Behavioral Dysphonia and Depression in Elementary School Teachers

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.

Voice Symptoms and Wellbeing in School Teachers in England

INTRODUCTION

Negative psychological factors such as depression and other common mental disorders have been found to be associated with voice problems in teachers. However, there is little research with teachers that investigates the relationship between positive psychological factors such as wellbeing and voice problems. Although negative and positive mental states are on a continuum of psychological health, research suggests negative and positive effects are not necessarily inversely correlated and therefore need to be investigated separately.

OBJECTIVE/HYPOTHESIS

To explore the relationship between voice symptoms and wellbeing in teachers working in primary and secondary schools in England. We hypothesise that as wellbeing increases voice symptoms will decrease.

DESIGN

Cross sectional study using a self-administered web-based questionnaire conducted with primary and secondary school teachers in England.

METHODS

The study included 1205 teachers from 608 primary and secondary schools, including state and fee paying, and mainstream and special schools. Voice symptoms were measured using The Voice Symptom Scale and wellbeing was measured using the Warwick Edinburgh Mental Wellbeing Scale. Information was also obtained on health, lifestyle, sociodemographic and environmental factors. Analysis was conducted using a linear multi-level regression model.

RESULTS

A statistically significant relationship between voice symptoms and wellbeing was identified (-0.31 95% CI -0.41, -0.20 P =< 0.001). Other factors found to be statistically significantly associated with voice symptoms were age, sex, gastroesophageal reflux, class size, background noise, speaking louder than normal and respiratory infection. Hours teaching per week, deprivation of school, voice training, teaching subject, smoking status and asthma were not associated with voice symptoms.

CONCLUSIONS

This study suggests that there is an association between vocal symptoms and wellbeing. Teachers with higher wellbeing had fewer voice symptoms.

Effectiveness and Feasibility of Telepractice on Voice Therapy for Female Teachers in Elementary Schools with Self-Reported Voice Disorders

PURPOSE

The purpose of this study is to explore the effectiveness of telepractice in voice intervention for female teachers in elementary schools with self-reported voice disorders.

METHODS

Thirty-five female elementary school teachers with self-reported voice disorders volunteered to participate in the study. They were divided into a telepractice voice intervention group (experimental group N=18) and a face-to-face voice intervention group (control group N=17) based on their employment setting. The exact same treatment protocol was applied to both groups of subjects, except that the intervention group was seen through telepractice, and the control group was seen face-to-face. The treatment protocol includes vocal hygiene education and resonant voice therapy twice a week for a total of eight sessions. Auditory perceptual analysis, acoustic assessment, aerodynamic assessment and self-assessment protocol were conducted before the intervention and one week after the last intervention, and the differences before and after interventions within each group and between groups were compared.

RESULTS

There was no significant difference in baseline data including age, working years, and voice symptoms between the two groups. Both groups showed significant improvement (P<0.05) in all voice assessment before and after the treatment sessions, except for the Voice Handicap Index-10 (VHI-10) assessment. No statistical difference was found in other pre- and post-intervention voice assessment changes between the two study groups. The control group presented higher improvement in the total score, and the two subdomain assessments of physiology and emotion.

CONCLUSIONS

Telepractice voice intervention can effectively improve the voice quality of female teachers in elementary schools, and telepractice therapy can be an effective alternative to face-to-face voice intervention.

Do You Like Your Voice? A Population-Based Survey of Voice Satisfaction and Voice Enhancement

OBJECTIVES

Voice enhancement for patients without obvious vocal pathology or loss of function is rarely discussed clinically or in academic research. Our objectives were to: (1) determine voice satisfaction on a population level, and (2) assess willingness to consider interventions to change one's voice.

METHODS

A standardized questionnaire was created to assess current and past voice disorders. Questions assessed demographics, health status, prevalence of voice disorders, and questions regarding satisfaction with voice. Iterative survey testing and piloting were performed. A cohort with age, gender, and geographic distribution of the general adult population was then queried in an online survey. Qualitative analysis and both descriptive and multivariate statistics were performed.

RESULTS

A total of 1522 respondents were included, with an age, gender, and regional distribution reflective of the US population. A minority (38.8%) of respondents reported that they did not like the sound of their own voice in normal conversation; when asked about listening to a recording of their own voice, a majority (57.5%) reported dissatisfaction with voice. Discontent with one's voice was associated with being middle age (p = 0.005), female gender (p < 0.0001), and white race (p < 0.0001). Approximately 50.6% of respondents without a history of dysphonia would consider interventions to change their voice. Of those who indicated they may elect to change their voice, qualities regarding clarity and pitch were paramount.

CONCLUSION

Dissatisfaction with one's speaking voice is common. A considerable percentage of the general population without a voice disorder would consider interventions to change their voice.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:3455-3461, 2023.

Voice disorder classification using convolutional neural network based on deep transfer learning

Voice disorders are very common in the global population. Many researchers have conducted research on the identification and classification of voice disorders based on machine learning. As a data-driven algorithm, machine learning requires a large number of samples for training. However, due to the sensitivity and particularity of medical data, it is difficult to obtain sufficient samples for model learning. To address this challenge, this paper proposes a pretrained OpenL3-SVM transfer learning framework for the automatic recognition of multi-class voice disorders. The framework combines a pre-trained convolutional neural network, OpenL3, and a support vector machine (SVM) classifier. The Mel spectrum of the given voice signal is first extracted and then input into the OpenL3 network to obtain high-level feature embedding. Considering the effects of redundant and negative high-dimensional features, model overfitting easily occurs. Therefore, linear local tangent space alignment (LLTSA) is used for feature dimension reduction. Finally, the obtained dimensionality reduction features are used to train the SVM for voice disorder classification. Fivefold cross-validation is used to verify the classification performance of the OpenL3-SVM. The experimental results show that OpenL3-SVM can effectively classify voice disorders automatically, and its performance exceeds that of the existing methods. With continuous improvements in research, it is expected to be considered as auxiliary diagnostic tool for physicians in the future.

What are the Symptoms that Characterize the Clinical Condition of Vocal Fatigue? A Scoping Review and Meta-Analysis

INTRODUCTION

Vocal fatigue is a clinical manifestation associated with a perception of negative vocal adjustment. It is related to the increase in the sensation of excessive effort when speaking and the lack of conditioning of the muscles and structures that involve vocal production. Because it has a complex and multifactorial diagnosis, there is still no consensus on the symptoms most commonly found in this clinical condition.

OBJECTIVE

To review and analyze the symptoms that characterize the clinical condition of vocal fatigue.

METHODS

This study consists of a scoping review carried out in the Cochrane Library, Embase, Lilacs, and Medline databases. Observational studies or clinical trials from the last 10 years. Studies with participants younger than 18 years of age were excluded; as well as research that did not describe symptoms of vocal fatigue or that presented vocal fatigue as a symptom; studies with patients with neurological, psychiatric, syndromic conditions, or head and neck cancer. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies NHLBI-NIH scale was used to assess the methodological quality of selected observational studies and the PEDro scale for the analysis of experimental studies. The steps were performed by three blinded evaluators. Subsequently, meta-analyses of global means were executed for each factor under study; a comparison of the difference in the mean score for each factor between exposed and unexposed; a comparison of the difference in the average score, among non-professional voice users, for each factor between exposed and unexposed.

RESULTS

In the searches performed, 956 articles were found and 29 articles were selected according to the eligibility criteria. Of these, 93.11% of the studies were observational and 6.89% were clinical trials. Regarding the gender and age group of the study samples, women aged between 30 and 45 years were predominant. As for the occupational use of voice, 68.97% of the samples were composed of professional voice users and 31.03% of non-professional voice users, with most professional voice users being teachers and non-professional voice users, individuals with dysphonia or vocal complaint. To assess vocal fatigue symptoms, 28 studies used the Vocal Fatigue Index (VFI) protocol, and only one study used another assessment protocol, Self-Administered Voice Rating. All studies were classified as regular, according to the scale used. As for the meta-analyses performed, the mean scores of the VFI factors were higher among professional voice users when compared to non-professional voice users and higher in dysphonic individuals compared to non-dysphonic individuals.

CONCLUSION

The vocal fatigue symptoms found in this review were common in the populations of professional voice users and non-professional voice users and dysphonic and non-dysphonic individuals. These symptoms were related to vocal recovery after rest, physical discomfort, and restricted vocal use.

Are Occupational Voice Disorders Accurately Measured? A Systematic Review of Prevalence and Methodologies in Schoolteachers to Report Voice Disorders

PURPOSE

Different measuring instruments have been described to determine the prevalence of voice disorders in schoolteachers. However, the heterogeneity of prevalence figures has made it difficult in determining the impact of voice disorders in this group. This investigation aims to review and identify scientific evidence of methodological analysis of voice disorders in teachers, the relevance of measuring instruments, the prevalence of dysphonia, and the impact on the development of vocal health prevention programs.

METHODS

A systematic review was conducted by searching six important scientific databases. Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines were carried out. Articles were included whether they presented data related to the prevalence of dysphonia and the impact of therapy programs on teachers.

RESULTS

Twenty articles out of 8,998 were selected. The cross-sectional design type was predominant throughout the investigations. Differences were observed in the number of participants across studies, leading to heterogeneous prevalence figures - which ranged from 10.5% to 69.1%. The assessment instruments are not standardly used to effectively determine the disease burden. Despite the fact of the extensive evidence of the effectiveness of programs that address dysphonia in teachers, the scarcity of literature is yet evident on systematic programs promoted by either the government or educational institutions.

CONCLUSION

Findings suggest that future investigations should consider the consensus of a global definition for occupational dysphonia in teachers in order to develop accurately measuring instruments and to assist with voice care programs and treatment approaches in this population. This might be crucial since it could also assist with the implementation of Delphi-type studies that could support the development of further evidence-based agreements around these programs (voice care and treatment approaches) in schoolteachers.

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.

Voice Problems Among School Teachers employing the Tele-teaching Modality

OBJECTIVES

To assess the prevalence of voice problems among teachers in Riyadh during tele-teaching and examine the relationship between the Voice Handicap Index 10 (VHI10) scores and a variety of risk factors believed to be related to voice problems. We also assessed awareness of voice hygiene and therapy among teachers.

STUDY DESIGN

An observational cross-sectional study conducted using a multistage random sampling method among Riyadh school teachers who taught by tele-teaching for a minimum of one year.

METHODS

A self-assessment questionnaire which included demographic information about teachers, factors related to their teaching backgrounds, tele-teaching settings, effects of tele-teaching on the voice, medical and social histories, reports of voice and reflux symptoms, VHI10, and general knowledge about voice hygiene. This was distributed to school teachers using an SMS link through the Ministry of Education's IT department.

RESULTS

A total 495 were included in the study after exclusions. The prevalence of teachers who had significant voice problems during tele-teaching (VHI10>11) was 21.6%. Multiple risk factors significantly increased the risk of voice problems during tele-teaching. These factors included being female, teacher age, the presence of background noise from both teachers and students, loud voices, using an open camera during the teaching, stress and anxiety, allergies, respiratory disease, reflux, hearing problems, and a family history of voice problems. Only 4.6% of respondents were familiar with voice hygiene and voice therapy, but 65% believe that it is important for teachers to be knowledgeable about them.

CONCLUSIONS

Due to the lower prevalence of voice disorders among tele-teaching compared to traditional teaching methods, tele-teaching may be a viable option for teachers who have voice problems. There are still several factors influencing voice problems among tele-teachers. To attenuate potential risks, it is crucial that teachers are aware of the concepts of voice hygiene and voice therapy.

The prevalence and risk factors for perceived voice disorders in public school teachers

Objectives

The aim of this study was to explore the prevalence and risk factors in public kindergarten and elementary school teachers in the Jimei district in Xiamen. We took particular interest in the relationship between work-related factors and voice disorders.

Study Design

A cross-sectional investigation; a General Investigation.

Methods

This study was conducted from September 14 to 18, 2020 at public kindergarten and elementary schools in Xiamen, China. A total of 3140 teachers were separated into a perceived voice disorder group (PVD) and no perceived voice disorder group (NPVD) according to the Voice Handicap Index. The chi-square test was applied to explore the differences between the PVD and NPVD groups. The univariate logistic regression models were used to identify the risk factors in terms of unadjusted odds ratio and 95% confidence interval. Stepwise logistic regression was then used to ascertain independent determinants.

Results

We found that the prevalence of PVD was 47.52%. The results showed that risk factors of PVD included being female (OR = 1.574), middle-rank technical title and higher (OR = 2.199), continuous lecturing for more than 3 classes (OR = 3.034), lectured more than 10 classes a week (OR = 1.436) and taught art or physical education (OR = 1.742).

Conclusions

Teachers' work-related characteristics were associated with PVD. This proves that a preventive voice care program for teachers, administered by the school or education bureau, is urgent. This could include components such as the reasonable arrangement of timetables and recruitment of a sufficient number of kindergarten and elementary school teachers.Level of evidence: Case-series.

Fostering emotional self-regulation in female teachers at the public teaching network: A mindfulness-based intervention improving psychological measures and inflammatory biomarkers

OBJECTIVE

To examine the effect of a mindfulness-based program specifically designed for teachers in reducing perceived stress and improving the quality of experienced emotion in female active working teachers. A second outcome evaluated is the associated change in cellular inflammatory activity, measured by peripheral blood levels of cytokines.

METHOD

Eighty-eight female active teachers from public schools from São Paulo Municipality were recruited, and randomly allocated to an eight-week Mindfulness-Based Health Program for Educators (MBHP-Educa) or to Neuroscience for Education Program (Neuro-Educa: active control group). The venue of both programs were several public school facilities, where many of the teachers actually worked. Both groups received activities during eight weeks in a 2 ​h/week regimen, totalizing 16 ​h. Sixty-five participants completed the program and pre- and post-interventions measures were taken from the following scales: Interpersonal Multidimensional Reactivity Scale (IRI), Positive-and-Negative Affects Scale (PANAS), Perceived Stress Scale (PSS), Connor-Davidson Resilience Scale (CD-RISC), and a primary outcome in Ryff's Psychological Well-Being Scale (PBWS). At pre-and post-intervention, blood samples were collected for the measurement of several important inflammatory biomarkers, Tumor Necrosis Factor - α (TNF-α), Interleukin 1β (IL-1β), Interleukin 6 (IL-6), Interleukin 8 (IL-8), Interleukin 10 (IL-10) and Interleukin 12p70 (IL-12P70) through flow cytometry assay. Intervention effects were analyzed via Generalized mixed models (GLMM).

RESULTS

According to the GLMM, MBHP-Educa significantly reduced the scores of perceived stress (p ​< ​0.0001), and negative affect (p ​< ​0.0001) compared to active control group (Neuro-Educa). Conversely, an increase was observed on Psychological Well Being Scale in dimensions of Self-acceptance (p ​< ​0.0001), and Autonomy (p ​= ​0.001), as well as improvements in Resilience (p ​< ​0.0001), and Positive Affect (p ​< ​0.0001). MBHP-Educa also promoted a reduction in the levels of IL-6 (p ​= ​0.003), IL-8 (p ​= ​0.036), and increase in the levels of IL-10 (p ​< ​0.0001) and IL-12p70 (p ​< ​0.044). TNF-α, IL-1β, and IL-10p70 showed results below theoretical limit of detection accepted for CBA kit.

CONCLUSIONS

Our data suggest that mindfulness-based interventions introduced as a strategy for reducing stress, promoting well-being and improve immune function can be a useful asset in promoting psychological health among teachers in Basic Education.

Prescribed medication use among elementary teachers: Prevalence and associated factors

The aims of the study were to assess the prevalence and analyze the associated factors of medication use among teachers. A cross-sectional study was carried out, involving 530 teachers from Londrina city, Paraná, Brazil. The dependent variable was prescribed medication use and the independent variables were sociodemographic, work-related, lifestyle, health disorders, and chronic diseases, all assessed through questionnaires. Prevalence of medication use was 59.1%. Chronic disease was associated with all medications analyzed. Variables positively associated with medication use according to health disorder type were: Cardiometabolic (Length of employment, overweight, not current tobacco use, and TV viewing); Psychological (Length of employment, common mental disorders, current tobacco use, and disability); Orthopedic (Length of employment, health insurance, overweight, musculoskeletal pain, low job support, and disability); Respiratory (TV viewing and problems related to dust or chalk powder); and Gastrointestinal (common mental disorders and physical activity [negative association]). Support for access, the appropriate use of medicines, and a reduction in medication use should consider work-related, lifestyle, and health disorders, as well as chronic diseases.

Voice-Related Quality of Life, Anxiety, and Depression in Female Teachers: Finger Kazoo Intensive Short-Term Vocal Therapy

BACKGROUND

Among professional voice users, teachers are subject to higher risks of developing occupational dysphonia due to their abusive use of the voice, usually under unfavorable conditions.

OBJECTIVES

Quantify the vocal self-perception, the voice-related quality of life, and the anxiety, and depression symptoms, of dysphonic female teachers, after a brief and intensive short-term voice therapy using the finger kazoo technique.

METHODS

Blinded, randomized, and controlled clinical trial. Questionnaires applied to two study groups (15 subjects without structural laryngeal disorder in one group, and nine subjects with vocal nodules in the other), and to two control groups (9 subjects without structural laryngeal disorder in one group, and eight subjects with vocal nodules in the other).

RESULTS

The Vocal Tract Discomfort Scale, the Voice Activity and Participation Profile, the Voice Symptom Scale, and the Voice-Related Quality of Life Protocol, showed significant improvement in both study groups. The Vocal Perception Protocol showed that negative vocal self-perception reduced significantly in subjects without structural alteration of the vocal folds in the study group. Anxiety symptoms improved significantly in subjects with vocal nodules in the study group; depression symptoms improved significantly in subjects with vocal nodules in the control group, and in subjects without structural alteration of the vocal folds in the study group.

CONCLUSION

Brief and intensive short-term voice therapy using the finger kazoo technique provided improvement in the vocal self-perception, the voice-related quality of life, and in the symptoms of anxiety and depression in dysphonic teachers, more evidently in teachers with vocal nodules.

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.

The Risk Factors Related to Voice Disorder in Teachers: A Systematic Review and Meta-Analysis

Background and Objectives: Identifying the risk factors of teachers’ voice disorders is very important for preventing voice disorders and the recurrence of them. This meta-study identified risk factors associated with teachers’ voice disorders through systematic review and meta-analysis and provided basic data for preventing them. Materials and Methods: This study collected literature on the risk factors of teachers’ voice disorders using six databases (i.e., CINAHL, EBSCO, PUBMED, SCOPUS, Web of Science, and Springer Link). Search was limited to studies published between 1 January 2000 and 15 October 2018, and a total of 16 publications were selected for the analysis of this study. The quality of selected literature was assessed using the “Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields”. The effect size was analyzed by odds ratio and 95% confidence interval. Results: The results of the quality assessment ranged from 20 to 24 points with six strong studies and ten good studies. The meta-analysis showed that gender, upper airway problems, caffeine consumption, speaking loudly, number of classes per week, and resignation experience due to voice problems were the major risk factors of teachers’ voice disorders. On the other hand, age, number of children, drinking, physical activity, smoking, water intake, singing habits, duration of teaching, perception of noise inside the school, number of classes per day, noise assessment inside the classroom, and perception of technology and instruments inside the workplace were not significantly related to voice disorders. Conclusions: Longitudinal studies should be conducted in the future to confirm causality between voice disorders and risk factors based on the results of this study.

Systematic review on the prevalence of illness and stress and their associated risk factors among educators in Malaysia

BACKGROUND

Despite evidence of physical (illness) and mental (stress) health problems, there appears to be a lack of studies or concern regarding occupational safety and health among educators in Malaysia.

OBJECTIVE

To review the prevalence of illness, stress, and corresponding risk factors among educators in Malaysia.

METHOD

Scopus, ProQuest, PubMed, ScienceDirect, CAB, and other computerized databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies published between January 2013 and April 2019 on the prevalence and associated risk factors of illness and stress among educators (S1 Checklist). The keywords used included educator, teacher, lecturer, academic staff, teaching profession, university staff, academician, faculty, illness, injury, disease, pain, WMSD, dysphonia, hoarseness, stress, mental health, strain, health problem, disorder, and/or Malaysia. Selected studies were evaluated by quality assessment.

RESULTS

Twenty-two articles fulfilled the eligibility criteria. The prevalence of illness and stress was determined for low back pain (33.3-72.9%); upper back pain (33.33-56.4%); neck/shoulder pain (40.4-80.1%); upper arm discomfort (91.3%); forearm pain (89.6%); wrist pain (16.7-93.2%); hip pain (13.2-40.9%); thigh discomfort (91.8%); lower leg discomfort (90.5%); knee pain (23.7-88.0%); ankle/feet pain (19.3-87.7%); elbow pain (3.5-13.0%); voice disorder (10.4-13.0%) and stress (5.5-25.9%). Sex, education level, teaching experience, quality of life, anxiety, depression, coping styles, and others were reported as associated risk factors across the studies.

CONCLUSIONS

There appears to be a cause for concern regarding musculoskeletal disorders, voice disorder, and stress reported among educators in Malaysia. While most risk factors matched those reported in studies elsewhere, others such as school characteristics (school level, government or private school, and location [rural/urban]) have not been investigated.

Communication self-assessment by public prosecutors in a north-eastern Brazilian state

Purpose

To describe how public prosecutors self-assess their communication approaches and how listeners react to them; to analyze how this relates to gender, age, and work experience.

Methods

Descriptive, transversal study. A questionnaire was developed and sent to 126 public prosecutors for completion. Thirty-three completed questionnaires were sent back. The independent variables were gender, age, and number of years of professional experience. The dependent variables were communication self-assessment throughout the years of work, communication parameters used, and listeners' reactions. A descriptive analyzis and Fisher's Exact Test was carried out.

Results

the sample contained both male and female participants with a median age of 43 years and an average of 20 years of professional experience. Most of the respondents claimed they had experienced demotivation, insecurity, tension, and difficulty when trying to convince listeners. More women than men reported they felt that their communication had worsened throughout their careers. All the women reported they experienced insecurity when speaking in public. One third of the public prosecutors stated they suffered from disorders on their voice. Those respondents aged over 43, experienced greater proportion on voice change than younger ones. In contrast to their younger colleagues, the majority of public prosecutors with more than 20 years of professional experience revealed that they felt insecure when speaking in public.

Conclusion

the public prosecutors identified their strong and weak communication parameters. Gender, age, and work experience affect communicative performance.