Assessing outcomes for dysphonic patients

This study was designed to evaluate a disease-specific outcome measure for patients with selected voice disorders and to relate this instrument to a standardized quality of life measurement. In addition, the study attempts to document the degree of handicap for dysphonia patients globally, between different vocal pathologies, and in comparison to other chronic diseases. In this prospective, observational study, 260 adult patients evaluated for alterations of voice completed a general quality of life measure (the Medical Outcomes Trust Short Form 36-Item[SF-36]) and a voice-specific instrument (Voice Handicap Index [VHI]) pretreatment.

The highest correlation was between the social functioning score of the SF-36and the total score of the VHI and the physical, emotional, and functional subscales (p < 0.001) of the VHI. Significant correlation was also obtained for the SF-36 domains mental health (p < 0.01), general health (p < 0.01), and role functioning emotional (p < 0.017) with the three VHI domains and the total VHI score. Patients had significantly lower scores than the general U.S. population in five of the eight domains of SF-36. Patients with vocal fold paralysis had the highest level of pretreatment disability as measured on both the VHI and SF-36 among voice patients. The patients with dysphonia had a lower level of physical functioning than the patients with chronic sinusitis (p < 0.01), reflecting a greater handicap. In addition, the dysphonia group had lower levels of social functioning than the angina (p < 0.01) and sciatica (p < 0.01) groups and a lower score for mental health than the angina group (p < 0.01).

The SF-36 correlates with the VHI in the domains of social functioning,mental health, and role functioning emotional. The baseline handicap for voice disorders represents a significant disability even in comparison to conditions such as angina pectoris, sciatica, and chronic sinusitis.     

Speech recognition in noise by individuals with mild hearing impairments

The study was designed to test the validity of the American Academy of Ophthalmology and Otolaryngology's (AAOO) 26-dB average hearing threshold level at 500, 1000, and 2000 Hz as a predictor of hearing handicap. To investigate this criterion the performance of a normal-hearing group was compared with that of two groups, categorized according to the AAOO [Trans. Am. Acad. Ophthal. Otolaryng. 63, 236-238 (1959)] guidelines as having no handicap. The latter groups, however, had significant hearing losses in the frequencies above 2000 Hz. Mean hearing threshold levels for 3000, 4000, and 6000 Hz were 54 dB for group II and 63 dB for group III. Two kinds of speech stimuli were presented at an A-weighted sound level of 60 dB in quiet and in three different levels of noise. The resulting speech recognition scores were significantly lower for the hearing-impaired groups than for the normal-hearing group on both kinds of speech materials and in all three noise conditions. Mean scores for group III were significantly lower than those of the normal-hearing group, even in the quiet condition. Speech recognition scores showed significantly better correlation with hearing levels for frequency combinations including frequencies above 2000 Hz than for the 500-, 1000-, and 2000-Hz combination. On the basis of these results the author recommends that the 26-dB fence should be somewhat lower, and that frequencies above 2000 Hz should be included in any scheme for evaluating hearing handicap.     

A BODY MASS DEPENDENT MECHANICAL IMPEDANCE MODEL FOR APPLICATIONS IN VIBRATION SEAT TESTING

A three degree-of-freedom model is proposed to predict the biodynamic responses of the seated human body of different masses. A baseline model is initially derived to satisfy both the mean apparent mass and seat-to-head transmissibility responses proposed in ISO/DIS 5982:2000 applicable for mean body mass of 75 kg. The validity of the resultant generic mass dependent model is verified by comparing the apparent mass and driving-point mechanical impedance responses computed for total body masses of 55, 75 and 90 kg with the range of idealized values proposed for body masses within the 49-93 kg range. Considering the lack of data that could be found to define the apparent mass/mechanical impedance of subjects with different body masses when applying the experimental conditions defined in ISO/DIS 5982:2000, an attempt is made to adapt the parameters of the base model to fit the measured apparent mass data applicable to groups of automobile occupants within different mass ranges. This is achieved through constrained parametric optimization which consists of minimizing the sum of squared errors between the computed response and the mean apparent mass data measured for automobile occupants within four mass groups: less than 60 kg, 60·5-70·5 kg, 70·5-80 kg and above 80 kg. The results show a reasonably good agreement between the model responses and the measured apparent mass data, particularly at frequencies below 10 Hz. The results suggest that the proposed mass dependent model can effectively predict the apparent mass responses of automobile occupants over a wide range of body masses and for two different postures: passenger (hands-in-lap) and driver (hands-on-steering wheel) postures.     

Effects of physical activity on quality of life and physical function in postoperative patients with gastrointestinal cancer

Objectives: This study was to clarify changes in physical function and quality of life (QOL) for postoperative, and to examine the influence of the amount of physical activity on these variables. Methods: This study included 29 patients who underwent gastrointestinal cancer surgery. The QOL measurement was used to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for preoperative and 2nd and 4th postoperative weeks. Physical function measured knee extension strength, 4 m walk time, 5 times sit-to-stand test, and 6-minute walk for preoperative and 1st and 2nd postoperative weeks. The amount of physical activity score was based on METs-hours, which is estimated from cumulative physical activity. As basic characteristics were investigated cancer stage, comorbidities and complications, and operative. Statistical analysis was repeated measures analysis of variance was performed to observe postoperative changes in physical function and QOL. Furthermore, stepwise multiple regression analysis was used to the parameters of physical function and QOL affected by the physical activity score were investigated. Results: Physical function decreased postoperatively and generally improved 2nd postoperative week. Though scores on the QOL functional scales improved, some items did not improve sufficiently. Multiple regression analysis showed that physical activity score had an effect on constipation and emotion functioning. Conclusions: Improvement in symptom scales is not sufficient in a short period of time, and they need to be followed up by increasing the amount of physical activity and promoting instantaneous exercise.     

Self-rated Changes of Health Status during Stay-at-home Orders among Older Adults Using the Long-term Care Insurance System of Japan: A Cross-sectional Study

Objectives: To reveal self-rated changes of health status during stay-at-home orders among older adults and to verify whether decrease in frequency of going outdoors during these orders was related to self-rated changes in health status. Method: A self-completed questionnaire for older adults was provided in 2 dayservice facilities and a nursing station. We operationally defined health status with 4 domains (motor function, oral and swallowing function, depression, and social networks) and designed the questionnaire to determine self-rated changes in health status using factor analysis. After factor analysis, regression analyses were conducted. Dependent variable was each factor score (self-rated changes of health status), and independent variable was decrease in frequency of going outdoors. Results: Approximately 80% of participants answered that their health status had “worsened” in motor function (75.0%-87.2%). Moreover, more than 70% of participants answered “worsened” in “Feeling energy” and “Getting together and speaking with friends” (72.3% and 75.7%, respectively). Regression analyses demonstrated that, after adjusting for covariates, the decrease in frequency of going outdoors was related to self-rated changes of motor function and friend network. Conclusion: During stay-at-home orders, older adults felt deterioration in their motor function, in feeling energy, and in their friend network, especially people who had decreased their frequency of going outdoors felt more deterioration in their motor function and in their friend network.     

Application of the BASNEF Model in Safety Training in Automobile Manufacturing Plants

After controls, including engineering and management, the final way to control noise is to use hearing protection devices. Due to the lack of a standardized questionnaire regarding investigating workers’ use of hearing protection devices on the basis of the BASNEF behavioral model, the present study was conducted to investigate the effect of health education based on the BASNEF model on the use of hearing protection devices in workers of an automobile manufacturing plant in Iran. This quasi-experimental and prospective intervention study was performed on 80 workers at an automobile manufacturing plant who are exposed to noise levels above 85 decibels and do not use hearing protection devices. In this study, 40 people working in a cast iron foundry were selected as the intervention group, and 40 working in aluminum casting were chosen as the control group. Questionnaires were analyzed at the beginning of the intervention and three months after the intervention in the intervention and control groups. There was no significant difference between the intervention and control groups before the intervention. There was a significant difference between the intervention and control groups after the intervention in the area of knowledge. A significant correlation was observed between the intervention and control groups after the intervention program in all areas of the BASNEF educational model except behavioral intention. In this study, the effect of educational intervention on the use of hearing protection devices was investigated, and with the educational intervention, it was tried to get help from influential people and enabling factors in education based on the BASNEF model. The results showed that the educational intervention based on the BASNEF model can improve the knowledge of individuals in both the intervention and control groups.     

Effect of Home-based Exercise Therapy for Peripheral Arterial Disease Patients Underwent Endovascular Treatment: A Clinical Controlled Design

Objective: This study aimed to clarify the effect of home-based exercise therapy on physical activity in peripheral arterial disease (PAD) patients after EVT. Methods: Study design was controlled clinical design. The subjects were 30 patients (76.6% men) who underwent EVT in the Sakakibara Heart Institute of Okayama. Patients with EVT meeting the inclusion criteria were divided into two groups, intervention group (Home-based exercise) and control group. Patients'' basic characteristics, the number of steps walked and QOL questionnaire (WIQ, SEPA, Vascu QOL) were assessed before surgery and, at the 3 month after discharge. A two-way analysis of variance (ANOVA) was performed to compare number of steps walked and QOL questionnaire. Results: Interaction effect were observed in the number of steps walked (F (1,28) =13.89, p<0.01). A multiple comparison test confirmed a significant increase between results of before surgery and at three months after surgery in the intervention group (p<0.01). An interaction between the presence and absence of intervention was found for the WIQ pain score (F(1,28) = 5.86, p=0.01), speed score (F(1,28) = 3.80, p=0.04) and SEPA (F(1,28) = 4.99, p=0.03). In a multiple comparison study, there was a significant increase in WIQ pain and speed scores in both groups before and 3 months after discharge from the hospital. Conclusion: Home-based exercise therapy using physical activity indices has the potential to improve number of steps and quality of life in patients with PAD after EVT.     

Voice Therapy Outcome—A Randomized Clinical Trial Comparing Individual Voice Therapy,Therapy in Group,and Controls Without Therapy

ObjectiveA stumbling-block in voice therapy is how the patient will be able to apply the new voice technique in everyday life. Possibly this generalization process could be facilitated by giving voice therapy in group because of the natural forum for training voice-to-speech early in communication between the patients in a group setting. The aim of the study was to compare treatment results from individual voice therapy and voice therapy in group, at several time points and in comparison to patients with no voice therapy.MethodsA randomized treatment study was performed with 77 consecutive patients diagnosed with a functional voice disorder. Thirty-one patients were randomized to individual and group therapy, respectively, and 15 patients to no therapy. The assessments included standardized voice recording and registration of voice range profile (VRP), answering Voice handicap index (VHI) and visual analogue scales for self-hoarseness and self-vocal fatigue, and perceptual voice evaluation by speech-language pathologist. The assessments were performed before, direct after therapy, and three months later in all groups. The 2 therapy groups were also assessed 12 months after therapy.ResultsAll VHI scores as well as the self-ratings of hoarseness and vocal fatigue, and the perceptual evaluation of voice quality and maximum VRP improved significantly in both therapy groups 3 months after treatment and at 12 months follow-up. There were no significant changes in the control group, with the exception of decreased self-rated hoarseness and increased maximum VRP. Comparisons between treatment groups showed significant larger improvement after group therapy for VHI physical subscale at 12 months, as well as significant lower VHI total score at all measurement sessions and lower subscale scores at 12 months. There were no differences between treatment groups in self-hoarseness or self-vocal fatigue and no difference in perceptual voice quality or VRP. Comparison between controls and treatment groups showed significant larger change in treatment groups from baseline to three months in VHI total and to end of therapy in functional subscale. Treatment groups also showed significant lower scores than controls at each measurement session, for VHI total and physical subscale as well as lower degree of perceptual aberration of voice quality and vocal fatigue, at three months follow-up.ConclusionsThis study shows long-term improvement from behavioral voice therapy, particularly in a group setting. The results indicate the importance of early transfer-to-speech and late posttherapy test to capture whether the goal of voice therapy was fulfilled or not for the patients.     

DIRECT SIMULATION OF DEEP INELASTIC SCATTERING OF HEAVY-IONS (I) ONE PARAMETER DISTRIBUTION

The distributions of dynamic variables in the deep inelastic scattering (DIS) of heavy-ions are studied by a direct simulation technique based on the single-nucleon-transfer-mechanism. The relative motion of the two collision partners is described by a Lagrange equation, and the transition probability of a single nucleon during the interaction time is calculated by the statisti-cal spectroscopy method.The occurrence of the transition event and the corresponding change of the dynamic variables are both treated randomly according to the transition probability. The calculated results for the reaction of ⁴⁰Ar+⁵⁸Ni(E_L=280MeV) are compared with experimental data.     

Speech reception in quiet and in noisy conditions by individuals with noise-induced hearing loss in relation to their tone audiogram.

Tone thresholds and speech-reception thresholds were measured in 200 individuals (400 ears) with noise-induced hearing loss. The speech-reception thresholds were measured in a quiet condition and in noise with a speech spectrum at levels of 35, 50, 65, and 80 dBA. The tone audiograms could be described by three principal components: hearing loss in the regions above 3 kHz, from 1 to 3 kHz and below 1 kHz; the speech thresholds could be described by two components: speech reception in quiet and speech reception in noise at 50-80 dBA. Hearing loss above 1 kHz was related to speech reception in noise; hearing loss at and below 1 kHz to speech reception in quiet. The correlation between the speech thresholds in quiet and in noise was only R = 0.45. An adequate predictor of the speech threshold in noise, the primary factor in the hearing handicap, was the pure-tone average at 2 and 4 kHz (PTA2,4, R = 0.72). The minimum value of the prediction error for any tone-audiometric predictor of this speech threshold was 1.2 dB (standard deviation). The prediction could not be improved by taking into account the critical ratio for low-frequency noise nor by its upward spread of masking. The prediction error is due to measurement error and to a factor common to both ears. The latter factor is ascribed to cognitive skill in speech reception. Hearing loss above 10 to 15 dB HL (hearing level) already shows an effect on the speech threshold in noise, a noticeable handicap is found at PTA2,4 = 30 dB HL.     

Self-reported voice problems among three groups of professional singers

A vocal health questionnaire was administered to three groups of professional singers and a “friendship-matched” group of nonsingers in Melbourne, Australia. The responses of 79 opera, 57 musical theatre and 31 contemporary (excluding rock) singers and 86 nonsingers were analysed. The questionnaire solicited information regarding biographical data speaking and singing voice-use behaviours, and vocal health over the previous 12 months in terms of experiences of vocal impairment, vocal disability, and handicap. Significant differences between singers and nonsingers in the prevalence and nature of voice problems were reported. Of the singers, 44% reported one or more occurrences of a diagnosed vocal condition compared to 21% of nonsingers and 69% of singers experienced vocal disability compared to only 41% of nonsingers, over the previous 12 months. In contrast, no significant differences were found between the three different styles of singers in their experience of vocal impairment, disability or handicap.     

Subjective evaluation of work environment with special reference to noise

The presence of subjective noise annoyance was investigated among workers in a machine factory and a textile mill by using a questionnaire. The relation between annoyance due to noise and annoyance caused by other factors in the work environment was also investigated. The results show that annoyance due to noise exposure was common in both factories. Apart from the relation to the noise level, other acoustical characteristics, such as frequency spectrum and intensity, as well as differences between background and peak levels seem to determine the extent of annoyance. In the machine factory, the general satisfaction at work was significantly less among workers who had reported annoyance from noise, insufficient natural and artificial daylight and dust. In the textile mill noise and dust as well as monotonous work and fast working pace were of importance for the general satisfaction at work. Headache and tiredness were more common in the textile mill. The techniques used in the study could be applied to obtain further information on other industrial noise exposure criteria than hearing damage to serve as a basis for standards for annoyance.     

Risk factors for hearing loss at different frequencies in a population of 47,388 noise-exposed workers.

Weighted regression analysis was applied to determine the dependence of the hearing thresholds of 47,388 noise-exposed workers on age, sex, noise immission level, ear disease, head injury, tinnitus, hearing protector usage, and audiometric frequency in the range from 0.5 to 6 kHz. It could be shown that the hearing thresholds at any frequency are dominated by the age of the worker and that women, after equivalent exposure conditions, hear better than men. The relative effects of sex, noise immission level, ear diseases, tinnitus, and hearing protector usage are related to the audiometric frequency. Users of hearing protectors at the last audiometric investigation hear worse than nonusers. Hearing protector usage is strongly related with the hearing threshold in the low-frequency range. The noise immission level does not noticeably affect the hearing threshold below 3 kHz. The most important frequency of the noise immission level is as expected 4 kHz. For 4 kHz, it was shown that the variables age, noise immission level, tinnitus, head injuries, and ear diseases act in a good approximation additively on the pure-tone hearing threshold.     

Noise exposure and hearing conservation for farmers of rural Japanese communities

Agricultural mechanization in Japan has progressed dramatically since 1955 with the introduction of tractors, harvesters, and processing machines. These technological developments have resulted in an increase in exposure to sources of noise that are not only annoying, but damaging to hearing. The present study was undertaken to determine, whether Japanese farmers are at risk for noise-induced hearing loss in comparison with office workers, and by evaluating the present conditions regarding occupational noise levels among agricultural workers.The results suggest that farmers, especially male farmers, have a high prevalence of hearing loss in the higher frequency ranges. Daily noise exposure levels in L_Aeq ranged from 81.5 to 99.1 dBA for tea harvesting and processing, and from 83.2 to 97.6 for sugar cane harvesting. Taking into account their rather long working hours and excessive noise from farm machinery, it is concluded that farmers are at risk for noise-induced hearing loss. These findings clearly indicate a strong need for implementation of hearing conservation programs among agricultural workers exposed to machinery noise.     

Industrial noise levels and annoyance in Egypt

Annoyance and increase of accident risk of workers from industrial noise levels in Egypt were studied. 683 workers from 15 Egyptian sites of industry, ranging from food to metal industry were evaluated. The goals of this study are to carry out measurements to evaluate industrial noise levels, are these levels exceeded the permissible levels set by Egyptian noise standard and policy to protect public health of workers?, to examine worker’s attitudes towards industrial noise, to know the relationship between industrial noise levels and degree of annoyance. Results showed that equivalent continuous noise levels ranged from 70 to 100 dB (A). Annoyance of respondents showed that 47.1% were highly annoyed, 5.8% their hearing were harmed. There was a strong relationship between industrial noise levels and percentage of highly annoyed respondents. By increasing industrial noise level possibility of workers to make accident was also increased. Respondents suggest less maximum daily exposure duration than those set by Egyptian law.     

Patient Versus Partner Perception of Voice Handicap

The primary purpose of this study was to compare patient's and communication partner's perceptions of handicap secondary to dysphonia. A secondary purpose was to compare patient health-related quality of life (HRQOL) to that of speakers with normal voice. Participants were 20 adults (mean age=69.15 years) with dysphonia and their communication partners. Patients completed the Voice Handicap Index (VHI), a questionnaire of self-perceived voice handicap, and the Short-Form 36 (SF-36), a general health questionnaire. Partners completed the Voice Handicap Index-Partner (VHI-P), a questionnaire derived from the VHI for this pilot study, to gauge partner perception of voice handicap. Patients in this study viewed themselves as only moderately handicapped by their dysphonia and their partners were in close agreement. Patients and their partners were also in close agreement on each of three VHI subscales (physical, functional, and emotional), and in all cases the physical domain was perceived by both patients and their partners to be most handicapped. Patients had lower SF-36 mean scores than those of persons with normal voice from the general U.S. population on scales assessing physical functioning, physical role, general health, vitality, social functioning, emotional role, and mental health. The results of this study are consistent with previous studies examining patient-partner agreement, which consider proxy ratings to be a useful alternative or collaborative source of patient's self-perception. Further research regarding the reliability of patient and partner agreement is necessary to most effectively assess and manage patients with dysphonia.     

EFFECT OF MUSCLE TENSION ON NON-LINEARITIES IN THE APPARENT MASSES OF SEATED SUBJECTS EXPOSED TO VERTICAL WHOLE-BODY VIBRATION

In subjects exposed to whole-body vibration, the cause of non-linear dynamic characteristics with changes in vibration magnitude is not understood. The effect of muscle tension on the non-linearity in apparent mass has been investigated in this study. Eight seated male subjects were exposed to random and sinusoidal vertical vibration at five magnitudes (0·35-1·4 m/s² r.m.s.). The random vibration was presented for 60 s over the frequency range 2·0-20 Hz; the sinusoidal vibration was presented for 10 s at five frequencies (3·15, 4·0, 5·0, 6·3 and 8·0 Hz). Three sitting conditions were adopted such that, in two conditions, muscle tension in the buttocks and the abdomen was controlled. It was assumed that, in these two conditions, involuntary changes in muscle tension would be minimized. The force and acceleration at the seat surface were used to obtain apparent masses of subjects. With both sinusoidal and random vibration, there was statistical support for the hypothesis that non-linear characteristics were less clear when muscle tension in the buttocks and the abdomen was controlled. With increases in the magnitude of random vibration from 0·35 to 1·4 m/s² r.m.s., the apparent mass resonance frequency decreased from 5·25 to 4·25 Hz with normal muscle tension, from 5·0 to 4·38 Hz with the buttocks muscles tensed, and from 5·13 to 4·5 Hz with the abdominal muscles tensed. Involuntary changes in muscle tension during whole-body vibration may be partly responsible for non-linear biodynamic responses.     

POPULATION-BASED QUESTIONNAIRE SURVEY ON HEALTH EFFECTS OF AIRCRAFT NOISE ON RESIDENTS LIVING AROUND U.S. AIRFIELDS IN THE RYUKYUS—PART II: AN ANALYSIS OF THE DISCRIMINANT SCORE AND THE FACTOR SCORE

Discriminant function values of psychosomatics and neurosis are calculated using the 12 scale scores of the Todai Health Index, a general health questionnaire, obtained in the survey done around the Kadena and Futenma U.S. airfields in Okinawa, Japan. The total number of answers available for the analysis is 6301. Factor analysis is applied to the 12 scale scores by means of the principal factor method, and Oblimin rotation is done because the factors extracted are considered likely to correlate with each other to a greater or lesser extent. The logistic regression analysis is made with the independent variables of discriminant function (DF) values and factor scores and with the dependent variables of L_dn, age (six levels), sex, occupation (four categories) and the interaction of age and sex. Results indicate that the odds ratio of the DF values regarding psychosomatic disorder and of the score of somatic factor have clear dose-response relationship. The odds ratios of the DF value of neurosis and of the score of the mental factor increase in the area where noise exposure is very intense.