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Pernambuco L.D.A.,Federal University of Rio Grande do Norte | Espelt A.,Agencia de Salut Publica de Barcelona ASPB | Espelt A.,Autonomous University of Barcelona | Espelt A.,CIBER ISCIII | And 3 more authors.
Journal of Voice | Year: 2016

Purpose To identify the validity evidence based on the content and response processes of the Rastreamento de Alterações Vocais em Idosos (RAVI; "Screening for Voice Disorders in Older Adults"), an epidemiologic screening for voice disorders in older adults. Study Design This is a prospective, nonrandomized, cross-sectional, validation study. Methods Criteria for defining the domains and elaborating the questions were established to confirm the validity evidence based on the content. A multidisciplinary committee of 19 experts evaluated the questions, and the relevance and representation of the domains were analyzed using the Content Validity Index for Items (CVI-I) and the Content Validity Index (CVI), respectively. For validity evidence based on the response processes, 40 individuals of both sexes, aged ≥60 years, were stratified by demographic and socioeconomic condition. They responded to the RAVI, made suggestions, and their verbal and nonverbal reactions were observed. Results The first version of the RAVI consisted of 20 questions related to sensations and perceptions associated with the voice. Although the CVI value of 0.80 was satisfactory, the CVI-I and the suggestions of the expert committee indicated that the scale needed to be reformulated. Consultation with older adults indicated a need for further adjustment. The preliminary version of the RAVI consisted of 16 questions. Conclusions The two aspects of validity evidence described in the present study were essential for adapting the questions to better fit the construct of the questionnaire. Other aspects of validity evidence and reliability analysis will be described in part II of this study. © 2016 The Voice Foundation. Source


Pernambuco L.,Federal University of Paraiba | Espelt A.,Agencia de Salut Publica de Barcelona ASPB | Espelt A.,Autonomous University of Barcelona | Espelt A.,CIBER ISCIII | Costa de Lima K.,Federal University of Rio Grande do Norte
Journal of Voice | Year: 2016

Aim: The aim of the study was to determine the cutoff score and clinical consistency of "Screening for Voice Disorders in Older Adults" (RAVI-Rastreamento de Alterações Vocais em Idosos). Study Design: This is a prospective, nonrandomized, cross-sectional diagnostic study. Methods: A sample of 301 subjects, including both sexes, aged 60 and more, and all of whom were living in either a community or an institution, was studied. To determine which subjects had or did not have voice problems, we used a composite reference standard (auditory-perceptual analysis of sustained vowel phonation, auditory-perceptual analysis of connected speech, and vocal self-assessment). The best cutoff score was identified using the receiver operating characteristic (ROC) curve analysis. The clinical consistency indicators were co-positivity, co-negativity, positive and negative predictive values, positive and negative likelihood ratio, and test efficiency. The significance level was 5%. Results: The area under the ROC curve was 0.763 (95% confidence interval: 0.706-0.821), and the best cutoff score for determining which older adults had or did not have a voice disorder was 2. All clinical consistency indicators were satisfactory: co-positivity (79%), co-negativity (60%), predictive positive value (51%), negative predictive value (84%), positive likelihood ratio (2.01), negative likelihood ratio (0.34), and test efficiency (69%). Conclusions: RAVI has satisfactory indicators of clinical consistency and is able to determine which older adults have voice disorders by a cutoff score of 2. The use of RAVI as a screening tool is recommended to help determine the prevalence of voice disorders in older adults. © 2016 The Voice Foundation. Source


Rocha K.B.,Grande Rio University | Muntaner C.,University of Toronto | Gonzalez Rodriguez M.J.,Major University | Baksai P.B.,Major University | And 3 more authors.
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2013

Objective. To analyze links between social class and health-related indicators and behaviors in Chilean workers, from a neo-Marxian perspective. Methods. A cross-sectional study based on the First National Survey on Employment, Work, Health, and Quality of Life of Workers in Chile, done in 2009-2010 (n = 9 503). Dependent variables were self-perceived health status and mental health, examined using the General Health Questionnaire (GHQ-12). Health-related behavior variables included tobacco use and physical activity. The independent variable was neo- Marxian social class. Descriptive analyses of prevalence were performed and odds ratio (OR) models and 95% confidence intervals (95%CI) were estimated. Results. Medium employers (between 2 and 10 employees) reported a lower prevalence of poor health (21.6% [OR 0.68; 95%CI 0.46-0.99]). Unskilled managers had the lowest mental health risk (OR 0.43; 95%CI 0.21-0.88), with differences between men and women. Large employers (more than 10 employees) reported smoking the least, while large employers, expert supervisors, and semi-skilled workers engaged in significantly more physical activity. Conclusions. Large employers and expert managers have the best health-related indicators and behaviors. Formal proletarians, informal proletarians, and unskilled supervisors, however, have the worst general health indicators, confirming that social class is a key determinant in the generation of population health inequalities. Source


Muntaner C.,University of Toronto | Rocha K.B.,Agencia de Salut Publica de Barcelona ASPB | Borrell C.,Agencia de Salut Publica de Barcelona ASPB | Vallebuona C.,Ministerio de Salud de Chile | And 3 more authors.
Revista Panamericana de Salud Publica/Pan American Journal of Public Health | Year: 2012

This paper reviews the principal concepts of social class, occupation, and social stratification, and their contribution to the analysis of the social determinants of health (SDH), and reviews empirical studies conducted in Latin America that use employment relations as an SDH. The review focuses on studies of the relationship between health and social class based on neo-Weberian or neo-Marxist perspectives. A search of the BIREME Virtual Health Library and the SciELO database found 28 articles meeting these characteristics. This relative dearth contrasts with the profusion of papers that use these approaches written in Europe and in the United States, with a long tradition in the analysis of SDH. In this regard, the political and programmatic implications of research on social class and employment relations are different from and complementary to studies of health gradients associated with income and education. Globalization of employment relations requires the development of new concepts to explain and measure the mechanisms of action of the SDH going beyond what is strictly labor related; in particular, the importance in the current Latin American reality of the impact of informal work on health. Source


Tobias A.,CSIC - Institute of Environmental Assessment And Water Research | de Olalla P.G.,Agencia de Salut Publica de Barcelona ASPB | Linares C.,Institute Salud Carlos III ISCIII | Bleda M.J.,Research Center y Desarrollo Josep Pascual Vila | And 2 more authors.
International Journal of Biometeorology | Year: 2010

The summer of 2003 was exceptionally hot, leading to an excess of mortality in Europe. Here, we assess the short-term effects of extreme hot summer temperatures on total daily mortality in Barcelona (Spain). Daily mortality from burial records, maximum temperature, relative humidity and photochemical pollutants, were collected for the period 1999-2003. Data was analysed using Poisson regression with generalised additive models. Mortality shows a considerable increase when maximum temperatures are over a threshold temperature of 30.5°C. The risk of death associated with an increase of 1°C above the threshold was 6%, 7% and 5% after 1, 2 and 3 days, respectively. Exposure to extreme hot temperatures leads to an significant increase in mortality. © 2009 ISB. Source

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