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In so doing, we laid out a path towards expansion of the field of occupational health, to enable analysis and interventions relating to a health problem that is still not very visible and for which work-related preventive actions and health promotion actions are still implemented only timidly or are non-existent. Our review was built on a basic observation, of which different social groups have become aware over recent decades: workers who use their voices intensely to carry out their activities are victims of illness that affects vocal production.

It describes the debate about the terms that best define this illness, its nature and causes, the ways in which official recognition of the phenomenon can be achieved and the care that needs to be provided for workers affected by it.

The analysis comprises three strands: a technical-scientific, in which the connection between voice disorders and work is discussed; b juridical-institutional, on the institutional forms of recognition of voice disorders; and c both of the preceding strands contextualize and support political-professional analysis, in which mobilization of social actors towards advocating recognition of work-related voice disorders WRVDs is discussed.

Consequently, documents were produced with the purposes of standardizing behaviors and defining technical norms for management of WRVDs and work-related laryngeal disease WRLD , such as the 3rdvoice consensus Protocolo de Complexidade Diferenciada. In addition to these initiatives, other actions have contributed towards greater visibility for WRVDs, such as voice campaigns Rev Soc Bras Fonoaudiol ; 14 1 Method This study comprised a narrative review, i.

It is presented as a critical and personal analysis by its authors, without any claim regarding its capacity for generalization Rother ET. Acta Paul Enferm ; 20 2 :v-vi. Since the authors of this review have participated in seeking recognition for WRVDs, they are both objects and subjects of this history.

The primary sources used were technical documents, articles in scientific journals and annals of events, which formed the basis for the historical narrative about WRVDs, tailored in accordance with the current legislation.

Technical-scientific analysis Empirical evidence on the relationship between work and voice disorders Although voice disorders are not yet on official WRD lists, many studies have empirically supported this linkage. Teachers are the group making professional use of the voice that has been studied most, in terms of the numbers of workers or working conditions, or because of the ease of investigation.

Epidemiological research has revealed that the prevalence of voice disorders among teachers is high, and that this is associated with environmental factors and work organization. The criticism that can be made regarding these studies is that they are of variable quality, had different operational definitions, used irregular methods, were not always well designed, did not use control groups and used self-reference as the means for scoring voice disorders, thus compromising the quality of the evidence Williams NR.

Occupational groups at risk of voice disorders: a review of the literature. Occ Med ; 53 7 Voice Disorder: case definition and prevalence in teachers.

Rev Bras Epidemiol ; 10 4 However, in more recent studies, the designs have been better, with greater sophistication of methods, thus resulting in evidence of greater robustness Voice disorders in teachers and their associations with work-related factors: a systematic review.

J Commun Disord ; 46 2 Voice disorders in teachers. A review.

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J Voice ; 28 6 In the WRVD protocol A recent systematic review showed that occurrences of voice disorder among teachers were increasing in comparison with other occupations, and were more commonly associated with presence of classroom noise, habitual use of a loud voice and being a physical education teacher In another review study The associated factors identified were inadequate classrooms, excessive noise, health problems and lifestyle habits. It can be emphasized that, even if there are personal factors that can trigger a voice disorder, environmental factors and work organization are the determinants of illness.

Schilling RSF.

More effective prevention in occupational health practice. J Soc Occup Med ; 34 3 Work-related voice disorder. Braz Otorhinolaryngol ; 81 2 Thus, the nexus between disease and work is epidemiological, given the excess frequency in certain occupational groups and the work-related risk factors Legal-institutional analysis Skills for defining WRDs There is a peculiar difficulty regarding official recognition of the nexus between voice disorders and work: the multiplicity of regulatory instruments and institutional competencies for dealing with work-related diseases and injuries Figure 1.

Figure 1 Legal-institutional attributions regarding formal recognition of work-related diseases and corresponding sample databases. Genebra; The latter regulatory instrument would then form support for defining social security regulations and regulations for compulsory notification of diseases within the Brazilian Notifiable Diseases Information System SINAN , which is also within the competence of the Ministry of Health.

The main list of work-related diseases was established under the terms of Ministry of Health ordinance No. It is based on law no.

Ordinance no. It is composed of around nosological entities that have been defined in the International Classification of Diseases ICD The social security list is stipulated in article 20 of law no. The compulsory notification list is still based on law no. Its latest edition was issued recently, through Ministry of Health ordinance no. Political-professional analysis Movement towards recognition of WRVDs in Brazil The initial course of action In seeking recognition of voice disorders as a WRD, the Speech-Language Pathology and Hearing School of PUC-SP played a pioneering role in fostering discussions and calling on different social actors to enter the debate, thereby enabling advancement of themes present in their agendas.

The beginnings of the movement were difficult. Its foundations were fragile and uncertainties persisted in this field, which historically had focused only on rehabilitation of individuals. Thus, speech-language pathologists SPLs became able to reshape their practice to respond to the reality of sickness among a large number of workers.

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Essay on trifles. In , two important documents resulting from the discussions that had been held up to that time were released almost simultaneously. One part of the questionnaire was validated and now comprises the screening index for voice disorder SIVD This was preceded by an initiative in the state of Alagoas Although well received, this initiative did not solve the major problem of WRVD recognition.