Cross-Cultural Adaptation of the Brazilian Version of the Vocal Fatigue Index - VFI

The purpose of this study was to perform the cultural adaptation of the Brazilian version of the Vocal Fatigue Index (VFI). Two Brazilian bilingual speech-language pathologists (SLP) translated the original version of the VFI in English into Portuguese. The translations were reviewed by a committee of five voice specialist SLPs resulting in the final version of the instrument. A third bilingual SLP back-translated this final version and the same committee reviewed the differences from its original version. The final Portuguese version of the VFI, as in the original English version, was answered on a categorical scale of 0-4 indicating the frequency they experience the symptoms: 0=never, 1=almost never, 2=sometimes, 3=almost always, and 4=always. For cultural equivalence of the Portuguese version, the option not applicable was added to the categorical scale and 20 individuals with vocal complaints and dysphonia completed the index. Questions considered not applicable would be disregarded from the Brazilian version of the protocol; no question had to be removed from the instrument. The Brazilian Portuguese version was entitled Índice de Fadiga Vocal - IFV and features 19 questions, equivalent to the original instrument. Of the 19 items, 11 were related with tiredness of voice and voice avoidance, five concerned physical discomfort associated with voicing, and three were related to improvement of symptoms with rest or lack thereof. The Brazilian version of the VFI presents cultural and linguistic equivalence to the original instrument. The IFV validation into Brazilian Portuguese is in progress

Vocal self assessment questionnaire: epidemological control tool of the ocupational dysphonic syndrome in professors

INTRODUCTION: The dysphonic syndrome is an occupational disease of high prevalence in the professor population. OBJECTIVE: In order to broach preventively the vocal aggression, it was tried to standardize a self assessment questionnaire to professors of all educational level, including beyond the clinical symptoms also the factors of the work organization. METHOD: It was performed a study of transversal cut in 328 professors of 4 educational institutions of the northern of São Paulo, which it was applied a self assessment questionnaire elaborated by TRipartite Commission of Standardization for Professional Voice. RESULTS: It was determined the prevalence of clinical symptoms that compound the dysphonic syndrome, as well as it was delineate the work organization and the quality of life of this population. CONCLUSION: The questionnaire applied was showed itself satisfactory en the description and elaboration of parameters with the aim of to implement preventive programs to populations exposed to professional overload of the voice use. Case study.INTRODUÇÃO: A síndrome disfônica é uma doença ocupacional de alta prevalência na população de professores. OBJETIVO: A fim de abordar preventivamente a agressão vocal, procurou-se padronizar um questionário de autoavaliação para professores de todos os níveis de ensino, incluindo além dos sintomas clínicos também os fatores da organização do trabalho. MÉTODO: Foi realizado um estudo de corte transversal em 328 professores de 4 instituições de ensino da região norte de São Paulo, aos quais aplicou-se um questionário de auto-avaliação elaborado pela Comissão Tripartite de Normatização para a Voz Profissional. RESULTADOS: Determinou-se a prevalência dos sintomas clínicos que compõem a síndrome disfônica, assim como retratou-se a organização do trabalho e qualidade de vida desta população. CONCLUSÃO: O questionário aplicado mostrou-se satisfatório na descrição e elaboração de parâmetros com o objetivo de implementação de programas preventivos para populações expostas à sobrecarga profissional do uso da voz. Estudo de caso.MTE Setor de Relações do TrabalhoUNIFESP Departamento de Otorrinolaringologia e Distúrbios da Comunicação HumanaUNIFESPSINPRO/SPUNIFESP, Depto. de Otorrinolaringologia e Distúrbios da Comunicação HumanaUNIFESPSciEL

Simulação de conversor CC-CC tipo Buck usando Matlab-Simulink® / Buck type CC-DC converter simulation using Matlab-Simulink®

Conversores estáticos são circuitos formados por elementos passivos e ativos associados seguindo a leis pré-estabelecidas. Neste artigo é discutida a capacidade de simulação do software Matlab®, através de sua extensão gráfica Simulink®, de um modelo de conversor CC-CC do tipo Buck, visando demonstrar que as simulações podem reduzir os custos de desenvolvimento, o tempo de modelação e oferecer uma alternativa confiável para os testes de desempenho. São apresentados os principais elementos que compõem o conversor Buck, as técnicas de controle empregadas e as etapas de operação. A fim de avaliar as ferramentas para desenvolvimento contidas no software, é proposta a modelagem de um conversor tipo Buck em malha fechada a partir de parâmetros estabelecidos. 

Lipoprotein(a) Genotype Influences the Clinical Diagnosis of Familial Hypercholesterolemia

: Background Evidence suggests that LPA risk genotypes are a possible contributor to the clinical diagnosis of familial hypercholesterolemia (FH). This study aimed at determining the prevalence of LPA risk variants in adult individuals with FH enrolled in the Italian LIPIGEN (Lipid Transport Disorders Italian Genetic Network) study, with (FH/M+) or without (FH/M-) a causative genetic variant. Methods and Results An lp(a) [lipoprotein(a)] genetic score was calculated by summing the number risk-increasing alleles inherited at rs3798220 and rs10455872 variants. Overall, in the 4.6% of 1695 patients with clinically diagnosed FH, the phenotype was not explained by a monogenic or polygenic cause but by genotype associated with high lp(a) levels. Among 765 subjects with FH/M- and 930 subjects with FH/M+, 133 (17.4%) and 95 (10.2%) were characterized by 1 copy of either rs10455872 or rs3798220 or 2 copies of either rs10455872 or rs3798220 (lp(a) score ≥1). Subjects with FH/M- also had lower mean levels of pretreatment low-density lipoprotein cholesterol than individuals with FH/M+ (t test for difference in means between FH/M- and FH/M+ groups <0.0001); however, subjects with FH/M- and lp(a) score ≥1 had higher mean (SD) pretreatment low-density lipoprotein cholesterol levels (223.47 [50.40] mg/dL) compared with subjects with FH/M- and lp(a) score=0 (219.38 [54.54] mg/dL for), although not statistically significant. The adjustment of low-density lipoprotein cholesterol levels based on lp(a) concentration reduced from 68% to 42% the proportion of subjects with low-density lipoprotein cholesterol level ≥190 mg/dL (or from 68% to 50%, considering a more conservative formula). Conclusions Our study supports the importance of measuring lp(a) to perform the diagnosis of FH appropriately and to exclude that the observed phenotype is driven by elevated levels of lp(a) before performing the genetic test for FH

The Role of Registers in Increasing Knowledge and Improving Management of Children and Adolescents Affected by Familial Hypercholesterolemia: the LIPIGEN Pediatric Group

Pathology registers can be a useful tool to overcome obstacles in the identification and management of familial hypercholesterolemia since childhood. In 2018, the LIPIGEN pediatric group was constituted within the Italian LIPIGEN study to focus on FH subjects under 18 years. This work aimed at discussing its recent progress and early outcomes. Demographic, biochemical, and genetic baseline characteristics were collected, with an in-depth analysis of the genetic defects. The analysis was carried out on 1,602 children and adolescents (mean age at baseline 9.9 ± 4.0 years), and almost the whole cohort underwent the genetic test (93.3%). Overall, the untreated mean value of LDL-C was 220.0 ± 97.2 mg/dl, with an increasing gradient from subjects with a negative (N = 317; mean untreated LDL-C = 159.9 ± 47.7 mg/dl), inconclusive (N = 125; mean untreated LDL-C = 166.4 ± 56.5 mg/dl), or positive (N = 1,053; mean untreated LDL-C = 246.5 ± 102.1 mg/dl) genetic diagnosis of FH. In the latter group, the LDL-C values presented a great variability based on the number and the biological impact of involved causative variants. The LIPIGEN pediatric group represents one of the largest cohorts of children with FH, allowing the deepening of the characterization of their baseline and genetic features, providing the basis for further longitudinal investigations for complete details

Coping strategies in teachers with voice complaint

Objetivos:Compreender as estrategias de enfrentamento utilizadas por professores com queixa de voz, comparar as diferencas entre os que procuram ou nao tratamento fonoaudiologico e verificar a relacao entre enfrentamento e analise perceptivo-auditiva, sinais e sintomas de voz e restricao de participacao e limitacao nas atividades vocais. Metodos: Participaram da pesquisa 90 sujeitos, divididos em tres grupos com idades semelhantes: Grupo 1 (G1) formado por 30 professoras com queixa de voz e que buscaram tratamento fonoaudiologico; Grupo 2 (G2) formado por 30 professoras com queixa de voz e que nunca buscaram tratamento fonoaudiologico; Grupo 3 (G3) formado por 30 professoras sem queixa vocal. Foram realizados os seguintes procedimentos: aplicacao do questionario de identificacao e caracterizacao pessoal e do trabalho, gravacao de material de fala para analise perceptivo-auditiva do desvio vocal, Lista de Sinais e Sintomas de Voz, Protocolo Perfil de Participacao e Atividades Vocais u PPAV e Protocolo de Estrategias de Enfrentamento nas Disfonias u PEED. Resultados: Em relacao a analise perceptivo-auditiva do desvio vocal houve diferenca estatisticamente significante entre os grupos com queixa (G1+G2), que apresentaram vozes desviadas em grau leve a moderado, e o sem queixa que apresentou voz dentro da variabilidade normal da qualidade vocal (media para G1 de 49,9, G2 de 43,7 e G3 32,3; p<0,001). O G1 teve maior media de sinais e sintomas de voz (G1=8,6 G2= 6,6 e G3 apenas 2,0 sintomas; p<0,001) e apresentou maiores escores em quase todas as dimensoes do PPAV (p<0,001), com excecao de efeitos no trabalho e efeitos na comunicacao social. Os individuos com queixa tiveram a tendencia a usar mais estrategias com foco no problema e os que procuraram tratamento fonoaudiologico apresentaram maior escore no PEED (G1=45,4; G2=38,5 e G3=9,5; p<0,001). Os aspectos que tiveram correlacao com o PEED nos tres grupos foram: para G1 grau do desvio vocal, escore total do PPAV e escores parciais auto-percepcao da voz, efeitos na comunicacao diaria, efeitos na emocao e Pontuacao de Restricao na Participacao; no G2 apenas escore total do PPAV e parcial efeitos na comunicacao diaria e G3 todos os dominios do PPAV. Em nenhum grupo os sinais e sintomas tiveram correlacao com o enfrentamento. Conclusao: Professores com queixa de voz usam mais estrategias de enfrentamento com foco no problema, sendo que os que buscam tratamento fonoaudiologico usam um numero ainda maior de estrategias. Os sintomas de voz tem influencia na procura por tratamento fonoaudiologico, porem nao se correlacionam com o enfrentamento em si. De modo geral, quanto maior a percepcao de limitacao e restricao na participacao em atividades vocais, maior o uso de estrategias de enfrentamentoBV UNIFESP: Teses e dissertaçõe