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Efeitos da inserção da terapia psicomotora no tratamento fonoaudiológico em adultos que gaguejam: ensaio clínico randomizado

2026-04-12T03:00:14Z

Title: Efeitos da inserção da terapia psicomotora no tratamento fonoaudiológico em adultos que gaguejam: ensaio clínico randomizado Author(s)/Inventor(s): Farias Junior, Jorge Agostinho de Advisor: Salles, Gil Fernando da Costa Mendes Abstract: Introduction: Fluent and effortless speech flow is only possible due to well-established connections between specific brain areas, and these areas are also involved in the development of phonological and temporal processing abilities. People who stutter usually have alterations in these brain areas, which suggest that these abilities may also be impaired. Few previous randomized trials investigated whether other therapies could improve the efficacy of the traditional treatment in adults who stutter (AWS). Objectives: 1) To evaluate in a randomized controlled clinical trial whether the addition of a psychomotor therapy over a standard combined-approach treatment could improve the efficacy of treatment in young AWS and 2) to evaluate phonological and temporal processing skills in adults who stutter, and compare them with a control group matched by age, sex and schooling. Methods: 1) Fortyseven young AWS (mean age 24 years, 79% males) with at least moderate stuttering (evaluated by the Stuttering Severity Instrument-3, SSI-3 ≥21 points) were randomized to either a standard combined-approach treatment (24 AWS, control group, sixteen 40min sessions over 8-weeks) or to standard treatment plus the psychomotor therapy (23 AWS, intervention group, adding 20min of psychomotor training after each session). Treatment efficacy was assessed by reductions in SSI-3 scores, examined by Wilcoxon tests. Primary outcome was the difference in SSI-3 reductions between control and intervention groups, evaluated by Mann-Whitney tests. In the second study, the Rapid Automatized Naming (RAN) and Verbal Fluency (VF) tests evaluated phonological processing in 47 young adults who stutter and compared to a control group matched by age, sex and schooling, by MannWhitney tests. In the group of individuals who stutter, we assessed associations between the tests results and the stuttering severity and duration.Conclusion: The randomized controlled trial did not demonstrate any benefit of adding a psychomotor therapy over a standard combined-approach treatment in young AWS. In the second study, young adults who stutter had alterations in almost all temporal and phonological processing abilities, especially in the phonological working memory and fast and accurate access to the mental lexicon, in relation to an age, gender and schooling-matched control group of fluent individuals. Considering stuttering severity, the RAN test seemed to be a better evaluation tool of these phonological processing impairments than the VF test. Publisher: Universidade Federal do Rio de Janeiro Type: Tese

Aspectos funcionais de crianças com paralisia cerebral submetidas à aplicação de toxina botulínica

2026-04-12T03:00:14Z

Title: Aspectos funcionais de crianças com paralisia cerebral submetidas à aplicação de toxina botulínica Author(s)/Inventor(s): Dorf, Sandro Rachevsky Advisor: Sztajnbok, Flávio Roberto Abstract: Introduction: Children with cerebral palsy (CP) can suffer functional limitations from spasticity and sialorrhea. Botulinum toxin type A (BTA) is a medication that can be applied to improve functionality. Objectives: To evaluate the functional aspects before and after the application of BTA in children with CP, according to the functional domains, followed from January 2015 to December 2020 at the Martagao Gesteira Institute of Childcare and Pediatrics (IPPMG) of the Federal University of Rio de Janeiro (UFRJ) and at the Institute of Physical Medicine and Rehabilitation (IMREA) of the Hospital das Clinicas of the Faculty of Medicine of the University of Sao Paulo (USP). Methods: Observational retrospective cohort study of children with CP aged 4 to 14 years followed at two Brazilian university centers from January 2015 to December 2020, according to: target functional domains, age group, biological sex, etiology of neurological sequelae, motor involvement, type of BTA, cumulative dose, effectiveness and safety, in addition to the analysis of the family profile and the perception of improvement of these caregivers. A Tonus Variation Index (TVI) was created and used before and after each BTA application according to the Modified Ashworth Scale by target functional domains: orthostatism and gait; manual activities; use of orthoses; hygiene; sialorrhea; analgesia; and prevention of deformities. Results: Seventy patients were included, the majority of whom were male (62.9%), with a mean age of 7.79 years, and 117 TBA applications were performed. The most common etiology was neonatal asphyxia and, regarding motor impairment, quadriplegics were predominant. There were higher TVIs and greater effectiveness in functional domains "Manual activity" and "Use of orthosis", with the lowest effectiveness being "Orthostatism and gait".The "Manual activity" and "Hygiene" domains were more effective in the age group 11-14 years. The comparison between the sexes for the targeted domains was not significant. . Most were undergoing physical therapy and/or occupational therapy. There was greater effective for those undergoing physical therapy in the "Orthostatism and gait", "Analgesia" and "Prevention of deformities" domains; and for those undergoing occupational therapy, in the domain "Analgesia". Applications with BTA AbobotulinumtoxinA were more effective than with BTA OnabotulinumtoxinA overall and in the "Orthostatism and gait", "Analgesia" and "Prevention of deformities". There were no reports of adverse effects. Conclusion: BTA applications are safe and effective, and should be focused on functional domains target. This study proposed the TVI, which can be used as a parameter for evaluating therapeutic response depending on further studies involving a larger number of children and adolescents with CP.Também disponível on-line. Publisher: Universidade Federal do Rio de Janeiro Type: Tese

Validação de instrumento para construção da cadeia de custos por paciente com tuberculose drogarresistente em nível ambulatorial

2026-04-12T03:00:14Z

Title: Validação de instrumento para construção da cadeia de custos por paciente com tuberculose drogarresistente em nível ambulatorial Author(s)/Inventor(s): Costa, Luciana Figueiredo da Advisor: Mello, Fernanda Carvalho de Queiroz Abstract: Tuberculosis is an infectious and transmissible disease that still remains a serious public health problem in Brazil and worldwide. Measuring the costs associated with tuberculosis is a challenge for researchers and managers, due to the complexity of the disease, the prolonged diagnostic process, and the various therapeutic modalities involved, especially in cases of drug-resistant tuberculosis. Increasing investments in this population is essential and, in this context, adequate cost measurement contributes significantly to improving health management, promoting greater efficiency in resource allocation and system sustainability. Therefore, it is imperative to conduct new studies aimed at evaluating and analyzing the cost flows related to the disease. Objective: To validate the content of an instrument aimed at constructing the cost chain for outpatient treatment of patients with drug-resistant tuberculosis. Method: This is a cross-sectional study with quantitative and qualitative analysis. Content validation was chosen as an expert-based assessment approach. A literature review was performed, the assessment instrument was developed for data collection, and experts assessed it, statistically analyzed it, items were changed and corrected, a second version of the instrument was developed, and a final assessment was performed, and a pilot test was conducted in the field. Results: Twenty judges were selected through snowball sampling in the first round and five for the final evaluation in the second round. The three domains (Objectivity, Clarity of Language and Relevance) showed Cronbach's alpha values between 0.80 and 0.91. The KMO test showed values of 0.62 to 0.75 and the content validity index showed CVI > 0.86. The form proved to be valid and reliable for professionals and managers in the outpatient setting.The use of the instrument could contribute to the preparation and planning of costs in the drug-resistant tuberculosis outpatient clinic, with the aim of facilitating the calculation of the cost chain and improving the effectiveness of budget management in the outpatient clinic. Publisher: Universidade Federal do Rio de Janeiro Type: Dissertação

Avaliação do perfil clínico e epidemiológico de pacientes em uso do dupilumabe no controle da dermatite atópica moderada a grave

2026-04-09T03:00:14Z

Title: Avaliação do perfil clínico e epidemiológico de pacientes em uso do dupilumabe no controle da dermatite atópica moderada a grave Author(s)/Inventor(s): Costa, Cinthia Dinis da Advisor: Santos, Omar Lupi da Rosa Abstract: Introduction: Atopic Dermatitis (AD) is a chronic inflammatory skin disease that significantly affects patients’ quality of life. Dupilumab is the first biologic therapy approved in Brazil for the treatment of moderate to severe AD. Objectives: To characterize the sociodemographic and clinical profile, as well as disease severity, of the participants. To evaluate the progression of clinical scores at three time points in order to assess therapeutic response. To investigate the correlation between score variations, particularly between baseline and week 16. Methods: Adult patients with na indication for dupilumab use and access to the medication were included, all under regular follow-up at the service during the study period. After the first application, they were evaluated at weeks 0, 4 and 16. At each visit, disease activity and severity, pruritus intensity and impact on quality of life were measured using the instruments EASI (Eczema Area and Severity Index), IGA (Investigator’s Global Assessment), SCORAD (Scoring Atopic Dermatitis), NRS (Numerical Rating Scale for itch), and DLQI (Dermatology Life Quality Index). Results: A statistically significant variation (p < 0.0001) was observed over time across all assessment scores, including SCORAD, EASI, NRS, IGA, and DLQI. The EASI demonstrated a 71% reduction from baseline to week 16. Significant correlations were found among the assessment scales. Adverse events were limited to facial erythema and conjunctivitis. Conclusions: Dupilumab resulted in significant clinical improvement. The consistent use of tools such as IGA, EASI, SCORAD, NRS, and DLQI is strongly recommended for monitoring patient outcomes. Publisher: Universidade Federal do Rio de Janeiro Type: Dissertação