41 cases of chronic obstructive pulmonary disease caused by occupational irritating chemicals / 中华劳动卫生职业病杂志

Objective: To analyze the case characteristics of Chronic obstructive pulmonary disease caused by occupational irritant chemicals (OI-COPD). To provide basis for revising its diagnostic criteria. Methods: From June to December 2021, we investigated the information of OI-COPD patients confirmed by Shandong Institute of Occupational Health and Prevention of Occupational Diseases, Guangxi Zhuang Autonomous Region Institute of Occupational Disease Prevention and Control, Qingdao Central Hospital affiliated to Qingdao University and other diagnostic institutions in the past five years, a total of 41 cases. The basic information of OI-COPD cases, occupational risk factors exposure information, medical history, smoking history and clinical symptoms were analyzed retrospectively. The measurement data were tested for normal distribution, which was described by x±s, and compared between groups by t test; Those who do not conform to the normal distribution are described by the median [M (Q(1), Q(3)) ] and analyzed by nonparametric test; The counting data were expressed in frequency and rate (% ), and the comparison between groups was tested. Results: Of the 41 cases, 33 were male and 8 were female. The age of the patient diagnosed with OI-COPD was (49.5±10.3) years old, and the minimum age was 30 years old; Among them, 8 patients had a definite long-term smoking history (more than 5 years) ; The exposure duration of occupational risk factors was (18.6±10.3) years, of which 3 patients had exposure duration of less than 5 years; The occupational risk factors leading to OI-COPD include acids and acid-forming compounds, bases, aldehydes, nitrogen oxides, chlorine and its compounds, etc. The exposure level of occupational risk factors is related to the degree of COPD airflow restriction (χ(2)=6.17, P <0.05). 18 patients with diagnosis age <50 years old were diagnosed as early-onset COPD. The incidence of respiratory symptoms in the early diagnosis COPD group was lower than that in the non-early diagnosis COPD group, and the FEV1% pred was significantly higher than that in the non-early diagnosis COPD group. The difference was statistically significant (P<0.01 ) . Conclusion: The exposure level of occupational risk factors may be the risk factor affecting the degree of COPD airflow restriction. With the increase of the exposure level of COPD patients, the proportion of respiratory symptoms will also increase accordingly.

Investigation and analysis of late reporting and under-reporting of occupational diseases from 2018 to 2020 in China / 中华劳动卫生职业病杂志

Objective: To understand the late reporting and the under-reporting of occupational disease from 2018 to 2020 in China and analyze the causes, so as to provide scientific evidence for improving the quality of occupational disease reports in China, timely acquiring the incidence of occupational disease, and assessing the occupational hazards. Methods: From May to December 2021, A total of 320 occupational disease diagnostic institutions were selected for investigation. The original documents of occupational disease diagnosis cases from 2018 to 2020 were compared with the online reported cases, and late reported and under-reported cases of occupational disease were analyzed. Results: A total of 32207 diagnosed cases from 2018 to 2020 were investigated, including 28934 confirmed cases and 3273 cases without occupational disease. The overall late reported rate and under-reported rate of confirmed cases were 20.2% and 2.1%, respectively. There were significant differences in the rate of late reporting and under-reporting of occupational diseases in different regions and different types of diagnostic institutions (P<0.001). The southwest region had the highest rates of late reporting and under-reporting, 61.6% and 7.9% respectively. The late reported rate of all kinds of occupational diseases was about 15.0%, and the under-reported rate was from 1.5.0% to 5.0%. Conclusion: At present, the phenomenon of late reporting and under-reporting occupational diseases is still obvious. It is necessary to strengthen the inspection of occupational disease reporting, improve the quality of occupational disease reporting, and provide scientific basis for the formulation of occupational disease prevention and control policies.

Two cases of airway dysfunction related to diacetyl exposure / 中华劳动卫生职业病杂志

Occupational exposure to diacetyl can lead to bronchiolitis obliterans. In this paper, two patients with severe obstructive ventilation disorder who were exposed to diacetyl at a fragrance and flavours factory were analyzed. The clinical manifestations were cough and shortness of breath. One of them showed Mosaic shadows and uneven perfusion in both lungs on CT, while the other was normal. Field investigation found that 4 of the 8 workers in the factory were found to have obstructive ventilation disorder, and 2 had small airway dysfunction. This paper summarizes the diagnostic process of patients in order to improve the understanding of airway dysfunction caused by occupational exposure to diacetyl and promote the development of relevant standards.

Research on early warning model of the hearing loss of workers exposed to noise / 中华劳动卫生职业病杂志

Objective: To explore the change of hearing threshold of workers exposed to noise, establish an individual-based hearing loss early warning model, accurately and differentiated the health of workers exposed to noise. Methods: In September 2019, all physical examination data of 561 workers exposed to noise from an enterprise were collected since their employment. Three indicators of average hearing threshold of the better ear, namely, at high frequency, 4000 Hz and speech frequency, were constructed. The generalized estimating equation (GEE) was used to adjust gender and age and establish the warning model of each indicator. Finally, sensitive indicators and warning models were screened according to AUC and Yoden index. Results: Among the 561 workers exposed to noise, 26 (4.6%) workers had hearing loss. The sensitivity indicators were the average hearing threshold at speech frequency ≥20 dB, high frequency ≥30 dB and 4000 Hz ≥25 dB. The AUC of each index was 0.602, 0.794 and 0.804, and the Youden indexes were 0.204, 0.588 and 0.608, respectively. In GEE of hearing loss warning models, high-frequency hearing threshold ≥20 dB and 4000 Hz hearing threshold ≥25 dB were the optimal models, with AUC of 0.862. Conclusion: Combined with the changes of individual hearing threshold over the years, can accurately assess the risk of individual hearing loss of workers exposed to noise.

Estudio preliminar para la validación de la versión chilena del Vocal Tract Discomfort-VTD en población docente / Validation of the chilean version of the Vocal Tract Discomfort-VTD on teachers: a preliminary study

Debido a la carga vocal a la que están expuestos los profesionales de la voz, como los profesores, son frecuentes los trastornos de voz y mal uso vocal en este grupo, lo que hace necesario poder contar con instrumentos de pesquisa rápidos y sencillos para un diagnóstico precoz de sintomatología vocal. El objetivo del presente estudio es realizar una adaptación y validación preliminar de la pauta "Vocal Tract Discomfort Scale (VTD)" al idioma español chileno en profesores. Se comenzó con la traducción al español del instrumento original por parte de dos expertos nativos y luego la retro-traducción por dos expertos en idioma inglés para determinar concordancias y discrepancias. Luego se continuó con la validación de apariencia y contenido realizada por valoración de grupo de expertos compuesto por dos metodólogos y cinco fonoaudiólogos con experiencia en el área vocal. La validez de criterio se obtuvo mediante la correlación entre la escala en estudio y el Voice Handicap Index en su versión validada al español como prueba gold-standard, para lo cual se aplicó en una muestra de 31 docentes. La validación de la escala VTD es fiable y deja a disposición de los fonoaudiólogos una herramienta sencilla y comprensible para el entendimiento del impacto generado en personas con disfonía, particularmente, en profesionales de la voz como los profesores.

Due to the vocal load to which voice professionals such as teachers are exposed, voice disorders and vocal misuse are frequently found in this group. This makes it necessary to have quick and simple assessment instruments that allow early detection of vocal symptoms. The objective of this study was to adapt the "Vocal Tract Discomfort Scale (VTD)" to Chilean Spanish and carry out a preliminary validation of this protocol on teachers. First, the original instrument was translated toSpanish by two native speakers, and then back-translated by two English experts, in order to determine the presence of agreements and discrepancies. Subsequently, a group of experts made up of two methodologists and five speech therapists with experience in the voice field performed an appearance and content validation. Criterion validity was obtained through the correlation between the Vocal Tract Discomfort Scale and the Spanish-validated version of the Voice Handicap Index as a gold-standard test, for which the first was appliedto a sample of 31 teachers. The validation of the VTD scale is reliable and provides speech therapists with a simple and understandable tool that allows them to comprehend the impact of dysphonia on people, particularly on voice professionals such as teachers.

Multisite musculoskeletal pain in the general population: a cross-sectional survey

BACKGROUND: Epidemiological studies focusing on multisite musculoskeletal pain have revealed that the prevalence of multisite pain is high in general populations. OBJECTIVE: To ascertain the prevalence of multisite musculoskeletal pain in the last 12 months and in the last seven days, in a population-based sample and investigate its association with demographic, socioeconomic, behavioral, reported morbidity and ergonomic variables. DESIGN AND SETTING: Cross-sectional population-based survey in Bauru, São Paulo (Brazil). METHODS: 600 individuals were interviewed. The following data were collected: participants' characteristics, through a precoded questionnaire; physical activity level, through the International Physical Activity Questionnaire; and musculoskeletal symptoms, through the Nordic questionnaire. Descriptive, bivariate and Poisson regression analyses were performed. RESULTS: The prevalence of multisite musculoskeletal pain was 46.5% (confidence interval, CI 42.5 to 50.5) in the last 12 months and 26.1% (CI 22.8 to 29.8) in the last seven days. The variables associated with multisite pain in the last 12 months were female sex, presence of hypertension, diabetes mellitus or depression, watching TV more than three times a week and working in a seated position. Formerly smoking was a protection factor. The variables associated with multisite pain in the last seven days were female sex, age group 60 years and over, low income, presence of comorbidities of hypertension, diabetes mellitus or depression and working in a seated position. CONCLUSION: There was high prevalence of multisite musculoskeletal pain, which was associated with demographic, socioeconomic, work-related, electronic device-related and reported morbidity variables.

Work-related asthma / Asma relacionada ao trabalho

ABSTRACT Work-related asthma (WRA) is highly prevalent in the adult population. WRA includes occupational asthma (OA), which is asthma caused by workplace exposures, and work-exacerbated asthma (WEA), also known as work-aggravated asthma, which is preexisting or concurrent asthma worsened by workplace conditions. In adults, the estimated prevalence of OA is 16.0%, whereas that of WEA is 21.5%. An increasing number of chemicals used in industrial production, households, and services are associated with the incidence of adult-onset asthma attributable to exposure to chemicals. This review article summarizes the different types of WRA and describes diagnostic procedures, treatment, prevention, and approaches to patient management. It is not always easy to distinguish between OA and WEA. It is important to establish a diagnosis (of sensitizer-/irritant-induced OA or WEA) in order to prevent worsening of symptoms, as well as to prevent other workers from being exposed, by providing early treatment and counseling on social security and work-related issues.

RESUMO A asma relacionada ao trabalho (ART) é um acometimento com elevada prevalência na população adulta. A ART inclui a asma ocupacional (AO), desencadeada pela exposição a um agente presente em um determinado ambiente de trabalho, e a asma agravada ou exacerbada pelo trabalho (AA/ET), que acomete indivíduos com antecedentes de asma ou que iniciaram um quadro de asma concomitante, mas sem relação causal com o ambiente de trabalho. Estima-se que 16,0% e 21,5% da asma no adulto sejam AO e AA/ET, respectivamente. O elevado e crescente número de substâncias químicas usadas na produção industrial, no uso domiciliar ou em serviços é responsável pela incidência de asma associada à exposição a agentes químicos na vida adulta. Este artigo de revisão descreve os principais tipos de ART, os procedimentos para seu diagnóstico, tratamento e prevenção e as condutas frente ao diagnóstico. Nem sempre é fácil a distinção entre AO e AA/ET. A importância do diagnóstico (AO ou AA/ET e asma induzida por sensibilizantes ou irritantes) tem relação com a adoção de medidas de prevenção para evitar que novos indivíduos sejam expostos e que os acometidos apresentem agravamento da doença, utilizando tratamento precoce e fornecendo orientação sobre aspectos previdenciários e trabalhistas.

Estresse e danos à saúde do alpinista industrial no contexto de trabalho / Stress and damage to the health of industrial climbers in the work context

A pesquisa teve como objeto o estresse laboral e sua relação com os danos à saúde do trabalhador alpinista industrial. O estresse ocupacional é capaz de influenciar a saúde dos trabalhadores, produzindo efeitos negativos sobre as condições de saúde mental e física, tornando-se um grande problema nos âmbitos de Saúde Pública e Saúde do Trabalhador. O estudo teve como objetivos: mensurar o estresse do trabalhador alpinista industrial nas suas situações de trabalho; identificar danos físicos, psicológicos e sociais à saúde do trabalhador alpinista industrial e associar o estresse com os danos à saúde do trabalhador alpinista industrial. Estudo epidemiológico transversal com 144 trabalhadores alpinistas industriais, realizado em uma empresa prestadora de serviços localizada no Rio de Janeiro e uma empresa certificadora e prestadora de serviços localizada no Rio de Janeiro e em São Paulo. A coleta de dados ocorreu entre os meses de dezembro de 2018 e julho de 2019. Para a coleta de dados foram utilizados um questionário para caracterização do perfil sociodemográfico, laboral e de condições de saúde e hábitos de vida; a Escala de Estresse no Trabalho ­ EET e a Escala de Danos Físicos e Psicossociais no Trabalho ­ EDT. A consistência interna das escalas mostrou fidedignidade com valores entre 0,954 e 0,993. Os dados foram armazenados, processados e analisados em banco de dados do programa Statistical Package for the Social Science (SPSS), versão 23.0. Foram feitas análises descritivas e bivariadas com Intervalo de Confiança de 95%. Na EET, os alpinistas industriais apresentaram média de nível de estresse percebido de 2,67, caracterizada como nível de estresse médio, e na EDT, apresentaram média de 2,96 para o fator Danos físicos, caracterizada como risco psicossocial médio. Houve associação significativa entre o estresse ocupacional e os danos físicos e psicossociais relacionados ao trabalho do alpinista industrial.

The research had as object the work stress and its relation with the damages to the health of the industrial climber worker. Occupational stress is capable of influencing the health of workers, producing negative effects on mental and physical health conditions, becoming a major problem in the areas of Public Health and Occupational Health. The study aimed to: measure the stress of the industrial climber worker in their work situations; identify physical, psychological and social damage to the health of the industrial climber worker and associate stress with damage to the health of the industrial climber worker. Cross-sectional epidemiological study with 144 industrial mountain climbers, carried out in a service provider company located in Rio de Janeiro and a certification and service provider company located in Rio de Janeiro and São Paulo. Data collection took place between the months of December 2018 and July 2019. For data collection, a questionnaire was used to characterize the sociodemographic, work and health conditions and lifestyle habits; the Stress Scale at Work - SSW and the Physical and Psychosocial Damage Scale at Work - DWS. The internal consistency of the scales showed reliability with values between 0.954 and 0.993. The data were stored, processed and analyzed in a database of the Statistical Package for the Social Science (SPSS), version 23.0. Descriptive and bivariate analyzes were performed with a 95% confidence interval. For data analysis, Chi Square and Fisher's Exact tests were used. In the SSW, the industrial climbers had an average perceived stress level of 2.67, characterized as a medium stress level, and in the DWS, they presented an average of 2.96 for the Physical damage factor, characterized as an average psychosocial risk. There was a significant association between occupational stress and physical and psychosocial damage related to the work of the industrial climber.

La investigación tuvo como objeto el estrés laboral y su relación con los daños a la salud del escalador industrial. El estrés ocupacional es capaz de influir en la salud de los trabajadores, produciendo efectos negativos en las condiciones de salud mental y física, convirtiéndose en un problema importante en las áreas de salud pública y salud ocupacional. El estudio tuvo como objetivo: medir el estrés de los trabajadores escaladores industriales en sus situaciones laborales; Identificar el daño físico, psicológico y social a la salud del escalador industrial y asociar el estrés con el daño a la salud del escalador industrial. Estudio epidemiológico transversal con 144 alpinistas industriales, realizado en una empresa proveedora de servicios ubicada en Río de Janeiro y una empresa proveedora de servicios y certificación ubicada en Río de Janeiro y São Paulo. La recopilación de datos tuvo lugar entre los meses de diciembre de 2018 y julio de 2019. Para la recopilación de datos, se utilizó un cuestionario para caracterizar las condiciones sociodemográficas, laborales y de salud y los hábitos de estilo de vida; la Escala de Estrés en el Trabajo - EET y la Escala de Daño Físico y Psicosocial en el Trabajo - EDT. La consistencia interna de las escalas mostró confiabilidad con valores entre 0.954 y 0.993. Los datos se almacenaron, procesaron y analizaron en una base de datos del Paquete Estadístico para las Ciencias Sociales (SPSS), versión 23.0. Se realizaron análisis descriptivos y bivariados con un intervalo de confianza del 95%. Para el análisis de datos, se utilizaron las pruebas Chi Square y Fisher's Exact. En el EET, los escaladores industriales tenían un promedio de nivel de estrés percibido de 2.67, caracterizado como un nivel de estrés medio, y en el EDT, presentaron un promedio de 2.96 para el factor de daño físico, caracterizado como un riesgo psicosocial promedio. Hubo una asociación significativa entre el estrés laboral y el daño físico y psicosocial relacionado con el trabajo del escalador industrial.

Fadiga vocal em professores universitários no início e ao final do ano letivo / Vocal fatigue in professors at the beginning and end of the school year

RESUMO Objetivo Caracterizar e comparar a percepção de fadiga vocal em professores universitários no início e ao final do ano letivo. Método Estudo observacional, analítico, de coorte prospectivo. Participaram 115 professores universitários, idade média de 40 anos, sendo 71 mulheres e 44 homens, funcionários de 28 instituições de ensino superior das regiões sul e sudeste do Brasil. Todos responderam ao Índice de Fadiga Vocal (IFV) no início (fevereiro ou março) e ao final (outubro ou novembro) do ano letivo. Resultados Os resultados obtidos no IFV nos dois momentos foram comparados estatisticamente (p<0,05). Resultados: Os escores médios obtidos nos domínios fadiga e restrição vocal (p<0,001) e recuperação com repouso vocal (p=0,001) dos professores universitários aumentaram ao final do ano letivo. Conclusão Professores universitários referiram maior percepção de fadiga vocal ao final do ano letivo, o que influenciou na restrição vocal e na recuperação com repouso vocal.

ABSTRACT Purpose To characterize and to compare the perception of vocal fatigue in professors at the beginning and at the end of the school year. Methods Observational, analytical, prospective cohort study was carried out. A total of 115 professors participated with a mean age of 40 years old, 71 women and 44 men, employees of 28 higher education institutions in the south and southeast regions of Brazil. All answered to the Vocal Fatigue Index (VFI) at the beginning (February or March) and at the end (October or November) of the Brazilian school year. The VFI results for both assessed moments were statistically compared (p<0.05). Results The professors' mean scores obtained in the factors of tiredness of voice and avoidance of voice use (p<0.001) and improvement of symptoms with rest (p=0.001) increased at the end of the school year. Conclusion Professors reported higher perception of vocal fatigue at the end of the school year, which influenced the avoidance of voice use and improvement of symptoms with the rest.

Telemonitoring of Brazilian Nursing homes before Coronavirus and COVID-19 Infections / Telemonitorización de hogares para ancianos frente a las infecciones por coronavirus y COVID-19 / Telemonitoramento a instituições de longa permanência para idosos frente às infecções por coronavírus e COVID-19

ABSTRACT Objective: to report the experience of telemonitoring Brazilian nursing homes before coronavirus and COVID-19 infections. Methods: a descriptive experience report that occurred between March 18 and April 25, 2020 through telemonitoring nursing homes in Salvador, Bahia, following a script previously prepared for first contact and follow-up. The telemonitoring was carried out by professors from the School of Nursing of Universidade Federal da Bahia and Graduate Program students for four weeks. Results: thirty-two institutions were followed for four weeks. Some facilities and difficulties appeared during the monitoring. Final consideratios: as nursing homes are collective households, their residents are vulnerable to transmission of infections. In addition, the diversity of structures and economic, social and human resources needs of these locations reveal their fragility and urgency of public policies that address such diversities.

RESUMEN Objetivo: informar la experiencia de telemonitorización de los Hogares para Ancianos frente a las infecciones por coronavirus y COVID-19. Métodos: informe descriptivo de la experiencia que tuvo lugar entre el 18 de marzo y el 25 de abril de 2020, a través de la telemonitorización de las instituciones de Salvador, Ba, siguiendo un guión previamente preparado para el primer contacto y seguimiento. La telemonitorización fue realizada por profesores y alumnos del Programa de Posgrado de la Escuela de Enfermería de la Universidade Federal da Bahía. Resultados: 32 instituciones fueron seguidas durante cuatro semanas. Algunas instalaciones y dificultades aparecieron durante el monitoreo. Consideraciones finales: como los Hogares para Ancianos son colectivos, sus residentes son vulnerables a la transmisión de infecciones. Además, la diversidad de estructuras y las necesidades de recursos económicos, sociales y humanos de estos lugares revela su fragilidad y la urgencia de las políticas públicas que abordan tales diversidades.

RESUMO Objetivo: relatar a experiência de telemonitoramento de Instituições de Longa Permanência para Idosos frente às infecções por coronavírus e COVID-19. Métodos: relato descritivo da experiência ocorrida entre 18 de março e 25 de abril de 2020, através de telemonitoramento das instituições de Salvador, Ba, seguindo um roteiro previamente elaborado para primeiro contato e de seguimento. O telemonitoramento foi realizado por docentes da Escola de Enfermagem da Universidade Federal da Bahia e discentes do Programa de Pós-Graduação dessa escola, durante quatro semanas. Resultados: foram acompanhadas 32 instituições durante quatro semanas. Algumas facilidades e dificuldades se apresentaram no decorrer do monitoramento. Considerações finais: como as Instituições de Longa Permanência para Idosos são domicílios coletivos, seus residentes são vulneráveis a transmissão de infecções. Ademais, a diversidade de estruturas e necessidades econômicas, sociais e de recursos humanos desses locais revela sua fragilidade e urgência de políticas públicas que atendam tais diversidades.

Audição em altas frequências em trabalhadores rurais expostos a agrotóxicos / High frequency hearing among rural workers exposed to pesticides

Resumo Os agrotóxicos podem causar inúmeros problemas de saúde e são considerados agentes otoagressores. O objetivo deste estudo foi analisar as características auditivas nas altas frequências em trabalhadores com e sem exposição aos agrotóxicos, que apresentaram resultados normais na audiometria convencional. Estudo transversal com 87 trabalhadores, de ambos os gêneros, entre 19 e 59 anos, com vínculo de trabalho formal, informal e/ou que atuavam na agricultura familiar e realizaram Audiometria de Altas Frequências. O uso de glifosato foi relatado por 73% dos trabalhadores e as misturas de agrotóxicos diversos ocorreram em 78% deles. Não foi identificado uso adequado dos equipamentos de proteção individual recomendados para a atividade agrícola. Os trabalhadores expostos a agrotóxicos apresentaram piores resultados na Audiometria de Altas Frequências quando comparados aos que não tiveram contato com agrotóxicos (p < 0,0001). A Audiometria de Altas Frequências pode ser considerada um instrumento sensível para detectar, precocemente, alterações auditivas em trabalhadores expostos a agrotóxicos, e, seu uso em serviços de saúde poderá contribuir para as ações de vigilância em saúde do trabalhador.

Abstract Pesticides may cause a number of health problems and are considered oto-agressive agents. The objective of this study was to investigate the high frequency hearing characteristics of workers both with and without exposure to pesticides, that presented normal conventional audiometry. It involved a cross-sectional study with 87 workers, of both genders, between 19 and 59 years, with formal or informal jobs and some of whom worked with family agriculture, either using pesticides or not, who had taken High-Frequency Audiometry tests. The use of glyphosate was reported by 73% of workers and several pesticide mixtures occurred in 78% of them. There were no cases of proper use of personal protective equipment recommended for the activity. The workers exposed to pesticides had worse results in High-Frequency Audiometry tests in comparison with those who had no contact with pesticides (p < 0.0001). High-Frequency Audiometry has proved to be a useful and effective tool in the early detection of hearing loss caused by pesticides.

Autopercepção da voz por professores de escola pública / Voice self-perception of public-school teachers / Auto-percepción de la voz por profesores de escuela pública

Introdução: O uso profissional da voz possui aspectos próprios e os professores apresentam um elevado risco vocal. Objetivo: Identificar a percepção que professores da rede pública possuem de suas vozes e o tipo e foco de estratégias de enfrentamento que eles usam quando percebem mudanças vocais. Métodos: Três protocolos de autoavaliação vocal foram respondidos por 100 professores (GE) e 40 não professores (GC): Termos Descritivos da Voz (TDV), Perfil de Participação e Atividades Vocais (PPAV), que permite o cálculo da Pontuação de Limitação de Atividade (PLA) e da Pontuação de Restrição de Participação (PRP) e o Protocolo de Estratégias de Enfrentamento das Disfonias (PEED), que classifica as estratégias usadas para lidar com distúrbios de voz com foco no problema e/ou na emoção. Escores mais altos no PPAV e no PEED indicam maior incapacidade. Os dados foram comparados com um nível de confiança de 95%. Resultados: Professores classificaram 53 descritores como negativos, com 1% a 40% de ocorrência, contra 40 descritores de não professores, com máximo de 11% de ocorrência. Os escores totais do PPAV e PEED foram, respectivamente, por grupo, 41,95/13,37 e 37,90/10,23, e a PLA foi de 7,59/1,96 e PRP, 4,95/1,43. O GE relatou mais (37,90) estratégias de enfrentamento do que o GC (10,23), sendo as focadas na emoção (GE = 23,21 e GC = 6,53) mais frequentes do que as focadas no problema (GE = 14,69 e GC = 3,70). Todos os dados mostraram diferença significativa (p<0,05) entre GE e GC. Conclusão: Os professores percebem o impacto das mudanças em suas vozes, com maior impacto na comunicação diária. Mostram maior ocorrência de estratégias de enfrentamento para lidar com estas modificações na voz e estas são mais centradas na emoção do que no problema.

Introduction: The professional voice usage has some aspects that are inherent to each profession and the teachers present a high vocal risk. Purpose: To identify the perception that public-school teachers have of their own voices and the type and focus of coping strategies they use when they perceive vocal changes. Methods: Three vocal self-assessment inventories were answered by 100 teachers (EG) and 40 non-teachers (CG): 100 Word-Descriptors for Voice (WDV), Voice Activity and Participation Profile (VAPP), which allows the calculation of the Activity Limitation Score (ALS) and Participation Restriction Score (PRS), and Voice Disability Coping Questionnaire (VDCQ), that classifies the strategies used to cope with voice disorders into focus on problem and on emotion. Higher scores on VAPP and VDCQ indicate greater disability. Data were compared with a 95% level of confidence. Results: Teachers classified 53 descriptors as negative, with 1% to 40% of occurrence, against 40 descriptors of the non-teachers, with maximum 11% of occurrence. The total scores of the VAPP and VDCQ were, respectively per group, 41.95/13.37 and 37.90/10.23, and the ALS was 7.59/1.96 and PRS, 4.95/1.43. EG reported more (37.90) coping strategies than CG (10.23), and the emotion-focused (EG = 23.21 and CG = 6.53) coping strategies were more frequent than problem-focused (EG = 14.69 and CG = 3,70) ones. All data showed significant difference (p<0.05) between EG and CG. Conclusion: Teachers perceive the impact of changes in their voices, with greater impact on daily communication. They show greater occurrence of coping strategies to deal with these modifications in their voices and these are more emotion than problem-focused.

Introducción: El uso profesional de la voz trae algunos aspectos inherentes a cada profesión, y los profesores presentan un alto riesgo vocal. Propósito: Identificar la percepción que los maestros de las escuelas públicas tienen de sus propias voces y el tipo y enfoque de las estrategias de afrontamiento que utilizan cuando perciben alteraciones vocales. Métodos: 100 maestros (EG) y 40 non docentes (CG) respondieron tres inventarios vocales de autoevaluación: los 100 Word-Descriptors for Voice (WDV), Perfil de Actividad y Participación Vocal (VAPP), que permite el cálculo de el Puntaje de Limitación de Actividad (ALS) y el Puntaje de Restricción de Participación (PRS), y el Voice Disability Coping Questionnaire (VDCQ), que clasifica las estrategias utilizadas para enfrentar los trastornos de la voz centradas en el problema y/o en la emoción. Puntuaciones más altas en VAPP y VDCQ indican mayor discapacidad. Los datos se compararon con un nivel de confianza del 95%. Resultados: Los maestros clasificaron 53 descriptores como negativos, con 1% a 40% de ocurrencia, contra 40 descriptores de non docentes, con un máximo de 11% de ocurrencia. Las puntuaciones totales de VAPP y VDCQ fueron, respectivamente por grupo, 41.95/13.37 y 37.90/10.23, y la ALS fue 7.59/1.96 y PRS, 4.95/1.43. EG informó más (37,90) estrategias de afrontamiento que el CG (10,23), y las estrategias de afrontamiento centradas en la emoción (EG = 23,21 y CG = 6,53) fueron más frecuentes que las centradas en el problema (EG = 14,69 y CG = 3,70). Todos los datos mostraron una diferencia significativa (p<0.05) entre EG y CG. Conclusión: Los maestros perciben el impacto de los cambios en sus voces, con mayor impacto en la comunicación diaria. Muestran mayor ocurrencia de estrategias de afrontamiento para lidiar con estas modificaciones en la voz y éstas están más centradas en la emoción que en el problema.

Anaphylaxis triggered by prick test with latex extract: a case report

ABSTRACT CONTEXT: Adverse reactions associated with prick tests are rare but may be present as serious systemic reactions. CASE REPORT: A 38-year-old female nursing technician complained of three episodes of anaphylaxis in one year, all in the workplace. To investigate latex allergy, the patient underwent the prick test with latex, and immediately developed a rash, itchy skin, hoarseness, dyspnea and dry cough. Her condition improved promptly after appropriate measures were established for controlling her anaphylaxis. CONCLUSION: The skin test must be performed under medical supervision, since complications that can lead to life-threatening reactions, if support measures are not readily implemented, have been attributed to this test.

Caracterización clínica de la leptospirosis grave en un hospital de alta complejidad de Cali, Colombia, 2010-2016 / Clinical characterization of patients with severe leptospirosis in a tertiary hospital in Cali, Colombia, 2010-2016

Resumen Introducción. La leptospirosis es una infección bacteriana endémica en Colombia. Su curso clínico puede ser variable y, en ocasiones, fatal. Hay pocos estudios en el país sobre los casos graves de esta enfermedad. Objetivo. Describir las características demográficas y clínicas de los pacientes con diagnóstico de leptospirosis grave hospitalizados en salas generales o atendidos en la unidad de cuidados intensivos de un hospital de cuarto nivel. Materiales y métodos. Se llevó a cabo un estudio observacional descriptivo de los pacientes adultos y niños con diagnóstico serológico de leptospirosis entre el 2010 y el 2016. Resultados. Se analizaron las historias clínicas de 87 pacientes, 74 % de los cuales correspondía a hombres y, el 84 %, a mayores de 18 años. El 35 % tenía alguna comorbilidad y la hipertensión arterial sistémica (16 %) y la diabetes mellitus (9 %) fueron las más comunes. Los síntomas más frecuentes fueron: fiebre, náuseas, astenia, mialgias, artralgias y dolor abdominal. El 34 % requirió atención en la unidad de cuidados intensivos, con una mediana de estancia de 5 días. El 61 % requirió hospitalización en sala general, con una mediana de estancia de 6 días. Todos los casos recibieron tratamiento antibiótico con ceftriaxona o doxiciclina. La tasa de letalidad fue del 1,1 % (n=1). Conclusiones. La infección por Leptospira spp. tiene el riesgo de diagnosticarse de manera tardía por su presentación clínica inespecífica, lo que implica considerar un gran número de diagnósticos diferenciales. La atención temprana de los pacientes con cuadros graves de esta enfermedad en la unidad de cuidados intensivos, puede evitar una mayor incidencia de complicaciones y disminuir la mortalidad.

Abstract Introduction: Leptospirosis is an endemic bacterial infection in Colombia. Its clinical course can be variable and occasionally fatal. There are few studies in the country about severe cases of leptospirosis. Objectives: To describe the demographic and clinical characteristics of patients with a diagnosis of leptospirosis, and their management in a high complexity hospital. Materials and methods: This was a descriptive retrospective study of patients with a serologic diagnosis of leptospirosis between 2010 and 2016. Results: We analyzed 87 patients, 74% of them were men, and 84% were older than 18 years; 35% had a comorbidity, the most common being arterial hypertension (16%) and diabetes mellitus (9%). The most frequent symptoms were fever, nausea, fatigue, myalgia, arthralgia, and abdominal pain. The majority of patients required hospitalization in general wards (61%), with a median stay of six days; 34% required management in the intensive care unit, with a median stay of five days. Mortality was 1.1% (n=1). All patients received treatment with either ceftriaxone or doxycycline. Conclusions: There is a risk of leptospira infections having a late diagnosis given their unspecific clinical presentation, which generates a high number of differential diagnoses. The early management in the intensive care unit could decrease the incidence of complications and the mortality of patients with leptospirosis.

Depression in the workplace: screening and treatment

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Lições de professores sobre suas alegrias e dores no trabalho / Lecciones de profesores sobre sus alegrías y padecimientos en el trabajo / Lessons from schoolteachers on their joys and pains at work

Resumo: Por que adoecem os professores? Essa é a questão que o ensaio levanta e para qual sugere pistas de respostas. Após constatar que as doenças que prevalecem entre professores brasileiros são as mesmas que prevalecem entre professores do mundo todo, conclui-se que o nó do problema está no trabalho dos professores, o invariante da questão. É, portanto, esse trabalho que precisa ser melhor e mais conhecido e que deve ser o centro das atenções. A autora defende a tese de que são os próprios professores os que têm as melhores condições de fazê-lo, exatamente porque são os que o conhecem melhor. Para ilustrar essa tese, apresenta os principais resultados de uma pesquisa de âmbito nacional na qual professores da Educação Básica, no Brasil, analisaram o seu próprio trabalho, amparados por um dispositivo metodológico, a Análise Coletiva do Trabalho (ACT), que lhes oferecia condições para se expressarem livremente e valorizava a sua palavra. A ACT se revelou um potente instrumento de análise do trabalho, pois integrava aspectos tanto da atividade como do emprego dos professores, em geral analisados separadamente, o que aumentava o seu poder explicativo. Além disso, evidenciou os lados positivos e negativos desse trabalho, oferecendo várias pistas para se compreender não só por que os professores adoecem como também o que os mantém saudáveis, duas questões diferentes, embora relacionadas entre si.

Resumen: ¿Por qué se ponen enfermos los profesores? Esta es la cuestión que presenta este ensayo y para la que se sugieren algunas respuestas. Tras constatar que las enfermedades que predominan entre los profesores brasileños son las mismas que prevalecen entre profesores de todo el mundo, se concluye que el foco del problema está en el trabajo de los profesores, aspecto invariable en este estudio. Por ello, es necesario estudiarlo y conocerlo mejor, además de convertirlo en el centro de atención de esta cuestión. La autora defiende la tesis de que son los propios profesores quienes tienen las mejores condiciones para hacerlo, precisamente porque son quienes lo conocen mejor. Para ilustrar esta tesis, presenta los resultados principales de una investigación en el ámbito nacional donde profesores de Educación Básica, en Brasil, analizaron su propio trabajo, mediante una metodología denominada Análisis Colectivo de Trabajo (ACT), que les ofrecía condiciones para que se expresaran libremente y valoraran sus comentarios. La ACT se reveló un potente instrumento de análisis de trabajo, pues integraba aspectos tanto de la actividad, como del propio oficio de los profesores, generalmente analizados por separado, lo que aumentaba su poder explicativo. Además, evidenció los aspectos positivos y negativos de este trabajo, ofreciendo varias pistas para comprender no sólo por qué enferman los profesores, sino también qué les mantiene sanos, dos cuestiones diferentes, aunque relacionadas entre sí.

Abstract: Why do schoolteachers get sick? The essay poses this question and points in some directions for answers. After discovering that the most prevalent diseases among Brazilian schoolteachers are the same as those in teachers the world over, the author concluded that the crux of the problem lies in the schoolteachers' work, the constant in the equation. Their work thus needs to be understood better, and their work should be the center of attention. The author contends that teachers themselves are best equipped for this task, precisely because they know their own work the best. The article presents the main results of a nationwide Brazilian survey in which schoolteachers in Basic Education (preschool through 16) analyzed their own work, backed by a method known as Collective Work Analysis (CWA) that enabled them to expound freely and that valued their own words. CWA proved to be a powerful tool for work analysis by integrating aspects of teaching activity per se with the schoolteachers' employment, which are usually analyzed separately, and which increased the study's explanatory power. The study also revealed positive and negative sides of this work, offering various clues for understanding not only why schoolteachers get sick but also what keeps them healthy, two different but interrelated issues.

Fadiga vocal em professores disfônicos que procuram atendimento fonoaudiológico / Vocal fatigue in dysphonic teachers who seek treatment

RESUMO Objetivo Verificar a autopercepção de fadiga vocal de professores disfônicos em atividade letiva que procuram atendimento fonoaudiológico. Método Participaram desta pesquisa 60 professores com queixa vocal, dentre estes, 30 que buscaram tratamento no Programa de Saúde Vocal do Sindicato dos Professores de São Paulo - SinproSP (G1) e 30 professores que não buscaram atendimento (G2). Todos os participantes responderam a um questionário de identificação, a um de caracterização pessoal e do trabalho, a uma lista de sinais e sintomas vocais e ao Índice de Fadiga Vocal - IFV. Além disso, foram registradas contagem de números de 1 a 10 e vogal sustentada "é" para definição do grau de desvio vocal por meio da análise perceptivo-auditiva. Resultados Os professores que procuraram o atendimento (G1) apresentaram piores escores nos protocolos IFV, maior número de sinais e sintomas, além de pior autoavaliação da voz quando comparados aos professores que não procuraram tratamento (G2). Além disso, os docentes dos dois grupos estudados apresentaram desvios de voz de leve a moderado. Conclusão Professores disfônicos que procuram atendimento fonoaudiológico apresentam maior sensação de fadiga vocal, principalmente em relação aos domínios restrição vocal e desconforto físico do IFV. Além disso, apresentaram maior número de sintomas e pior autoavaliação vocal em relação àqueles que não procuraram o atendimento, apesar de ambos os grupos apresentarem vozes desviadas.

ABSTRACT Purpose to verify the self-perception of vocal fatigue of dysphonic teachers in school year activity who sought speech-language pathology assistance. Methods Sixty teachers with voice complaints participated in the study, 30 of whom sought treatment in the Programa de Saúde Vocal do Sindicato dos Professores de São Paulo (SinproSP), and 30 volunteers' teachers who did not seek treatment (G2). All the participants answered a personal identification protocol and work characterization, vocal self-assessment, vocal signs and symptoms checklist, Vocal Fatigue Index protocol (VFI). In addition, a number counting from 1 to 10 and sustained vowel "e" were registered for the definition of the mean vocal deviation using perceptual-auditory judgment. Results Teachers who sought treatment (G1) obtained worst scores in the VFI, more numbers of signs and symptoms, and worst self-evaluation of the voice when compared with those who did not seek treatment (G2). In addition, teachers in both groups had light to moderate vocal deviation. Conclusion Dysphonic teachers who sought vocal treatment presented greater sensation of vocal fatigue, especially in the factors of tiredness of voice and voice avoidance and related to physical discomfort associated with voicing of the VFI. In addition, they reported greater number of symptoms and worse vocal self-assessment in relation to those who did not seek treatment, although both groups present deviated voices.

Análise da timidez na desvantagem vocal percebida em professores / Analysis of shyness on vocal handicap perceived in school teachers

RESUMO Objetivo Verificar a relação entre a timidez autorreferida e a desvantagem vocal percebida em professores da Educação Infantil e Fundamental I e II. Método 200 professores (média de 41,8 anos), sem queixa vocal atual, preencheram 3 protocolos: uma ficha de identificação pessoal e caracterização do trabalho, composta por 11 questões, elaborada pelo Programa de Saúde Vocal do SinproSP; o Índice de Desvantagem Vocal, instrumento de autoavaliação que investiga a autopercepção do impacto de um problema vocal; e a Escala de Timidez, com 14 itens sobre sentimentos e comportamentos comunicativos relacionados ao cotidiano organizacional. Resultados Do total da amostra, 142 (71%) professores não apresentaram desvantagem vocal, sendo 42% (n=59) professores tímidos e 58% (n=83) não tímidos. Para os 58 (29%) professores que apresentaram desvantagem vocal, houve um maior número de tímidos (64%) do que não tímidos (26%). Entre o total de professores tímidos, houve uma proporção maior destes entre os professores que atuam exclusivamente na Educação Infantil, com faixa etária entre 20-30 anos, formados em até 10 anos e com queixa da presença de ruído na sala de aula. A presença de afecções de vias aéreas superiores foi o único aspecto que diferenciou tímidos com e sem desvantagem vocal, sendo mais frequente nos professores tímidos sem desvantagem vocal. Conclusão Professores tímidos percebem mais desvantagem vocal quando comparados aos não tímidos. Os docentes com faixa etária entre 20 e 30 anos, com até 10 anos de formados e que lecionam para Educação Infantil relatam timidez, porém sem associação com a desvantagem vocal.

ABSTRACT Purpose To verify the relation between the self-reported shyness and perceived vocal handicap in teachers from Early childhood and Primary education (elementary and middle school). Methods 200 teachers (mean age 41.8 years old) without vocal complaint answered to personal identification protocol, work characterization information, the Vocal Handcap Index and the Shyness Scale. Results From the total sample, 142 (71%) teachers had no vocal disadvantage, 42% (n = 59) were shy and 58% (n = 83) were non-shy. Among the 58 (29%) teachers with vocal disadvantage, most of them were shy (64%) instead of non-shy (26%). Considering the shy teachers, most of them worked in Early Childhood Education, were aged between 20-30 years old, had from 1 to 10 years of teaching experience and were working in a noisy classroom. The presence of upper airway affections was more frequent in shy teachers without vocal disadvantage and this was the only aspect that differentiated shy and non-shy teachers. Conclusion Shy teachers showed higher frequency of vocal disadvantage when compared to non-shy teachers. Teachers between 20 and 30 years old, with up to 10 years of teaching experience and who teach in Early Childhood Education reported shyness, but there was no relation with vocal disadvantage.

Comparação da ocorrência de sinais e sintomas de alteração vocal e de desconforto no trato vocal em professores de diferentes níveis de ensino / Comparison of the occurrence of signs and symptoms of vocal and change discomfort in the vocal tract in teachers from different levels of education

RESUMO Objetivo Analisar e comparar a ocorrência de sinais e sintomas de voz e de desconforto no trato vocal em docentes de diferentes níveis de ensino. Método Participaram da pesquisa 112 docentes, de ambos os gêneros, de diferentes níveis de ensino, sendo: 38 do Ensino Infantil, 28 do Ensino Fundamental I, 18 do Ensino Fundamental II e 28 do Ensino Médio. Os participantes autoavaliaram suas vozes e responderam um questionário de caracterização pessoal e do trabalho, a Lista de Sinais e Sintomas Vocais, a Escala do Desconforto do Trato Vocal (somente frequência da sensação). Os dados obtidos foram analisados estatisticamente em função dos níveis de ensino utilizando-se o Teste Krukal-Wallis e o Teste Qui-quadrado de Pearson (p<0,05). Resultados No ensino médio, a mediana de idade e a frequência de docentes do gênero masculino foi significativamente maior que nos demais níveis de ensino. Não houve diferença na autoavaliação vocal, na ocorrência de sinais e sintomas vocais e na frequência de desconforto no trato vocal, em função do nível de ensino dos docentes. Conclusão Conclui-se que não houve diferença na ocorrência de sinais e sintomas de voz e de desconforto no trato vocal em docentes de diferentes níveis de ensino.

ABSTRACT Purpose To analyze and compare the occurrence of signs and symptoms of voice and vocal tract discomfort in teachers from different educational levels. Methods There were 112 teachers, of both sexes, of different grade levels, as follows: 38 of kindergarten, 28 of elementary I, 18 elementary school II and 28 high school. Participants self-rated their voices and answered a questionnaire of personal characteristics and work, Signs and Symptoms Vocal Check list, the Vocal Tract Discomfort Scale (frequency scale). The data were statistically analyzed according to the teaching levels using the Kruskal-Wallis test and Pearson's Chi-Square test (p < 0.05). Results In high school, the median age and the frequency of male teachers was significantly higher than in other levels of education. There was no difference in the vocal self-assessment, the occurrence of vocal signs and symptoms and frequency of vocal tract discomfort, depending on the level of education of teachers. Conclusion It is concluded that there was no difference in the occurrence of signs and symptoms of voice and vocal tract discomfort in teachers from different educational levels.