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- Clinical education reflective ecological model for health science majorsPublication . Mendes, Ana; Martins, Paula; Alarcão, Isabel; Melo, Elsa; Pereira, João C.; Rua, Marília; Brandão, Piedade; Costa, Rui; Sancho, LuísThe clinical education is an integral part of the Health Science majors’ curriculum programs of the University of Aveiro’s School of Health (i.e., Nursing, Physical Therapy, Radiology, Radiotherapy and Speech-Language Pathology) and aims to develop clinical competences in order to generate excellent health care professionals. The organization was based on the Ecological Model of Clinical-Reflective Training, which was characterized by inter-institutional interaction and student’s reflection on actions on a professional setting. This study encompassed two moments of clinical internships in the Nursing, Physical Therapy, Radiology and Radiotherapy majors. The Clinical Internship I provided the 123 students with a global view of the health care professional activities. The Clinical Internship II, with 119 students, developed competences of each health professional. Questionnaires with categorical scales from 1 to 5 evaluated the organization and efficiency of the two internships. The results revealed averages over 3 in all items. In conclusion, the Ecological Model of Clinical-Reflective Training was well accepted by students and clinical supervisors. Applications in the health care area were demonstrated.
- A mulher com obesidade: que vivência da sexualidade?: um estudo de casoPublication . Germano, Helena; Moisão, Catarina
- Prevalence of vocal problems in portuguese primary and secondary shool level teachersPublication . Mendes, Ana; Salema, Luís; Rodrigues, Américo; Conceição, Iolanda; Bonança, Íris; Santos, MargaridaThis study compared the prevalence of vocal problems in two Portuguese groups: 73 teachers that use their voice as professional tool (teachers’ group) and 73 non-voice professionals (control group). It also identified the risk factors that contributed to teachers’ group voice problems. A questionnaire was applied to both goups in order to obtain information about vocal health, hygiene and behavior, professional activity and general physical health. Statistical results revealed that the teachers’ group presented a higher prevalence of vocal problems than the control group: 52% reported hoarseness, 46.6% vocal fatigue and 45.2% vocal discomfort compared with 31.5%, 20.5 % e 28.7%, respectively. Environmental factors (eg., smoke and cold temperatures), vocal abuse and upper respiratory pathologies (e.g., colds, laryngitis and pharyngitis) seemed to increase teachers’ voice disorders (p-value < .05). In conclusion, the absence of vocal pedagogy in the curricular plan of teachers’ higher education associated to poor working environmental conditions and professional voice demands explained the higher prevalence of vocal problems in teachers’ group.
- The effects of ILFN-exposure on voice acoustic parameters of commercial cabin crewmembersPublication . Mendes, Ana; Graça, Andreia; Jorge, Ana; Alves-Pereira, Mariana; Castelo-Branco, Nuno A. A.; Freitas, Adriana; Laranjeira, Mara; Bonança, ÍrisBackground: Long-term exposure to infrasound and low frequency noise (ILFN <500 Hz, including infrasound) can lead to the development of vibroacoustic disease (VAD). VAD is a systemic pathology characterized by the abnormal growth of extracellular matrices in the absence of inflammatory processes, namely of collagen and elastin, both of which are abundant in the basement membrane zone of the vocal folds. ILFN-exposed workers include pilots, cabin crewmembers, restaurant workers, ship machinists and, in previous studies, even though they did not present vocal symptoms, ILFN-exposed workers had significant different voice acoustic patterns (perturbation and temporal measures) when compared with normative population. Study Aims: The present study investigates the effects of age and years of occupational ILFN-exposure on voice acoustic parameters of 37 cabin crewmembers: 12 males and 25 females. Specifically, the goals of this study are to: 1) Verify if acoustic parameters change over the age and years of ILFN-exposure and 2) Determine if there is any interaction between age and years of ILFNexposure on voice acoustic parameters of crewmembers. Materials and Methods: Spoken phonatory tasks were recorded with a C420III PP AKG head-worn microphone and a DA-P1 Tascam DAT. Acoustic analyses were performed using KayPENTAX Computer Speech Lab and Multi-Dimensional Voice Program. Acoustic parameters included speaking fundamental frequency, perturbation measures (jitter, shimmer and harmonicto- noise ratio), temporal measures (maximum phonation time and s/z ratio) and voice tremor frequency. Results: One-way ANOVA analysis revealed that as the number of ILFN-exposure years increased male cabin crewmembers presented significant different shimmer values of /i/ as well as tremor frequency of /u/. Females presented significantly different jitter % of /i, a, O/ (p <0.05). Lastly, Two-way ANOVA analysis revealed that for females, there was a significant interaction between age and occupational ILFN-exposure for voice acoustic parameters, namely for jitter’s mean for /a, O/ and shimmer’s (%) mean for /a, i/ (p <0.05). Discussion and Conclusion: These perturbation measure patterns may be indicative of histological changes within the vocal folds as a result of ILFN-exposure. The results of this study suggest that voice acoustic analysis may be an important tool for confirming ILFN-induced health effects.
- Contributos para a construção de um texto foneticamente equilibrado para o português-europeu.Publication . Mendes, Ana; Costa, Alexandra Nunes da; Martins, Alexandra Delgado; Fernandes, André Filipe; Vicente, Sara Margarida; Freitas, TâniaObjectivo: o objectivo deste estudo consiste na criação de um Texto Foneticamente Equilibrado para o Português-Europeu (PE) designado “O Sol”. Método: quatro sujeitos da região de Setúbal, entre [21-49] anos (dois do sexo feminino e dois do masculino) leram em voz alta o texto “O Sol”. As gravações realizadas com Olympus (VN- 240PC e VN- 2100PC com microfones integrados) serviram para a contabilização dos fonemas produzidos. Os procedimentos foram: 1) a comparação entre as frequências relativas dos fonemas do “O Sol” e as frequências relativas descritas no PF_fone, através do coeficiente de correlação de Pearson e do teste de Mann-Whitney; 2) a comparação entre a transcrição larga e a estreita, verificando-se os fenómenos de coarticulação; e 3) a análise dos formatos silábicos. Resultados: a análise estatística demonstrou que as frequências relativas de ocorrência dos fonemas do texto “O Sol” têm uma correlação forte com as do PF_fone (r = 0,924). As medianas das frequências relativas de ocorrência dos fonemas do texto foram significativamente iguais às do PF_fone (p<.05). Conclusão: o texto “O Sol” está próximo de um texto foneticamente equilibrado ideal, uma vez que se verificaram os pressupostos pré-definidos. Fonologicamente, apresenta os formatos silábicos mais frequentes no PE, verificou-se ainda uma diminuição na frequência relativa de fonemas na transcrição estreita, devido a fenómenos de coarticulação. Futuros trabalhos incidirão no aumento da amostra.
- Voice acoustic profi le of males exposed to occupational infrasound and low-frequency noisePublication . Mendes, Ana; Bonança, Íris; Jorge, Ana; Alves-Pereira, Mariana; Castelo-Branco, Nuno A. A.; Caetano, Marlene; Oliveira, Nádia; Graça, Andreia; Santos, Carolina; Ferraria, RenataBackground: Vibroacoustic disease (VAD) is a systematic pathology characterized by the abnormal growth of extra-cellular matrices in the absence of infl ammatory processes, namely collagen and elastin, both of which are abundant in the basement membrane zone of the vocal folds. VAD can develop due to long-term exposure to infrasound and low-frequency noise (ILFN, <500 Hz). Mendes et al. (2006, 2008 and 2012) revealed that ILFN-exposed males and females presented an increased fundamental frequency (F0), decreased jitter %, and reduced maximum phonation frequency range, when compared with normative data. Temporal measures of maximum phonation time and S/Z ratio were generally reduced. Study Aims: Herein, the same voice acoustic parameters of 48 males, 36 airline pilots and 12 cabin crewmembers (age range 25-60 years) were studied, and the effects and interaction of age and years of ILFN exposure were investigated within those parameters. ILFN-exposure time (i.e. years of professional activity) ranged from 3.5 to 36 years. Materials and Methods: Spoken and sung phonatory tasks were recorded with a DA-P1 Tascam DAT and a C420III PP AKG head-worn microphone, positioned at 3 cm from the mouth. Acoustic analyses were performed using KayPENTAX Computer Speech Lab and Multi-Dimensional Voice Program. Results: Results revealed that even though pilots and cabin crewmembers were exposed to occupational environments with distinct (ILFN-rich) acoustical frequency distributions and sound pressure levels, differences in the vocal acoustic parameters were not evident. Analyzing data from both professional groups (N = 48) revealed that F0 increased signifi cantly with the number of years of professional activity. Conclusion: These results strongly suggest that the number of years of professional activity (i.e. total ILFN exposure time) had a signifi cant effect on F0. Furthermore, they may refl ect the histological changes specifi cally observed on the vocal folds of ILFN-exposed professionals.
- Validade e sensibilidade do texto foneticamente equilibrado para o Português-Europeu “O Sol”Publication . Mendes, Ana; Moreira, Miriam; Costa, Alexandra; Murtinheira, Andreia; Jorge, AnaFace ao crescente índice de envelhecimento e às alterações motoras da fala decorrentes, torna-se emergente a validação de instrumentos de recolha e análise das características da produção dos sons da fala de adultos. Os objetivos deste estudo foram verificar se o texto foneticamente equilibrado (TFE) “O Sol” contém os fone(ma)s na mesma frequência de ocorrência do discurso espontâneo, recorrendose aos corpus PF_fone e FrePOP e determinar a sensibilidade do TFE “O Sol” às variações dialetais do português-europeu (PE). Uma população de 55 sujeitos normofalantes, com uma média de idades de 29 anos num intervalo entre [18 – 58] anos, leram em voz alta o TFE “O Sol”. As amostras foram recolhidas com um gravador Sony linear PCM-D50 (96KHz/24bit). A frequência relativa (Fr) dos fones do TFE “O Sol” foi comparada com a Fr dos dois corpus de referência, sendo o limiar de aceitação estabelecido, maior ou igual a -0,05. A frequência absoluta (Fa) dos fones do TFE “O Sol” foi comparada em função do dialeto dos sujeitos. Verificou-se que a Fr de 30 dos 38 fones do TFE “O Sol” são iguais ou superiores ao limiar de aceitação. A Fa de 6 dos 38 fones foi diferente significativamente (p<0,05) nos três dialetos. Concluindo, o TFE “O Sol” apresenta todos os fones do PE, sendo 78.9% numa frequência de ocorrência próxima à do discurso espontâneo, estando assim asseguradas as validades de conteúdo, de construção e concorrente. O TFE “O Sol” pode ser aplicado em sujeitos dos três dialetos do PE por apresentar sensibilidade a estes.
- Construção de um instrumento de triagem de perturbações motoras da fala: standardização do texto foneticamente equilibrado "O Sol"Publication . Mendes, Ana; Moreira, Miriam; Costa, Alexandra; Murtinheira, Andreia; Jorge, Ana; Araújo, MarleneO envelhecimento, as doenças neurodegenerativas ou as lesões cerebrais são as principais etiologias das perturbações motoras da fala (PMF) que impactam na eficácia comunicativa e qualidade de vida dos utentes com mais de 60 anos. Torna-se pertinente identificar precocemente as PMF para minorar os seus efeitos. Objetivo: Assegurar os critérios psicométricos de validade, fiabilidade e sensibilidade do texto foneticamente equilibrado (TFE) “O Sol” em normofalantes do Português-Europeu (PE). Metodologia: Para a validade e sensibilidade participaram 55 sujeitos dos três dialetos do PE com idades entre [18-58] anos. Para a fiabilidade participaram 10 sujeitos do dialeto centro-meridional com idades entre os [19-50] anos. Os sujeitos leram em voz alta o TFE “O Sol”. As amostras, recolhidas com um gravador Sony Linear PCM-D50 com microfone integrado, foram transcritas com o International Phonetic Alphabet. Resultados: O TFE “O Sol” respeitou os sete pressupostos para a construção de um TFE e apresentou todos os segmentos do PE. A média das frequências absolutas de 6/38 segmentos foram significativamente diferentes (p<0,05) nos três dialetos. A percentagem de concordância inter-examinador foi de 82% e intraexaminador foi 91.3 %, p<0,05. Conclusão: O TFE “O Sol” é um instrumento válido, fiável e sensível às variações dialetais do PE.
- Early Identification of Pre-school Children with Speech-language Disorder in Primary Health Care SettingsPublication . Mendes, Ana; Valente, Ana Rita; Loureiro, Helena; Clemêncio, Graça; Melo, Elsa; Lousada, MarisaSpeech-language disorders in pre-school children is considered a public health problem since its international prevalence is reportedly to be 20%. This study aimed to identify European-Portuguese pre-school children with speech-language disorder through RALF speech-language screening (Rastreio de Linguagem e Fala), in primary health care settings. RALF is a reliable and valid instrument that revealed strong levels of reliability, sensitivity and specificity for European-Portuguese (EP) pre-school children. 10 nurses with more than 6 years of clinical experience in a primary health care centers administered RALF to 37 (5-6 years old) EP children as part of health-child care routine. Results indicate that 21.6% of children did not pass the RALF screen and were referred to an in-depth speech and language assessment. This finding was in agreement with international research and reinforces the need for an early and precocious identification of the speech-language disorder in pre-school children. That is, way before the disorder has installed and has an impact on the academic, social and emotional development. This action-research study also reveals the important of using a valid, reliable, sensitive, and specific, as well as, culturally and linguistically adequate screening instruments by the health professionals as part of health-child care routine in primary health care centers.
- Personalising the user experience of a mobile health application towards Patient EngagementPublication . Madeira, Rui Neves; Germano, Helena; Macedo, Patrícia; Correia, NunoStuttering is a multifactorial speech disorder that usually has several impacts on daily life, especially regarding loss of confidence in social situations and increased anxiety levels. BroiStu is a mobile health application that was developed to address the impacts of stuttering on people who stutter, allowing them to be more aware of their speech disorder in their everyday life. The personalisation of the user experience may be particularly important to maintain the patient engaged with the application towards a long-term use to take full advantage of the application’s features. This paper presents the implementation of personalisation aspects in BroiStu, introducing the model that is being followed, describing the features used, and presenting the results obtained with a preliminary experiment. The personalisation mechanisms are provided by a cloud-based platform that is designed to serve different applications. Interesting findings and further work are presented.