Thesis (M. Med. Sc.)--University of Hong Kong, 2004. / Also available in print.

Thesis (M. Med. Sc.)--University of Hong Kong, 2004. / Also available in print.

A report on a study submitted to the Department of Speech Pathology, Faculty of Arts. University of The Witwatersrand, Johannesburg in Partial fulfilment of the requirements for the Degree of Masters of Arts in Speech Pathology, Johannesburg, 1998. / This study was designed to examine the incidence of dysphagia in a group of fifty diabetic patients. The interrelationship between dysphagia and other complications of diabetes was examined. These included neuropathy, orthostatic dysfunction, renal dysfunction and respiratory disorders. Issues such as type of diabetes, patient age and age of onset were addressed. The utility and sensitivity of an interview schedule devised by the researcher was critically evaluated. Data were obtained through the administration of a standardized open-ended interview schedule coupled with an examination of the patients' hospital files. Results were interpreted and tabulated by the researcher. Results revealed that a significant proportion of diabetic patients are experiencing swallowing difficulties within all three phases of the swallow process. It is postulated that the cause of the dysphagia may be due to severe autonomic neuropathy and consequent vagal denervation. The highest incidence of dysphagia appeared to be amongst Type I diabetics who developed diabetes before the age of forty. The interview schedule was thus able to detect those patients experiencing dysphagia. However it was found to be unsuccessful in determining the severity of the problem. Clinical implications for both the Speech Therapist and the Medical team are discussed. Suggestions for future research are put forward.

Nasopharyngeal cancer (NPC) is more common in the Southern China region than the rest of the world. Radiation therapy (RT) is the contemporary and standard treatment for nasopharyngeal cancer. Chronic complications arise from RT including hearing loss, xerostomia, trismus and dysphagia. Previous research has shown that dysphagia is prevalent in irradiated NPC patients. Radiation therapy techniques have improved in the last decade with the emergence of Intensity Modulated Radiation Therapy (IMRT), which allows more precise radiation beams directed at the tumor. In turn, it should also allow greater sparing of surrounding structures that are vital for preservation of swallowing function. This study was designed to investigate the difference in the degree of swallowing function preservation in two groups of irradiated NPC patients: the conventional RT and the IMRT group. Thirty patients with NPC who received RT from 1998 to 2006 in Queen Mary Hospital, Hong Kong were randomly recruited during the period from January to December 2011. Participant’s swallowing competence and its effect on the quality of life was assessed by videofluoroscopic swallowing study (VFSS) and by the MD Anderson Dysphagia Inventory, respectively. In comparison of swallowing performance with VFSS between the two groups, only one measure (Duration of Laryngeal Elevation) out of 13 showed significant difference on thin liquid and congee diet. Results from the MDADI did not show significant difference between the two groups. From the results, it was concluded that IMRT only resulted in subtle improvement in preserving the swallowing function as compared to conventional RT. One possibility is the subject self-compensation of their swallowing impairments that led to functionally similar performance despite their differences in the anatomy and physiology. Swallowing is a highly complex body function and no single parameter can be used to accurately quantify and characterize one’s swallowing function. The interaction between the anatomical and physiological impairments resulted from radiation therapy and the compensatory mechanism could not be clearly explained with this study. Future research could adopt a longitudinal approach such that the changes in NPC patients who received radiation therapy can be better understood. / published_or_final_version / Speech and Hearing Sciences / Master / Master of Philosophy

Introduction: Feeding difficulty and dysphagia are common problems in elderly patients with dementia. Malnutrition and aspiration pneumonia may result from feeding problem and swallowing dysfunction. There were limited previous reports on the course of cognitive functional decline and the relationship among cognitive function, feeding performance and swallowing function in dementia patients. Objectives: The objectives of the present study were to investigate the association between cognitive function and feeding performance in elderly with dementia, and to investigate the association between cognitive function and severity of dysphagia in elderly with dementia. Method: In this cross-sectional study, we recruited 215 Chinese participants from hospital clinics and old aged homes from March 2014 to July 2014. The participants were over 65-year-old, with diagnosis of dementia and without history of other neurological diseases. Sociodemographic information of the participant was interviewed. Medical records were reviewed for the diagnoses of dementia and associated medical conditions. The Abbreviated Mental Test (AMT) was adopted to assess participants’ cognitive function. The feeding performance was evaluated by the Chinese version of Edinburgh Feeding Evaluation in Dementia (EdFED) Scale. The swallowing function was assessed by the Gugging Swallowing Screen (GUSS) test and Therapy Outcome Measure (TOM) impairment scale. Results: Significant negative correlation was demonstrated between AMT score with EdFED score (rho= -0.571, p<0.001). After adjustment of confounders, AMT score was an independent predictor of EdFED score (p=0.034), with age (p=0.016) and functional status (p=0.001) being two additional independent factors. The AMT score manifested significant associations with the measures of severity of dysphagia from the bivariate analysis of results from GUSS (p<0.001) and TOM (p<0.001). After adjustment of confounders, the AMT score was not a significant independent predictor when the swallowing function was assessed by GUSS, but it was an independent predictor when the former was assessed by TOM (p=0.004). Age, functional status, male gender, living in old aged homes, caregivers being children/family members and maids were also independent factors of dysphagia. Conclusion: In this pilot study, we found the cognitive function of elderly with dementia was related to feeding performances. Those with the poorest cognitive function had the worst feeding performance. We also found poor cognitive function was related to poor swallowing function in elderly with dementia. Furthermore, age and functional status were also predictors of feeding performance in dementia. Future prospective studies are recommended to examine the effects of other possible confounding factors including co-morbid neurological diseases, medications and behavioral symptoms, on the association between cognitive function and feeding performance and swallowing function. Early assessment, education and intervention on feeding problem and dysphagia to elderly with dementia and their caregivers are recommended in daily clinical practice. / published_or_final_version / Medicine / Master / Master of Medical Sciences

No description available.

Thesis (M.D.S.)--University of Adelaide, Dept. of Dentistry, 1998? / Bibliography: leaves 163-170.

Thesis (M.S.L.T.)--University of Canterbury, 2008. / Typescript (photocopy). Includes bibliographical references (leaves 67-70). Also available via the World Wide Web.

Thesis (M. Med. Sc.)--University of Hong Kong, 2004. / Also available in print.

Introdução: O Diabetes Melito afeta o sistema digestório ao longo dos anos. Embora seja grande o relato da ocorrência de disfagia nesta população, não existem na literatura descrições da frequência de dificuldade na deglutição destes pacientes. Objetivo: Esta pesquisa teve como objetivo caracterizar a presença de sintomas autorreferidos de dificuldade de deglutição nos pacientes portadores de Diabetes Melito e relacioná-los com idade, sexo, índice de massa corporal, controle glicêmico, tratamento medicamentoso, tempo de diagnóstico do diabetes e suas complicações. Materiais e Métodos: Foram selecionados 221 indivíduos adultos portadores de Diabetes Melito para compor os grupos Diabetes Melito tipo 1 (GDM1) e Diabetes Melito tipo 2 (GDM2). O GDM1 consistiu de 112 indivíduos, 36 homens e 76 mulheres, média de 36 anos e o GDM2 de 109 indivíduos, sendo 39 homens e 70 mulheres com idade média de 57 anos. Foram selecionados ainda 217 adultos para compor o Grupo Controle (GC), divididos em Grupo Controle Diabetes Melito tipo 1 (GC1) e Grupo Controle Diabetes Melito tipo 2 (GC2) selecionados de acordo com a idade e sexo do grupo estudo. Tais participantes responderam ao questionário de autoavaliação alimentar Eating Assessment Tool (EAT-10), a fim de mensurar suas dificuldades de deglutição para identificação do risco de disfagia. A possibilidade de disfagia no EAT-10 foi definida quando os resultados foram >=3. Resultados: Os indivíduos com Diabetes Melito tipo 2 apresentaram maior frequência de disfagia, uma vez que a comparação entre os grupos de estudo GDM1 e GDM2 evidenciou que os indivíduos do grupo GDM2 pontuaram mais no protocolo EAT-10 do que os do GDM1, com uma diferença de 1,38 pontos (p 0,003). Os resultados do EAT-10 para os indivíduos com Diabetes Melito sofreram influência da idade, sexo, tempo de diagnóstico, dosagem de hemoglobina glicada, presença de neuropatia diabética, nefropatia e retinopatia, bem como medicamentos anti-hipertensivos e antiaglutinantes plaquetários. Conclusão: Os Dissertação de Mestrado 8 indivíduos com Diabetes Melito tipo 2 que apresentam maior tempo de diagnóstico da doença e com controle glicêmico alterado apresentaram maiores frequências de sintomas de disfagia em relação aos indivíduos com Diabetes Melito tipo 1. Estudos futuros são necessários para caracterizar a biodinâmica da deglutição nesses indivíduos. / Introduction: Diabetes mellitus affects the digestive system over the years. Although the occurrence of dysphagia in this population is large, there are no descriptions in the literature of the frequency of dysphagia in these patients. Objective: This study aimed to characterize the presence of self-reported symptoms of swallowing difficulty in diabetic patients and to relate them to age, sex, body mass index, glycemic control, drug treatment, time of diagnosis and others complications. Materials and Methods: Twentyone adult individuals with Diabetes mellitus were selected to form the groups Diabetes mellitus type 1 (GDM1) and Diabetes mellitus type 2 (GDM2). GDM1 consisted of 112 individuals, 36 men and 76 women, mean age of 36 years, and GDM2 of 109 individuals, 39 men and 70 women and 117 adults to be part of the Control Group (CG), selected according to age and sex of the study group. These participants answered a self-assessment questionnaire regarding their swallowing difficulties, in order to identify the risk of dysphagia. The possibility of dysphagia in EAT-10 was defined when the results were >=3. Results: Individuals with type 2 diabetes mellitus presented greater symptoms of dysphagia. The results of the EAT-10 for individuals with Diabetes were influenced by age, sex, time of diagnosis, glycated hemoglobin levels, presence of diabetic neuropathy, nephropathy and retinopathy, as well as antihypertensive drugs and platelet anti-caking agents. Conclusion: Individuals with type 2 diabetes mellitus who present a longer diagnosis and with altered glycemic control presented greater symptoms of dysphagia. Future studies are needed to characterize the biodynamics of swallowing in these individuals.