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Die objektive Stimmanalyse ist für die tägliche phoniatrische Praxis von grundlegender Bedeutung bezüglich der Diagnostik und Therapie von Stimmstörungen. Als Goldstandard gilt das Göttinger Heiserkeits-Diagramm (GHD), welches die Aufzeichnung von 28 Vokalen durch geschultes Fachpersonal mit einem zeitlichen Aufwand von ca. 15 Minuten pro Patient erfordert. In der vorliegenden Studie wurde untersucht, ob das GHD auch dann valide Ergebnisse für die Stimmqualität liefert, wenn statt des Standardprotokolls gehaltene Phonationen aus indirekter Laryngoskopie oder Videostroboskopie analysiert werden (sog. „reduziertes Protokoll“). Wäre dies der Fall, ließe sich Stimmanalyse und Untersuchung des Larynx in einem Arbeitsschritt durchführen und somit der zeitliche und personelle Aufwand deutlich reduzieren. Es wurden Stimmaufnahmen aus Stroboskopie und Laryngoskopie von 213 Patienten (97 männlich, 116 weiblich) mit Hilfe des GHD analysiert. Am gleichen Untersuchungstag erfolgte zudem eine typische Mikrophonaufnahme gehaltener Phonationen zur Analyse nach dem vollständigen GHD-Protokoll. Die aus reduziertem und vollständigem Protokoll ermittelten Werte für die Irregularität und die Rauschkomponente des Stimmsignals als objektive Marker der Stimmqualität wurden jeweils korreliert. Sowohl für die Irregularitätskomponente (r=0,65) als auch für die Rauschkomponente (r=0,55) ergaben sich signifikante Korrelationen (p<0,001) zwischen beiden Verfahren. Außerdem zeigte sich, dass bereits eine einzige Stimmgebung aus Laryngoskopie und Stroboskopie ein zuverlässiges Ergebnis liefert. Es konnte eine Mindesttonhaltedauer von 1 Sekunde ermittelt werden. Die Vereinfachung des Vokals während Laryngoskopie beeinflusst das Ergebnis nicht und beide Methoden eignen sich zur klinischen Verlaufskontrolle.

The present thesis concerns people with Usher syndrome (USH) and their health. People with USH have a congenital hearing loss of various degrees and an eye disease with a progressive course; for some, the balance is also affected. Three clinical groups have been identified 1, 2 and 3, and 13 genes have currently been identified. USH is the most common cause of deafblindness. Clinical knowledge and the limited research that exists have shown that people with deafblindness can experience difficulties in everyday life. Depression, anxiety and social withdrawal have been described. The general aim of the present thesis was to describe the health of people with USH. The empirical material employed was based on an extensive survey in which people with USH answered two questionnaires concerning health, anxiety, depression, social trust, work, health-care, financial situation, and alcohol and drug use. The focus of the present thesis is on general health, physical health and psychological health, social trust and finance. Three studies in the present theses focus on USH1, 2 and 3, respectively; finally, the fourth study provides an in-group comparison of people with USH. The results of studies I and III are compared with a crosssection of the Swedish population. The results revealed poor physical and psychological health, a lack of social trust and a strained financial situation regardless of clinical diagnosis. The discussion stresses the importance of taking a biopsychosocial approach when describing the health of people with USH, in which previous research is lacking. Additional research should focus on the mechanisms at different levels that affect people with USH and their health from a life- course perspective. Furthermore, research should include a salutogenic perspective to explore the resources and strengths of people with USH.

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Background. The current understanding on caries and enamel developmental defects prevalence and frequency, caries risk, health-related quality life (HRQoL) and stress response in young children with cleft lip and/or palate (CL/P) are sparse. In this thesis these aspects were investigated in 5- and 10- year-old children with CL/P in comparison to non-cleft children in the same ages. Design. The studies in this thesis have a cross-sectional case-control design. Participants. The study group consisted of 139 children with CL/P (80 children aged 5 years and 59 aged 10 years) and 313 non-cleft controls (144 children aged 5 years and 169 aged 10 years). Method. Caries was scored according to International Caries Detection and Assessment System (ICDAS II) and developmental enamel defects were measured as presence and frequency of hypoplasia and hypomineralization. Oral hygiene was assessed using Quigley-Hein plaque index. Stimulated saliva samples were analyzed for mutans streptococci, lactobacilli, buffering capacity and secretion rates. Information regarding children’s oral hygiene routines, dietary habits and fluoride exposure were collected with questionnaires. Caries risk was evaluated with algorithm-based software, Cariogram while HRQoL was perceived with KIDSCREEN-52. Stress response was analyzed with cortisol concentration in saliva at three different time points using a commercial competitive radioimmunoassay. Results. Caries prevalence (36% versus 18%) and caries frequency (1.2 dmfs versus 0.9 dmfs) was significantly higher in 5-year-old children with CL/P in comparison to non-cleft controls. In 10-yearolds no significant difference was found between children with CL/P and non-cleft controls in caries prevalence (47% versus 38%) or in caries frequency (0.7 DMFS versus 0.5 DMFS). Children with CL/P had significantly higher prevalence of enamel defects, higher counts of salivary lactobacilli and less good oral hygiene. The odds of being categorized with high caries risk were elevated in children with CL/P. Children with CL/P had similar HRQoL and salivary cortisol concentrations as non-cleft controls. However, 10-year-old boys with CL/P had significantly higher cortisol concentrations in the evening than non-cleft boys. Conclusions. Preschool children with CL/P seem to have more caries in the primary dentition than non-cleft controls. Children with CL/P had increased odds of being categorized as high caries risk individuals compared to controls. Some of the contributing factors seem to be higher prevalence of enamel defects, impaired oral hygiene and elevated salivary lactobacilli. Furthermore, as measured with the help of cortisol concentrations in saliva, children with CL/P were not more stressed than noncleft controls and their HRQoL was comparable to a European norm population. It appears that regular comprehensive preventive oral care in children with CL/P is effective in preventing caries development in permanent teeth. However, children with CL/P are at risk of caries development and preventive oral care should be implemented and started earlier than today.

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本論文以川端康成的《山之音》《湖》《睡美人》《蒲公英》為切入視點，考察川端康成老人文學中老年的生(性)。 本論之中心課題乃以川端處女作的《十六歲的日記》(1918)為首，歷經《伊豆的舞孃》《雪國》《千羽鶴》《睡美人》等名作，到未完成的遺作《蒲公英》(1968)為止，考察川端在作品世界究竟是以何種形式，將透過末期之眼所映照出之逸脫的自然來具體呈現、使其達成變化。 本論文由六個章節所組成，第一章闡述研究動機、研究方法，第二章著眼於四部作品中具體呈現的魔界空間性、脫離現實之程度、魔界之異空間及置身其中 之老人間的關係性，並嘗試分析各個相異的特徵。第三章則探討自覺到衰老之老人自我意識，與凝視老人之衰老的他者視線兩者間如何產生交疊與共鳴。第四章則是剖析老人在非日常性的魔界空間中，藉由各種聲音表現來對抗面對死亡的恐懼，並以此作為對冥界的線索，進而跨越、試圖達成生命回復之身影。在第五章則論述老年的情慾感覺如何捕捉與老人有性關係的女性身體並掌握其表徵，再根據西格蒙德‧佛洛伊德的《性理論三篇》、《夢之解析》來闡述老人之擬似性行為與夢的意涵。 / This dissertation is viewed from the works of Yasunari Kawabata─ "Yama no Oto", "Mitsuumi", "Nemunerubizyo" and "Tanpopo" to discuss the elderly’s spirit(Sexuality) in the Elder Literature. The topic begins with the maiden work of Kawabata─ "Zyuurossai no Nikki"(1918)and goes through his other famous works─ "Izu no Odoriko", "Yukiguni", "Yama no Oto", "Senbaturu", "Nemunerubizyo", and the unfinished work─ "Tanpopo"(1968).This dissertation discusses the manner the author uses in the works’ situation to show and achieve the transcendence which is reflected by “the eye of dying”. The dissertation is composed of six chapters. The first chapter illustrates the motivation, and the methodology. The second chapter focuses on the spatiality in the Makai, the extent of distance from reality, the relationship between the elders and the Makai where they are situated. The differences among the preceding points would also be analyzed. Chapter three points out the self-identity of the elders who are aware of their aging, and shows the overlap and consonance happen between the elders and the onlookers who are observing the aging process. Chapter four would explore how the author manipulates the sound to present the confrontation of fear in death when the elders are in the unusual space of Makai, and how they take the sound for the clues of hell, trying to transcend and achieve the rebirth. In chapter five, the discussion is on the features of how the elders use the erotic affections to attract women who have sexual relations with them and grasp the features of the women’s body. Meanwhile, the theories of Sigmund Freud- "Three Essays on the Theory of Sexuality" and "The Interpretation of Dreams" are used to illustrate the connotation of the elder’s dream and their mock sexual behavior.

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No description available.