Fernando Martins Carvalho

Fatores associados a alterações vocais em professoras

This study aimed to identify risk factors for voice disorders (hoarseness in the previous six months as an initial manifestation, and vocal cord nodules as a more severe manifestation of overt disease) among teachers. The cross-sectional study included 747 women teachers from elementary and middle schools in the public school system in Vitoria da Conquista, Bahia State, Brazil. Data were collected using a self-applied, standardized questionnaire. Hoarseness in the previous six months was reported by 59.2% of teachers and vocal cord nodules by 12.9%. Logistic regression techniques showed that hoarseness was statistically associated with > 24 classroom hours per week, work in more than one school, and having to make an effort to speak. Vocal cord nodules were associated with working > 5 years as a teacher, work in more than one school, working at another job besides teaching, and having to make an effort to speak. In conclusion, voice disorders are frequent among schoolteachers and are associated with multiple occupational risk factors, besides purely biological ones.

Prevalência de dor musculoesquelética em professores

Este artigo descreve a prevalencia de dor musculoesqueletica segundo variaveis sociodemograficas e ocupacionais de professores do ensino basico. Um estudo epidemiologico de corte transversal, de carater censitario, incluiu todos os 4.496 professores do ensino fundamental da rede municipal de Salvador, Bahia, Brasil. As prevalencias de dor musculoesqueletica em membros inferiores (41,1%), membros superiores (23,7%) e dorso (41,1%) foram elevadas. A prevalencia global de dor musculoesqueletica relacionada a qualquer um dos tres segmentos corporais foi de 55%. A dor musculoesqueletica foi mais prevalente, nos tres segmentos investigados, entre as mulheres, os mais velhos, de nivel educacional medio, casados, com tres ou mais filhos e que trabalhavam mais de quatorze anos como docente. A prevalencia de dor musculoesqueletica associou-se as seguintes variaveis ocupacionais: tempo de trabalho superior a cinco anos na escola estudada, elevado esforco fisico, outra atividade remunerada nao docente e calor em sala de aula. Esses achados alertam para a necessidade de adocao de politicas publicas para melhoria das condicoes de trabalho do professor.

Associação entre distúrbios psíquicos e aspectos psicossociais do trabalho de professores

OBJECTIVE To investigate the association between work-related psychosocial factors and the prevalence of mental disorders among pre-school and elementary school teachers. METHODS This cross-sectional study was undertaken with 1,024 teachers from municipal public schools and from the ten largest private schools in Vitória da Conquista, Bahia State (Northeastern Brazil) in 2001. The main independent variable was based on the demand-control model, which classifies individuals according to their job pressures. The dependent variable was the incidence of mental disorders as evaluated by a self-reporting questionnaire. The measure of frequency was prevalence, and the measure of association was the prevalence ratio. A logistic regression model was used as the main statistical technique. RESULTS There was a 44% prevalence of mental disorders among teachers. Evidence suggests that these were associated with work-related demands and control issues, after controlling for confounding variables such as sex, geographic region and social support. The prevalence of mental disorders among high-strain teachers was 1.5 times greater than that among low-strain teachers. CONCLUSIONS The prevalence of mental disorders was high among teachers of the municipality. There was evidence that this was associated with job demands.

Chumbo no sangue de crianças e passivo ambiental de uma fundição de chumbo no Brasil

OBJETIVO: Determinar os niveis de chumbo no sangue de criancas que moravam proximo a uma fundicao de chumbo desativada na Cidade de Santo Amaro da Purificacao, Estado da Bahia, em setembro de 1998; e identificar fatores associados a variacao destes niveis. METODOS: Estudo de corte transversal com criancas de 1 a 4 anos de idade que residiam a menos de 1 km da fundicao. Maes ou responsaveis por 47 criancas responderam questionarios sobre transtornos do habito alimentar (comer barro, terra, reboco ou outros materiais) e outros aspectos epidemiologicos relevantes. A concentracao de chumbo no sangue foi determinada por espectrofotometria de absorcao atomica. RESULTADOS: O nivel medio de chumbo foi de 17,1 ± 7,3 mig/dL. Os niveis de chumbo no sangue foram cerca de 5 mig/dL mais elevados em criancas que tinham transtorno do habito alimentar, independentemente da idade, presenca de escoria visivel no peridomicilio, situacao de emprego do pai, historia familiar de intoxicacao pelo chumbo e desnutricao. CONCLUSOES: O passivo ambiental da fundicao de chumbo, desativada em 1993, permanece como um fator de risco relevante para elevar os niveis desse metal no sangue de criancas, particularmente aquelas que apresentam transtornos do habito alimentar.

Non-alcoholic fatty liver disease and insulin resistance: importance of risk factors and histological spectrum.

Background Non-alcoholic fatty liver disease (NAFLD) has been associated with several metabolic conditions (MC) and secondary causes, but the relationship between insulin resistance (IR) and the underlying aetiology of NAFLD has not been extensively explored. Objective To determine the frequency of IR among NAFLD patients and to describe IR according to risk factors and histological findings of the disease. Methodology A case-series study of 64 patients with clinical and histological diagnosis of NAFLD. IR was calculated by homeostasis model assessment (HOMA) and IR was considered when HOMA ⩾3. Histological grades of NAFLD were: stage 1, steatosis isolated; stage 2, steatosis and inflammation; stage 3, steatosis and ballooning degeneration; stage 4, steatosis and fibrosis and/or Mallory bodies. Fibrosis was graded 0–4 (cirrhosis). Results IR was found in 21 (33%) patients. Among those with IR, 16 patients (76%) had associated MC and five patients (24%) had exposure to petrochemicals. The mean value of HOMA varied from 3.5 in NAFLD associated with MC to 1.6 in patients with exposure to petrochemicals (P<0.03). Waist circumference was the metabolic factor most strongly associated with IR (P<0.005). Steatohepatitis (NASH) was observed in 54 (84.3%) cases. The HOMA mean value was significantly higher in patients with advanced fibrosis. Conclusions IR occurred in 33% of the NAFLD patients, being more frequent among those with MC than among those with exposure to petrochemicals. The presence of IR in cases with advanced fibrosis suggests that it may influence the prognosis of NAFLD.

Clinical and histopathological features of NASH in workers exposed to chemicals with or without associated metabolic conditions

Background/Aims: Non‐alcoholic steatohepatitis (NASH) has been associated with exposure to chemicals among workers from an industrial complex in Brazil. We investigated the NASH profile of these individuals associated or not with metabolic conditions.

Repeated surveillance of lead poisoning among children

In 1980, a survey of lead poisoning was carried out among 592 children aged 1 to 9 years living within 900 m of a lead smelter in Santo Amaro, Brazil. From 1980 to 1985, the lead smelter carried out a number of major improvements aimed at reducing environmental pollution. In January, 1985, a second survey was carried out among a sample of 250 children living in this same geographical area. The geometric mean of zinc protoporphyrin (ZPP) concentration in whole blood was 1.17 (standard deviation = 1.5) mumol l-1. Blood lead concentrations (PbB) determined in a subsample of 53 children had an arithmetic mean and standard deviation of 1.77 +/- 1.00 mumol l-1, with 22 children showing PbB greater than or equal to 1.68 mumol l-1. Twenty-nine (11.6%) of the 250 children lived in houses where the lead content of the soil was greater than 10,000 ppm, and they presented higher ZPP levels than the rest of the population. Children with the habit of pica for soil had elevated ZPP levels. Comparing the results from the 1980 and 1985 surveys, slight improvements in ZPP and PbB levels were observed. However, new cases of lead poisoning are still occurring in the area. The soil is highly contaminated by lead and represents a long-lasting risk factor for child intoxication.

Fatores associados a patologias de pregas vocais em professores

OBJETIVO: Analizar factores asociados a la prevalencia del diagnostico medico referido de patologias de las cuerdas vocales en profesores. METODOS: Estudio epidemiologico transversal, censitario, con 4.495 profesores de la red publica municipal de ensenanza primaria y media de Salvador, Noreste de Brasil, de marzo a abril de 2006. La variable dependiente fue el diagnostico medico referido de patologias de las cuerdas vocales y las independientes, caracteristicas sociodemograficas, actividad profesional, organizacion del trabajo/relaciones interpersonales, caracteristicas fisicas del ambiente de trabajo, frecuencia de trastornos mentales comunes, medida por el Self-Reporting Questionnaire-20 (SRQ-20>7) y condiciones de salud general. Se aplicaron tecnicas de analisis estadistico descriptivo, bivariada y regresion logistica multiple. RESULTADOS: La prevalencia de diagnostico medico referido de patologias de las cuerdas vocales fue de 18,9%. En el analisis de regresion logistica, las variables que permanecieron asociadas al diagnostico medico de patologia de las cuerdas vocales fueron: sexo femenino, trabajar como profesor por mas de siete anos, uso intensivo de la voz, referir mas de cinco caracteristicas desfavorables del ambiente fisico de trabajo, una o mas enfermedades del tracto respiratorio, perdida auditiva, y presentar trastornos mentales comunes. CONCLUSIONES: La presencia de patologias de las cuerdas vocales referidas se asocio a factores que indican la necesidad de acciones de promocion de la salud vocal del profesor y modificaciones en la organizacion y estructura del trabajo docente.

Avaliação perceptivo-auditiva e fatores associados à alteração vocal em professores

O professor e um profissional que exige muito de sua voz e, consequentemente, apresenta elevado risco de desenvolver alteracao vocal durante o exercicio do seu trabalho. OBJETIVO: Identificar fatores associados a alteracao vocal em professores. METODO: Estudo exploratorio do tipo corte transversal que investigou 476 professores do ensino fundamental e medio de escolas municipais da cidade de Salvador, BA. Os professores responderam a um questionario e foram submetidos a avaliacao fonoaudiologica perceptivo-auditiva da voz. Para diagnostico de alteracao vocal utilizou-se a escala GRBAS. RESULTADOS: A populacao do estudo foi composta por 82,8% de mulheres. Os professores do estudo tinham media de idade igual a 40,7 anos, escolaridade superior (88,4%), jornada de trabalho media de 38 horas semanais, media de 11,5 anos de atuacao profissional e renda media mensal de R

Interactions between physical and psychosocial demands of work associated to low back pain

1.817,18. A prevalencia de alteracao vocal foi de 53,6% (255 professores). A analise bivariada evidenciou associacoes estatisticamente significantes entre alteracao vocal e idade maior que 40 anos (RP = 1,83; IC 95%; 1,27-2,64), historico familiar de disfonia (RP = 1,72; IC 95%; 1,06-2,80), carga horaria semanal maior que 20 horas (RP = 1,66; IC 95%; 1,09-2,52) e presenca de po de giz na sala de aula (RP = 1,70; IC 95%; 1,14-2,53). CONCLUSAO: O estudo realizado concluiu que os professores com 40 ou mais anos de idade, com historico familiar de disfonia, com carga horaria semanal maior que 20 horas e que lecionam em salas de aula com po de giz tem maior chance de ter alteracao vocal do que os demais.UNLABELLED Teachers are professionals who demand much of their voices and, consequently, present a high risk of developing vocal disorders during the course of employment. OBJECTIVE To identify factors associated with vocal disorders among teachers. METHOD An exploratory cross-sectional study, which investigated 476 teachers in primary and secondary schools in the city of Salvador, Bahia. Teachers answered a questionnaire and were submitted to auditory vocal analysis. The GRBAS was used for the diagnosis of vocal disorders. RESULTS The study population comprised 82.8% women, teachers with an average age of 40.7 years, teachers with higher education (88.4%), with an average workday of 38 hours per week, average 11.5 years of professional practice and average monthly income of R