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Peter B, Bruce L, Finestack L, Dinu V, Wilson M, Klein-Seetharaman J, Lewis CR, Braden BB, Tang YY, Scherer N, VanDam M, Potter N. Precision Medicine as a New Frontier in Speech-Language Pathology: How Applying Insights From Behavior Genomics Can Improve Outcomes in Communication Disorders. Am J Speech Lang Pathol 2023; 32:1397-1412. [PMID: 37146603 PMCID: PMC10484627 DOI: 10.1044/2023_ajslp-22-00205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 11/07/2022] [Accepted: 03/01/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Precision medicine is an emerging intervention paradigm that leverages knowledge of risk factors such as genotypes, lifestyle, and environment toward proactive and personalized interventions. Regarding genetic risk factors, examples of interventions informed by the field of medical genomics are pharmacological interventions tailored to an individual's genotype and anticipatory guidance for children whose hearing impairment is predicted to be progressive. Here, we show how principles of precision medicine and insights from behavior genomics have relevance for novel management strategies of behaviorally expressed disorders, especially disorders of spoken language. METHOD This tutorial presents an overview of precision medicine, medical genomics, and behavior genomics; case examples of improved outcomes; and strategic goals toward enhancing clinical practice. RESULTS Speech-language pathologists (SLPs) see individuals with various communication disorders due to genetic variants. Ways of using insights from behavior genomics and implementing principles of precision medicine include recognizing early signs of undiagnosed genetic disorders in an individual's communication patterns, making appropriate referrals to genetics professionals, and incorporating genetic findings into management plans. Patients benefit from a genetics diagnosis by gaining a deeper and more prognostic understanding of their condition, obtaining more precisely targeted interventions, and learning about their recurrence risks. CONCLUSIONS SLPs can achieve improved outcomes by expanding their purview to include genetics. To drive this new interdisciplinary framework forward, goals should include systematic training in clinical genetics for SLPs, enhanced understanding of genotype-phenotype associations, leveraging insights from animal models, optimizing interprofessional team efforts, and developing novel proactive and personalized interventions.
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Affiliation(s)
- Beate Peter
- College of Health Solutions, Arizona State University, Tempe
| | - Laurel Bruce
- College of Health Solutions, Arizona State University, Tempe
| | - Lizbeth Finestack
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Twin Cities, Minneapolis
| | - Valentin Dinu
- College of Health Solutions, Arizona State University, Tempe
| | - Melissa Wilson
- Center for Evolution and Medicine, School of Life Sciences, Arizona State University, Tempe
| | | | - Candace R. Lewis
- School of Life Sciences, Arizona State University, Tempe
- Department of Psychology, Arizona State University, Tempe
| | - B. Blair Braden
- College of Health Solutions, Arizona State University, Tempe
| | - Yi-Yuan Tang
- College of Health Solutions, Arizona State University, Tempe
| | - Nancy Scherer
- College of Health Solutions, Arizona State University, Tempe
| | - Mark VanDam
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Nancy Potter
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
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Potter NL, VanDam M, Bruce L, Davis J, Eng L, Finestack L, Heinlen V, Scherer N, Schrock C, Seltzer R, Stoel-Gammon C, Thompson L, Peter B. Virtual Post-Intervention Speech and Language Assessment of Toddler and Preschool Participants in Babble Boot Camp. J Speech Lang Hear Res 2023:1-13. [PMID: 37235746 DOI: 10.1044/2023_jslhr-22-00687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE Babble Boot Camp (BBC) is a parent-implemented telepractice intervention for infants at risk for speech and language disorders. BBC uses a teach-model-coach-review approach, delivered through weekly 15-min virtual meetings with a speech-language pathologist. We discuss accommodations needed for successful virtual follow-up test administration and preliminary assessment outcomes for children with classic galactosemia (CG) and controls at age 2.5 years. METHOD This clinical trial included 54 participants, 16 children with CG receiving BBC speech-language intervention from infancy, age 2 years, five children receiving sensorimotor intervention from infancy and changing to speech-language intervention at 15 months until 2 years of age, seven controls with CG, and 26 typically developing controls. The participants' language and articulation were assessed via telehealth at age 2.5 years. RESULTS The Preschool Language Scale-Fifth Edition (PLS-5) was successfully administered with specific parent instruction and manipulatives assembled from the child's home. The GFTA-3 was successfully administered to all but three children who did not complete this assessment due to limited expressive vocabularies. Referrals for continued speech therapy based on PLS-5 and GFTA-3 scores were made for 16% of children who received BBC intervention from infancy as compared to 40% and 57% of children who began BBC at 15 months of age or did not receive BBC intervention, respectively. CONCLUSIONS With extended time and accommodations from the standardized administration guidelines, virtual assessment of speech and language was possible. However, given the inherent challenges of testing very young children virtually, in-person assessment is recommended, when possible, for outcome measurements.
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Affiliation(s)
- Nancy L Potter
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Mark VanDam
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Laurel Bruce
- College of Health Solutions, Arizona State University, Phoenix
| | - Jenny Davis
- College of Health Solutions, Arizona State University, Phoenix
| | - Linda Eng
- College of Health Solutions, Arizona State University, Phoenix
| | - Lizbeth Finestack
- Department of Speech-Language-Hearing Sciences, University of Minnesota, Twin Cities
| | - Victoria Heinlen
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Nancy Scherer
- College of Health Solutions, Arizona State University, Phoenix
| | - Claire Schrock
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Ryan Seltzer
- College of Health Solutions, Arizona State University, Phoenix
| | - Carol Stoel-Gammon
- Department of Speech & Hearing Sciences, University of Washington, Seattle
| | - Lauren Thompson
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Beate Peter
- College of Health Solutions, Arizona State University, Phoenix
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Finestack LH, Potter N, VanDam M, Davis J, Bruce L, Scherer N, Eng L, Peter B. Feasibility of a Proactive Parent-Implemented Communication Intervention Delivered via Telepractice for Children With Classic Galactosemia. Am J Speech Lang Pathol 2022; 31:2527-2538. [PMID: 36251874 PMCID: PMC9911118 DOI: 10.1044/2022_ajslp-22-00107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE This study evaluated the feasibility of Babble Boot Camp (BBC) for use with infants with classic galactosemia (CG) starting at less than 6 months of age. BBC is a parent-implemented intervention delivered by speech-language pathologists (SLPs) entirely via telepractice with the potential to increase access to early preventative interventions. We evaluated BBC feasibility based on acceptability, implementation, and practicality. METHOD We obtained data from 16 parents of infants with CG (mean age at enrollment = 3.38 months) involved in a large randomized clinical trial of BBC. BBC uses a teach-model-coach-review approach to provide parents with strategies to support their child's communication development. Families completed, on average, eighty-one 15-min sessions over a 20-month intervention period. We drew data from surveys completed by parents at the end of the intervention period, intervention logs maintained by the SLPs, and intervention fidelity checks completed by research assistants. RESULTS Data drawn from parent surveys, intervention logs, and intervention fidelity checks revealed high parent acceptability, high rates of completion and compliance, and low costs in terms of parent and clinician time. CONCLUSION Results suggest that BBC is feasible for families of infants with CG, warranting further examination of BBC across a broader range of children with CG as well as other infants who are at predictable risk for speech and language impairment.
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Mathad VC, Liss JM, Chapman K, Scherer N, Berisha V. Consonant-Vowel Transition Models Based on Deep Learning for Objective Evaluation of Articulation. IEEE/ACM Trans Audio Speech Lang Process 2022; 31:86-95. [PMID: 36712557 PMCID: PMC9879020 DOI: 10.1109/taslp.2022.3209937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Spectro-temporal dynamics of consonant-vowel (CV) transition regions are considered to provide robust cues related to articulation. In this work, we propose an objective measure of precise articulation, dubbed the objective articulation measure (OAM), by analyzing the CV transitions segmented around vowel onsets. The OAM is derived based on the posteriors of a convolutional neural network pre-trained to classify between different consonants using CV regions as input. We demonstrate that the OAM is correlated with perceptual measures in a variety of contexts including (a) adult dysarthric speech, (b) the speech of children with cleft lip/palate, and (c) a database of accented English speech from native Mandarin and Spanish speakers.
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Affiliation(s)
| | - Julie M Liss
- College of Health Solutions, Arizona State University, Tempe, AZ-85287
| | - Kathy Chapman
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT-84112
| | - Nancy Scherer
- College of Health Solutions, Arizona State University, Tempe, AZ-85287
| | - Visar Berisha
- College of Health Solutions and School of Electrical, Computer, & Energy Engineering, Arizona State University, Tempe, AZ-85284
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Peter B, Davis J, Finestack L, Stoel-Gammon C, VanDam M, Bruce L, Kim Y, Eng L, Cotter S, Landis E, Beames S, Scherer N, Knerr I, Williams D, Schrock C, Potter N. Translating principles of precision medicine into speech-language pathology: Clinical trial of a proactive speech and language intervention for infants with classic galactosemia. Human Genetics and Genomics Advances 2022; 3:100119. [PMID: 35677809 PMCID: PMC9168611 DOI: 10.1016/j.xhgg.2022.100119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Precision medicine is an emerging approach to managing disease by taking into consideration an individual’s genetic and environmental profile toward two avenues to improved outcomes: prevention and personalized treatments. This framework is largely geared to conditions conventionally falling into the field of medical genetics. Here, we show that the same avenues to improving outcomes can be applied to conditions in the field of behavior genomics, specifically disorders of spoken language. Babble Boot Camp (BBC) is the first comprehensive and personalized program designed to proactively mitigate speech and language disorders in infants at predictable risk by fostering precursor and early communication skills via parent training. The intervention begins at child age 2 to 5 months and ends at age 24 months, with follow-up testing at 30, 42, and 54 months. To date, 44 children with a newborn diagnosis of classic galactosemia (CG) have participated in the clinical trial of BBC. CG is an inborn error of metabolism of genetic etiology that predisposes up to 85% of children to severe speech and language disorders. Of 13 children with CG who completed the intervention and all or part of the follow-up testing, only one had disordered speech and none had disordered language skills. For the treated children who completed more than one assessment, typical speech and language skills were maintained over time. This shows that knowledge of genetic risk at birth can be leveraged toward proactive and personalized management of a disorder that manifests behaviorally.
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Affiliation(s)
- Beate Peter
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
- Corresponding author
| | - Jennifer Davis
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Lizbeth Finestack
- Speech-Language-Hearing Sciences, University of Minnesota, Minneapolis, MN, USA
| | | | - Mark VanDam
- Speech and Hearing Sciences, Washington State University, Spokane, WA, USA
| | - Laurel Bruce
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Yookyung Kim
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Linda Eng
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Sarah Cotter
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Emily Landis
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Sam Beames
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Nancy Scherer
- College of Health Solutions, Arizona State University, Tempe, AZ, USA
| | - Ina Knerr
- National Centre for Inherited Metabolic Disorders, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Delaney Williams
- Speech and Hearing Sciences, Washington State University, Spokane, WA, USA
| | - Claire Schrock
- Speech and Hearing Sciences, Washington State University, Spokane, WA, USA
| | - Nancy Potter
- Speech and Hearing Sciences, Washington State University, Spokane, WA, USA
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Peter B, Davis J, Cotter S, Belter A, Williams E, Stumpf M, Bruce L, Eng L, Kim Y, Finestack L, Stoel-Gammon C, Williams D, Scherer N, VanDam M, Potter N. Toward Preventing Speech and Language Disorders of Known Genetic Origin: First Post-Intervention Results of Babble Boot Camp in Children With Classic Galactosemia. Am J Speech Lang Pathol 2021; 30:2616-2634. [PMID: 34665663 PMCID: PMC9135004 DOI: 10.1044/2021_ajslp-21-00098] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/13/2021] [Accepted: 07/08/2021] [Indexed: 05/19/2023]
Abstract
Purpose Babble Boot Camp (BBC) is a package of proactive activities and routines designed to prevent speech and language disorders in infants at predictable risk. It is implemented via parent training and currently undergoing clinical trial in children with a newborn diagnosis of classic galactosemia (CG), a metabolic disease with high risk of speech and language disorders. The purpose of this study is to provide updates to a previous pilot study and to present the first set of post-intervention results. Method The intervention and data collection occurred during child ages < 6-24 months, with follow-up assessments of speech and language at ages 2.5 and 3.5 years. Treatment targets included earliest vocalization rates, babble complexity, speech production accuracy, and vocabulary and syntactic growth. The oldest 15 children with CG (including three untreated controls) completed the first set of follow-up assessments. Aggregate data up to 10 months were available for 17 treated children with CG, six untreated children with CG, and six typical controls. Results At ages 7-9 months, babbling complexity, as measured with mean babbling level, was higher in the treated children with CG than in the untreated children with CG and the typical controls. Prior to 24 months of age, the treated children with CG had greater expressive but not receptive vocabulary sizes than an untreated control. Follow-up testing showed typical language scores for all 12 treated children with CG and typical articulation scores for 11 of these, whereas one of three untreated children with CG had low articulation and expressive language scores. Conclusions The BBC appears to be a viable intervention to support the speech and expressive language development of children with GC. Future studies will evaluate the relative contributions of the earliest and later BBC components to outcomes.
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Affiliation(s)
- Beate Peter
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
- Department of Communication Sciences and Disorders, Saint Louis University, MO
| | - Jennifer Davis
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Sarah Cotter
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Alicia Belter
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Emma Williams
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Melissa Stumpf
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Laurel Bruce
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Linda Eng
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Yookyung Kim
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Lizbeth Finestack
- Department of Speech-Language-Hearing Sciences, University of Minnesota Twin Cities, Minneapolis
| | - Carol Stoel-Gammon
- Department of Speech and Hearing Sciences, University of Washington, Seattle
| | - Delaney Williams
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Nancy Scherer
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe
| | - Mark VanDam
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Nancy Potter
- Department of Speech and Hearing Sciences, Elson S. Floyd College of Medicine, Washington State University, Spokane
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Mathad VC, Scherer N, Chapman K, Liss JM, Berisha V. A Deep Learning Algorithm for Objective Assessment of Hypernasality in Children With Cleft Palate. IEEE Trans Biomed Eng 2021; 68:2986-2996. [PMID: 33566756 PMCID: PMC9023650 DOI: 10.1109/tbme.2021.3058424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Evaluation of hypernasality requires extensive perceptual training by clinicians and extending this training on a large scale internationally is untenable; this compounds the health disparities that already exist among children with cleft. In this work, we present the objective hypernasality measure (OHM), a speech-based algorithm that automatically measures hypernasality in speech, and validate it relative to a group of trained clinicians. METHODS We trained a deep neural network (DNN) on approximately 100 hours of a publicly-available healthy speech corpus to detect the presence of nasal acoustic cues generated through the production of nasal consonants and nasalized phonemes in speech. Importantly, this model does not require any clinical data for training. The posterior probabilities of the deep learning model were aggregated at the sentence and speaker-levels to compute the OHM. RESULTS The results showed that the OHM was significantly correlated with perceptual hypernasality ratings from the Americleft database (r = 0.797, p < 0.001) and the New Mexico Cleft Palate Center (NMCPC) database (r = 0.713, p < 0.001). In addition, we evaluated the relationship between the OHM and articulation errors; the sensitivity of the OHM in detecting the presence of very mild hypernasality; and established the internal reliability of the metric. Further, the performance of the OHM was compared with a DNN regression algorithm directly trained on the hypernasal speech samples. SIGNIFICANCE The results indicate that the OHM is able to measure the severity of hypernasality on par with Americleft-trained clinicians on thisdataset.
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Peter B, Scherer N, Liang WS, Pophal S, Nielsen C, Grebe TA. A phenotypically diverse family with an atypical 22q11.2 deletion due to an unbalanced 18q23;22q11.2 translocation. Am J Med Genet A 2021; 185:1532-1537. [PMID: 33569883 DOI: 10.1002/ajmg.a.62121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/03/2021] [Accepted: 01/24/2021] [Indexed: 11/08/2022]
Abstract
The 22q11.2 deletion syndrome (22q11.2 DS) is the most common deletion syndrome in humans. In most cases, it occurs de novo. A rare family of three with 22q11.2 deletion syndrome (22q11.2 DS) resulting from an unbalanced 18q;22q translocation is reported here. Their deletion region is atypical in that it includes only 26 of the 36 genes in the minimal critical 22q11.2 DS region but it involves the loss of the centromeric 22q region and the entire p arm. The deletion region overlaps with seven other rare atypical cases; common to all cases was the loss of a region including SEPT5-GP1BB proximally and most of ARVCF distally. Interrogation of the deleted 22q region proximal to the canonical 22q11.2 deletion region in the DECIPHER database showed seven cases with isolated or combined traits of 22q11.2 DS, including three with clefts. The phenotypes in the present family thus may result from the loss of a subset of genes in the critical region, or alternatively the loss of other genes or sequences in the proximal 22q deletion region, or interactive effects among these. Despite the identical deletion locus in the three affected family members, expression of the 22q11.2 DS traits differed substantially among them. These three related cases thus contribute to knowledge of 22q11.2 DS in that their unusual deletion locus co-occurred with the cardinal features of the syndrome while their identical deletions are associated with variable phenotypic expression.
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Affiliation(s)
- Beate Peter
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, Arizona, USA.,Department of Communication Sciences and Disorders, Saint Louis University, Saint Louis, Missouri, USA
| | - Nancy Scherer
- Speech and Hearing Science, College of Health Solutions, Arizona State University, Tempe, Arizona, USA
| | - Winnie S Liang
- Translational Genomics Research Institute, Phoenix, Arizona, USA
| | - Stephen Pophal
- Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Colby Nielsen
- College of Medicine, University of Arizona, Phoenix, Arizona, USA
| | - Theresa A Grebe
- Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix, Arizona, USA
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Scherer N, Hameed S, Acarturk C, Deniz G, Sheikhani A, Volkan S, Örücü A, Pivato I, Akıncı İ, Patterson A, Polack S. Prevalence of common mental disorders among Syrian refugee children and adolescents in Sultanbeyli district, Istanbul: results of a population-based survey. Epidemiol Psychiatr Sci 2020; 29:e192. [PMID: 33298230 PMCID: PMC7737189 DOI: 10.1017/s2045796020001079] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/02/2020] [Accepted: 11/08/2020] [Indexed: 11/06/2022] Open
Abstract
AIMS Research demonstrates elevated levels of common mental disorders among Syrian refugees, but the majority of studies have, to date, focused on adult populations. This study aims to estimate the prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) among Syrian children and adolescents living in Sultanbeyli district of Istanbul, Turkey. METHODS A population-based survey among Syrian children and adolescents aged 8-17 years living in Sultanbeyli district was conducted in 2019, as part of an all-age survey of disability. 80 clusters of 50 participants (all-ages) were selected from the local municipality's refugee registration database using probability proportionate to size sampling. Children aged 8-17 years were assessed for symptoms of common mental disorders using the Child Revised Impact of Event Scale (CRIES-8) and abbreviated versions of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) and the Screen for Child Anxiety Related Disorders (SCARED). RESULTS Of the 852 participants, 23.7% (95% CI 19.9-27.2) screened positive for symptomatic depression, PTSD and anxiety. The prevalence estimates for depression, PTSD and anxiety were 12.5% (95% CI 9.8-15.6), 11.5% (95% CI 9.1-14.4) and 9.2% (95% CI 6.8-12.1), respectively. Depression and PTSD were significantly more common in older adolescents, whilst anxiety and PTSD were significantly more common in girls. Depression was more common in children from poorer households and those who had received no education. Children coming from larger households were less likely to show symptoms of PTSD. CONCLUSIONS Syrian refugee children and adolescents are vulnerable to common mental disorders, and culturally appropriate prevention and intervention support are needed for this population.
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Affiliation(s)
- N. Scherer
- Department of Clinical Research, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - S. Hameed
- Department of Clinical Research, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
| | - C. Acarturk
- Department of Psychology, Koç University, Istanbul, Turkey
| | - G. Deniz
- Mülteciler Derneği, Istanbul, Turkey
| | | | - S. Volkan
- Relief International, Istanbul, Turkey
| | - A. Örücü
- Mülteciler Derneği, Istanbul, Turkey
| | - I. Pivato
- Relief International, Istanbul, Turkey
| | - İ. Akıncı
- Mülteciler Derneği, Istanbul, Turkey
| | | | - S. Polack
- Department of Clinical Research, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK
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Hägele S, Rolke R, Kraemer H, Pohl K, Scherer N, Treede RD, Birklein F, Vog T. Quantitative sensorische Testung bei Patienten mit idiopathischem Parkinson-Syndrom. Akt Neurol 2005. [DOI: 10.1055/s-2005-866653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
This study compared the longitudinal performance of two groups of toddlers with palatal clefts and an age-matched group of children without palatal clefts on measures of elicited symbolic play at 18, 24, and 30 months. The results indicated that the group with isolated cleft palate differed significantly from both the cleft lip and palate group and the noncleft group on all but 1 play measure. Correlational analyses for each group indicated significant positive correlations between a number of the play variables at 18 months and productive vocabulary and MLU at 24 and 30 months of age. The findings suggest that assessment of early play gestures may assist clinicians in identifying children with clefts who are at risk for later language impairment.
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Affiliation(s)
- Lynn E Snyder
- Department of Speech, Language, and Hearing Sciences, University of Colorado at Boulder, Campus Box 409, Boulder, CO 80309-0409, USA.
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Schmidt-Trucksäss A, Schmid A, Brunner C, Scherer N, Zäch G, Keul J, Huonker M. Arterial properties of the carotid and femoral artery in endurance-trained and paraplegic subjects. J Appl Physiol (1985) 2000; 89:1956-63. [PMID: 11053349 DOI: 10.1152/jappl.2000.89.5.1956] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In humans, the relationships of blood flow changes to structure, function, and shear rate of conducting arteries have not been thoroughly examined. Therefore, the purpose of this study was to investigate these parameters of the elastic-type, common carotid artery (CCA) and the muscular-type, common femoral artery (CFA) in long-term highly active and extremely inactive individuals, assuming that the impact of activity-induced blood flow changes on conduit arteries, if any, should be seen in these subjects. We examined 21 highly endurance-trained athletes (A), 10 paraplegic subjects (P), and 20 sedentary subjects (S) by means of noninvasive ultrasound. As a result, the CFA diameter and compliance were highest in A (9.7+/-0.81 mm; 1.84 +/-0.54 mm(2)/kPa) and lowest in P (5.9+/-0.7 mm; 0.54+/-0.27 mm(2)/kPa) compared with S (8.3+/-1.0 mm; 0.92+/-0.48 mm(2)/kPa) with P <0.01 among the groups. Both parameters correlated with each other (r = 0.62; P<0.01). Compared with A (378+/-84 s(-1); 37+/-15 s(-1)) and S (356+/-113 s(-1); 36+/-20 s(-1)), the peak and mean shear rates of the CFA were almost or more than doubled in P (588+/-120 s(-1); 89+/-26 s(-1)). In the CCA, only the compliance and peak shear rate showed significant differences among the groups (A: 1.28+/-0.47 mm(2)/kPa, 660+/-138 s(-1); S: 1.04+/-0.27 mm(2)/kPa, 588+/-109 s(-1); P: 0.65+/- 0.22 mm(2)/kPa, 490+/-149 s(-1); P<0.05). In conclusion, the results suggest a structural and functional adaptation in the CFA and a predominantly functional adaptation of the arterial wall properties to differences in the physical activity level and associated exercise-induced blood flow changes in the CCA. The results for humans confirm those from animal experiments. Similar shear rate values of S and P in the CFA support the hypothesis of constant shear stress regulation due to local blood flow changes in humans. On the other hand, the increased shear rate in the CFA in P indicates an at least partially nonphysiological response of the arterial wall in long-term chronic sympathectomy due to a change in local blood flow.
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Affiliation(s)
- A Schmidt-Trucksäss
- Department of Prevention, Rehabilitation, and Sports Medicine, Center for Internal Medicine, Freiburg University Hospital, D-79106 Freiburg, Germany.
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Birnbaumer L, Codina J, Mattera R, Yatani A, Scherer N, Toro MJ, Brown AM. Signal transduction by G proteins. Kidney Int Suppl 1987; 23:S14-42. [PMID: 2450220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- L Birnbaumer
- Department of Cell Biology, Baylor College of Medicine, Houston, Texas
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Owings NO, McManus MD, Scherer N. A deinstitutionalized retarded adult's use of communication functions in a natural setting. Br J Disord Commun 1981; 16:119-128. [PMID: 7326209 DOI: 10.3109/13682828109011392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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