Revisão sistemática de intervenções para prevenção da perda auditiva induzida por ruído ocupacional – uma atualização
Systematic Review of Interventions to Prevent Occupational Noise-Induced Hearing Loss – A Follow-up
Alessandra Giannella Samelli, Carla Gentile Matas, Raquel Fornaziero Gomes, Thais Catalani Morata
Resumo
Objetivo: realizar uma revisão sistemática sobre a efetividade de intervenções para prevenção da perda auditiva induzida por ruído ocupacional, atualizando os achados da mais recente versão da revisão sistemática Cochrane do mesmo tema. Estratégia de pesquisa: As buscas ocorreram nas bases PubMed, Web of Science e Scopus. Critérios de seleção: Como intervenções, foram considerados: controles de engenharia/administrativos; dispositivos de proteção auditiva (DPA); vigilância auditiva e monitoramento audiológico. Análise dos dados: Para a análise de risco de viés, cada estudo foi avaliado de acordo com a adoção de randomização, alocação, cegamento, desfecho, outras fontes de viés. Resultados: Foram obtidas 475 referências no total. Destas, 17 estudos cumpriram os critérios de inclusão: um randomizado, um de série temporal interrompida e 15 de antes e depois. A maioria dos estudos foi realizada em indústrias; três em ambiente militar e/ou de treinamento de tiro; um em orquestra e outro em construção civil. A maioria dos estudos mostrou alto risco de viés. Seis estudos verificaram redução da exposição ao ruído a curto prazo por meio de controles de engenharia/administrativos; um verificou impacto positivo decorrente de mudança na legislação; cinco verificaram efeitos positivos dos DPA na diminuição da exposição ao ruído e dos treinamentos educacionais no uso do DPA; e dois encontraram redução dos níveis de ruído e aumento no uso do DPA decorrentes da implementação de programas de conservação auditiva. Conclusão: Todos os estudos analisados concluíram que as intervenções utilizadas resultaram em efeitos positivos sobre a audição e/ou sobre a exposição ao ruído. Em relação aos efeitos de longo termo, a grande maioria dos estudos limitou-se a avaliar efeitos imediatos ou de curto termo, reforçando que estudos incluindo follow-up de longo termo devem ser desenvolvidos.
Palavras-chave
Abstract
Purpose: To conduct a systematic review of the effectiveness of interventions to prevent occupational hearing loss, following up on the findings of the most recent version of Cochrane systematic review on the same topic. Research strategy: Searches were carried out in PubMed, Web of Science and Scopus databases. Selection criteria: The following interventions were considered: engineering/administrative controls; hearing protection devices (HPD); and audiological monitoring. Data analysis: For bias risk analysis, each study was assessed according to randomization, allocation, blinding, outcomes, other sources of bias. Results: 475 references were obtained. Of these, 17 studies met the inclusion criteria: one randomized, one interrupted time series, and 15 before and after studies. Most studies were conducted in industries; three in military and/or shooting training environments; one in an orchestra, and one in construction. Most studies showed a high risk of bias. Six studies found a reduction in short-term exposure to noise through engineering/administrative controls; one found a positive impact due to changes in legislation; five studies have found positive effects of HPD in reducing exposure to noise and of educational trainings in the use of HPD; lastly, two studies found a reduction in noise levels and an increase in the using of HPD due to the implementation of hearing conservation programs. Conclusion: All the studies concluded that the interventions used resulted in positive effects on hearing and/or on exposure to noise. Regarding long-term effects, most studies were limited to assessing immediate or short-term effects, reinforcing that studies including long-term follow-up be developed.
Keywords
Referências
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Submetido em:
23/07/2019
Aceito em:
17/02/2020
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