What happened to health labour markets during COVID-19? Insights from the analysis of cross-sectional survey data on the perceptions of medical doctors in Brazil.

OBJECTIVES: To examine physicians' perceptions of changing employment opportunities in Brazil, and gain an insight into labour markets in low/middle-income countries (LMICs) during the pandemic. STUDY DESIGN: Descriptive and inferential analysis of a quantitative dataset from a representative cross-sectional survey of physicians of two Brazilian states. SETTINGS: São Paulo and Maranhão states in Brazil. PARTICIPANTS: Representative sample of 1183 physicians. OUTCOME MEASURES: We estimated prevalence and 95% CIs for physicians' perceptions of changes in demand and supply of doctors, as well as changes in prices of medical services for facilities of practice in the two states, stratified by public, private and dual-practice physicians. RESULTS: Most doctors reported increased job opportunities in the public sector (54.9%, 95% CI 52.0% to 57.7%), particularly in Maranhão state (65.0%, 95% CI 60.9% to 68.9%). For the private sector, increased opportunities were reported only in large private hospitals (46.7%, 95% CI 43.9% to 49.6%) but not in smaller clinics. We recorded perceptions of slight increases in availability of doctors in Maranhão, particularly in the public sector (51.4%, 95% CI 43.2% to 59.5%). Younger doctors recounted increased vacancies in the public sector (64%, 95% CI 58.1% to 68.1%), older doctors only in walk-in clinics in Maranhão (47.5%, 95% CI 39.9% to 55.1%). Those working directly with patients with COVID-19 saw opportunities in public hospitals (65%, 95% CI 62.3% to 68.4%) and in large private ones (55%, 95% CI 51.8% to 59.1%). CONCLUSIONS: Our findings hint that health labour markets in LMICs may not necessarily shrink during epidemics, and that impacts will depend on the balance of public and private services in national health systems.

Sources of Sport Satisfaction and Perceived Self-Efficacy Among Youth in a Competitive Environment.

Young people's sources of satisfaction in sport are an important indicator of their long-term sport participation. Contextual factors and an individual's internal dispositions act synergistically to determine a positive experience. We studied sources of sport satisfaction and perceived self-efficacy of 1,151 male and female youth athletes (M age = 14.72, SD = 1.56 years) in Brazil who were engaged in school state level competition. The participants responded to questionnaires on their sport satisfaction and perceived self-efficacy. We considered sex, training time, and last game results as independent variables in accessing participant differences in perceived satisfaction. We observed an increasing trend toward more significant satisfaction as sport experience increased. Perceived self-efficacy was a moderator for young participants' self-reported positive experience in sports. Thus, in our offer of evidence on sources of satisfaction in sport and perceived self-efficacy among youth in competition, we found the extent of the sport experience and self-efficacy to be important factors in the developmental pathway.

Acute Limb Ischemia After Self-Injection of Crushed Morphine Tablets into the Radial Artery: Role of Infrared Thermography in the Assessment of Tissue Perfusion.

BACKGROUND This article presents a case involving complications after intentional injection of crushed tablets into the arterial circulation, its diagnosis, and the treatment adopted. The diagnosis process illustrates the potential of techniques based on thermal imaging as tools to assess tissue perfusion. Inadvertent intravenous injection of crushed tablets is more common, but there are few reports on arterial circulation, and no studies were found on the self-injection of crushed morphine tablets, particularly into the radial artery. CASE REPORT A 51-year-old man with alcoholism and a history of illegal drug usage intentionally self-injected 3 crushed morphine tablets into his right radial artery. The patient progressed with compartment syndrome, requiring decompressive fasciotomy of the right forearm and ischemia of the right fingers, which were amputated. He presented with rhabdomyolysis and required dialysis. The patient agreed to full heparinization, corticotherapy, and the use of nitroglycerin and prostaglandin E1. Due to the progression of the necrotic area, the patient underwent proximal phalanx excision and surgical reconstruction of the right-hand remnant. CONCLUSIONS The injection of morphine tablets into circulation caused severe complications, which led to the excision of the proximal phalanx and the surgical reconstruction of the remnant of the right hand. In the present case, infrared thermography proved to be an effective method in assessing tissue perfusion.

Curcuma longa hydrolate improves Nile tilapia survival in a recirculation rearing system, maintaining the animal homeostasis and modulating the gut microbial community.

This study aimed to evaluate the effects of the dietary supplementation Curcuma longa hydrolate on Nile tilapia (Oreochromis niloticus) reared in a recirculation system. Hemato-immunological parameters, growth performance, nitrogen and phosphorus retention, as well as body composition and its interaction with the intestinal microbiota, were studied. Nile tilapia fingerlings (120) were distributed randomly in 8 polyethylene tanks (40 L). The experimental units were divided into two treatments, in quadruplicate: commercial diet supplemented with 2.5% of C. longa hydrolate and commercial diet without supplementation (control). After 45 days, the treatment supplemented hydrolate showed higher survival than the control group, 95.25% and 82.22%, receptively. In the blood profile, fish supplemented with hydrolate had a higher count of total leukocytes and neutrophils, as well as mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration, than control group. The hydrolate group showed a substantial increase in the relative abundance of Cetobacterium and Romboutsia, as well as lower diversity in gut microbiota. The dietary addition of C. longa hydrolate for Nile tilapia seems to have a beneficial effect on gut microbiota, in addition to a likely positive effect on the physiological performance of Nile tilapia by maintaining intestinal homeostasis and promoting survival in reared conditions.

Radiation levels of UV-A and UV-B on growth parameters and coumarin content in guaco / Níveis de radiação UVA e UVB sobre parâmetros de crescimento e conteúdo de cumarina em guaco

ABSTRACT: Guaco is a medicinal plant species containing coumarin, a secondary metabolite whose concentration is influenced by various factors, such as the level of exposure to UVA (315-400 nm) and UVB (280-315 nm) radiation, age of the plant, and position of the storage organ in the plant. This study aimed to assess the effect of different blocking levels of UVA and UVB radiation on growth parameters and coumarin content of two guaco accessions. Treatments did not affect any of the growth parameters assessed, except leaf area. Coumarin content was higher in leaves collected from the upper canopy and with unblocked exposure to UVA and UVB.

RESUMO: Guaco é uma espécie medicinal que apresenta em sua composição a cumarina, um metabólito secundário cuja concentração no vegetal é influenciada por fatores como os níveis de radiação UV-A (315-400 nm) e UV-B (280-315 nm) incidentes, bem como pela idade e posição do órgão de armazenamento na planta. O objetivo deste estudo foi o de avaliar o efeito de diferentes níveis de bloqueio das radiações UV-A e UV-B sobre parâmetros de crescimento e teor de cumarina em dois acessos de guaco. Os tratamentos não apresentaram efeito sobre os parâmetros de crescimento avaliados, com exceção dos valores de área foliar. Em relação aos teores de cumarina, estes foram superiores nas folhas coletadas do dossel superior, bem como no tratamento sem bloqueio das radiações UV-A e UV-B incidentes.

The first Acanthamoeba keratitis case in the Midwest region of Brazil: diagnosis, genotyping of the parasite and disease outcome.

We report an Acanthamoeba keratitis case associated with the use of contact lens in a 28-year-old female from Brasília, Brazil. Samples from corneal scraping and contact lens case were used for culture establishment, PCR amplification, and partial sequencing (fragments of ~400kb) of small subunit rDNA; both culture and PCR were positive. The sequence analyses of the cornea and of isolates from the contact lens case showed similarity with the T4 genotype. To the best of our knowledge, this is the first report of T4 Acanthamoeba keratitis case from the Midwest region of Brazil.

The first Acanthamoeba keratitis case in the Midwest region of Brazil: diagnosis, genotyping of the parasite and disease outcome

Abstract We report an Acanthamoeba keratitis case associated with the use of contact lens in a 28-year-old female from Brasília, Brazil. Samples from corneal scraping and contact lens case were used for culture establishment, PCR amplification, and partial sequencing (fragments of ~400kb) of small subunit rDNA; both culture and PCR were positive. The sequence analyses of the cornea and of isolates from the contact lens case showed similarity with the T4 genotype. To the best of our knowledge, this is the first report of T4 Acanthamoeba keratitis case from the Midwest region of Brazil.

Facial trauma reconstruction with polymethyl methacrylate-A case report.

BACKGROUND: Polymethyl methacrylate (PMMA) is a dermatologic filler commonly used in esthetic procedures. However, it can also be used in more severe cases such as reconstruction of facial traumas. AIMS: The aim of this report was to describe the use of PMMA in a nasal reconstruction of a patient victim of an automobilist accident which presented previous rejection of autograft. PATIENT: A young female patient, 26 y, victim of automobilist accident, with no bone support due to trauma both in the mandibulum and maxilla, presented fracture of several facial bones. Presented rejection of a bone autograft from the skullcap implanted on the nose. In order to harmonize the facial aspect, a nasal fill with PMMA for the anatomic reconstruction of the nose was performed. RESULTS AND CONCLUSIONS: PMMA promoted the recovery of facial and nasal esthetic characteristics of the patient ensuring a satisfactory result.

Optimization of animal manure vermicomposting based on biomass production of earthworms and higher plants.

The goal of this study was to optimize the mixture of swine manure (SM) and cattle manure (CM) used in the vermicomposting process, seeking to increase the manure biodegradation rate and enhance the biomass production of both earthworms and higher plants. To achieve this goal, physico-chemical parameters were determined to assess the final compost quality after 50 days of vermicomposting. The different manure ratios used to produce the composts (C) were as follows (SM:CM, % m/m basis): C1 100:0, C2 (75:25), C3 (50:50), C4 (25:75), and C5 (0:100). In addition, the earthworm biomass and the phytoproductivity of lettuce (Lactuca sativa L.) plants grown in mixtures (1:1) of natural soil and the most viable vermicomposts were investigated. The C1 and C2 compost compositions were associated with high earthworm mortality rates. The C3 compost provided the highest mineral concentrations and C5 showed the highest lettuce yield (wet biomass). The results verify that stabilized cattle manure is an excellent substrate for the vermicomposting process and that fresh swine manure must be mixed with pre-stabilized cattle manure to ensure an optimized vermicomposting process, which must be controlled in terms of temperature and ammonia levels. It is concluded that small livestock farmers could add value to swine manure by applying the vermicomposting process, without the need for high investments and with a minimal requirement for management of the biodegradation process. These are important technical aspects to be considered when circular economy principles are applied to small farms.

Anaerobic Metabolism in T4 Acanthamoeba Genotype.

Members of the genus Acanthamoeba are of the most common protozoa that has been isolated from a variety of environment and affect immunocompromised individuals, causing granulomatous amoebic encephalitis and skin lesions. Acanthamoeba, in immunocompetent patients, may cause a keratitis related to corneal microtrauma. These free-living amoebas easily adapt to the host environment and wield metabolic pathways such as the energetic and respiratory ones in order to maintain viability for long periods. The energetic metabolism of cysts and trophozoites remains mostly unknown. There are a few reports on the energetic metabolism of these organisms as they are mitochondriate eukaryotes and some studies under aerobic conditions showing that Acanthamoeba hydrolyzes glucose into pyruvate via glycolysis. The aim of this study was to detect the energetic metabolic pathways with emphasis on anaerobic metabolism in trophozoites of three isolates of Acanthamoeba sp belonging to the T4 genotype. Two samples were collected in the environment and one was a clinical sample. The evaluation of these microorganisms proceeded as follows: rupture of trophozoites (7.5 × 103 parasites/ml) and biochemical analysis with high performance liquid chromatography and spectrophotometry. The anaerobic glycolysis was identified through the detection of glucose, pyruvate, and lactate. The protein catabolism was identified through the detection of fumarate, urea, and creatinine. The fatty acid oxidation was identified through the detection of acetate, beta-hydroxybutyrate, and propionate. The detected substances are the result of the consumption of energy reserves such as glycogen and lipids. The anaerobic glycolysis and protein catabolism pathways were observed in all three isolates: one clinical and two environmental. This study represents the first report of energetic pathways used by trophozoites from different isolates of the T4 genotype Acanthamoeba.

Atualização sobre ultrassom doppler das artérias vertebrais: síndrome do roubo da subclávia / An update on doppler ultrasound of vertebral arteries: subclavian steal syndrome

A síndrome do roubo da subclávia refere-se a uma desordem vascular na qual ocorre inversão do fluxo de sangue da artéria vertebral ipsilateral, decorrente de uma estenose proximal à sua origem, geralmente uma oclusão da artéria subclávia ou, mais raramente, do troncobraquiocefálico. É uma doença relativamente rara, relatadaem aproximadamente 6% dos pacientes assintomáticos com sopros cervicais. O Doppler pulsado (PW) é útil na análiseda artéria vertebral, registrando informações capazes de identificar a presença da Síndrome do Roubo da Subclávia. Com base nas alterações hemodinâmicas da artéria vertebralavaliadas pelo estudo com Doppler espectral, pode ser classificada nos tipos 1 (oculto), 2 (intermitente ou parcial)e 3 (completo). Com o advento da angioplastia transluminal percutânea e, em seguida, dos stents, muitos advogam essa combinação de procedimentos como o tratamento de escolha dos casos sintomático dessa síndrome.

Experimental infection of T4 Acanthamoeba genotype determines the pathogenic potential.

T4 is the Acanthamoeba genotype most related to cases of granulomatous amoebic encephalitis (GAE) in immunocompromised patients and of keratitis in contact lens wearers. The determination of the pathogenic potential of Acanthamoeba clinical and environmental isolates using experimental models is extremely important to elucidate the capacity of free-living organisms to establish and cause disease in hosts. The aim of this study was to compare and evaluate the histopathology and culture between two different routes of experimental infection of T4 Acanthamoeba isolated from environmental and clinical source in mice (intracranial and intraperitoneal). Swiss isogenic healthy mice were inoculated with 10(4) trophozoites by intracranial (IC) and intraperitoneal (IP) routes and observed during 21 days. The brains from animals inoculated by the IC route were collected and from the animals of the IP inoculation group, the brains, livers, kidneys, spleens, and lungs were removed. The organs were prepared and appropriately divided to be evaluated with histopathology and culture. There was no significant difference between the inoculation routes in terms of isolates recovery (χ(2) = 0.09; p = 0.76). In the IC group, isolate recovery rate was significantly higher in histopathology than the one achieved by culture (χ(2) = 6.45; p < 0.01). Experimental infection revealed that all isolates inoculated could be considered invasive because it was possible to recover evolutive forms of Acanthamoeba in both routes. This work represents the first in vivo pathogenicity assay of primary isolation source in Central region of Brazil showing in vivo pathogenicity and hematogenous spread capacity of these protozoa, improving the knowledge on free-living amoebae isolates.

Síndrome do roubo oculto da subclávia direita causado por dissecção aórtica tipo A de Stanford que evoluiu no pós-operatório tardio com suboclusão do tronco braquicefálico / Occult-right subclavian steal syndrome caused by stanford type A aortic dissection that evolved in the late postoperative period with subocclusion of the brachiocephalic trunk

Paciente de 50 anos, sem fatores de risco e/ou desencadeantes conhecidos, apresentou dissecção aórtica tipo A de Stanford. Foi submetido à excisão da valva aórtica nativa, implante de prótese mecânica e reconstrução da raiz da aorta com enxerto orgânico. Três meses após cirurgia, estando totalmente assintomático, foi submetido, em nosso serviço, à ecografia vascular, com Doppler colorido, das carótidas e vertebrais que mostrou fluxo em artéria vertebral direita com padrão de desaceleração mediossistólica (roubo oculto da subclávia direita), também chamado Sinal do Coelho. A angiotomografia mostrou tronco braquiocefálico com lâmina de dissecção em toda a sua extensão, artéria subclávia direita com lâmina de dissecção em seu terço proximal, artéria carótida comum direita com lâmina de dissecção visualizada em seu terço proximal, artéria vertebral direita com origem na artéria subclávia direita (na sua porção sem dissecção). Em face do estado clínico do paciente, foi adotada observação clínica, com acompanhamento angiotomográfico e ecográfico dos vasos cervicais, semestralmente.

A 50-year old patient with an aortic dissection (Stanford type A) with no previous risk factors. Excision of the native valve and implantation of mechanical aortic prosthesis were made. Also, carried out reconstruction of the aortic root with organic graft. Postoperatively, the patient came to our department after three months totally asymptomatic and the color Doppler of carotid and vertebral arteries showed a right vertebral artery flow pattern with mid-systolic deceleration (partial subclavian steal) – bunny rabbit sign. The angiotomography showed brachiocephalic trunk dissection with progression to the proximal third of the right subclavian and common carotid arteries. The right vertebral artery had its origin from the right subclavian artery (in its portion without dissection). Considering the patient’s clinical status, conservative clinical approach was adopted, with angiotomography and ultrasound of cervical vessels every six months.

Síndrome do roubo da subclávia / Suclavian steal syndrome

A síndrome do roubo da subclávia refere-se a uma desordem vascular na qual ocorre inversão do fluxo de sangue da artéria vertebral ipsilateral, decorrente de uma estenose proximal à sua origem, geralmente uma oclusão da artéria subclávia ou, mais raramente, do tronco braquiocefálico. É uma doença relativamente rara, relatada em aproximadamente 6% dos pacientes assintomáticos com sopros cervicais. O Doppler pulsado (PW) é útil na análise da artéria vertebral, registrando informações capazes de identicar a presença da Síndrome do Roubo da Subclávia. Com base nas alterações hemodinâmicas da arteria vertebral avaliadas pelo estudo com Doppler Espectral, podem ser identificados três tipos de roubo da subclávia: oculto, parcial e completo. Com o advento da angioplastia transluminal percutânea e, em seguida, dos Stents, muitos advogam esta combinação de procedimentos como o tratamento de escolha dos casos sintomático desta síndrome.

Echocardiographic diagnosis of acute aortic dissection in the emergency room: case report / Diagnóstico ecocardiográfico da dissecção aórtica aguda na sala de emergência: relato de caso

BACKGROUND AND OBJECTIVES: The transthoracic echocardiography in the emergency room, by ultra-portable equipment has been increasingly useful for the diagnosis of acute dissection of ascending aorta, reason for the present report, the objective of which was to elucidate this emergency, using that important propedeutic method.CASE REPORT: A previously healthy, 49 year-old patient admitted to the Emergency Unit with typical chest pain (without triggers) whose diagnosis of acute aortic dissection was performed with the aid of transthoracic echocardiography. CONCLUSION: Considering that 65% of intimal tears occurin the ascending aorta, transthoracic echocardiography is afast and effective tool in a medical emergency. The method has a sensitivity of 59% - 85% and specificity of 63% - 96% for the diagnosis of aortic dissection. It is noteworthy that, even though infrequent in experienced hands, negative findings at transthoracic echocariography do not rule out the diagnosis of this disease.

JUSTIFICATIVA E OBJETIVOS: A ecocardiografia transtorácica na sala de emergência, por meio de equipamentos ultraportáteis, tem sido cada vez útil no diagnóstico da dissecção aguda da aorta ascendente, o que justifica o presente relato, cujo objetivo foi elucidar o quadro emergencial com o auxílio desta importante ferramenta propedêutica.RELATO DO CASO: Paciente de 49 anos, previamente saudável, admitido na Unidade de Emergência com quadro de dor torácica típica (sem fatores desencadeantes) cujo diagnóstico de dissecção aórtica aguda foi realizado com o auxílio do ecocardiograma transtorácico.CONCLUSÃO: Considerando-se que 65% das lacerações intimais ocorrem na aorta ascendente, o ecocardiograma transtorácico é uma ferramenta rápida e eficaz em uma situação de emergência médica. O método apresenta sensibilidade de 59 a 85%e especificidade de 63% a 96% para o diagnóstico de dissecção aórtica. Ressalta-se que, mesmo infrequentes em mãos experientes, achados negativos ao ecocardiograma transtorácico não descartam o diagnóstico desta comorbidade.

Rapid assessment of avoidable blindness and diabetic retinopathy in Chiapas, Mexico.

OBJECTIVE: To estimate the prevalence and causes of blindness in Chiapas, Mexico, and to assess the feasibility of using the Rapid Assessment of Avoidable Blindness framework to estimate diabetic retinopathy (DR) prevalence. DESIGN: A cross-sectional population-based survey. PARTICIPANTS: Sixty-six clusters of 50 people 50 years of age or older were selected by probability proportionate to size sampling. Households within clusters were selected through compact segment sampling. METHODS: Participants underwent visual acuity (VA) screening and diagnosis of cause of visual impairment by an ophthalmologist. Participants were classed as having diabetes if they had a previous diagnosis of diabetes, were receiving treatment for glucose control, or had a random blood glucose level of more than 200 mg/dl. Participants with diabetes were assessed for DR using dilated clinical examination (direct and indirect ophthalmoscope) and 1 dilated digital fundus photograph per eye (graded by an ophthalmologist during the survey and regraded by a retinal specialist-"reference standard") following the Scottish DR grading protocol. MAIN OUTCOME MEASURES: Prevalence of blindness (VA <20/400 in the best eye with available correction) and DR. RESULTS: Three thousand three hundred subjects were selected, of whom 2864 (87%) were examined. The estimated prevalence of bilateral blindness was 2.3% (95% confidence interval [CI], 1.7%-2.9%). Cataract was the leading cause of bilateral blindness (63%), followed by posterior segment diseases (24%), which included DR (8% of blindness). The prevalence of diabetes was 21% (19.5%-23.1%). Among participants with diabetes, the prevalence of DR (in at least 1 eye) was 38.9% (95% CI, 33.7%-44.1%). The prevalence of sight-threatening DR (STDR; defined as proliferative DR, referable maculopathy, or both) was 21.0% (95% CI, 16.7%-25.3%). Agreement with the reference standard was good for any retinopathy and STDR for the clinical examination (κ = 0.80 and 0.79, respectively) and the photograph graded during the survey (κ = 0.80 and 0.82, respectively). CONCLUSIONS: The prevalence of diabetes and DR in Chiapas was high. Including the DR component was possible, but added considerably to the cost and complexity of the survey, and so would be warranted only if a high prevalence of diabetes is expected and if resources and time permit.

Utilization of rocks and ectomycorrhizal fungi to promote growth of eucalypt

The utilization of rocks as fertilizers is limited by their low solubility. However, solubilization may be achieved by some micro-organisms, such as ectomycorrhizal fungi (ECMf). The aim of this study was to evaluate the potential of seven isolates of ECMf to solubilize two rocks, alkaline breccia and granite, and to liberate potassium and phosphorus for Eucalyptus dunnii seedlings under greenhouse conditions. Fungal inoculants were produced in a peat-vermiculite-liquid medium mixture and added to the planting substrate at 10 percent. Rocks were ground up and added at 0.500 mg and 16.0 mg per plant, as a source of phosphorus and potassium, respectively. Other nutrients were added and E. dunnii seeds were sown. Control plants, non-inoculated, were fertilized with the same amount of phosphorus and potassium using soluble forms. After 90 days, the plant height, shoot dry weight, root length, phosphorus and potassium contents, and mycorrhizal colonization were evaluated. Alkaline breccia was more efficient than granite as a source of phosphorus and potassium for the plants, and may be an alternative to conventional fertilizers. Isolates UFSC-Pt22 (Pisolithus sp.) and UFSC-Pt186 (Pisolithus microcarpus) were the most efficient in promoting plant growth, mainly when combined with alkaline breccia to replace potassium and phosphorus fertilizers, respectively.

Prevalência de queixas vocais e estudo de fatores associados em uma amostra de professores de ensino fundamental em Maceió, Alagoas, Brasil / Prevalence of vocal complaints and study of associated factors in a sample of elementary school teachers in Maceió, Brazil

Introdução: A voz é o principal instrumento na vida profissional do professor, requerendo uma adaptação precisa dos órgãos da fonação. O desconhecimento da disfonia em professores de nossa região motivou esta pesquisa.Objetivos: Avaliar a frequência de disfonia em professores do Ensino Fundamentalda rede municipal em Maceió-AL e identificar sintomas associados às queixas vocais e possíveis fatores de risco ao aparecimento de alterações vocais. Metodologia: Estudo transversal abrangendo 126 docentes selecionadosaleatoriamente, avaliados a partir de entrevista, com aplicação de questionário dirigido, em 2008. Resultados: Dos 126 professores avaliados, 87,3% referiram ocorrência de disfonia na docência. Observou-se relação entre carga horária semanal e presença de disfonia (p=0,0038). Em relação ao ambiente de trabalho, poeira e ambiente seco foram as queixas mais relatadas, ambas apresentando associação significativa (p<0,04). Os sintomas de obstrução nasal, prurido, tosse e dispepsia apresentaram relação com a presença de rouquidão. Não houve associação entre disfonia e tabagismo ou tabagismopassivo (p<0,6). Conclusão: O estudo permitiu concluir que existe elevada prevalência de disfonia no grupo estudado e que o comprometimento vocal na atividade docente está relacionado aos fatores ambientais, bem como asintomas clínicos associados à rinopatia e ao refluxo gastroesofágico.

Introduction: Voice is teachers main tool and demands an accurate adaptation of the phonation organs. Teachers unawareness of dysphonia in our region lead to this survey. Objectives: Assess frequency of dysphonia in elementary public school teachers from Maceió, state of Alagoas, Brazil, and identify symptoms associated to vocal complaints and possible risk factors for changes in voice. Methodology: Transversal study with 126 teachers selected randomly, who have been assessed through interviews, and structured questionnaires in 2008. Results: From 126 teachers assessed, 87,3% reported dysphonia. A relation between weekly working hours and dysphonia (p=0,0038) was observed. In relation to work environment, dust and air dryness were the most reported complaints, both showing significant association (p<0,04). Nasal obstruction, itching, cough, and dyspepsia were the symptoms related to hoarseness. There was no association between dysphonia and smoking, either active or passive (p<0,6). Conclusion: There is a high prevalence of vocal problems in the studied group, and dysphonia in teaching activity is related to environmental factors, as well as to clinical symptoms associated to allergic rhinitis and gastroesophageal reflux.