Objective: To propose a single qualifier scale for voice problems based on the International Classification of Functioning, Disability, and Health (ICF) that classifies a voice problem considering its multidimensionality. Method: A multicultural database was analyzed (280 subjects). The analyzed information was: the perceptual judgment of the overall voice quality (G); the acoustic analysis (A) with the Acoustic Voice Quality Index; the laryngeal diagnosis (L) and the patient self-assessment (P) using the Voice Handicap Index. The variables were categorized. A 2-step cluster analysis was performed to define groups with common characteristics. Results: A 7-point qualifier scale, the GALP, was defined to generally classify levels of voice problems considering 4 dimensions of the voice evaluation. Each level of voice problem, that is, no problem, mild, moderate, severe, or complete voice problem, has its own possible outcome for G, A, L, and P that will change, or not, the overall level of voice problem. The extremes of the scale represent "no problem" at all when all parameters are normal, and "complete problem" when all parameters are altered. The 3 levels in between were defined by the cluster analysis (mild, moderate, and severe problem) and change according to the outcome of each evaluation (G, A, L, and P). Thus, changes in one parameter alone may or not contribute to the change of the level of voice problem. Also, there are 2 categories for cases that do not fit the classification (not specified) and for which some of the variables are missing (not applicable). Conclusion: The GALP scale was proposed to classify the level of voice problem. This approach considers important dimensions of voice evaluation according to the ICF. It is a potential tool to be used by different professionals, with different assessment procedures, and among different populations, clinicians, and study centers.
At present, the act of thinking appears as idle and is displaced by the instrumental. Comprehensive local risk management (CLRM) and information systems (IS) in the field of environmental health (EH) are analyzed ignoring the actor's conception and the time from which they start. Common practice does not respect the ontological character that we recognize as artisanal and based on movements of social re-association and re-assembly. Because of this it is necessary to catch up with the innovations of the actors, in order to know and learn about the collective existence from their own point of view, without imposing any order, limiting diversity, teaching what they are or adding reflexivity to their practice. The purpose of this article is to challenge CLRM and IS as a technical answer without questions, versus a CLRM and IS as a territory, that is, as a space with questions based on institutions, procedures and concepts capable of bringing together and re-relating the social. For this purpose, we will analyze the science that moves in the dimension of philosophy and recover the passion that represents the question; the territory as a space of the singular and site of acting, where the relational and the symbolic are expressed crossed by capitals and fields that exceed the epistemological simplicity; equity and equality to reduce long-term risk; the moments of the processual logic of an SI in the reference framework: data, information, knowledge, communication for action (DIKCA); cognitive justice; the processes of co-building knowledge essentially constituted by the word and conversations that trigger processes. We affirm that environmental health is a key tool of social practice. It corresponds to all this vast set of practices and knowledge that a society sets in place to know its health and environment, in order to transform it. Therefore, the proposal is to cease understanding CLRM and SI as rational products, and to come to understand them as a human product and, therefore, made by humans who construct language a central feature of their existence. We believe that change is necessary, that new, or not so new problems cannot be solved with outdated ideas. However, acquiring and developing renewed ideas or concepts can create the false illusion that everything is easy, but it is not. The challenge is daunting, as much as the need is inescapable. 46 Maria del Carmen Rojas et al.: Territorialize Comprehensive Local Risk Management and Information Systems: Co-building Knowledge in the Field of Environmental Health
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