Effect of Speaking Valves on Tracheostomy Decannulation

Abstract Introduction Despite several pediatric tracheostomy decannulation protocols there remains tremendous variability in practice. The effect of tracheostomy capping on decannulation has been studied but the role of speaking valves (SVs) is unknown. Objective Given the positive benefits SVs have on rehabilitation, we hypothesized that SVs would decrease time to tracheostomy decannulation. The purpose of the present study was to evaluate this in a subset of patients with chronic lung disease of prematurity (CLD). Methods A retrospective chart review was performed at a tertiary care children's hospital. A total of 105 patients with tracheostomies and CLD were identified. Data collected included demographics, gestational age, congenital cardiac disease, airway surgeries, granulation tissue excisions, SV and capping trials, tracheitis episodes, and clinic visits. Statistics were performed with logistic and linear regression. Results A total of 75 patients were included. The mean gestational age was 27 weeks (standard deviation [SD] =3.6) and the average birthweight was 1.1 kg (SD = 0.6). The average age at tracheostomy was 122 days (SD = 63). A total of 70.7% of the patients underwent decannulation and the mean time to decannulation (TTD) was 37 months (SD = 19). A total of 77.3% of the patients had SVs. Those with an SV had a longer TTD compared to those without (52 versus 35 months; p = 0.008). Decannulation was increased by 2 months for every increase in the number of hospital presentations for tracheitis (p =0.011). Conclusion The present study is the first, to our knowledge, to assess the effect of SVs on tracheostomy decannulation in patients with CLD showing a longer TTD when SVs are used.

Processo formativo a distância em Segurança Alimentar e Nutricional na Comunidade dos Países de Língua Portuguesa: construindo práticas educativas / Proceso formativo a distancia en Seguridad Alimentaria y Nutricional en la Comunidad de los Países de Lengua Portuguesa: construcción de prácticas educativas / Distance formative process in Food Security and Nutrition in the Community of Portuguese Speaking Countries: building educational practices

Resumo Processos formativos para fortalecer a segurança alimentar e nutricional (SAN) como política são demandas da Comunidade dos Países de Língua Portuguesa (CPLP). Objetivamos descrever e analisar práticas educativas desenvolvidas pelos docentes, visando refletir e propor ajustes para aprimorar o processo formativo a distância em SAN no contexto da CPLP. O curso foi composto por alunos do Brasil; Cabo Verde; Moçambique e São Tomé e Príncipe. A pesquisa é aplicada, teve abordagem qualitativa e natureza descritiva e explicativa, empregando videoaulas como materiais de estudo, principalmente, com base na Análise Textual Discursiva. A proposta indica que cursos de mesma natureza requerem da gestão educacional formação docente; reconhecimento do conhecimento dos discentes; inserção de dialogia nas videoaulas; oferecimento de atividades locais capazes de gerar compreensão da realidade; criação de sequência para elaboração do Trabalho de Conclusão (TCC); e desenvolvimento do TCC visando à transformação da realidade. (AU)

Resumen Procesos formativos para fortalecer la Seguridad Alimentaria y Nutricional (SAN) como política son demandas de la Comunidad de los Países de Lengua Portuguesa (CPLP). El objetivo es describir y analizar prácticas educativas desarrolladas por los docentes, con el objetivo de reflexionar y proponer ajustes para el perfeccionamiento del proceso formativo a distancia en SAN en el contexto de la CPLP (Brasil, Cabo Verde, Mozambique y Santo Tomé y Príncipe). Se realizó la investigación, con abordaje cualitativo y naturaleza descriptiva y explicativa, empleando videoclases como material de estudio, principalmente con base en el Análisis Textual Discursivo. La propuesta indica que cursos de la misma naturaleza demandan de la gestión educativa: formación docente, reconocimiento del conocimiento de los discentes, inserción de dilogía en las videoclases, ofrecimiento de actividades locales capaces de generar comprensión de la realidad, creación de secuencia para elaboración del Trabajo de Conclusión (TCC) y desarrollo del TCC con el objetivo de transformación de la realidad. (AU)

Abstract Formative processes to strengthen Food Security and Nutrition (FSN) are demanded by the Community of Portuguese Speaking Countries (CPLP). Our objective was to describe and analyze the educational practices developed by teachers, aiming to reflect and propose adjustments to improve the distance formative process in FSN in the CPLP context (Brazil, Cape Verde, Mozambique and São Tomé and Príncipe). This is applied research, with a qualitative approach and a descriptive and explanatory nature, using video classes as study material, mainly based on Discursive Textual Analysis. The proposal indicates that courses of the same nature require: teacher education; recognition of students' knowledge; insertion of dialogue in the video lessons; offering local activities capable of generating an understanding of the reality; creation of a sequence for the elaboration of the undergraduate thesis (UT); and writing UTs aimed at transforming reality. (AU)

Carga de Doenças Cardiovasculares Atribuível aos Fatores de Risco nos Países de Língua Portuguesa: Dados do Estudo "Global Burden of Disease 2019" / Burden of Cardiovascular Diseases Attributable to Risk Factors in Portuguese-Speaking Countries: Data from the "Global Burden of Disease 2019" Study

Resumo Fundamento: O impacto dos fatores de risco (FR) sobre a morbimortalidade por doença cardiovascular (DCV) na maioria dos países de língua portuguesa (PLP) é pouco conhecido. Objetivo: Analisar a morbimortalidade por DCV atribuível aos FR e sua variação nos PLP de 1990 a 2019, a partir de estimativas do estudo Global Burden of Disease (GBD) 2019. Métodos: Avaliamos as mudanças nos FR ocorridas no período, as taxas de mortalidade e os anos de vida perdidos por incapacidade (DALYs), padronizados por idade, entre 1990 e 2019. Realizou-se a correlação entre a variação percentual das taxas de mortalidade e o índice sociodemográfico (SDI) de cada PLP pelo método de Spearman. O valor p<0,05 foi considerado estatisticamente significativo. Resultados: A pressão arterial sistólica (PAS) elevada foi o principal fator de risco para mortalidade e DALY por DCV para todos os PLP. A mortalidade por DCV mostrou uma tendência de redução em 2019, maior em Portugal (-66,6%, IC95% -71,0 - -61,2) e no Brasil (-49,8%, IC95% -52,5 - -47,1). Observou-se tendência à correlação inversa entre SDI e a variação percentual da mortalidade, que foi significativa para os riscos dietéticos (r=-0,70, p=0,036), colesterol LDL elevado (r=-0,77, p=0,015) e PAS elevada (r=-0,74, p=0,023). Conclusões: Além da PAS, os FR dietéticos e metabólicos justificaram uma maior variação da carga de DCV, correlacionada com o SDI nos PLP, sugerindo a necessidade de adoção de políticas de saúde adaptadas à realidade de cada país, visando a redução de seu impacto sobre a população.

Abstract Background: The impact of risk factors (RF) on morbidity and mortality from cardiovascular disease (CVD) for most Portuguese-speaking countries (PSC) is little known. Objectives: We aimed to analyze the morbidity and mortality from CVD attributable to RF and its variation, from 1990 to 2019, in PSC, based on estimates from the Global Burden of Disease (GBD) 2019 study. Methods: We evaluated changes in cardiovascular RF, mortality rates and age-standardized disability-adjusted life years (DALYs) between 1990 and 2019. The correlation between percentage changes in mortality rates and the sociodemographic index (SDI) of each PSC was evaluated by the Spearman method. A p-value <0.05 was considered statistically significant. Results: Elevated systolic blood pressure (SBP) was the main RF for mortality and DALYs for CVD for all PSC. Mortality from CVD showed a downward trend in 2019, more accentuated in Portugal (-66.6%, 95%CI -71.0 - -61.2) and in Brazil (-49.8%, 95%CI -52.5 - -47.1). There was a trend towards an inverse correlation between SDI and the percent change in mortality, which was significant for dietary risks (r=-0.70, p=0.036), high LDL cholesterol (r=-0.77, p=0.015) and high SBP (r=-0.74, p=0.023). Conclusions: In addition to SBP, dietary and metabolic RF justified a greater variation in the burden of CVD correlated with SDI in the PSC, suggesting the need to adopt health policies adapted to the reality of each country, aiming to reduce their impact on population.

The effects of transtracheal pressure on the utility of speaking valves in critically ill patients after tracheostomy / 中华物理医学与康复杂志

Objective:To analyze the effect of transtracheal pressure (TTP) on the application of a speaking valve in critically ill patients after tracheostomy.Methods:A retrospective analysis was conducted of 50 patients wearing a speaking valve after tracheostomy. Patients who had been wearing a speaking valve for 30min or more were the tolerance group, while those with less than 30min were the intolerance group. Transtracheal pressure was monitored during resting breathing, forced expiration and speaking. Linear regression models were evaluated to isolate the factors best predicting tolerance. The changes in respiratory muscle contraction before and after wearing a speaking valvs were evaluated using ultrasound. The patients′ satisfaction with wearing a speaking valve was also recorded.Results:TTP during speaking significantly predicted tolerance. The baseline values of diaphragmatic thickening fraction and physical functioning also positively predicted tolerance. Acute physiology and chronic health (APACHE II) score was a significant negative predictor. After wearing the speaking valve, the average contraction of the rectus abdominis, external oblique, internal oblique and transverse abdominis muscles increased significantly. Both groups expressed high satisfaction with the speaking valves.Conclusions:Transtracheal pressure during speaking can help predict the tolerance for wearing a speaking valve among critically ill patients after a tracheostomy. Baseline diaphragmatic thickening fraction, physical functioning and APACHE II score can predict the duration of speaking valve tolerance.

Expresión oral en inglés para el discurso médico en la presentación y discusión de casos

RESUMEN La investigación se desarrolló durante el curso 2019-2020; pertenece al proyecto Desarrollo de la expresión oral en inglés con fines médicos, del departamento de Idiomas de la universidad de Ciencias Médicas de Camagüey. El artículo tiene como objetivo fundamentar la estructura, etapas y acciones de una estrategia didáctica para el desarrollo de la expresión oral en inglés para favorecer el discurso médico durante la presentación real o simulada de casos y su discusión diagnóstica. En su desarrollo se emplearon métodos teóricos, empíricos y matemático-estadísticos. La lógica didáctica que se ofrece en las etapas Exploratoria inicial/perspectiva, Planeación/orientación, Ejecución y Evaluación contribuyen a la autogestión de conocimientos de los estudiantes de 4to año de la carrera Medicina, a la movilización de sus recursos afectivos, cognitivos y procedimentales, para fomentar la ejecución de acciones didácticas lingüístico-estratégicas para el desarrollo de la expresión oral en inglés, como potencialidad para la reinterpretación y reconstrucción personalizada y enriquecedora de significados y sentidos.

ABSTRACT During 2019-2020, the research was developed; it belongs to the project "Development of speaking in English with medical purposes of Language Department of the University of Medical Sciences of Camagüey. The article aims to support the structure, phases and actions of a didactic strategy for the development of speaking to favor medical speech during real or simulated reports of cases and their diagnostic discussion. In the investigation, the theoretical, empirical and mathematical-statistical methods were used. The didactic logic present in the phases Initial/perspective exploration, Planning/orientation, Implementation, and Assessment contributes to knowledge self-management of fourth year medical students, to the use of their emotional, cognitive and procedural sources, to contribute the implementation of linguistic-strategic didactic actions for the development of speaking, in reinterpreting and personal and enriching reconstruction of meaning and sense.

De autonomia roubada ao fortalecimento da profissão: conexões entre Enfermagem Brasileira e Africana / De la autonomía robada al fortalecimiento de la profesión: conexiones entre Enfermería Brasileña y Africana / From stolen autonomy to the strengthening of the profession: connections between the Brazilian and African Nursing

Resumo Objetivo caracterizar os desafios vivenciados pela Enfermagem nos países africanos de língua portuguesa e discutir as potencialidades da cooperação internacional neste contexto. Método estudo qualitativo, descritivo. Dados obtidos por meio de entrevista semiestruturada com enfermeiros de países africanos de língua portuguesa e categorizados por análise de conteúdo. Resultados participaram nove enfermeiros, provenientes dos seguintes países: Angola, Cabo Verde, Guiné-Bissau, Moçambique e São Tomé e Príncipe. Foram desenvolvidas duas categorias: a primeira retrata as dificuldades da Enfermagem de países africanos de língua portuguesa acerca da autonomia e valorização necessárias ao desenvolvimento e exercício de suas competências. A segunda categoria evidenciou possibilidades de conexões a partir de redes para integração e fortalecimento da Enfermagem, em cooperação internacional. Conclusão e implicações para a prática o estudo caracterizou como principais dificuldades aquelas relacionadas a processos de trabalho, falta de autonomia, de estrutura humana e física. Nessa perspectiva, a cooperação internacional representou importante estratégia para o fortalecimento da formação dos enfermeiros de países africanos de língua portuguesa, assim como para lidarem com os expressivos desafios que se apresentam em sua prática cotidiana.

Resumen Objetivo caracterizar los retos vivenciados por la Enfermería en los países africanos de lengua portuguesa y discutir las potencialidades de la cooperación internacional en este contexto. Método estudio cualitativo y descriptivo. Datos recolectados por medio de entrevistas semiestructuradas con enfermeros de países africanos de lengua portuguesa y categorizados por medio de análisis de contenido. Resultados participaron nueve enfermeros de los países: Angola, Cabo Verde, Guiné-Bissau, Mozambique y San Tomé y Príncipe. Fueron desarrolladas dos categorías, una que retrata las dificultades de la Enfermería en los países africanos de lengua portuguesa sobre la autonomía y apreciación necesárias al desarrollo y ejercício de sus competencias. La segunda ha evidenciado posibilidades de conexiones a partir de redes para integración y fortalecimiento de la Enfermería, por medio de la cooperación internacional. Conclusión e implicaciones para la práctica el estudio ha caracterizado como principales dificultades las relacionadas a procesos de trabajo, falta de autonomía, de estructura humana y física. En esa perspectiva, la cooperación internacional ha representado importante estratégia para el fortalecimiento de la formación de enfermeros de países africanos de lengua portuguesa, así como para lidiar con los expresivos retos que se presentan en su práctica cotidiana.

Abstract Aim to characterize the challenges experienced by nurses in Portuguese-speaking African countries and discuss the potential of international cooperation in this context. Method qualitative and descriptive study. Data were collected through semi-structured interviews with nurses from Portuguese-speaking African countries and categorized through content analysis. Results nine nurses participated in the study. They were from the following countries: Angola, Cape Verde, Guinea Bissau, Mozambique and San Tome and Príncipe. Two categories emerged from the results, one focusing on the difficulties of Nursing in Portuguese-speaking African countries regarding the autonomy and appreciation necessary for the development and exercise of its competences. The second evidenced possibilities of connections based on networks for the integration and strengthening of Nursing, through international cooperation. Conclusion and implications for practice the study characterized as main difficulties the ones related to the work process, lack of autonomy, of human and physical structure. Therefore, international cooperation emerged as an important strategy for the capacity building of nurses from Portuguese-speaking African countries, as well as to deal with the huge challenges faced by nurses in their daily activities.

Conocimiento y adaptación de válvulas de habla a traqueostomía por parte de fonoaudiólogos colombianos / Knowledge of colombian speech- language pathologists and adaptation of tracheostomy speaking valves

El propósito de este estudio fue describir el conocimiento que poseen los fonoaudiólogos colombianos acerca de las válvulas de habla y determinar si las emplean como parte del manejo de usuarios con traqueostomía así como las variables que puedan influir en su uso. Para ello, se distribuyó un formulario digital a fonoaudiólogos egresados en Colombia. Las preguntas se agruparon en cinco secciones a partir de las cuales se ajustaron varios modelos lineales generalizados para determinar la influencia de variables como la ciudad, la experiencia profesional, los posgrados, la población, el escenario de atención y la presencia de equipos de traqueostomía en la adaptación de las válvulas. Las preguntas abiertas se analizaron a partir de tendencias temáticas en las respuestas de los participantes. El cuestionario fue respondido por 27 fonoaudiólogos de distintas latitudes con variedad en el nivel posgradual. La totalidad de los encuestados conoce el insumo; de estos, el 66.66% manifestó haber adaptado válvulas y ratifica su beneficio fisiológico. Solo un 33.33% indica que el proceso administrativo para ordenar el insumo fue sencillo. Ninguna de las variables predictoras fue significativa para explicar la adaptación de válvulas de habla (p>0.05). Este estudio plantea que los fonoaudiólogos conocen las válvulas de habla y sus beneficios. Adicionalmente, advierte que las variables estudiadas no tienen influencia significativa en la adaptación del dispositivo. Por último, ratifica que los procesos administrativos relacionados con órdenes médicas y autorizaciones pueden tener un rol desfavorable para lograr acceder a estos insumos

The purpose of this study was to describe the knowledge that Colombian speech-language pathologist have about sepaking valves and to determine whether they use them as part of the management of tracheostomized clients, as well as the variables that may influence their use. To do this, a digital form was distributed to graduated speech therapists in Colombia. The questions were grouped into five sections from which several generalized linear models were adjusted to determine the influence of variables such as city, professional experience, postgraduate degrees, population, setting of care and the presence of tracheostomy teams in the adaptation of the valves. Open questions were analyzed based on thematic trends in the participants' responses. The questionnaire was answered by 27 speech- language pathologists from different latitudes with a variety at the postgraduate level. All of the respondents know the device; of these, 66.66% stated that they had adapted valves and confirmed their physiological benefit. Only 33.33% indicated that the administrative process to order the device was simple. None of the predictor variables was significant to explain the adaptation of speaking valves (p> 0.05). This study suggests that speech- language pathologists are aware of speaking valves and their benefits. Additionally, it warns that the variables studied have no significant influence on the adaptation of the device. Finally, it confirms that the administrative processes related to medical orders and authorizations may play an unfavorable role in gaining access to these supplies.

A experiência das Bibliotecas Virtuais em Saúde nos países de língua portuguesa / The experience of Virtual Health Libraries in Portuguese speaking countries / La experiencia de las Bibliotecas Virtuales de Salud en los países de habla portuguesa

A Biblioteca Virtual de Saúde dos países de língua portuguesa foi desenvolvida para facilitar o acesso à informação científica e técnica para estudantes, docentes e profissionais de saúde dos países envolvidos. O objetivo deste artigo é descrever a criação e o seu desenvolvimento nos países de língua portuguesa por meio da Rede ePORTUGUÊSe da Organização Mundial de Saúde. Utilizou-se uma metodologia qualitativa baseada em revisão da literatura e análise da documentação técnica, científica e administrativa disponível em repositórios públicos internacionais e instituições nacionais, incluindo relatórios do programa ePORTUGUÊSe entre 2005 e 2015. O desenvolvimento e operacionalização da Biblioteca Virtual de Saúde foi gradual e individualizado e fortemente dependente do envolvimento de profissionais e instituições locais. Mudanças nas prioridades políticas e dificuldades econômicas levaram à sua desaceleração. O aumento da conectividade na África e acesso à Internet estão criando novas oportunidades para retomar seu desenvolvimento nos países de língua portuguesa.

The Virtual Health Library of the Portuguese speaking countries was developed to facilitate access to scientific and technical information for students, teachers, and health professionals in the countries involved. This article aims to describe its development in Portuguese-speaking countries through the World Health Organization's ePORTUGUÊSe Network. It was used a qualitative methodology based on literature review and analysis of technical, scientific, and administrative documentation available in international public repositories and national institutions was used, including reports from the ePORTUGUÊSe program between 2005 and 2015. The development and operation of the Virtual Health Library were gradual and individualized and strongly dependent on the involvement of local professionals and institutions. Changes in political priorities and financial difficulties led their development to slow down. The increase in connectivity in Africa and access to the Internet are creating new opportunities to resume its development in Portuguese-speaking countries.

La Biblioteca Virtual en Salud de los países de habla portuguesa fue desarrollada para facilitar el acceso a información científica y técnica para estudiantes, profesores y profesionales de la salud en los países involucrados. El objetivo de este artículo es describir el desarrollo de la Biblioteca Virtual en Salud a través de la Red ePORTUGUÊSe de la Organización Mundial de la Salud. Se utilizó una metodología cualitativa basada en la revisión de la literatura y el análisis de la documentación técnica, científica y administrativa disponible en repositorios públicos internacionales e instituciones nacionales, incluidos los informes del programa ePORTUGUÊSe entre 2005 y 2015. El desarrollo y la operacionalización de la BVS fue individualizado y dependió de la participación de profesionales e instituciones locales. Cambios en las prioridades políticas y las dificultades económicas llevaran a su desaceleración. El aumento de la conectividad e Internet en África están creando nuevas oportunidades para reanudar el desarrollo de la Biblioteca Virtual en Salud.

Planificación de la rehabilitación de la vía aérea superior y la función de la deglución en el paciente con cánula de traqueostomía / Plan for the Rehabilitation of the Upper Airway and Deglutition Function in Patients with a Tracheostomy Cannula

Los sistemas respiratorio, fonatorio y deglutorio actúan de manera coordinada y sincrónica permitiendo el accionar independiente de cada uno de ellos; la cánula de traqueostomía interrumpe la coordinación de este proceso. El motivo por el cual el paciente fue traqueostomizado, las patologías previas del mismo y los diferentes tipos de cánula de traqueostomía hace que no todos los pacientes traqueostomizados se comporten de la misma manera, lo que nos lleva a organizar la rehabilitación desde diferentes puntos de vista: el estructural (cánula de traqueostomía) y el clínico (disfunción en la encrucijada aerodigestiva). Se realizó una revisión narrativa, con el objetivo de conocer la evidencia disponible de las complicaciones por el uso prolongado de la cánula de traqueostomía sobre la función de la vía aérea superior y su posterior rehabilitación. Es considerado de importancia comenzar la rehabilitación de la deglución de manera precoz, siempre que sea posible, para no perder la función deglutoria.

The respiratory, phonatory and deglutitive systems function in a coordinated and synchronized manner, allowing each one of them to operate independently. The tracheostomy cannula interrupts the coordination of this process. Not all tracheostomized patients behave in the same way, it depends on the reason for which they were tracheostomized, their previous diseases and the different types of tracheostomy cannulas, that is why we have to plan their rehabilitation according to different points of view: the structural (tracheostomy cannula) and the clinical (aerodigestive junction dysfunction). A narrative review was carried out for the purpose of studying available evidence about complications in the upper airway caused by prolonged use of tracheostomy cannula, and subsequent rehabilitation. It is important to begin the rehabilitation of deglutition as soon as possible so as not to lose the deglutitive function.

Avaliação da ansiedade de estudantes de psicologia em situações experimentais de falar em público / Evaluation of anxiety in experimental situations of public speaking with psychology students / Evaluación de la ansiedad de estudiantes de psicología en situaciones experimentales de hablar en público

Resumo Durante o percurso no ensino superior, os universitários se deparam com diversas atividades acadêmicas de falar em público (como, por exemplo, apresentações de seminários), que podem ser fortes causadores de ansiedade e afetos negativos, implicando prejuízos significativos para o rendimento acadêmico dos alunos e seus respectivos contextos sociais. Objetivou-se comparar grupos com e sem plateia em relação ao grau de ansiedade vivenciada frente a uma situação experimental de falar em público. Participaram 72 estudantes de psicologia, que foram submetidos ao Teste de Simulação de Falar em Público e responderam ao Inventário de Ansiedade de Beck, Inventário de Habilidades Sociais, Escala de Auto-Avaliação ao Falar em Público e Questionário Sociodemográfico e Ocupacional. Verificou-se que o grupo com plateia apresentou uma redução significativa do nível de ansiedade geral, subjetiva e autonômica após o discurso. Além disso, constatou-se que quanto mais elaborado o repertório de habilidades sociais gerais e de falar em público de um universitário e mais positivas as autoavaliações frente a essa tarefa, menor foi o grau de ansiedade experimentado nessa situação. Sugerem-se novas pesquisas com maior número de universitários, provenientes de diferentes cursos universitários, que permitam examinar as associações entre habilidades sociais, autoavaliações ao falar em público e ansiedade social.

Abstract Throughout the course of higher education, college students are faced with a variety of academic public speaking activities (such as seminar presentations), which can be strong causes of anxiety and negative feelings, leading to significant damage to their academic performance and social contexts. It was aimed to compare groups with and without audience as to the level of anxiety experienced facing an experimental situation of public speaking. 72 psychology students were submitted to the Public Speaking Simulation Test and answered the Beck's Anxiety Inventory, Social Skills Inventory, Public Self Statements During Public Speaking Scale and Sociodemographic and Occupational Questionnaire. It was verified that the group with the audience presented a significant reduction of the level of general, subjective and autonomic anxiety after the speech. Besides, it was found that the more elaborate the general social skills and public speaking repertoire of a student were, as well as more positive self-assessments facing this task, the lower the degree of anxiety undergone in this situation. Further research is suggested with higher number of students, from different courses, allowing the examination and associations between social skills, self-assessment when public speaking and social anxiety.

Resumen Durante su camino en la enseñanza superior, los estudiantes universitarios enfrentan a diversas actividades académicas de hablar en público (como las presentaciones de seminarios), que pueden provocar ansiedad y afectos negativos, causándoles pérdidas significativas en el rendimiento académico y sus respectivos contextos sociales. Se objetivó comparar grupos con y sin audiencia en relación con el grado de ansiedad experimentado frente a una situación experimental de hablar en público. Participaron 72 estudiantes de psicología, que realizaron la Prueba de Simulación de Hablar en Público y respondieron al Inventario de Ansiedad de Beck, el Inventario de Habilidades Sociales, la Escala de Autoevaluación al Hablar en Público y el Cuestionario sociodemográfico y ocupacional. Se verificó que el grupo con audiencia presentó una reducción significativa del nivel de ansiedad general, subjetiva y autonómica después del discurso. Además, se constató que cuanto más elaborado el repertorio de habilidades sociales generales y de hablar en público de un universitario y más positivas las autoevaluaciones frente a esa tarea, menor fue el grado de ansiedad experimentado en la situación. Se sugieren nuevas investigaciones con más universitarios de diferentes cursos para examinar las asociaciones entre habilidades sociales, autoevaluaciones al hablar en público y ansiedad social.

Latin American and Spanish-speaking perspectives on the challenges of global psychiatry

The multi-faceted phenomenon known as globalization has a particular impact on the conceptual and practical development of mental health disciplines in general, and psychiatry in particular, across different world regions. To be theoretically and functionally effective, global psychiatry requires an integration of its different components. To such objective, and after a brief review of continental European and Anglo-Saxon contributions, this article examines the history, characteristics, and contributions of Latin/Iberian American and Spanish-speaking psychiatry, in order to substantiate its role in world psychiatry. The Latin American proper (including Portuguese-speaking Brazil), Spain, and U.S.-based Hispanic components are described, revealing an identity that is based on a humanistic tradition, a value-based, culturally-determined clinical approach to patient care, and a pragmatic adaptation of different treatment resources and techniques. These may constitute supportive elements of an instrumental inter-regional bond in the present and future of our discipline.

Effect of One-way Tracheostomy Speaking Valve on Aspiration of Dysphagia Patients after Tracheotomy for Cerebral Hemorrhage / 中国康复理论与实践

Objective:To investigate the effects of a one-way tracheostomy speaking valve based on neuromuscular electrical stimulation on aspiration in patients with dysphagia after tracheotomy for cerebral hemorrhage. Methods:From January to December, 2018, 37 patients with dysphagia after tracheotomy for cerebral hemorrhage were randomly divided into control group (n = 21) and experimental group (n = 16). Both groups accepted neuromuscular electrical stimulation, while the experimental group was trained to use one-way tracheostomy speaking valve additionally, for three weeks. They were assessed with Functional Oral Food Intake Scale (FOIS) and Penetration-Aspiration Scale (PAS) before and after treatment. Results:The scores of FOIS and PAS improved in both groups after treatment (|Z| > 3.544, P < 0.001), and was better in the experimental group than in the control group (|Z| > 2.094, P < 0.05). Conclusion:One-way tracheostomy speaking valve training based on neuromuscular electrical stimulation could improve swallowing and reduce aspiration of patients with dysphagia after tracheotomy.

Effects of the Passy-Muir speaking valve on tracheotomized patients′ swallowing function after brain damage / 中华物理医学与康复杂志

Objective@#To investigate the effect of a Passy-Muir speaking valve (PMV) on the biomechanics of swallowing and on aspiration among persons tracheotomized after brain damage.@*Methods@#Twenty tracheotomized patients with aspiration after brain injury were selected and randomly divided into a non-PMV intervention group and a PMV intervention group, each of 10. Both groups were given routine swallowing training, while the PMV intervention group was additionally provided with a PMV and trained to use it. The treatment ended when the tracheal tube was removed or after 2 weeks. High-resolution manometry and videofluoroscopy were used to evaluate the maximum pressure in the velopharynx (VP-Max), the maximum post-deglutitive upper esophageal sphincter (UES) pressure (UES-Max) and Rosenbek penetration aspiration (PAS) scores for both groups before and after the treatment.@*Results@#Before the treatment there was no significant difference between the two groups in terms of average VP-Max, UES-Max or PAS score. After the treatment, the average VP-Max and UES-Max had increased significantly in both groups, and the average PAS score of the PMV intervention group had decreased significantly. There was a significant positive correlation between the increases in VP-Max and the decrease in PAS scores.@*Conclusion@#Inserting a PMV can improve velopharynx contraction and post-deglutitive UES among persons tracheotomized after a brain injury. The increase in maximum velopharynx pressure is positively correlated with decreases in aspiration.

Association between Social Skills, Sociodemographic Factors and Self-Statements during Public Speaking by University Students / Associação entre Habilidades Sociais, Fatores Sociodemográficos e Autoavaliações ao Falar em Público de Estudantes Universitários / Asociación entre Habilidades Sociales, Factores Sociodemográficos y Autoevaluaciones al Hablar en Público de Estudiantes Universitarios

Abstract Possessing a good repertoire of interpersonal skills and a good performance when speaking in public can be considered indispensable for the social and academic adaptation of college students. The aim was to characterize and compare the social skills repertoire of college students from different fields of study (the human, exact and biological sciences) and from different higher education institutions (public and private), and to investigate the associations between these abilities and their self-assessment about speaking in public. A total of 818 college students took part, who answered the Social Skills Inventory (IHS-Del-Prette), Self-Statements During Public Speaking Scale and a Socio-demographic and Occupational Questionnaire. The groups did not differ significantly in relation to their social skills' repertoire, with most of the participants (n = 432) having a below-average repertoire of abilities when compared to the normative group of the instrument. It was found that male college students and those who had a partner, a job or their own income, and direct contact with the public gave more positive self-assessments about speaking in public. The skills' classes of self-exposure to strangers and new situations, self-confidence in expressing positive feelings, conversation and social resourcefulness, self-control of aggressivity, and coping and self-confidence with risk, and having a vocational course were the variables that predicted a more positive self-assessment by college students about speaking in public.

Resumo Possuir um bom repertório de habilidades interpessoais e de desempenho ao falar em público pode ser considerado indispensável para a adaptação social e acadêmica dos universitários. Objetivou-se caracterizar e comparar o repertório de habilidades sociais de universitários provindos de diferentes áreas do conhecimento (humanas, exatas e biológicas) e instituições de ensino superior (pública e privada), bem como investigar as associações entre estas habilidades e as autoavaliações ao falar em público. Participaram 818 universitários, que responderam ao Inventário de Habilidades Sociais (IHS-Del-Prette), Escala de Auto-Avaliação ao Falar em Público e um Questionário Sociodemográfico e Ocupacional. Os grupos não diferiram significativamente quanto ao repertório de habilidades sociais, com a maioria dos participantes (n = 432) apresentando um repertório de habilidades abaixo da média em relação ao grupo normativo do instrumento. Verificou-se que os universitários do gênero masculino e aqueles que possuíam um companheiro, trabalho ou renda própria e contato direto com o público apresentavam autoavaliações ao falar em público mais positivas. As classes de habilidades de autoexposição a desconhecidos, autoafirmação na expressão de sentimento positivo, conversação e desenvoltura social, autocontrole da agressividade e enfrentamento e autoafirmação com risco e possuir um curso profissionalizante foram as variáveis preditoras de uma autoavaliação mais positiva dos universitários ao falar em público.

Resumen Poseer un buen repertorio de habilidades interpersonales y de desempeño al hablar en público puede ser considerado indispensable para la adaptación social y académica de los universitarios. Se objetivó caracterizar y comparar el repertorio de habilidades sociales de universitarios provenientes de diferentes áreas del conocimiento (humanas, exactas y biológicas) e instituciones de enseñanza superior (pública y privada), así como investigar las asociaciones entre estas habilidades y las autoevaluaciones al hablar en publico. Participaron 818 universitarios, que respondieron al Inventario de Habilidades Sociales (IHS-Del-Prette), Self Statements During Public Speaking Scale y un Cuestionario Sociodemográfico y Ocupacional. Los grupos no diferían significativamente en cuanto al repertorio de habilidades sociales, con la mayoría de los participantes (n = 432) presentando un repertorio de habilidades por debajo de la media en relación al grupo normativo del instrumento. Se comprobó que los universitarios masculinos y aquellos que tenían un compañero, trabajo, ingresos propios y contacto directo con el público, presentaban autoevaluaciones más positivas al momento de hablar en público. Los tipos de habilidades de autoexposicion a desconocidos, el reconocimiento en la expresión del sentimiento positivo, el diálogo y el desenvolvimiento social, el autocontrol de la agresividad y haber hecho un curso profesional, fueron las variables clave al momento de una auto evaluación positiva de los universitarios al hablar en público.

Behavioral Therapy and Virtual Reality Exposure for Public Speaking Anxiety / Terapia Comportamental e Exposição por Realidade Virtual para Ansiedade de Falar em Público / Terapia Comportamental y Exposición por Realidad Virtual para la Ansiedad de Hablar en Público

Abstract Virtual reality (VR) has been shown to be effective in the treatment of anxiety disorders. The effects of a behavioral intervention procedure that included exposure to VR, diaphragmatic breathing, differential reinforcement, and functional analysis of behavior of participants with public speaking anxiety were investigated. The Virtua Therapy simulator with an Oculus Rift® was used for VR exposure. Six university students participated in the procedure involving the following sequence of sessions: initial interview and baseline measures (3-5), intervention (6), closure (1), follow-up (2). In the baseline sessions, the participants gave a speech in a room without an audience (avatars): in the intervention sessions and follow-up they spoke in a classroom or auditorium with an audience, and verbal consequences (feedback) were provided for appropriate speech pitch and speed. Verbal and non-verbal measures of behaviors were recorded. In the intervention sessions, functional analyses of everyday public speaking situations were performed. There was statistically significant difference in the pre- and post-intervention data in the Self-Statements during Public Speaking Scale (improvement in self-evaluation) and improvement in speech quality. The conclusion was reached that the intervention procedure contributed to the reduction of anxiety.

Resumo A realidade virtual (RV) tem se mostrado eficaz no tratamento de transtornos de ansiedade. Os efeitos de um procedimento de intervenção comportamental que incluiu a exposição à RV, a respiração diafragmática, o reforço diferencial e a análise funcional de comportamentos de participantes com ansiedade de falar em público foram investigados. O simulador Virtua Therapy com um Oculus Rift® foi usado para a exposição à RV. Seis estudantes universitárias participaram do procedimento envolvendo a seguinte sequência de sessões: entrevista inicial e medidas de linha de base (3-5), intervenção (6), encerramento (1), acompanhamento (2). Nas sessões de linha de base, as participantes faziam um discurso em uma sala sem audiência (avatares): em sessões de intervenção e follow-up, elas discursavam em sala de aula ou auditório com audiência, sendo liberadas consequências verbais (feedback) para altura e velocidade apropriadas da fala. Medidas verbais e não verbais dos comportamentos foram registradas. Nas sessões de intervenção, eram realizadas análises funcionais de situações cotidianas de falar em público. Verificou-se diferença estatisticamente significativa nos dados pré e pós-intervenção na Self-Statements during Public Speaking Scale (melhora na autoavaliação) e melhora na qualidade dos discursos. Concluiu-se que o procedimento de intervenção contribuiu para a redução da ansiedade.

Resumen La realidad virtual (RV) se ha mostrado eficaz en el tratamiento de trastornos de ansiedad. Se investigaron los efectos de un procedimiento de intervención comportamental que incluyó exposición a la RV, respiración diafragmática, refuerzo diferencial y análisis funcional de comportamientos de participantes con ansiedad de hablar en público. El simulador Virtua Therapy con un Oculus Rift® se utilizó para la exposición a la RV. Seis estudiantes universitarios participaron del procedimiento con la siguiente secuencia de sesiones: entrevista inicial y línea-de-base (3-5), intervención (6), cierre (1), follow-up (2). En las sesiones de línea-de-base, las participantes hacían un discurso en una sala sin audiencia (avatares): en las sesiones de intervención y follow-up ellas discursaban en sala de aula o auditorio con audiencia, siendo liberadas consecuencias verbales (feedback) para altura y velocidad apropiadas del discurso. Las medidas verbales y no verbales de los comportamientos se registraron. En las sesiones de intervención, se realizaron análisis funcionales de situaciones cotidianas de hablar en público. Se verificó diferencia estadísticamente significativa entre los datos pre y post-intervención en la Self-Statements durante Public Speaking Scale (mejora de la autoevaluación) y mejora en la calidad de los discursos. Se concluyó que el procedimiento de intervención contribuyó a la reducción de la ansiedad.

Cannabidiol presents an inverted U-shaped dose-response curve in a simulated public speaking test

Objective: Cannabidiol (CBD), one of the non-psychotomimetic compounds of Cannabis sativa, causes anxiolytic-like effects in animals, with typical bell-shaped dose-response curves. No study, however, has investigated whether increasing doses of this drug would also cause similar curves in humans. The objective of this study was to compare the acute effects of different doses of CBD and placebo in healthy volunteers performing a simulated public speaking test (SPST), a well-tested anxiety-inducing method. Method: A total of 57 healthy male subjects were allocated to receive oral CBD at doses of 150 mg (n=15), 300 mg (n=15), 600 mg (n=12) or placebo (n=15) in a double-blind procedure. During the SPST, subjective ratings on the Visual Analogue Mood Scale (VAMS) and physiological measures (systolic and diastolic blood pressure, heart rate) were obtained at six different time points. Results: Compared to placebo, pretreatment with 300 mg of CBD significantly reduced anxiety during the speech. No significant differences in VAMS scores were observed between groups receiving CBD 150 mg, 600 mg and placebo. Conclusion: Our findings confirm the anxiolytic-like properties of CBD and are consonant with results of animal studies describing bell-shaped dose-response curves. Optimal therapeutic doses of CBD should be rigorously determined so that research findings can be adequately translated into clinical practice.

Cooperação internacional em saúde do Brasil na era do SUS / Brazilian international cooperation in health in the era of SUS

Resumo O artigo aborda a presença da saúde na diplomacia da saúde e na cooperação internacional do Brasil, desde o surgimento do Sistema Único de Saúde (SUS), com ênfase na cooperação Sul-Sul e em linha com as prioridades da cooperação técnica internacional do país desde então, que enfatiza as relações com países da América Latina e Caribe (ALC) e da Comunidade de Países de Língua Portuguesa (CPLP), particularmente com os Países Africanos de Língua Oficial Portuguesa (PALOP) e Timor Leste. Ressalta os papéis do Ministério da Saúde, por meio da Assessoria Internacional em Saúde (AISA) e da Fundação Oswaldo Cruz (Fiocruz), além da Agência Brasileira de Cooperação (ABC), do Ministério das Relações Exteriores, e da Organização Pan-Americana da Saúde (OPAS). Aponta o papel do Termo de Cooperação TC-41 como um dos principais instrumentos da viabilização da cooperação. Apresenta os casos das redes estruturantes dos sistemas de saúde, assim como as negociações paradigmáticas da Convenção-Quadro sobre Controle do Tabaco, do Acordo TRIPS e da criação da UNAIDS, nos quais o papel da diplomacia brasileira foi preponderante.

Abstract This paper addresses the role of health in Brazil's health diplomacy and international cooperation since the emergence of the Brazilian Unified Health System (SUS), focusing in particular on South-South cooperation, in line with the priorities of the country's international technical cooperation since its creation. It highlights the relationship with the Latin American and Caribbean Countries (LAC) and the Community of Portuguese Speaking Countries (CPLP), more specifically, with the Portuguese Speaking African Countries (PALOP) and East Timor. It emphasizes the roles of the Ministry of Health, through the International Advisory Working Group on Health (AISA) and the Oswaldo Cruz Foundation (Fiocruz), the Brazilian Cooperation Agency (ABC), the Ministry of Foreign Affairs, and the Pan American Health Organization (PAHO). The article points out that the TC-41 Co-operation Agreement is one of the main instruments for enabling cooperation. It presents the cases of the structuring networks of health systems, as well as the paradigmatic negotiations of the Framework Convention on Tobacco Control, the TRIPS Agreement and the establishment of UNITAIDS, in which Brazilian diplomacy had a predominant role.

Establishment and teaching application of an English spoken corpus for traditional Chinese medicine / 国际中医中药杂志

An English spoken mini-corpus for traditional Chinese medicine can be established and used on the basis of data-driving teaching model with teaching procedures of students observation, analysis deduction and oral output to improve students' spoken English. A total of 60 graduate students from international exchange classin pharmacology of Jiangxi University of traditional Chinese Medicine were divided into the control class and the experimental class randomly with 30 students in each class. The control class were taught by traditional teaching methods while the experimental class were taught by teaching method based on corpus data. The study shows there exists significance difference (P<0.05) between the experimental class and the control class and then indicates that the TCM teaching methods based on the corpus plays a positive role on the TCM English.