Behind the Headset: Predictive Accuracy of Patient-Reported Outcome Measures for Voice Symptoms in Call Centers.

Objective: This study examines factors predicting self-reported voice symptoms in call center workers. Methods: Multivariate analysis and predictive modeling assess personal, work-related, acoustic, and behavioral factors. Generalized Linear Models (GLMs) and Receiver Operating Characteristic (ROC) curves are employed. Results: Age and sleep patterns impacted voice quality and effort, while workplace factors influenced symptom perception. Unhealthy vocal behaviors related to tense voice and increased effort, while hydration was protective. Voice acoustics showed diagnostic potential, supported by ROC data. These findings emphasize voice symptom complexity in call center professionals, necessitating comprehensive assessment. Limitations: This study recognizes its limitations, including a moderate-sized convenience sample and reliance on PROM metrics. Future research should incorporate more objective measures in addition to self-reports and acoustic analysis. Value: This research provides novel insights into the interplay of personal, occupational, and voice-related factors in developing voice symptoms among call center workers. Predictive modeling enhances risk assessment and understanding of individual susceptibility to voice disorders. Conclusion: Results show associations between various factors and self-reported voice symptoms. Protective factors include sleeping more than six hours and consistent hydration, whereas risk factors include working conditions, such as location and behaviors like smoking. Diagnostic models indicate good accuracy for some voice symptom PROMs, emphasizing the need for comprehensive models considering work factors, vocal behaviors, and acoustic parameters to understand voice issues complexity.

Objetivo: Este estudio examina los factores que predicen los síntomas de voz en los trabajadores de call centers. Métodos: Se utilizan análisis multivariados y modelos predictivos para evaluar factores personales, laborales, acústicos y de comportamiento. Se emplean Modelos Lineales Generalizados (GLM) y curvas ROC. Resultados: La edad y los patrones de sueño afectaron la calidad vocal y el esfuerzo, mientras que los factores laborales influyeron en la percepción de síntomas. Los comportamientos vocales no saludables se relacionaron con voz tensa y mayor esfuerzo, mientras que la hidratación fue protectora. Los parámetros acústicos de voz mostraron potencial diagnóstico respaldado por datos de ROC. Los hallazgos subrayan complejidad de síntomas vocales en profesionales de centros de llamadas, requiriendo una evaluación integral. Limitaciones: Este estudio reconoce sus limitaciones, que incluyen una muestra de conveniencia de tamaño moderado y la dependencia de medidas PROMs. Futuras investigaciones deberían incorporar medidas objetivas, además de los autorreportes y análisis acústico. Importancia: Esta investigación aporta nuevos conocimientos sobre factores personales, laborales y síntomas de voz en trabajadores de call centers. El modelado predictivo mejora la evaluación de riesgos y la comprensión de la susceptibilidad individual a trastornos de la voz. Conclusión: Los resultados muestran asociaciones entre diversos factores y los síntomas vocales reportados. Los factores de protección incluyen dormir más de seis horas y una hidratación constante; los factores de riesgo incluyen las condiciones de trabajo, como la ubicación y comportamientos como fumar. Los modelos de diagnóstico indican una buena precisión para algunas PROMs de síntomas de la voz, lo que subraya la necesidad de modelos integrales que tengan en cuenta los factores laborales, los comportamientos vocales y los parámetros acústicos para comprender la complejidad de los problemas de la voz.

Vocal Hygiene: What Are Professional Voice Users Saying About It on YouTube?

PURPOSE: Health content has been presented and accessed freely on social networks and can generate misinformation; hence, this study aimed to analyze the voice guidance in videos available on YouTube. METHOD: This observational cross-sectional research selected the 45 most-viewed videos on YouTube in 2022, produced by professional voice users with guidance on vocal hygiene and well-being. The content was described and compared with the scientific literature on the topic, analyzing which category of professional voice users produced the most scientifically based content. RESULTS: Altogether, 38 topics were found in the videos, distributed in nine blocks, identified from A to I. Block A (foods with a positive effect on the voice) was the only one that had no citations in scientific articles, whereas block D (negative habits for the voice) had the highest mean number of articles in relation to the others. The most publicized guidelines were mainly related to actions and/or behaviors and resources considered positive for the voice. Eight professional categories were found who produced these videos. Singing teachers who also worked as singers produced the most scientifically based content. CONCLUSION: The study showed that not all the information in the videos was scientifically based, which means that people with voice problems have easy access to information that could even harm them if used in their professions.

Zygosity Effects on Human Voice: Fundamental Frequency Analysis of Brazilian Twins' Speech.

Voice production can be influenced by interindividual variations related to genetic, physiological, behavioral, and several environmental factors. Here we examined the effect of zygosity on speaking fundamental frequency (F0) statistical descriptors. Our aims were: (1) to determine whether the genetic similarity between monozygotic (MZ) and dizygotic (DZ) twins affects F0 characteristics, and (2) to quantify the contribution of genetic factors to these characteristics. The study involved 79 same-sex twin pairs of Brazilian Portuguese speakers, comprising 65 MZ and 14 DZ twins, aged 18 to 66 years (31.7 ± 11.6 years), with 21 male and 58 female pairs. Participants were recorded while uttering a greeting phrase and the Brazilian Portuguese version of the 'Happy Birthday to You' song. Speech segments were analyzed using Praat free software, and F0 measures were automatically extracted in both Hertz and semitone scales. Statistical descriptors, including centrality, dispersion, and extreme values of F0 were examined, and the ACE model (i.e., total genetic effects, A; shared environmental influences, C; and nonshared environmental influences, E) was employed to estimate the additive effect;ts of monozygosity. As anticipated, we observed a zygosity effect on several F0 parameters, with more similarity between MZ twins compared to DZ twins. We discuss the genetic influences on F0 parameters and the absence of a monozygosity effect in two of them. Additionally, we briefly address potential biases associated with the selected measurement scale for statistical modeling. Finally, we explore the influence of genetic factors on F0 patterns, as well as environmental, life history and linguistic factors, particularly concerning F0 variation in speech.

Urban Care for Unpaid Caregivers: Community Voices in the Care Block Program, in Bogotá, Colombia.

The Care Block of Bogotá, Colombia, is an urban program that offers services for low-income unpaid caregivers. This study aimed to (i) characterize unpaid caregivers' subjective well-being, mental health symptoms, physical activity levels, and use of public spaces linked to the Care Block; (ii) identify caregivers' perceived built and social environment facilitators and barriers to accessing the Care Block facility; and (iii) document the community-led advocacy process to improve the Care Block program. The quantitative component included a subjective well-being and mental health symptoms survey, and the System for Observing Play and Recreation in Communities (SOPARC) instrument. The qualitative component included the Our Voice citizen science method augmented with portable virtual reality equipment to engage participants in advocacy for changes. Participants (median age of 53 years) dedicated a median of 13.8 h a day to unpaid caregiving, had an average subjective well-being score of 7.0, and 19.1% and 23.8% reported having depression and generalized anxiety symptoms respectively. Caregivers reported that the program fosters their perception of purpose, enjoyment, resilience, and cognitive and emotional awareness. SOPARC evaluation showed that most women engaged in moderate to vigorous physical activity. The caregivers highlighted education, physical activity services, and integration of facilities as facilitators to accessing the Care Block program. Poor quality and lack of sidewalks and roads, limited personal safety, and the risk of pedestrian-vehicle collisions were identified as barriers. Virtual Reality sparked compelling dialogue between participants and stakeholders, allowing stakeholders to reflect on an urban program facilitating unpaid care work.

Emotion Comprehension and Socio-cognitive Skills in Children with High Functioning Autism Spectrum Disorders.

BACKGROUND AND OBJECTIVES: This study aimed to compare socio-cognitive skills and emotion comprehension between children with Autism Spectrum Disorder (ASD) and children with neurotypical development. METHODS: This quantitative, cross-sectional, controlled study involved 19 children in each group, matched by age (6-12 years) and sex. The assessments examined cognitive aspects (Intelligence Quotient was assessed using the Vocabulary and Matrix Reasoning subtests; working memory using the digit span and letter-number sequencing subtests; attention using the Continuous Performance Test - Identical Pairs; and executive functions using the Trail Making Test), social functions (Children's Social Skills, Behavior Problems, and Academic Competence Inventory), and emotion comprehension (language was assessed using the Strange Stories Test; emotional facial expressions using the digital emotion comprehension test; emotional/affective prosody using the Profiling Elements of Prosody in Speech-Communication - Brazilian Portuguese adapted version). RESULTS: The group with ASD exhibited better performance in executive functions (p=0.02). However, they lagged the control group in social skills (p=0.04), behavior problems (p=0.03), and emotion comprehension (language, facial expressions, and prosody) (all p<0.05). CONCLUSION: The findings indicate that children with ASD have diminished performance in social skills and emotion comprehension compared to children with neurotypical development. Therefore, the development of technologies and/or therapeutic interventions that address these deficits among children with ASD is recommended.

Swallowing during provision of helmet ventilation: Review and provisional multidisciplinary guidance.

Use of noninvasive ventilation provided by a helmet increased globally during and after the COVID-19 pandemic. This approach may reduce need for intubation and its associated clinical complications in critically ill patients. Use of helmet interface minimizes virus aerosolization while enabling verbal communication, oral feeding and coughing/expectoration of secretions during its administration. Although improved oral hydration is a recognized benefit of helmet NIV, relatively little is known about the safety and efficiency of swallowing during helmet NIV. Risk of aspiration is a key consideration given the fragile pulmonary status of critically ill patients requiring respiratory support, and therefore the decision to initiate oral intake is best made based on multidisciplinary input. We reviewed the current published evidence on NIV and its effects on upper airway physiology and swallowing function. We then presented a case example demonstrating preservation of swallowing performance with helmet NIV. Last, we offer provisional multidisciplinary guidance for clinical practice, and provide directions for future research.

Cepstral Acoustic Measurements: Influence of Speech Task and Degree of Vocal Deviation.

OBJECTIVE: To analyze whether there are differences in the cepstral measures obtained in different speech tasks, depending on the presence and degree of vocal deviation, and to analyze if there is a correlation between the cepstral measures obtained from different speech tasks and the general degree of vocal deviation. METHOD: Analysis of 258 vocal samples of the sustained vowel [a] and connected speech (counting numbers) from a database, including 160 dysphonic and 98 nondysphonic voices. The counting number samples were edited in three different durations: counting from 1 to 10, from 1 to 11, and from 1 to 20. Five speech-language pathologists (SLPs), voice specialists, carried out the perceptual-auditory judgment of the overall degree of vocal deviation (ODD) using the G from the overall dysphonia grade, roughness, breathiness, asthenia, and strain (GRBAS) scale. We extracted the cepstral peak prominence (CPP) and smoothed cepstral peak prominence (CPPS) measurements from all the vocal samples using an extraction script in the free software Praat. RESULTS: CPP and CPPS were different between dysphonic and nondysphonic individuals, regardless of the speech task, with lower values for dysphonic. Also, CPP values between the vowel and the connected speech tasks were different between both groups. Only the CPPS showed differences between all the speech tasks depending on the degree of vocal deviation. There was a strong negative correlation between the CPPSVowel, CPPS10, CPPS11, CPPS20, and the ODD, and a moderate negative correlation between CPPVowel, CPP10, CPP11, CPP20, and ODD. CONCLUSIONS: There are differences in the cepstral measures obtained in different speech tasks, depending on the presence of dysphonia and ODD. CPP and CPPS values are different between dysphonic and nondysphonic individuals in all speech tasks. There is a moderate negative correlation between CCP in the different speech tasks and ODD, while there is a strong negative correlation between CPPS in the different speech tasks and ODD.

"She has become my best friend": a qualitative study on the perspective of elderly with type 2 diabetes regarding the use of an interactive virtual assistant device for diabetes care and mental health promotion.

AIMS: To qualitatively evaluate the experiences and emotional responses of elderly individuals with type 2 diabetes regarding the use of an interactive virtual assistant device. METHODS AND RESULTS: This qualitative study included elderly individuals who were diagnosed with type 2 diabetes and who had been using the Smart Speaker EchoDot 3rd Gen (Amazon Echo®) device for three months. A structured face-to-face interview with open-ended questions was conducted to evaluate their experiences and emotional responses associated with the device. Data analysis was performed using inductive thematic content analysis with deductive coding followed by narrative synthesis to present the overall perceptions of the participants. Thirty individuals with a mean diabetes duration of 17.1 ± 9.45 years and a mean age of 71.9 ± 5.1 years were interviewed to ensure saturation of responses. Three major themes were identified through response analysis: (1) Emotional response to user experience; (2) Humanization feelings in human-device interactions; (3) Diabetes-related self-care. Overall, participants experienced a wide range of feelings regarding the use of the interactive virtual assistant device, predominantly with positive connotations, highlighting aspects of humanization of technology and its use, and experiencing assistance in self-care related to diabetes. CONCLUSION: Our results highlight the overwhelmingly positive emotional responses and strong sense of humanization expressed by elderly individuals with diabetes toward an interactive virtual assistant device. This underscores its potential to improve mental health and diabetes care, although further studies are warranted to fully explore its impact.

Voz, monotonia e autonomia no ambiente de trabalho de professores / Voice, monotony, and autonomy in teachers' work setting / Voz, monotonía y autonomía en el entorno laboral docente

Introdução: a relação entre voz e trabalho é objeto de estudo constante. Ainda não há investigação sobre a relação de monotonia e autonomia com queixas vocais. Objetivo: investigar a relação entre a monotonia e a autonomia no ambiente de trabalho com o surgimento de queixas vocais entre professores. Método: estudo exploratório, qualitativo e descritivo, realizado a partir de grupo focal considerando o ineditismo da temática do estudo. Dez professores triados em estudo anterior com suspeita de distúrbio de voz pelo Índice de Triagem de Distúrbio de Voz, que indicaram percepção de monotonia e falta de autonomia no ambiente de trabalho por meio do instrumento Condições de Produção Vocal de Professores foram convidados a participar. Sete professores aceitaram e foram conduzidos dois grupos focais. Perguntas disparadoras sobre monotonia e autonomia no ambiente de trabalho foram feitas. Após análise de conteúdo, foram criadas quatro categorias principais e subcategorias de análise. Resultados: os participantes debateram questões relacionadas à quebra de expectativas sobre o trabalho, frustrações, rotina e desafios diários. Considerações sobre a voz estavam relacionadas ao uso repetitivo e por longos períodos e ambiente com acústica desfavorável. Queixas como rouquidão e baixa projeção vocal foram citadas. Conclusão: monotonia no ambiente de trabalho foi percebida como algo repetitivo e as relações com o surgimento de queixas vocais podem estar relacionadas a situações de uso da voz de forma intensa e constante. A falta de autonomia parece ocasionar a monotonia e, consequentemente, desmotivação, frustração com a carreira e adoecimento, dentre eles, o distúrbio de voz. (AU)

Introduction: the relationship between voice and work is the subject of constant study. There is still no investigation into the relationship between monotony and autonomy and vocal complaints. Objective:to investigate the relationship between monotony and autonomy in the workplace with the emergence of vocal complaints among teachers. Method: exploratory, qualitative and descriptive study, carried out through a focus group considering the novelty of the study theme. Ten teachers screened in a previous study with suspected voice disorders using the Voice Disorder Screening Index, who indicated a perception of monotony and lack of autonomy in the work environment using the Teacher Vocal Production Conditions instrument were invited to participate. Seven teachers accepted and two focus groups were conducted. Triggering questions about monotony and autonomy in the workplace were asked. After content analysis, four main categories and subcategories of analysis were created. Results: participants discussed issues related to broken expectations about work, frustrations, routine and daily challenges. Considerations about the voice were related to repetitive use for long periods and an environment with unfavorable acoustics. Complaints such as hoarseness and low vocal projection were cited. Conclusion: monotony in the work environment was perceived as something repetitive and the relationship with the emergence of vocal complaints may be related to situations of intense and constant use of the voice. The lack of autonomy seems to cause monotony and, consequently, demotivation, frustration with one's career and illness, including voice disorders. (AU)

Introducción: la relación entre voz y trabajo es objeto de constante estudio. Todavía no se ha investigado la relación entre monotonía, autonomía y quejas vocales. Objetivo: investigar la relación entre monotonía y autonomía en el lugar de trabajo con la aparición de quejas vocales entre docentes. Método: estudio exploratorio, cualitativo y descriptivo, realizado a través de un grupo focal considerando la novedad del tema de estudio. Se invitó a participar a diez docentes evaluados en un estudio previo con sospecha de trastornos de la voz mediante el Voice Disorder Screening Index, que indicaron una percepción de monotonía y falta de autonomía en el ambiente de trabajo utilizando el instrumento Teacher Vocal Production Conditions. Siete profesores aceptaron y se realizaron dos grupos focales. Se formularon preguntas desencadenantes sobre la monotonía y la autonomía en el lugar de trabajo. Luego del análisis de contenido, se crearon cuatro categorías y subcategorías principales de análisis. Resultados:los participantes discutieron cuestiones relacionadas con expectativas rotas sobre el trabajo, frustraciones, rutina y desafíos diarios. Las consideraciones sobre la voz estuvieron relacionadas con el uso repetitivo por períodos prolongados y un ambiente con acústica desfavorable. Se citaron quejas como ronquera y baja proyección vocal. Conclusión: la monotonía en el ambiente laboral fue percibida como algo repetitivo y la relación con la aparición de quejas vocales puede estar relacionada con situaciones de uso intenso y constante de la voz. La falta de autonomía parece provocar monotonía y, en consecuencia, desmotivación, frustración con la propia carrera y enfermedades, incluidos trastornos de la voz. (AU)

Estudantes de fonoaudiologia: autoavaliação da voz, sintomas vocais e diagrama de desvio fonatório / Speech pathologist students: voice self-assessment, vocal symptoms and phonatory deviation diagram / Estudiantes de fonoaudiología: autoevaluación de la voz, síntomas vocales y diagrama de desviación fonatoria

Introdução: considera-se importante que fonoaudiólogos apresentem suas vozes como modelo ao realizar uma intervenção fonoaudiológica. Objetivo: conhecer a autoavaliação da voz e sintomas vocais de um grupo de acadêmicos de fonoaudiologia relacionando os achados ao diagrama de desvio fonatório. Método: estudo do tipo analítico, observacional, com 88 estudantes de Fonoaudiologia de uma mesma faculdade, 82 mulheres e seis homens, média de idade de 21,9 anos, sem diagnóstico de disfonia, autorreferidos saudáveis. Foram registrados e comparados dados relativos à autoavaliação da voz e de sintomas vocais, utilizando-se a Escala de Sintomas Vocais. Numa segunda etapa os estudantes foram convidados a realizar uma análise acústica de suas vozes e os que aceitaram (63,6%) procederam com a coleta das amostras de voz, programa VoxMetria® ­ CTS. Para tratamento dos dados foram utilizados Teste T ­ student e Matriz de Correlações construída com os resultados do Teste T- student (nível de confiança de 95%, alpha 5%). Resultados: a Escala de Sintomas Vocais revelou 44,31% dos participantes com escores brutos igual ou superior a 16 pontos, indicando risco vocal, com maior comprometimento do domínio físico. Alunos do último ano obtiveram escores mais elevados, com predomínio de secreção e pigarro na garganta. Houve correlação positiva entre fumar (7,95%) e aumento da nota final. A análise acústica revelou 40% das vozes com diagrama de desvio fonatório fora do quadrante de vozes normais, irregularidade da voz, jitter e shimmer alterados. Conclusão: a combinação dos dois instrumentos utilizados para conhecimento de risco de disfonia em estudantes de Fonoaudiologia mostra-se relevante e reforça a importância de programas de prevenção de saúde vocal também em futuros fonoaudiólogos. (AU)

Introduction: speech therapists must present their voices as a model for a speech therapy intervention. Objective: to understand the voice self-assessment and vocal symptoms of a group of speech therapy students, relating the findings to the phonatory deviation diagram. Method: an analytical observational study was conducted with 88 speech therapy students from the same college, consisting of 82 women and 6 men, averaging 21.9 years old, who reported no diagnosis of dysphonia, and self-reported as healthy. Data relating to voice self-assessment and vocal symptoms were recorded and compared, using the Vocal Symptoms Scale (VoiSS). In the second stage, students were invited to perform an acoustic analysis of their voices and those who accepted (63.6%) proceeded with the collection of voice samples, using the VoxMetria® ­ CTS program. To process the data, the T-student Test and Correlation Matrix constructed with the results of the T-student Test (confidence level of 95%, alpha 5%) were used. Results: The Vocal Symptoms Scale (student T-test) revealed 44.31% of participants with raw scores equal to or greater than 16 points, indicating vocal risk and greater impairment of the physical domain. Final year students obtained higher scores, with a predominance of secretion and throat clearing. There was a positive correlation between smoking (7.95%) and an increase in the final grade. The acoustic analysis revealed 40% of the voices with a phonatory deviation diagram outside the quadrant of normal voices, voice irregularity, altered jitter, and shimmer. Conclusion: The combination of the two instruments used to understand the risk of dysphonia in speech therapy students is relevant and reinforces the importance of vocal health prevention programs for future speech therapists. (AU)

Introducción: los fonoaudiologos deben presentar su voz como modelo para realizar una intervención logopédica. Objetivo: comprender la autoevaluación vocal y los síntomas vocales de un grupo de estudiantes de fonoaudiología, relacionando los hallazgos con el diagrama de desviación fonatoria. Método: se realizó un estudio observacional analítico, observacional, con 88 estudiantes de fonoaudiología de la misma facultad, conformados por 82 mujeres y 6 hombres, com edad promedio de 21,9 años, quienes no refirieron diagnóstico de disfonia y se autorefiriron como sanos. Los datos relacionados con la autoevaluación de la voz y los síntomas vocales se registraron y compararon mediante la Escala de Síntomas Vocales. En la segunda etapa, los estudiantes fueron invitados a realizar un análisis acústico de sus voces y los que aceptaron (63,6%) procedieron a la recolección de muestras de voz, utilizando el programa VoxMetria® ­ CTS. Para procesar los datos se utilizó la Prueba T de Student y la Matriz de Correlación, construida con los resultados de la Prueba T de Student (nivel de confianza del 95%, alfa 5%). Resultados: La Escala de Síntomas Vocales (prueba T de Student) reveló puntuaciones brutas iguales o superiores a 16 puntos (44,31%), lo que indica riesgo vocal y mayor afectación del dominio físico. Los estudiantes de último año obtuvieron puntuaciones más altas, con predominio de secreción y carraspeo. Hubo correlación positiva entre fumar (7,95%) y aumento en la nota final. El análisis acústico reveló voces presentando diagrama de desviación fonatoria fuera del cuadrante de normaliadad (40%), irregularidad de la voz, jitter y shimmer alterados. Conclusión: La combinación de los dos instrumentos utilizados para comprender el riesgo de disfonía en estudiantes de fonoaudiologia es relevante y refuerza la importancia de los programas de prevención de la salud vocal para futuros fonoaudiologos. (AU)

Fonoaudiologia empresarial: revisão de dissertações defendidas entre 2002-2022 / Corporate speech therapy: review of dissertations and theses defended between 2002-2022 / Fonoaudiología corporativa: revisión de disertaciones y tesis defendidas entre 2002-2022

Introdução: o presente estudo visa mapear e avaliar a produção registrada sobre Fonoaudiologia Empresarial, a fim de identificar as temáticas mais pesquisadas, bem como as temáticas pouco exploradas em dissertações e teses na área. Objetivo: analisar a produção científica brasileira defendida entre 2002-2022, considerando nível de produção, ano, rede de ensino, instituição de ensino superior (localização geográfica), tipo de pesquisa, descritor registrado (primeiro), local, temática, total da amostra pesquisada e áreas de conhecimento. Método: revisão realizada na Biblioteca Digital Brasileira de Teses e Dissertações, em 05 de maio de 2023, considerando os termos "Fonoaudiologia" e "Empresa", pesquisados no período 2002-2022, segundo as variáveis anteriormente descritas, analisados de forma descritiva. Resultados:dentre 30 fontes registradas, 24-80,0% são dissertações, sendo 2007 o ano mais produtivo (6-20,0%). A Região Sudeste liderou a pesquisa (20-66,7%), representada pela PUC-SP (10-33,3%) e o destaque foi de pesquisas do tipo observacional (22-73,3%), sendo Empresas os locais mais pesquisados (20-66,7%) e o descritor "saúde do trabalhador" o mais utilizado (03-10,0%). A área de conhecimento (CNPq) que mais pesquisou foi Ciências da Saúde (25-83,3%) por meio da subárea Fonoaudiologia (20-66,7%%), sendo a Audiologia a temática mais pesquisada (16-53,3%). Conclusão: foram encontrados 16,53,3% registros na área de Audiologia e as pesquisas realizadas na área de Voz (7-23,3%) abordam os temas relacionados a qualidade vocal, comunicação e expressividade, no entanto, não abordam liderança. Tal dado sugere esforços em pesquisas científicas e atuação profissional, já que a Fonoaudiologia tem como objeto de estudo e atuação, a comunicação humana.(AU)

Introduction: this study aims to explore the Speech-Therapy's literature and its contribution to identify the most researched and few explored themes in dissertations and theses in the area. Objective:to analyze the Brazilian scientific production submitted between 2002 and 2022, considering production level, publication year, institution of defense, geographical location, research methodology, the first descriptor, research location, the thematic focus, total sample size and knowledge areas. Method: the review analysis was conducted using data obtained from the Brazilian Digital Library of Theses and Dissertations on May 5, 2023, using the terms: "Speech-Therapy" and "Company" to retrieve theses and dissertations from 2002 to 2022 according to the variables described above. Data were analyzed descriptively. Results: among the 30 entries retrieved, 24-80,0% were dissertations, most of which defended in 2007 (6-20,0%). The majority of the studies were from the Southeast region (20- 66.7%), represented by Pontifícia Universidade Católica de São Paulo: PUC-SP (10-33.3%) and the highlight was observational researches (22-73.3%) and the majority of the research was conducted at business companies (20-66,7%). In addition, "worker's health" was the most used descriptor (3-10,0%). The knowledge area (CNPQ) that produced the most studies was Health Sciences (25-83,3%) through the subarea of Speech-Language-Pathology (20-66,7%%), with Audiology being the most researched theme (16-53,3%). Conclusion: Audiology was the area with the highest number of studies found 16,53,3%. Research conducted in the Voice field (7-23,3%) addresses topics related to vocal quality, communication and expressiveness, however, they do not address leadership. The findings suggest a need for future research. Further studies can build upon insights to advance knowledge and promote evidence-based practice in the field of business companies, considering that Speech-Therapy has as its object of study and activity human communication. (AU)

Introducción: este estudio tiene como objetivo mapear y evaluar la producción grabada sobre Fonoaudiología Empresarial, con el fin de identificar los temas más investigados, así como los temas poco explorados en disertaciones y tesis en el área. Objetivo: analizar la producción científica brasileña defendida entre 2002-2022, considerando nivel de producción, año, red educativa, institución de educación superior (ubicación geográfica), tipo de investigación, descriptor registrado (primero), ubicación, tema, muestra total investigada y áreas. del conocimiento. Método: revisión realizada en la Biblioteca Digital Brasileña de Tesis y Disertaciones, el 5 de mayo de 2023, considerando los términos "Fonoaudiología" y "Empresa", investigados en el período 2002-2022, según las variables previamente descritas, analizadas en una manera descriptiva. Resultados: entre 30 fuentes registradas, 24-80,0% son disertaciones, siendo 2007 el año más productivo (6-20,0%). La Región Sudeste lideró la investigación (20-66,7%), representada por la PUC-SP (10-33,3%) y destaque para la investigación observacional (22-73,3%), siendo las Empresas las localidades más investigadas (20-66,7%) y el descriptor "salud del trabajador" el más utilizado (03-10,0%). El área del conocimiento (CNPq) más investigada fue Ciencias de la Salud (25-83,3%) a través de la subárea Fonoaudiología (20-66,7%), siendo la Audiología el tema más investigado (16-53,3%). Conclusión: Se encontraron 16,53,3% registros en el área de Audiología y las investigaciones realizadas en el área de Voz (7-23,3%) abordan temas relacionados con la calidad vocal, la comunicación y la expresividad, sin embargo, no abordan el liderazgo. Estos datos sugieren esfuerzos en la investigación científica y en el desempeño profesional, ya que la Fonoaudiología tiene como objeto de estudio y actividad la comunicación humana. (AU)

Health actions and occupational vocal conservation: how are they being implemented?

The actions in Occupational Speech Therapy are becoming more evident with the emergence of new experiences and interventions that aim to intercept the disease process, emphasizing the prevention and protection of vocal health in the occupational context. This work aims to analyze how health and occupational vocal conservation actions are being implemented. This is an integrative literature review, whose survey was carried out from June to October 2020, in the Capes Periódicos platform, using the descriptors "worker's health" and voice. After applying the defined exclusion and inclusion criteria and subtraction of repeated publications, a total of 16 articles were selected. The teacher's voice has been a priority object in Brazilian speech therapy research in recent years. The results presented show the importance of health promotion actions that aim at the well-being of workers as a whole, in an integral and multidisciplinary way. Occupational vocal health and conservation actions encompass activities related to vocal health surveillance and risk conditions for the development of voice disorders, vocal health education, direct vocal interventions, voice assessment, laryngological assessment, referrals and assessment of workers' perception of the proposed actions.

As ações em Fonoaudiologia do Trabalho vêm se tornando mais evidentes com o surgimento de novas experiências e intervenções que visam interceptar o processo da doença, enfatizando a prevenção e a proteção da saúde vocal no contexto ocupacional. Este trabalho visa analisar como estão sendo implementadas as ações de saúde e conservação vocal ocupacional. Tratou-se de uma revisão bibliográfica integrativa, cujo levantamento foi realizado no período de junho a outubro de 2020 na plataforma Periódicos CAPES, utilizando-se os descritores "saúde do trabalhador" e "voz". Após a aplicação dos critérios de exclusão e inclusão definidos e subtração das publicações repetidas, foi selecionado um total de 16 artigos. A voz de professores vem sendo objeto priorizado nas pesquisas fonoaudiológicas brasileiras nos últimos anos. Os resultados apresentados elencam a importância de ações de promoção da saúde, que objetivem o bem-estar dos trabalhadores como um todo, de forma integral e multidisciplinar. As ações de saúde e conservação vocal ocupacional englobam atividades relacionadas à vigilância da saúde vocal e de condições de risco para o desenvolvimento dos distúrbios de voz, à educação em saúde vocal, a intervenções vocais diretas, à avaliação da voz e laringológica, a encaminhamentos e à avaliação da percepção dos trabalhadores diante das ações propostas.

Is tetrodotoxin intoxication the cause of "zombi voice" in Haiti?

OBJECTIVE: Zombification, a magical and religious process in Haiti, has been scientifically studied and remains relevant. Originating from the convergence of African, Caribbean, and Christian rites, it involves a comatose trance, transforming individuals into living dead through Voodoo practices. Haitian zombies consistently exhibit a preserved expression marked by a nasal voice, a result of nasalization-using nasal cavities as resonators during phonation. The aim of this study was to ascertain the mechanisms through which zombification could impact the voices of the subjects. METHODS: A comprehensive investigation was conducted using both primary and secondary sources. Primary sources involved direct or reported testimonies of individuals undergoing zombification, with audio or video recordings available from the collections of the Laboratory of Anthropology, Archaeology, and Biology (UVSQ/Paris-Saclay University), as well as on the internet. Secondary sources encompassed the entirety of existing literature regarding zombification in Haiti on one hand, alterations in the voices of subjects when mentioned on the other hand, and toxicological hypotheses or evidence available on PubMed/Medline and Google Scholar. RESULTS: Few post-zombification observations exist, but 20th-century studies clarified the physio pathological process, confirming its reality. Wade Davis demonstrated in 1983 that zombification results from poisoning, with effects ranging from reversible to fatal, implicating substances like tetrodotoxin and datura. Nasalization can be natural or pathological, affecting various phonemes. No mutilating acts or surgery have been reported related to Haitian zombification. CONCLUSION: The pharmacological characteristics of tetrodotoxin, coupled with testimonials, present a medical hypothesis elucidating the biological mechanism underlying nasalization in this context. Given that tetrodotoxin induces flaccid paralysis as a neurotropic poison, its neurological impact could account for soft palate paralysis or spasms. Additionally, the severe hypotension induced by tetrodotoxin may elucidate oral and pharyngeal necrosis.

Prevalence and Risk Factors for Occupational Voice Disorders in Nepalese Teachers: A Cross-Sectional Study.

Introduction Teachers are a high-risk group for the development of vocal dysfunction, as they use voice extensively in their profession. Objective To know the prevalence and risk factors associated with voice strain in teachers. Methods A cross-sectional study was conducted among schoolteachers in Chitwan, Nepal. The Voice Handicap Index questionnaire was used as a survey tool. Result A total of 315 teachers were enrolled in the study. The mean age of the participants was of 36.7 years. Teachers from public schools, primary grade classes, > 50 pupils in the classroom, > 24 hours of classes per week, dust in class, and recurrent tonsil problems were associated with various degrees of vocal handicap. Conclusion There is a high prevalence of voice disorder among teachers. A holistic approach, which includes teacher education regarding voice care during their work and management of their voice handicap by taking into consideration different risk factors, must be adopted.

Reliability, Measurement Error, and Responsiveness of the Voice Handicap Index: A Systematic Review and Meta-analysis.

OBJECTIVE: To analyze the reliability, measurement error, and responsiveness of the Voice Handicap Index (VHI) for measuring voice handicap in individuals with voice disorders. METHODS: This systematic review followed the recommendations of the COnsensus-based Standards for the Selection of Health Measurement INstruments. Studies that validated the VHI, analyzed the measurement properties of reliability, measurement error, or responsiveness, and had dysphonic individuals as the study population were included. The following electronic databases were searched: Cochrane Library, EMBASE, LILACS, PubMed, Scopus, and Web of Science. The manual search was carried out on gray literature in the Biblioteca Digital Brasileira de Teses e Dissertações and ProQuest Dissertation & Theses, in addition to mapping citations and consulting an expert in the field. Evidence selection, data extraction, risk of bias analysis, certainty of evidence, and good psychometric measurements were performed by two blinded and independent reviewers. A meta-analysis was performed using Fisher's transformed r-to-z correlation coefficient and standardized mean difference. Heterogeneity was calculated using Tau² and I² statistical tests in JAMOVI 2.3.2 software. RESULTS: Eighty studies were included in the meta-analysis. When assessing the risk of bias, most studies were classified as inadequate during the reliability and measurement error stages. In the responsiveness stage, they were classified as doubtful in the sensitivity and specificity sub-boxes and good in the comparison sub-box with a gold standard instrument. For psychometric properties, most studies were classified as indeterminate in terms of both reliability and responsiveness. In test-retest reliability and responsiveness, the average outcome differed significantly from zero, indicating agreement between the test and retest moments and a significant reduction in the VHI score after intervention. Considering certainty of the evidence, the level of evidence was very low in both the reliability and responsiveness stages. The analyzed studies did not evaluate observational errors, and hence, they were not considered in this review. CONCLUSION: The VHI proved to be reliable and responsive in measuring voice handicap. However, it should be used with caution, as there is heterogeneity, a risk of bias, and no adherence to the analysis of observational error.

Trabajo interdisciplinario en las profesiones de la voz humana: retos, límites y proyecciones

El presente documento resume los principales aportes del conversatorio titulado "Trabajo interdisciplinario en las profesiones de la voz humana: retos, límites y proyecciones", organizado por Vocology Center el 18 de julio de 2023, que reunió a líderes y representantes de diversas agremiaciones relacionadas con la voz humana, incluyendo profesionales del ámbito clínico, artístico, rehabilitación vocal, voz ocupacional, pedagogía vocal y otras disciplinas afines. El propósito de este conversatorio fue promover un debate crítico sobre la naturaleza del trabajo interdisciplinario en el estudio de la voz humana. Se exploraron los desafíos que surgen al configurar equipos de trabajo que incluyan profesionales con diferentes enfoques y experticias en el abordaje de la voz, así como los límites inherentes a los diversos roles y funciones desempeñados por los profesionales especializados en este campo, junto con las cuestiones éticas emergentes en este proceso. Con un enfoque encaminado a fortalecer alianzas interdisciplinarias, el evento se centró en la búsqueda de una comunicación y colaboración más efectiva. Este documento marca un avance significativo en la comprensión y colaboración interdisciplinar en el cuidado de la voz humana.

This document summarizes the main contributions of the panel discussion titled "Interdisciplinary work in the human voice professions: challenges, limits and projections" organized by the Vocology Center on July 18, 2023. The event brought together leaders and representatives from various associations related to the human voice, including professionals from the clinical, artistic, vocal rehabilitation, occupational voice, vocal pedagogy, and other related disciplines. The purpose of this panel discussion was to promote a critical debate on the nature of interdisciplinary work in the study of the human voice. The discussion explored the challenges that emerge when teams that include professionals with different approaches and expertise address voice production, as well as the inherent boundaries of the various roles and functions performed by specialized professionals in this field, along with the emerging ethical issues in this process. With a focus on strengthening interdisciplinary collaborations, the event centered on seeking more effective communication and collaboration. This document represents a significant step forward in understanding and fostering interdisciplinary cooperation in the care of the human voice.

Voice Disorder, Job Stress, and COVID-19 in Teachers: Impacts in Times of Pandemic

Introduction: The conditions of teachers' work during the COVID-19 pandemic affected teachers' lives regarding voice disorder and stress, even in emergency remote classroom situation. Objective: To analyze the relationship between the presence of voice disorder, job stress, and COVID-19 in teachers when in emergency remote classroom teaching situation at the time of the pandemic. Method: This is a primary, exploratory, observational cross-sectional study with the use of survey forwarded online during the period of emergency classes after the arrival of COVID-19 pandemic in Brazil. The teachers answered the sociodemographic questions about the presence of COVID-19 and the following instruments: Condition of Vocal Production-Teacher [Condição de Produção Vocal - Professor (CPV-P)], Screening Index for Voice Disorder (SIVD), and Job Stress Scale (JSS). Results: Of the 118 teachers analyzed, 94.1% were female; the average age was 44 years. The SIVD recorded the presence of voice disorder in 66.9% of the participants. Regarding the JSS, which are the findings related to stress at work in the demand domain, the teachers showed high levels, a fact which presupposes the existence of pressure of psychological nature to perform their work. Conclusion: The teachers self-reported the presence of voice disorder even in remote class situation, on the occasion of COVID-19, which were more common in older teachers. When comparing the presence of voice disorders, coronavirus symptoms, and stress domains in relation to demand, control, and social support, there was no significance. It is hoped that this study will help to reflect on the need to improve teachers' working conditions, strengthening work-related voice disorder actions and guiding actions for vocal care and well-being.

Introducción: Las condiciones de trabajo de los profesores durante la pandemia de COVID-19 afectaron sus vidas en lo que respecta al trastorno de la voz y el estrés, incluso en situaciones de emergencia en aulas remotas. Objetivo: Analizar la relación entre la presencia de trastorno de la voz, estrés laboral y COVID-19 en profesores cuando se encontraban en situación de emergencia de enseñanza en aulas remotas en la época de la pandemia. Método: Se trata de un estudio primario, exploratorio, observacional de tipo transversal, con el uso de encuesta remitida online durante el periodo de clases de emergencia tras la llegada de la pandemia de COVID-19 en Brasil. Los profesores respondieron a las preguntas sociodemográficas sobre la presencia de COVID-19 y a los siguientes instrumentos: Condición de Producción Vocal-Profesor (CPV-P), Índice de Detección de los Trastornos de la Voz (SIVD) y Escala de Estrés Laboral (JSS). Resultados: De los 118 profesores analizados, el 94,1% eran mujeres; la mediana de edad era de 44 años. El (SIVD) registró la presencia de trastorno de la voz en el 66,9% de los participantes. En cuanto a la JSS, que son los hallazgos relacionados con el estrés laboral en el dominio de la demanda, los profesores mostraron niveles elevados, hecho que presupone la existencia de presiones de naturaleza psicológica para realizar su trabajo. Conclusión: Los profesores autoinformaron de la presencia de trastornos de la voz incluso en situación de clase a distancia, con ocasión del COVID-19, que fueron más frecuentes en los profesores de más edad. Al comparar la presencia de trastornos de la voz, los síntomas del coronavirus y los dominios de estrés en relación con la demanda, el control y el apoyo social, no hubo resultados significativos. Se espera que este estudio ayude a reflexionar sobre la necesidad de mejorar las condiciones de trabajo de los docentes, fortaleciendo las acciones de Trastorno de la voz relacionado con el trabajo (WRVD) y orientando acciones para el cuidado y bienestar vocal.

Vocal Approach to Transgender Individuals: The Journey Taken in Chile and Argentina

In recent years, there have been international references to the vocal approach for the specific group of transgender individuals, although the Latin American literature is still very timid on this matter. The purpose of this article is to identify the current norms, statistics, and vocal approach towards transgender individuals in Chile and Argentina, considering the experience of two speech and language pathologists with more than twenty years of experience on voice therapy. Reflections were made on the transgender reality in these countries, the limitations in the implementation of the depathologization of the transgender group were outlined, some current and unreliable statistics were presented, some innovative actions in the public system were highlighted, and the lack of knowledge about the benefits of vocal work for transgender men and women was discussed. The identified aspects could benefit from multicenter research that strengthens speech therapy actions with this group, contributing to depathologization and positive approach.

Desde los últimos años es posible encontrar referencias internacionales sobre el abordaje vocal al grupo específico de las personas transgénero, aunque la literatura latinoamericana sigue muy tímida en este asunto. La propuesta de este artículo es identificar las normas vigentes, estadísticas y abordaje vocal hacia las personas transgénero en Chile y Argentina, considerando la experiencia de dos fonoaudiólogas con más de veinte años de experiencia en terapia vocal. Se hicieron reflexiones sobre la realidad transgénero en los países citados, se delinearon las limitaciones en la puesta en práctica de la despatologización del grupo transgénero, se expusieron algunas estadísticas -vigentes y poco confiables-, se plasmaron algunas acciones novedosas en el sistema público y el desconocimiento sobre los beneficios del trabajo vocal en hombres y mujeres transgénero. Los aspectos detectados podrían beneficiarse de investigaciones multicéntricas que fortalezcan acciones fonoaudiológicas con este grupo, contribuyendo a la despatologización y el abordaje positivo.

Adaptación y validación del Voice Handicap Index y su versión abreviada al español rioplatense de Argentina

Objetivo: Este estudio tuvo como objetivo principal validar el Voice Handicap Index (VHI) y su versión abreviada (VHI-10) adaptados al español rioplatense de Argentina, con objetivos específicos centrados en evaluar su fiabilidad y validez. Metodología: La adaptación cultural incluyó técnicas de traducción directa, síntesis y retrotraducción, evaluación de la equivalencia semántica y aplicación a un grupo piloto. Para la validación se evaluó la fiabilidad de ambos índices adaptados mediante la consistencia interna (coeficiente alfa de Cronbach) y la estabilidad test-retest (prueba de Bland-Altman, CCI y r de Spearman). Además, se examinó la validez de criterio y de constructo. 213 sujetos participaron en la validación del índice adaptado de 30 ítems (123 disfónicos; 90 de control); 113, en la del índice abreviado (63 disfónicos; 50 de control). Resultados: Se constituyó el Índice de Desventaja Vocal (IDV) como la versión adaptada del VHI al español rioplatense de Argentina. Ambos índices demostraron excelente consistencia interna (IDV-30 α = 0,96; IDV-10 α = 0,92) y estabilidad y concordancia (IDV-30 CCI = 0,95; IDV-10 CCI = 0,96). Se halló alta correlación entre los puntajes de ambos índices y la autoevaluación de la severidad de la disfonía de los participantes (r = 0,85). Ambos índices demostraron capacidad de diferenciar entre individuos con disfonía y sujetos sanos (p< 0,001). El análisis factorial reveló tres factores para el IDV-30 y un factor para el IDV-10. Conclusiones: El IDV-30 e IDV-10 presentan grados adecuados de fiabilidad y validez. Ambos pueden ser incluidos en protocolos de valoración de la función vocal por profesionales de Argentina.

Aim: This study aimed to validate the Voice Handicap Index (VHI) and its abbreviated version (VHI-10) adapted into Rioplatense Spanish from Argentina, with specific goals centered on assessing their reliability and validity. Methods: Cultural adaptation involved direct translation, synthesis and back-translation techniques, followed by an assessment of semantic equivalence and application to a pilot group. For the validation process, the reliability of both adapted indices was assessed through measures of internal consistency (Cronbach's alpha coefficient) and test-retest stability (Bland-Altman test, ICC and Spearman's correlation coefficient). Additionally, we conducted analyses to asses criterion and construct validity. 213 subjects participated in the validation of the adapted 30-items index, (123 with dysphonia; 90 from control group); 113, in the abbreviated version (63 with dysphonia; 50 from control group). Results: The "Índice de Desventaja Vocal" (IDV) was established as the adapted version of the VHI into Rioplatense Spanish from Argentina. Both indeces exhibited excellent internal consistency (IDV-30 α = 0,96; IDV-10 α = 0,92) and satisfactory stability and agreement (IDV-30 CCI = 0,95; IDV-10 CCI = 0,96). Regarding validity, a strong correlation was observed between the scores of both indeces and the participant's self-assessment of dysphonia degree (r = 0,85). Both indices effectively differentiated between individuals with dysphonia and healthy subjects (p< 0,001). Factor analysis revealed three factors for the IDV-30 and one factor for the IDV-10. Conclusion: The IDV-30 and IDV-10 demonstrate satisfactory levels of reliability and validity. Both indices can be incorporated into the assessment protocols for evaluating the vocal function by professionals in Argentina.

Behind the Headset: Predictive Accuracy of Patient-Reported Outcome Measures for Voice Symptoms in Call Centers

Objective: This study examines factors predicting self-reported voice symptoms in call center workers. Methods: Multivariate analysis and predictive modeling assess personal, work-related, acoustic, and behavioral factors. Generalized Linear Models (GLMs) and Receiver Operating Characteristic (ROC) curves are employed. Results: Age and sleep patterns impacted voice quality and effort, while workplace factors influenced symptom perception. Unhealthy vocal behaviors related to tense voice and increased effort, while hydration was protective. Voice acoustics showed diagnostic potential, supported by ROC data. These findings emphasize voice symptom complexity in call center professionals, necessitating comprehensive assessment. Limitations: This study recognizes its limitations, including a moderate-sized convenience sample and reliance on PROM metrics. Future research should incorporate more objective measures in addition to self-reports and acoustic analysis. Value: This research provides novel insights into the interplay of personal, occupational, and voice-related factors in developing voice symptoms among call center workers. Predictive modeling enhances risk assessment and understanding of individual susceptibility to voice disorders. Conclusion: Results show associations between various factors and self-reported voice symptoms. Protective factors include sleeping more than six hours and consistent hydration, whereas risk factors include working conditions, such as location and behaviors like smoking. Diagnostic models indicate good accuracy for some voice symptom PROMs, emphasizing the need for comprehensive models considering work factors, vocal behaviors, and acoustic parameters to understand voice issues complexity.

Objetivo: Este estudio examina los factores que predicen los síntomas de voz en los trabajadores de call centers. Métodos: Se utilizan análisis multivariados y modelos predictivos para evaluar factores personales, laborales, acústicos y de comportamiento. Se emplean Modelos Lineales Generalizados (GLM) y curvas ROC. Resultados: La edad y los patrones de sueño afectaron la calidad vocal y el esfuerzo, mientras que los factores laborales influyeron en la percepción de síntomas. Los comportamientos vocales no saludables se relacionaron con voz tensa y mayor esfuerzo, mientras que la hidratación fue protectora. Los parámetros acústicos de voz mostraron potencial diagnóstico respaldado por datos de ROC. Los hallazgos subrayan complejidad de síntomas vocales en profesionales de centros de llamadas, requiriendo una evaluación integral. Limitaciones: Este estudio reconoce sus limitaciones, que incluyen una muestra de conveniencia de tamaño moderado y la dependencia de medidas PROMs. Futuras investigaciones deberían incorporar medidas objetivas, además de los autorreportes y análisis acústico. Importancia: Esta investigación aporta nuevos conocimientos sobre factores personales, laborales y síntomas de voz en trabajadores de call centers. El modelado predictivo mejora la evaluación de riesgos y la comprensión de la susceptibilidad individual a trastornos de la voz. Conclusión: Los resultados muestran asociaciones entre diversos factores y los síntomas vocales reportados. Los factores de protección incluyen dormir más de seis horas y una hidratación constante; los factores de riesgo incluyen las condiciones de trabajo, como la ubicación y comportamientos como fumar. Los modelos de diagnóstico indican una buena precisión para algunas PROMs de síntomas de la voz, lo que subraya la necesidad de modelos integrales que tengan en cuenta los factores laborales, los comportamientos vocales y los parámetros acústicos para comprender la complejidad de los problemas de la voz.