Tuberculose: limites e potencialidades do tratamento supervisionado

Objetivou-se analisar potencialidades e limites da estratégia do tratamento supervisionado (DOTS) para a tuberculose, sob a percepção de usuários em tratamento e de trabalhadores de saúde de uma supervisão técnica de saúde do município de São Paulo. Entrevistaram-se 4 usuários e 17 profissionais de saúde de nove unidades básicas de saúde, entre abril e junho de 2006, após consentimento livre e esclarecido. Os depoimentos foram decodificados segundo a técnica de análise de discurso. Adotou-se a teoria da determinação social do processo saúde/doença como referencial teórico. Foram potencialidades: criação de vínculo entre profissional/usuário e incentivos ao tratamento, o que favorece a adesão. Foram limites: restrito envolvimento dos profissionais no DOTS e conciliar horário de trabalho do usuário com a supervisão. Reitera-se que a adesão ao tratamento transcende o âmbito biológico, sendo fundamental que os trabalhadores de saúde reconheçam os usuários como portadores de necessidades, não se restringindo apenas à supervisão da tomada de medicamentos.

Investigation of auditory processing disorder and language impairment using the speech-evoked auditory brainstem response

This study investigated whether there are differences in the Speech-Evoked Auditory Brainstem Response among children with Typical Development (TD), (Central) Auditory Processing Disorder (C) APD, and Language Impairment (LI). The speech-evoked Auditory Brainstem Response was tested in 57 children (ages 6-12). The children were placed into three groups: TD (n = 18), (C)APD (n = 18) and LI (n = 21). Speech-evoked ABR were elicited using the five-formant syllable/da/. Three dimensions were defined for analysis, including timing, harmonics, and pitch. A comparative analysis of the responses between the typical development children and children with (C)APD and LI revealed abnormal encoding of the speech acoustic features that are characteristics of speech perception in children with (C)APD and LI, although the two groups differed in their abnormalities. While the children with (C)APD might had a greater difficulty distinguishing stimuli based on timing cues, the children with LI had the additional difficulty of distinguishing speech harmonics, which are important to the identification of speech sounds. These data suggested that an inefficient representation of crucial components of speech sounds may contribute to the difficulties with language processing found in children with LI. Furthermore, these findings may indicate that the neural processes mediated by the auditory brainstem differ among children with auditory processing and speech-language disorders. (C) 2012 Elsevier B.V. All rights reserved.

Speech Graphs Provide a Quantitative Measure of Thought Disorder in Psychosis

Background: Psychosis has various causes, including mania and schizophrenia. Since the differential diagnosis of psychosis is exclusively based on subjective assessments of oral interviews with patients, an objective quantification of the speech disturbances that characterize mania and schizophrenia is in order. In principle, such quantification could be achieved by the analysis of speech graphs. A graph represents a network with nodes connected by edges; in speech graphs, nodes correspond to words and edges correspond to semantic and grammatical relationships. Methodology/Principal Findings: To quantify speech differences related to psychosis, interviews with schizophrenics, manics and normal subjects were recorded and represented as graphs. Manics scored significantly higher than schizophrenics in ten graph measures. Psychopathological symptoms such as logorrhea, poor speech, and flight of thoughts were grasped by the analysis even when verbosity differences were discounted. Binary classifiers based on speech graph measures sorted schizophrenics from manics with up to 93.8% of sensitivity and 93.7% of specificity. In contrast, sorting based on the scores of two standard psychiatric scales (BPRS and PANSS) reached only 62.5% of sensitivity and specificity. Conclusions/Significance: The results demonstrate that alterations of the thought process manifested in the speech of psychotic patients can be objectively measured using graph-theoretical tools, developed to capture specific features of the normal and dysfunctional flow of thought, such as divergence and recurrence. The quantitative analysis of speech graphs is not redundant with standard psychometric scales but rather complementary, as it yields a very accurate sorting of schizophrenics and manics. Overall, the results point to automated psychiatric diagnosis based not on what is said, but on how it is said.

Speech perception and cortical auditory evoked potentials in cochlear implant users with auditory neuropathy spectrum disorders

Objective: To characterize the PI component of long latency auditory evoked potentials (LLAEPs) in cochlear implant users with auditory neuropathy spectrum disorder (ANSD) and determine firstly whether they correlate with speech perception performance and secondly whether they correlate with other variables related to cochlear implant use. Methods: This study was conducted at the Center for Audiological Research at the University of Sao Paulo. The sample included 14 pediatric (4-11 years of age) cochlear implant users with ANSD, of both sexes, with profound prelingual hearing loss. Patients with hypoplasia or agenesis of the auditory nerve were excluded from the study. LLAEPs produced in response to speech stimuli were recorded using a Smart EP USB Jr. system. The subjects' speech perception was evaluated using tests 5 and 6 of the Glendonald Auditory Screening Procedure (GASP). Results: The P-1 component was detected in 12/14 (85.7%) children with ANSD. Latency of the P-1 component correlated with duration of sensorial hearing deprivation (*p = 0.007, r = 0.7278), but not with duration of cochlear implant use. An analysis of groups assigned according to GASP performance (k-means clustering) revealed that aspects of prior central auditory system development reflected in the P-1 component are related to behavioral auditory skills. Conclusions: In children with ANSD using cochlear implants, the P-1 component can serve as a marker of central auditory cortical development and a predictor of the implanted child's speech perception performance. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

The influence of speech stimuli contrast in cortical auditory evoked potentials

Studies about cortical auditory evoked potentials using the speech stimuli in normal hearing individuals are important for understanding how the complexity of the stimulus influences the characteristics of the cortical potential generated. OBJECTIVE: To characterize the cortical auditory evoked potential and the P3 auditory cognitive potential with the vocalic and consonantal contrast stimuli in normally hearing individuals. METHOD: 31 individuals with no risk for hearing, neurologic and language alterations, in the age range between 7 and 30 years, participated in this study. The cortical auditory evoked potentials and the P3 auditory cognitive one were recorded in the Fz and Cz active channels using consonantal (/ba/-/da/) and vocalic (/i/-/a/) speech contrasts. Design: A crosssectional prospective cohort study. RESULTS: We found a statistically significant difference between the speech contrast used and the latencies of the N2 (p = 0.00) and P3 (p = 0.00) components, as well as between the active channel considered (Fz/Cz) and the P3 latency and amplitude values. These correlations did not occur for the exogenous components N1 and P2. CONCLUSION: The speech stimulus contrast, vocalic or consonantal, must be taken into account in the analysis of the cortical auditory evoked potential, N2 component, and auditory cognitive P3 potential.