Iara Barreto Bassi

Occupational and individual risk factors for dysphonia in teachers

BACKGROUND In recent decades several groups of researchers have been interested in describing and understanding vocal morbidity in teachers in order to explain the large number of teachers diagnosed with dysphonia and account for the absenteeism attributed to vocal disability. AIMS To determine the proportion of teachers who reported a diagnosis of dysphonia and measure associations between individual and contextual factors and the event of interest. METHODS Teachers were recruited from the city of Belo Horizonte and invited to complete a web-based institutional intranet questionnaire. RESULTS In total, 649 teachers responded; 32% (CI 28.5-35.5) reported that they had received a physician diagnosis of dysphonia. This prevalence was significantly higher among female teachers (prevalence ratio (PR) 2.33; CI 1.41-3.85), and groups who reported limited technical resources and equipment (PR 1.56; CI 1.14-2.15), a diagnosis of gastritis (PR 1.59; CI 1.28-1.98), not being summoned for an annual physician examination (PR 0.47; CI 0.32-0.68), or absenteeism (PR 1.39; CI 1.06-1.81). CONCLUSIONS The high prevalence of dysphonia in teachers was not associated with any individual variables, except for sex and comorbidity (diagnosis of gastritis). Limited technical resources and equipment were associated with dysphonia and suggests policy change is important in preventing dysphonia.

Adesão a orientações fonoaudiológicas após a alta do tratamento vocal em docentes: estudo prospectivo

PURPOSE: to investigate the adherence to voice therapy guidelines of teachers in municipal schools that were treated at the Voice Clinic of Hospital das Clinicas, Federal University of Minas Gerais, and that were discharged from voice therapy. METHOD: 39 patients treated at the Voice Clinic of Hospital das Clinicas, Federal University of Minas Gerais were interviewed by phone from August 2007 to December 2008. The interviews aimed to analyze the adherence to the guidelines after voice therapy discharge. RESULTS: this study outcome indicates that 34 patients (87.1%) report following the guidelines, four (10.2%) do it partially and one (2.5%) referred not following the guidelines. CONCLUSION: the majority of teachers adhere to the guidelines after voice therapy discharge. The outcome suggests that the voice therapy helps to maintain the standard of voice and a healthy vocal behavior.

Relationship between adherence to speech therapy in patients with dysphonia and quality of life.

OBJECTIVE The present study analyzed if aspects of voice-related quality of life (VRQOL) were associated with adherence to voice therapy in teachers. STUDY DESIGN Retrospective survey in which the medical records of 179 dysphonic teachers (62, abandonment group and 114, discharge group) who underwent speech therapy at the Speech Therapy Clinic at the Hospital das Clínicas of the Universidade Federal de Minas Gerais (AV-HCUFMG) were analyzed. METHODS Female teachers with dysphonia referred by Gerência de Saúde e Perícia Médica (Department of Health and Medical Analysis) of Belo Horizonte City Hall were included. The variables of interest were: age, number of voice therapy sessions attended (attendance), number of sessions missed (absence), type of dysphonia, and Vocal Activity and Protocol Profile (VAPP) scores administered during the first therapy session as a component of voice assessment. The chi-square test was used to assess categorical variables. For continuous variables, the Mann-Whitney test, a nonparametric test for independent samples, was used. RESULTS The groups differed with regard to the type of dysphonia as well as the several parameters of the VAPP: vocal self-perception, effects at work, effects on daily communication, effects on emotion, and the total VAPP score. CONCLUSIONS Individuals with less favorable VRQOL scores were less adherent to voice therapy compared with subjects with more favorable VRQOL.

Eficácia do emprego do espelho de Glatzel na avaliação da permeabilidade nasal

PURPOSE: To compare the measurement of nasal air escape, carried out using the Glatzel mirror, in children with and without upper respiratory tract obstruction, according to sex and age. METHODS: The sample comprised 43 subjects, with mean age of 6.9 years, divided into four groups: children with surgical indication to clearing of the upper respiratory tract (surgical group), allergic children with upper respiratory tract obstruction (allergic group), allergic children with obstruction and surgical indication (surgical and allergic group), and children without obstruction (control group). Nasal air escape measurement was carried out using the Altmanns Millimetered Nasal Mirror, and data was measured in cm2 by the AutoCAD 2002 software. Data was analyzed using descriptive statistics and hypotheses testing, with a significance level of 5%. RESULTS: The control group presented the highest mean (6.53 cm2) of nasal air escape, while surgical and allergic group presented the lowest mean (3.07 cm2). The means of the allergic group and the surgical group were 4.74 cm2 and 5.91 cm2, respectively. Only the surgical and allergic group presented statistically significant difference compared to the control group. CONCLUSION: The Glatzel mirror demonstrated not to be a trustworthy instrument for the evaluation of nasal permeability in the analyzed sample, except in cases of severe nasal obstruction, that is, allergic patients with surgical indication. No correlations were found with the variables sex and age.

Estudo do efeito do apoio visual do traçado espectrográfico na confiabilidade da análise perceptivo-auditiva

OBJETIVO: avaliar a concordância intra e inter-sujeitos na avaliacao perceptivo-auditiva realizada de forma isolada e simultaneamente a apresentacao do tracado espectrografico correspondente, a fim de verificar se a apresentacao simultânea dos estimulos vocais e espectrograficos aumenta a concordância da avaliacao perceptivo-auditiva da voz. METODOS: trata-se de um estudo longitudinal, em que seis fonoaudiologas avaliaram, em dois momentos distintos, 105 vozes disfonicas e nao disfonicas, de forma perceptivo-auditiva: primeiramente sem e posteriormente com a apresentacao dos espectrogramas correspondentes. Vinte por cento das vozes foram repetidas aleatoriamente nos dois momentos, a fim de se analisar as concordâncias intra-avaliadoras. Utilizou-se a escala GRBASI para realizacao da avaliacao vocal. Para analise da concordância inter-avaliadores, foi utilizado o indice estatistico Kappa Fleiss e, para calculo da concordância intra-avaliador, foi utilizado o coeficiente de correlacao de Spearman. RESULTADOS: nao houve diferenca estatisticamente significante entre as avaliacoes perceptivo-auditivas inter-sujeitos com e sem a leitura espectrografica, porem houve aumento da concordância entre os avaliadores para as variaveis G, R, B e S. Nao houve diferenca estatisticamente significante entre as avaliacoes perceptivo-auditivas intra-sujeitos sem e com o apoio visual do espectrograma, entretanto, houve aumento da concordância intra-avaliadores apos a apresentacao do estimulo visual, para as variaveis G, B e I. CONCLUSAO: o apoio visual do espectrograma nao aumenta significativamente a confiabilidade da avaliacao perceptivo-auditiva da voz, mas a auxilia, uma vez que promove um aumento da concordância inter e intra-avaliadores.

Adesão das professoras disfônicas ao tratamento fonoterápico

PURPOSE: To study the possible factors associated with adherence to the speech-language pathology treatment of dysphonia in female teachers of municipal schools of Belo Horizonte. METHODS: This was a retrospective study that analyzed the medical records of 251 teachers treated at the Voice Ambulatory Speech Language Pathology Service, Hospital das Clinicas da Universidade Federal de Minas Gerais (AV-UFMG) from August 2007 to December 2009. The collected data included age, number of scheduled sessions, number of absences, number of children, type of dysphonia, degree of dysphonia, monthly family income, and education. We calculated the distance, in kilometers, of the residence to the place of treatment and the workplace to place of treatment. We also analyzed the social vulnerability index of the workplace. RESULTS: The results of this research indicated that of the 135 records that were included in the study, 89 (65.93%) corresponded to the discharged group and 46 (34.07%) corresponded to the abandonment group. In comparison with all the variables studied, only the number of faults and the type of dysphonia were associated with poor adherence to voice therapy. CONCLUSION: Results showed that the number of absences in sessions, treatment-related factor, organofuncional dysphonia type, and clinical-related factor were all associated with the abandonment of voice therapy.

Analysis of aspects of quality of life in teachers' voice after discharged: longitudinal study

PURPOSE To evaluate the long-term effects of voice therapy on the life quality of teachers who were discharged or abandoned the voice therapy for dysphonia. METHODS This was a longitudinal study based on analysis of assessments with teachers of municipal schools in Belo Horizonte, who were referred to voice therapy and were discharged or abandoned the speech-language therapy for more than six months. A total of 33 teachers in the discharged group and 20 teachers in the abandoned group were contacted by phone and invited to participate in the study by answering the Voice activity and participation profile, which was forwarded to the researchers and sent via letter. RESULTS At the moment of the pre speech therapy, the discharged and abandoned groups were homogeneous, except in relation to daily communication parameter. Comparing the discharged group in the pre and post speech-language therapy, it was showed improvements in social communication parameter as well as in the total score. The discharged group presented worsening in self-perception parameter when comparing the average values in the post therapy and current moments, and the group abandoned presented worsening in work, social communication and total score when comparing to the average values in the pre therapy and current moments. The discharged and abandoned groups differ in the present moment in all investigated parameters. CONCLUSION Speech-language therapy for dysphonia have long term positive effects on life quality and voice of teachers who were soon discharged from the therapy and in a period of two years on average. Teachers who have abandoned treatment and did not obtain improvement in the voice showed negative impact in life quality and voice in a time of 2 years and 2 months on average.

Idiopathic Parkinson's disease: vocal and quality of life analysis

OBJECTIVE To compare voice and life quality of male patients with idiopathic Parkinsons disease, with individuals without disease (Control Group). METHODS A cross-sectional study that evaluated the voice of individuals with Parkinsons disease, the group was composed of 27 subjects, aged from 39 to 79 years-old (average 59.96). The Control Group was matched on sex and age. Participants underwent voice recording. Perceptual evaluation was made using GRBASI scale, which considers G as the overall degree of dysphonia, R as roughness, B as breathiness, A as asthenia, S as strain and I as instability. The acoustic parameters analyzed were: fundamental frequency, jitter, shimmer, and harmonic to noise ratio (NHR). For vocal self-perception analysis, we used the Voice Related Quality of Life protocol. RESULTS Fundamental frequency and jitter presented higher values in the Parkinsons group. NHR values were higher in the Control Group. Perceptual analysis showed a deviation ranging. The vocal disorder self-perception demonstrated a worse impact on quality of life. CONCLUSIONS Individuals with Parkinsons disease have an altered voice quality and a negative impact on quality of life.

Alteração de mobilidade de prega vocal unilateral: avaliação subjetiva e objetiva da voz nos momentos pré e pós-fonoterapia

OBJETIVO: avaliar de forma subjetiva e objetiva a voz de pacientes com paralisia unilateral de prega vocal nos momentos pre-tratamento e pos-tratamento. METODOS: trata-se de um estudo retrospectivo por meio de revisao de prontuario, que analisou as gravacoes de vozes de 12 individuos com diagnostico otorrinolaringologico de paralisia unilateral de prega vocal. O material de voz colhido foi a emissao sustentada da vogal /a/, seguida de fala encadeada. As vozes pre e pos-terapia foram analisadas por meio da escala GRBASI, analise espectrografica e medida do tempo maximo de fonacao (TMF). Os parâmetros para analise espectrografica foram: forma do tracado, grau de escurecimento dos harmonicos, continuidade do tracado, presenca de ruidos, presenca de sub-harmonicos e harmonicos definidos. A medida do TMF da vogal /a/ representou a maior de tres emissoes. Os dados obtidos foram submetidos a analise descritiva de tendencia central e dispersao, e ao Teste Wilcoxon. RESULTADOS: na analise perceptivo-auditiva, o parâmetro que mais se modificou no momento pos- tratamento foi o de soprosidade (B) (p=0,003), seguido do grau da disfonia (G) (p=0,004) e astenia (A) (p=0,01), sendo que estes resultados foram estatisticamente significantes. Com relacao ao espectrograma, houve melhora do tracado em 91% dos pacientes, e os parâmetros que mais se modificaram foram: aumento do numero de harmonicos (32%) e diminuicao do ruido (24%). A medida do TMF da vogal /a/ apresentou-se significantemente maior no momento pos-fonoterapia (p=0,003%). CONCLUSAO: pacientes com paralisia de prega vocal que foram submetidos ao tratamento fonoaudiologico apresentaram melhora dos dados perceptivo-auditivos, espectrografico e do TMF.

Absenteísmo-doença segundo autorrelato de servidores públicos municipais em Belo Horizonte

The purpose of this study was to analyze the profile of municipal public servants who reported illnessrelated absenteeism in the preceding 12 months. The study involved a sample of 5,646 (14%) of all 38,304 municipal workers in the city of Belo Horizonte, Minas Gerais, Brazil, in 2009. A questionnaire was placed on the Internet, where entry depended on the respondents’ consent. Poisson regression analysis was used to determine the associated factors. Absenteeism due to illness was highly correlated with women (PR 1.12) and decreased with age: 30-39 years (PR 0.79), 40-49 years (PR 0.72) and 50 years of over (PR 0.68). Sickness-related absenteeism was closely associated with work involving monitoring and surveillance groups (PR 1.46), general services (PR 1.22), information, education and culture (PR 1.50), and health (PR 1.50). Comorbidities included WRMD (PR 1.19), lower-back pain (PR 1.16), depression / anxiety (PR 1.20) and perception of mental fatigue (PR 1.12). The reported use of medication for depression / anxiety proved to be a protective factor (PR 0.82). Factors such as Greater likelihood of mental disorder (PR 1.23) according to SRQ20, Dissatisfaction with one’s ability to work (PR 1.08), Reasonable conditions (PR 1.21) and Poor working conditions (PR 1.19), were associated with the outcomes. Health promotion programs would be useful to decrease illness-related absenteeism because interventions for preventing musculoskeletal comorbidity and psychosocial complaints would attenuate situations that are probably the source of absenteeism due to illness.