DSpace Coleção: PPGMDS

Impacto da Atenção Primária à Saúde sobre as internações por condições sensíveis no estado da Paraíba

2026-09-11T06:12:36Z

Título: Impacto da Atenção Primária à Saúde sobre as internações por condições sensíveis no estado da Paraíba Autor(es): Nunes, Janaina Cristine Pereira Orientador: Leite, José Carlos de Lacerda Abstract: In Brazil’s Unified Health System (Sistema Único de Saúde – SUS), Primary Health Care (PHC) constitutes the first level of care and is responsible for coordinating patient care and organizing actions and services within the health care network. Over the years, PHC has undergone successive transformations, making it essential to assess the effectiveness of these changes. To this end, the number of Hospitalizations for Ambulatory Care Sensitive Conditions (ACSC) is used as an indicator, referring to hospital admissions that could be avoided through effective, accessible, and high-quality PHC. The objective of this study was to analyze the profile and determinants of ACSC in the state of Paraíba in 2023, investigating the correlation between health care performance and socioeconomic and demographic indicators. An ecological and retrospective study was conducted across the 223 municipalities of Paraíba, using data from the Hospital Information System of the Unified Health System (SIH/SUS), e-Gestor AB, and the Brazilian Institute of Geography and Statistics (IBGE). Data systematization was performed using the csapAIH package in the R environment. For association analysis, Beta regression with a complementary log-log link function was applied. A total of 67,229 ACSC hospitalizations were recorded, with urinary tract infections, cerebrovascular diseases, and pneumonia being the most prevalent causes, predominantly affecting females. Although regional health hubs concentrated the highest absolute volumes of hospitalizations, the highest rates were observed in small municipalities, with an atypical persistent pattern identified in Uiraúna. The model (R² = 0.2774) indicated that the number of Family Health Strategy (FHS) teams exerts a robust protective effect. However, the positive association between the volume of registered individuals and ACSC suggests that nominal expansion of coverage, without corresponding clinical resolutiveness, may increase hospital demand. Notably, Gross Domestic Product (GDP) and the Municipal Human Development Index (MHDI) were not statistically significant, indicating that health system organization outweighs isolated economic determinants in explaining avoidable hospitalizations. It is concluded that the consolidation of the health care network depends on overcoming the hospital-centered model and strengthening longitudinal clinical management within PHC. Editor: Universidade Federal da Paraíba Tipo: Dissertação

Efficacy of voice therapy associated with photobiomodulation in individuals with behavioral dysphonia: a randomized triple-blind clinical trial

2026-08-13T06:11:41Z

Título: Efficacy of voice therapy associated with photobiomodulation in individuals with behavioral dysphonia: a randomized triple-blind clinical trial Autor(es): Santana, Émile Rocha Orientador: Lopes, Leonardo Wanderley Abstract: OBJECTIVE: To compare the efficacy of vocal therapy associated with photobiomodulation with isolated voice therapy in patients with behavioral dysphonia. METHODS: This was a randomized, prospective, triple-blind clinical trial, with random allocation of participants in two intervention groups: VT-LLLT (Vocal Therapy Associated with Low-Level Laser Therapy), VT-PLT (Vocal Therapy Associated with Placebo Laser Therapy). VT-LLLT received low-level laser therapy (10mW power, 808nm infrared, point, 30J) associated with the Comprehensive Vocal Rehabilitation Program (CVRP) for 8 sessions; VT-PLT received laser placebo before performing the CVRP for 8 sessions. 39 women with behavioral dysphonia between the ages of 18 and 60 years attended the Speech Therapy Clinic at the Federal University of Paraíba (UFPB) and the State University of Bahia to participate. The subjects who agreed to participate in the study signed a Free and Informed Consent Form (ICF). Videolaringostroboscopy were assessed using the Laryngeal Vibration and Structural Assessment Form (LVSAF); vocal self-assessment tools were also applied [The Voice Symptom Scale (VoiSS), Voice Handicap Index (VHI-10) and Voice Severity Rating Scale (VSRS)]; computerized acoustic assessment of the voice samples was performed with extraction of Jitter, Shimmer, Cepstral Peak Prominence Smoothed (CPPS), difference between the amplitude of the first and second harmonics (H1-H2), Harmonic-to-Noise Ratio (HNR), Glottal-to-Noise Excitation Ratio (GNE), Acoustic Voice Quality Index (AVQI), Acoustic Breathness Index (ABI), using the PRAAT and Voxplot softwares; Overall Severity of dysphonia (OS) was extracted through Visual Analog Scale (VAS) using the software VOXMore after choosing the most reliable judge. All evaluations were performed before and after intervention in subjects of all groups. The intervention lasted 8 weeks with weekly monitoring by the researcher and team in the proposed procedures. Statistical analysis to compare all evaluation outcomes before and after intervention, as well as the group differences that occurred, applying parametric and non-parametric tests with Statistical Package Software for Social Sciences (SPSS) 29.0.2.0 and R Studio 2025.09.1 programs, considering a confidence level of 95%. Machine Learning classifier results were generated using Weka 3.8.6 to recognize voice parameter patterns in the acoustic and self-assessment post-intervention data and classify the groups. RESULTS: ENT and self-assessment variables did not show statistical difference between the groups, only related to the time factor; CPPS (p=0.049), and AVQI (p=0.014) demonstrated a group factor statistically significant with better values on the VT-LLLT group after intervention; OS also showed a statistically significant effect related to the group factor with a better progress in the VT-LLLT group (p=0.002). Hybrid machine learning classifiers showed good accuracy (84,62%) on recognizing patterns and classifying both groups, but the VT-LLLT stood up. CONCLUSION: The results suggest that the LLLT combined with vocal therapy is more effective than isolated vocal therapy on BD treatment. Editor: Universidade Federal da Paraíba Tipo: Tese

Escala de avaliação da fadiga: evidências de validade e análise de correlatos

2026-07-29T06:11:13Z

Título: Escala de avaliação da fadiga: evidências de validade e análise de correlatos Autor(es): Oliveira, Edjaclécio da Silva Orientador: Gouveia, Valdiney Veloso Abstract: Introduction: Fatigue is a multidimensional phenomenon that negatively affects occupational performance, mental health, and quality of life, and is particularly relevant among healthcare professionals. Valid and reliable instruments are essential for screening and for guiding occupational health interventions. Objective: To examine validity evidence for the Fatigue Assessment Scale (EAF) and to investigate the main correlates of fatigue in a national sample of physicians. Method: We conducted a correlational, ex post facto study with a national sample of 7,170 physicians recruited from the Federal Council of Medicine registry. Participants completed the EAF, the 12-item General Health Questionnaire (GHQ-12), and a questionnaire assessing sociodemographic, occupational, and clinical variables. Exploratory and confirmatory factor analyses, measurement invariance testing, Spearman’s correlations, Mann–Whitney U tests, and hierarchical linear regression were performed. Results and Discussion: Results supported the EAF’s unidimensional structure, with excellent internal consistency (α = 0.91; ω = 0.84). Confirmatory factor analysis supported the model, with fit indices varying across regions; multigroup analyses provided evidence of configural, metric, scalar, and residual invariance across Brazil’s five regions, indicating measurement stability. Fatigue was associated with sociodemographic, occupational, clinical, and psychosocial variables. Psychological distress showed the strongest association (ρ = 0.61–0.68) and was the main predictor in the hierarchical regression model, explaining the largest share of variance. Final Considerations: The EAF showed robust psychometric properties for assessing fatigue among physicians in Brazil. Fatigue was multifactorial, with psychosocial determinants, particularly psychological distress, playing a central role, underscoring the need to integrate mental health promotion into workplace management and occupational health surveillance. Editor: Universidade Federal da Paraíba Tipo: Dissertação

Escala de Sintomas Vocais (ESV-TRI) : avaliação das evidências de validade e predição de desfechos vocais por meio de modelos de aprendizado de máquina

2026-07-28T06:08:59Z

Título: Escala de Sintomas Vocais (ESV-TRI) : avaliação das evidências de validade e predição de desfechos vocais por meio de modelos de aprendizado de máquina Autor(es): Alencar, Sauana Alves Leite de Orientador: Almeida, Anna Alice Figueirêdo de Abstract: Introduction: Vocal assessment requires a multidimensional approach that includes the patient’s perception of their own voice. Self-assessment instruments, such as the Vocal Symptoms Scale (VSS), allow measuring the impact of vocal changes on daily life and monitoring therapeutic progress. The Brazilian version validated through Item Response Theory (VSS-IRT) represents a methodological advancement but lacked additional validity evidence based on relationships with other variables and responsiveness. Thus, the present study aimed to (1) investigate validity evidence based on relationships with other variables and (2) analyze the responsiveness of the VSS-IRT. Methods: The research was structured into two complementary studies. The cross-sectional study included 293 dysphonic participants treated at the Speech-Language Pathology teaching clinic of the Federal University of Paraíba (UFPB). Sociodemographic data, selfassessment measures (VSS-IRT, Voice Handicap Index—VHI-IRT, Voice-Related Quality of Life—V-RQOL-IRT, and Vocal Tract Discomfort Scale—VTDS-IRT), auditory-perceptual judgment (APJ), acoustic analysis, and laryngeal examination were collected. Pearson, polychoric, and tetrachoric correlations, logistic regression with recursive feature elimination (RFE), and machine learning models (Random Forest, Logistic Regression, and Gradient Boosting) with stratified cross-validation were performed. The longitudinal study involved 72 participants divided into an intervention group (IG) and a control group (CG). The IG completed six sessions of voice therapy, and both groups were evaluated using the VSS-IRT, APJ, and acoustic measures at preand post–six weeks. Analyses were conducted using Wilcoxon, Mann–Whitney, and mixed ANOVA tests. Results: The VSS-IRT showed strong positive correlations with VHI-IRT (r = 0.636; p < 0.001), V-RQOL-IRT (r = 0.602; p < 0.001), and VTDS-IRT (r = 0.720; p < 0.001), confirming convergent validity. There was a significant association between the VSS-IRT and the presence of vocal deviation according to the APJ (p = 0.011), and a moderate positive correlation with the overall severity grade (p = 0.025). Weak correlations were found between the VSS-IRT score and acoustic measures (F0sd, F0cv, shimmer, HNR, and CPPS). A moderate positive correlation was observed between the VSS-IRT and the presence of laryngeal structural alterations (p = 0.048). These findings reinforce the concurrent criterion validity of the VSS-IRT in relation to vocal deviation (APJ), acoustic measures, and laryngeal alterations. Clinical groups categorized by vocal deviation severity (p < 0.0001), laryngeal diagnoses (p < 0.001), and type of dysphonia (p = 0.005) showed significant differences in VSS-IRT scores, demonstrating the instrument’s discriminant validity. No differences were observed regarding gender, education level, or being a voice professional. Machine learning models were developed to test the prediction of VSS-IRT scores based on multidimensional voice assessment outcomes. The Random Forest model identified ten acoustic variables as the most predictive of the VSS-IRT score—F0 deviation, HNR, CPPSmax, HNRD, Shimmer.APQ3, LNPSD, F0 quartile 1, GNE3000, F0min, and GNE2000—with 82% accuracy and AUC > 0.80, indicating predictive capability. In the longitudinal study, the IG showed significant reductions in VSS-IRT scores and improvements in seven acoustic measures and in the APJ overall severity grade, whereas the CG remained stable. Mixed ANOVA confirmed a significant interaction between group and time, indicating vocal improvement only in the IG. The VSS-IRT showed 90.91% specificity, 80.70% overall accuracy, and an 85.11% negative predictive value relative to APJ, demonstrating excellent diagnostic performance for ruling out dysphonia and detecting clinically relevant changes. Conclusion: The VSS-IRT demonstrates full validity evidence in its Brazilian Portuguese version. The study provides validity evidence based on external variables and responsiveness. The VSS-IRT shows (1) convergent validity with VHI-IRT, V-RQOL-IRT, and VTDS-IRT; (2) concurrent criterion validity with laryngeal structural alterations, APJ vocal deviation, and acoustic measures; (3) discriminant validity regarding APJ deviation severity, laryngeal diagnostic categories, and dysphonia types; (4) predictive criterion validity between the VSS-IRT, acoustic measures, and APJ vocal deviation; and (5) responsiveness, demonstrated by its ability to detect significant changes in vocal symptoms throughout therapy. This characteristic reinforces its clinical utility by enabling sensitive and accurate monitoring of patient progress and identifying improvements or persistence of vocal symptoms during intervention. Editor: Universidade Federal da Paraíba Tipo: Tese