Prevalence of occupational voice disorders in teachers.

INTRODUCTION: In Italy the number of teachers among private and public schools is around one million. Voice disorders are thought to be one of the major occupational hazards of school teaching; in fact the teachers often use their voice with high-intensity, in noisy classes, for a long time and without suitable breaks. The aim of the study was to assess the prevalence of voice problems in teachers of Naples district, identifying risk factors for developing voice pathology. METHODS: In this study we evaluated 504 teachers (322 F-182 M) with an age ranging between 24 and 62 years, randomly choiced in 28 schools of the district of Naples submitted to a questionnaire to determine the prevalence of voice disorders. In our study we have also introduced a comparison group of not-teachers workers of 402 subjects (244 F-158 M); they were in the same age range as the teacher sample (range: 22-65 years). The control group was also submitted to a questionnaire regarding sociodemographic characteristics, smoking and alcohol use, a self-report of voice problems, voice symptoms, frequency of acute and chronic voice problems, absenteeism due to voice problems. RESULTS: The prevalence of reporting a current voice problem was significantly greater in teachers compared with not-teachers (8.7% vs 2.9%), as the prevalence of voice disorders during their lifetime too (51.4% vs 25.9%), chi2 = 86.672, p < 0.001. Women, compared with men had a higher lifetime prevalence of voice disorders. An other important data evidenced, is that 116 workers of the teachers group (23.01%) have been forced, during their professional activity, to miss job for problems related to voice; only 22 subjects of control group (5.47%) instead, missed job for voice troubles. DISCUSSION AND CONCLUSIONS: This study confirms that teachers have a higher rate of self-reported voice problems than subjects working in other occupations. Teachers, compared with not-teachers, were significantly more likely to have experienced multiple voice symptoms including hoarseness, discomfort while using their voice, difficulty projecting their voice and tiring or change in voice quality after short use. Large proportion of these problems may be preventable and prevention programs need to be developed and evaluated. Italian teachers do not receive any preventive voice training; that, in combination with poor hygienic work conditions, could increase health problems. Thus, voice training of teachers and teacher college students in some cases should be considered as a useful tool to prevent voice disorders.

Epidemiological study on vocal disorders in paediatric age.

Few studies analyzed the diffusion of vocal alterations especially in childhood. Aim of our study was to quantify the numbers of subjects, in paediatric age, in which dysphonia was diagnosed in our department of Phoniatrics, during a period of 5 years, (January 2002-December 2006), and also to evaluate the influence of some potential risk factors. In the considered period it emerged that the diagnosis of dysphonia was made in 312 children (17.2% of the patients affected from dysphonia), aged between 2 and 16-years-old, with a major prevalence amongst males (57%) than females (43%). On the contrary in the adult population the prevalence was: 23% in males and 77% in females. In paediatric population, the most affected range of age is the one between 8 and 14, in both male and female gender (59.6%). In 82.4% of the cases there were vocal fold lesions. The 90.3% of children with vocal fold alterations presented lesions secondary to vocal abuse and misuse and classifiable as functional dysphonia. The proportion of functional dysphonia in our sample was 92%. The 65% of children belonged to large families with more than two children, and the 30% had a family history of dysphonia (brothers, parents). The study of the behavioural characteristics has shown aggressive and hyperactive attitudes in 83% of the cases. Since in the ethiopathogenesis of the childhood dysphonia the tendency to vocal abuse has a predominant role, it would be useful to encourage the diffusion of programmes of information to show the risks linked to this abuse in children, in order to prevent the development of dysphonia in paediatric age.

[Myocardial metabolism of calcium in heart failure: from physiology to new therapeutic perspectives]. / Metabolismo miocardico del calcio nell'insufficienza cardiaca: dalla fisiologia ai nuovi orizzonti terapeutici.

Development of heart failure is associated with an impairment of intracellular calcium handling. The precise mechanisms involved are still obscure. When membrane depolarization occurs, a small amount of extracellular calcium enters the intracellular milieu through the L-type channels. Such "trigger" calcium acts on specific receptors of the sarcoplasmic reticulum, that, in turn, according to the so-called calcium entry-calcium release mechanism, allows the release of a larger amount of calcium from the sarcoplasmic reticulum. Removal of calcium from the cytosol is the key event of the diastolic phase. Calcium removal from cytosol occurs through specific membrane pumps. Recent therapeutic approaches involving gene targeting of calcium pumps have yielded promising results. Specifically, increased levels of SERCA 2 in the myocardium have shown to enhance cardiac contractility under normal circumstances and in experimental heart failure. Future research is needed to confirm these findings in human heart failure.

Bone mineral density and circulating cytokines in patients with acromegaly.

Acromegalic patients present an increase of osteoblastic and osteoclastic activity, showing a different effect on the axial and appendicular skeletal structures. At this regard controversial data about bone mineral density (BMD) have been published in literature. In fact an increase of BMD levels in femoral neck and Ward's triangle without any difference in lumbar spine has been described. On the other hand normal BMD levels at forearm and reduced BMD levels at lumbar spine were found. These patients seem to have a reduction of trabecular BMD similar to postmenopausal osteoporotic patients despite normal or slightly elevated cortical BMD. Recently, it has been described that cytokines, in particular tumor necrosis factor-alpha (TNF-alpha) and interleukin-1 (IL-1), are implicated in the pathogenetic mechanism of postmenopausal osteoporosis. Taking into account that growth hormone (GH) can increase TNF-alpha and IL-1 secretion by mononuclear blood cells, the evaluation of possible relationship between the reduced BMD at lumbar spine and circulating cytokines levels was carried out in acromegalic patients. In addition we evaluated the effect of acute octreotide administration on serum TNF-alpha and IL-I concentrations. Eleven patients with active acromegaly and eleven healthy age-, sex-, weight- and heightmatched subjects were enrolled in this study. BMD was significantly reduced at lumbar spine (0.80 +/- 0.29 g/cm2 vs 1.02 +/- 0.11 g/cm2; p < 0.01), but not at femoral neck level or at Ward's triangle level (0.92 + 0.15 g/cm2 vs 0.97 + 0.11 g/cm2, p = NS; and 0.74 +/- 0.16 g/cm2 vs 0.85 +/- 0.1 g/cm2, p = NS) when compared to controls. Baseline serum levels of TNF-alpha and IL-1 were in the normal range both in patients and controls. After acute octreotide administration, no differences in circulating TNF-alpha and IL-1 levels were found. In conclusion, acromegalic patients present a reduced BMD at lumbar spine but not at femoral neck level and Ward's triangle. Circulating cytokines such as TNF-alpha and IL-1 are in the normal range. These data suggest that cytokines are not involved in the pathogenesis of GH-excess induced osteoporosis. The possibility that the GH excess might affect bone turnover inducing an increase of cytokines acting by a paracrine/autocrine mechanism cannot be ruled out.