Validity based on the response processes of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofuncional Clinical History. / Validade baseada nos processos de respostas - Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial.

PURPOSE: Present the step of evidence of validity based on the responses to procedures of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History. METHODS: Study developed according to phonoaudiologic tests validations recommendations. Validity analysis performed based on the process of instrument response. Ten speech therapists, that work on phonoaudiology clinic and/or orofacial myofunctional research on the population with age between 6 to 71 months, participated and applied the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History with those responsible for the children. The speech therapists appraised the instrument applicability via Google®ï¸ electronic forms, containing dichotic and/or multiple-choice questions, and likert scale with space to justify negative answers. The data was tabulated on Microsoft Excel 2016®ï¸ worksheets and analyzed by the content validity index (CVI). The software R Core Team 2022 (Versão 4.2.2) was used. RESULTS: All items from the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History were valid when applied to real contexts. Orofacial Myofunctional Clinic history protocol- IVC 100% in terms of ease of application and filling and usage in professional practice; IVC 90% in terms of usefulness for phonoaudiology clinic. The instructional got IVC 80% in terms of clinic usefulness and 70% regarding to the prior reading necessity to fill the MMBGR Protocol Infants and Preschoolers. CONCLUSION: The Instrucional and Orofacial Myofunctional Clinical History, in the MMBGR Protocol Infants and Preschoolers had its validity proven based on the processes of responses to the usage on phonoaudiology clinic.

OBJETIVO: Apresentar a etapa da evidência de validade baseada nos processos de respostas do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial. MÉTODO: Estudo desenvolvido conforme recomendações para validação de testes em Fonoaudiologia. Realizada análise da validade baseada nos processos de resposta do instrumento. Participaram dez fonoaudiólogos, que atuam em clínica e/ou pesquisa da Motricidade Orofacial com população entre 6 e 71 meses de idade, que aplicaram o Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial junto aos responsáveis pelas crianças. Os fonoaudiólogos emitiram apreciação sobre aplicabilidade do instrumento via formulário eletrônico do Google®, contendo questões dicóticas e/ou múltipla escolha, e escala likert com espaço para justificar respostas negativas. Os dados foram tabulados em planilhas Microsoft Excel 2016® e analisados pelo Índice de Validade de Conteúdo (IVC). Utilizado software R Core Team 2022 (Versão 4.2.2). RESULTADOS: Todos os itens do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial foram válidos na aplicação em contexto real. Protocolo de História Clínica Miofuncional Orofacial - IVC 100% quanto à facilidade de aplicação e preenchimento, e uso na prática profissional; e IVC 90% quanto à utilidade para clínica fonoaudiológica. O Instrutivo obteve IVC 80% quanto à utilidade e 70% referente à necessidade de leitura prévia para preenchimento do Protocolo MMBGR Lactentes e Pré-escolares. CONCLUSÃO: O Instrutivo e o Protocolo História Clínica Miofuncional Orofacial, pertencentes ao protocolo MMBGR ­ Lactentes e Pré-escolares tiveram comprovada validade baseada nos processos de resposta, para uso na clínica fonoaudiológica.

Análise comparativa do desfecho entre pacientes com minoca e infarto agudo do miocárdio tipo 1 / Comparative analysis of the outcome between patients with minoca and type 1 acute myocardial infarction

INTRODUÇÃO: A entidade MINOCA (do inglês: myocardial infarction with non-obstructive coronary arteries) vem sendo tema de diversos estudos desde que o termo foi usado pela primeira vez, em 2013. Trata-se de um infarto agudo do miocárdio (IAM), sem evidência de obstruções coronarianas epicárdicas >50%. Apesar de existir menor associação a fatores de risco cardiovasculares clássicos, ainda não está definido se os desfechos são similares ou de menor gravidade aos encontrados no IAM tipo 1. OBJETIVOS: objetivo primário foi um desfecho composto de morte cardiovascular, IAM não fatal, acidente cerebrovascular (AVC) não fatal e re-hospitalização, avaliados nos grupos MINOCA e infarto tipo 1. Os objetivos secundários foram taxa de re-hospitalização, IAM, AVC e morte intrahospitalares. MÉTODOS: estudo observacional retrospectivo, caso controle aninhado, com análises multivariadas. Foram avaliados 2022 pacientes, no período entre 2018 e 2022. O teste qui-quadrado foi utilizado para avaliar a associação entre variáveis categóricas e, a regressão log-binomial, utilizada para estimar o risco relativo, identificando preditores significativos das variáveis de desfecho. RESULTADOS: pacientes com MINOCA eram significativamente mais jovens (30% x 5,2%), predominantemente do sexo masculino (57,5% x 31,5%), menos propensos a obesidade (17,5% x 72,3%), hipertensão (57,5% x 76,8%) e diabetes (20% x 43,2%). A taxa de reinternação foi menor em pacientes que tiveram MINOCA (10% x 19,7%, p = 0,045). Em relação ao desfecho composto, foi menor em pacientes com MINOCA (15% x 27,8%, p = 0,017). CONCLUSÕES: MINOCA está relacionada a menos reinternação, morte, AVC e IAM não fatais. Não houve diferença estatística entre IAM, AVC e morte intrahospitalares nos grupos estudados.

The Impact of Diabetes Education on Continuous Glucose Monitoring in SUS-Dependent Patients in a Northeastern Brazilian City.

BACKGROUND: Diabetes Mellitus (DM) is an important chronic disease that occurs worldwide. AIMS: This study aims to investigate how the use of the FreeStyle® Libre system in Unified Health System (SUS) patients impacts diabetes parameters in patients who receive education on proper insulin administration and the use of the continuous monitoring device, as well as how this affects patients without any concomitant multidisciplinary support in Sergipe, Brazil. METHODS: We conducted a prospective randomized study in a diabetes clinic in Sergipe, Brazil, using the flash method FreeStyle® Libre (Abbott). The participants were divided into two groups: one receiving diabetes education on CGM (continuous glucose monitoring), while the other did not. Before the intervention, the patient's treatment motivation and quality of life were assessed using a questionnaire, and baseline levels of glycated hemoglobin were measured using high-performance liquid chromatography (HPLC) and the point of care AlereTM Afinion with boronate fixation. We compared first- and second-phase data with respect to glycated hemoglobin, mean interstitial blood glucose, time on and above target for hypoglycemic and hyperglycemic events, and mean hypoglycemic duration. RESULTS: In group A, which received the diabetes education intervention, there was a significant reduction in average HbA1c levels from 8.6% to 7.9% after 3 months (p = 0.001). However, there was no significant difference in average glycemic values. Time above target decreased significantly from 50.62% to 29.43% (p = 0.0001), while time below target decreased from 22.90% to 20.21% (p = 0.002). There was no significant change in the number of hypoglycemic events, but the duration of hypoglycemia decreased significantly from 130.35 min to 121.18 min after 3 months (p = 0.0001). In Group B, there was no significant difference in mean HbA1c levels before (7.07%) and after (7.28%) sensor installation. This group maintained lower HbA1c levels compared to the other group. Average blood glucose levels also remained similar before (148.37 mg/dL) and after (154.65 mg/dL) the intervention. Although the time above the target glucose level increased significantly from 35.94% to 48.17%, the time at target decreased from 50.40% to 37.97%. No significant changes were observed in the time below target, the number of hypoglycemic events, or the duration of hypoglycemia. CONCLUSIONS: Our findings indicate that utilizing continuous glucose monitoring technology can enhance glycemic control, particularly in motivated, educated, low-income patients dependent on the SUS. To achieve positive results with FreeStyle Libre, it is imperative to allocate resources for multidisciplinary support.

Prevalence and Risk Factors for Dysphonia in Preschoolers at Five Years Old in a Capital City in the Northeast of Brazil.

GOALS: Identifying the prevalence and risk factors of childhood dysphonia in children turning 5 years old; and assess the link with the interactional, behavioral, sociodemographic, economic, and biological indicators METHOD: Analytical, transversal, nested within a birth cohort 5 years after its creation. Original cohort biologic data were recovered from the previous database. The current demographic and personal data were acquired from the official health institutions where the individuals were found. We managed to find 371 preschoolers, both sexes, enrolled in 141 public and private schools. Face-to-face interviews were performed with mothers regarding maternal and child health and biological, sociodemographic, economic, interactional-affective, and behavioral indicators. Speech therapists used the Consensus of Auditory-Perceptual Evaluation of Voice authorized for Portuguese for the perceptual-auditory judgment of children's voices. Bivariate and multivariate analyzes of the data were performed. A significance level of 5% (P < 0.05) was considered in all analyses. RESULTS: The prevalence of mild-moderate general dysphonia occurred in 26.4% of the preschoolers assessed with tense, rough, and breathy voice quality; low pitch; strong loudness and laryngeal resonance. There was a contrast between preschoolers with dysphonia, calm temperament, and family income of up to three minimum wages and those without these characteristics. We also have noted that a greater chance of dysphonia occurred in preschoolers with a calm temperament, family income of up to three minimum wages, nocturnal bruxism up to 3 years old and who did not use a pacifier. CONCLUSION: There was a high prevalence of dysphonia at 5 years old. Biological indicators have an impact on voice, while interactional, behavioral, sociodemographic, and economic indicators have a higher impact. There is a great need for investments in prevention, promotion, and vocal treatment to minimize negative socio-educational impacts and provide higher quality of life for children at greater risk for dysphonia.

Validade baseada nos processos de respostas - Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial / Validity based on the response processes of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofuncional Clinical History

RESUMO Objetivo Apresentar a etapa da evidência de validade baseada nos processos de respostas do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial. Método Estudo desenvolvido conforme recomendações para validação de testes em Fonoaudiologia. Realizada análise da validade baseada nos processos de resposta do instrumento. Participaram dez fonoaudiólogos, que atuam em clínica e/ou pesquisa da Motricidade Orofacial com população entre 6 e 71 meses de idade, que aplicaram o Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial junto aos responsáveis pelas crianças. Os fonoaudiólogos emitiram apreciação sobre aplicabilidade do instrumento via formulário eletrônico do Google®, contendo questões dicóticas e/ou múltipla escolha, e escala likert com espaço para justificar respostas negativas. Os dados foram tabulados em planilhas Microsoft Excel 2016® e analisados pelo Índice de Validade de Conteúdo (IVC). Utilizado software R Core Team 2022 (Versão 4.2.2). Resultados Todos os itens do Protocolo MMBGR Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial foram válidos na aplicação em contexto real. Protocolo de História Clínica Miofuncional Orofacial - IVC 100% quanto à facilidade de aplicação e preenchimento, e uso na prática profissional; e IVC 90% quanto à utilidade para clínica fonoaudiológica. O Instrutivo obteve IVC 80% quanto à utilidade e 70% referente à necessidade de leitura prévia para preenchimento do Protocolo MMBGR Lactentes e Pré-escolares. Conclusão O Instrutivo e o Protocolo História Clínica Miofuncional Orofacial, pertencentes ao protocolo MMBGR - Lactentes e Pré-escolares tiveram comprovada validade baseada nos processos de resposta, para uso na clínica fonoaudiológica.

ABSTRACT Purpose Present the step of evidence of validity based on the responses to procedures of the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History. Methods Study developed according to phonoaudiologic tests validations recommendations. Validity analysis performed based on the process of instrument response. Ten speech therapists, that work on phonoaudiology clinic and/or orofacial myofunctional research on the population with age between 6 to 71 months, participated and applied the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History with those responsible for the children. The speech therapists appraised the instrument applicability via Google®️ electronic forms, containing dichotic and/or multiple-choice questions, and likert scale with space to justify negative answers. The data was tabulated on Microsoft Excel 2016®️ worksheets and analyzed by the content validity index (CVI). The software R Core Team 2022 (Versão 4.2.2) was used. Results All items from the MMBGR Protocol Infants and Preschoolers: Instructional and Orofacial Myofunctional Clinical History were valid when applied to real contexts. Orofacial Myofunctional Clinic history protocol- IVC 100% in terms of ease of application and filling and usage in professional practice; IVC 90% in terms of usefulness for phonoaudiology clinic. The instructional got IVC 80% in terms of clinic usefulness and 70% regarding to the prior reading necessity to fill the MMBGR Protocol Infants and Preschoolers. Conclusion The Instrucional and Orofacial Myofunctional Clinical History, in the MMBGR Protocol Infants and Preschoolers had its validity proven based on the processes of responses to the usage on phonoaudiology clinic.

Impact of the Koala Project on clinical outcomes of preterm infants in two maternity hospitals / Impacto do Projeto Coala nos resultados clínicos de pacientes prematuros em duas maternidades

ABSTRACT Objective: To describe the impact of the Koala project (Actively Controlling Target Oxygen) on clinical outcomes in patients born with less than 36 weeks of gestation, in two maternity hospitals, comparing before and after the strategy implementation. Methods: This is an intervention study with 100 preterm infants with gestational age ≤36 weeks, who used oxygen in two maternity hospitals between January 2020 and August 2021. One of the hospitals was a private institution and the other was philanthropic. The goal for the target oxygen saturation with this project was 91-95%. Comparisons between the two stages (before and after the implementation of the project) were made evaluating the outcomes of retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and deaths. The continuous variables were described using mean, median, standard deviation and interquartile interval. The significance level adopted was 5% and the software used was R Core Team 2021 (version 4.1.0). Results: After oxygen control use according to the Koala protocol, there was a significant reduction in the cases of retinopathy of prematurity (p<0.001) and bronchopulmonary dysplasia (p<0.001). There were no deaths in the second stage, and there was a non-significant increase in the absolute number of necrotizing enterocolitis cases. Conclusions: The Koala project seems to be an effective and feasible strategy to reduce adverse situations in the management of premature children, but research with a greater sample is needed.

RESUMO Objetivo: Descrever o impacto do projeto Coala (Controle Ativo de Oxigênio Alvo) nos desfechos clínicos em pacientes nascidos com menos de 36 semanas de gestação, em duas maternidades, comparando antes e depois da implementação da estratégia. Métodos: Trata-se de um estudo de intervenção com cem prematuros vivos, com idade gestacional ≤36 semanas, que utilizaram oxigênio em duas maternidades entre janeiro de 2020 e agosto de 2021. A meta para a saturação de oxigênio alvo com este projeto foi de 91-95%. Comparações entre as duas etapas (antes e depois da implantação do projeto) foram feitas avaliando os desfechos de retinopatia da prematuridade, displasia broncopulmonar, enterocolite necrosante e óbitos. As variáveis contínuas foram descritas por meio de média, mediana, desvio padrão e intervalo interquartil. O nível de significância adotado foi de 5% e o software empregado foi o R Core Team 2021 (versão 4.1.0). Resultados: Observou-se que, após o uso de controle de oxigênio segundo o protocolo Coala, houve redução significativa nos casos de retinopatia da prematuridade (p<0,001) e displasia broncopulmonar (p<0,001). Não houve óbitos na segunda etapa e houve aumento não significativo no número absoluto de casos de enterocolite necrosante. Conclusões: O projeto Coala parece ser uma estratégia eficaz e viável para reduzir situações adversas no manejo de crianças prematuras, mas pesquisas com amostras maiores são necessárias.

Growth and Nutritional Biomarkers in Brazilian Infants with Cow's Milk Allergy at Diagnosis and 18-Month Follow-Up: A Prospective Cohort Study.

Purpose: This study aimed to describe the growth, body protein status, and micronutrient biomarkers of Brazilian infants with cow's milk allergy (CMPA) at baseline and at 18 months of follow-up in comparison with their healthy peers. Methods: Thirty infants with CMPA younger than six months of age were included in this longitudinal study, and their nutritional status was compared with that of 24 non-allergic age-matched children. Anthropometric measurements were used to assess growth, and blood and urine samples were analyzed for protein and micronutrient status. Mixed linear models adjusted for birth weight, socioeconomic status, infant feeding at baseline, weight-for-age, C-reactive protein, serum albumin, micronutrient dietary supplementation, and salt consumption were employed to evaluate the evolution of nutritional parameters throughout the follow-up period. Results: Overall, the mean age of the children at enrolment was 2.9 (standard deviation 1.7) months, and 29 children (53.7%) were male. Infants with CMPA showed a higher prevalence of functional iron depletion (transferrin saturation <20) (p=0.027), lower serum ferritin (p=0.009), and lower urinary iodine (p=0.034) levels than non-allergic children at baseline. Patients with CMPA showed a higher increment in weight-for-age and length-for-age over time than those in the control group (p<0.01). Mixed linear analyses showed a significantly lower increase in serum vitamin B12 (s-B12) (p=0.001) and urinary iodine (p<0.001) concentrations over time compared to the control group. Conclusion: Infants with CMPA on a cow's milk elimination diet had a higher weight and length at 18 months of follow-up but showed signs of inadequate iron, iodine, and B-12 vitamin status.

Orofacial Myofunctional Aspects of Nursing Infants and Preschoolers.

Introduction Clinical assessment in orofacial motricity is required for the speech therapist to diagnose and treat disorders involving the stomatognathic system. Validated tools can help establish a prognosis and outline intervention methods connected to human development. Objective The goal of the present study was to examine the domains of the oromyofunctional assessment of nursing infants and preschoolers according to sex and age group, as well as the application of the MMBGR Protocol - Nursing Infants and Preschool Children. Methods A quantitative technique was used to conduct an analytical and cross-sectional investigation. The present study included a total of 214 healthy breastfeeding infants and preschoolers of both sexes. The Mann-Whitney test was used to compare the medians. The Spearman correlation of each test domain was determined. R Core Team 2021 (R Foundation, Vienna, Austria) was used, and the significance threshold was set at 5%. Results In intraoral and extraoral examinations, there was a difference between sexes for tongue scores in nursing infants (d = - 0.428; p = 0.045), worse in males. When the orofacial functions were considered in nursing infants, there were differences between the sexes for the liquid/solid/semisolid deglutition scores (d = 0.479; p = 0.031), with females performing worse. There were sex differences in solid/semisolid deglutition (d = - 0.335; p = 0.043), and speech in preschoolers (d = - 0.478; p = 0.034), including the production of phones/phonemes (d = - 0.599; p = 0.007), which were always worse in males. Conclusion The research revealed sex disparities and related the domains of oromyofunctional assessment, according to scores, of the domains of myofunctional assessment, as recorded in a standardized oromyofunctional assessment protocol by age group.

Pediatric Dysphonia and the Access to Voice Therapy: A Study in Speech Therapy Services Available in a Capital City in the Northeast of Brazil.

OBJECTIVES: Defining the laryngeal and vocal alterations in the pediatric group studied in private speech therapy facilities; and estimating the time period between the problem being identified by the parents and the access to the proper provided services. METHODS: A cross-sectional analytical observational research with data collected from medical records by the speech therapist of each private facility. A written form was prepared and sent to the speech therapists of the 40 existing facilities. We received 124 of them from the pediatric group being assisted in 15 of the facilities. The form included questions about gender, age, vocal complaints; general degree of dysphonia; otorhinolaryngological diagnosis of vocal fold alterations; the age that the problem was identified by the parents and the beginning of speech therapy. The larynx was examined by videonasopharyngolaryngoscopy, and voice quality by auditory-perceptual assessment. RESULTS: The time period between the identification of the participant's dysphonia by the parents and the start of speech therapy was considered long (3.5years). The group showed variance in the proportion of nodule and cyst between genders. The highest prevalence of nodules occurred in boys; and the cyst in girls. Moderate general dysphonia occurred between 4 and 17years old, average age of 7years and 7months, with greater distribution between 5 and 10years of age. CONCLUSIONS: The average time delay until the start of speech therapy was 3.5years, more frequently in the 5-10years group and due to nodules in boys and cysts in girls.

Impact of the Koala Project on clinical outcomes of preterm infants in two maternity hospitals.

OBJECTIVE: To describe the impact of the Koala project (Actively Controlling Target Oxygen) on clinical outcomes in patients born with less than 36 weeks of gestation, in two maternity hospitals, comparing before and after the strategy implementation. METHODS: This is an intervention study with 100 preterm infants with gestational age ≤36 weeks, who used oxygen in two maternity hospitals between January 2020 and August 2021. One of the hospitals was a private institution and the other was philanthropic. The goal for the target oxygen saturation with this project was 91-95%. Comparisons between the two stages (before and after the implementation of the project) were made evaluating the outcomes of retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and deaths. The continuous variables were described using mean, median, standard deviation and interquartile interval. The significance level adopted was 5% and the software used was R Core Team 2021 (version 4.1.0). RESULTS: After oxygen control use according to the Koala protocol, there was a significant reduction in the cases of retinopathy of prematurity (p<0.001) and bronchopulmonary dysplasia (p<0.001). There were no deaths in the second stage, and there was a non-significant increase in the absolute number of necrotizing enterocolitis cases. CONCLUSIONS: The Koala project seems to be an effective and feasible strategy to reduce adverse situations in the management of premature children, but research with a greater sample is needed.

A higher number of SARS-COV-2 infections in quilombola communities than in the local population in Brazil.

The historical and social vulnerability of quilombola communities in Brazil can make them especially fragile in the face of COVID-19, considering that several individuals have precarious health systems and inadequate access to water. This work aimed to characterize the frequency of SARS-COV-2 infections and the presence of IgM and IgG SARS-CoV-2 antibodies in quilombola populations and their relationship with the presence of risk factors or preexisting chronic diseases in the quilombola communities. We analyzed the sociodemographic and clinical characteristics, serological status, comorbidities, and symptoms of 1,994 individuals (478 males and 1,536 females) from 18 Brazilian municipalities in the State of Sergipe of quilombola communities, which were evaluated at different epidemiological weeks, starting at the 32nd (August 6th) and ending at the 40th (October 3rd) epidemiological week. More than 70% of studied families live in rural areas and they have an extreme poverty social status. Although we found a higher number of SARS-COV-2 infections in quilombola communities than in the local population, their SARS-CoV-2 reactivity and IgM and IgG positivity varied across the communities investigated. Arterial hypertension was the most risk factor, being found in 27.8% of the individuals (9.5% in stage 1, 10.8% in stage 2, and 7.5% in stage 3). The most common COVID-19 symptoms and comorbidities were headache, runny nose, flu, and dyslipidemia. However, most individuals were asymptomatic (79.9%). Our data indicate that mass testing must be incorporated into public policy to improve the health care system available to quilombola populations during a future pandemic or epidemic.

Prevalência de aleitamento materno em pré-termos egressos de uma maternidade no nordeste brasileiro / Prevalence of breastfeeding in preterm infants discharged from a maternity hospital in northeastern Brazil

Objetivo: Analisar a prevalência de aleitamento materno aos seis meses de idade em pré-termos egressos de uma maternidade de referência no Nordeste brasileiro. Materiais e méto-dos: Estudo transversal com análise retrospectiva de dados secundários obtidos de 487 pré-termos, nascidos entre janeiro de 2018 e dezembro de 2019. Resultados:Aamostra foi consti-tuída de 487 recém-nascidos pré-termos, sendo 64,5% pré-termos extremos ou moderados (> 28 a < 34 semanas de idade gestacional); 30,4% prematuros tardios (> 34 e < 37 semanas de idade gestacional); e 5,1% prematuros muito extremos (idade gestacional < 28 semanas). Aprevalência de aleitamento materno aos 6 meses foi de 42,1%, estando o aleitamento materno exclusivo presente nesta idade em apenas 13,8%. Aidade média de interrupção do aleitamen-to materno foi de 4,8 meses. Houve relação de significância estatística entre a duração do aleitamento materno exclusivo e a presença do aleitamento materno aos 6 meses de idade corrigida. Conclusões: Os resultados desta pesquisa evidenciam uma baixa prevalência de aleitamento materno no primeiro ano de vida dos pré-termos egressos da maternidade, com taxa aquém do recomendado pela Organização Mundial da Saúde

Impact of the Koala Project on clinical outcomes of preterm infants in two maternity hospitals / Impacto do Projeto Coala nos resultados clínicos de pacientes prematuros em duas maternidades

ABSTRACT Objective: To describe the impact of the Koala project (Actively Controlling Target Oxygen) on clinical outcomes in patients born with less than 36 weeks of gestation, in two maternity hospitals, comparing before and after the strategy implementation. Methods: This is an intervention study with 100 preterm infants with gestational age ≤36 weeks, who used oxygen in two maternity hospitals between January 2020 and August 2021. One of the hospitals was a private institution and the other was philanthropic. The goal for the target oxygen saturation with this project was 91-95%. Comparisons between the two stages (before and after the implementation of the project) were made evaluating the outcomes of retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and deaths. The continuous variables were described using mean, median, standard deviation and interquartile interval. The significance level adopted was 5% and the software used was R Core Team 2021 (version 4.1.0). Results: After oxygen control use according to the Koala protocol, there was a significant reduction in the cases of retinopathy of prematurity (p<0.001) and bronchopulmonary dysplasia (p<0.001). There were no deaths in the second stage, and there was a non-significant increase in the absolute number of necrotizing enterocolitis cases. Conclusions: The Koala project seems to be an effective and feasible strategy to reduce adverse situations in the management of premature children, but research with a greater sample is needed.

RESUMO Objetivo: Descrever o impacto do projeto Coala (Controle Ativo de Oxigênio Alvo) nos desfechos clínicos em pacientes nascidos com menos de 36 semanas de gestação, em duas maternidades, comparando antes e depois da implementação da estratégia. Métodos: Trata-se de um estudo de intervenção com cem prematuros vivos, com idade gestacional ≤36 semanas, que utilizaram oxigênio em duas maternidades entre janeiro de 2020 e agosto de 2021. A meta para a saturação de oxigênio alvo com este projeto foi de 91-95%. Comparações entre as duas etapas (antes e depois da implantação do projeto) foram feitas avaliando os desfechos de retinopatia da prematuridade, displasia broncopulmonar, enterocolite necrosante e óbitos. As variáveis contínuas foram descritas por meio de média, mediana, desvio padrão e intervalo interquartil. O nível de significância adotado foi de 5% e o software empregado foi o R Core Team 2021 (versão 4.1.0). Resultados: Observou-se que, após o uso de controle de oxigênio segundo o protocolo Coala, houve redução significativa nos casos de retinopatia da prematuridade (p<0,001) e displasia broncopulmonar (p<0,001). Não houve óbitos na segunda etapa e houve aumento não significativo no número absoluto de casos de enterocolite necrosante. Conclusões: O projeto Coala parece ser uma estratégia eficaz e viável para reduzir situações adversas no manejo de crianças prematuras, mas pesquisas com amostras maiores são necessárias.

Perfil dos fonoaudiólogos com formação em motricidade orofacial no Brasil / Profile of speech therapists trained in orofacial myology in Brazil

RESUMO Objetivo Caracterizar o perfil do fonoaudiólogo brasileiro com formação especializada em motricidade orofacial (MO). Métodos Estudo descritivo e exploratório, transversal, de abordagem quantitativa, realizado entre setembro 2022 e fevereiro 2023, com parceria do Conselho Federal de Fonoaudiologia. Participaram 87 fonoaudiólogos com formação em MO. Resultados Evidenciou-se predominância feminina, faixa etária entre 41 e 50 anos e tempo de formação especializada em MO entre 16 e 20 anos; maioria com título de especialista e da Região Sudeste do Brasil, atuando em consultórios/ambulatórios e/ou clínicas, com ações interdisciplinares com Medicina e Odontologia, abrangendo adultos e crianças, principalmente na rede privada. Prevaleceram os domínios da MO quanto à reabilitação de estruturas moles e hábito oral e maior uso de tecnologias: leve - acolhimento e assistência; leve-dura - avaliação e terapia e dura - fotobiomodulação. Conclusão Os fonoaudiólogos brasileiros com formação especializada em MO, participantes do estudo, são, em sua maioria, mulheres com mais de 41 anos de idade, que detêm titulação de especialista, com práticas nos vários domínios e níveis de tecnologia da área, principalmente em diagnóstico e reabilitação dos distúrbios miofuncionais orofaciais.

ABSTRACT Purpose To characterize the profile of Brazilian speech therapists with specialized training in orofacial myology (OM). Methods Descriptive and exploratory, cross-sectional study, with a quantitative approach, carried out between September 2022 and February 2023, in partnership with CFFa. Eighty-seven speech therapists with specialized training in OM participated. Results showed female predominance, age between 41 and 50 years, and time of specialized training in OM between 16-20 years; most with specialist titles in the Southeast of Brazil. Most work in offices/outpatient clinics and/or clinics with interdisciplinary actions with Medicine and Dentistry; seeing adults and children, mainly in a private sector. As to OM domains there was a predominance of rehabilitation of soft structures and oral habits, and most use technologies: light - reception and assistance, light-hard - evaluation and therapy, and hard - photobiomodulation (40.2%). Conclusion The Brazilian speech therapists with specialized training in OM participating in the study are mostly women over 41 years old, who hold the title of specialists, and carry out practices in various domains and levels of technology in the area, with a predominance of diagnosis and rehabilitation of oromyofunctional disorders.

Orofacial Myofunctional Aspects of Nursing Infants and Preschoolers

Abstract Introduction Clinical assessment in orofacial motricity is required for the speech therapist to diagnose and treat disorders involving the stomatognathic system. Validated tools can help establish a prognosis and outline intervention methods connected to human development. Objective The goal of the present study was to examine the domains of the oromyofunctional assessment of nursing infants and preschoolers according to sex and age group, as well as the application of the MMBGR Protocol - Nursing Infants and Preschool Children. Methods A quantitative technique was used to conduct an analytical and cross-sectional investigation. The present study included a total of 214 healthy breastfeeding infants and preschoolers of both sexes. The Mann-Whitney test was used to compare the medians. The Spearman correlation of each test domain was determined. R Core Team 2021 (R Foundation, Vienna, Austria) was used, and the significance threshold was set at 5%. Results In intraoral and extraoral examinations, there was a difference between sexes for tongue scores in nursing infants(d =-0.428; p = 0.045), worse in males. When the orofacial functions were considered in nursing infants, there were differences between the sexes for the liquid/solid/semisolid deglutition scores (d = 0.479; p = 0.031), with females performing worse. There were sex differences in solid/semisolid deglutition (d = -0.335; p = 0.043), and speech in preschoolers (d = - 0.478; p = 0.034), including the production of phones/phonemes (d = - 0.599; p = 0.007), which were always worse in males. Conclusion The research revealed sex disparities and related the domains of oromyofunctional assessment, according to scores, of the domains of myofunctional assessment, as recorded in a standardized oromyofunctional assessment protocol by age group.

MMBRG Protocol - Infants and Preschoolers: Myofunctional Orofacial Clinic Examination. / Protocolo MMBRG ­ Lactentes e Pré-Escolares: Exame Clínico Miofuncional Orofacial.

PURPOSE: To present the Myofunctional Orofacial Clinical Examination Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including its validation. METHODS: Initially, test content-based validity was evaluated from the MBGR Protocol to be used with the age group between 6 and 71 months based on the bibliography and experience between the authors (original and current). For the content and appearance analysis, 10 speech therapists specialized in Orofacial Motricity attended and filled out an electronic form with dichotic and Likert scale questions in two moments. We used the Content Validity Index and the Exact Binomial Test. Then there was a validity based on the response processes analysis followed by a reliability of the Clinical Examination with 155 participants by 7 experienced and calibrated speech therapists, and the examiners between and within agreement was verified by the Intraclass Correlation Coefficient. RESULTS: There were additions, modifications, and exclusions of items according to the age group, resulting in the Myofunctional Orofacial Clinical Examination Protocol for Infants and Preschoolers, which obtained 90.5% agreement; and 100% of the appropriate scores by at least 90% of the specialists. In reliability, most items of the Extraoral and Intraoral Examination and Chewing obtained a reasonable to good, or even excellent, agreement. CONCLUSION: The "Clinical Myofunctional Clinical Examination" was validated based on the test content, response process, and reliability and, along with the "Instructional" and the "Clinical History" is part of the "MMBGR Protocol - Infants and Preschoolers" for speech therapy activities in the age group between 6 and 71 months of age.

OBJETIVO: Apresentar Exame Clínico Miofuncional Orofacial pertencente ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo sua validação. MÉTODO: Inicialmente foi realizada a validade do conteúdo do teste adaptado do Protocolo MBGR, para faixa etária entre 6 e 71 meses, fundamentada na bibliografia e experiência entre autores (originais e atuais). Para análise de conteúdo e aparência participaram 10 fonoaudiólogos especialistas em Motricidade Orofacial, que preencheram formulário eletrônico com questões dicóticas e escala de Likert, em dois momentos. Foi calculado Índice de Validade de Conteúdo e Teste Binomial Exato. Na sequência houve análise da validade baseada nos processos de resposta, seguida da análise da confiabilidade do Exame Clínico, com 155 participantes, por 7 fonoaudiólogos experientes e calibrados, sendo verificada a concordância entre e intra examinadores pelo Coeficiente de Correlação Intraclasse. RESULTADOS: Houve acréscimos, modificações e exclusão de itens conforme faixa etária, concluindo-se o Protocolo Exame Clínico Miofuncional Orofacial para lactentes e pré-escolares, que obteve 90,5% com concordância; e 100% dos escores adequados por pelo menos 90% dos especialistas. Quanto à confiabilidade, a maioria dos itens dos Exames Extraoral e Intraoral e Mastigação obtiveram concordância razoável a boa, ou, até mesmo, excelente. CONCLUSÃO: O "Exame Clínico Miofuncional Orofacial" teve validação baseada no conteúdo do teste, nos processos de resposta e confiabilidade concluída, e junto ao "Instrutivo" e à "História Clínica" integra o "Protocolo MMBGR - Lactentes e Pré-escolares", para atuação fonoaudiológica na faixa etária entre 6 e 71 meses de idade.

Analysis of breast cancer survival in a northeastern Brazilian state based on prognostic factors: A retrospective cohort study.

Breast cancer is a major health problem worldwide. Analysis of breast cancer epidemiology in emerging countries enables assessment of prognostic factors, cancer care quality, and the equity of resource distribution. We aimed to estimate the overall (OS) and cancer-specific survival (SS) of breast cancer patients in the northeastern Brazilian state of Sergipe to identify independent prognostic factors. We analyzed a cohort for the factors age at diagnosis, place of residence, time to treatment, staging, and molecular classification, using the Kaplan-Meier method, log-rank test, Pearson's chi-squared test and Cox regression model. The outcome was the vital status at the end of the study. Our analysis showed an OS probability of 0.72 and an SS probability of 0.75. In multivariate analysis, time to treatment within 60 days, stage IV, and triple-negative classification remained independent prognostic factors for both OS [unadjusted hazard ratio (HRp) 1.50 (1.21; 1.86), HRp 16.56 (8.35; 32.85), and HRp 2.73 (1.73; 4.29), respectively] and SS [HRp 1.43 (1.13; 1.81), HRp 20.53 (9.45; 44.56), and HRp 3.14 (1.88; 5.26), respectively]. Better survival was demonstrated for the following patients: those receiving their first treatment after 60 days, with an OS of 52.5 months (51.2; 53.8) and SS of 53.5 months (52.3; 54.7); stage I patients, with an OS of 58.8 months (57.7; 60.0) and SS of 59.2 months (58.1; 60.3); patients without nodal metastasis, with an OS of 54.2 months (53.0; 55.4) and SS of 55.6 months (54.5; 56.7); and patients with luminal A classification, with an OS of 56.8 months (55.0; 58.5) and SS of 57.8 months (56.2; 59.4). This study identified independent prognostic factors and that OS and SS were lower for patients from Sergipe than for patients in high-income areas. Therefore, determining the profiles of breast cancer patients in this population will inform specific cancer care.

MMBGR Protocol - infants and preschoolers: Instructive and Orofacial Myofunctional Clinical History. / Protocolo MMBRG ­ Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial.

PURPOSE: To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. METHODS: Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. RESULTS: We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. CONCLUSION: "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.

OBJETIVO: Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. MÉTODO: Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. RESULTADOS: Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. CONCLUSÃO: "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.

Protocolo MMBRG - Lactentes e Pré-escolares: Instrutivo e História Clínica Miofuncional Orofacial / MMBGR Protocol - infants and preschoolers: Instructive and Orofacial Myofunctional Clinical History

RESUMO Objetivo Apresentar Instrutivo e Protocolo de História Clínica Miofuncional Orofacial pertencentes ao Protocolo MMBGR - Lactentes e Pré-escolares, incluindo adaptação e validação do conteúdo e aparência destes. Método Estudo tipo validação, descritivo e transversal. Adaptação a partir do Protocolo MBGR, fundamentada em estudos teóricos e experiência dos autores. Considerados lactentes entre 6 e 23 meses de vida e pré-escolares entre 24 e 71 meses. Obtido consentimento e consenso da versão adaptada pelos autores (originais e atuais). Analisados aparência e conteúdo do novo instrumento por 10 fonoaudiólogos especialistas em Motricidade Orofacial. Realizadas duas rodadas de análise: Primeira com formulário eletrônico contendo questões dicóticas (sim/não), com espaço para justificar as respostas negativas; calculado Índice de Validade de Conteúdo e Teste Binomial Exato; e Segunda com escala Likert 5 posições. Resultados Produzido instrutivo inédito e adaptado o Protocolo de História Clínica, com manutenção de 23 itens pertinentes à faixa etária em questão. Excluídas informações em 7 itens e acrescidas em 8 itens. Inicialmente obteve-se concordâncias de 70% do instrutivo, por pelo menos 70% dos especialistas; e 64% dos itens da História Clínica, por ao menos 90% dos especialistas. Obteve-se na segunda rodada 100% de respostas "Concordo totalmente" dos especialistas. Conclusão "Instrutivo" e "História Clínica Miofuncional Orofacial" tiveram validade de conteúdo e aparência concluída, e junto ao "Exame Clínico" integram o "Protocolo MMBGR - Lactentes e Pré-escolares", com potencial contribuição para atuação clínica e na pesquisa em Motricidade Orofacial na faixa etária de 6 meses a 5 anos e 11 meses de idade.

ABSTRACT Purpose To present Myofunctional Orofacial Clinical History Instructive and Protocol belonging to the MMBGR Protocol - Infants and Preschoolers, including the adaptation and validation of content and appearance. Methods Validation, descriptive and cross-sectional study. Adaptation based on the MBGR Protocol, based on theoretical studies and the authors' experience. Infants between 6 and 23 months of age and preschoolers between 24 and 71 months were considered. Consent and consensus of the version adapted by the authors (original and current) was obtained. The appearance and content of the new instrument were analyzed by 10 speech therapists specialized in Orofacial Motricity. We performed two analysis rounds. First: an electronic form containing dichotic questions (yes / no), with justification for negative answers; Content Validity Index and Exact Binomial Test; Second: 5 points-Likert scale. Results We produced an unprecedented instructional and adapted Clinical History protocol maintaining 23 age group related items. We excluded information from 7 items and included information in 8. Initially, we achieved agreement in 70% instructional specialist items by at least 70% of the specialists; and 64% of Clinical History items, by at least 90% of specialists. In the second round, there were 100% of "I totally agree" responses from the experts. Conclusion "Instructive" and "Myofunctional Clinical History, Orofacial" had validity of content and appearance concluded, and together with the "Clinical Examination" they integrate the "Protocol MMBGR - Infants and Preschoolers", being able to contribute to clinical practice and research in Motricity Orofacial area in the age group between 6 months and 5 years and 11 months of age.

Prevalência e fatores de risco associados ao delirium em uma unidade de terapia intensiva / Prevalencia y factores de riesgo asociados al delirium en una unidad de cuidados intensivos / Prevalence and risk factors associated with delirium at a critical care unit

Resumo Objetivo Identificar a prevalência e os fatores de risco associados ao delirium em pacientes internados em uma unidade de terapia intensiva no nordeste do Brasil. Métodos Estudo transversal realizado entre julho de 2017 e abril de 2018 com 316 pacientes hospitalizados por pelo menos 48h, ≥18 anos, com Richmond Agitation-Sedation Scale ≥ -3. A análise estatística incluiu análise univariada e multivariada; um modelo log-binomial foi utilizado para razões de prevalência ajustadas. Resultados A análise univariada indicou uma prevalência de delirium em 45,9%, meia idade (49,8 ± 17,4 vs. 44,0 ± 17,6, p=0,003) e neurocirurgia (62,5% vs. 26,1%, p<0,001). A contenção física (81,3% vs. 40,9%, p<0,001), alimentação por sonda nasoenteral (85,9% vs. 57,6%, p<0,001) e ventilação mecânica (50,0% vs. 29,2%, p<0,001) foram associadas à prevalência de delirium. Conclusão Idade, contenção física, alimentação por sonda e uso de anticonvulsivantes aumentaram a prevalência de delirium em nossa amostra.

Resumen Objetivo Identificar la prevalencia y los factores de riesgo asociados al delirium en pacientes internados en una unidad de cuidados intensivos en el nordeste de Brasil. Métodos Estudio transversal realizado entre julio de 2017 y abril de 2018 con 316 pacientes hospitalizados por al menos 48 horas, ≥18 años, con Richmond Agitation-Sedation Scale ≥ -3. El análisis estadístico incluyó análisis univariado y multivariado. Se utilizó un modelo log-binomial para razones de prevalencia ajustadas. Resultados El análisis univariado indicó una prevalencia de delirium en el 45,9 %, mediana edad (49,8 ± 17,4 vs. 44,0 ± 17,6, p=0,003) y neurocirugía (62,5 % vs. 26,1 %, p<0,001). La contención física (81,3 % vs. 40,9 %, p<0,001), alimentación por sonda nasoenteral (85,9 % vs. 57,6 %, p<0,001) y ventilación mecánica (50,0 % vs. 29,2 %, p<0,001) fueron factores asociados a la prevalencia de delirium. Conclusión Edad, contención física, alimentación por sonda y uso de anticonvulsivos aumentaron la prevalencia de delirium en nuestra muestra.

Abstract Objective Identify the prevalence and risk factors associated with delirium in patients in a critical care unit in northeastern Brazil. Methods A cross-sectional study that enrolled 316 patients with at least 48h of hospitalization, ≥18 years old, with Richmond Agitation-Sedation Scale ≥ -3, between July 2017 and April 2018. Statistical analysis included univariate and multivariate analysis, we employed a log-binomial model for adjusted prevalence ratios. Results Univariate analysis indicated that delirium was prevalent among 45.9%, middle age (49.8 ± 17.4 vs. 44.0 ± 17.6, p=0.003) and neurosurgery (62.5% vs. 26.1%, p<0.001). Physical restraining (81.3% vs. 40.9%, p<0.001), nasoenteral tube feeding (85.9% vs. 57.6%, p<0.001) and mechanical ventilation (50.0% vs. 29.2%, p<0.001) was associated with prevalence of delirium . Conclusion Age, physical restraint, tube feeding, and the use of anticonvulsants increase the prevalence of delirium in our sample.