Protective and Risk Factors Associated With Voice Strain Among Teachers in Castile and Leon, Spain: Recommendations for Voice Training

Self-assessment of teachers with normal larynges and vocal and osteomuscular complaints

INTRODUCTION

Teachers face vocal problems related to long periods of speech and increased sound pressure, as well as environmental noise, inadequate posture and tension of the cervical muscles.

OBJECTIVE

To verify the results of self-assessment of teachers with normal larynges and vocal and musculoskeletal complaints, and compare them with the reference values.

METHODS

Fifty-seven teachers, aged between 21 and 60 years (average 40.14 years) participated in the study. Anamnesis, otorhinolaryngological examination, hearing screening and self-assessment protocols were performed.

RESULTS

In the Nordic musculoskeletal questionnaire, the majority of teachers had discomfort in most parts of the body and in the situations evaluated; on the voice-related quality of life, the total and physical subscores were lower than the normative values while the emotional subscore was higher; regarding voice symptoms scale and vocal tract discomfort scale, the scores were higher than the normative values; in the hospital anxiety and depression scale, there was alteration in the total score; in the Vocal Activity and Participation Profile, the effects on work and emotion were above the normative values; on the University of Rhode Island change assessment-voice and on the voice handicap index there were no significant differences.

CONCLUSION

Most of the teachers presented vocal, musculoskeletal, and emotional complaints on the self-assessment results, what suggests excessive voice use as well as overload on the body muscles, including the larynx and vocal tract, and that they presented emotional changes. These aspects had an impact on their quality of life, but they showed no action in coping with the condition.

Prevalence and Risk Factors for Occupational Voice Disorders in Nepalese Teachers: A Cross-Sectional Study

Introduction  Teachers are a high-risk group for the development of vocal dysfunction, as they use voice extensively in their profession. Objective  To know the prevalence and risk factors associated with voice strain in teachers. Methods  A cross-sectional study was conducted among schoolteachers in Chitwan, Nepal. The Voice Handicap Index questionnaire was used as a survey tool. Result  A total of 315 teachers were enrolled in the study. The mean age of the participants was of 36.7 years. Teachers from public schools, primary grade classes, > 50 pupils in the classroom, > 24 hours of classes per week, dust in class, and recurrent tonsil problems were associated with various degrees of vocal handicap. Conclusion  There is a high prevalence of voice disorder among teachers. A holistic approach, which includes teacher education regarding voice care during their work and management of their voice handicap by taking into consideration different risk factors, must be adopted.

Occupational health disorders among physical education teachers compared to classroom and subject specialist teachers

During the course of their work, teachers may be subjected to conditions that cause different health problems. This study examines occupational health disorders in a representative sample of 858 teachers (528 female; age 44.0 ± 9.67 years) divided into three groups of teachers with specific occupational requirements: specialist physical education teachers (specialist PETs), classroom teachers, and specialist teachers. The number of health disorders in the last 12 months was recorded using the Chronic Health Disorders Questionnaire. The differences between the different types of teachers, controlled for sex and age, were analyzed using binary logistic regression. The results showed that 89% of teachers experienced colds as the most frequently reported health problem, followed by 58% for lower back problems, 57% for headaches, 51% for hoarseness, and 43% for neck problems. A binary logistic regression showed that specialist PETs were the group with the highest health risk. They were about twice as likely to have musculoskeletal or hearing disorders than the other two groups of teachers. They were also significantly more likely to suffer from hoarseness. Understanding these different health challenges is critical to developing targeted interventions and robust support systems. These interventions should include initiatives aimed at raising awareness of health risk factors, implementing injury interventions and vocal cord hygiene programs, making ergonomic adjustments, and promoting awareness of self-care (both mental and physical). Given that the teaching profession is currently struggling with an aging workforce and a shortage of teachers, addressing these challenges is critical to the continued well-being of the teaching professionals.

Prevalence of Occupational Voice Disorder Among Teachers of Kathmandu District, Nepal

The objective of this research was to identify the prevalence of voice disorders among teachers in the Kathmandu District of Nepal, with an emphasis on identifying possible risk factors that may be associated with these disorders. A cross-sectional study design was used, with both quantitative and qualitative data-gathering techniques using a mixed-methods approach. Data were collected from 95 non-teachers and 194 participating teachers from different schools in Kathmandu Valley. The analysis covered self-reported voice problem prevalence, job details, and demographic data. We examined the relationships between several variables and voice issues, including gender, class size, length of instruction, and tobacco usage. Findings: Compared with nonteachers (33.7%), teachers had a considerably greater prevalence of voice issues (69.1%). Greater class size and more than ten years of teaching experience were shown to be risk factors, while female instructors reported a greater prevalence of voice issues. Additionally, it was shown that instructors' voice issues are also linked to tobacco usage. The results of this study highlight how critical it is to provide voice therapy to educators employed in the Kathmandu District, particularly those in at-risk categories such as female instructors, more experienced educators, and educators with larger class sizes. The outcomes demonstrated important impacts on teacher well-being, job satisfaction, and academic achievement. More research and intervention strategies are needed to minimize the effects of voice problems and promote a positive teaching and learning environment.

The Effects of Classroom Acoustic Conditions on Teachers' Health and Well-Being: A Scoping Review

PURPOSE

Teachers spend a significant amount of time in classrooms, which can be noisy environments. The aim of this scoping review was to determine what is known from the literature about the effect of classroom acoustic conditions on teachers' health and well-being.

METHOD

This scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol. Four bibliographic databases were searched: ERIC, PubMed, Scopus, and Web of Science.

RESULTS

Thirty-three articles were deemed relevant for the review. The most studied health aspect was teachers' vocal health. The majority of results showed higher noise levels or a higher number of students have a negative effect on teachers' health and well-being (61% and 60%, respectively), while 39% showed a negative effect of longer reverberation times. Most other results showed no effect.

CONCLUSIONS

These results show that poor classroom acoustic conditions can have a negative effect on teachers' health and well-being. Therefore, creating classrooms with good acoustic conditions and controlling noise is vital. Limitations are discussed, and future research to better understand the relationship between classroom acoustic conditions and teachers' health and well-being is proposed. This future research will help in understanding the acoustic conditions that are needed to optimize teachers' health and well-being in the classroom.

Factors Associated With the Limitation at Work Because of the Voice: Study With Teachers of Basic Education In Brazil

INTRODUCTION

The voice disorder can cause limitations at work, as it affects the communication and the performance of the teaching function.

OBJECTIVE

To analyze the limitation at work because of the voice and to examine possible associations with sociodemographic characteristics, life and health habits and work conditions among Basic Education teachers in Brazil.

METHODS

Cross-sectional epidemiological study, with a representative sample, carried out between October 2015 and March 2016, with 6,324 teachers working in Basic Education in Brazil. Data collection was carried out through the application of a questionnaire via telephone with questions regarding health and working conditions. The "limitation at work because of the voice" was considered a dependent variable, whose response options were a scale with four Likert items that varied from frequently to never. The independent variables were grouped in blocks for ordinal logistic regression analysis with hierarchical entry. The magnitude of the association was assessed by the Odds Ratio (OR) with the respective confidence intervals (95% CI).

RESULTS

One third of Brazilian teachers (32.7%) reported some frequency of limitation at work (sometimes; rarely, frequently) because of the voice at some moment in the month before the survey and, of these, 5% declared high frequency. The factors that increased the chance of a greater frequency of limitation at work because of the voice were: being female (OR = 1.32; 95% CI = 1.15-1.51); teaching for elementary school (OR = 1.35; 95% CI = 1.02-1.78); use anxiolytic or antidepressant medications (OR = 1.46; 95% CI = 1.20-1.78); losing sleep due to concerns (OR = 1.69; CI = 95% = 1.46-1.95); high noise at school (OR = 2.09; 95% CI = 1.78-2.46); agitated environment by students' indiscipline (OR = 1.37; 95% CI =1.15-1.63); high demands at work (OR = 1.18; 95% CI = 1.02-1.36); not having social support (OR = 1.19; 95% CI = 1.04-1.38); having suffered verbal violence by the students (OR = 1.43; 95% CI = 1.23-1.67). On the other hand, the practice of regular physical activity (OR = 0.86; 95% CI = 0.75-1.00) and the fact of having enough time to complete work tasks (OR = 0.71; 95% CI = 0,62-0.82) decreased the chance of a higher frequency of limitation at work due to vocal problems. The perception that the work limits the teaching performance because of the voice was more frequent among teachers in the North (OR=1.41; 95% CI = 1.17-1.71) and Northeast (OR=1.46; 95% CI = 1.22-1.76) compared to the Southeast region.

CONCLUSION

Factors associated with an increase in the chance of higher frequency of reporting work limitations due to the voice: being female, lack of physical activity, losing sleep due to concern, using anxiolytic or antidepressant medication, school location in the North and Northeast, teaching for the elementary school stage, high noise at school and psychosocial aspects of work organization. The Brazilian educational sector needs public policies that take into account regional inequalities and the health and work conditions of teachers.

Cambios en los parámetros vocales de los docentes durante el curso escolar

La voz es una herramienta fundamental para el docente. La alteración de sus cualidades básicas es definida como disfonía y resulta ser muy común. Nuestro objetivo es estudiar si la voz de los docentes cambia, como consecuencia del esfuerzo vocal provocado por su profesión, en los trimestres del curso escolar y tras la jornada laboral, midiendo el índice acústico de calidad de voz (AVQI). Además, estudiamos si el cambio tras la jornada laboral difiere en los distintos trimestres del curso. La muestra está compuesta de 93 docentes de los cuales 40 imparten su labor en un centro público y 53 en un centro concertado. Por sexos, el 29% son hombres y el 71% son mujeres. El 41.4% imparte en infantil y/o primaria y el 58.6% en ESO y/o Bachillerato. Para la grabación de voz se utilizó el programa de análisis acústico PRAAT. Se encuentran evidencias de que en el segundo y tercer trimestre el parámetro AVQI empeora en los docentes de forma significativa tras su jornada lectiva y de forma más acusada en los que imparten ESO y Bachillerato. Los docentes de centros públicos registran niveles AVQI significativamente superiores a los de centros concertados. La disfonía es significativamente menor en los docentes que imparten las materias de música, idioma distinto del castellano y/o educación física. No se encuentran cambios significativos de AVQI entre los distintos trimestres.

Potential stressors in (prospective) physical education teachers: a comparison of different career stages

Previous studies have identified stressors in physical education (PE) teachers. However, these studies lack a comprehensive consideration of potential teaching-related stressors combined with an analysis of differences in these potential stressors between different career stages. Given that many physical education teachers suffer from stress, the purpose of the present study was to investigate potential stressors in three career stages of (prospective) physical education teachers (student teachers, pre-service teachers, teachers) in order to further develop their education in terms of stress management. The results of a survey of 723 German (prospective) physical education teachers (255 student teachers, 117 pre-service teachers, 351 teachers) showed that, overall, noise, heterogeneity of students, and inadequate curriculum were reported to be the most frequent potential stressors. When controlling for teaching hours per week, teachers, and pre-service teachers did not differ in the frequency of potential stressors. However, both teachers and pre-service teachers reported significantly less lack of facilities/equipment, pupils’ discipline problems, and lack of pupils’ motivation than student teachers, and significantly more noise than PE student teachers. Additionally, teachers reported more heterogeneity of pupils than student teachers. These findings can be explained by characteristics of the specific career stages. For practical application, it can be concluded that there is a need for coping interventions that are tailored to the stressors which are salient in a specific career phase. In future research, studies should investigate stressors in different career stages longitudinally.

Diseño y validación de una escala vocal multidimensional para la detección del riesgo vocal en docentes

En el colectivo docente es frecuente el mal uso de la voz, para preservar su salud vocal es necesario un diagnóstico precoz. El objetivo del estudio fue diseñar, según criterios de especificidad y sencillez, una escala vocal multidimensional y fiable que contribuya a detectar situaciones de riesgo vocal del docente en el contexto escolar (EVM-D). Participaron 299 docentes, de 18 centros educativos de A Coruña seleccionados aleatoriamente, se dividieron en dos submuestras, una (n =143) para la realización del análisis factorial exploratorio, tanto con Análisis Paralelo como con factorización de ejes principales y rotación oblimin, y otra (n = 156) para el análisis factorial confirmatorio utilizando el método de mínimos cuadrados no ponderados. Una vez analizados los modelos, se optó por uno de tres factores de primer orden (Síntomas vocales, Hábitos de habla y Abusos vocales) y uno de segundo orden (Riesgo vocal). Los índices de bondad de ajuste fueron GFI = ,98, AGFI = ,97, SRMR = ,05; la fiabilidad compuesta (FC) en los tres factores de ,80; ,70 y ,73 y la varianza media extraída (AVE) de ,44; ,43 y ,47 respectivamente; la FC del factor de primer orden fue de ,83 y la AVE ,63. Se obtuvieron valores de corte según el sexo para los percentiles P90, P75 y P60 de riesgo vocal: alto, medio, bajo y muy bajo. La escala EVM-D fiable y consistente podría ser útil para detectar factores etiológicos o síntomas y aplicar la higiene vocal de forma precoz y autónoma por el docente.

Stress in Physical Education Teachers: A Systematic Review of Sources, Consequences, and Moderators of Stress

Purpose: The purpose of this systematic review was to identify sources of stress, consequences of chronic stress and moderators of stress in physical education teachers and to formulate implications for future research and teacher education. Methods: The initial search identified 2483 publications, including 47 that met the inclusion criteria. Results: The most important sources of stress in physical education teachers were the curriculum, inadequate facilities/equipment, the low status of PE and students´ discipline problems. Regarding the consequences of chronic stress, the majority of studies assessed burnout and reported low to moderate levels of burnout in general. However, of the studies that reported percentages, 20-25% of physical education teachers indicated high levels of burnout. Conclusions: Regarding the relationship between sources of stress and consequences of chronic stress in physical education teachers, future studies should (a) take into account the whole stress process (b) use more adequate measures for stress and (c) address potential moderators of stress. In terms of practical implications, PE teachers should receive an adequate pre- and in-service training that aims at being aware of the main sources of stress in PE teachers and building up adequate coping strategies. In addition, PE teacher education should consider interventions to prevent health consequences of stress such as voice disorders.

Relevant Work Factors Associated with Voice Disorders in Early Childhood Teachers: A Comparison between Kindergarten and Elementary School Teachers in Yancheng, China

Background: Early childhood teachers consist of kindergarten and elementary school teachers in the lower grades. Young children at school may increase the vocal load of these teachers. Therefore, the objectives of this study were to determine the prevalence of voice disorders and the associated factors in early childhood teachers, and to determine if differences exist between kindergarten and elementary school teachers. Method: A cross-sectional survey was performed in July 2019 as a network questionnaire. Through cluster sampling, teachers (n = 414) from all five public kindergartens (n = 211) in the urban area of Yancheng, China, and four public elementary schools (n = 203) in the same school district participated in this study. Multivariate logistic regression models were used to analyze the associations among the prevalence of voice disorders in the teachers, school type, and relevant factors. Results: Our results indicated, based on the Voice Handicap Index scale (VHI-10, China), that the prevalence of voice disorders in early childhood teachers was 59.7%, while that in elementary school teachers (65.5%) was significantly higher than that in kindergarten teachers (54.0%) during the previous semester. Contributing factors included daily class hours, classroom air humidity, and speaking loudly during teaching. Additionally, certain types of voice usage in teaching such as falsetto speak, speaking more than other teachers, not using vocal techniques, and habitual voice clearing, were significantly associated with voice disorders. Conclusion: Most early childhood teachers have voice disorders. Compared with the kindergarten teachers, the elementary school teachers experienced a significantly higher prevalence of voice disorders. Several factors among work organization, work environment, and types of voice usage in teaching were associated with the voice disorders in early childhood teachers. The finding suggests that voice training should be provided for early childhood teachers, classroom teaching time should be decreased, and the number of teachers in basic subjects should be increased in the lower grades of elementary schools.

Incidence of Common Mental Disorders in Teachers: Is There a Relationship with Voice Disorders?

OBJECTIVE

This study aims to evaluate the risk factors associated with the incidence of common mental disorders (CMD) in teachers, particularly the possible relationship with voice disorders.

MATERIAL AND METHODS

A longitudinal quantitative study of 469 teachers of the municipal schools of Pelotas in Brazil was conducted over three years after a baseline interview. The symptoms of CMD were assessed with the Self-Reporting Questionnaire 20 items (SRQ-20 scale) and the voice disorder was assessed with the Voice Handicap Index Protocol with cutoff of 19 points. A bivariate analysis was performed using Poisson regression to verify the difference in proportion of the incidence of CMD in the different categories of independent variables.

RESULTS

The incidence of CMD was 18% (N = 265). In the bivariate analysis, the risk for CMD was 77% higher for teachers who presented with a voice disorder (RR 1.77 95% CI 1.04 to 3.03).

CONCLUSIONS

Teachers who reported a voice disorder had an increased risk of developing a CMD.

Factors associated with perception of loud occupational noise by school teachers in basic education in Brazil

OBJECTIVE

To determine the prevalence of the perception of loud noise in basic education schools in Brazil and the associated factors.

METHODS

A cross-sectional study with a representative national sample of teachers. The data collection was conducted with 6,510 teachers from October 2015 to March 2016. All teachers answered a telephone questionnaire with questions related to health and working conditions. The measure of association was prevalence ratio, estimated using Poisson regression.

RESULTS

The prevalence of reported loud occupational noise was 33.0%. There was a positive association in the outcome of classroom disturbance reports (PR = 3.41; 95%CI 3.07 - 3.75), feeling of working under high-pressure levels (PR = 1.33; 95%CI 1.22-1.45), having suffered verbal abuse from students (PR = 1.21; 95%CI 1.11-1.31), teaching in different teaching modalities (PR = 1.21; 95%CI 1.02-1.42), more than 30 active teachers in the school (PR = 1.28; 95%CI 1.07-1.54). The teachers who reported a pleasant school environment (PR = 0.81; 95%CI 0.75-0.87), along with the teachers who worked in rural areas (PR = 0.84; 95%CI 0.75-0.95), experienced less noise at work.

CONCLUSION

The prevalence of loud noise perception in Brazilian schools reached high levels and showed statistical significance with the characteristics of schools and teacher's work environment. These results demonstrate the need for developing public policies that take into consideration the reduction of noise levels in schools.

Study of Voice Disorders Among School Teachers in Goa

Teachers are heavy voice users, and they suffer from voice problems more frequently than other occupational voice users. Various studies have demonstrated that teachers speak longer than other professionals and that school teachers in particular, are at risk for voice problems such as vocal fatigue and vocal nodules. The present study is undertaken to study the prevalence of voice disorders in the teachers in different schools at any time and accesses the relationship of different working conditions like class room size, background noise, number of hours taught every day and role of chalk allergy in development of these voice disorders. The study was carried out on 133 school teachers with self reporting of voice problems through detailed questionnaire. A significant number of teachers, more so females had voice problems attributed to various factors. Voice amplification and reduction of background noise along with measures to control allergy are suggested.

Potential Risk Factors and Prevalence of Voice Symptoms in Students Starting Their Teacher Education

The aim of the present study was to determine prevalence of voice problems and potential risk factors in teacher students at the start of their education. A total of 1494 students from seven teacher education schools participated in the study. The students answered a questionnaire about 11 risk factors, and one with six questions about voice symptoms, Screen6, and 30 statements in the Voice Handicap Index (VHI). Students reporting at least 2 weekly voice symptoms in Screen6 were assigned to the group with voice problems. Significance level was P < 0.05. Results: prevalence of risk factors was about the same in the seven groups of teacher students except the group with highest proportion of women that also showed the highest proportion of voice problems, 38%. Prevalence of voice problems in the total group was 17%. Comparison of students with or without voice problems showed that all factors except one were more prevalent among students with voice problems and women were overrepresented. Mean total VHI score was 22 in students with voice problems and eight in students without voice problems. Multiple regression analyses showed that frequent throat infections, hearing problems, previous speech therapy, or voice training were the potential risk factors that had the strongest association with voice symptoms as well as with total score in VHI. Conclusions: results from this study show that it is common that teacher students experience voice problems already at the start of their education and potential risk factors associated with voice problems are identified. Knowing that teaching is a high-risk profession for developing voice disorders, it is crucial that teacher students should receive compulsory preprofessional voice education including voice ergonomics and voice training.

Acoustic Comfort in Learning Spaces: Moving Towards Sustainable Development Goals

The association between learning spaces and new pedagogical approaches is a current issue. Research shows that the classical, more silent, master class is being bypassed by student centered methods with participative classes and active methodologies. Major efforts in teacher training are taken to help teachers implement these new approaches in their lessons. The conditions of the learning space are also influential. The following question is raised: Can acoustic comfort facilitate innovation and consequently help in the progress towards SDG? We have focused on public high schools in Spain (IES), in the Valencian Community. Data has been gathered from the visit to thirty high schools. International scientific studies and valid guidelines referring to noise have been reviewed. Findings on the research conclude that acoustic comfort is essential in education and is directly related with the implementation of emerging pedagogies. Likewise, the outcomes of the investigation hope to raise awareness among authorities and civil society that improvement of sound quality in learning spaces facilitates the achievement of sustainable development goals (SDG), particularly those concerning goal 3 (health and wellbeing), goal 4 (quality education) and goal 9 (sustainable infrastructures).

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.

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…).