A Perda Auditiva Induzida pelo Ruído (PAIR) na formação odontológica: conhecimentos e níveis de exposição

The rationalization of work in the Dentistry has been taking the professional to work for ways and systems based in the ergonomics, turning their work efficient and less tiring. Since their academic formation, the dentists surgeons are concerned with the high productivity in clinic and with the final result of the work, neglecting the way as it is executed, which reduce their work capacity and exhibits them to occupational diseases that could be minimized and/or forewarned. This research had as the main objective to investigate the knowledge of the Dentistry academics of Rio Grande do Norte Federal University concerning the Noise-induced Hearing Loss (NIHL), relating them at the noise levels that they are exposed, as well as to the preventive measures taken during the clinical activities. Was observed that 95% of the individuals know that the dentist surgeon is a professional in risk for NIHL. Among the causes of NIHL, the one that obtained the largest frequency citation was the high-speed handpieces, reminded by 92,4% of the academics. Among the students which enumerated protective measures for NIHL, 92% mentioned the use of the ear plugs, although 97% of the researched have told do not use any kind of preventive measure related to the noise. Was also observed that 96% of the academics notice the noise during the clinical attendance, what inconvenience 28,1% of them. Related the noise levels, the high-speed handpieces of the academics presented a medium value of 80,5 dB varying from 72,3 to 88,3 dB. The average of the ambient noise observed at the Integrated Clinic was about 74,8 dB. In spite of the noise levels in this research were observed below the established limits of tolerance by the legislation, they can provoke damages to the Dentistry professionals' health, or that suggests the need of an intervention and use of immediate preventive measures able to generate a healthy atmosphere of work and less risky

Análise das manifestações auditivas em individuos com hipertensão arterial sistêmica

Objective: To determine the prevalence of auditory manifestations in individuals with hypertension and analyze the association between hearing loss, systemic hypertension and quality of life in hypertensive patients. Method: This was a prospective, observational, case-control study, carried out from June 2010 to December 2013 at the University Hospital Onofre Lopes, in Natal, Brazil, which involved 120 patients of both sexes were analyzed with a diagnosis of hypertension and 120 patients without a diagnosis of hypertension. The audiological function was assessed by tonal and vocal audiometry. The quality of life was defines by the MINICHAL BRASIL questionnaire. Results: The prevalence of hearing loss was high in both groups (82.5 % and 75.8 %, in hypertension group and control, respectively, p=0.003). The sensorineural was the most common type of hearing loss (48.5 %) in hypertension group while conductive hearing loss was predominant (61.5 %) in the control group. There were no difference in the intensity of hearing loss between the groups (p=0,21). The main hearing complaint was hearing loss (51 %), followed by ear pain (14 %). There was worse quality of life in hypertensive individuals with hearing loss (p= 0.0001). Conclusion: Hypertensive individuals showed higher prevalence of auditory events, including hearing loss, sensorineural hearing loss is predominant . Hearing loss is associated with worse quality of life of hypertensive individuals even when these pressure values are within normal limits

Desempenho auditivo ao longo do tempo e satisfação dos usuários de implante coclear com perda auditiva pós-lingual

Most cochlear implant (CI) users, who suffer from post lingual hearing loss, are able to perceive sounds and comprehend speech after the implant. The prediction of maximal benefit over time, with the use of CI, can be useful for counseling patients about their expectations in using the new device. The measurement of satisfaction should be of primary interest in medical intervention, as the results may be used for intervention feedback. The purpose of this study is to analyze auditory performance of CI over time, as well as to evaluate users‟ satisfaction. Therefore two types of study designs were employed: a) retrospective cohort study with the analysis of medical records from 59 subjects about auditory performance before and after surgery. Results were submitted to the Kaplan -Meier estimator of cumulative probability and compared to prognostic factors of auditory performance using the logrank test. b) A sectional study design was conducted to evaluate the satisfaction of 51 subjects. The instrument consists of two specific questionnaires: Satisfaction with Amplification in Daily Life SADL and International Outcome Inventory Cochlear Implant IOI- CI. Results show statistical significant differences (p<0,001) in auditory performance before and after CI. The majority obtained satisfactory results of CI use during the first six months. Logrank tests does not indicate significant correlation between the analyzed covariates and the time in which adequate speech perception occurs. SADL e IOI-CI questionnaires indicate that most of the CI users are satisfied with their devices. The SADL detected a 27, 5% insatisfaction amongst CI users in relation to services and costs involved with the CI. The results of the IOI show 4% of insatisfaction with the use of CI and the social environment. In conclusion CI is capable to rehabilitate social auditory function in a short period of time and CI users demonstrate satisfaction with auditory, social and psychological gain offered through CI device

Percepção da equipe de saúde, discentes e usuários sobre a comunicação com indivíduos surdos na atenção primária

The study aimed to identify in the professionals and students of health courses that work in a health Basic Unit in the city of Natal/RN their perceptions of the care of deaf patients, and with the population's needs with hearing loss in relation to health care. This is a cross-sectional, exploratory, descriptive study, conducted between April to July 2014, with a population composed of 21 health professionals, 17 students and 8 deaf users. For data collection, we used a structured questionnaire with open and closed questions applied to groups composed of health professionals (doctors, dentists, nurses and health workers) and students of medical schools, nursing, physical education, nutrition and social service. The professionals/students answered a semi-structured questionnaire with open and closed questions concerning the possible difficulties the care of the deaf and hearing impaired. Data collection with deaf users was conducted through filmed interview for the Brazilian Sign Language (Libras) could be interpreted as to the Portuguese by the researcher. With the latter it was conducted a survey of their reactions when looking for a care in the health service. Regarding the profile of identification of the subjects, it was analyzed by simple descriptive statistics (absolute and relative frequencies). The open questions were analyzed through the content analysis technique which allowed the categorization process preserving all the points raised in the discussion so that the lines were representative of the whole. When asked about the professionals and students attitude used to communicate with deaf patients possible the following categories emerged: the "writing", the "gestures" and the "third party assistance". With regard of the deaf, when asked about their experiences in seeking care in health, the elucidated categories were: "quality of care to the hearing impaired", "communication with the hearing impaired adequacy" and "dependence on third parties." The closed questions were measured and adapted to the 5 degrees of variation Likert Scale, which comprised three of these issues: degree of difficulty in communication to meet a patient with hearing loss (minimum to great difficulty); feeling of comfort while using sign language (minimum to severe discomfort); and knowledge of the Law 10.436, which provides for the Brazilian Sign Language (Libras) (low knowledge to entirely clear). The data collected with professionals and students revealed some misunderstanding and discomfort in health care for deaf patients, reality also evidenced in the opinion of the deaf participants. This study revealed problems in communication, resulting in negative consequences in serving this population. This diagnosis may be relevant to public policy development and curriculum guidelines essential to the training of health professionals, inclusion and improving assistance to deaf.

Prevalência e fatores associados à alteração vocal em idosos institucionalizados com capacidade cognitiva preservada

Voice disorders (VD) in the elderly can interfere negatively in communication, emotional well-being and quality of life, conditions that correspond to greater exposure to illness and social isolation bringing consequent economic impact for the health system. It is assumed that institutionalized confinement, weakness and morbidity associated to nursing home (NH) contribute to transform VD an especially prevalent condition in institutionalized elderly, including those without cognitive impairment. Thus, the aim of this study was to determine the prevalence and associated factors of VD in NH elderly residents without cognitive impairment. There is no epidemiological diagnostic instruments of VD for elderly populations, so the first step of this study was dedicated to prepare and analyze the psychometric properties of a short, inexpensive and easy to use questionnaire named Screening for Voice Disorders in Older Adults (Rastreamento de Alterações Vocais em Idosos—RAVI). The methodological procedures of this step followed the guidelines of the Standards for Educational and Psychological Testing and contemplated validity evidence based on test content, based on response processes, based on internal structure and based on relations with other variables, as well as reliability analysis and clinical consistency. The result of the validation process showed that the RAVI final score generate valid and reliable interpretations for the epidemiological diagnosis of VD in the elderly, which endorsed the use of the questionnaire in the second stage of the study, performed in ten NH located in the city of Natal, Rio Grande do Norte. At this stage, data from socioeconomic and demographic variables, lifestyle, general health conditions and characterization of the institution were collected. It was performed a bivariate analysis and it was calculated the prevalence ratio as a magnitude association measure, with a confidence interval of 95%. The variables with p-value less than 0.20 were included in the multiple logistic regression model that followed the Forward selection method. The odds ratio found in the multivariate model was converted into prevalence ratio and the level of significance was 5%. The sample consisted of 117 subjects with predominance of females and average of 79.68 (± 7.92) years old. The prevalence of VD was 39.3% (95% CI: 30.4-48.1%). The multivariate model showed statistically significant association between VD and depressive symptoms, smoking for a year or more and selfreported hearing loss. In conclusion, VD is a prevalent health condition in NH elderly residents without cognitive impairment and is associated with factors involving psychosocial, lifestyle and communicative disability that require attention of managers and professionals involved with NH environment. Strategies to encourage communication and social integration, actions to combat smoking and minimizing the effects of hearing loss could stimulate the physical well-being, emotional and mental health of institutionalized elderly population, contributing to the vocal and communicative maintenance, a more effective social inclusion and better overall health condition.

Medium change monitoring using ambient seismic noise and coda wave interferometry: examples from intraplate NE Brazil and the Mid-Atlantic Ridge

This thesis presents and discusses the results of ambient seismic noise correlation for two different environments: intraplate and Mid-Atlantic Ridge. The coda wave interferometry method has also been tested for the intraplate data. Ambient noise correlation is a method that allows to retrieve the structural response between two receivers from ambient noise records, as if one of the station was a virtual source. It has been largely used in seismology to image the subsurface and to monitor structural changes associated mostly with volcanic eruptions and large earthquakes. In the intraplate study, we were able to detect localized structural changes related to a small earthquake swarm, which main event is mR 3.7, North-East of Brazil. We also showed that the 1-bit normalization and spectral whitening result on the loss of waveform details and that the phase auto-correlation, which is amplitude unbiased, seems to be more sensitive and robust for our analysis of a small earthquake swarm. The analysis of 6 months of data using cross-correlations detect clear medium changes soon after the main event while the auto-correlations detect changes essentially after 1 month. It could be explained by fluid pressure redistribution which can be initiated by hydromechanical changes and opened path ways to shallower depth levels due to later occurring earthquakes. In the Mid-Atlantic Ridge study, we investigate structural changes associated with a mb 4.9 earthquake in the region of the Saint Paul transform fault. The data have been recorded by a single broadband seismic station located at less than 200 km from the Mid-Atlantic ridge. The results of the phase auto-correlation for a 5-month period, show a strong co-seismic medium change followed by a relatively fast post-seismic recovery. This medium change is likely related to the damages caused by the earthquake’s ground shaking. The healing process (filling of the new cracks) that lasted 60 days can be decomposed in two phases, a fast recovery (70% in ~30 days) in the early post-seismic stage and a relatively slow recovery later (30% in ~30 days). In the coda wave interferometry study, we monitor temporal changes of the subsurface caused by the small intraplate earthquake swarm mentioned previously. The method was first validated with synthetics data. We were able to detect a change of 2.5% in the source position and a 15% decrease of the scatterers’ amount. Then, from the real data, we observed a rapid decorrelation of the seismic coda after the mR 3.7 seismic event. This indicates a rapid change of the subsurface in the fault’s region induced by the earthquake.

Medium change monitoring using ambient seismic noise and coda wave interferometry: examples from intraplate NE Brazil and the Mid-Atlantic Ridge

This thesis presents and discusses the results of ambient seismic noise correlation for two different environments: intraplate and Mid-Atlantic Ridge. The coda wave interferometry method has also been tested for the intraplate data. Ambient noise correlation is a method that allows to retrieve the structural response between two receivers from ambient noise records, as if one of the station was a virtual source. It has been largely used in seismology to image the subsurface and to monitor structural changes associated mostly with volcanic eruptions and large earthquakes. In the intraplate study, we were able to detect localized structural changes related to a small earthquake swarm, which main event is mR 3.7, North-East of Brazil. We also showed that the 1-bit normalization and spectral whitening result on the loss of waveform details and that the phase auto-correlation, which is amplitude unbiased, seems to be more sensitive and robust for our analysis of a small earthquake swarm. The analysis of 6 months of data using cross-correlations detect clear medium changes soon after the main event while the auto-correlations detect changes essentially after 1 month. It could be explained by fluid pressure redistribution which can be initiated by hydromechanical changes and opened path ways to shallower depth levels due to later occurring earthquakes. In the Mid-Atlantic Ridge study, we investigate structural changes associated with a mb 4.9 earthquake in the region of the Saint Paul transform fault. The data have been recorded by a single broadband seismic station located at less than 200 km from the Mid-Atlantic ridge. The results of the phase auto-correlation for a 5-month period, show a strong co-seismic medium change followed by a relatively fast post-seismic recovery. This medium change is likely related to the damages caused by the earthquake’s ground shaking. The healing process (filling of the new cracks) that lasted 60 days can be decomposed in two phases, a fast recovery (70% in ~30 days) in the early post-seismic stage and a relatively slow recovery later (30% in ~30 days). In the coda wave interferometry study, we monitor temporal changes of the subsurface caused by the small intraplate earthquake swarm mentioned previously. The method was first validated with synthetics data. We were able to detect a change of 2.5% in the source position and a 15% decrease of the scatterers’ amount. Then, from the real data, we observed a rapid decorrelation of the seismic coda after the mR 3.7 seismic event. This indicates a rapid change of the subsurface in the fault’s region induced by the earthquake.