What do autistic children who are interested in letters and numbers do with them? A qualitative study

PURPOSE

Over a third of autistic children exhibit an intense or exclusive interest in letters and numbers at the time of diagnosis. This article aims to qualitatively investigate the atypical manifestations of this interest in autism compared to typically developing children and determine if and how it can benefit children and their families.

METHODS

The participants were the parents of 138 autistic children (84% were non-speaking or minimally speaking) and 76 typically developing children ages 2-6. They were administered a questionnaire on their child's interest in letters and numbers, the manifestations of these interests, the parental attitude towards it, and the child's oral language. An inductive thematic analysis was performed on the qualitative data to establish recurring themes.

RESULTS

Eight themes were identified: atypical behaviours related to written material, emotional attachment to letters and numbers, language acquisition, use of screens, solitary behaviour, reduction of the interest over time, parental attitudes, and other special abilities.

CONCLUSION

This study reveals that the interest in written material manifests itself in atypical ways in autism and is not comparable to the development of an interest in reading in a typically developing context. This interest also presents multiple beneficial aspects for children and their families.

Clinical and genetic diagnosis and management of Silver-Russell syndrome: Report of four cases

BACKGROUND

Silver-Russell syndrome (SRS) is a clinically heterogeneous entity characterized by intrauterine and postnatal growth restriction, relative macrocephaly at birth, distinct facial features, and body asymmetry combined with other malformations.

CASE SUMMARY

Herein, we describe four individuals with SRS, focusing on their prenatal phenotype, postnatal presentation, diagnosis, and management. All cases had a typical phenotype, including postnatal growth failure, short stature (chronic malnutrition), and protruding forehead. Individually, they presented with feeding difficulties, leg length discrepancy, triangular face, or relative macrocephaly at birth, and each one exhibited distinct SRS features, including motor and/or speech delay, experiencing frequent hypoglycemic episodes. The fact that each patient exhibited a different combination of clinical findings underlines the heterogeneity of the syndrome.

CONCLUSION

SRS is diagnosed clinically. However, only 60% of cases are genetically confirmed, while most are sporadic. Although SRS is a well-described syndrome, a delayed diagnosis can have grave consequences on a child’s growth. Recombinant human growth hormone treatment is often initiated shortly after the diagnosis. The follow-up requires a multidisciplinary approach.

An Umbrella Review of Diabetes Mellitus and Hearing Impairment

AIM

This study aims to synthesize current meta-analyses to propose a potentially existing association between diabetes and hearing impairment (HI), elevating their relationship to "high" level of evidence.

METHODS

A systematic search was performed in 9 databases up to March 31, 2025. The pooled results were synthesized to elucidate the direction and magnitude of the effects. We used the AMSTAR-2 scale to assess study quality and the GRADE tool to assess the certainty of the evidence. Subgroup analysis was conducted according to age (PROSPERO-ID: CRD42024606416).

RESULTS

This umbrella review comprehensively encompassed over 22 million participants from more than 226 studies. After screening, 21 studies were finally included. Primary outcomes showed that individuals with HI were at a higher risk of developing diabetes, referring to [odds ratio (OR) = 1.88, 95% confidence interval (CI): (1.01, 3.50)] with moderate evidence certainty. Simultaneously, participants with diabetes exhibited a more prevalent occurrence of HI. Higher pure tone audiometric thresholds, lower distortion product otoacoustic emission amplitudes, and increased auditory brainstem-evoked response latency time collectively indicated an increased risk of HI associated with diabetes. Subgroup analysis results revealed that in the younger population, the association between HI and diabetes risk is also high.

CONCLUSIONS

Overall, the current body of evidence underscores a latent bidirectional association between diabetes and HI, coupled with mutually aggravating effects. Our findings suggest that HI may serve as an indicator of the risk of developing diabetes.

HEARINGtogether study: barriers to hearing aid acquisition and use in German nursing homes - The residents' perspective

OBJECTIVES

This study investigates barriers to hearing aid acquisition and usage in nursing homes from the residents' perspective.

DESIGN AND STUDY SAMPLE

85 residents (mean age 83.8 years) were recruited from four nursing homes. Residents underwent pure tone and speech audiograms, completed the Nursing Home Hearing Index (NHHI), and a questionnaire on hearing aids.

RESULTS

25 residents had untreated severe hearing loss (29.4%), but many were reluctant to pursue rehabilitation (15/25). Those hesitant to adopt hearing aids had less severe hearing loss (55.2 dB vs. 66.0 dB for residents open towards hearing aids), were less aware of their hearing loss, felt less impact in their daily life (NHHI 29.3pts vs. 40.4pts), and held more negative preconceptions towards hearing aids. Among residents that already used hearing aids, problems with practical handling were the predominant barrier to regular use, followed by lack of perceived benefit, and barriers in healthcare access.

CONCLUSIONS

Raising early awareness for hearing loss is important to improve chances for rehabilitation. Educating medical staff in hearing health is crucial to raise awareness for hearing loss, support residents in daily life, and improve adherence to hearing aids. On-site services are essential for nursing homes to facilitate access to healthcare providers.

Examining How U.S.-Educated Students Navigate International Clinical Practice in Audiology and Speech-Language Pathology

PURPOSE

The current qualitative study aimed to explore the experiences and challenges reported by United States (U.S.)-educated international clinicians practicing outside of the U.S. upon graduate degree completion. Identification of strategies for international practice was sought.

METHOD

Nine participants, including seven speech-language pathologists (six women, one man) and two male audiologists practicing in 10 countries, were interviewed. Content analysis was used to systematically structure interview data, and a phenomenological orientation with qualitative analyses was adopted to explore the value and significance of the international practitioners' experiences.

RESULTS

Data analysis revealed three overarching themes that emphasized the influence of local context on clinical practice, professional autonomy, and navigating strategies for professional success. These thematic results were supported by several subthemes addressing a range of topics, such as evidence-based practice, colonialism, encroachment, resilience, and self-care. Analysis and interpretation of themes led to specific outcomes, including (a) suggestions for curricular and clinical changes within graduate programs, (b) optimal personal skills and strategies professionals utilize to achieve success during international engagements, and (c) recommendations for universities and professional organizations to enhance graduate personnel preparation of clinicians.

CONCLUSIONS

Study implications offered recommendations that graduate programs and professional organizations could use to optimize the preparation of the audiology and speech-language pathology workforce internationally. The implications include advising, mentoring, curriculum, service provision coaching, clinical placement, and alumni relations that benefit international graduate degree candidates, departments, and universities. Insights from this study are an invaluable resource for academicians and future graduate students planning to work internationally.

Prevalence of sleep problems in children with cerebral palsy: A systematic review and meta-analysis

BACKGROUND

Children with cerebral palsy (CwCP) often struggle with sleep issues, which has a serious negative influence on their general health and quality of life. There are insufficient data on the prevalence of various sleep disorders, even though recognising and treating them is vital.

OBJECTIVES

Determining the prevalence of sleep disorders in CwCP is the primary objective of this systematic review and meta-analysis.

METHODS

An electronic search was conducted on MEDLINE, Embase, Scopus, ScienceDirect, and Web of Science for all relevant articles using pre-specified eligibility criteria. Pooled proportions of CwCP having sleep problems were calculated in a random effects model using R version 4.3.2.

RESULTS

The updated systematic review and meta-analysis included 42 studies. The Sleep Disturbance Scale for Children (SDSC) showed abnormal scores in 26 % (95 % CI: 17 %-37 %) of children with CP. Subscale abnormalities included disorders of initiation and maintenance of sleep (28 %), sleep breathing disorders (17 %), excessive somnolence (12 %), sleep hyperhidrosis (10 %), and sleep-wake transition disorders (19 %). The Paediatric Sleep Questionnaire (PSQ) indicated abnormal scores in 39 % (95 % CI: 6 %-80 %) of children. Sensitivity analyses confirmed these findings, though some publication bias was noted in the PSQ outcome.

CONCLUSION

About a quarter of CwCP have experienced sleep problems, which may deteriorate their quality of life. In order to improve the quality of life for CwCP, regular sleep examinations and focused therapies are necessary.

Cortical auditory evoked potentials in the identification and monitoring of learning disorders: a systematic review and meta-analysis

INTRODUCTION

Approximately 5-10% of the population faces learning disorders (LDs) and encounter difficulties with tasks like reading, writing, and processing auditory information. One method used to assess auditory information processing in the brain is by measuring cortical auditory evoked potentials (CAEPs). This study aims to explore whether abnormalities in CAEPs could serve as clinical indicator for the early diagnosis of LDs, and if modifications in these components could be beneficial in tracking neural changes following intervention in individuals with LDs.

METHOD

The systematic literature search followed the PRISMA guideline. Two independent reviewers searched five electronic databases (Medline, Science Direct, Cochrane, Google Scholar, and ProQuest) from their inception to 16 April 2024, using relevant keywords.

RESULTS

Upon assessing the quality of articles and applying inclusion and exclusion criteria, 22 studies were selected for analysis. The majority of these studies observed delayed latency and reduced amplitude of CAEP components in individuals with LDs. The results of the meta-analysis emphasized delayed latency, particularly a significant delay in the N2 component, as the most prominent distinction between the LD and control groups. Additionally, certain studies have reported therapeutic interventions resulting in improved latency and amplitude of CAEPs in the LD population.

CONCLUSION

Based on the findings, the presence of an abnormal CAEP pattern, characterized by delayed component latencies, may serve as a potential indicator for LDs, assisting in the early identification of this disorder, and assessment of CAEPs can be used to evaluate the effectiveness of therapeutic interventions for individuals with LDs.

MRI changes and clinical characteristics in temporomandibular joints with displacement of the articular disk without reduction - a cross-sectional observational study

OBJECTIVES

This study examined changes in magnetic resonance imaging (MRI) of temporomandibular joints (TMJ) with anterior displacement disk without reduction (DDwoR) and its correlation to clinical symptoms.

METHODS

190 individuals with DDwoR were evaluated according to Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and MRI. Pain's chronicity/intensity and limited mouth opening (locking) were correlated with: TMJ degeneration (MRI T1), effusion (T2), disc's shape and position (proton density).

RESULTS

In 103 TMJ with DDwoR, hemiconvex shape (41.6%), sclerosis (45.6%) and mild effusion (47.6%) were the most prevalent findings. There was not association (p > .05) between: different DDwoR positions with pain's intensity/chronicity; effusion with locking. Disk deformation was associated with degeneration (p = .034) and pain's intensity (p = .006). Locking was associated with degeneration (p = .05).

CONCLUSIONS

Condylar osteodegeneration is often related to DDwoR. Locking by DDwoR is associated with severe levels of chronic pain and articular disk deformation.

Investigation of Validity and Reliability of Voice Activity and Participation Profile-Turkish Version (VAPP-TR)

A voice activity and participation profile (VAPP) is a self-assessment tool used to measure activity and participation limitations resulting from voice disorders. This study aims to demonstrate the adaptation, validity, and reliability of the Turkish version of the VAPP scale. A total of 231 individuals, 155 with voice disorders (patient group) and 76 without voice disorders (normal group), were included in this study. With reliability, internal consistency, and test-retest methods; validity was evaluated with criterion and convergent validity methods. The Cronbach α coefficient calculated for internal consistency was found to be 0.985 for the VAPP total and between 0.914 and 0.978 for the subsections. Intraclass Correlation Coefficient was found to be 0.974 for the VAPP total and between 0.800 and 0.981 for the subsections. Total and subsection scores of the VAPP scale had correlation coefficients ranged between 0.725 and 0.903 with VHIT and V-RQOLT in the whole sample (all P<0.001). The cut-off point was determined as ≥ 8 by ROC curve analysis for criterion validity. VAPP-TR is a valid and reliable tool that can be used to evaluate the quality of life of Turkish patients with voice disorders, particularly those with activity limitations and participation restrictions.

Initial therapeutic approaches for orofacial myofascial pain: three pilot studies

OBJECTIVE

Myofascial pain diminishes the stomatognathic function and hinders clinical diagnosis. Therefore, initial pain reduction is crucial before definitive treatment. Here, the clinical validity of non-pharmaceutical therapies, including the Aqualizer® splint, physiotherapy, and dry-needle acupuncture was comparatively assessed.

METHODS

Myofascial pain patients (n = 28; 20-65 years old) were examined through a visual analog scale, and intra- and extra-oral muscle palpation. Mandibular maximum opening and neck mobility were also evaluated. Changes in parameters through time were analyzed via the Kruskal-Wallis test, while the Friedman test and dot-plots were used for comparative therapies assessment. General patient improvement was represented via an isometric Principal Component.

RESULTS

The Aqualizer® and physiotherapy resulted in improvement of all parameters except for mouth opening. Acupuncture improved extra-oral muscle pain and neck mobility.

CONCLUSION

The Aqualizer®, physiotherapy, and oral acupuncture are effective initial pain therapies. Among all, physiotherapy provided the greatest benefits, followed by the Aqualizer®.

The Clinical Efficacy of Microsuture Technique Combined With Voice Therapy in Patients with Reinke's Edema

OBJECTIVE

This study aimed to explore the clinical efficacy of the microsuture technique combined with voice therapy in patients with Reinke's edema.

METHODS

46 patients with Reinke's edema admitted between April 2017 and August 2021 were selected and randomly divided into simple surgical and combined therapy groups. The simple surgical and combined therapy group were evaluated preoperatively and at 3 months after surgery using subjective and objective voice analysis.

RESULTS

Compared with the preoperative state, there was a significant improvement in the acoustic parameters 3 months postoperatively. The G and R scores, Voice Handicap index-10 (VHI-10), and jitter parameters of the combined therapy group were lower, whereas F0 and maximum phonation time (MPT), changed significantly in the combined therapy group, fundamental frequency perturbation (jitter), and MPT acoustic parameters of the combined therapy group were lower than those of the simple surgery group (P < 0.05).

CONCLUSION

The microsuture technique is preferable for eliminating vocal folds surgical wounds and promoting mucosal recovery, and combined with voice therapy is more helpful to comprehensive improve the quality of phonation.

Experiences of Breastfeeding Mothers of Infants With Ankyloglossia: A Qualitative Study

BACKGROUND

Ankyloglossia, or limited tongue mobility due to a restrictive sublingual frenulum, can complicate breastfeeding. Treatment typically involves a frenotomy, a procedure that cuts the restrictive tissue parallel to the tongue.

RESEARCH AIM

To describe the experiences of breastfeeding mothers with children affected by ankyloglossia, before any treatment for the condition.

METHOD

This was a qualitative descriptive study. Using purposive sampling, 20 participants were recruited. Data were collected through individualized semi-structured interviews. The interviews were recorded and transcribed verbatim. Thematic analysis was used for data analysis with ATLAS.ti computer software.

RESULTS

Four main themes were identified: (1) Breastfeeding: An idyllic and intuitive process; (2) When idyllic becomes problematic; (3) Looking for a solution; and (4) Recommendations based on experience. During pregnancy, the participants perceived breastfeeding as an idealized process. After delivery, participants described physical and emotional difficulties with breastfeeding that they attributed to ankyloglossia. Although the care received by midwives in the hospital was satisfactory, the participants described shortcomings, including the lack of breastfeeding training for healthcare professionals and the lack of specialized physiotherapists.

CONCLUSIONS

This study shows the difficulties experienced by breastfeeding mothers of children with ankyloglossia prior to treatment, emphasizing the importance of a comprehensive approach. Despite satisfaction with midwifery care, shortcomings in the hospital were described.

The Usability and Acceptability of the mHealth "Health and Voice" for Promoting Teachers' Vocal Health

OBJECTIVE

To evaluate the usability and acceptability of "Health and Voice" for the promotion of vocal health, and to analyze the same with sociodemographic data, work data, self-knowledge data on vocal care, voice disadvantage, and vocal fatigue symptoms in elementary school teachers.

MATERIAL AND METHODS

A cross-sectional observational study, with a sample of 277 elementary school teachers from a Brazilian capital. Teachers were invited to access, interact and evaluate the mHealth: "Health and Voice". The evaluation instruments were the questionnaire with information on socio-demographic and work data, the System Usability Scale (SUS), the questionnaire with questions about acceptability, the Voice Handicap Index Protocol (VHI-10), and the Vocal Fatigue Index Protocol (VFI). Descriptive and association analyses were performed by the Chi-square, Fisher exact, Mann-Whitney, and Wilcoxon tests (P ≤ 0.05) RESULTS: the mean SUS score was 81.9 points; the mean of the acceptability questions was 17.24; the VHI-10 was 6.96 points; the VFI was 21.11 points. Most participants rated the acceptability of mHealth as high. There was an association between acceptability and working in two shifts (P = 0.019); between acceptability and usability (P < 0.001); and between usability and self-perception of knowledge about voice care after using mHealth (P = 0.000). The activity perceived as most important was guidance on voice care.

CONCLUSION

"Health and Voice" is a vocal guidance tool for teachers that promotes vocal health. It has high usability and acceptability by elementary school teachers. Self-reported knowledge about vocal care increases after its use and those who evaluate the technology with high acceptability are 3.6 times more likely to also classify it with high usability.

The Impact of Early Childhood Otitis Media on Hearing Abilities: A Scoping Review

OBJECTIVES

Otitis media (OM) is among the most common childhood diseases. Many studies have suggested that recurrent OM episodes during early childhood can have long-lasting adverse effects on essentially every level of the auditory system. However, the literature on this topic is heterogeneous and results are mixed. Hence, a need exists to structure the available evidence. Here, a scoping review was conducted, aiming to (1) map the many different outcome measures used to assess the long-term impact of OM, (2) appraise the quality of the available OM documentation, and (3) provide a summary of the available evidence and its potential link with OM documentation.

DESIGN

Original articles were identified through systematic searches in the PubMed, Embase, and Cochrane Library databases. To be included, studies were required to assess the long-term impact of resolved early childhood OM on hearing abilities. Two reviewers independently screened studies for inclusion. A data charting form, developed by author LVY, was used to extract information about the publication (year, journal, country of data collection) and study characteristics (sample size, outcome measures, OM documentation).

RESULTS

The search identified 16,267 records, out of which 94 articles were included. Most of the current evidence is based on retrospective data from high-income countries, using a wide range of outcome measures. The retrospective study design poses challenges for thorough OM documentation, especially regarding OM history of the controls. A narrative synthesis showed consistently elevated audiometric thresholds in the extended high-frequency range and poorer gap detection abilities in children with a history of early childhood OM. Mixed results were found in terms of speech perception and binaural unmasking.

CONCLUSIONS

This scoping review demonstrates the breadth of the literature on this topic. A wide range of outcome measures have been used, and the quality of OM documentation varies greatly across studies. Variability of the literature results may-at least to some extent-be explained by inadequate OM documentation, recruitment bias, and variability in the time since the last OM episode. Recommendations for future research are provided.

Analysis of the Immediate Effects of the LaxVox Technique on Digital Videokymography Parameters in Adults With Voice Complaints

OBJECTIVES

Digital videokymography based on high-speed videoendoscopy enables the evaluation of therapeutic techniques and voice training, such as the LaxVox technique, on vocal fold vibrations. This study investigated the immediate effects of the LaxVox technique on digital videokymographic parameters obtained through high-speed videolaryngoscopy in adults with voice complaints.

STUDY DESIGN

An experimental intrasubject comparative study of adults with voice complaints was conducted.

METHODS

Image processing software was used to analyze the videos and obtain digital videokymography parameters. The intraclass correlation coefficient was used to determine the intra-rater reliability of the analyzed parameters. The paired t test and Wilcoxon signed-rank test were used to compare digital videokymography parameters before and after the LaxVox technique, in sex-specific analyses. The significance level was set at 5%.

RESULTS

In total, 25 laryngeal images from 15 women and 10 men were analyzed. On digital videokymography analysis, the mean vocal fold opening in the posterior glottal region was decreased immediately after using the LaxVox technique in women. In contrast, no significant changes were found in other parameters compared to pre LaxVox technique values in both men and women with voice complaints.

CONCLUSION

Digital videokymography analysis revealed that the LaxVox technique reduces the mean vocal fold opening in the posterior glottal region of women with voice complaints.

Speech and language therapists' insights into severity of speech sound disorders in children for developing the speech sound disorder severity construct

BACKGROUND

Children with speech sound disorders (SSD) are at higher risk of communication breakdown, but the impact of having an SSD may vary from child to child. Determining the severity of SSD helps speech-language therapists (SLTs) to recognise the extent of the problem and to identify and prioritise children who require intervention.

AIMS

This study aimed to identify severity factors for SSD in order to develop a multifactorial Speech Sound Disorder Severity Construct (SSDSC) using SLTs' views and the International Classification of Functioning, Disability and Health (ICF).

METHOD

In an explorative five-staged qualitative study, the research question was answered: 'How do SLTs determine the severity of SSD in children?'. A total of 91 SLTs from The Netherlands participated in data collection and analysis. The iterative process included three different qualitative research methodologies (thematic analysis [TA], constructivist grounded theory [CGT] and content analysis [CA]) to ensure validation of the results by means of method triangulation.

RESULTS

SLTs considered nine themes: intelligibility, speech accuracy, persistence, the child's perception, impact, communicative participation, concomitant factors, professional point of view, and environmental factors. The themes were summarised in three main severity factors: (I) Speech accuracy, (II) The child's perception of the impact of their speech, and (III) Intelligibility in communication. Other severity factors were concomitant factors and impact. Expertise and support were identified as facilitators or barriers that may worsen or relieve the severity of SSD.

CONCLUSIONS

This study highlights the need for SLTs to rethink how they think about severity as a simplistic construct reflecting only speech accuracy. It is recommended that a broader holistic approach to measuring severity is adopted.

WHAT THIS PAPER ADDS

What is already known on the subject Although there are several proposals aiming to define the severity of SSD, the extent to which these align with clinical practice is not well understood. In recent years, speech accuracy and other factors such as intelligibility have been suggested as possible indicators of SSD severity. Flipsen et al. (2005) concluded that experienced clinicians evaluated the number, type and consistency of speech errors as well as intelligibility, considering articulatory competence at both the segmental and whole word level when determining severity. Enderby et al. (2013) developed ICF-based Therapy Outcome Measures (TOMs), including a TOM for phonological disorder. Although there is evidence in the literature that multiple factors should be considered when determining severity, there is still no clear guidance on this. In this discussion, the perspective of SLTs is an important contribution to the development of a measure of severity, but is lacking in the known literature. What this paper adds to the existing knowledge As a first step, this study examines SLT's perspectives on how they define and measure severity of SSD, and determines how those views align with the ICF in order to develop a severity construct that can be further tested and validated. Using the views of SLTs and the ICF, this qualitative study resulted in the multifactorial SSDSC. What are the potential or actual clinical implications of this work? The practical experience of SLTs, combined with what is known from the literature, provides insight into the different factors that may contribute to severity of SSD. These factors may be considered in developing a measure of SSD severity in the future.

Vocal Impact in Patients With Unilateral Diaphragmatic Paralysis

OBJECTIVES

This study aimed to investigate the possible vocal impact confirmed by diagnostic tests, the degree of perception of possible vocal impairment by patients with Unilateral Diaphragmatic paralysis (UDP) and its correlation with ventilatory weakness.

METHODS

The researchers conducted an analytical, observational and case-control study with 70 individuals, including 35 UDP patients and 35 healthy patients in a control group, who underwent the following assessments: 1) Self-assessment of voice handicap (VHI-10); 2) Self-Assessment of Quality of Life (SF-36); 3) Self-Assessment of Dyspnea (MRC); 4) Objective vocal measures (Maximum Phonation Time (MPT) in /a/, /s/, /z/ and glottal-to-noise excitation ratio); 5) Functional respiratory pressures (Spirometry and maximum ventilatory pressures); 6) General degree of dysphonia - G on the GRBAS Scale. The sex, age and body mass index (BMI) of the individuals were the variables used to match the sample of this study.

RESULTS

When compared with controls, patients with UDP had a restrictive functional pattern and inspiratory weakness, with symptoms of dyspnea and worsening quality of life. When associated with a possible vocal impact, these patients had voice handicap and decreased MPT values for all phonemes, especially /a/. There was also a correlation between vocal performance and inspiratory weakness. However, it should be noted that, despite having vocal impairment, many patients did not report the perception of this fact, somehow neglecting such impairment.

CONCLUSIONS

In addition to the expected weakness of the ventilatory muscles, patients with UDP had clinically verified vocal impact, and those who had greater inspiratory weakness also had greater voice impairment. Finally, it is relevant that not all patients perceived such vocal impact, which showed a very reduced perception of this impairment in patients with UDP.

Different Performances of Machine Learning Models to Classify Dysphonic and Non-Dysphonic Voices

OBJECTIVE

To analyze the performance of 10 different machine learning (ML) classifiers for discrimination between dysphonic and non-dysphonic voices, using a variance threshold as a method for the selection and reduction of acoustic measurements used in the classifier.

METHOD

We analyzed 435 samples of individuals (337 female and 98 male), with a mean age of 41.07 ± 13.73 years, of which 384 were dysphonic and 51 were non-dysphonic. From the sustained /ε/ vowel sample, 34 acoustic measurements were extracted, including traditional perturbation and noise measurements, cepstral/spectral measurements, and measurements based on nonlinear models. The variance method was used to select the best set of acoustic measurements. We tested the performance of the best-selected set with 10 ML classifiers using precision, sensitivity, specificity, accuracy, and F1-Score measurements. The kappa coefficient was used to verify the reproducibility between the two datasets (training and testing).

RESULTS

The naive Bayes (NB) and stochastic gradient descent classifier (SGDC) models performed best in terms of accuracy, AUC, sensitivity, and specificity for a reduced dataset of 15 acoustic measures compared to the full dataset of 34 acoustic measures. SGDC and NB obtained the best performance results, with an accuracy of 0.91 and 0.76, respectively. These two classifiers presented moderate agreement, with a Kappa of 0.57 (SGDC) and 0.45 (NB).

CONCLUSION

Among the tested models, the NB and SGDC models performed better in discriminating between dysphonic and non-dysphonic voices from a set of 15 acoustic measures.

Relationships Between Sense of Coherence, Self-perception of Voice and Work Environment Among Teachers

OBJECTIVE

to analyze the relationship between sense of coherence and sociodemographic data, remote physical work environment, and self-perception of symptoms, vocal handicap and vocal fatigue in teachers.

METHODS

Seventy eight teachers pertaining to the municipal education network of a Brazilian capital city participated in the study, during the period of social isolation by COVID-19. An online questionnaire was applied with sociodemographic and physical remote work environment questions, the Sense of Coherence Scale (SOC-13), the Brazilian Dysphonia Screening Tool (Br-DST), the Vocal Fatigue Index (VFI), and the Vocal Handicap Index (VHI-10). Descriptive analysis, bivariate and multivariate Logistic regression models were performed to check the proportion of teachers with high and low SOC among the different categories of independent variables. Student's t test and Mann Whitney test were used to compare SOC, IDV, and VFI scores between the groups, and Hedge's g test was used to access the effect size. The total scores of SOC, VHI and VFI were correlated using Pearson's Correlation Coefficient. All tests adopted a 5% significance level.

RESULTS

Male teachers and those over 45 years old were, respectively, 6.79 (95%CI = 1.16-39.58) and 5.27 (95%CI = 1.40-19.76) times more likely to present a high SOC. The variables associated with a lower chance of presenting high SOC were vocal restriction (OR = 0.21; 95%CI = 0.06-0.79) and voice-related physical discomfort (OR = 0.13; 95%CI = 0.02-0.78). Regarding the remote work environment, in bivariate analysis, teachers who were dissatisfied with air quality (OR = 0.08; 95%CI = 0.01-0.65), temperature (OR = 0.11; 95%CI = 0.01-0.92), and noise (OR = 0.25; 95%CI = 0.61-0.99) were less likely to have high SOC. Higher values of SOC are associated with lower self-perception of vocal fatigue and voice handicap (P < 0,001).

CONCLUSION

The way individuals face stressful situations interferes with the self-perception of their voice and their work environment. The relationship between the sense of coherence and voice perception is relevant to favor programs to promote vocal health and stress management in teachers.

Communicative participation of school-aged children with cochlear implants: parental perceptions

This qualitative study aimed to explore parents' perceptions regarding the communication of their school-aged child with cochlear implants (CIs) in various social contexts. To this end, the construct of "communicative participation" (World Health Organization (2001), International Classification of Functioning, Disability, and Health, https://www.who.int/standards/classifications/international-classification-of-functioning-disability-and-health) was broadly applied to the population of children with CIs. Nineteen parents participated in semi-structured interviews and described their perceptions and experiences regarding the communication of their child in social contexts. Data were analyzed using a thematic analysis approach. The results showed that overall, despite describing very positive outcomes with CIs, parents reported that their children do experience participation restrictions and activity limitations because of communication difficulties and/or environmental and social barriers. The findings from this study unveiled the communication difficulties of school-aged children with CIs, as experienced by their parents. These difficulties-which may seem subtle-can significantly impact the participation in communication. Language interventions could be improved to better support pupils who are experienced CI users.

Relationships between nurses' perceived social support, emotional labor, presenteeism, and psychiatric distress during the COVID-19 pandemic: a cross-sectional study

BACKGROUND

Nurses play a significant role in providing care and support to patients in the healthcare system. However, their role can often lead to high stress levels and psychiatric distress. This study aimed to examine the impact of socio-demographic, and work-related characteristics, perceived social support, emotional labor, and presenteeism on psychiatric distress among Iranian nurses during the COVID-19 pandemic. This study examined nurses' knowledge, attitudes, use, and acceptance of the use of artificial intelligence in nursing care.

METHODS

This was a cross-sectional survey study. A total of 296 nurses were recruited via stratified random sampling from 9 teaching hospitals in a province in the northwestern region of Iran in 2020. The survey package included socio-demographic and work-related questions, the General Health Questionnaire (GHQ-28), the Dutch Questionnaire for Emotional Labor, the Multidimensional Scale of Perceived Social Support, and the Stanford Presenteeism Scale. Descriptive and multiple regression analyses were performed to examine the associations between nurses' psychiatric distress and potential factors.

RESULTS

The mean age of the participants was 29.3 ± 7.6 years, and they were mostly female (50.3%). Psychiatric distress was reported by more than half of the participants (53.8%). Multiple regression analysis revealed that female sex, rotating shift work, contract employment status, less work experience, lower social support, higher emotional labor, and presenteeism were positively related to nurses' psychiatric distress and explained 28.2% of the variance in psychiatric distress among nurses.

CONCLUSION

This study highlights the significant prevalence of psychiatric distress among nursing staff during the COVID-19 pandemic. Targeted interventions are necessary to improve mental health outcomes in this population. To protect nurses against the negative effects of health crises, healthcare organizations must provide a supportive work environment that prioritizes nurses' psychological well-being. Providing nurses with basic support, especially for their preferred shift schedules, and offering contract employees the same benefits as permanent employees, including health insurance, retirement plans, and paid leave, can create a sense of stability and support. Additionally, healthcare organizations should invest in workplace initiatives that promote positive mental health, such as stress management programs and team-building activities.

Thai Voice Handicap Index-10: A Validity Study

BACKGROUND

The Voice Handicap Index (VHI) is a widely accepted tool for the self-assessment of voice severity. While comprehensive, its 30-item format can be time-consuming. The Voice Handicap Index-10 (VHI-10) provides a concise alternative, maintaining reliability and validity. This study aimed to develop and validate the Thai version of the VHI-10 and compare its performance with the full Thai VHI.

METHODS

The original Thai VHI was translated and abbreviated into the Thai VHI-10 using established translation and validation methods developed in 2004. This prospective study involved 40 patients diagnosed with voice disorders and 40 individuals without voice disorders, each completing both versions of the questionnaire. Internal consistency was assessed with Cronbach's alpha, and the correlation between the two versions was analyzed using Pearson's correlation coefficient. Sensitivity and specificity were determined via receiver operating characteristic (ROC) analysis.

RESULTS

The Thai VHI-10 demonstrated excellent internal consistency (Cronbach's alpha = 0.965) and a strong correlation with the full Thai VHI (r = 0.969, P < 0.001). ROC analysis identified a sensitivity and specificity of 92.5% at a cutoff score of 7. The Thai VHI-10 effectively distinguished patients from controls (P < 0.001) and required significantly less time to complete (mean: 4.2 vs. 14.3 minutes).

CONCLUSION

The Thai VHI-10 serves as a practical alternative to the full Thai VHI, facilitating quicker evaluations. Further research may explore its application in broader populations and varied clinical settings.

Use of Meludia to evaluate the effect of music training in cochlear implant users: study protocol of a randomised controlled study

INTRODUCTION

Although most cochlear implant (CI) users achieve good speech understanding in quiet without visual cues, they may have limited speech understanding in noise and often have poor music perception. The present study was designed to investigate the degree to which the use of Meludia training can improve music perception, music enjoyment and speech understanding in paediatric and postlingually deafened adult CI users. The study also aims to assess the participants' changes in cognitive skills (attention and memory) and quality of life.

METHODS AND ANALYSIS

This randomised controlled trial will randomise new CI users and experienced CI users older than 6 years who meet the inclusion criteria in a 1:1 ratio to either a musical training (MT) group or a non-MT (NMT) group. The NMT group will receive standard care that does not include MT. Participants in the MT group will practise with Meludia software for 4 weeks and later for 12 additional weeks. Outcomes will include scores in: 'Listening Up' exercises, the -Music-Related Quality of Life questionnaire, the Music Questionnaire for Paediatric Population, Disyllables in silence, Matrix test, Mini Mental State Examination, Performance IQ and the Wechsler intelligence scale for children and the Assessment of Quality of Life-8 Dimensions questionnaire. The NMT group will receive standard care that does not include MT.

ETHICS AND DISSEMINATION

On 16 October 2023, the study protocol was approved by the La Paz Hospital in Madrid (Spain). The findings of this study will be published in peer-reviewed publications and presented at appropriate conferences.

TRIAL REGISTRATION NUMBER

NCT06540677.

Health-related quality of life perspectives of cochlear implanted children, their hearing peers, and their parents: a prospective case-control study

BACKGROUND

Hearing loss is one of the most common sensory alterations in humans. Cochlear implants in children provide significant benefits from a clinical point of view. However, the benefits in the health-related quality of life have been seldom studied.

OBJECTIVE

To assess whether the health-related quality of life of 5-18 old children with cochlear implants, as measured with the PedsQL pediatric quality of life questionnaire version 4.0, is comparable with the perception of their parents/caregivers.

DESIGN

Prospective, observational, cross-sectional and analytical study.

SETTING(S)

Hearing loss Unit of the Hospital Universitario Insular Materno-Infantil (Mother and Child University Hospital), León y Castillo Infant and Primary Education Center and La Minilla Secondary Education Institute.

PARTICIPANTS

140 pediatric subjects (108 with cochlear implants, 32 hearing) plus one of their parents or guardians.

METHODS

The original and Spanish-validated PedsQL™ pediatric quality of life questionnaires version 4.0 were used.

RESULTS

Cochlear implantation yielded statistically significant results in terms of physical functioning and psychosocial health in children of 5-18 years of age.

CONCLUSIONS

The health-related quality of life of cochlear implanted pediatric patients (5-18 years old) evaluated with the PedsQL™ pediatric quality of life questionnaire version 4.0, is comparable to the perception of their parents/caregivers.

The mediating role of resilience in job satisfaction and burnout among Chinese plateau military personnel

Despite the challenging working conditions in plateau regions, research on factors influencing job satisfaction among military personnel in these areas is limited, particularly regarding burnout and resilience. Job satisfaction is closely linked to career development and work effectiveness. Given the unique occupational characteristics of military personnel, particularly those stationed in plateau regions, it is essential to examine their job satisfaction. The objective of this study was to investigate the impact of burnout on the job satisfaction of military personnel in plateau regions and to explore whether resilience serves as a mediating factor in this relationship. A cross-sectional survey was conducted involving 2,054 military personnel from Tibet and Qinghai provinces in China by stratified random cluster sampling. The instruments utilized included the Maslach Burnout Inventory, Connor-Davidson Resilience Scale, and Job Satisfaction Scale. Hierarchical linear regression analysis was employed to identify predictors of job satisfaction, while structural equation modeling (SEM) was used to analyze the pathway from burnout to job satisfaction. The results from hierarchical linear regression indicated that both burnout and resilience are significant predictors of job satisfaction among military personnel in plateau areas (P < 0.01). In SEM analysis, the total effect of burnout on job satisfaction was found to be -8.862 (95%CI[-9.049, -8.673], P < 0.001). Furthermore, resilience partially mediated the relationship between burnout and job satisfaction; specifically, the indirect effect accounted for 24.6% of the total effect.These findings suggest that burnout significantly impacts job satisfaction among military personnel stationed in plateau regions while highlighting that resilience can mitigate some negative effects associated with burnout on job satisfaction. Consequently, it is recommended that military managers focus on enhancing military personnel' resilience as a strategy for better coping with various occupational pressures encountered in plateau environments-ultimately improving work efficiency and supporting healthy career development for these individuals.

Self-Perception of Drooling Impact in People with Parkinson's Disease: A Case-Control and Cross-Sectional Study

BACKGROUND

Drooling, defined as the involuntary loss of saliva from the anterior oral cavity, is potentially problematic for people with Parkinson's disease (PwP). However, there is little research on how PwP perceive the impact of drooling and what factors contribute to it.

OBJECTIVES

The objective was to evaluate the self-perceived impact of drooling in people with and without Parkinson's disease and the contributing clinical factors in PwP.

METHODS

We conducted a cross-sectional and case-control study. Participants were clinically examined, and the primary outcome was the Sialorrhea Clinical Scale for Parkinson's disease. Clinical variables were compared between PwP and control subjects using the Mann-Whitney test, correlations between drooling impact and clinical factors in PwP were analyzed using Spearman's test, and predictors were identified using linear regression.

RESULTS

The study included 101 PwP and 101 sex- and age-matched controls. PwP experienced significantly more severe impact of drooling compared to controls across all domains: diurnal and nocturnal drooling, drooling severity and frequency, social discomfort, speech, and eating impairments. The greater impact of drooling in PwP was significantly associated with drooling severity, disease duration, levodopa equivalent daily dose, clinical global impression of saliva accumulation (CGI-S), chewing, swallowing, speech, oromotor, motor and non-motor impairments. Significant predictors of greater impact of drooling in PwP include drooling severity, higher CGI-S, facial expression, and swallowing impairments.

CONCLUSIONS

PwP have a significantly greater impact of drooling compared to controls, affecting several domains. Drooling impact and its contributing clinical factors should be investigated in a Parkinson's consultation.

Curricular integration of augmentative and alternative communication for students on the autism spectrum in inclusive-oriented schools: A scoping review

Many students with autism spectrum condition who require augmentative and alternative communication systems attend inclusive-oriented schools, where it is expected that curricula support their preferred communication methods. While augmentative and alternative communication is recognized as an evidence-based practice, its integration within inclusive-oriented school curricula remains insufficiently understood. To address this gap, a scoping review was conducted in alignment with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, examining 34 studies on augmentative and alternative communication use in inclusive-oriented school settings for students with autism spectrum condition. The findings highlight limited teacher engagement, a variety of strategies, and an emphasis on communication skills, but leave a gap in understanding how inclusive-oriented schools employ augmentative and alternative communication to promote learning for autistic students. The review also addresses the restricted curricular integration of augmentative and alternative communication, noting that it is often implemented outside the classroom and primarily for social rather than academic purposes.Lay Abstracta. What is already known about the topic? It is well established that in inclusive-oriented schools, both the attitudes and training of teachers, as well as the accessibility of the learning environment, are crucial for the participation and success of individuals with autism. While practices like augmentative and alternative communication systems are used in these schools, their effectiveness is often contingent on the level of training and the time available to the professionals involved.b. What does this paper add? This article highlights that augmentative communication for individuals with autism in inclusive-oriented schools is not effectively integrated into the curriculum. Instead, it is mainly used for brief socialization activities, without proper evaluation, and with limited involvement from teachers.c. Implications for practice, research, or policy: The findings suggest the need for a more inclusive curriculum that incorporates augmentative and alternative communication systems, enabling them to be taught, assessed, and applied in a way that supports the learning of individuals with autism.

Clonidine mitigates noise-induced hearing loss by regulating TRPC6-mediated calcium influx in cochlear hair cells

Noise-induced hearing loss (NIHL) is a common auditory disorder driven by calcium overload, oxidative stress, and apoptosis in cochlear sensory hair cells. The transient receptor potential canonical 6 (TRPC6), a nonselective cation channel that can be activated by norepinephrine, is implicated in calcium influx and associated cellular damage. This study explores the protective effects of clonidine, an FDA-approved α2-adrenergic receptor agonist that reduces sympathetic nervous system activity and norepinephrine release, on NIHL in mice. Clonidine treatment significantly preserved hearing thresholds, reduced damage to outer hair cells and ribbon synapses, and suppressed TRPC6 channel activation induced by noise exposure. Mechanistically, clonidine alleviated calcium influx, inhibited the calcium-dependent MLCK-MRLC signaling pathway, and attenuated oxidative stress and apoptosis in cochlear hair cells. Molecular docking analyses demonstrated strong binding between norepinephrine and TRPC6, elucidating the regulatory role of clonidine in calcium signaling. These findings highlight clonidine's potential to prevent NIHL by maintaining intracellular calcium homeostasis and reducing cochlear damage via the modulation of norepinephrine and TRPC6 activity. TRPC6 emerges as a promising therapeutic target for preventing and managing noise-induced auditory dysfunction.

Novel CTNNB1 Gene Variants in Spanish CTNNB1 Syndrome Patients: Clinical and Psychological Manifestations

CTNNB1 Syndrome is a neurodevelopmental disorder caused by de novo pathogenic variants characterized by global cognitive impairment, microcephaly, speech and motor delay, abnormal muscle tone, ophthalmologic impairments, behaviour problems and autistic spectrum disorder (ASD) symptoms. The aim of this study is to carry out a thorough clinical and psychological characterization of Spanish CTNNB1 syndrome patients. We used standard clinical assessment instruments and an ad hoc questionnaire to measure motor functioning, neurodevelopmental milestones, sleep problems, daily life activities, behavioural problems, communication and speech impairments, eating disorders and autistic features in 25 participants with CTNNB1 syndrome (15 females, 10 males; mean age 7.1 ± 4.1). Main clinical manifestations reported were microcephaly, motor impairment, sight problems, sleep disturbances and sensorial problems. Attainment of developmental milestones indicated motoric, language and daily living skills to be generally delayed. All participants had adaptative skills below their chronological age, even though verbal individuals had better functioning compared to nonverbal. Regarding behaviour impairments, CTNNB1 syndrome patients scored significantly high at internalizing and externalizing behavioural problems. Additionally, about 60% presented symptoms of ASD. Our findings have important implications for the psychotherapeutic and clinical approaches of CTNNB1 syndrome patients. We show the importance of early stimulation, given that an early attainment of developmental milestones is related to a current better function of many clinical variables. Moreover, previous underrated symptoms such as sleep problems, impaired adaptative skills and high rates of behavioural symptoms should be taken into consideration due to the harmful impact that have on every day life.

The impact of Anchor, a home visitation programme for maltreated children, on child developmental and behavioural outcomes

Introduction

Adverse childhood experiences (ACEs) are associated with significant long-term impacts, yet few interventions specifically target ACE exposure, especially in Asian populations. Anchor, Singapore's first home visitation programme, addresses maltreat-ment among preschool children. This study evaluated Anchor's impact on children's developmental and behavioural outcomes.

Method

We conducted a prospective evaluation of children under 4 years assessed for maltreatment from November 2019 to July 2023. Developmental and behavioural progress was measured every 6 months using the Ages and Stages Questionnaires (ASQ-3) and ASQ:Social-Emotional (ASQ:SE-2), and annually using the Child Behaviour Checklist (CBCL).

Results

The results of 125 children (mean age 20.0 months, 48% female) were analysed. The mean length of stay in programme was 21.2 (7.3) months. At baseline, 92 (73.6%) children were at risk of develop-mental delay and 25 (31.7%) children aged ≥18 months had behavioural concerns. The programme was associated with significant improvements in gross motor (P=0.002) and fine motor (P=0.001) domains of the ASQ-3 and internalising problem scale (P=0.001) of the CBCL.

Conclusion

Anchor effectively enhances develop-mental and behavioural outcomes for children exposed to maltreatment. Targeted early intervention through such programmes can mitigate adverse impacts, optimising developmental trajectories and potentially reducing the long-term clinical and economic burdens associated with ACEs.

Longitudinal high-density cortical auditory event-related potentials and speech-sound discrimination in the first two years of life in extremely and very preterm infants without developmental disorders

Maturation of the auditory system in early childhood significantly influences the development of language-related perceptual and cognitive abilities. This study aims to provide insights into the neurophysiological changes underlying auditory processing and speech-sound discrimination in the first two years of life. We conducted a study using high-density electroencephalography (EEG) to longitudinally record cortical auditory event-related potentials (CAEP) in response to synthesized syllable sounds with pitch/duration change in a cohort of 79 extremely and very preterm-born infants without developmental disorders. EEG were recorded at 6 timepoints from term to 24 months corrected age, using a pseudorandom oddball paradigm. We found that the infant-P1 component of CAEP showed decreasing latency with age and more focalized cortical source stabilizing in the left primary auditory cortex by 6 months. By 6 months, a negative infant-N1 component emerged, its amplitude increasing with age and source localization showing increasing distribution over the left temporal, parietal and frontal lobes. Mismatch responses demonstrated significant differences in auditory discrimination capabilities starting from 6 months, indicating the infants' ability to detect phonetic differences. There was no correlation between infant-P1 latency, infant-P1 amplitude or mismatch response at term age and gestational age. This study suggests that cortical sound detection occurs very early and is not significantly influenced by the extent of prematurity but rather by corrected age. Early sound detection is followed by cortical sound content processing from about 6 months, with gradual organization along the cortical auditory dorsal stream and mirror neuron system in the first two years of life. Auditory discrimination of speech sounds also significantly changes from around 6 months of age.

Knowledge and Practices of Brazilian Speech-Language-Hearing Pathologists in Voice and Communication Services for Transgender and Gender-Diverse Individuals

OBJECTIVE

To investigate the knowledge and practices of Speech-Language Pathology professionals (SLP) in Brazil regarding voice and communication care for trans and transvestite individuals.

METHOD

This is an observational, cross-sectional, and analytical study approved by the Research Ethics Committee under number 6.574.268. Data collection was conducted online through a questionnaire via Google Forms, including sociodemographic questions and questions about knowledge and practices in voice care for trans and transvestite individuals or those with gender diversity experiences. Professionals who refused to sign the Informed Consent Form and those who submitted incomplete questionnaires were excluded from the study.

RESULTS

128 SLP with active registrations in the Regional SLP Councils from all regions of Brazil participated in the study. The majority were women, white, and had postgraduate education. Most professionals believe their academic curricula inadequately address this topic, and only a minority have received specific training to serve this population. While many rated their knowledge as basic or intermediate, only a small percentage considered themselves highly specialized. Social media was the main source of information for 70.3%, while 43% turned to scientific articles. Regarding creating inclusive environments, almost 60% implemented team training strategies. However, 46.1% rated the cultural and gender sensitivity of professionals as poor, 79.7% acknowledged specific barriers to accessing services, and 72.7% were unaware of care protocols for this population.

CONCLUSION

Most speech-language pathologists recognize the barriers faced by the trans and gender-diverse population in accessing voice and communication services. However, there is still a significant gap in the knowledge and training of these professionals, with more than half having basic or intermediate levels of understanding of the needs of this population. The low frequency of treatments and the lack of specific training highlight the urgency of more inclusive and specialized training. Additionally, the predominant use of social media as an information source, rather than scientific literature, underscores the need for greater engagement with scientific literature to ensure evidence-based practice.

Research on the perception of pre-semen collection stress and its influencing factors in men on the day of oocyte retrieval in IVF-ET

PURPOSE

This study aimed to investigate the status and influencing factors of perceived stress in men before sperm collection on the day of oocyte retrieval during IVF-ET, thereby providing a theoretical basis for nursing interventions.

METHODS

A cross-sectional survey was conducted using convenience sampling. We examined 507 male IVF-ET patients undergoing sperm collection using a demographic questionnaire, the Generalized Anxiety Disorder Scale, the Perceived Stress Scale, and the Chinese version of the Connor-Davidson Resilience Scale. Univariate analysis, Pearson correlation, and multivariate linear regression were utilized to identify factors affecting perceived stress before sperm collection.

RESULTS

The average score for perceived stress before sperm collection was 14.64 ± 4.54. For generalized anxiety, it was 6.28 ± 3.92; and for psychological resilience, it was 68.14 ± 18.46. Multivariate linear regression analysis revealed that monthly family income, psychological resilience, and anxiety were significant predictors of perceived stress in men before sperm collection (P < 0.05).

CONCLUSIONS

Men experienced mild anxiety and perceived stress before sperm collection on the day of oocyte retrieval, accompanied by moderate psychological resilience. Monthly family income is independent predictors of perceived stress. Anxiety correlates positively with perceived stress and can predict elevated stress levels, while psychological resilience correlates negatively with stress, serving as a protective factor. Nursing staff must address perceived stress, anxiety, and resilience in men undergoing IVF-ET, providing comprehensive information and support to enhance their psychological well-being.

Motivation Theories and Constructs in Experimental Studies of Online Instruction: Systematic Review and Directed Content Analysis

BACKGROUND

The motivational design of online instruction is critical in influencing learners' motivation. Given the multifaceted and situated nature of motivation, educators need access to a range of evidence-based motivational design strategies that target different motivational constructs (eg, interest or confidence).

OBJECTIVE

This systematic review and directed content analysis aimed to catalog the motivational constructs targeted in experimental studies of online motivational design strategies in health professions education. Identifying which motivational constructs have been most frequently targeted by design strategies-and which remain under-studied-can offer valuable insights into potential areas for future research.

METHODS

Medline, Embase, Emcare, PsycINFO, ERIC, and Web of Science were searched from 1990 to August 2022. Studies were included if they compared online instructional design strategies intending to support a motivational construct (eg, interest) or motivation in general among learners in licensed health professions. Two team members independently screened and coded the studies, focusing on the motivational theories that researchers used and the motivational constructs targeted by their design strategies. Motivational constructs were coded into the following categories: intrinsic value beliefs, extrinsic value beliefs, competence and control beliefs, social connectedness, autonomy, and goals.

RESULTS

From 10,584 records, 46 studies were included. Half of the studies (n=23) tested strategies aimed at making instruction more interesting, enjoyable, and fun (n=23), while fewer studies tested strategies aimed at influencing extrinsic value beliefs (n=9), competence and control beliefs (n=6), social connectedness (n=4), or autonomy (n=2). A focus on intrinsic value beliefs was particularly evident in studies not informed by a theory of motivation.

CONCLUSIONS

Most research in health professions education has focused on motivating learners by making online instruction more interesting, enjoyable, and fun. We recommend that future research expand this focus to include other motivational constructs, such as relevance, confidence, and autonomy. Investigating design strategies that influence these constructs would help generate a broader toolkit of strategies for educators to support learners' motivation in online settings.

TRIAL REGISTRATION

PROSPERO CRD42022359521; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022359521.

Breastfeeding: The Multifaceted Impact on Child Development and Maternal Well-Being

Breastfeeding is recognized as the gold standard in infant nutrition, providing necessary nutrients for optimal growth and development. Beyond its nutritional function, breastfeeding has numerous benefits for both mother and child. This literature review examines the effects of breastfeeding on the development of the nervous and immune systems, its influence on cognitive development, and the impact of stress on lactation. In addition, it explores the emotional effects of breastfeeding on mothers, the challenges associated with exclusive breastfeeding, and the process of weaning along with its implications for both mother and infant. It is indicated that stress significantly affects lactation regulation, with elevated cortisol levels potentially disrupting hormonal balance. Furthermore, the essential roles of oxytocin, sialic acid, and docosahexaenoic acid in infant brain development and cognitive functions are highlighted. Breastfeeding is associated with the regulation of the baby's sleep through the effects of tryptophan, serotonin, and melatonin, which at the same time provide the baby with a sense of security with the mother. It is indicated that women who breastfeed are less likely to suffer from mental health problems and are at a lower risk of hypertension, diabetes, and cardiovascular disease. The weaning process is often a difficult time for mother and child; thus, it should be introduced gradually to minimize stress, anxiety, and potential mood disturbances in the mother.

The reliability and validity of a Chinese version of the Beach Center Family Quality of Life Scale in Mainland China for families of children with autism

PURPOSE

The objective of this study was to translate the Family Quality of Life (FQOL) Scale into simplified Chinese and assess its reliability and validity in mainland China for families of children with autism.

METHODS

The FQOL Scale was professionally translated from English into simplified Chinese using a forward-backward process. We conducted a survey in which families with autistic kids were asked to participate, it comprised of a general condition questionnaire and the FQOL Scale translated to Chinese. A total of 402 families took part in the study, out of which 333 data sets were complete and available for analysis. The FQOL Scale model was subject to exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to probe its scale dimensional design and structure, as well as its adaptability to autistic children and their families using SPSS AMOS 24.0. The internal consistency and reliability was examined using Cronbach's α (SPSS 22.0). And stepwise regression analysis was conducted to predict parents' attitudes towards prognosis based on the five dimensions of the modified Chinese version of the FQOL Scale (SPSS 22.0).

RESULTS

The data analysis yielded a revised Chinese version of the FQOL Scale. The analysis revealed that the overall reliability coefficient of the scale, as indicated by Cronbach's α, was 0.918. The results of the CFA provided support for the best fit of a five-factor model (χ2 = 285.237, CFI = 0.930, TLI = 0.916, SRMR = 0.061, RMSEA = 0.062). The predictive equation for parents' attitudes towards prognosis based on the five-dimensional model of the modified Chinese version of the FQOL Scale was as follows: Parent prognostic attitude = -0.863 + 0.456* Parenting + 0.2* Physical/Material Well-being.

CONCLUSION

The modified Chinese version of the FQOL Scale is suitable in mainland China for families of children with autism and has good reliability and model fit. The two dimensions of Parenting and Physical/Material Well-being can significantly predict parents' prognostic attitude, indicating that the better the status of Parenting and Physical/Material Well-being, the better the parents' prognosis attitude.

A nomogram for assisting in diagnosing mouth breathing based on maxillofacial surface electromyographic activity

OBJECTIVE

A nomogram based on maxillofacial surface electromyographic (sEMG) activities was developed to assist in diagnosing mouth breathing (MB).

METHODS

Differences in maxillofacial sEMG activities between MB and nasal breathing (NB) subjects were compared across a sample of 250 participants to identify MB diagnostic factors, a nomogram was developed to assist in diagnosing MB.

RESULTS

In the univariate analysis, there were significant differences in sEMG activity of masseter muscle with the lips closed lightly, orbicularis oris superior during rest, orbicularis oris superior with the lips closed lightly (OOS3), orbicularis oris superior during swallowing, mentalis muscle during rest, mentalis muscle during maximal intercuspation (MT2), mentalis muscle with the lips closed lightly (MT3) and mentalis muscle during swallowing between the MB and NB groups. Multivariate analysis revealed that OOS3 and MT3 were independent risk factors for MB, while MT2 might be a protective factor against MB. The nomogram exhibited a good clinical application value with an area under the ROC curve of 0.774 (95% CI 0.713-0.834) and fitted calibration curves.

CONCLUSION

MB could affect maxillofacial sEMG activities. We developed a nomogram to assist in diagnosing MB in the clinic.

CLINICAL SIGNIFICANCE

The nomogram can help clinicians diagnose MB quickly and easily, providing a more effective way to diagnose children with MB early so that they can receive timely treatment and block abnormal neuromuscular reflexes early, thereby avoiding the harmful effects of MB.

The impact of sleep in high-risk infants

Most of an infant's day is devoted to sleep - and normal sleep is vital to normal brain development. Sleep disruptions may impair overall health, well-being, and neurodevelopment. Disruptors of sleep and circadian health, such as noise, light, respiratory support, and clinical interventions, are highly prevalent in hospital and nursing care facilities. These factors particularly affect infants who already have an increased risk of sleep disorders and their consequences due to an underlying disease. Preterm infants and infants with disorders such as neonatal abstinence syndrome, craniofacial malformations, congenital heart disease, hypoxic-ischemic encephalopathy, Chiari-malformation/myelomeningocele, congenital musculoskeletal disease, and Down syndrome are all at high risk for impaired development of sleep-wake cycling and for sleep-disordered breathing. Since abnormal sleep is a potentially treatable risk factor for impaired neurodevelopment, there is an urgent need for effective monitoring, timely interventions, and treatment strategies to improve sleep physiology and thereby optimize overall neurodevelopment in these high-risk populations. IMPACT: Healthy sleep plays a fundamental role in normal infant brain development. Many factors can disrupt sleep during a hospital stay. This is particularly important for infants who have an increased risk of sleep disorders due to neonatal disorders such as prematurity, congenital heart disease, or Chiari malformation. Sleep protective strategies are readily available and need to be systematically implemented into hospital care.

Clinical and audiological profile of patients with sudden sensorineural hearing loss after exposure to recreational noise

According to the World Health Organization, significant hearing loss in young people exposed to recreational acoustic trauma has become a public health issue.

OBJECTIVE

To describe the clinical and audiological profile of individuals with Sudden Sensorineural Hearing Loss (SSNHL) exposed to recreational noise.

METHODS

A prospective cohort study was conducted involving outpatients with SSNHL and a history of exposure to acute recreational noise. Follow-up occurred weekly in the first month, then monthly for up to six months of follow-up. All were treated with oral corticosteroids with prednisone 1 mg/kg/day, followed by a gradual dose reduction of 20 mg every 7-days until complete withdrawal of the medication.

RESULTS

Twelve individuals were included, 8 (66.7%) males, with a mean age of 24.16-years. 58.3% of the individuals had binaural involvement. Only one patient had permanent profound hearing loss, with no sign of recovery after treatment. All had associated tinnitus. Half of the participants reported having used recreational drugs, and the type of exposure varied from New Year's Eve parties, funk and electronic music, concerts and games in stadiums. Regarding the duration of exposure and the distance from the sound source, most reported a time of 3-5 h, with a short distance from the source.

DISCUSSION

Recreational noise exposures have the potential to increase the risk of hearing loss in individuals outside of the workplace. Data such as sex, age group and the most prevalent type of noise exposure in these cases reported in this study corroborate the findings in the literature. Regarding the persistence of hearing loss after treatment, the outcome was varied, and the studies are still controversial.

CONCLUSION

There is an association between exposure to recreational noise and SSNHL, and the epidemiological profile of patients affected by this condition is marked by adolescents and young male adults with unilateral and binaural involvement, severe degree of hearing loss at onset, and commonly associated with the use of recreational drugs, risking permanent hearing damage.

LEVEL OF EVIDENCE

3 (OCEBM Levels of Evidence Working Group*. "The Oxford 2011 Levels of Evidence").

Novel cVEMP procedure reveals sexual dimorphism in peak to trough latency

Introduction

Sex difference in latency for cervical vestibular-evoked myogenic potential (VEMP) has been reported in Brown Norway rats. Human investigations of sex difference in VEMP latency have shown inconsistent results, although there are indicators of sexual dimorphism in vestibular function and a higher reporting rate for vestibular disorder in women than in men.

Methods

Sex effects in human VEMP were re-evaluated here using a procedure adapting clinical protocols for higher sensitivity. VEMP was compared between 24 women and 24 men using a novel procedure that (1) controlled neck tension with biofeedback and a padded head bar; (2) used body-conducted stimuli to eliminate sound exposure concerns and collect appreciably more data than is feasible with air-conducted stimuli; which in turn (3) increased statistical power because there were sufficient data for a linear mixed effects regression modelling analysis.

Results

Women had significantly shorter VEMP peak to trough latency than men. The sex difference of 2.4 ms (95% CI [-0.9, -3.9], p = 0.0020) was 21% of the mean 11.4 ms VEMP peak to trough latency measured across women and men. There was no significant sex difference in VEMP peak to trough amplitude. These findings are a reversal of several prior studies in humans, reviewed here with a simulation indicating the studies may have been underpowered.

Discussion

Findings are consistent with those in Brown Norway Rats, for which a study design featuring a custom rodent holder to control neck tension, extension of test sequences in comparison to those typically used in VEMP protocols for humans, and insertion of electrodes subcutaneously will have increased sensitivity compared to that achievable with clinical VEMP protocols for humans. Findings are interpreted as sex hormones affecting myelination or synaptic response; sexual dimorphism in neck/head size may also have contributed. The vestibular periphery and brainstem are highly conserved across vertebrates with similar findings in rat and human supporting use of VEMP as a reliable, non-invasive indicator of vestibular function. VEMP measures in humans may require higher sensitivity than is achievable using current clinical protocols in order to produce consistent results.

Low-volume resistance training: a feasible, cost-effective strategy for musculoskeletal frailty in older adults attending daycare centers

Introduction

Frailty is a prevalent geriatric syndrome, posing significant health risks for older adults attending daycare centers or residing in institutional settings. Addressing frailty with interventions that are feasible and cost effective and also promote high adherence within these environments is crucial.

Objective

This study aimed to evaluate the impact of a low-volume, remotely supervised resistance training protocol on physical frailty among frail older adults attending daycare centers. Secondary outcomes included changes in sarcopenia prevalence and fall risk.

Methods

Thirty-one frail older adults participated in a 12-week usual care period, followed by a 12-weeks intervention featuring low-volume (10-minute sessions) resistance training three times weekly. The program was delivered locally by non-specialized staff under remote supervision. Musculoskeletal, functional, and clinical assessments were conducted at three-time points: baseline, pre-intervention, and post-intervention.

Results

During the usual care period, a decline was observed in handgrip strength (19.2-18.5 kg) and sit-to-stand time (14.5-17.4s) (p < 0.05). However, these measures were preserved during the intervention. Relative muscle power decreased during the usual care but improved with training (4.3-5.2 W/Kg, p < 0.001). While body composition, physical function, gait speed, and Short Performance Physical Battery scores remained stable, reductions were observed in exhaustion and physical inactivity prevalence (p < 0.05). Frailty prevalence showed a decreasing trend (48%-26%, p = 0.099), with significant reductions in sarcopenia prevalence (29%-10%, p = 0.045), and fall frequency (p = 0.022).

Conclusion

The low-volume strength training protocol was a feasible, cost-effective strategy for mitigating musculoskeletal frailty criteria, sarcopenia and fall risk among older adults in daycare centers, potentially delaying the progression of these conditions.

The effects of the DHACA method on expressive communication in children with autism spectrum disorder

PURPOSE

This study aimed to assess the contributions of the DHACA method to expressive communication development in children with autism spectrum disorder (ASD).

METHODS

This longitudinal case series study had a sample of 12 children with ASD, nonverbal or minimally verbal communication, and support level one or two. Data were collected by applying the ACOTEA-R Protocol by analyzing videos recorded during intervention sessions before and after using the DHACA. Participants underwent 20 individual speech-language-hearing sessions with the DHACA.

RESULTS

After the intervention with the ACOTEA-R, 10 of the 12 children improved their overall expressive communication skills. Concerning the communicative profile, initially, 10 children were nonverbal and 2 were minimally verbal. After the intervention, 7 evolved to a verbal pattern, whereas 5 remained nonverbal. The progress of the following communication skills stands out: use of sentences with four or more words, naming objects, social expressions, greeting people, and making comments. Moreover, 8 of the 12 participants advanced to the third skill in the DHACA, characterized by request with lexical and morphosyntactic expansion.

CONCLUSION

The children's speech and use of the communication book indicated progress in their expressive communication development after intervention with the DHACA.

Auditory Brainstem Response in Intrauterine Growth Restriction

PURPOSE

The purpose of this study was to evaluate the auditory brainstem response (ABR) of infants with asymmetric intrauterine growth restriction (IUGR) in response to different stimuli and to compare the findings with those of term infants.

METHOD

A total of 20 infants with asymmetric IUGR who had no risk factors for hearing loss and 20 term healthy infants as a control group participated. Click, chirp, and 4-kHz tone burst at 90 dB nHL stimuli were used, and Waves I, III, and V absolute latencies; Waves I-III, I-V, and III-V interpeak intervals; and wave amplitudes were evaluated.

RESULTS

The Wave V absolute latency and Waves I-V interpeak interval of both click and chirp stimuli in infants with asymmetric IUGR were significantly shorter in both ears (p < .05). In contrast, only Wave III absolute latency was significantly shorter for both ears (p < .05) with a 4-kHz tone burst.

CONCLUSIONS

ABR test with click, chirp, and 4-kHz tone-burst stimuli revealed that there are functional differences attributed to IUGR. Contrary to popular belief, these findings are evidence of neurosensory changes caused by IUGR, which is not included as a risk factor in newborn hearing screening programs. The type of stimulus used in the assessment was critical.

Dietary total antioxidant capacity and frailty in Turkish community-dwelling and nursing home: cross-sectional study

Background

This study examines the relationship between dietary total antioxidant capacity, frailty, and nutritional status in Turkish older adults living in the community and nursing homes.

Methods

This study included 160 older adults (50% female) living in the community (n = 80) and a nursing home (n = 80). Anthropometric measurements were taken, and BMI was calculated. Demographic characteristics, nutritional status (MNA-SF: Mini Nutritional Assessment Short Form), frailty (FRAIL Scale), activities of daily living (Katz ADL), and three-day food consumption records were assessed. Dietary total antioxidant capacity was determined based on the three-day food consumption record.

Results

The mean ages of the groups were similar (72.5 ± 6.0 and 72.2 ± 5.9 years). Nursing home residents had significantly higher rates of chronic disease (91.3%) and regular medication use (90.0%) (p < 0.05). Overweight was more prevalent among community dwellers (50.0%, p < 0.05), while obesity was more common in nursing home residents (26.2%, p > 0.05). Frail (32.5%) and pre-frail (40.0%) rates were higher in nursing home residents compared to elderly community dwellers (21.2 and 38.8%, respectively). Dependence ratios were similar between the groups (p > 0.05). Community-dwelling participants had a lower risk of malnutrition. While their daily carbohydrate intake was lower, nursing home residents had higher intakes of protein, fat, ω-3 fatty acids, fiber, vitamins (except vitamin E), and minerals. Frailty showed a strong negative correlation with Katz (r = -0.56, p < 0.001) and MNA-SF scores (r = -0.44, p < 0.001), while weak positive correlations were observed with TRAP, TEAC, and FRAP3 values. A negative correlation was observed between the residential setting and TORAC (r = -0.424, p < 0.001), TRAP (r = -0.190, p < 0.001), TEAC (r = -0.257, p < 0.001), and total VCEAC (r = -0.241, p = 0.002) values.

Conclusion

Residential setting may affect nutrient intake, frailty, dietary total antioxidant capacity, and overall health in older adults.

Swallowing Safety after Remote sub-total Esophagectomy: How Important is Tongue Pressure?

The factors related to oropharyngeal dysphagia after remote esophagectomy (greater than five months) remain unclear. This study aimed to assess patient perception of dysphagia, maximum anterior isometric pressure (MAIP), maximum posterior isometric pressure (MPIP), lingual swallowing pressure (LSP) and radiographic physiological components of the oral and pharyngeal phases of swallowing in patients who are post remote sub-total esophagectomy (SE). Patient perception of dysphagia was assessed using the Eating Assessment Tool (EAT-10). MAIP, MPIP, and LSP were measured using the Iowa Oral Performance Instrument. Videofluoroscopy was used to assess the physiologic components of swallowing with the Modified Barium Swallow Impairment Profile (MBSImP) and the Penetration-Aspiration Scale (PAS). Ten patients were included in the study (53.2% male; mean age 54.5 ± 18.0). The mean postoperative time was 30 months (range, 5.0-72 months). Seven patients had elevated EAT-10 scores (> 3). All patients demonstrated impaired oropharyngeal swallowing on at least three MBSImP components (range 3-12) and two patients aspirated (PAS 8). There was a significant difference in MAIP values when comparing patients with normal versus impaired laryngeal elevation and epiglottic movement (p < 0.001). MPIP values were significantly different in patients with normal versus impaired epiglottic movement as well as normal versus elevated PAS scores (p < 0.001). Decreased lingual pressure and physiological changes in swallowing coexist after SE. Our results indicate that the decrease in tongue strength may be one of the factors related to unsafe swallow. The assessment of lingual pressure provides diagnostic value and should be incorporated as part of a comprehensive assessment in this population.

Hearing Loss and Cognitive Function: An Analysis in Older Adults at the Beginning of the Auditory Rehabilitation Process

To investigate the association between auditory thresholds and cognitive impairment in older adults at the beginning of the auditory rehabilitation process in a hearing health service. Cross-sectional study with older people (60 years and older) undergoing hearing rehabilitation at a hearing health care service (SASA) in the State of Santa Catarina from March to December 2022. Data was collected from users who attended to undergo an initial evaluation and start the auditory rehabilitation process during this period. Sociodemographic data, hearing and health perception, Montreal Cognitive Assessment (MoCA) cognitive screening test, Hearing Handicap Inventory for the Elderly (HHIE-S), and pure tone audiometry were collected. 652 older adults participated in the research, with a mean age of 73 years, 51.68% female, 76.56% with sensorineural hearing loss, and 42.06% with moderately severe degree. It was found that for every 1 dB in the mean hearing thresholds, there was a reduction of 0.06 points in MoCA. This reduction was statistically significant, regardless of sex, age, education, and income. There was an association between worsening hearing thresholds and reduced MoCA scores in the older population. Most older adults reported a significant handicap in living with hearing loss and mean advanced age in the search for initial evaluation and hearing aid fitting.

Neuropsychological evaluation of children and adolescents with fetal alcohol spectrum disorders in the Brazilian population

Fetal Alcohol Spectrum Disorder (FASD) is a collective name for lifelong physical and neurodevelopmental problems caused by the gestational consumption of alcohol affecting fetal development. In Brazil, the lack of awareness among healthcare professionals, and the scarcity of suitable diagnostic tools and trained clinicians, can contribute to the underestimation of FASD prevalence and severity. The present review aims to map and analyze studies conducted in Brazil on children and adolescents with FASD or a history of prenatal alcohol exposure (PAE). Additionally, it intends to report the psychometric properties of the neurodevelopmental assessment tools applied in the selected articles. Searches were carried out in the databases Scielo, LILACS, PePSIC, EMBASE, PsycINFO, Web of Science, selecting original clinical studies that have investigated the neurodevelopment of this population. From a total of 175 studies, ten articles fit the inclusion criteria in which 18 instruments were identified. The most reported deficits were related to language, general intelligence quotient (IQ), adaptive behavior, attention, and visual perception. Our results point to the need for more clinical research on FASD in Brazil, as well as for the standardization and validation of neurodevelopmental assessment tools for the accurate diagnosis of FASD in Brazil.

A qualitative systematic review of the impact of hearing on quality of life

PURPOSE

Hearing loss, deafness, and other hearing-related conditions can significantly impact quality of life; numerous qualitative studies have sought to describe these impacts. Synthesis of these findings may provide additional or more robust insights.

METHODS

A qualitative systematic review of studies reporting qualitative data relating to the impact of hearing problems on adults' health-related quality of life. A subset of studies was included in the review and subsequently analysed using a thematic approach.

RESULTS

The literature search yielded 129 studies, of which 22 met our inclusion criteria and were included for analysis. The included studies, primarily from Australia, the UK, and the USA, involved approximately 450 participants with various hearing conditions. Semi-structured interviews and focus groups were the most common data collection methods, with thematic analysis being the predominant analytical approach. Three overarching categories of descriptive themes were identified: Physical, Mental, and Social. Physical encompassed sound localization, sound clarity, speech, and physical fatigue. Social included relationships, isolation, communication, independence, work function, social stigma, and confidence. Mental encompassed depression, anxiety, listening effort, mental fatigue, fear, and identity. The identified themes shed light on the diverse domains of health-related quality of life affected by hearing conditions.

CONCLUSION

Differences in hearing function impact upon people's health-related quality of life in a variety of ways relating to physical, mental, and social aspects of health, and these themes are clearly demonstrated across qualitative studies. These results will inform the development of hearing-specific questionnaire items for with the EQ-5D descriptive system, a commonly used patient-reported outcome measure.

Validity and Reliability of Dysphagia Outcome Severity Scale (DOSS) When Used to Rate Flexible Endoscopic Evaluations of Swallowing (FEES)

The Dysphagia Outcome and Severity Scale is used both clinically and within dysphagia research, internationally. Although it was developed using videofluoroscopic swallowing studies, it is frequently used to rate Flexible Endoscopic Evaluations of Swallowing. The validity and reliability of DOSS-use with FEES, however, has not previously been evaluated. This study investigated the validity and rater reliability of clinicians using DOSS to rate FEES. Eleven Speech-Language Pathologists (SLPs) with varied dysphagia experience were recruited to review and DOSS-rate 17 soundless FEES (198 bolus swallows) recorded from 11 heterogenic dysphagic patients (2 cases with repeat FEES) and 4 healthy adults. The SLPs DOSS-ratings were compared against the initial comprehensive dysphagia evaluation (including patient diagnosis, interview, cranial nerve and complete FEES assessment) with Functional Oral Intake Scale (FOIS) and DOSS outcome measures. The SLPs were blinded to patient details and comprehensive dysphagia examination. Re-randomised rating of FEES cases occurred two weeks later (intra rater reliability). Criterion validity for DOSS-ratings (compared against comprehensive dysphagia evaluation with FOIS and DOSS) were strong-very strong (rs = 0.858 and 0.936 respectively; p < 0.001). Inter rater reliability demonstrated high agreement (α = 0.891), also intra rater reliability demonstrated almost perfect agreement (Kw = 0.945). This study's results, with strong-very strong criterion validity and high rater reliability by SLPs, adds to the evidence for DOSS-use with FEES. Future validity research comparing DOSS with both FEES and VFSS simultaneously is recommended.