DANIELA REGINA MOLINI AVEJONAS

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Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, Faculdade de Medicina - Docente
LIM/34 - Laboratório de Ciências da Reabilitação, Hospital das Clínicas, Faculdade de Medicina

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  • article 7 Citação(ões) na Scopus
    Insertion and performance of Speech-Language Pathology and Audiology in Family Health Support Centers
    (2014) MOLINI-AVEJONAS, Daniela Regina; ABOBOREIRA, Meiriane Silva; COUTO, Maria Inês Vieira; SAMELLI, Alessandra Giannella
    PURPOSE: To analyze the structure of the Centers for Supporting the Family Health (NASF), in 2010, identify the satisfaction degree of speech language pathologists who work in this area and compare the model proposed by the Brazilian Ministry of Health with practice. METHODS: Prospective and descriptive study, with 40 speech language pathologists inserted in NASF type one, from all Brazilian regions, in 2010. It was used a questionnaire with nine questions related to different topics (work infrastructure, NASF team, actions developed by these professionals and satisfaction about the work), sent by electronic mail to the speech language pathologists. Descriptive statistics, χ2, ANOVA and Pearson coefficient of variation were used to analyze variables. Significance level of 5% was adopted. RESULTS: The speech language pathologists reported that, in their working places (NASF), there was an average of 12.2 Health Family Teams, with 8.9 professionals and 1.6 speech language pathologists. Most of them work 40 hours per week. Routine activities cited by speech language pathologists were: promotion and health prevention actions, matricial, therapies, support to health community workers, referrals, home visits, intersectoral actions and administrative tasks. There was variability in the satisfaction score: the majority of interviewees indicated the degree ""Somewhat satisfied"" for work infrastructure and referrals, as well as reported ""Very satisfied"" degree for home visits and support for health community workers. Comparing the model proposed by the Ministry of Health with the speech language pathologists' practices, there was no significant difference. The results show that 40% of speech language pathologists consider that the NASF actions are below the proposed model. CONCLUSION: The NASF structure varied in terms of the number of Family Health Teams, professionals involved and actions performed. There was also significant variability in the satisfaction degree among the subjects studied.
  • article
    Challenges on network care considering the perceptions of preceptors of a Pet-Network regarding people with disabilities and at-risk infants: access, comprehensiveness and communication
    (2017) AOKI, Marta; BATISTA, Marina Picazzio Perez; ALMEIDA, Maria Helena Morgani de; MOLINI-AVEJONAS, Daniela Regina; OLIVER, Fatima Correa
    Introduction: Health Care Networks (HCN) are seen as a possibility for articulating and coordinating actions, health services and is a priority in the health system. One strategy to assure their improvement is the Tutorial Education Program (PET-Redes) in the health area. Within this context, it is important to understand the challenges and strengths for the effectiveness of HCN to the network care. Objective: To identify and analyze the perceptions of professionals who are preceptors of PET-Networks (Stork/at-risk infants Network and Disabled People Network) about the configuration of the network care and the challenges of professional actions related to it. Method: Qualitative study conducted through two focus groups with professionals that are preceptors of the PET-Networks. Thematic analysis was used for data analysis. Results: Both networks presented the following categories related to the network care configuration: access, comprehensive health care and communication. For this care network configuration, some challenges mentioned include geographical and architectural barriers, lack of social support, lack of transportation, failure on care flow and discontinuities in the communicative process. To deal with these challenges, the following strategies were mentioned: implementation of electronic medical records and formulation of specific forums for debate and articulation of actions, among others. It is important to notice that these categories are intertwined and that more challenges than strategies to overcome them were pointed out by the participants. Conclusion: There are several challenges for effective HCN from different levels and the construction of strategies needs to be convened among all persons involved in the HCN.
  • article 8 Citação(ões) na Scopus
    Prevalência de alterações fonoaudiológicas na infância na região oeste de São Paulo
    (2017) LONGO, Isadora Altero; TUPINELLI, Gabriella Gonçalves; HERMÓGENES, Caroline; FERREIRA, Laís Vignati; MOLINI-AVEJONAS, Daniela Regina
    ABSTRACT Purpose To establish the speech-language disorders in children living in the western region of São Paulo; to assess associations between diagnosis hypotheses (DH) and the age, gender and origin of referral; and to investigate the degree of agreement between the complaint and the DH at the moment of speech-language screening. Methods Observational epidemiological study conducted at a laboratory of Primary Health Care. A survey of 525 medical records of children between 2002 and 2011 was conducted. The following variables were analyzed: gender and age of the child; origin of referral, complaint reported by parents, diagnosis hypothesis and referrals. Results There was a predominance of male children (68.3%) and of the age group between 3 and 5 years and 11 months (48.7%), referred by a health professional (51.9%) and with more than one complaint reported by parents (26.1%). The most frequent DH were Phonological Disorder (22.9%) and more than one Diagnosis Hypothesis (19.4%). Most children were referred to a clinic-school where screening was performed (77.9%). There was an association between DH and the variables age (p <0.001*), gender (p = 0.008*) and origin of referrals (p <0.001). The degree of agreement between complaints and DHs was moderate. Conclusion It has been proven that there are different DHs according to age, gender and origin of referrals. The use of speech-language screening with the information provided by parents for tracking of speech pathology is recommended.
  • article 7 Citação(ões) na Scopus
    Referred speech-language and hearing complaints in the western region of Sao Paulo, Brazil
    (2014) SAMELLI, Alessandra Giannella; RONDON, Silmara; OLIVER, Fatima Correa; JUNQUEIRA, Simone Renno; MOLINI-AVEJONAS, Daniela Regina
    OBJECTIVE: The aim of this study was to characterize the epidemiological profile of the population attending primary health care units in the western region of the city of Sao Paulo, Brazil, highlighting referred speech-language and hearing complaints. METHOD: This investigation was a cross-sectional observational study conducted in primary health care units. Household surveys were conducted and information was obtained from approximately 2602 individuals, including (but not limited to) data related to education, family income, health issues, access to public services and access to health services. The speech-language and hearing complaints were identified from specific questions. RESULTS: Our results revealed that the populations participating in the survey were heterogeneous in terms of their demographic and economic characteristics. The prevalence of referred speech-language and hearing complaints in this population was 10%, and only half the users of the public health system in the studied region who had complaints were monitored or received specific treatment. CONCLUSIONS: The results demonstrate the importance of using population surveys to identify speech-language and hearing complaints at the level of primary health care. Moreover, these findings highlight the need to reorganize the speech-language pathology and audiology service in the western region of Sao Paulo, as well as the need to improve the Family Health Strategy in areas that do not have a complete coverage, in order to expand and improve the territorial diagnostics and the speech-language pathology and audiology actions related to the prevention, identification, and rehabilitation of human communication disorders.
  • article 5 Citação(ões) na Scopus
    Speech-Language Intervention for Children With Autism Spectrum Disorder in Brazil
    (2014) FERNANDES, Fernanda Dreux Miranda; AMATO, Cibelle A. H.; DEFENSE-NETRVAL, Danielle A.; MOLINI-AVEJONAS, Daniela R.
    Brazil has more than 200 million inhabitants living in an area of more than 8.5 million km(2) (Ministerio da Saude, Brasil, 2013a,b). Granting access to health and educational services for populations in such different environments clearly demands different actions and resources. Official policies regarding rehabilitation services and education to children and adolescents with autism spectrum disorders (ASDs) are being gradually defined and implemented. This article aims to present an overview of the Brazilian health system that considers health as a universal right and a state's duty. Some of the strategies created to provide services to persons with different needs living in different environments are outlined. Specifically in what refers to persons with ASD, there are laws, bills of rights, and guidelines, but their implementation is gradual and uneven. More developed regions provide more comprehensive support to these persons and their families, but some initiatives of outreach are being implemented. Speech-language pathology services are integrated to the health system and present their own challenges. Undergraduate programs for speech-language pathology include ASD as part of the mandatory training, and there are postgraduate studies in the field. Some challenges are being met by several initiatives by different groups as parents, scientific associations, and universities. Issues such as tests and protocols that can be used to Portuguese-speaking children and the identification of efficient methods that can be applied in different situations and orientation to parents and families have been object of research for some decades. There are still many challenges that must be addressed to provide adequate health and educational services to children with ASD and their families in Brazil.
  • article 0 Citação(ões) na Scopus
    Development of speech therapy app for parents
    (2020) COSTA, Caroline Hermogenes; MOLINI-AVEJONAS, Daniela Regina
    Purpose: To elaborate and show an innovative speech and language guidance program for smartphones, tablets, and computers, with technological support. The program aims to help parents of children at risk for language disorder in order to minimize the consequences of a developmental language disorder (DLD). Method: An app was developed to provide a dynamic interaction between the researcher and the families for at a distance intervention, aiming to reach the greatest number of children to promote language development in a broad, low-cost and effective way. Results: The content was organized in video-lessons (theoretical orientations were carried out in the form of video-lessons, taught by the researcher), videos (documentaries and videos from YouTube), reports (reports linked to sites specializing in child development), complementary content (cultural and leisure activities to be done in family) and activities (activities to stimulate the skills worked on in each week's video lesson proposed in the application). Conclusion: We created a remote orientation program proposing an innovative, technological, and motivating therapeutic environment compatible with the reality of today's families.
  • article 2 Citação(ões) na Scopus
    Ataxia Telangiectasia in Siblings: Oral Motor and Swallowing Characterization
    (2017) RONDON-MELO, Silmara; ALMEIDA, Isabel Junqueira de; ANDRADE, Claudia Regina Furquim de; SASSI, Fernanda Chiarion; MOLINI-AVEJONAS, Daniela Regina
  • article 16 Citação(ões) na Scopus
    Risk factors identification in children with speech disorders: pilot study
    (2013) SILVA, Gabriela Martins Duarte; COUTO, Maria Ines Vieira; MOLINI-AVEJONAS, Daniela Regina
    PURPOSE: To identify the main risk factors related to children and their parents, associated with speech and language disorders. METHODS: A prospective descriptive study conducted with 170 children and their parents assisted at a school clinic in the period between March 2010 and July 2012. A protocol was developed for this study in order to identify risk factors for language and speech disorders. Data were tabulated and analyzed using descriptive and inferential statistics by the Χ2 and Student' s t-test . RESULTS: The demographic profile is composed of male children aged between 4 and 5 years old, ethnicity declared by parents as being white, residents of the western region of the city of São Paulo, and whose parents had completed high school. The factors related to family and considered as risks for language impairment were being an only child and having a family history of speech and language disorders. As for the children' s health, prematurity, hospitalization for a long period, and the presence of deleterious oral habits were also considered as risk factors. CONCLUSION: The protocol allows establishing the main risk factors related to children with speech and language disorders. It is suggested that children who present with one or more of the aforementioned risk factors should be regularly monitored for speech and language development and, if necessary, referred for early intervention.
  • article 2 Citação(ões) na Scopus
    Organization of the referral and counter-referral system in a speech-language pathology and audiology clinic-school
    (2015) MOLINI-AVEJONAS, Daniela Regina; ESTEVAM, Stephanie Falarara; COUTO, Maria Inês Vieira
    OBJECTIVE: To analyze the effectiveness of the referral and counter-referral flow in a speech-language pathology and audiology clinic-school and to characterize the patients' profiles. METHODS: Evaluation, retrospective, and prospective study, in which 503 patient records, without age restriction, were selected from a clinic-school and the following variables were analyzed: demographic information, speech and hearing diagnosis, and references. Patients were distributed into two groups according to the referrals made: internal (G1, n=341) and external (G2, n=162) to the clinic-school. RESULTS: A prevalence of male subjects under 12 years of age and with diagnosis of language disorders (primary and secondary) was found. It was observed that 83% patients in G1 were recalled for evaluation and speech therapy after an average of 7 months of waiting; and from the patients in G2 that were contacted (n=101), 13.9% were summoned and are satisfied with the place indicated for therapy after an average of 4 months of waiting. From those who did not receive care, 46% sought another service, and of these, 72.5% were successful. CONCLUSION: The data show the effectiveness and appropriateness of referrals made internally, suggesting that, when the team works together, the network operates more adequately. However, in relation to external referrals, they did not reach the proposed goals, indicating a lack of speech-language pathologists in public services and the low interest of patients in looking for other places of care.
  • article 4 Citação(ões) na Scopus
    Sensitivity and specificity of a low-cost screening protocol for identifying children at risk for language disorders
    (2020) DIAS, Daniela Cardilli; RONDON-MELO, Silmara; MOLINI-AVEJONAS, Daniela Regina
    OBJECTIVES: To compare the diagnostic accuracy of a low-cost screening test for identifying children at risk for language disorders with that of a specific language assessment. METHODS: The study was conducted during a polio vaccination campaign in basic health units in western Sao Paulo, Brazil. The parents/guardians of 1000 children aged between 0 and 5 years were asked to answer questions of a specific screening test. The instrument consisted of a uniform set of questions about the main milestones in language development (from 0 to 5 years of age) with scaled scores to assess responses. There were no exclusion criteria. After the screening test, the children were referred to a specific language assessment by ABFW, following a determined flow of referrals. The results obtained in the screening were compared to those obtained in the specific language assessment; then, the sensitivity, specificity, accuracy, and positive and negative predictive values were determined for the screening test. Children who failed the screening test also underwent an audiological evaluation. The statistical significance was set at 5%. RESULTS: The majority of the participants were aged between 4 and 5 years (21.82%) and were male (51.6%). The sensitivity and specificity values were 82.5% and 98.93%, respectively. The area under the curve was 0.907 (0.887-0.925), and the screening test showed 96% accuracy. CONCLUSIONS: The screening test showed high diagnostic efficiency in determining the risk of language disorders in children aged between 0 and 5 years.