Impact of early postnatal androgen exposure on voice development.

BACKGROUND: The impact of early postnatal androgen exposure on female laryngeal tissue may depend on certain characteristics of this exposure. We assessed the impact of the dose, duration, and timing of early androgen exposure on the vocal development of female subjects who had been treated for adrenocortical tumor (ACT) in childhood. METHODS: The long-term effects of androgen exposure on the fundamental vocal frequency (F0), vocal pitch, and final height and the presence of virilizing signs were examined in 9 adult (age, 18.4 to 33.5 years) and 10 adolescent (13.6 to 17.8 years) female ACT patients. We also compared the current values with values obtained 0.9 years to 7.4 years after these subjects had undergone ACT surgery, a period during which they had shown normal androgen levels. RESULTS: Of the 19 subjects, 17 (89%) had been diagnosed with ACT before 4 years of age, 1 (5%) at 8.16 years, and 1 (5%) at 10.75 years. Androgen exposure (2 to 30 months) was sufficiently strong to cause pubic hair growth in all subjects and clitoromegaly in 74% (14/19) of the subjects, but did not reduce their height from the target value. Although androgen exposure induced a remarkable reduction in F0 (132 Hz) and moderate pitch virilization in 1 subject and partial F0 virilization, resulting in F0 of 165 and 169 Hz, in 2 subjects, the majority had normal F0 ranging from 189 to 245 Hz. CONCLUSIONS: Female laryngeal tissue is less sensitive to androgen exposure between birth and adrenarche than during other periods. Differential larynx sensitivity to androgen exposure in childhood and F0 irreversibility in adulthood are age-, concentration-, duration-, and timing-dependent events that may also be affected by exposure to inhibitory or stimulatory hormones. Further studies are required to better characterize each of these factors.

Padrões do conhecimento de enfermagem e sua interface ao atendimento domiciliar à saúde / Standards of the nursing knowledge and its interface to the attendance to the domiciliary: a literature review

The attendance to the domiciliary health resurges as an alternative modality to the model of attention to the health of the country and the professional nurse who acts in this area as commitment and responsibility to improve its knowledge. Thus, this article, is a theoretical reflection on the interface of the standards of the knowledge of nursing identified by Barbara Carper (1978), Munhall (1993), White (1995) and brazilians studious where they point the possibility, importance and relevancy with respect to the area of nursing and in special in domiciliary attendance to the health while caring practice that confers an uneven and particular situation to the inserted client in its domicile. This interface is based on the reciprocity with the well-taken care of being, propitiating learning and growth conditions, in order to contribute for the consolidation of new experiences, enriching the capacity to take care of the nurse, patient and family member.

O atendimento domiciliar à saúde ressurge como uma modalidade alternativa ao modelo de atenção à saúde do país e o profissional enfermeiro que atua nesta área tem como compromisso e responsabilidade aprimorar seus conhecimentos. Assim, esse artigo é uma reflexão teórica sobre a interface dos padrões do conhecimento de enfermagem identificados por Bárbara Carper (1978), Munhall (1993), White (1995) e estudiosos brasileiros em que apontam a possibilidade, importância e pertinência para a área de enfermagem e em especial para o atendimento domiciliar à saúde enquanto prática cuidativa que confere uma atenção ímpar e particular ao cliente inserido em seu domicílio. Essa interface baseia-se na reciprocidade com o ser cuidado, propiciando condições de crescimento e de aprendizagem, a fim de contribuir para a consolidação de novas experiências, enriquecendo a capacidade de cuidar do enfermeiro, paciente e familiar.

La atención de la salud domiciliar resurge como una modalidad alternativa al modelo de atención de la salud del país, y el profesional enfermero que actúa en esta área tiene como compromiso y responsabilidad el perfeccionar sus conocimientos. Así, este artículo es una reflexión teórica sobre la interrelación entre el uso e importancia de las pautas de conocimiento de enfermería, identificados por Bárbara Carper en 1978, Munhall (1993), White (1995) y estudiosos brasileros quienes señalan la posibilidad, importancia y competencia del área de enfermería principalmente para la atención de la salud domiciliar como práctica de cuidados que atribuye una situación impar y particular al cliente dentro de su domicilio. Esta interrelación se basa en la reciprocidad con el ser cuidado, propiciando condiciones de crecimiento y de aprendizaje, a fin de contribuir a la consolidación de nuevas experiencias, enriqueciendo la capacidad del enfermero de cuidar del paciente y de su familia.