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Primary health care (PHC) systems are a crucial instrument for achieving equitable population health, but there is little evidence of how PHC reforms impact equities in population health. In 2010, Sweden implemented a reform that promoted marketization and privatization of PHC. The present study uses a novel integration of intersectionality-informed and evaluative epidemiological analytical frameworks to disentangle the impact of the 2010 Swedish PHC reform on intersectional inequities in avoidable hospitalizations. The study population comprised the total Swedish population aged 18–85 years across 2001–2017, in total 129 million annual observations, for whom register data on sociodemographics and hospitalizations due to ambulatory care sensitive conditions were retrieved. Multilevel Analysis of Individual Heterogeneity and Discriminatory Analyses (MAIHDA) were run for the pre-reform (2001–2009) and post-reform (2010–2017) periods to provide a mapping of inequities. In addition, random effects estimates reflecting the discriminatory accuracy of intersectional strata were extracted from a series MAIHDAs run per year 2001–2017. The estimates were re-analyzed by Interrupted Time Series Analysis (ITSA), in order to identify the impact of the reform on measures of intersectional inequity in avoidable hospitalizations. The results point to a complex reconfiguration of social inequities following the reform. While the post-reform period showed a reduction in overall rates of avoidable hospitalizations and in age disparities, socioeconomic inequities in avoidable hospitalizations, as well as the importance of interactions between complex social positions, both increased. Socioeconomically disadvantaged groups born in the Nordic countries seem to have benefited the least from the reform. The study supports a greater attention to the potentially complex consequences that health reforms can have on inequities in health and health care, which may not be immediate apparent in co

Background: The Swedish Primary Health Care (PHC) system has, like in other European countries, undergone a gradual transition towards marketization and privatization, most distinctly through a 2010 choice reform. The reform led to an overall but regionally heterogenous expansion of private PHC providers in Sweden, and with evidence also pointing to possible inequities in various aspects of PHC provision. Evidence on the reform's impact on population-level primary health care performance and equity in performance remains scarce. The present study therefore aimed to examine whether the increase in private provision after the reform impacted on population-average rates of avoidable hospitalizations, as well as on corresponding socioeconomic inequities. Methods: This register-based study used a multiple-group interrupted time-series design for the study period 2001-2017, with the study population (N = 51 million observations) randomly drawn from the total Swedish population aged 18-85 years. High, medium, and low implementing comparison groups were classified by tertiles of increase in private PHC providers after the reform. PHC performance was measured by avoidable hospitalizations, and socioeconomic position by education and income. Interrupted time series analysis based on individual-level data was used to estimate the reform impact on avoidable hospitalization risk, and on inequities through the Relative Index of Inequality (RII). Results: All three comparisons groups displayed decreasing risk of avoidable hospitalizations but increasing socioeconomic inequities across the study period. Compared to regions with little change in provision after the reform, regions with large increase in private provision saw a steeper decrease in avoidable hospitalizations after the reform (relative risk (95%): 1.6% (1.1; 2.1)), but at the same time steeper increase in inequities (by education: 2.0% (0.1%; 4.0); by income: 2.2% (-0.1; 4.3)). Conclusions: The study suggests that the

The purpose of this research project is the development of vegan mirror icings with the use of plant-based dyes, focused on the techniques and ingredients used in traditional mirror icing and its vegan substitutes, as well as on the natural ingredients of vegetable origin that will provide the color to each of them to be applied in cold desserts. Within this project, qualitative and quantitative methodology was used, traditional pastry research was carried out focused on mirror icing, to then be able to define the ingredients of animal origin that would be replaced by ingredients of vegetable origin and preparation techniques. Here, also, the natural pigments to be used for the different colors of frostings were identified. To determine the organoleptic characteristics, a quantitative analysis of the types of glazes made was carried out, we had a panel of professors from the gastronomy career and a focus group with knowledge in the area of veganism. Keywords: mirror icing, plant-based dyes, vegan, plan-based, vegan pastry.

Background: The voice is the sound that is produced through the vibration of the vocal cords, being an essential means to practice several professions, such as teaching. However, its misuse or vocal abuse can have consequences within the functional, physical, and emotional areas, so it is important to self-evaluate it to know its impact on the quality of life. General Objective: Determine vocal self-perception in teachers of public educational units in the city of Cuenca in the period 2023 – 2024. Methods: A cross-sectional descriptive study was carried out where vocal selfperception was determined. The sample was made up of 80 teachers from the public educational units of Cuenca. Informed consent, a data collection form, and the Voice Handicap Index test (VHI-30) were used. Subsequently, the data obtained were analyzed by the SPSS program, version 22. Results: Of the 80 teachers, 45 were female and 35 were male. A higher occurrence of vocal disability was found in females, with mild vocal disability predominating. According to the number of working hours per day, there is a greater prevalence of vocal disability in teachers who work 8 hours a day. On the other hand, considering age, those between 36 and 45 years old represent the highest number with vocal disability. Conclusions: There is a higher percentage of predominant mild vocal alteration in the female sex, finding greater alteration on the physical scale.

Background: The speech therapist is part of the health professionals such as: the early stimulator, physiotherapist, neurologist, neuropediatrist, dentist, otolaryngologist, pediatrician, clinical or educational psychologist, however, it is unknown if these professionals are familiar with the role of the same. Objective: To identify the knowledge of health professionals involved in speech therapy. Methods: A descriptive cross-sectional analytical study was carried out with a sample of 155 health professionals, linked to speech therapy who were surveyed in different health institutions in the city of Cuenca, the data were tabulated in SPSS 22, analyzed and presented in tables of frequencies and percentages. Results: 94.19% of the professionals surveyed were aware of the role of the speech therapist in the health team, while 5.81% were unaware of it. 93.55% indicated that it is important to link their health specialty with speech therapy. On the other hand, 41% refer cases frequently; The main causes are: speech disorders, hearing problems, swallowing disorders and language disorders, with 18.06% of health professionals who have never referred a case. Conclusions: There is a high level of knowledge about the role of the speech therapist, however, of the professionals participating in the present study, only 65.81% have been able to know the final results of the speech therapy intervention

Background: The voice is the main means of communication for teachers in the classroom. However, when teaching classes, they often use inappropriate behaviors, such as raising the tone of their voice, shouting, clearing their throat, using if for long hours without breaks, among others. It is important that they avoid these behaviors that alter the health of their voice, affecting their communication, physical well-being, and social, personal, family, emotional and work relationships. Objective: Determine vocal misuse and abuse in basic education teachers of the Panama Basic Fiscal school and the Leoncio Cordero Jaramillo Educational Unit of the city of Cuenca in the period 2023-2024. Methods: A cross-sectional quantitative descriptive study was carried out with a sample of 61 teachers where vocal habits were analyzed through the questionnaire “Occupational and personal factors that affect the phonatory system” and tabulated using the SPSS version 25 program. Results: Of the 61 respondents, the women with the highest percentage were the age groups 31-40 and 41-50 years old with 29.5% while the age group of men were 51-60 years old or older with 13.1%. There were risk behaviors, such as increasing their voice by 44.3% and sharpening it by 34.4% when they had between 31 to 40 students, and increasing their voice by 42.6% and sharpening it by 24.6% when they had between 21 and 30 students, Conclusion: Teachers engage in behaviors that reflect vocal abuse and misuse, such as smoking, drinking alcohol, coffee, tea, aggravating the tone

BACKGROUND: Speech sound disorders (TSH) refer to any difficulty with perception, motor production, or phonological representation of speech sounds and speech segments. TSHs are a variety of expressive and receptive difficulties seen in children as a result of a medical problem or with no known cause. Therefore, there is little consensus on the best way to define and identify them. Objective: To determine speech sound disorders in users who attended the Los Girasoles comprehensive development center in the period 2018 - 2020. Methodology: A descriptive, retrospective, cross-sectional study using frequency and percentage tables, with a universe of 110 users. The collected data will be transcribed into a digital database and analyzed with the SPSS v22 statistical program. Results: 61.8% of the children who attended the Integral Los Girasoles center were male and according to age, 29.1% were 4 years old. According to the TSH, the Mixed represented 59.1% being more frequent in children with 38.2% and according to age the same type occurred between 3 and 4 years in 17.3% respectively. Finally, according to the errors of the speech sounds, the substitution occurred in 98.2% of the cases, with children being the most affected with 60% and according to age, 28.2% affected the 4 years. Conclusions: Speech disorders in preschool children are a public health problem, these children upon entering school will be a vulnerable group that will require not only speech-related intervention but also, in some cases, emotional and behavioral support.

Background: Singers are highly susceptible to suffer vocal pathologies, since they utilize their voice to perform, and require the implementation of vocal hygiene standards, which are based on a set of recommendations to optimize their voice and avoid vocal pathologies. General Objective: To determine vocal hygiene habits that singers of the polyphonic choirs of the canton Cuenca in the year 2022. Methods: The current study implements a descriptive cross-sectional study, with a sample size of 133 polyphonic choir singers from canton Cuenca in the year 2022. A Vocal Awareness Questionnaire for Singers was implemented to understand the vocal hygiene habits utilized and associated risk factors which influence the presentation of vocal pathologies, such as (gender, age, musical education, type of voice, hours sung weekly). The analysis of data was tabulated through SPSS 29 free version, using tables created in Excel 2021 by means of frequencies and percentages. Results: Of the 133 respondents, 73.7% belong to the age group of 18 to 29 years 11 months. 38.3% correspond to the male gender and 61.7% to the female gender; 42.1% of this gender drink water when feeling mucus or phlegm in the throat. 30.1% of the male gender prefer to cough or clear their throat. Participants of this study responded that speaking more frequently with laryngitis, throat clearing, air conditioning, and speaking in noisy environments were associated factors both behaviorally and environmentally on vocal mechanism. Conclusions: It was concluded that the singers of the Polyphonic Choirs of the canton do not elicit optimal vocal hygiene habits.

Background: the main work tool of teachers is their voice and their efficiency in their professional activities depends on it, therefore they are exposed to risk factors that can cause vocal disorders and interfere in their work performance. Generally, they consult a specialist when their voice is poorly appreciated, therefore, it is important to know the self-perception of the teacher with respect to their voice. (1) (2) Type of study: the research corresponds to a descriptive-prospective study. General Objective: to evaluate the self-perceived vocal disability through the Voice Handicap Index questionnaire in teachers of the Cuenca City Educational Unit in virtual classes 2020 - 2021. Methodology: to evaluate the self-perceived vocal disability, surveys were conducted through Google Forms, the results were tabulated in SPSS 22 and Microsoft Excel. The analysis of variables was performed using contingency tables, for the quantitative analysis mean, median, mode and for the qualitative variables frequency and percentage were calculated. Results: when the questionnaire was applied to the 53 teachers, it was determined that 84.91% presented a mild self-perceived degree of vocal affectation, 15.09% a moderate degree and none presented a severe or serious degree. Conclusion: teachers are prone to suffer vocal disorders because the use of their voice is indispensable. Therefore, it is important to know their vocal self-perception in functional, organic and emotional aspects to identify if there is an alteration and the degree to which it influences their performance.

Background: In the COVID-19 pandemic, medical services found alternative ways such as teletherapy to maintain the provision of health services to patients. Teletherapy provides prevention, evaluation and intervention services through videoconference. Speech therapy is one of the clinical fields in which teletherapy has been found useful and has made it possible to treat pathologies such as Speech Sound Disorder (SSD). (1) SSD occurs due to affectation of the phonetic component (articulatory production of sounds) or affectation of the phonological component (functional use of contrastive segments of speech). (2) Objective: To determine the prevalence of Speech Sound Disorders in patients aged 3-5 years attended by teletherapy. Cuenca, March-December 2020. Methodology: The SPSS and Excel programs were used to tabulate, in the analysis of the results qualitative variables were used: frequency, number and percentages; to represent them, simple and contingency tables were used. Results: The majority of those surveyed with 37.1% treated 1-5 patients with TSH through teletherapy; the highest percentage with 46.78% treated male patients; the majority with 22.58% attended patients between 4 years 1 month to 4 years 6 months of age; 69.4% used the Phonetic-Phonological-Revised Evaluation Protocol (PEFF-R); 64.5% diagnosed their patients with Phonetic-Phonological TSH and the majority with 33.9% used a care time greater than 4 months.

BACKGROUND: Phonoaudiological pathologies are alterations in one or more of the areas of phonoaudiology, such as: language, speech, voice, swallowing and hearing. Among the most relevant are: late language onset, language development disorder, speech sounds disorder, dysphonia, dysphagia and hypoacusis. To achieve this research, clinical histories and phonoaudiological reports of children between the ages of 3 years 11 months to 5 years 11 months, who attended the phonoaudiology area during the period 2016 - 2019, were reviewed. OBJECTIVE: To determine the prevalence of phonoaudiological pathologies in the CEDIUC 2016-2019 phonoaudiology area. METHOD: The analysis of the results was performed using Microsoft Excel program version 2010 and SPSS; for quantitative variables through statistical analysis of measures of central tendency. For qualitative variables, frequencies and percentages were used. RESULTS: The present study registered a sample of 117 participants, including clinical histories and speech therapy reports of CEDIUC assistants in the period 2016-2019. The prevalent sex was male with 65.81%, the age range with the highest rate of phonoaudiological pathologies was from 3 years to 3 years 11 months with 46.15%. The most prevalent phonoaudiological pathologies are: late onset of language (24.80%) and phonetic speech sounds disorder (25.65%), followed by dysphagia without specification (0.85%) and oral dysphagia (0.85%), in addition to transmission hypoacusis and without specification (0.85%) and additionally dysphonia (1.70%).

Background: In 2010, Sweden opened up for establishment of privately owned primary health care providers, as part of a national Free Choice in Primary Health Care reform. The reform has been highly debated, and evidence on its effects is scarce. The present study therefore sought to evaluate whether the reform have impacted on primary health care service performance. Methods: This ecological register-based study used a natural experimental approach through an interrupted time series design. Data comprised the total adult population of the 21 counties of Sweden 2001–2009 (pre-intervention period) and 2010–2016 (post-intervention period). Hospitalizations and emergency department visits for ambulatory care sensitive conditions (ACSC) were used as indicators of primary health care performance. Segmented regression analysis was used to assess the effects of the reform, in Sweden as a whole, as well as compared between counties grouped by (i) change in private provision pre- to post reform; (ii) the timing of the implementation; and (iii) sustained presence of private providers both pre- and post-reform. Results: The results suggest that, following the introduction of the reform in Sweden as a whole, the trends in total hospitalizations rates were slowed down by 1.0% albeit acute emergency visits increased 1.1% more rapidly after the introduction of the reform. However, we found no evidence of more beneficial effects in counties where the reform had been implemented more ambitiously, specifically those with a larger increase in private primary care providers, or where the reform was introduced early and thus had longer time effects to emerge. Lastly, counties with a sustained high presence of private primary care providers displayed the least favorable development when it comes to ACSC. Conclusion: Taken together, the present study does not support that the Swedish Free Choice reform has improved performance of the primary care delivery system in Sweden, and suggests tha