Absenteeism due to voice disorders in female teachers: a public health problem

Relationship Between Voice Problems and Depression Among American Adults

OBJECTIVE

Voice problems have a large impact on quality-of-life and societal participation. It has been previously reported that persons with voice problems have a higher likelihood of depression than those without voice problems. Despite this knowledge, little has changed in clinical practice related to screening for depression or incorporating the presence of depression in treatment planning. This study aims to provide an updated analysis of the prevalence of depressive symptoms in persons with voice disorders to elucidate the current magnitude of the relationship in hopes that this will provoke greater awareness of the co-occurrence of voice problems and depression and improve clinical care.

STUDY DESIGN

Cross-sectional design with a national survey.

SETTING

None.

METHODS

The study examined the 23,706 adults from the 2022 National Health Interview Survey database. A series of logistic regression models with propensity score matching approaches were used to examine the association between voice problems and depression by accounting for demographics and health conditions.

RESULTS

When comparing persons with and without voice problems, there were statistical differences in demographics and health conditions (all P < .05); however, those differences were balanced by propensity score matching methods (all P > .05). The balanced samples revealed that those with voice problems were approximately twice as likely to experience depressive symptoms (odds ratios ranged from 1.532 to 2.024, all P < .05) compared to those without voice problems. Depressive symptoms increased with the severity (P < .0001) and duration of the voice problem (P = .0328).

CONCLUSION

The study found robust associations between voice problems and depression within the current American adult population in 2022. To achieve optimal treatment outcomes, it is critical that the co-occurrence of voice problems and depression is understood, and that treatment planning addressed both conditions, when applicable.

Prevalence of Perceived Voice Disorders and Associated Risk Factors in Teachers and General Population in Croatia

OBJECTIVES

There is no available data on the prevalence of voice disorders in Croatia. The objective of this research was to determine the prevalence of perceived voice disorders (PVD) in teachers and general population in Croatia using the Croatian Voice Handicap Index (VHI-HR) questionnaire.

METHODS

This research was divided into two phases. In phase I, the potential of the VHI-HR questionnaire to distinguish individuals with and without voice disorders was assessed. A total of 113 participants completed the VHI-HR. Receiver operating characteristic analysis was performed. In phase II, a cross-sectional study was conducted. A total of 1898 participants, including 1088 teachers from 434 Croatian schools, and 810 nonteachers were included in the study. The questionnaire on sociodemographic factors, potential risk factors associated with voice disorders, and the VHI-HR was administered. The differences in the PVD prevalence in teachers and nonteacher adults and adverse effects of PVD were investigated. The multiple logistic regression model was used to examine the factors associated with PVD occurrence.

RESULTS

In phase I, the cut-off point of 18.32 with 93.44% sensitivity and 98.08% specificity for VHI-HR was determined. In phase II, higher lifetime PVD prevalence was found among teachers. The point prevalence of PVD was 45.68% for teachers, and 21.11% for nonteachers. This study demonstrated that being a teacher, a woman, having a family history of voice disorders, reflux, working in environment with elevated noise levels, and having more than 30years of employment are associated with PVD occurrence.

CONCLUSIONS

VHI-HR score of 19 and higher proves effective in distinguishing individuals with voice disorders from those without. The odds of having PVD for teachers are 2.83 times higher than for nonteachers. Risk factors for voice disorders, among others, include occupational use of voice and working in environments with elevated noise levels.

Can rapid maxillary expansion affect speech sound production in growing patients? A systematic review

Rapid maxillary expansion (RME) may change speech sound parameters due to the enlargement of oral and nasal cavities. This study aimed to systematically review the current evidence on speech changes as a side effect of RME. An electronic search was conducted in nine databases, and two of them accessed the 'grey literature'. The eligibility criteria included clinical studies assessing orthodontic patients with maxillary transverse deficiency and the relationship with speech alterations without restricting publication year or language. Only interventional studies were included. The JBI Critical Appraisal Tool assessed the risk of bias. The initial search provided 4853 studies. Seven articles (n = 200 patients) met the inclusion criteria and were analysed. The primary source of bias was the absence of a control group in four studies. RME altered speech production by changing vowel fundamental frequency and fricative phoneme formant frequency. Shimmer and jitter rates changed in one and two studies, respectively. Two studies presented deterioration during orthodontic treatment, but speech improved after appliance removal. Despite the limited evidence, RME affects speech during and after treatment.

Impact of naturalistic smartphone positioning on acoustic measures of voicea)

Smartphone technology has been used for at-home health monitoring, but there are few available applications (apps) for tracking acoustic measures of voice for those with chronic voice problems. Current apps limit the user by restricting the range of smartphone positions to those that are unnatural and non-interactive. Therefore, we aimed to understand how more natural smartphone positions impacted the accuracy of acoustic measures in comparison to clinically acquired and derived measures. Fifty-six adults (11 vocally healthy, 45 voice disordered, aged 18-80 years) completed voice recordings while holding their smartphones in four different positions (e.g., as if reading from the phone, up to the ear, etc.) while a head-mounted high-quality microphone attached to a handheld acoustic recorder simultaneously captured voice recordings. Comparisons revealed that mean fundamental frequency (Hz), maximum phonation time (s), and cepstral peak prominence (CPP; dB) were not impacted by phone position; however, CPP was significantly lower on smartphone recordings than handheld recordings. Spectral measures (low-to-high spectral ratio, harmonics-to-noise ratio) were impacted by the phone position and the recording device. These results indicate that more natural phone positions can be used to capture specific voice measures, but not all are directly comparable to clinically derived values.

Voice Disorders and Mental health of Basic Education Teachers in a Brazilian Municipality

OBJECTIVE

To identify associations with voice disorders in elementary school teachers of a Brazilian municipality STUDY DESIGN: This was a quantitative cross-sectional and analytical study with probability sampling carried out in the 2016 school year METHOD: Self-report of vocal complaints was used for the dependent variable vocal disorder. The independent variables were sociodemographic and occupational characteristics, working conditions that generate discomfort, habits and behaviors, mental health and self-perception of health. For the evaluation of the Burnout Syndrome (BS), the questionnaire Cuestionário para la Evaluación del Syndrome de Quemarse por el Trabajo (CESQT) was used and, for depression, the Beck Depression Inventory (BDI) scale instrument. Multiple fit models were used applying the Binary Logistic Regression RESULTS: A total of 634 teachers participated in this study. There was a predominance of women (85.3%) with mean age 40.6 years (SD ±9.5); 62.1% were married, 70.2% had children and a mean teaching time of 12.9 years (SD ±8.4); 19.3% had voice disorders; 14.5% experienced BS and 24.0% depression. Voice disorders were associated with women (OR=2.30) working longer weekly hours (OR=1.75), with psycho-emotional problems, with burnout (OR=1.95) and depressive symptoms (OR=1.70), and were also associated with women who reported negative self-perception of health (OR= 1.97) CONCLUSION: Voice disorders appear to be strongly associated with mental health problems, mainly in women, in those with a longer working week and those who reported a negative perception of health. Public policies are required to prevent psycho-emotional problems and for vocal health promotion of the teaching category.

Social Vulnerability of Brazilian Metropolitan Schools and Teachers' Absence from Work Due to Vocal and Psychological Symptoms: A Multilevel Analysis

Teachers' voices and psychological symptoms are the main reasons for absence from work. The objectives of this study were: (i) to spatially represent, through a webGIS, the standardized rates of teachers' absences due to voice (outcome 1) and psychological symptoms (outcome 2) in each Brazilian Federative Unit (FU = 26 states plus Federal District) and (ii) to analyze the relationship between each national outcome rate and the Social Vulnerability Index (SVI) of the municipality where urban schools are located, adjusted for sex, age, and working conditions. This cross-sectional study comprised 4979 randomly sampled teachers working in basic education urban schools, of which 83.3% are women. The national absence rates were 17.25% for voice symptoms and 14.93% for psychological symptoms. The rates, SVI, and school locations in the 27 FUs are dynamically visualized in webGIS. The multilevel multivariate logistic regression model showed a positive association between voice outcome and high/very high SVI (OR = 1.05 [1.03; 1.07]), whereas psychological symptoms were negatively associated with high/very high SVI (OR = 0.86 [0.85 0.88]) and positively associated with intermediate SVI (OR = 1.15 [1.13; 1.16]), in contrast with low/very low SVI. Being a woman (voice: OR = 1.36 [1.35; 1.38]; psychological: 1.22 [1.21; 1.24]) and working in schools with various precarious conditions (17 variables) increased the odds of being absent due to voice and psychological symptoms. The results confirm the need for investments to improve working conditions in schools.

Prevention of occupational dysphonia in scientific university personnel: A cross-sectional study

Aim

The aim of the study was to identify occupational and individual factors that influence the occurrence of voice problems in university staff and to investigate whether there is a link between voice problems and physical, psychological or functional changes?

Subject and methods

The voices of university teachers are exposed to increased stress. As members of the group of professional speakers, they have an increased prevalence of developing a voice disorder, so-called dysphonia. In the worst case, chronic, occupational dysphonia can occur. In an empirical-quantitative study in form of a cross-sectional study in Germany, an online questionnaire was used to determine whether university teaching staff is more frequently affected by voice problems than their colleagues in the administrative sector.

Results

The results show that dry room climate, background noise, poor spatial acoustics, lack of breaks, and increasing age influence the occurrence of voice problems in university teachers. Teaching staff is therefore more frequently affected by impaired vocal function due to frequent throat clearing/coughing and a raspy, hoarse and scratchy voice than their administrative colleagues. In addition, there is a need for regular training and counselling.

Conclusion

In order to prevent the development of occupational dysphonia among university teachers, diagnostic, practical and theoretical interventions for the target group are needed. To this end, the appropriate structural and personnel conditions must be created in the university environment.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-022-01805-0.

Effects of Virtual Teaching on Swedish Teachers' Voices During the COVID-19 Pandemic

PURPOSE

Since the beginning of 2020, teachers all over the world have had to switch over to virtual teaching because of the COVID-19 pandemic. This change of teaching mode has unknown consequences on the vocal health of teachers who already experience voice disorders at a rate nearly double that of the general population. Therefore, the purpose of this study is to investigate teachers' self-reported voice problems during virtual teaching compared to face-to-face teaching and how they are associated to perceived risk factors in the work environment.

METHOD

Participants included 141 teachers (49 males, 92 females) in high schools and higher education in Sweden who responded to an internet-based survey. Information was collected about participants' self-reported voice handicap using a translated version of the Voice Handicap Index-10 (VHI-10). Information about self-reported VTD (Vocal Tract Discomfort) symptoms and dysphonia was collected in regard to both modes of teaching (virtual vs face-to- face). The survey also included questions on risk factors related to vocal health.

RESULTS

Self-reported voice handicap and VTD symptoms were slightly lower during periods of virtual teaching compared to periods of face-to-face teaching. There was a lower frequency of dysphonia symptoms during virtual teaching compared to face-to- face teaching, however the difference was not statistically significant. In addition, 34% of teachers reported experiencing more voice problems when teaching face-to-face while 15% reported more voice problems when teaching virtually. The most reported VTD symptoms during both virtual and face-to-face teaching were having a dry and a tight throat. The dysphonia symptoms with the highest reported frequency were a tense voice and hoarseness in both modes of teaching. Risk factors associated with higher prevalence of voice symptoms and/or higher levels of voice handicap during virtual teaching were air quality and straining the voice while teaching face-to-face. In addition, those teachers who reported more voice problems while teaching virtually also reported feeling more stressed.

CONCLUSION

The results showed a slight decrease in voice symptoms and voice handicap during virtual teaching compared to face-to-face teaching. Although multifactorial, results suggest that a potential positive effect may be attributed to better air quality in the work environment and more favorable acoustic conditions preventing teachers from straining their voice.

Prevalence of Voice Problems and Associated Risk Factors Among Tamil-Speaking Imams

PURPOSE

Voice of Professional Voice Users (PVUs) are of particular interest to practicing Speech-Language Pathologists. There is a dearth of studies concerning the prevalence of voice disorders and the associated risk factors among Tamil-speaking Imams. We address this research gap using non-experimental survey research.

METHODS

A questionnaire was framed by reviewing earlier literature. The derived questionnaire was administered to one hundred Tamil-speaking Imams actively involved in religious service in Tamil Nadu. We analyzed the obtained responses quantitatively and qualitatively. We also examined the effect of age on the prevalence of voice disorders and associated risk factors.

RESULTS

Based on survey responses, the career prevalence of voice problems among Tamil-speaking Imams was as high as 89%, and the point prevalence was 64%. The general health status of the Imams were good. However, vocal health was not satisfactory. This study identified several factors that contribute to voice problems, such as constant use of loud voice, acid reflux, unhealthy vocal habits, and insufficient hydration. A positive aspect observed during this study was the absence of smoking and consumption of alcohol among Imams. Even though the Imams presented good awareness of the voice production mechanism, they reported not seeking medical help when facing a voice problem. Current findings report a minimal impact of age-related differences on associated risk factors for voice disorders among the Imams.

CONCLUSIONS

Voice disorders are prevalent among Tamil-speaking Imams. Several risk factors leading to voice disorders among these individuals need to be addressed.

Efficacy of the Accent Method of Voice Therapy in Professional Voice Users with Minimal Associated Pathological Lesions of the Vocal Folds

Aims

Minimal associated pathological lesions (MAPLs) of the vocal folds are a group of benign disorders commonly related to phonotraumatic conditions and behaviors. Voice therapy (VT) can play a major role in readjusting these maladaptive behaviors and improve overall voice quality, thereby replace surgical intervention in some cases or act as a complementary treatment to enhance the ultimate therapeutic outcomes. This study aims to explore the short-term effect of the Accent method of VT on vocal subjective measures and acoustics in professional users with MAPLs, evaluate the responsiveness of each vocal fold lesion to the VT, and propose a simple model for providing VT to a sector of the population in great need of non-invasive management.

Materials and methods

This analytical cross-sectional included fifty professional voice users with different MAPLs were exposed to multidimensional voice assessments before and after receiving VT training in a tertiary care hospital. These assessments include GRBAS score, Multidimensional Voice Program (MDVP) and validated Arabic version Voice Handicap Index (VHI-30).

Results

This study showed variable positive effects of VT on the different types of MAPLs. Cysts had the highest level of responsiveness to VT in comparison to other lesions, followed by nodules, polyps, contact granuloma, and Reinke's edema.

Conclusions

VT is a substantial solution for managing voice disorders. It should be considered in the management plan of the various types of MAPLs, even in Reinke's edema, which showed the minimum improvement.

Prevalence of Work-Related Voice Disorders in Voice Professionals: Systematic Review and Meta-Analysis

OBJECTIVE

To analyze the prevalence of work-related voice disorders (WRVD) among the voice professionals.

METHODS

The study protocol was registered in PROSPERO (CRD42021250121). The search was performed in the Embase, Lilacs, Medline, SCOPUS, and Web of Sciences databases. There were no limitations to the year of publication and the search included observational studies which reported data on the prevalence of dysphonia in voice professionals measured through vocal complaints, vocal self-assessment, the auditory-perceptual judgment of the voice, and laryngoscopy examinations. The critical appraisal instrument for studies reporting prevalence data was used to analyze the risk of bias of the studies. Data analysis was performed using Jamovi and R software with a significance level of 5%.

RESULTS

The initial search identified 561 articles, 73 of which were finally included and analyzed. The total number of participants was 63,126. Dysphonia was diagnosed in 45,996 participants based on a vocal complaint, 12,843 using vocal self-assessment, 1,254 using the auditory-perceptual judgment, and 1,683 using laryngoscopies. The prevalence of total dysphonia was 44.0 (95% CI 38.47; 49.69). The prevalence of vocal complaints was 43.9% (95% CI 37.37; 50.52), 42.5% (95% CI 28.57; 57.08) for self-assessment, 53.0% (95% CI 29.87; 77.19) for auditory-perceptual judgment, and 36.9% (95% CI 18.62; 57.08) for laryngoscopic examination. In the auditory-perceptual judgment, voice professionals in class 3 (moderate quality, high demand) had a higher prevalence of dysphonia than those in class 4 (moderate quality, moderate demand) (P = 0.04). In the auditory-perceptual judgment (P = 0.04), there was a higher prevalence of dysphonia in teachers than among other voice professionals non-teachers, and in the laryngeal evaluation, no differences were found between professionals (P = 0.8).

CONCLUSION

There was a high prevalence of dysphonia in voice professionals, especially in the detection by auditory-perceptual judgment. High vocal demand and being a teacher influenced the increase in the prevalence of WRVD.

Prevalence of common mental disorders among Brazilian workers: systematic review and meta-analysis

Abstract The aim of the present study was to summarize the prevalence of common mental disorders (CMD) among Brazilian workers through a systematic review and meta-analysis. Searches were conducted in SciELO, LILACS, PubMed, Scopus, and Web of Science. Articles were included if they had; an observational design, a sample of Brazilian workers, used a validated instrument and cut-off to assess CMD, and provided the prevalence value. A random-effect meta-analysis using professional categories as subgroups and a meta-regression were conducted. In total, 89 studies were included, with a total of 56,278 workers from 26 professional categories. The overall pooled prevalence of CMD was 0.30 (95%CI: 0.27-0.34), varying from 0.07 to 0.58. Professional categories that presented higher prevalences of CMD were: Prostitutes 0.58 (95%CI: 0.51-0.65), Social Educators 0.54 (95%CI: 0.50-0.59), Banking Workers 0.45 (95%CI: 0.44-0.47), Ragpickers 0.45 (95%CI: 0.40-0.49), and Teachers 0.40 (95%CI: 0.32-0.48). No other variable in addition to profession was associated with prevalence of CMD in the meta-regression analysis. Workers from the most affected professional categories should be monitored to prevent social, occupational, and health impairment from CMD.

Violence Against Teachers and Work Ability: A Cross-Sectional Study in Northeast Brazil

This study aimed to describe teacher work ability in relation to violence against teachers and certain sociodemographic and occupational features. A cross-sectional study investigated 525 kindergarten and elementary grade school teachers from Jaboatão dos Guararapes, Northeast Brazil. Information from each teacher was collected through a self-administered questionnaire. The main outcome was teacher reports about their current and future (in 2 years' time) physical and emotional work ability. The teachers were predominantly female, young, with heavy workloads and on low incomes. Teachers reported being victimized in the school by physical violence (22.9%), verbal violence (42.9%), theft or robbery (36.4%), aggression or threats with a firearm or a non-firearm weapon (knife, glass, etc.; 7.0%), or by some form of violence (58.4%). Teachers reported low physical (56.0%) and emotional (40.6%) current work ability. Low physical work ability was significantly associated with physical and verbal violence, theft and robbery, and some form of violence; low emotional work ability was associated with physical and verbal violence, aggression or threat with a weapon, and some form of violence. Expectation of low work ability in the future was reported by 42.9% of the teachers and was associated with higher education level, and physical violence, verbal violence, theft or robbery, aggression or threat with a weapon, and some form of violence. The association between violence and work ability was modified by education level. Subsequent control of confounding in the strata of education confirmed the associations between violence and low work ability. The physical, emotional, and future work ability of teachers was low and associated with school violence, indicating the need to promote a safer work environment inside the school and in society as a whole.

Scoping opinion: Speech and language therapists' views on extending their role to the urgent ear, nose and throat pathway

BACKGROUND

In the UK, there is increasing pressure on ear, nose and throat (ENT) clinicians and departments, which is anticipated to amplify in the coming months and years due to the coronavirus disease 2019 pandemic and other workforce pressures. In the context of a national drive to advance practice of Allied Health Professionals to address some key challenges facing the National Health Service, we explored whether UK speech and language therapists (SLTs) felt it is possible to utilize and extend their existing skills to patients on the urgent 2-week wait (2ww) ENT pathway.

AIMS

To explore SLTs' views of extending their role to work with patients referred on the ENT 2ww pathway.

METHODS & PROCEDURES

Two separate focus groups were conducted using nominal group technique to generate and rank benefits and challenges of the proposed extension of role. Participants were invited to take part through Clinical Excellence Networks relevant to head and neck cancer and voice sub-specialties. Participants were competent in performing nasendscopy in at least a highly specialist role in voice or head and neck subspecialties.

OUTCOMES & RESULTS

Nine SLTs from England, Wales and Northern Ireland attended two focus groups. All were employed in band 8 roles in head and neck and/or voice. Eight were competent to Royal College of Speech and Language Therapists' scoping level 3. Important benefits of the proposed novel service delivery model were generated and ranked by participants, with both groups identifying improved quality and efficiency of service for patients among the most important. Disadvantages were then generated and ranked across the two groups with potential for misdiagnosis ranked as the most important by both.

CONCLUSIONS & IMPLICATIONS

Participants responded that extending the SLT role into assessment of 2ww patients would provide benefits for quality of care, healthcare efficiency and the SLT workforce. The identified disadvantages require addressing if the proposed SLT-led model of service delivery is piloted in the UK. These include practical matters such as referral and prescribing rights, alongside wider implications such as support, governance, indemnity, acknowledgement and remuneration for the extended role. Nationally agreed competencies and training for the role are required if this model is to be successful.

WHAT THIS PAPER ADDS

What is already known on this subject? International studies have shown that SLTs provide safe and effective assessment for routine ENT referrals with dysphonia and dysphagia, reducing ENT waiting lists in the process (Payten et al., 2020; Seabrook et al., 2019). The current study is the first, to the authors' knowledge, to explore views of the profession regarding SLTs' involvement in assessing patients on the more urgent ENT 2ww pathway in the UK, particularly in the primary care setting. What this study adds The greatest benefits of SLTs assessing patients with dysphonia and dysphagia in the 2ww wait clinic were felt to be for patients through prompt, holistic consultation from a clinician with expert knowledge in their disorder. The greatest disadvantages were posed for the workforce such as potential to miss diagnoses, risk of litigation and the increased burden of responsibility. While advantages are clear for service users, the disadvantages must be addressed if such a model is to be implemented. Clinical implications of this study Expert SLTs communicated strongly that SLTs would be a beneficial addition to the 2ww assessment clinic for patients with dysphonia and dysphagia. For this role to be piloted and implemented successfully, their concerns around increased responsibility, potential for litigation and missed diagnoses need to be addressed. If the SLT role is to be extended to the 2ww clinic, robust training, competencies, supervision, guidance and recognition are necessary to support clinicians in this role and protect patients. Some practical matters such as referral and prescription rights also require exploration.

Myofascial Release Effects in Teachers' Posture, Muscle Tension and Voice Quality: A Randomized Controlled Trial

OBJECTIVE

Myofascial release (MFR) comprises a set of manual therapeutic techniques applied to many conditions, but specific evidence concerning its effects on body posture, muscle tension and voice has been lacking. Thus, the aim of this study was to verify the effects of MFR in teachers' posture, muscular tension and voice quality.

STUDY DESIGN

Randomized controlled trial - crossover.

METHODS

Twenty-four teachers, after completing a Sociodemographic and Clinical Questionnaire and providing written informed consent, were randomly distributed into two groups designated Group 1 (G1; n = 12; received MFR first) and Group 2 (G2; n = 12; belong to control group first). All participants received treatment and were into control group, since, after a 14 day period, procedures were switched between groups. Photogrammetry, muscle tension assessed through palpation, algometry, aerodynamic assessment of voice, acoustic and auditory-perceptual analysis of voice were performed before and after interventions.

RESULTS

Regarding voice, statistically significant differences were found when intervention was applied to both groups for maximum phonation time (MPT) (G1 P = 0.019; G2 P = 0.004). The acoustic variables did not differ. Concerning the auditory-perceptual analysis of voice statistically significant differences were found when intervention was applied in both groups for Grade in G2 (P = 0.046) and for Roughness in G1 (P = 0.025). Regarding the photogrammetry assessment statistically significant differences were found when intervention was applied to both groups in many parameters while as control group they did not. Concerning the algometry and muscle tension assessed through palpation statistically significant differences were found when intervention was applied in all muscles.

CONCLUSIONS

Findings indicated that MFR seems to be an effective therapy in improving MPT, two subscales (Grade and Roughness) of the GRABASH scale, muscle tension assessed through palpation and algometry. Regarding photogrammetry, MFR had an immediately effect in improvement of the posture, especially related with head.

Cross-sectional and longitudinal relationships between psychological violence and teacher burnout

OBJECTIVE

This study aimed to identify cross-sectional and longitudinal relationships between psychological violence (PV) and burnout after two years of follow-up.

METHODS

This is a longitudinal study involving 430 public school teachers from a city in southern Brazil. PV was defined as insults by students, humiliation or embarrassment by colleagues or superiors or threats by any member of the school. Burnout was measured using the emotional exhaustion (EE) and depersonalization (DP) subscales of the Maslach Burnout Inventory-Human Services Survey. Analyses were performed using structural equation models in R.

RESULTS

Younger age (β = - .167) and poor/fair relationship with students (β = .275) had a direct effect on PV. Temporary employment (β = - .111) and poor/fair perception of the number of students in the classroom (β = .124) had a direct effect on EE. Cross-sectionally, PV showed a direct effect at both T0 and T1 on EE (T0: β = .435; T1: β = .334) and on DP (T0: β = .332; T1: β = .325). Longitudinally, PV at T0 did not have a significant direct effect on burnout at T1. However, indirect effects of PV on EE (β = .459) and DP (β = .428) at T1 were observed.

CONCLUSIONS

The effect of PV on burnout occurs in a short period of time. However, the long-term effect should be considered because there is a cumulative burden of exposure to violence over time.

Job strain is prospectively associated with a lower frequency of fruit consumption in schoolteachers

OBJECTIVE

The current study aimed to analyse the prospective association between perceived work demand and changes in eating behaviours in schoolteachers.

DESIGN

This was a prospective cohort study with self-reported information obtained on the Demand Control Support Questionnaire and eating behaviours at baseline and after a 2-year follow-up. The analyses were performed using mixed-effects models adjusted for the main confounders.

SETTING

The setting consisted of elementary and secondary schools located in a large city in southern Brazil.

PARTICIPANTS

The participants were 502 schoolteachers (65·9 % females, median age of 42·7 years [interquartile range 34·2, 49·4]).

RESULTS

A total of 39·2 % of the schoolteachers were classified at baseline with job strain, 28·9 % with passive job, 12·2 % with active job and 19·7 % with low-strain job. In the fully adjusted models, compared with teachers who reported low-strain job, those with higher levels of job strain were more likely to reduce (coefficient = 0·064; 95 % CI 0·018, 0·109) and less likely to increase (coefficient = -0·066; 95 % CI -0·115, -0·016) their frequency of fruit consumption regardless of sociodemographic, lifestyle, health conditions and social support at work.

CONCLUSION

Job strain plays a relevant role in the frequency of fruit consumption over time in schoolteachers. The balance between demand and control at work must be considered in strategies for promoting healthy eating despite perceived social support.

Predictors of health-related absenteeism, presenteeism and sick leave among brazilian elementary school teachers: A cross-sectional study

BACKGROUND

The health risks that usually affect teachers are already known; however, the predictors of health related absenteeism, presenteeism, and sick leave have not yet been fully described.

OBJECTIVE

To analyze the predictors of health-related absenteeism, presenteeism, and sick leave among elementary school teachers.

METHODS

This study involved a probabilistic sample of 519 Brazilian elementary school teachers. The outcomes were days of health-related absenteeism, presenteeism, and sick leave in the previous 12 months. Work-place and individual factors were the independent variables analyzed.

RESULTS

Inadequate infrastructure of schools, disability, and medical consultations were positively associated with all outcomes. Teachers who reported having a chronic disease, common mental disorders, and voice disorders presented higher absenteeism and presenteeism days. Musculoskeletal pain and low job support were associated with higher presenteeism and sick leave days. Teachers who performed strength and flexibility activities presented less presenteeism, those who reported physical violence at school were more frequently absent, and teachers with depersonalization presented a higher likelihood of sick leave.

CONCLUSIONS

The prevention of health-related absenteeism, presenteeism, and sick leave among elementary teachers should ensure adequate work conditions and prevention and monitoring of health risks.

Poor Relationships and Physical Violence at School Are Associated With More Forms of Psychological Violence Among Brazilian Teachers: A Cross-Sectional Study

Our purpose was to identify individual and work-related factors that are associated with psychological violence (PV) and are related to a higher number of PV forms among teachers. This cross-sectional study included 789 elementary and high school teachers in a municipality in southern Brazil. Data were obtained through interviews and a self-administered questionnaire. PV was characterized by reports of insults from students, humiliation by colleagues or teachers, and threats in the 12 months preceding the study. Factors associated with the number of PV forms were also investigated. Poisson regression models were used for the analyses. More than half (64.1%) of the teachers reported at least one event of PV, 38.3% reported only one form, 21.5% reported two forms, and 4.3% reported all three surveyed forms. After adjustments, poor relationships with superiors or students and having suffered physical violence at school remained associated with at least one PV episode. The same variables were associated with the number of forms of PV, as were age (inverse relationship) and violence outside of school. The higher the number of aggregated factors, the more estimated forms of PV, particularly among the younger teachers. These results highlight the importance of adopting strategies that promote a nonviolent and safe school environment for teachers, which will in turn improve work conditions, the quality of education, and teachers' health.

Determinants of teachers' work ability in basic education in Brazil: Educatel Study, 2016

The study aimed to analyze the relationship between health, work characteristics, education, and skills on the work ability of teachers in basic education in Brazil. This was a cross-sectional, population-based study using data from the Brazilian National Survey on Health, Work Conditions, and Absences in Schoolteachers in Basic Education (Educatel Study). A probabilistic sample of 6,510 teachers answered a telephone interview in 2015 with questions on sociodemographic data, health status, education and skills, work characteristics, and absenteeism. Structural equation modeling (SEM) was used in multivariate analysis and standardized coefficients (SC) were calculated to analyze direct and indirect effects between the outcomes. Health status showed a direct effect on work ability (SC = -0.83, p < 0.01). Work characteristics directly affected health status (SC = 0.60, p < 0.01) and work ability (SC = -0.25, p < 0.05), especially noise at work and students' unruliness. Total effect (sum of direct and indirect effects) of work characteristics on work ability was -0.75 (p < 0.01). The study concluded that the relations between health status and work characteristics of Brazilian teachers in basic education are complex and negatively affect work ability. Potential actions to promote and maintain work ability should take into account the psychosocial demands of teaching and measures to maintain order and discipline in the classroom.

Risk Factors for Recurrent Perceived Voice Disorders in Elementary School Teachers-A Longitudinal Study

OBJECTIVE

To identify the progression of voice disorders and their risk factors in teachers.

DESIGN

Longitudinal quantitative study conducted in municipal schools.

METHOD

Of the 575 teachers who participated in the baseline study, 469 were re-evaluated after 3 years of the initial study. Out of these, 152 reported having a voice disorder at baseline and participated in the re-evaluation. Voice disorders were diagnosed with the Voice Handicap Index (VHI) and teachers were considered positive for voice disorders when the total score was above 19. Symptoms of common mental disorder were measured with the SRQ-20 scale (Self-Reporting Questionnaire, 20 items), with a cut-off value of 8 points. A bivariate analysis was performed using Poisson regression to verify the differences in the proportion of teachers who continued presenting a voice disorder among the different categories of the independent variables in the study.

RESULTS

A total of 69.1% of the teachers reported having a voice disorder after 3 years. High prevalence of acute common mental disorder symptoms was a predictor for a recurring perceived voice disorder. The risk of having a voice disorder was 30% higher for teachers who presented a common mental disorder 3 years after.

CONCLUSIONS

Teachers who had both a voice disorder and symptoms of common mental disorder were more likely to maintain the voice disorder.

Effects of a Voice Training Program on Acoustics, Vocal Use, and Perceptual Voice Parameters in Catalan Teachers

<b><i>Objectives:</i></b> To assess the effect of EVES (Education for a Healthy and Efficient Voice), a voice training program aimed at promoting the use of an efficient and healthy voice in teachers. <b><i>Sample and Method:</i></b> Twenty-two teachers in the city of Granollers (Catalonia, Spain) were included in this research. The effect of the EVES program was evaluated focusing on the analysis of physiologic parameters on the one side (stroboscopy analysis), and on perceptual parameters on the other (Q-EVES questionnaire, Voice Handicap Index-10 [VHI-10], and GRBAS [Grade, Roughness, Breathiness, Asthenia, Strain Scale]). <b><i>Results:</i></b> The teachers incorporated the vocal strategies in their professional life and reported that the perception of difficulty in using their voice decreased. We observed a significant improvement in VHI-10 markers, in voice management abilities in the classroom, in perceptive and subjective voice parameters, and in some functional lesions. <b><i>Conclusions:</i></b> The results suggest that the educational intervention model may have a positive effect on teachers’ vocal care.

Hypotheses, design, and instruments in the Educatel Study, Brazil, 2015/2016

The Educatel Study 2015/2016 was designed to evaluate health and work conditions in a representative sample of the 2,220,000 schoolteachers working in Basic Education in Brazil. The article aimed to describe the telephone survey's basis and design, using a questionnaire consisting of 54 short, simple questions, most of which with multiple-choice answers (closed questions) addressing diseases, accidents, absenteeism, frequency of healthy behaviors, physical and psychosocial environment, and employment characteristics. In the pilot stage, the multi-theme questionnaire was assessed in order to verify the effects of the terminology, the format of the questions and the multiple-choice answers, the questionnaire's internal organization, production of the answers, and duration of the interview. The interviewers' training and follow-up and listening of the calls in real time aimed to identify communications problems. The teachers were interviewed at school after prior contact with the school assistant to set appointments. The advantages and risks of biases related to the telephone interview modality should be considered to interpret the results. The results on the teachers' profile, illnesses, and school environment will provide inputs for elaborating inter-sector measures to improve the target group's health, which is related to Brazil's school system indicators based on the concepts presented here.

Work absenteeism due to voice disorders in Brazilian schoolteachers

The study aimed to investigate the prevalence and duration of work absenteeism due to voice disorders in Brazilian schoolteachers and the association with work-related factors and health status. This was a cross-sectional study with a representative sample of 6,510 female and male schoolteachers in basic education, from October 2015 to March 2016. The dependent variable was the teacher's report of some work absence due to a voice problem in the previous 12 months. The independent variables related to work conditions and health status. A descriptive analysis was performed of the prevalence and duration of work absences due to voice problems. The association between the target event and the other variables was measured as the prevalence ratio with 95% confidence intervals, using Poisson regression. The main reason for teachers missing classroom work was voice disorders (17.7%), and most absences (78%) were short (seven days or less). In the final multivariate model adjusted by gender, higher prevalence of absence due to voice disorders was associated with schoolteachers in the North and Northeast of Brazil, longer time commuting to and from work, self-report of occupational disease, visit to health services, and report of psychological and respiratory problems during the same 12-month period. There was a high prevalence of short work absences due to voice problems, associated with comorbidities. Macrostructural factors suggest the social nature of the illness process and work absenteeism in Brazilian schoolteachers.

Multiple exposures to the risk of work absenteeism among Brazilian schoolteachers

The study aimed to identify multiple exposures to the risk of work absenteeism among Brazilian schoolteachers, independently of the reasons reported by teachers (n = 6,510). The data came from a telephone survey on health, working conditions, and absenteeism among schoolteachers in Brazil (Educatel Study, 2015/2016). Exposures were identified and studied by principal components analysis and Poisson regression, with a focus on working conditions and quality of school administration. Three components of risk factors for work absenteeism were identified. Component 1 featured lack of opportunities for new learning experiences, insufficient time for performing tasks, constraints on teachers' autonomy, and little or no social support in the school environment; component 2 was characterized by the perception of heavy demand from tasks and an agitated classroom environment due to students' lack of discipline and intense noise; and component 3 by the experience of verbal or physical violence from students. All three components were specially associaed with stress-related work absenteeism in relation to reported stress at school (aPR = 3.87; 95%CI: 2.93-5.10; p < 0.05/aPR = 3.18; 95%CI: 2.47-4.09; p < 0.05/aPR = 3.31; 95%CI: 2.58-4.25; p < 0.05; respectively) and emotional problems (aPR = 2.28; 95%CI: 1.93-2.70; p < 0.05/aPR = 2.43; 95%CI: 2.05-2.87; p < 0.05/aPR = 2.09; 95%CI: 1.78-2.45; p < 0.05; respectively). The identification of these risk components highlighted the need for systemic changes in Brazilian Basic Education schools.

Pressão laboral, saúde e condições de trabalho dos professores da Educação Básica no Brasil

Morbidades em geral e licenças médicas são prevalentes no grupo dos professores da Educação Básica, cuja missão é essencial para a formação dos cidadãos. O objetivo foi produzir informações sobre as características demográficas, características da escola e da rede de ensino, e situação de saúde do grupo que percebeu pressão laboral. A amostra probabilística foi calculada por seleção aleatória simples, de maneira a representar o universo de 2.229.269 professores da Educação Básica no Brasil. O questionário multitemático foi respondido ao telefone. A pergunta que deu origem à variável desfecho, “Você tem dificuldade para faltar ao trabalho mesmo quando está com dor ou outro problema de saúde?”, foi testada e validada. A resposta viabilizou operacionalizar empiricamente o conceito de pressão laboral. Utilizou-se o teste do qui-quadrado de Pearson e o método de árvore de decisão na análise multivariada. O ajuste do modelo final foi avaliado por meio da estimativa de risco de classificação incorreta. As subdivisões da árvore indicam o apoio social como o primeiro determinante da pressão laboral, 55% relataram que têm dificuldade para faltar ao trabalho, mesmo quando estão com dor ou qualquer outro problema de saúde, 70% do grupo que avaliou sua saúde como ruim e muito ruim se sentiram pressionados para comparecer ao trabalho quando doentes ou com dor. Os fatores associados foram: fraco apoio social, ambiente agitado em função da indisciplina dos alunos e problema de saúde considerado como doença ocupacional. Diante das metas de valorização dos professores da Educação Básica, diferenciais de gênero e estilos de gestão, além da infraestrutura nas escolas, devem ser considerados.

A Bayesian decision analysis approach to assess voice disorder risks by using acoustic features

Vocal fold nodules are recognized as an occupational disease for all collective of workers performing activities for which maintained and continued use of voice is required. Computer-aided systems based on features extracted from voice recordings have been considered as potential noninvasive and low cost tools to diagnose some voice-related diseases. A Bayesian decision analysis approach has been proposed to classify university lectures in three levels of risk: low, medium, and high, based on the information provided by acoustic features extracted from healthy controls and people suffering from vocal fold nodules. The proposed risk groups are associated with different treatments. The approach is based on the calculation of posterior probabilities of developing vocal fold nodules and considers utility functions that include the financial cost and the probability of recovery for the corresponding treatment. Maximization of the expected utilities is considered. By using this approach, the risk of having vocal fold nodules is identified for each university lecturer, so he/she can be properly assigned to the right treatment. The approach has been applied to university lecturers according to the Disease Prevention Program of the University of Extremadura. However, it can also be applied to other voice professionals (singers, speakers, coaches, actors…).

Vocal Health Practices Among School Teachers: A Study From Chennai, India

INTRODUCTION

A healthy vocal system is a prerequisite to produce a serviceable voice for any vocal profession. The concept of vocal health (VH) among teachers is worth exploring considering their known risk of developing voice disorders.

AIM

To provide socioculture-specific information on VH practices and nature of voice problems in teachers.

METHOD

A VH questionnaire was developed to elicit opinions toward one's own voice health and factors that indicated and contributed to impaired/poor VH from 384 school teachers.

RESULTS AND DISCUSSION

'Flexible voice' (23%), 'enduring voice' (22%), and 'good voice' (22%) were descriptions to indicate good VH by teachers. 'Vocal fatigue' (13%), 'dry throat' (9.4%), 'throat irritation' (4.7%), and 'pain while swallowing/speaking' (3.1%) were frequently reported throat sensations to indicate poor VH. For 30.2% of the teachers, voice mattered for professional needs. However, most of them managed to cope with voice problems through several home remedies and 'intentional/self-imposed neglect' despite their vocal difficulties. Sociocultural factors influencing these findings and scope to escalate voice problems in teachers as a public health issue are discussed.

CONCLUSION AND IMPLICATION

Insight and perception of VH based on self-reports and information on voice practices among teachers pertinent to this geographical location provide scope to develop models for counseling and preventive treatment for voice problems.

Cross-cultural Adaptation and Validation of the Persian Version of Voice Disability Coping Questionnaire (P-VDCQ): Introducing a New Instrument

OBJECTIVES

Coping is one of the important concepts in psychology, which is pertinent to how persons with illness manage the stress of that condition. Voice Disability Coping Questionnaire (VDCQ) is an assessment tool for quantifying coping strategies in those with voice disability. The purpose of the present study was to investigate reliability and validity of the Persian version of VDCQ (P-VDCQ).

METHOD

Translation procedure was performed according to the World Health Organization guidelines, and then 138 persons (88 persons with voice disorders and 50 controls) completed the questionnaire. Psychometric properties of the P-VDCQ were investigated.

RESULTS

There was a significant difference between the mean value of patients with dysphonia and that of the control group. The results of test-result reliability indicated that there is a high correlation between repeated administration of the questionnaire (intraclass correlation coefficient = 89.7). Also, a high Cronbach's alpha coefficient (α = 0.94) revealed a good internal consistency. Participants' scores in this instrument had a moderate correlation with their scores on Voice Activity Participation Profile-Persian version (r = 0.41, P < 0.001).

CONCLUSION

The P-VDCQ is a reliable and a valid instrument that can be used to investigate coping strategies of patients with dysphonia in clinical settings and for research purposes.

Physical violence against schoolteachers: an analysis using structural equation models

This study aimed to identify associations between sociodemographic, workplace, and school environmental factors and the occurrence of physical violence against teachers at school. This was a cross-sectional study of teachers that had been working for at least a year in elementary or middle schools in the state school system in Londrina, Paraná State, Brazil. A convenience sample was taken of the 20 schools with the most teachers in the city of Londrina. Data were obtained through interviews and self-completed questionnaires in 2012 and 2013. Physical violence was defined as reports of attempted or actual physical aggression using cold steel weapons or firearms in the 12 months prior to the study. Structural equation models were used for the data analysis. Of the 937 teachers eligible for the study, 789 (84.2%) were interviewed. The physical violence victimization rate in schoolteachers was 8.4%. Work conditions (number of schools where the teachers worked and type of employment contract) showed a direct effect on physical violence (p = 0.032), as did having experienced previous situations of violence in the school (p = 0.059). Age (up to 40 years) was indirectly related to physical violence, correlating with worse work conditions. The results highlight the importance of improving teachers' work conditions and implementing measures to prevent violence both in schools and in society as a whole.

The Importance of The Occupational Vocal Load for The Occurence and Treatment of Organic Voice Disorders

Introduction

The voice represents a basic working tool for carrying out certain occupations. Hoarseness, as a consequence of vocal fold lesions, presents an important cause of work-related absences for voice professionals.

Methods

Our study was designed as a retrospective cohort one. Data on gender, workplace, vocal load and exposure to risk factors for voice disorders of the patients who had surgery in the 2014-2015 period at the tertiary centre due to benign vocal fold lesions were collected from their clinical records. We compared professional voice users (PVU) to subjects with no vocal load at work (NPVU). The SPSS programme, version 22.0, was used for statistical analysis.

Results

From 2014 to 2015, 103 PVU and 132 NPVU were surgically treated for benign vocal fold lesions. In comparison to the second group, loud speech use was reported significantly more often by PVU (40.8% vs. 14.4%), as was a fast speaking rate (22.3% vs. 9.8%) and additional vocal load outside of the workplace (23.3% vs. 12.9%). The time that had passed between the occurrence of the hoarseness and the surgical treatment did not differ between the groups. The majority of patients were satisfied with the outcome of the operation.

Conclusions

Nearly a half of the operated patients had a considerable vocal load at work. An ENT assessment prior to starting a job as well as priority phoniatric treatment of voice disorders for PVU would significantly reduce the costs of work absences and contribute to a speedier recovery and return to the workplace.

The importance of the occupational vocal load for the occurence and treatment of organic voice disorders

Introduction

The voice represents a basic working tool for carrying out certain occupations. Hoarseness, as a consequence of vocal fold lesions, presents an important cause of work-related absences for voice professionals.

Methods

Our study was designed as a retrospective cohort one. Data on gender, workplace, vocal load and exposure to risk factors for voice disorders of the patients who had surgery in the 2014-2015 period at the tertiary centre due to benign vocal fold lesions were collected from their clinical records. We compared professional voice users (PVU) to subjects with no vocal load at work (NPVU). The SPSS programme, version 22.0, was used for statistical analysis.

Results

From 2014 to 2015, 103 PVU and 132 NPVU were surgically treated for benign vocal fold lesions. In comparison to the second group, loud speech use was reported significantly more often by PVU (40.8% vs. 14.4%), as was a fast speaking rate (22.3% vs. 9.8%) and additional vocal load outside of the workplace (23.3% vs. 12.9%). The time that had passed between the occurrence of the hoarseness and the surgical treatment did not differ between the groups. The majority of patients were satisfied with the outcome of the operation.

Conclusions

Nearly a half of the operated patients had a considerable vocal load at work. An ENT assessment prior to starting a job as well as priority phoniatric treatment of voice disorders for PVU would significantly reduce the costs of work absences and contribute to a speedier recovery and return to the workplace.

Dose Vocal: uma revisão integrativa da literatura

RESUMO O objetivo da pesquisa foi realizar uma revisão da literatura referente aos tipos de dose vocal e aos resultados destas medidas em diferentes situações comunicativas. Houve levantamento da literatura nacional e internacional, publicada nos idiomas Inglês, Espanhol ou Português, utilizando-se as bases de dados MEDLINE, LILACS, IBECS e ISI (Web of Science), dos últimos 21 anos, cujos artigos estavam disponíveis na íntegra. Quinze estudos contemplaram os critérios propostos. A maioria dos artigos estudou professores, visto que são mais vulneráveis para a ocorrência de disfonia. Os tipos de dose encontrados foram porcentagem de fonação, dose temporal, dose cíclica, dose de distância, dose de energia radiada e dose de energia dissipada. O aumento da dose vocal está associado ao uso excessivo e prolongado da voz na atividade docente, principalmente entre os professores da educação infantil e os de canto. As altas doses vocais correlacionam-se também à presença de disfonia, ao maior nível de ruído ambiental, à grande variação prosódica na fala e à autopercepção de fadiga vocal. Pacientes com disfonia comportamental (nódulos e pólipos) apresentam maiores doses vocais que pacientes com outros quadros disfônicos. Fatores como repouso de voz e uso do amplificador vocal indicam a diminuição da dose da voz.

Acute exposure to vibration is an apoptosis-inducing stimulus in the vocal fold epithelium

Clinical voice disorders pose significant communication-related challenges to patients. The purpose of this study was to quantify the rate of apoptosis and tumor necrosis factor-alpha (TNF-α) signaling in vocal fold epithelial cells in response to increasing time-doses and cycle-doses of vibration. 20 New Zealand white breeder rabbits were randomized to three groups of time-doses of vibration exposure (30, 60, 120min) or a control group (120min of vocal fold adduction and abduction). Estimated cycle-doses of vocal fold vibration were extrapolated based on mean fundamental frequency. Laryngeal tissue specimens were evaluated for apoptosis and gene transcript and protein levels of TNF-α. Results revealed that terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining was significantly higher after 120min of vibration compared to the control. Transmission electron microscopy (TEM) revealed no significant effect of time-dose on the mean area of epithelial cell nuclei. Extrapolated cycle-doses of vibration exposure were closely related to experimental time-dose conditions, although no significant correlations were observed with TUNEL staining or mean area of epithelial cell nuclei. TUNEL staining was positively correlated with TNF-α protein expression. Our findings suggest that apoptosis can be induced in the vocal fold epithelium after 120min of modal intensity phonation. In contrast, shorter durations of vibration exposure do not result in apoptosis signaling. However, morphological features of apoptosis are not observed using TEM. Future studies are necessary to examine the contribution of abnormal apoptosis to vocal fold diseases.

Risk Factors for the Incidence of Perceived Voice Disorders in Elementary and Middle School Teachers

OBJECTIVE/HYPOTHESIS

This study aimed to identify risk factors for the incidence of perceived voice disorders in teachers, specifically related to the influence of common mental disorders.

DESIGN

This is a longitudinal quantitative study conducted in municipal schools.

METHOD

We performed a data analysis of 469 teachers, reassessed 3 years after an initial study. The Voice Handicap Index was used to measure the impact of a probable voice problem with a cutoff value of 19 points. Mental disorder symptomatology was measured by the Self-Reporting Questionnaire (20 items), with a cutoff value of eight points. Bivariate analysis was conducted through Poisson regression to verify proportion differences in the occurrence of perceived voice disorders among the study's different categories of independent variables. The same technique of Poisson regression was used to assess risk factors for perceived voice disorder incidence in a specific hierarchic model.

RESULTS

The incidence of a perceived voice disorder was 17.1%. Teachers who lectured in fourth grade and below presented a risk of 20% less than those who lectured from the fifth grade up (P = 0.046). Teachers who reported taking a leave of absence because of their voice had a 32% more chance of a probable perceived voice disorder (P = 0.024). Teachers who presented a common mental disorder had twice the risk of perceived voice disorder (P > 0.001).

CONCLUSIONS

This study concluded that teachers presented a higher risk of developing a perceived voice disorder when they have the following features: lectured from fifth grade up, have gone on leave because of their voice, and showed behavior indicative of common mental disorder.

Sintomas vocais relatados por professoras com disfonia e fatores associados

RESUMO Objetivo Verificar o número de sintomas vocais relatados por professoras e a relação com a autopercepção das limitações das atividades diárias associadas à voz, aspectos pessoais, ocupacionais e clínicos. Métodos Trata-se de estudo realizado por meio da análise de dados secundários dos prontuários das professoras atendidas no ambulatório de voz de um hospital de ensino. As informações de interesse foram: idade, número de turnos lecionados, atividades paralelas à docência, uso de ventilador, ruído de conversação, poeira, ruído de obras, ruído externo, hábito de gritar, tabagismo, hidratação, uso de pastilha, prática de atividade física associada à fala, tipo e grau da disfonia, sintomas vocais proprioceptivos e respostas ao Protocolo do Perfil de Participação e Atividades Vocais (PPAV). Foi realizada análise descritiva e inferencial. Resultados Foram coletadas informações de 103 prontuários, nos quais se verificou elevada prevalência de sintomas vocais, sendo os mais frequentes: fadiga após o uso prolongado da voz, garganta seca, pigarro e ardência. Observou-se associação entre o número de sintomas vocais e o hábito de gritar, ruído de conversação e percepção do impacto da disfonia pelas docentes. O número de sintomas vocais autorrelatados foi positivamente correlacionado com todos os parâmetros avaliados pelo PPAV. Conclusão Há elevada frequência de sintomas vocais proprioceptivos entre as professoras. O ruído por conversação e o hábito de gritar estão associados ao número de sintomas vocais, assim como os parâmetros de autopercepção do impacto da disfonia, segundo o PPAV.

Prevalence and Influencing Risk Factors of Voice Problems in Priests in Kerala

OBJECTIVE

Voice problems are commonly reported by professionals in occupations involving a large amount of voice loading. The aim of the present study was to investigate the prevalence of voice problems in Mar Thoma priests and identify possible risk factors responsible for voice problems.

STUDY DESIGN

This is a cross-sectional study.

METHOD

The study group consisted of 270 Mar Thoma priests with 1-35 years of professional experience. A self-reported questionnaire was used to collect the data.

RESULTS

Mar Thoma priests were found to have higher career (47.8%) and year prevalence (25.2%) of voice problems with 17.8% of them reporting frequent voice problems during their career. Asthma, allergy and frequent throat clearing behavior were found to have significant association with priests reporting frequent voice problems. Significantly higher number of priests with frequent voice problems missed their work.

CONCLUSION

The study results provide valuable preliminary information regarding the prevalence voice problems and associated risk factors in Mar Thoma priests. However, further investigations are required for in-depth understanding of the types of voice problems these priests experience and their impact on their quality of life.

The economic impact of vocal attrition in public school teachers in Miami-Dade County

OBJECTIVES/HYPOTHESIS

Teachers are a known at-risk population for voice disorders. The prevalence and risk factors for voice disorders have been well studied in this population, but little is known about the associated economic cost. The purpose of this study is to assess the economic impact of voice dysfunction in teachers and understand the difference between the cost of absenteeism and presenteeism as a direct result of voice dysfunction.

STUDY DESIGN

Cross-sectional analysis via self-administered online questionnaire.

METHODS

A total of 14,256 public school teachers from Miami-Dade County, Florida, were asked to participate. Questions were formatted based on the previously validated Work Productivity and Activity Impairment: Specific Health Problem questionnaire adapted for hoarseness and voice disorders. Additional demographic questions were included in the questionnaire.

RESULTS

A total of 961 questionnaire responses were received. The demographic characteristics of respondents closely matched known statistics for public school teachers in Miami-Dade County. Economic calculations were performed for each questionnaire respondent and summed for all respondents to avoid bias. Per week, absenteeism-related costs were $25,000, whereas presenteeism-related costs were approximately $300,000. These figures were used to extrapolate annual cost. Per year, absenteeism-related costs were $1 million, whereas presenteeism-related costs were approximately $12 million.

CONCLUSION

The economic impact of voice dysfunction on the teaching profession is enormous. With the above calculations only including lost wages and decreased productivity, the actual figures may in fact be larger (cost of substitute teachers, impact on nonwork activities, etc.). Research investigating preventative measures for voice dysfunction in teachers is necessary to reduce this costly issue.

LEVEL OF EVIDENCE

2C. Laryngoscope, 126:665-671, 2016.

Voice complaints among public transport workers in the metropolitan region of Belo Horizonte, Brazil

OBJECTIVE

To investigate the prevalence of voice complaints among bus transport workers in a metropolitan area in Brazil and examine whether sociodemographic and occupational factors were associated with this outcome. This study is part of a larger study that investigated the working conditions and health of drivers and conductors of urban transportation.

METHODS

The sample size (1,607 participants) was calculated by means of quotas and was stratified according to occupation (drivers and conductors) in the bus companies of Belo Horizonte, Betim and Contagem. Face-to-face interviews were facilitated by means of a digital questionnaire, applied by the interviewer using a netbook. The outcome variable was constructed from combining the responses to the following two questions: (1) Over the last two weeks, have you felt tired when speaking? (no/sometimes/every day). (2) Over the last two weeks, have you noticed any worsening of your voice quality? (no/sometimes/every day). Sociodemographic, lifestyle, occupational characteristic and health situation data were gathered.

RESULTS

The prevalence found was 29% overall: 24% for drivers and 34% for conductors. Attention was drawn to positive associations with the function of conductor and with reports of exposure to vibration and thermal discomfort. Among the individual factors, only female gender reached statistical significance.

CONCLUSION

Risk factors exist that justify interventions to promote voice health within the urban transport sector under study. It would be appropriate to investigate whether vibration of the whole body would influence the functioning and morphology of the larynx.

Características da violência escolar no Brasil: revisão sistemática de estudos quantitativos

Objetivos: dimensionar e identificar fatores associados à violência escolar no Brasil descritos na literatura. Métodos: foram selecionados artigos com dados quantitativos sobre violência escolar no Brasil e indexados nas bases de dados SciELO, LILACS e PubMed, até maio de 2013, sem restrição temporal para o início. A seleção de artigos e a extração dos dados foram realizadas de modo independente por duas pesquisadoras e as inconsistências resolvidas por consenso. Resultados: vinte e quatro estudos cumpriram os critérios de inclusão. A maioria destes foi desenvolvida com alunos do ensino fundamental em escolas públicas localizadas no Sul e no Sudeste brasileiro e durante os anos 2000. A definição de violência escolar e as modalidades estudadas diferiram entre os artigos analisados. A violência psicológica e a física foram as mais abordadas. O bullying destacou-se como modalidade específica da violência escolar. Ser do sexo masculino e ter vivenciado situações de violência na família foram os fatores mais freqüentemente associados à violência escolar. Conclusões: a presente revisão detectou poucos estudos quantitativos sobre violência em escolas brasileiras, sobretudo entre professores. É necessário estabelecer critérios para o estudo desse fenômeno, que permitam comparação de sua ocorrência no tempo e no espaço.