior information on the subject did not significantly influence the students' aptitude during dental care. Most students do not feel able and safe to care for patients with visual and hearing impairments and that the fact of having a family member and/or relative with this type of disability and having received prior information on the subject does not increase the safety of the students. students.

Atenção à saúde da mulher surda no ciclo gravídico-puerperal: uma revisão de escopo / Health care for deaf women in the puerperal pregnancy cycle: a scoping review / Atención a la salud de mujeres sordas en el ciclo embarazo-puerperal: una revisión del alcance

ResumoObjetivo: identificar e sumarizar as evidências disponíveis na literatura nacional sobre a atenção à saúde da mulher surda no ciclo gravídico-puerperal. Método: Estudo de revisão de escopo, segundo preceitos teóricos metodológicos do Joanna Briggs Institute. A busca foi realizada via periódicos CAPES, nas bases LILACS, MEDLINE via PubMed®, Biblioteca eletrônica SCIELO, WOS e CINAHL. Resultados: Identificaram-se 1.831 estudos, dos quais 12 compuseram a amostra final. As dificuldades na comunicação e ausência de profissionais capacitados em Libras, além de sofrimento, preconceito e discriminação, fazem parte da vivência da mulher surda no ciclo gravídico-puerperal. Conclusão: a produção do conhecimento no âmbito nacional sobre a assistência à mulher surda no período gravídico-puerperal ainda é incipiente e faz-se necessário fomento de estudos e práticas baseadas em evidências para a produção de iniciativas que dialoguem sobre a autonomia e o fortalecimento do exercício dos direitos sexuais e reprodutivos da mulher surda no Brasil.

AbstractObjective: to identify and summarize the evidence available in the national literature on health care for deaf women in the pregnancy-puerperal cycle. Method: Scope review studies according to theoretical and methodological precepts of the Joanna Briggs Institute. The research was performed via CAPES journals, in the bases LILACS; MEDLINE via PubMed®; SCIELO, WOS, and CINAHL electronic library. Results: A total of 1,831 studies were identified, and 12 made up the final sample. Difficulties in communication, and the lack of trained professionals in Libras, in addition to suffering, prejudice, and discrimination, are part of the experience of deaf women in the pregnancy-puerperal cycle. Conclusion: the production of knowledge at the national level about assistance to deaf women in the pregnancy-puerperal period is still leadoff, and encouraging studies and evidence-based practices to produce initiatives that dialogue about the autonomy and strengthening of the exercise of sexual and reproductive rights of deaf women in Brazil is necessary.

ResumenObjetivo: identificar y resumir las evidencias disponibles en la literatura nacional sobre la atención a la salud de la mujer sorda en el ciclo embarazo-puerperio. Método: Estudio de revisión de alcance según preceptos teóricos y metodológicos del Instituto Joanna Briggs. La investigación se realizó en las revistas CAPES, en las bases LILACS; MEDLINE vía PubMed®; Biblioteca electrónica SciELO, WOS y CINAHL. Resultados: se identificaron 1.831 estudios, de los cuales 12 conformaron la muestra final. Las dificultades en la comunicación, la falta de profesionales capacitados en lengua de señas, además de sufrimiento, prejuicio y discriminación son frecuentes en la vivencia de las mujeres sordas en el ciclo puerperal del embarazo. Conclusión: la producción de conocimiento a nivel nacional sobre la atención a las mujeres sordas en el período embarazo-puerperio es aún incipiente, y es necesario incentivar estudios y prácticas basadas en evidencias para producir iniciativas que dialoguen sobre la autonomía y el fortalecimiento del ejercicio de los derechos sexuales y reproductivos de las mujeres sordas en Brasil.

Rapid neurodevelopmental assessment of newborn: a promise to ensure proper growth and development of all newborns in Bangladesh

Background: Neonates are susceptible to neurodevelopmental impairments due to various factors. The aim of the study was to use the n-RNDA tool to identify such impairments in neonates, enabling early interventions for improved outcomes.Methods: This facility-based cross-sectional study was conducted in Square Hospital Child Development Center from April 2019 to Nov 2021 with all neonates between ages of 15-28 days. A total 2928 neonates were enrolled and underwent n-RNDA assessment for detection of any types of neurodevelopmental impairments.Results: Among 2928 enrolled neonates, 8.1% exhibited neurodevelopmental impairments. Majority (60.6%) were from the NICU. Impairments varied across domains, with gross motor skills (99.2%) being most prevalent. Causes included respiratory distress syndrome (74%), sepsis (60%), and others. The study population was primarily urban (99.1%), with 100% parental literacy.Conclusions: The n-RNDA screening program for neonates facilitates early assessment, interventions, and long-term follow-up, potentially enhancing outcomes and quality of life. These findings advocate for policy development to institutionalize n-RNDA for early diagnoses and better outcomes in all neonates.

7. The Employment Landscape and Challenges Facing Healthcare Professionals with Hearing Impairments / 医学教育

Following the amendment of the Exclusionary Clause, there has been an increase in the number of healthcare professionals with hearing impairments actively contributing in various fields, although the total count remains unclear. Drawing from experiences and inquiries received by the Japan Network of Deaf and Hard of Hearing Medical Professionals, this paper examines the current status and challenges faced by these individuals. The work environment for healthcare professionals with hearing impairments is not adequately established, largely relying on individual efforts and trial and error within workplaces. The enrollment of individuals with hearing impairments in higher education institutions aiming for healthcare qualifications remains limited, with educators and mentors often having limited experience in collaborating with individuals with hearing impairments, indicating a lack of understanding. Barriers to training and career advancement persist even after graduation from higher education institutions.　The presence of hearing-impaired healthcare workers is significant to provide medical services to a diverse population. There is a need for the use of text and sign language interpreters, as well as the development of information sharing and support systems, to create a better working environment that accounts for communication needs.

Use of masks in the oral communication of hearing device users / Uso de máscara na comunicação oral para usuários de dispositivos auxiliares à audição

ABSTRACT Purpose: to assess the influence of wearing a mask on auditory-visual speech recognition, in a favorable listening situation, in hearing devices users. Methods: a cross-sectional observational study comprising 52 hearing aid users, whose speech recognition was assessed with six video-recorded lists of sentences with and without masks. The mean test results in the various situations were compared using the Friedman test with Bonferroni post hoc, the significance level being set at 5%. Results: speech recognition assessment results differed between the situations with and without masks and between mask types, with a small effect size. The post hoc, with p-values adjusted with the Bonferroni method, showed a difference between transparent masks and others. The transparent one had a higher mean (77.8%) of auditory-visual sentence recognition between the various situations. There were statistically significant differences, as the transparent mask provided a better performance than the others. Conclusion: the auditory-visual recognition of the hearing-impaired people was better with the transparent mask.

RESUMO Objetivo: avaliar a influência do uso de máscara no reconhecimento auditivo-visual de fala, em situação de escuta favorável, em usuários de dispositivos eletrônicos auxiliares à audição (DEAA). Métodos: estudo observacional transversal. Participaram 52 usuários de dispositivos auxiliares à audição que realizaram avaliação do reconhecimento de fala com seis listas de frases apresentadas em vídeo com e sem máscaras. Para comparar as médias dos resultados do teste nas diferentes situações, foi aplicado o Teste de Friedman, com pos-hoc de Bonferroni e nível de significância 5%. Resultados: houve diferença dos resultados da avaliação de reconhecimento de fala entre as diferentes situações, com e sem máscara, assim como entre os tipos de máscara, com tamanho de efeito de pequeno. O post-hoc, com valor de p ajustado pelo método de Bonferroni, mostrou diferença entre a máscara transparente e as demais. A máscara transparente apresentou maior média (77,8%) do reconhecimento auditivo-visual nas sentenças utilizadas entre as situações. Foram observadas diferenças estatisticamente significantes com desempenho superior da máscara transparente em relação aos outros tipos de máscaras. Conclusão: conclui-se que o reconhecimento auditivo-visual para os deficientes auditivos foi melhor com a máscara transparente.

Associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros: estudo populacional / Association between self-perceived hearing status and cognitive impairment in the older Brazilian population: a population-based study

Resumo Saúde cognitiva é um fator importante para qualidade de vida e a autonomia dos idosos, sendo influenciada pela capacidade auditiva. O objetivo deste artigo é analisar a associação entre autopercepção auditiva e comprometimento cognitivo em idosos brasileiros. Trata-se de um estudo transversal de base populacional com 4.977 idosos que participaram do ELSI Brasil 2015. Comprometimento cognitivo (desfecho, categorizado como sim e não) e a variável de interesse (autopercepção auditiva, categorizada como boa, regular e ruim), ambos obtidos de forma autorreferida. Para a cognição foram considerados os domínios orientação temporal, memória (curto e longo prazo) e linguagem (recente e tardia). Foi utilizada a regressão de Poisson com estimativa de variância robusta para aferir a associação nas análises bruta e ajustada. Variáveis sociodemográficas, de estilo de vida e de histórico clínico foram utilizadas para ajuste das análises. Dos participantes, 31,8% relataram audição regular ou ruim e 42% apresentaram comprometimento cognitivo. Na análise ajustada, idosos com audição ruim apresentaram maior força de associação com comprometimento cognitivo, em comparação com seus pares com audição boa. Em idosos brasileiros, quanto pior a autopercepção auditiva, maior a associação com o comprometimento cognitivo.

Abstract Cognitive health plays an important role in the quality of life and autonomy of older adults. and it is influenced by hearing ability. This article aims to analyze the association between self-perceived hearing status and cognitive impairment in Brazilian older adults. This cross-sectional population-based study was conducted with 4,977 older adults who participated in ELSI Brazil 2015. The cognitive impairment status (outcome. categorized as "yes" and "no") and variable of interest (self-perceived hearing status. categorized as "good" "fair" and "poor") were obtained using a self-report method. The following domains were considered for cognition: temporal orientation. memory (short and long term). and language (recent and late). Poisson regression with robust variance estimation was used to assess the self-perceived hearing status-cognitive impairment association in the crude and adjusted analyses. Sociodemographic. lifestyle. and medical history variables were used to adjust the analyses. We found that 31.8% of the participants reported fair or poor hearing and 42% had cognitive impairment. In the adjusted analysis. older adults with poor hearing were revealed to have a stronger association with cognitive impairment than their peers with good hearing. Therefore. in older Brazilian adults. lower self-perceived hearing status is associated higher levels of cognitive impairment.

Role of Resting Electrocardiography and Transthoracic Echocardiography in the Diagnosis of Cardiac Impairments in Type 2 Diabetics

Background: The cardiac changes associated with diabetes are thought to comprise thickening of the myocardium and is characterized by predominantly diastolic dysfunction (DD), the diabetic cardiomyopathy. So, this study aimed to evaluate cardiac impairments in patients in delta region with type 2 diabetes mellitus using resting electrocardiogram (ECG) and resting transthoracic echocardiography. Methods: This was a cross-sectional study carried out on 50 diabetic patients to evaluate of cardiac impairments in patients in delta region with type 2 diabetes mellitus using resting ECG and resting transthoracic echocardiography at the Department of Cardiology, Tanta University Hospitals in a period of six months starting from January 2020 till June 2020. Results: There were significant negative correlations between abnormal echocardiography with (body mass index) BMI, duration of diabetes and systolic blood pressure (SBP) (P<0.05). The sensitivity of ejection fraction (EF), early trans-mitral flow velocity (E), atrial trans-mitral flow velocity (A) and E/A in detecting cardiac changes in type 2 diabetes mellitus (DM) was 68%, 52%, 76%, 72% and specificity was 52%, 68%, 36%, 30% at cut-off value 65, 75, 65, 77.5 and AUC 0.619, 0.606, 0.538, 0.534, respectively (P> 0.05). Conclusions: The effect of DM on the left ventricular (LV) diastolic function is still controversial. Therefore, they need to be further substantiated, preferably with evidence from extensive longitudinal studies in people with type 2 diabetes representative of type 2 diabetes healthcare populations. Echocardiographic and ECG abnormalities are very common in outpatients with type 2 diabetes. DD is the main cardiac impairment caused by DM.

Protective effects of ginsenosides Rg1 and Rb1 against cognitive impairment induced by simulated microgravity in rats / 中国药理学与毒理学杂志

OBJECTIVE Microgravity exerts several negative effects on the learning and memory of astro-nauts during space flight.Rg1 and Rb1,the key steroidal components of ginseng,have shown potent neuroprotec-tive effects with a high safety profile.The object of the current study is to investigate the influence of Rg1 and Rb1 on simulated microgravity-induced memory and learning dysfunction in the hindlimb suspension(HLS)rat model.METHODS The HLS rats were orally administered Rg1(30 and 60 μmol·kg-1)or Rb1(30 and 60 μmol·kg-1)for four weeks.The Morris water maze test(MWM)and reward operating conditioning reflex test(ROCR)were conducted to evaluate spatial and associative learning and memory.After the behavior tests,the serum and the prefrontal cortex(PFC)were dissected to measure the mechanism.RESULTS Rg1 and Rb1 treatment amelio-rated the cognitive deficits of HLS-exposure rats in MWM and ROCR,reduced reactive oxygen species generation and increased antioxidant enzyme activity.Rg1 and Rb1 also assisted in the recovery of mitochondrial complex Ⅰ(NADH dehydrogenase)activities and Mfn2,and decrea-sed Drp-1 expression.Furthermore,Rg1 and Rb1 reduced the ratio of Bax/Bcl-2 and the expression of cleaved-cas-pase 3,cytochrome c,increased the levels of SYN,PSD95 and activated BDNF-TrkB/PI3K-Akt pathway in the PFC.CONCLUSION Rg1 and Rb1 treatment attenuated cog-nitive deficits induced by HLS,mitigated mitochondrial dysfunction,attenuated oxidative stress,inhibited apopto-sis,and increased the synaptic plasticity,which was partly mediated by the modulation of the BDNF-TrkB/PI3K-Akt signaling.

Prenatal PM2.5 Exposure and Its Association with Neurodevelopmental Impairment in Children: A Narrative Review

Introduction@#Air pollutants, including PM2.5, are an increasing threat to public health. Studies have reported the adverse effect of PM2.5 exposures during pregnancy on neurodevelopment in children. We performed a narrative review using the PubMed, Web of Science, and Scopus databases from 2017 to 2022 using keywords such as prenatal, particulate matter, neurodevelopment, and children. This review aims to identify symptoms of impaired neurodevelopment in children associated with prenatal PM2.5 exposure, the association between the timing of prenatal exposure PM2.5 and symptoms of impaired neurodevelopment in children as well as other factors that may influence the association of prenatal PM2.5 exposure and symptoms of impaired neurodevelopment in children@*Methods@#A total of 25 articles were included in this review. @*Results@#Symptoms of neurodevelopmental impairment associated with prenatal exposure to PM2.5 include language, speech, and communication symptoms; motor skills; behaviour and social skills; memory as well as learning/cognitive symptoms. Neurodevelopmental impairments were associated with exposure to PM2.5 across all three trimesters with impairment in communication and behavioural domains predominating in those exposed during the first trimester.@*Conclusions@#Generally, males were more susceptible to having neurodevelopmental impairment symptoms compared to females. More information regarding the effect of prenatal PM2.5 exposure on neurodevelopmental domains of children will support public health policies that reduce air pollution and improve children’s health.

Screening for neurocognitive deficits in adult populations reliant on toxic cassava as the main source of food

Context and objective. Chronic dietary reliance on improperly processed cyanogenic toxic cassava is widespread in sub-Saharan Africa. The objective of the present study was to screen for neurocognition impairments and daily-life functioning in adults with dietary dependency on cyanogenic cassava as the main source of food. Methods. A cross-sectional design enrolled heads of households (in couples) in the rural district of Kahemba, Democratic Republic of Congo. Participants were screened for neurocognitive impairments using the Community Screening Interview for Dementia (CSID). Detailed neuropsychiatric evaluations were performed and disease entities classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria when applicable. Cassava cyanogenic exposure was ascertained by urinary concentrations of thiocyanate (SCN). Regression models were used to identify predictors of CSID performance at the 0.05 significance level. Results. For hundred and six households (203 couples, mean age 38.4 ± 11. 4 years) were involved. One hundred thirty-six subjects (33.5 %) [69 women and 67 men, mean age 39 ± 14.4 years)] and 13 (3.2 %) [7 women and 6 men, mean age: 32 ± 2.6 years] fulfilled the criteria for mild cognitive impairment (MCI) and Major Neurocognitive disorder (MNCD), respectively. The overall mean urinary concentration of SCN was 949.5+518.3 mol/l after adjusting Context and objective. Chronic dietary reliance on improperly processed cyanogenic toxic cassava is widespread in sub-Saharan Africa. The objective of the present study was to screen for neurocognition impairments and daily-life functioning in adults with dietary dependency on cyanogenic cassava as the main source of food. Methods. A cross-sectional design enrolled heads of households (in couples) in the rural district of Kahemba, Democratic Republic of Congo. Participants were screened for neurocognitive impairments using the Community Screening Interview for Dementia (CSID). Detailed neuropsychiatric evaluations were performed, and disease entities classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria when applicable. Cassava cyanogenic exposure was ascertained by urinary concentrations of thiocyanate (SCN). Regression models were used to identify predictors of CSID performance at the 0.05 significance level. Results. For hundred and six households (203 couples, mean age 38.4 ± 11. 4 years) were involved. One hundred thirty-six subjects (33.5 %) [69 women and 67 men, mean age 39 ± 14.4 years)] and 13 (3.2 %) [7 women and 6 men, mean age: 32 ± 2.6 years] fulfilled the criteria for mild cognitive impairment (MCI) and Major Neurocognitive disorder (MNCD), respectively. The overall mean urinary concentration of SCN was . for age, gender, nutritional status, and history of konzo, neurocognition domain-specific deficits were independently associated with either hypertension or USCN (350mol / l incremental increase in excretion Functional impairments in daily-life activities increased as subjects poorly performed at the CSID screening (Spearman r = - .2, p < 0.01). Conclusion. Neurocognitive deficits in adults are common in Congolese adults relying on cyanogenic cassava as the main source of food. Our study findings warrant further studies to elucidate the overall lifespan brain/behavioral burden and mechanisms of cassava toxicity among adults with dietary dependency on cyanogenic cassava as the main source of food

Eye care utilization among older subjects with visual impairment in Northwest Ethiopia

Purpose: To find out the level of eye care service utilization and its determinants among the elderly visually impaired populations while visiting ophthalmic outreach locations in North Western Ethiopia, 2021. Methods: An ophthalmic outreach-based cross-sectional study was conducted on 852 visually impaired older people. Participants were selected by using a systematic random sampling method from January to July 2021. Data were collected by using an interviewer-administered questionnaire and an ocular examination. The collected data were entered into the Epi Info 7, and analyzed using SPSS 20. A binary logistic regression was fitted. Results: A total of 821 participants, with a response rate of 96.5%, were included in the study. The utilization of eye care services within the past two years prior to the study was 21.1% (95 % CI: 18.2­23.9). Having systemic disease (AOR = 3.2, 95% CI: 1.5­7.0), being a spectacle wearer (AOR = 4.5, 95% CI: 2.0­9.4), having visual impairment at distance (AOR = 2.9; 95% CI: 1.5­5.6), being blind (AOR = 2.9; 95% CI: 1.5­5.6), duration of visual impairment ≤1 year (AOR = 2.5; 95% CI: 1.3­4.9) were all significantly associated. Conclusion: In this study, utilization of eye care services was low. Being visually impaired at distance, being blind, recent onset of visual impairment, being a spectacle wearer, and having systemic disease were all related to the use of eye care services. The commonest barriers to utilization of eye care services were financial scarcity and long distances between eye care facilities.

Effectiveness of educational video on deaf people's knowledge and skills for cardiopulmonary resuscitation: a randomized controlled trial / Efectividad de video educativo sobre conocimiento y habilidad de personas sordas para reanimación cardiopulmonar: ensayo controlado aleatorizado / Efetividade de vídeo educativo no conhecimento e habilidade de surdos para ressuscitação cardiopulmonar: ensaio randomizado controlado

ABSTRACT Objective: To analyze the effectiveness of an educational video on deaf people's knowledge and skills about cardiopulmonary resuscitation. Method: A randomized trial, carried out at three schools with 113 deaf people (control group = 57 and intervention group = 56). After the pre-test, the control group was exposed to the lecture, while the intervention group was exposed to the video. The post-test occurred immediately after the intervention and was repeated after 15 days. A validated instrument was used, with 11 questions, presented in video/Libras (to enable understanding by deaf people) and in written/printed form (to record the answers). Results: In the analysis of knowledge, the median of correct answers in the pre-test was similar between the groups (p = 0.635), while the intervention group had a higher accuracy in the immediate post-test (p = 0.035) and after 15 days (p = 0.026). In the skill analysis, the median of correct answers in the pre-test was higher in the control group (p = 0.031). There was no difference in the immediate post-test (p = 0.770), and there was a higher accuracy in the intervention group in the post-test after 15 days (p = 0.014). Conclusion: The video proved to be effective in increasing deaf people's knowledge and skills about cardiopulmonary resuscitation. Brazilian Registry of Clinical Trials: RBR-5npmgj.

RESUMEN Objetivo: Analizar la efectividad de un video educativo sobre el conocimiento y la habilidad de las personas sordas acerca de la reanimación cardiopulmonar. Método: Ensayo aleatorizado, realizado en tres escuelas con 113 personas sordas (grupo control = 57 y grupo intervención = 56). Después de la prueba previa, el grupo de control fue expuesto a la conferencia, mientras que el grupo de intervención fue expuesto al video. La posprueba se realizó inmediatamente después de la intervención, y se repitió a los 15 días. Se utilizó un instrumento validado, con 11 preguntas presentadas en video/Libras (para que los sordos comprendan) y en forma escrita/impresa (para registrar las respuestas). Resultados: En el análisis de conocimientos, la mediana de aciertos en la preprueba fue similar entre los grupos (p = 0,635), mientras que el grupo intervención tuvo mayor acierto en la posprueba inmediato (p = 0,035) y después 15 días (p = 0,026). En el análisis de habilidades, la mediana de aciertos en la preprueba fue mayor en el grupo control (p = 0,031). No hubo diferencia en la posprueba inmediato (p = 0,770), y el grupo intervención tuvo más éxito en la posprueba a los 15 días (p = 0,014). Conclusión: El video demostró ser efectivo para aumentar el conocimiento y las habilidades de las personas sordas sobre la reanimación cardiopulmonar. Registro Brasileño de Ensayos Clínicos: RBR-5npmgj.

RESUMO Objetivo: Analisar a efetividade de vídeo educativo no conhecimento e habilidade de surdos acerca da ressuscitação cardiopulmonar. Método: Ensaio randomizado, realizado em três escolas com 113 surdos (grupo controle = 57 e grupo intervenção = 56). Após o pré-teste, o grupo controle foi exposto à aula expositiva, enquanto o grupo intervenção foi exposto ao vídeo. O pós-teste ocorreu imediatamente depois da intervenção, e foi repetido após 15 dias. Foi utilizado instrumento validado, com 11 questões apresentadas em vídeo/libras (para viabilizar compreensão dos surdos) e de forma escrita/impressa (para registro das respostas). Resultados: Na análise do conhecimento, a mediana dos acertos do pré-teste foi semelhante entre os grupos (p = 0,635), enquanto houve maior acerto do grupo intervenção no pós-teste imediato (p = 0,035) e após 15 dias (p = 0,026). Na análise da habilidade, a mediana dos acertos do pré-teste foi maior no grupo controle (p = 0,031). Não houve diferença no pós-teste imediato (p = 0,770), e houve maior acerto do grupo intervenção no pós-teste após 15 dias (p = 0,014). Conclusão: O vídeo mostrou-se efetivo no aumento do conhecimento e habilidade de surdos acerca da ressuscitação cardiopulmonar. Registro Brasileiro de Ensaios Clínicos: RBR-5npmgj.

Criteria to classify degrees of hearing loss and the social protection of people with this disability / Critérios para a classificação do grau da perda auditiva e proteção social de pessoas com essa deficiência

ABSTRACT Purpose: to identify criteria used nationally and internationally to classify degrees of hearing loss, compare them with what is established in the Brazilian law, and discuss possible consequences of such a law on the social protection of people with hearing loss. Methods: a narrative review was conducted to identify the criteria used in this classification, by searching the platforms VHL and PubMed in April 2020. It included primary human research explicitly mentioning the criteria used to classify the degree of hearing loss, published between 2015 and 2019 in English, Spanish, and Portuguese. Literature Review: there is a preference for the four-frequency mean at 0.5, 1, 2, and 4 kHz. The Brazilian law does not follow these criteria, which may pose a barrier to people with hearing loss, hindering their access to social protection programs. Final Considerations: there is no consensus on the best criteria, although the most encompassing ones in hearing assessment predominate - which are not the ones legally used in Brazil. It is necessary to debate the Brazilian legal criteria to ensure existing social rights to part of people with hearing loss in Brazil.

RESUMO Objetivos: identificar critérios adotados nacional e internacionalmente para classificação do grau da perda auditiva, compará-los com o estabelecido na legislação brasileira e discutir as possíveis consequências dessa legislação para a proteção social de Pessoas com Deficiência (PcD) auditiva. Métodos: realizou-se uma revisão narrativa para a identificação dos critérios utilizados nessa classificação. A busca foi realizada em abril de 2020, a partir das plataformas BVS e PUBMED. Foram incluídos estudos publicados entre 2015 e 2019, em inglês, espanhol e português, sobre pesquisas primárias realizadas com seres humanos e menção explícita aos critérios utilizados para a classificação do grau da perda auditiva. Revisão da Literatura: observou-se que há uma predileção pela média entre as frequências de 0,5, 1, 2 e 4 kHz. A legislação brasileira não segue esse critério, o que pode ser uma barreira para o acesso das PcD auditiva aos programas de proteção social. Considerações Finais: não há consenso sobre qual é o melhor critério, todavia há predominância de utilização do considerado mais abrangente para a avaliação auditiva, que não é o legalmente adotado no Brasil. É necessário um debate sobre o critério legal brasileiro, a fim de promover os direitos sociais instituídos para parte das PcD auditiva no Brasil.

Saúde auditiva nas Coordenadorias Regionais de Saúde do estado do Rio Grande do Sul: regulação de acesso, desafios e perspectivas / Hearing health care in the Regional Health Coordinating Bodies in Rio Grande do Sul: access regulation, challenges, and perspectives

RESUMO Objetivo compreender a dinâmica da regulação de acesso, os desafios e as perspectivas da atuação das Coordenadorias Regionais de Saúde do Rio Grande do Sul (CRS/RS) em saúde auditiva. Métodos estudo exploratório, transversal, de natureza censitária e análise descritiva. Envolveu os responsáveis pela regulação dos procedimentos de saúde auditiva nas CRS/RS, entrevistados quanto à formação profissional, identificação dos procedimentos disponíveis e respectiva oferta, sistemática da regulação de acesso e outras ações em saúde auditiva. Resultados participaram 15 profissionais, todas mulheres, de 16 das 18 CRS/RS existentes, entre 30 e 47 anos de idade: 13 fonoaudiólogas e duas fisioterapeutas, graduadas entre 1997 e 2012; 13 possuíam pós-graduação. Sobre a regulação nas CRS/RS, 13 utilizavam o Sistema Nacional de Regulação e três a realizavam manualmente; 12 utilizavam o protocolo disponibilizado pela Secretaria Estadual de Saúde/RS; dez CRS/RS regulavam procedimentos de Triagem Auditiva Neonatal e 16, de avaliação e diagnóstico, bem como de reabilitação. Verificou-se demanda reprimida para todos os procedimentos (maior para reabilitação auditiva) em 12 CRS/RS. Todas as CRS/RS realizavam uma ou mais ações promotoras da saúde auditiva, como vigilância, apoio matricial e atividades de educação em saúde. Conclusão a regulação de acesso em saúde auditiva é realizada de forma qualificada na maioria das CRS/RS. A oferta de procedimentos é insuficiente, sobretudo em reabilitação auditiva, que implica exclusiva atuação fonoaudiológica por meio de tecnologias leves e leve-duras.

ABSTRACT Purpose To understand the dynamics of access regulation, the challenges, and perspectives of the performance of the Regional Health Coordinating Bodies of Rio Grande do Sul (RHCB/RS) in hearing health care. Methods This is an exploratory, cross-sectional, census study and the analysis is descriptive. It involved those responsible for the regulation of hearing health care procedures in RHCB/RS, interviewed about professional training, identification of available procedures and their respective offer, access regulation systematics, and other actions in hearing health care. Results 15 professionals participated, all were women, from 16 of the 18 existing RHCB/RS, aged between 30 and 47; 13 speech-language pathologists and audiologists and two physiotherapists, who graduated between 1997 and 2012; and 13 had post -graduate degrees. Regarding regulation in RHCB/RS, 13 used the National Regulation System and three performed it manually; 12 used the protocol provided by the State Health Department/RS; ten RHCB/RS regulated procedures for Neonatal Hearing Screening and 16 for assessment and diagnosis, as well as auditory rehabilitation. There is a repressed demand for all procedures (greater for auditory rehabilitation) in 12 RHCB/RS. All RHCB/RS performed one or more actions to promote hearing health care such as surveillance, matrix support, and health education. Conclusion The access regulation in hearing health care is performed in a qualified way in most RHCB/RS; the offer of procedures is insufficient, especially in auditory rehabilitation, which includes exclusive speech-language pathologists and audiologists' performance through soft and soft-hard technologies.

Salud sexual y reproductiva en tiempos del COVID-19: accesibilidad de mujeres sordas y con discapacidad auditiva / Access of chilean deaf women to healthcare information and reproductive care

Background: The COVID-19 pandemic threatened the accessibility and response of healthcare systems worldwide. People with disabilities face specific access challenges to healthcare services and to healthcare information in accessible formats. Aim: To explore how deaf women acceded to information and sexual and reproductive health care during the first wave of COVID-19. Material and Methods: Sixty-one women with a median age of 32 years diagnosed with deafness and hearing loss were surveyed using an online questionnaire about access to healthcare information and midwifery care during the COVID-19 pandemic. Results: Forty-nine percent of respondents lived in the Metropolitan Region. Sixty-eight percent of respondents mentioned that information about COVID-19 was not accessible for them. The main source of information that they used to learn about the pandemic were videos made by deaf people available on the internet. Seventy-five percent of women reported that they had not received accessible information about sexual and reproductive health, and 70.0% of women requiring midwife care could not book an appointment. Conclusions: The pandemic generated a crisis in the Chilean healthcare system that demands a new strategy to ensure people's healthcare access. People with disabilities such as those herein studied are marginalized when these new policies are being discussed and implemented. Decision-makers and sexual and reproductive health services must improve their strategies to allow women with disabilities, particularly deaf women gain access.

Cuidado às pessoas com deficiência auditiva sob o olhar do enfermeiro de família

Objetivo: Describir aspectos del cuidado a personas con discapacidad auditiva a partir de la evaluación de enfermeros que trabajan en salud familiar. Método: Estudio piloto exploratorio, cualitativo, descriptivo. La población inicial del estudio fue de 53 individuos, sin embargo, la muestra estuvo conformada por 37 enfermeros, entre egresados y estudiantes del Curso de Especialización en Enfermería en Salud de la Familia, en la Modalidad Residencia. Para el desarrollo de la investigación, el proyecto propuesto fue evaluado por un Comité de Ética en Investigación y aprobado bajo el dictamen número 2.543.278. Resultados: 62,16% de los participantes ha atendido a pacientes con discapacidad auditiva; El 92% informó que este servicio no era plenamente efectivo y solo el 11% mencionó la existencia de recursos que aseguren una atención adecuada; 27% de los participantes no se sintió capaz de brindar asistencia a este público y todos percibieron la necesidad de capacitación para brindar atención a personas con discapacidad auditiva, y la estrategia más citada fue la incorporación de contenidos en la graduación. Conclusión: Este análisis fue responsable de un diagnóstico concluyente de inseguridad, incapacidad de atención y falta de preparación de la propia unidad de salud, lo que apunta a la necesidad de construir y reformular políticas públicas de educación permanente y mantenimiento de ambientes institucionales de salud amigables que garanticen la estructuración de un sistema de servicio decidido para esta población

Objetivo: Descrever aspectos do cuidado às pessoas com deficiência auditiva a partir da avaliação de enfermeiros atuantes na saúde da família. Métodos: Estudo qualitativo, descritivo, exploratório do tipo piloto. A população inicial do estudo era de 53 indivíduos, entretanto, a amostra foi de 37 enfermeiros entre egressos e alunos do Curso de Especialização em Enfermagem em Saúde da Família, na Modalidade Residência. Para o desenvolvimento da investigação, o projeto proposto foi avaliado por um Comitê de Ética em Pesquisa e aprovado sob número de parecer 2.543.278. Resultados: 62,16% dos participantes já atenderam pacientes com deficiência auditiva; 92% relataram que este atendimento não foi totalmente eficaz e apenas 11% mencionaram a existência de recursos que garantiam um atendimento adequado; 27% dos participantes não se sentiam aptos para prestar assistência a este público e todos perceberam a necessidade de qualificação para efetuar o cuidado à pessoa com deficiência auditiva, sendo que a estratégia mais citada foi a incorporação de conteúdos na graduação. Conclusão: Esta análise foi responsável por um diagnóstico conclusivo de insegurança, incapacidade de atendimento e despreparo da própria unidade de saúde, o que aponta para a necessidade de construção e reformulação de políticas públicas de educação permanente e de manutenção de ambientes institucionais de saúde amigáveis que possam garantir a estruturação de um sistema de atendimento resolutivo à esta população.

Objective: To describe aspects of care for people with hearing impairment from the assessment of nurses working in family health. Method: Qualitative, descriptive, exploratory pilot study. The initial population of the study was 53 individuals, however, the sample consisted of 37 nurses, including graduates and students of the Specialization Course in Nursing in Family Health, in the Residence Modality. For the development of the investigation, the proposed project was evaluated by a Research Ethics Committee and approved under opinion number 2.543.278. Results: 62.16% of participants have seen patients with hearing impairment; 92% reported that this service was not fully effective and only 11% mentioned the existence of resources that ensure adequate care; 27% of participants did not feel able to provide assistance to this audience and all perceived the need for qualification to provide care to people with hearing impairment, and the most cited strategy was the incorporation of content in graduation. Conclusion: This analysis was responsible for a conclusive diagnosis of insecurity, incapacity of care and unpreparedness of the health unit itself, which points to the need to build and reformulate public policies for permanent education and maintenance of friendly institutional health environments that guarantee the structuring of a resolute service system for this population.

Políticas de saúde e concepções de surdez e de deficiência auditiva no SUS: um monólogo? / Health policies and definitions of deafness and hearing impairment in the SUS: a monologue? / Políticas de salud y concepciones de sordera y deficiencia auditiva en el SUS: ¿un monólogo?

Duas concepções teóricas são centrais na discussão sobre a deficiência auditiva e a surdez: a orgânico-biológica e a socioantropológica. Elas são fundamentalmente distintas na definição de uma hipotética fronteira da normalidade e no entendimento dos surdos como uma minoria linguística. O objetivo deste trabalho foi o de identificar como essas concepções se expressaram nas políticas de saúde voltadas às pessoas com deficiência auditiva/surdez no Sistema Único de Saúde (SUS). Foi realizada um pesquisa documental com foco nas políticas de saúde voltadas à deficiência auditiva/surdez de 1990 a 2019. Os documentos (n = 185) foram identificados na Biblioteca Virtual em Saúde e no Sistema de Legislação da Saúde. Desses, foram selecionados 11 que versavam sobre normativas de implementação tecnológica ou ação prática na assistência com foco na deficiência auditiva/surdez, os demais tinham caráter fundamentalmente pontual. Os resultados evidenciam que todas as políticas analisadas foram pautadas na concepção orgânico-biológica, pois nenhuma referência às particularidades linguísticas e culturais do surdo foi identificada. Essa lógica pode contribuir para dificultar o acesso dessa população ao sistema de saúde, especialmente ao aumentar a barreira comunicacional. Para que de fato se cumpram os princípios doutrinários do SUS é central que as políticas de saúde incorporem os aspectos socioculturais, refletindo em suas formulações o surdo como um cidadão que apreende o mundo pelas vivências e experiências prioritariamente visuais, no qual a língua de sinais é elemento central.

Two theoretical definitions are central to the discussion on hearing impairment and deafness: the organic/biological definition and the social/anthropological definition. They differ essentially in the definition of a hypothetical boundary of normality and in the understanding of deaf individuals as a linguistic minority. This study aimed to identify how these definitions were expressed in the health policies for persons with hearing impairment/deafness in the Brazillian Unified National Health System (SUS). A document survey was performed with a focus on health policies for hearing impairment/deafness from 1990 to 2019. The documents (n = 185) were identified through the Virtual Health Library and Health Legislation System, 11 of which were selected that dealt with rulings on technological implementation or practical action in care with a focus on hearing impairment/deafness (the rest dealt with specific administrative issues). The results show that all 11 policies were based on the organic/biological conception, since no reference was found to deaf individuals' linguistic and cultural specificities. The logic may hinder access by this population to the health system, especially by increasing the communication barrier. In order to meet the principles of the SUS in practice, it is essential for health policies to incorporate sociocultural aspects, respecting deaf individuals as citizens who interact with the world mainly through their visual experiences, where sign language is a central element.

Dos concepciones teóricas son centrales en la discusión sobre deficiencia auditiva y sordera: la orgánico-biológica y la socio-antropológica. Ambas son fundamentalmente distintas en la definición de una hipotética frontera entre la normalidad y la concepción de los sordos como minoría lingüística. El objetivo de este trabajo fue identificar como ambas concepciones se expresaron en las políticas de salud, dirigidas a las personas con deficiencia auditiva/sordera, en el Sistema Único de Salud (SUS). Se realizó una investigación documental centrada en las políticas de salud, dirigidas a la deficiencia auditiva/sordera de 1990 a 2019. Los documentos (n = 185) se identificaron a partir de la Biblioteca Virtual en Salud y del Sistema de Legislación de la Salud, de estos fueron seleccionados 11, que versaban sobre normativas de implementación tecnológica o acción práctica en la asistencia, centrándose en la deficiencia auditiva/sordera, los demás tenían un carácter fundamentalmente puntual. Los resultados evidencian que todas las políticas analizadas se pautaban por la concepción orgánico-biológica, puesto que no se identificó ninguna referencia a las particularidades lingüísticas y culturales del sordo. Esta lógica puede contribuir a dificultar el acceso de esta población al sistema de salud, especialmente al aumentar la barrera comunicativa. De hecho, para que se cumplan los principios doctrinarios del SUS es central que las políticas de salud incorporen aspectos socioculturales, reflejando en sus formulaciones sobre los sordos un tratamiento donde se les considere ciudadanos, que aprehenden el mundo mediante vivencias y experiencias prioritariamente visuales, en el que la lengua de signos es un elemento central.

Construção de vídeo sobre uso dos preservativos para surdos e ouvintes / Construction of a video about condom use for deaf and hearing people

RESUMO Objetivo: construir tecnologia assistiva, no formato de vídeo, para surdos e ouvintes sobre saúde sexual e o uso do preservativo. Métodos: estudo metodológico constituído das etapas de pré-produção, produção e pós-produção. Na pré-produção construiu-se roteiro, storybord e cenas, seguindo os princípios da Teoria da Aprendizagem de Lev Semenovich Vygotsky. Na produção houve o desenvolvimento da animação e gravação das cenas pelo intérprete de Libras. Na pós-produção ocorreu a edição final do vídeo. Resultados: o vídeo "Preservativo: aprenda a usar corretamente", com duração de nove minutos e 25 segundos discorre sobre o sistema sexual e reprodutivo do homem e da mulher; modo de ação, benefícios e cuidados com o uso do preservativo. Diante da escassez de materiais educativos sobre o tema, empregaram-se recursos de acessibilidade para construir um vídeo para surdos e ouvintes. Conclusão: a construção do vídeo como tecnologia assistiva dirigida aos surdos foi realizada com êxito.

ABSTRACT Objective: to build assistive technology, in video format, for deaf and hearing people about sexual health and condom use. Methods: methodological study consisting of the stages of pre-production, production and post-production. In pre-production we built the script, storyboard and scenes, following the principles of Lev Semenovich Vygotsky's Theory of Learning. In production there was the development of the animation and recording of the scenes by the Libras interpreter. In post-production the final editing of the video took place. Results: the video "Condom: learn to use correctly", lasting nine minutes and 25 seconds discusses the sexual and reproductive system of man and woman; mode of action, benefits and care with the use of condoms. Given the scarcity of educational materials on the subject, accessibility resources were used to build a video for deaf and hearing people. Conclusion: the construction of the video as an assistive technology directed to the deaf was successfully accomplished.

Representações sociais do cuidado à saúde de pessoas surdas por profissionais de saúde / Social representation of health care for deaf people by health professionals

Profissionais de saúde pouco conhecem sobre a comunidade surda e suas necessidades de saúde. Crenças baseadas em senso comum podem influenciar nas concepções sobre este grupo, com consequências no processo de cuidar. Nesse sentido, conhecer as representações sociais dos profissionais de saúde sobre o cuidado às pessoas surdas e as potenciais repercussões no cuidado à saúde pode contribuir com novos atos de cuidar, implementação de políticas públicas de inclusão social e de formação no campo da saúde. Para isso, foi desenvolvida uma pesquisa de caráter qualitativo, com aplicação da Teoria das Representações Sociais em sua abordagem processual. Realizou-se entrevista em profundidade com 37 profissionais de saúde de um hospital em Rondônia, dentre eles enfermeiros, médicos, fisioterapeutas e técnicos de enfermagem. Os dados oriundos da entrevista em profundidade foram analisados por meio do Alceste 2012 e os provenientes do instrumento de caracterização dos participantes foram submetidos à análise estatística. No material não aproveitado pela análise lexical realizada pelo Alceste aplicou-se análise de conteúdo temático-categorial. Como resultados, após a rodagem no software, o corpus dividiu-se em três classes. O Bloco 1 abrangeu a Classe 1 a qual resultou no tema "Cuidado ao surdo no serviço de saúde: um clamor silenciado", que apresenta representações sociais do cuidado à saúde da pessoa surda, sua dimensão simbólica, associada a interdição da comunicação, afetiva, demonstrando sofrimento, angústia e receio em atender usuários surdos, comportamental, ao se afastarem, evitarem atender ou dedicando mais tempo e atenção durante o cuidado e atitudinal, em que os profissionais se utilizavam de seu arsenal de estratégias na tentativa de estabelecer comunicação durante o atendimento, seja por meio de leitura labial, acompanhante, português escrito, gestos, dentre outros. O Bloco 2 resultou no tema "Demandas dos profissionais de saúde sobre o cuidado ao surdo" e abrangeu a Classe 2 ­ "O cuidado de agora: o que os profissionais demandam" em que se apontou as necessidades dos profissionais para atendimento aos surdos situados temporalmente no presente e a Classe 3 ­ "O cuidado do futuro: o que a formação necessita", situada no futuro, no que pode ser feito durante a formação do cidadão e do profissional de saúde para melhoria da inclusão social de pessoas surdas na sociedade. A partir dos resultados encontrados e da discussão com a literatura, elaborou-se propostas de intervenção para qualificação do cuidado à saúde de pessoas surdas com vistas à acessibilidade nos serviços de saúde, para disciplina de Libras para graduações em saúde e para educação permanente de profissionais de saúde. Conclui-se que a representação do cuidado à saúde do surdo centraliza-se na dificuldade comunicacional entre profissional de saúde e pessoa surda. A abordagem da temática na graduação e em educação permanente são fundamentais para mudança dessa realidade, assim como garantir acessibilidade nas unidades de saúde.

Health professionals understand very little about the deaf community and their health needs. Many beliefs based on common sense can influence the conceptions about this group, with consequences in the care process. In this sense, knowing the social representations of health professionals about the care for deaf people and its potential repercussions on health care can contribute to new acts of care, as well as implementation of public policies for social inclusion and training in the health field. In order to understand this gap, a qualitative research was developed, with application of the Theory of Social Representations in its procedural approach. In-depth interviews were carried out with 37 health professionals from a hospital in Rondônia State, amongt which there were nurses, doctors, physical therapists, and nursing technicians. The data from this in-depth interview were analyzed using Alceste 2012 and the characterization instrument of the participants was submitted to statistical analysis. Thematic content analysis was applied to the material that was not used by the lexical analysis performed by Alceste. As results, after running the software, the corpus was divided into three classes. Class 1 resulted in the theme "Care for the deaf in the health service: a silenced clamor", which presents the social representations of health care for the deaf person, its symbolic dimension, associated with the interdiction of communication, affective, showing suffering, anguish and fear in attending deaf users, as well as behavioral, by moving away, avoiding attending or devoting more time and attention during care and lastly attitudinal, in which professionals used their arsenal of strategies in an attempt to establish communication during care, either through lip reading, companion, written Portuguese, gestures, among other strategies. Block 2 resulted in the theme "Demands of health professionals on deaf care" and included the Class 2 - "The care of now: what professionals demand" in which the needs of professionals for care to the deaf were pointed out, situated temporally in the present and Class 3 - "The care of the future: what training needs", situated in the future, in what can be done during the training of citizens and health professionals to improve the social inclusion of deaf people in society. From the results found and the discussion with the literature, we developed intervention proposals for qualification of health care for deaf people with a view to accessibility in health services, for offering the course of Libras for graduates in health and continuing education for health professionals. It is concluded that the representation of health care for deaf people is centered on the difficulty of communication between health professionals and deaf people. The approach of the theme in undergraduate and continuing education is essential to change this reality, as well as to ensure accessibility in health units.

Los profesionales de la salud conocen poco sobre la comunidad sorda, sus necesidades de salud. Las creencias basadas en el sentido común pueden influir en las concepciones sobre este grupo, con consecuencias en el proceso de cuidado. En este sentido, conocer las representaciones sociales de los profesionales de la salud sobre el cuidado de las personas sordas y las posibles repercusiones en el cuidado de la salud puede, contribuir con nuevos actos de cuidado, implementación de políticas públicas de inclusión social y de formación en el campo de la salud. Para ello, se desarrolló una investigación de carácter cualitativo, con aplicación de la Teoría de las Representaciones Sociales en su enfoque procesal. Se realizó una entrevista en profundidad con 37 profesionales de la salud de un hospital del Estado de Rondônia, Brasil, entre ellos enfermeros, médicos, fisioterapeutas y técnicos de enfermería. Los datos provenientes de la entrevista en profundidad fueron analizados por medio del Alceste 2012 y los procedentes del instrumento de caracterización de los participantes fueron sometidos al análisis estadístico. En el material no aprovechado por el análisis léxico realizado por Alceste se aplicó el análisis contenido temático. Como resultados, después del rodaje en el software, el corpus se dividió en tres clases. La Clase 1 resultó en el tema "Cuidado al sordo en el servicio de salud: un clamor silenciado", que muestra representaciones sociales del cuidado de la salud de la persona sorda, su dimensión simbólica, asociada a la interdicción de la comunicación; afectiva, manifestando sufrimiento, angustia y temor de atender a los usuarios sordos, conductuales, al apartarse, evitar atender o dedicar más tiempo y atención durante el cuidado y actitudinal, en que los profesionales se utilizaban de su arsenal de estrategias en el intento de establecer comunicación durante el atendimiento, sea por medio de lectura labial, acompañante, portugués escrito, gestos, entre otros. El bloque 2 resultó en el tema "Demandas de los profesionales de salud sobre el cuidado al sordo" y abarcó la Clase 2 - "El cuidado de ahora: lo que los profesionales demandan" en donde fueron señaladas las necesidades de los profesionales para atender a los sordos situados temporalmente en el presente y la Clase 3 - "El cuidado del futuro: lo que la formación necesita", situada en el futuro, en lo que se puede hacer durante la formación del ciudadano y del profesional de la salud para mejorar la inclusión social de personas sordas en la sociedad. A partir de los resultados encontrados y de la discusión con la literatura, se elaboraron propuestas de intervención para la calificación del cuidado de la salud de personas sordas con énfasis a la accesibilidad en los servicios de salud, para la asignatura de Libras (Lengua de Señas Brasileña) para carreras del área de la salud y para la educación permanente de profesionales de la salud. Se concluye que la representación del cuidado a la salud del sordo se centra en la dificultad comunicacional entre profesional de salud y persona sorda. El enfoque de la temática en la carrera y en educación permanente son fundamentales para cambiar esa realidad, así como garantizar accesibilidad en las unidades de salud.