研究生: |
陶亞萍 TAO, Ya-Ping |
---|---|
論文名稱: |
幼兒園教師嗓音障礙相關因素及結構方程模型研究——以江蘇省鹽城市為例 Study on Kindergarten Teachers’ Voice Disorders Related Factors and the Structural Equation Model in Yancheng city, Jiangsu Province |
指導教授: |
胡益進
Hu, Yih-Jin 李子奇 Lee, Tzu-Chi |
學位類別: |
博士 Doctor |
系所名稱: |
健康促進與衛生教育學系 Department of Health Promotion and Health Education |
論文出版年: | 2020 |
畢業學年度: | 108 |
語文別: | 中文 |
論文頁數: | 165 |
中文關鍵詞: | 嗓音障礙 、職業因素 、個人因素 、嗓音保健信念 、工作環境 、工作安排 |
英文關鍵詞: | voice disorders, occupational factors, personal factors, voice health beliefs, work environments, work organizations |
DOI URL: | http://doi.org/10.6345/NTNU202001062 |
論文種類: | 學術論文 |
相關次數: | 點閱:208 下載:0 |
分享至: |
查詢本校圖書館目錄 查詢臺灣博碩士論文知識加值系統 勘誤回報 |
研究背景:近年來中國大陸地區幼兒園專任教師人數已達到240多萬,他們的嗓音障礙問題逐漸凸顯,但是針對幼兒園教師嗓音障礙的調查和研究卻遠少於中小學及大學教師。本研究目的是探討當前幼兒園教師嗓音障礙的狀況、相關因素及相關因素的結構方程模型,進而引起大眾對幼兒園教師職業健康的關注和重視,並提出有價值的建議。
研究方法:本研究以文獻、焦點團體和個別訪談資料研擬問卷,運用分層集群抽樣的方法對中國大陸江蘇省鹽城市的幼兒園教師進行線上問卷調查。調查回收到問卷1501份,有效問卷1392份。研究分析運用SPSS 23.0和AMOS 24.0兩個套裝軟體進行信度分析、因素分析、描述性分析、迴歸分析,並建構和驗證了幼兒園教師嗓音障礙影響因素的結構方程模型。
研究結論:
一、依據「嗓音障礙指數量表」,鹽城市幼兒園教師的嗓音障礙率為43%。88.1%的教師有嗓音症狀,嗓音疾病率近一個學期為54.3%,整個職業生涯為60.4%。
二、社會人口學因素、健康狀況、嗓音知識、嗓音保健信念、用嗓行為、職業壓力、工作環境、工作安排均對幼兒園教師嗓音障礙有顯著影響,其中嗓音保健信念達到中度解釋力(R2=0.336),健康狀況、用嗓行為、職業壓力和工作環境具有一定解釋力(0.19<R2<0.33)。具體的因素中,年齡、受教育程度、自覺健康狀況、所患與嗓音相關疾病數、睡眠品質、對嗓音障礙的自覺罹患性、對嗓音保健行為的自覺障礙、自我效能、說話方式、工作強度造成的職業壓力、環境噪音、空氣品質與空間大小、音響設備條件、年資、班級幼兒數、集體教學時間、帶班時間、有沒有嗓音訓練或嗓音保健培訓、有沒有其他職務等19個因素顯著影響幼兒園教師的嗓音障礙。
三、職業因素、個人因素與幼兒園教師嗓音障礙之間完整的結構模型,整體適配度良好,自變項「工作環境」、「工作安排」對依變項路徑係數達到顯著,模式的整體解釋力為46.5%。無自變項相關的結構模型,潛在變項「嗓音保健信念」、「職業壓力」、「工作環境」三條路徑係數達到顯著,模式整體的解釋力為28%,但模型的適配度不佳。
研究建議:幼兒園教師個人要提升嗓音保健意識;師範教育與托幼機構師資培訓應納入嗓音訓練及嗓音保健的內容;托幼機構的制度與管理中融入教師嗓音障礙預防,全面提升教師的職業健康。未來研究建議改善結構模型適配度並開展教師嗓音保健的介入。
Background: In recent years, the number of full-time kindergarten teachers in mainland China has reached more than 2.4 million, whose voice disorders gradually become prominent. However, the investigation and research on the voice disorders of kindergarten teachers is far less than that of teachers in elementary, middle and university schools. This research aims at exploring and discussing the current state and relevant factors of kindergarten teachers’ voice disorders, and the structural equation model in order to arouse the public's attention and care to the occupational health of kindergarten teachers and propose valuable suggestions.
Method: In this research, it formulates questionnaire based on literature, focus groups and individual interview data to carry out the online questionnaire survey of kindergarten teachers in Yancheng City, Jiangsu Province, China by adopting the stratified cluster sampling method. 1,501 questionnaires are collected, among which it includes 1,392 valid questionnaires. Meanwhile, it adopts the SPSS 23.0 and AMOS 24.0 software packages to carry out the reliability analysis, factor analysis, descriptive analysis, regression analysis, as well as constructs and verifies the structural equation model of related factors influencing the kindergarten teachers' voice disorders.
Results:
1. According to the Voice Handicap Index scale, the rate of voice disorders of the kindergarten teachers in Yancheng is 43%. 88.1% of teachers have voice symptoms. And the rate of voice disease of the recent semester is 54.3%, while in the entire career, it accounts for 60.4%.
2. Factors such as social demographic factors, health conditions, voice knowledge, voice health beliefs, voice behavior, occupational pressure, work environments, and work organizations have a significant impact on the voice disorders of kindergarten teachers, among which the voice health care beliefs reach the moderate explanatory power (R2=0.336), while health status, voice behavior, occupational pressure and work environments have certain explanatory power (0.19<R2<0.33). What’s more, 19 factors out of the specific factors, such as ages, education level, conscious health status, number of voice-related diseases, sleep quality, conscious susceptibility to voice disorders, conscious barriers to voice health care behaviors, self-efficacy, voice usage, occupational pressure caused by work intensity, environmental noise, air quality and space size, sound equipment conditions, seniority, number of children in the class, mass teaching time, shift time, voice training or voice health care training, other jobs, etc. are affecting the voice disorders of kindergarten teachers.
3. The full structural equation model between occupational factors, personal factors and kindergarten teachers' voice disorders has a good fitness. The independent variable "work environments" and "work organizations" are significant to the path coefficient of the dependent variable. The overall explanatory power of the model is 46.5%. As for the structural equation model without correlation between independent variables, the three path coefficients of potential variables, the voice health beliefs, occupational stress and working environments have reached significant levels. The overall explanatory power of this model is 28%. However, the fitness of the model is short of expectations.
Suggestions: The individual kindergarten teachers shall improve their voice health care awareness; the voice training and voice health care content shall be added to the teacher education and kindergarten teacher training; the voice disorders prevention shall be covered in the system and management of kindergarten institutions to comprehensively improve teachers’ occupational health. The future research suggests that it is necessary to improve the goodness-of-fit of the structural equation model and carry out the intervention of the voice health care for teachers.
中華人民共和國中央人民政府、國務院(2016)。「健康中國2030」規劃綱要。取自http://www.gov.cn/zhengce/2016-10/25/content_5124174.htm
中華人民共和國教育部(2010)。國家中長期教育改革和發展規劃綱要(2010-2020年)。取自http://old.moe.gov.cn/publicfiles/business/htmlfiles/moe/info_list/201407/xxgk_171904.html。
中華人民共和國教育部(2019)。中國教育概況—2018年全國教育事業發展情況。取自http://www.moe.gov.cn/jyb_sjzl/s5990/201810/t20181018_352057.html。
王建群、高下、沈曉輝、俞晨傑、楊燁(2007)。女性教師電聲門圖及聲學檢測參數分析。江蘇醫藥,33(12),1223-1225。
王慧(2009)。180名女性教師嗓音參數及嗓音障礙指數分析。天津醫科大學學報,15(3),379-381。
付畇、嶽聖東(2011)。中小學教師嗓音疾患的現狀、成因與應對措施。四川教育學院學報,27,106-109。
成源、王桂敏(2004)。西安市1007例教師發聲器官健康狀況的調查。中國全科醫學,2,348-349。
何偉林、柳恒卓、冉昱(2015)。長沙市中小學教師嗓音疾病狀況及影響因素研究。中國衛生統計,32(5),781-783。
吳明隆(2010)。問卷統計分析實務。重慶:重慶大學出版社。
吳虹、徐潔潔、喬明哲、陳曦、胡環宇、張舒、劉美暢(2013)。行銷人員聲嘶患者喉鏡觀察及嗓音主客觀評估。聽力學及言語疾病雜誌,21(04),345-348。
呂丹、楊慧、徐亞男、鄒劍、祝佼、肖浩、鄭義濤(2016)。成都市某區小學教師嗓音相關生活質量調查分析。臨床耳鼻咽喉頭頸外科雜誌,30(17),1385-1387。
宋豐倫(2012)。臺北市高中教師自覺嗓音健康問題及其相關因素之研究(碩士學位論文),臺灣師範大學,臺北市
李紅豔、徐文、胡蓉、張麗、韓德民(2010)。嗓音障礙指數量表簡化中文版的研究。聽力學及言語疾病雜誌,18(6),566-570。
李燕(2011)。嗓音障礙 RBH 聽感知評估系統中文版的研究(碩士學位論文)。第二軍醫大學,上海市。
李響、李月玲、田建東(2018)。廣州市某區幼兒園及小學教師嗓音狀況及影響因素調查分析。中國中西醫結合耳鼻咽喉科雜誌,26(1),54、72-74。
於萍、壬榮光(2009)。嗓音障礙主觀聽感知評估研究現狀。聽力學及言語疾病雜誌,17(1),1-9。
邱皓政(2010)。量化研究與統計分析:SPSS(PASW)資料分析範例解析。臺北:五南。
金德斌(2007)。秦皇島市中小學教師嗓音疾病的調查報告(碩士學位論文)。承德醫學院,承德市。
阿拉坦巴根、劉曉明(2014)。幼兒園教師職業壓力問卷編制與現狀分析。學前教育研究,230,21-48。
姜泗長、顧瑞(2005)。言語語言疾病學。北京:科學技術出版社。
姜瑋瑋(2010)。青島市中小學、幼兒教師嗓音現狀調查及分析(碩士學位論文)。青島大學,青島市。
唐俊、萬萍、陳旭輝(2016)。關於中小學教師嗓音障礙及其康復介入的研究進展。臨床耳鼻咽喉頭頸外科雜誌,30(1),84-88。
徐文、李紅豔、胡蓉、胡慧英、侯麗珍、張麗、莊佩耘、韓德民(2008)。嗓音障礙指數量表中文版信度和效度評價。中國耳鼻喉頭頸外科雜誌,9(43),670-675。
耿浩然(2009)。高校教師嗓音疾病危險因素研究(碩士學位論文),山西醫科大學,太原市。
張素芹、汪賀媛、劉輝、崔一(2008)。378例教師嗓音疾病分析,中國醫藥導刊,10(5),680-682。
郭文俊、何霞、於文永、鄭智英、王斌全(2018)。聲帶良性增生性病變教師嗓音主客觀評估及危險因素分析。護理學雜誌,33(7),30-33。
郭永清、林生智、徐新林(2012)。空氣動力學參數在嗓音功能評估中的意義。中華耳鼻喉頭頸外科雜誌,10(47),858-861。
陳恩清(2009)。幼兒教師嗓音健康的影響因素——來自溫州的調查。教育評論,2,120-122。
鹿道溫、丁寶君、謝娟, 孫玉桂、牛紅衛(2000)。162名大學教師嗓音調查分析。中國中西醫結合耳鼻咽喉科雜誌,8(3),125-127。
傅德慧、陳磊、崔壯(2016)。天津市47796名中小學及幼兒園教師嗓音健康現狀調查。聽力學及言語疾病雜誌,24(6),559-564。
喬宇、盛玉彪、張玉芳(2016)。邯鄲市教師人群嗓音疾病發生情況及嗓音障礙指數的研究。職業與健康,32(20),2778-2782。
彭波、王最青、王光卻(2004)。湛江市霞山區中小學教師喉病的調查與分析。廣東醫學院學報,22(5),539-540。
彭莉佳(2016)。教師嗓音訓練及保健。上海:華東師範大學出版社。
黃澄清(1990)。醴陵縣中小學教師嗓音調查。中國學校衛生,11(3),46-47。
楊燁、王建群、高下(2008)。南京市中小學及幼兒園教師嗓音疾病的調查。南京醫科大學學報(自然科學版),152(2),269-270。
葛平江(2011)。嗓音的電腦客觀評價。中國醫學文摘耳鼻喉科學,26(6),306-307。
董貞吟、殷蘊雯、黃乾全、宋慧娟、張家儒(2002)。教師職業病風險評估調查一以自覺嗓者健康問題為例。學校衛生,40,1-21。
董貞吟、黃乾全(2000)。教師嗓音保健知識、行為及自覺健康之分析研究-吵靜地區學校教師之比較。師大學報:教育類,45(2),75-86。
廖國翔、王泰隆、張欣平(2005)。國小教師嗓音障礙調查。北市醫學雜誌,2(4),342-347。
劉波、由娟(2009)。遼東學院專任教師的嗓音狀況調查。遼東學院學報(自然科學版),16(3),254-256。
劉俊傑,郭會麗,趙豔麗,朱豔豔(2012)。登封市6350例教師嗓音病調查報告。中國社區醫師(醫學專業),14,403。
樓正才、樓梓涵、樓鵬(2008)。義烏市小學教師嗓音言語疾患及其相關因素分析。中國學校衛生,29(1),34-35。
韓仲明(2006)。嗓音聲學檢測分析。中國耳鼻喉頭頸外科,13(5),351-353。
韓德民、徐文、Robert, T., & Sataloff(2007)。嗓音醫學。北京:人民衛生出版社。
韓豔豔、王剛、李芳(2012)。烏魯木齊市11689名中學教師咽喉疾病調查分析。臨床耳鼻咽喉頭頸外科雜誌,26(7),302-305。
羅暉暉(2014)。不同嗓音疾病的相關發病因素和聲學的分析(碩士學位論文)。福建醫科大學,廈門市。
羅麗(2013)。中小學教師嗓音疲勞問題及對策。成都師範學院學報,29(8),59-61、66。
ASHA. (1993). Definitions of communication disorders and variations [relevant paper]. http://www.asha.org/policy
Ahlander, V., Rydell, R., & Lofqvist, A. (2010). Speaker’s comfort in teaching environments: Voice problems in swedish teaching staff. J Voice, 25(4), 430–440. doi:10.1016/j.jvoice.2009.12.006
Akin Senkal, O., & Ciyiltepe, M. (2013). Effects of voice therapy in school age children. J Voice, 27(6), e719-725. doi:10.1016/j.jvoice.2013.06.007
Angelillo, M., Di Maio, G., Costa, G., Angelillo, N., & Barillari, U. (2009). Prevalence of occupational voice disorders in teachers. J Prev Med Hyg, 50(1), 26-32.
Banks, R. E., Bottalico, P., & Hunter, E. J. (2017). The effect of classroom capacity on vocal fatigue as quantified by the vocal fatigue index. Folia Phoniatr Logop, 69(3), 85-93. doi:10.1159/000484558
Behlau, M., Zambon, F., Guerrieri, A. C., & Roy, N. (2012). Epidemiology of voice disorders in teachers and nonteachers in brazil-prevalence and adverse effects. Mosby, Inc., 26(5), 665.e669-665.e618.
Bhuta, T., Patrick, L., & Garnett, J. D. (2004). Perceptual evaluation of voice quality and its correlation with acoustic measurements. J Voice, 18(3), 299-304. doi:10.1109/EMS.2013.49
Bolbol, S. A., Zalat, M. M., Hammam, R. A., & Elnakeb, N. L. (2017). Risk factors of voice disorders and impact of vocal hygiene awareness program among teachers in public schools in egypt. J Voice, 31(2), 251 e259-251 e216. doi:10.1016/j.jvoice.2016.07.010
Byeon, H. (2019). The risk factors related to voice disorder in teachers: A systematic review and meta-analysis. Int J Environ Res Public Health, 16(19), 3675. doi:10.3390/ijerph16193675
Cantor Cutiva, L. C., & Burdorf, A. (2015). Medical costs and productivity costs related to voice symptoms in colombian teachers. Elsevier Inc., 29(6), 776.e715-776.e722. doi:10.1016/j.jvoice.2015.01.005
Cantor Cutiva, L. C., & Burdorf, A. (2016). Work-related determinants of voice complaints among school workers: An eleven-month follow-up study. Am J Speech Lang Pathol, 25(4), 590-597. doi:10.1044/2016_AJSLP-14-0191
Cantor Cutiva, L. C., Vogel, I., & Burdorf, A. (2013). Voice disorders in teachers and their associations with work-related factors: A systematic review. J Commun Disord, 46(2), 143-155. doi:10.1016/j.jcomdis.2013.01.001
Ceballos, A. G. d. C. d., Carvalho, F. M., Araújo, T. M. d., & Reis, E. J. F. B. d. (2011). Auditory vocal analysis and factors associated with voice disorders among teachers. Rev Bras Epidemiol, 14(2), 285-295.
Chen, S. H., Chiang, S. C., Chung, Y. M., Hsiao, L. C., & Hsiao, T. Y. (2010). Risk factors and effects of voice problems for teachers. J Voice, 24(2), 183-190, quiz 191-182. doi:10.1016/j.jvoice.2008.07.008
Choong, C. T., & Kan, H. M. P. (2011). Voice problems amongst primary school teachers in Singapore. J Voice, 26(4), e141-e147. doi:10.1016/j.jvoice.2011.05.004
Da Costa, V., Prada, E., Roberts, A., & Cohen, S. (2012). Voice disorders in primary school teachers and barriers to care. J Voice, 26(1), 69-76. doi:10.1016/j.jvoice.2010.09.001
De Bodt, M., Van de Heyning, P., Wuyts, F., & Lambrechts, L. (1996). The perceptual evaluation of voice disorders. Acta oto-rhino-laryngologica Belgica, 50(4), 283-291.
de Brito Mota, A. F., Giannini, S. P. P., de Oliveira, I. B., Paparelli, R., Dornelas, R., & Ferreira, L. P. (2019). Voice disorder and burnout syndrome in teachers. J Voice, 33(4), 581 e587-581 e516. doi:10.1016/j.jvoice.2018.01.022
De Jong, F., Kooijman, P., Thomas, G., Huinck, W., Graamans, K., & Schutte, H. (2006). Epidemiology of voice problems in dutch teachers. Folia Phoniatrica etLogopedica, 58(3), 186–198.doi:10.1159/000091732
Devadas, U., Bellur, R., & Maruthy, S. (2017). Prevalence and risk factors of voice problems among primary school teachers in india. J Voice, 31(1), 117 e111-117 e110. doi:10.1016/j.jvoice.2016.03.006
Giannini, S. P., Latorre Mdo, R., Fischer, F. M., Ghirardi, A. C., & Ferreira, L. P. (2015). Teachers' voice disorders and loss of work ability: A case-control study. J Voice, 29(2), 209-217. doi:10.1016/j.jvoice.2014.06.004
Giannini, S. P. P., LatorreII, M. d. R. D. d. O., & Ferreira, L. P. (2010). Voice disorders (dysphonia) in public school female teachers working in belo horizonte: Prevalence and associated factors. J Voice, 22(6), 676-687. doi:10.1590/S1516-80342010000300025
Hawkshaw, M. J., Pebdani, P., & Sataloff, R. T. (2013). Reflux laryngitis: An update 2009-2012. J Voice, 27, 486–494.
Hazlett, D. E., Duffy, O. M., & Moorhead, S. A. (2011). Review of the impact of voice training on the vocal quality of professional voice users: Implications for vocal health and recommendations for further research. J Voice, 25(2), 181-191. doi:10.1016/j.jvoice.2009.08.005
Helidoni, M., Murry, T., Chlouverakis, G., Okalidou, A., & Velegrakis, G. (2012). Voice risk factors in kindergarten teachers in greece. Folia Phoniatr Logop, 64(5), 211-216. doi:10.1159/000342147
Himberg, L., & Pentti, J. (1992). Prevalence of vocal symptoms among teachers compared with nurses: A questionnaire study. Scandinavian Journal of Logopedics and Phoniatrics, 17(2), 113-117.
Holmberg, E. B., Doyle, P., Perkell, J. S., Hammarberg, B., & Hillman, R. E. (2003). Aerodynamic and acoustic voice measurements of patients with vocal nodules: Variation in baseline and changes across voice therapy. J Voice, 17(3), 269-282. doi:10.1067/s0892-1997(03)00076-6
Hunter, E. J., & Titze, I. R. (2009). Variations in intensity,fundamental frequency,and voicing for teachers in occupational versus non-occupational settings. The Journal of the Acoustical Society of America, 126(4), 2164. doi:10.1121/1.3248421
Joanna Morawska, & Niebudek-Bogusz, E. (2017). Risk factors and prevalence of voice disorders in different occupational groups: a review of literature. Otorynolaryngologia, 16(3), 94-102. doi:E63ec8e48506f3ed3b2aaabbfb607bf2
Jónsdottir, V., Boyle, B., Martin, P., & Sigurdardottir, G. (2002). A comparison of the occurrence and nature of vocal symptoms in two groups of icelandic teachers. Logopedics, Phoniatrics, Vocology, 27(3), 98–105. doi:10.1080/140154302760834822
Kaiser, H. (1974). An index of factorial simplicity. Psychometrika, 39, 31-36. doi:10.1007/BF02291575
Kankare, E., Geneid, A., Laukkanen, A. M., & Vilkman, E. (2012). Subjective evaluation of voice and working conditions and phoniatric examination in kindergarten teachers. Folia Phoniatr Logop, 64(1), 12-19. doi:10.1159/000328643
Kim, K. H., Kim, R. B., Hwang, D. U., Won, S. J., & Woo, S. H. (2016). Prevalence of and sociodemographic factors related to voice disorders in south korea. J Voice, 30(2), e241-247. doi:10.1016/j.jvoice.2015.04.010
Kline, R. B. (2010). Principles and practice of structure equation modeling. New York: Guilford Press.
Kooijman, P. G. C., de Jong, F. I. C. R. S., Thomas, G., Huinck, W., Donders, R., Graamans, K., & Schutte, H. K. (2006). Risk factors for voice problems in teachers. Folia Phoniatrica et Logopedica, 58(3), 159–174. doi:10.1159/000091730
Korn, G. P., Augusto de Lima Pontes, A., Abranches, D., & Augusto de Lima Pontes, P. (2016). Vocal tract discomfort and risk factors in university teachers. J Voice, 30(4), 507 e501-508. doi:10.1016/j.jvoice.2015.06.001
Leao, S. H., Oates, J. M., Purdy, S. C., Scott, D., & Morton, R. P. (2015). Voice problems in new zealand teachers: A national survey. J Voice, 29(5), 645 e641-645 e613. doi:10.1016/j.jvoice.2014.11.004
Lee, Y. R., Kim, H. R., & Lee, S. (2018). Effect of teacher's working conditions on voice disorder in korea: A nationwide survey. Ann Occup Environ Med, 30, 43. doi:10.1186/s40557-018-0254-8
Lindstrom, F., Ohlsson, A. C., Sjöholm, J., & Waye, K. P. (2008). Mean f0 values obtained through standard phrase pronunciation compared with values obtained from the normal work environment- a study on teacher and child voices performed in a preschool environment. J Voice, 24(3), 319-323. doi:D47a9f0545e06569ae3617dadaafdd97
Maria, S., Svante, G., Britta, H., & Annika, S. (2002). Vocal behavior and vocal loading factors for preschool teachers at work studied with binaural dat recordings. J Voice, 24(3), 356-371. doi:10.1016/S08921997(02)001078
Martins, R. H., Pereira, E. R., Hidalgo, C. B., & Tavares, E. L. (2014). Voice disorders in teachers: a review. J Voice, 28(6), 716-724. doi:10.1016/j.jvoice.2014.02.008
Medeiros, A. M. d., Assunção, A. Á., & Barreto, S. M. (2012). Absenteeism due to voice disorders in female teachers- a public health problem. Int Arch Occup Environ Health, 85, 853-864. doi:10.1007/s00420-011-0729-1
Morawska, J., & Niebudek-Bogusz, E. (2017). Risk factors and prevalence of voice disorders in different occupational groups:A review of literature. Otorynolaryngologia, 16(3), 94-102. doi:E63ec8e48506f3ed3b2aaabbfb607bf2
Moy, F. M., Hoe, V. C., Hairi, N. N., Chu, A. H., Bulgiba, A., & Koh, D. (2015). Determinants and effects of voice disorders among secondary school teachers in peninsular malaysia using a validated malay version of vhi-10. PLoS One, 10(11), e0141963. doi:10.1371/journal.pone.0141963
Munier, C., Brockmann-Bauser, M., Laukkanen, A.-M., Ilomäki, I., Kankare, E., & Geneid, A. (2018). Relationship between laryngeal signs and symptoms, acoustic measures, and quality of life in finnish primary and kindergarten school teachers. J Voice. doi:E1123e22cebcf068945f6d128af088fa
Munier, C., & Farrell, R. (2016). Working conditions and workplace barriers to vocal health in primary school teachers. J Voice, 30(1), 127 e131-141. doi:10.1016/j.jvoice.2015.03.004
Niebudek-Bogusz, E., Sznurowska-Przygocka, B., Fiszer, M., Kotylo, P., Modrzewska, M., Sinkiewicz, A., & Sliwinska-Kowalska, M. (2008). The effectiveness of voice therapy for teachers with dysphonia. Folia Phoniatr Logop, 60, 134-141. doi:10.1159/000120290
Nuunally, J. C. (1978). Psychometric thoery. New York: McGraw-Hill.
Ohlsson, A. C., Andersson, E. M., Sodersten, M., Simberg, S., & Barregard, L. (2012). Prevalence of voice symptom and risk factors in teacher students. J Voice, 2, 629–634. doi:10.1016/j.jvoice.2011.11.002
Pendleton, H., Ahlner-Elmqvist, M., Olsson, R., Thorsson, O., Hammar, O., Jannert, M., & Ohlsson, B. (2013). Posterior laryngitis:A disease with different aetiol-ogies affecting health-related quality of life: A prospective case-controlstudy. BMC Ear Nose Throat Disord, 13, 11. doi:10.1186/1472-6815-13-11
Pereira, E. R., Tavares, E. L., & Martins, R. H. (2015). Voice disorders in teachers: Clinical, videolaryngoscopical, and vocal aspects. J Voice, 29(5), 564-571. doi:10.1016/j.jvoice.2014.09.019
Perez Fernandez, C. A., & Preciado Lopez, J. (2003). Vocal fold nodules.Risk factors in teachers.A case control study deaign. Acta Otorrinolaringol Esp, 54(4), 253-260.
Pinto, G. S. P., Oliveira, L. M. d. R. D. d., & Piccolotto, F. L. (2013). Factors associated with voice disorders among teachers-a case-controlstudy. CoDAS, 25(6), 566-576.doi:7a506b641c9e3f6a8dfa6162df33f9ab
Pizolato, R. A., Mialhe, F. L., Cortellazzi, K. L., Ambrosano, G. M. B., CornacchioniRehder, M. I. B., & Pereira, A. C. (2013). Evaluation of risk factors for voice disorders in teachers and vocal acoustic analysis as an instrument of epidemiological assessment. Rev CEFAC, 15(4), 957-966. doi:F96cd989641ffb6b7723167d7e12cf43
Preciado-Lopez, J., Perez-Fernandez, C., Calzada-Uriondo, M., & Preciado-Ruiz, P. (2008). Epidemiological study of voice disorders among teaching professionals of la rioja, spain. J Voice, 22(4), 489–508. doi:10.1016/j.jvoice.2006.11.008
Remacle, A., Morsomme, D., & Finck, C. (2014). Comparison of vocal loading parameters in kindergarten and elementary school teachers. JSpeechLangHearRes, 57(2), 406-415.doi:10.1044/2013_JSLHR-S-12-0351
Rocha, B. R., & Behlau, M. (2017). Quality of life, self-perceived dysphonia, and diagnosed dysphonia through clinical tests in teachers. J Voice, 32(6), 771.e771–771.e. doi:10.1016/j.jvoice.2017.08.009
Rosen, C. A., Lee, A. S., Osborne, J., Zullo, T., & Murry, T. (2004). Development and validation of the voice handicape index-10. Laryngoscope, 114, 1549–1556. doi:1097/00005537-200409000-00009
Roy, N., Merrill, R., Thibeault, S., Gray, S., & Smith, E. (2004). Voice disorders in teachers and the general population: Effects on work performance, attendance, andfuture career choices. Journal of speech, language, and hearing research, 47(3), 542–551. doi:10.1044/1092-4388(2004/042)
Roy, N., Merrill, R. M., Thibeault, S., Parsa, R. A., Gray, S. D., & Smith, E. M. (2004). Prevalence of voice disorders in teachers and the general population. J Speech Lang Hear Res, 47(2), 281-293. doi:10.1044/1092-4388(2004/023)
R.Titze, I., Lemke, J., & Montequin, D. (1997). Populations in the u.S. Workforce who rely on voice as a primary tool of trade: A preliminary report. J Voice, 11(3), 254-259. doi: 10.1016/S0892-1997(97)800021
Sadegh, S., Farzad, I., Ali-Ashraf, J., Farhad, T., Javad, S., Davood, S. R., & Majid, G. (2016). Prevalence of voice disorders and associated risk factors in teachers and nonteachers in iran. J Voice, 30(4), 506.e519-523. doi:10.1016/j.jvoice.2015.05.019
Sala, E., Laine, A., Simberg, S., Pentti, J., & Suonpää, J. (2001). The prevalence of voice disorders among day care center teachers compared with nurses: A questionnaire and clinical study. J Voice, 15(3), 413-423. doi:10.1016/S0892-1997(01)00042-X
Sampaio, M. C., dos Reis, E. J., Carvalho, F. M., Porto, L. A., & Araujo, T. M. (2012). Vocal effort and voice handicap among teachers. J Voice, 26(6), 820 e815-828. doi:10.1016/j.jvoice.2012.06.003
Seifpanahi, S., Izadi, F., Jamshidi, A. A., Torabinezhad, F., Sarrafzadeh, J., Sobhani-Rad, D., & Ganjuie, M. (2016). Prevalence of voice disorders and associated risk factors in teachers and nonteachers in iran. J Voice, 30(4), 506 e519-523. doi:10.1016/j.jvoice.2015.05.019
Servilha, E., Leal, R., & Hidaka, M. (2010). Occupational risks in the brazilianlabor legislation: Highlight on those related to teacher’s health and voice. Rev Soc Bras Fonoaudiol, 15, 505–513.
Silvia, U., Javier, C., Jaime, I., & Ioseba, I. (2015). Protective and risk factors associated with voice strain among teachers in castile and leon, spain-recommendations for voice training. J Voice, 29(2), 261.e261-e212. doi:10.1016/j.jvoice.2014.08.005
Smolander, S., & Huttunen, K. (2006). Voice problems experienced by finnish comprehensive school teachers and realization of occupational health care. Logopedics Phoniatrics Vocology, 31(4), 166–171.
Södersten, M., Granqvist, S., Hammarberg, B., & Szabo, A. (2002). Vocal behavior and vocal loading factors for preschool teachers at work studied with binaural dat recordings. Journal of Voice, 16(3), 356-371. doi:10.1016/s0892-1997(02)00107-8
Sophie, Y.-y. L., Lao, X. Q., & Ignatius, T.-s. Y. (2010). A cross-sectional survey of voice disorders among primary school teachers in hong kong. J Occup Health, 52, 344–352.
Souza, C. L. d., Carvalho, F. M., Araújo, T. M. d., Reis, E. J. F. B. d., Lima, V. M. C., & Porto, L. A. (2011). Factors associated with vocal fold pathologies in teachers. Rev Saúde Pública, 45(5), 1-7.
Thibeault, S. L., Merrill, R. M., Roy, N., Gray, S. D., & Smith, E. M. (2004). Occupational risk factors associated with voice disorders among teachers. Ann Epidemiol, 14(10), 786-792. doi:10.1016/j.annepidem.2004.03.004
Thomas, G., Kooijman, P., Cremers, C., & De Jong, F. (2006). A comparative study of voice complaints and risk factors for voice complaints in female student teachersand practicing teachers early in their career. European Archives of Oto-Rhino-Laryngology, 263(4), 370–380. doi:10.1007/s00405-005-1010-6
Tinsley, H. E., & Tinsley, D. J. (1987). Uses of factor analysis in counseling psychology research. Journal of Counseling Psychology, 34, 414-424. doi:10.1037/0022-0167.34.4.414
Trinite, B. (2017). Epidemiology of voice disorders in latvian school teachers. J Voice, 31(4), 508 e501-508 e509. doi:10.1016/j.jvoice.2016.10.014
Ubillos, S., Centeno, J., Ibanez, J., & Iraurgi, I. (2015). Protective and risk factors associated with voice strain among teachers in castile and leon, spain: Recommendations for voice training. J Voice, 29(2), 261 e261-212. doi:10.1016/j.jvoice.2014.08.005
Vilkman, E. (2004). Occupational safety and health aspects of voice and speech professions. Folia Phoniatricaet Logopaedica, 56(4), 220-253. doi:10.1159/000078344
Whitling, S., Lyberg-Åhlander, V., & Rydell, R. (2017). Long-time voice accumulation during work, leisure and a vocal loading task in groups with different levels of functional voice problems. J Voice, 31(2), 245.e241-246.e210. doi:10.1016/j.jvoice.2016.08.008
Williams, N., & Carding, P. (2005). Occupational voice loss. Boca Raton, USA: Taylor & Francis Group.
Williams, N. R. (2003). Occupational groups at risk of voice disorders a review of the literature. Occupational Medicine, 53 (7), 456-460. doi:10.1093/occmed/kqg113
Williams, N. R. (2012). Occupational groups at risk of voice disorders: A review of the literature. Occupational Medicine, 62(7), 588. doi:10.1093/occmed/kqs167