Em busca do reconhecimento do distúrbio de voz como doença relacionada ao trabalho: movimento histórico-político

Voice Disorders in the Workplace: A Scoping Review

OBJECTIVE

Occupational voice users (OVU) are at risk for developing voice disorders (VD). Otolaryngologists need to advocate for workplace accommodations for these patients. The objective of this study was to assess the literature on VDs in the workplace and to describe how results may guide the Otolaryngologist.

DATA SOURCES

EBSCO, PubMed, Google Scholar, UBC libraries, and SpringerLink databases.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews protocol was used to conduct a scoping review from inception to December 30, 2019. Oxford Levels of Evidence were used to assess the quality of included studies. Common themes and types of accommodations and barriers were explored. This study was registered with the Open Science Framework Open Source for Collaboration in Scientific Research (10.17605/OSF.IO/RYDVN).

RESULTS

One hundred and ninety-three abstracts were screened; 32 studies met inclusion criteria. Oxford Levels of Evidence ranged from 3 to 5. Eight overarching themes were identified: prevalence of VDs among OVUs; identifying risk factors for VDs; raising awareness of VDs medico-legally, politically; the education and treatment of VDs, the importance of diagnosing VDs; measuring the impact of VDs on work productivity; identifying perceived barriers to integration into the workplace; and calculating the economic costs of VDs. VDs affect workplace productivity and have associated absenteeism, medical, and economic costs. Increased awareness and education on the risk factors for VD development can assist with prevention, early diagnosis, and treatment. Accommodations and barriers are discussed.

CONCLUSION

There is emerging literature on VDs in the workplace. A multitude of VDs exist with varying pathologies, associated barriers, and implications for functioning within the workplace. Otolaryngologists play a unique role in diagnosing voice disorders and defining and facilitating workplace accommodations.

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.

Effect of Akson Therapy on Acoustic Parameters in Patients with Functional Dysphonia

OBJECTIVE

Functional dysphonia can impair the language expression ability and adversely affect the career development of some patients. Therefore, an active exploration of effective treatment options is imperative. This study investigated the effect of Akson therapy on acoustic parameters in patients with functional dysphonia.

MATERIALS AND METHODS

In this retrospective analysis, 79 patients with functional dysphonia who received conventional voice correction training from June 2020 to June 2021 were included in the reference group (RG). Our hospital has implemented Akson therapy since July 2021. Correspondingly, 72 patients with functional dysphonia who underwent Akson therapy from July 2021 to July 2022 were enrolled in the observation group (OG). The acoustic parameters such as fundamental frequency (F0), jitter, shimmer, and normalized noise energy (NNE); the aerodynamic parameters including maximum phonation time (MPT), mean airflow rate (MFR), and Voice Handicap Index-10 (VHI-10) score; and the Grade, Roughness, Breathiness, Asthenia, and Strain scale (GRBAS) score were measured before and after treatment and compared between the two groups.

RESULTS

The F0, jitter, shimmer, NNE, MPT, and MFR values as well as the VHI-10 score and the grade (G), roughness (R), and breathiness (B) scores on the GRBAS did not significantly differ between the two groups before treatment (P > 0.05). However, significantly lower F0, jitter, shimmer, NNE, and MFR values and higher MPT levels were found in the OG compared to the RG after treatment (P < 0.001). Furthermore, the VHI-10 score and the G, R, and B scores were significantly lower in the OG than in the RG after treatment (P < 0.001), whereas the asthenia (A) and strain (S) scores remained at 0 before and after treatment.

CONCLUSION

Akson therapy can improve the acoustic parameters of patients with functional dysphonia to a certain extent, indicating its potential application value.

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.

Factors Predicting Dysphonia in Professional Voice Users

OBJECTIVE

To analyze the contribution of organizational, environmental, and personal factors in predicting dysphonia in professional voice users.

STUDY DESIGN

This was a cross-sectional documentary study.

METHODS

The study sample consisted of 128 professional voice users (104 female and 24 male), with a mean age of 39.3 years. Dysphonia (laryngeal disorder associated with vocal complaints) was defined as the dependent variable. Organizational, environmental, and personal factors were defined as independent variables. Logistic regression models were used as predictive methods for data analysis. Evaluation and interpretation of the final model were performed using the ROC curve, odds ratio, and probability estimation.

RESULTS

Professional voice users exposed to low humidity and who talked a lot on their phones were less likely to be dysphonic than individuals who were not exposed to these factors. Those exposed to excessive vocal demand and who reported talking with effort were more likely to be dysphonic than those who were not exposed to these factors. The accuracy of the prediction model was 80.8%.

CONCLUSIONS

Exposure to low humidity and talking a lot on the phone were protective factors. However, excessive vocal demand and straining were risk factors for predicting the presence of dysphonia in professional voice users with high accuracy.

Panorama de tres países latinoamericanos en problemas de voz relacionados con condiciones de trabajo

PURPOSE

To identify the normative framework on work-related voice disorders in three Latin American countries: Brazil, Chile and Colombia.

METHODS

Documentary research focused on regulations and statistics occupational voice in the three included countries.

RESULTS

In the three countries included there are normatives that regulate the relationship between work and vocal health.

CONCLUSION

Although previous research has reported the negative effect of adverse working conditions on vocal functioning, it is common for workers with vocal problems to continue working in these environments, which reduces their quality of life and increases associated costs. This study shows that there are limitations in the implementation of the regulations. Weaknesses detected in this study could benefit from multicenter investigations that strengthen speech therapy actions in prevention, promotion, diagnosis and rehabilitation.

Effectiveness of a Blended-Learning Intervention in Teachers' Vocal Health

OBJECTIVE

To verify the effectiveness of a blended-learning voice assistance program for elementary school teachers.

STUDY DESIGN

Nonrandomized and comparative interventional clinical trial.

METHODS

A total of 59 teachers participated; 33 of the 59 teachers participated in face-to-face learning (control group-CG), and 26 of the 59 teachers participated in blended learning (experimental group-EG). The Voice Assistance Program included the following for both groups: preintervention assessment, four voice workshops and postintervention assessment. The instruments used were the Vocal Production Condition - Teacher (VPC-T) questionnaire, the Screening Index for Voice Disorder (SIVD), the Vocal Health and Hygiene Questionnaire (VHHQ) and the Voice-Related Quality of Life (V-RQOL) measure. Additionally, voice samples were collected for auditory-perceptual analysis of voice quality. The workshops included theoretical and practical content for both groups. All the workshops for the CG were conducted face-to-face, while the workshops for the EG consisted of two online workshops and two face-to-face workshops. A descriptive analysis of the data was performed, and paired Wilcoxon and Mann-Whitney tests were performed using R software, with a significance level of 0.05.

RESULTS

Both groups showed improved acquisition of knowledge regarding vocal health and improved voice quality, but the improvement was greater for the EG. There was a significant decrease in the risk of voice disorder in the EG. Only the CG showed significant improvement in voice-related quality of life.

CONCLUSION

The voice assistance program with blended learning is effective for increasing knowledge about vocal health, reducing the risk of voice disorder and improving the voice quality of teachers.

Speech therapy strategies to promote the vocal health of teachers: integrative literature review

Objective: To identify the speech therapy strategies used to promote vocal health to teachers of early childhood, elementary and high school, participating in programs/actions for prevention and promotion of vocal health, as well as to describe and analyze their effects through an integrative literature review. Methods: An integrative review was conducted, which consisted of searches in the Lilacs, SciELO, and Medline databases. Inclusion criteria were complete articles available online in any language and year of publication that addressed strategies for promoting vocal health and preventing disorders in the target population, used in vocal health programs/actions with teachers. Results: Of the 624 articles that were included, six were selected to compose the study. It was possible to verify that the most used resources were educational strategies, through programs of guidance and attention to the teacher's vocal health. The results of the interventions were analyzed using self-assessment questionnaires, some of which have been standardized, with validation and adaptation to Brazilian Portuguese. Among practical strategies, exercises involving semi-occluded vocal tract, breathing, relaxation, resistance, and vocal projection, as well as vocal warm-up and cool-down, were the most used. Conclusions: Vocal health programs present diversified strategies, such as time and results analysis. The accurate study allowed to verify that the programs are effective and allow better vocal performance to the teacher, notably, through direct and indirect strategies.

The narrative field in Journal Ciência & Saúde Coletiva

This paper analyzes Journal Ciência & Saúde Coletiva's approach to the narrative field. The concept of "narrative field" is built on the relationships of three dimensions, namely, the cognitive (epistemic), the socio-political-pedagogical, and the applied. This is an analytical, quantitative, and qualitative research of authors, themes, theoretical and methodological approaches, concepts, and disciplines. The search on the SciELO database was developed in two stages: 1. Context - Restricted to the health publications, research on 29/01/2019, with the Portuguese descriptor "narrativa" + "saúde" (without filter); 2. Bibliometric research - data collected in December 2019 using descriptor "narrative" + "ciência e saúde coletiva", period 2002-2019. No reference was found in the searched journal before 2002. In the analysis of the 43 texts, the keywords were grouped into narrative analyses, narrative reviews, narrative texts, biography, and translation. We conclude by affirming the relevance of the theme, despite the small number of works, and suggest scholars emphasize in future works the theoretical approaches of narrative work and demarcate their perspectives, as an approach or an object, or both.

Danos morais por distúrbio de voz relacionado ao trabalho: levantamento de julgados do Tribunal Superior do Trabalho

Resumo Introdução: trabalhadores expostos a condições ocupacionais inadequadas podem ser acometidos por distúrbio de voz relacionado ao trabalho (DVRT). Enquanto o DVRT não é legalmente reconhecido, há uma fragilização no estabelecimento do nexo causal entre trabalho e agravo vocal. Objetivo: analisar as decisões do Tribunal Superior do Trabalho (TST) nas ações movidas por trabalhadores que alegaram DVRT na Justiça. Método: estudo quantitativo, exploratório e descritivo. Para o levantamento dos acórdãos, utilizou-se o termo de busca “disfonia” no portal do TST. Resultados: identificaram-se 87 acórdãos proferidos entre os anos de 1999 a 2016, impetrados sobretudo por mulheres (88,5%), do setor de Teleatendimento (59,8%). Em 39,1% das ações, houve reconhecimento do nexo causal entre o trabalho e a doença, ganho de causa parcial (42,5%), indenização por danos morais (50,6%), indenização por danos materiais (8,0%), e multa (5,7%). Conclusão: os acórdãos mostraram a relação entre distúrbio de voz e trabalho. O reconhecimento legal do DVRT poderá contribuir para a redução do sofrimento e do tempo de espera do trabalhador pela compensação por seu adoecimento. Também poderá auxiliar na construção de políticas públicas que visem a promoção, proteção, recuperação e, sobretudo, vigilância em saúde, de modo a garantir condições de trabalho adequadas para o uso da voz no trabalho.

Distúrbio de voz relacionado ao trabalho: revisão integrativa

Resumo Objetivos: identificar e sumarizar evidências de estudos sobre a associação entre trabalho e distúrbio de voz. Métodos: revisão integrativa da literatura publicada nas bases de dados PubMed e SciELO entre 2003 e 2017. Foram elegíveis estudos observacionais, em português ou inglês, disponíveis na íntegra para consulta, que abordassem a frequência de disfonia (prevalência ou incidência). Resultados: foram analisados 47 artigos, a idade media sumarizada dos participantes era de 40,6 anos, 78,7% dos artigos estudaram ambos os sexos e 80,9% pesquisaram professores. A prevalência média de distúrbios da voz associados ao trabalho foi de 44,2% e a incidência de 17,0%. O ruído foi indicado como fator associado à disfonia em 25,5% dos estudos, seguido da carga horária de trabalho extensa (17,0%) e alergias (14,9%). Conclusão: os resultados indicam forte conexão entre distúrbio de voz e trabalho, confirmando a elevada prevalência de disfonia, especialmente em trabalhadores que utilizam a voz profissionalmente, bem como sua associação com fatores da organização e do ambiente de trabalho, contribuindo para: a) fortalecer o reconhecimento formal do distúrbio de voz relacionado ao trabalho; b) oferecer embasamento técnico à legislação; c) reforçar a premência de uma política pública para proteção vocal dos trabalhadores.

Teachers' work and health in Brazil: thoughts on the history of research, strides, and challenges

This Essay discusses the theme of teachers' work and health in Brazil. The objectives are to describe the initial history of research on teachers' health, discuss elements leading to a consensus on the characterization of the group's work and principal health problems, and systematize the main strides and challenges. The Essay draws on more than two decades of research and practice in this field. Based on this experience, the authors identify the movements, the accumulated evidence, and prospects for future development. The elements brought to the discussion point to substantial growth in the field: the number of studies, the diversity and scope of topics, the groups of men and women teachers studied, and the experiences with application of the knowledge (programs and interventions). Despite these strides, the studies and practices still emphasize the individual and the disease, with little or no attention to work factors (work process and management) in the health/disease process. Issues pertaining to gender differences (in work and in health status) also remain invisible. There is little linkage between researchers and teachers' movements (a relevant characteristic of the first initiatives in the field). There are no public policies to regulate the workplace and work management. The contributions to the discussion provide insight for thought to assist the identification of critical nodes and analytical scenarios with the potential for progress in this field of research and intervention.