Velofarynxinsufficiens (VPI) innebär en otillräcklig förmåga att stänga passagen mellan mun- och näshåla. En ofullständig slutning får konsekvenser framför allt för talet, då luft passerar genom näsan även vid orala språkljud och leder till en avvikande talklang och artikulation. Dessa avvikelser kan vara mer eller mindre framträdande i talet och innebära allt ifrån en lätt förvrängning av talklangen till att talet blir oförståeligt för omgivningen, vilket får allvarliga konsekvenser för möjligheten att kommunicera verbalt.   VPI kan behandlas på flera sätt, dels protetiskt, dels med kirurgi. Deltagarna i denna studie har alla genomgått operation med uppåtbaserad farynxlambå, som är en väldokumenterad och effektiv metod för att behandla VPI. En vanligt förekommande biverkning till operationen är luftvägshinder, exempelvis nästäppa, snarkning och sömnapné.    Syftet med studien var att undersöka deltagarnas egen uppfattning om operationsresultatet gällande tal och biverkningar, med hjälp av en enkät för självskattning. 61 patienter opererade med uppåtbaserad svalglambå under perioden 2000-2011 vid Akademiska Sjukhuset i Uppsala deltog i studien. Deltagarna delades in i tre undergrupper utifrån etiologi: deltagare med spalt (n  =  35), deltagare med spalt och syndrom (n  =  13), samt deltagare utan spalt (n  =  13).   Resultat: 55 av 61 deltagare (90  %) ansåg att operationen förbättrade deras tal. 49 av 61 deltagare (80  %) skulle dessutom rekommendera operationen till någon annan med samma besvär. 42 av 61 deltagare (68,8  %) uppgav att de är nöjda med sitt tal. Kvarstående biverkningar som rapporterades var nästäppa, snarkning, dagtrötthet och muntorrhet. Deltagarna upplevde dock dessa biverkningar i liten grad. Ingen tydlig skillnad sågs mellan de olika patientgrupperna. / Velopharyngeal insufficiency (VPI) is the inability to completely close the velopharyngeal port. Velopharyngeal closure is an important part of speech. VPI leads to a leakage of air into the nasal cavity during speech, which can cause hypernasal resonance and misarticulations. The effect of VPI on speech differs depending on the nature of the insufficiency. It can affect speech intelligibility severely.   VPI can be treated prosthetically or surgically. The patients in this study have all undergone pharyngeal flap surgery; a well established surgical method with documented effect in correcting VPI and reducing hypernasality in speech. Pharyngeal flap surgery can have negative consequences, such as airway obstruction, sleep apnea and snoring.   The aim of this study was to investigate the patients experiences of speech, complications and side-effects after pharyngeal flap surgery, through self-reports. 61 patients who underwent superior pharyngeal flap surgery during the period 2000 to 2011 at Uppsala University Hospital participated in the study. They were divided into three sub-groups: patients with cleft (n  =  35), patients with cleft and syndrome (n  =  13), patients without cleft (n  =  13).   Result: 55 of 61 participants (90 %) were of the opinion that the pharyngeal flap surgery had improved their speech. 49 of 61 participants (80 %) said they would recommend someone else with the same problem to undergo the operation. 42 of 61 participants (68,8 %) were content with their speech. Reported residual side effects, though experienced in low degree, were nasal congestion, snoring, weariness during daytime and dry mouth. No evident difference was seen between the sub-groups.

The objectives of this thesis were to examine (1) associations between primary care type (team-based versus non-team based) and access problems (difficulty in access and self-reported unmet need), and (2) if socioeconomic variations in access problems were less graded for team-based than non-team-based primary care. Data came from a nationally representative cross-sectional survey, the 2008 Canadian Survey of Experiences with Primary Health Care. Using logistic regression, we examined the associations between primary care type and access problems, adjusting for demographic, health status, socioeconomic, and health care supply factors. We then stratified by primary care type to compare steepness of socioeconomic associations with access problems. Primary care type had no statistically significant, independent associations with access problems. No statistically significant socioeconomic gradients in access problems were observed regardless of primary care type, except that difficulty in access was statistically significantly and positively graded by education for non-team-based primary care.

Background: Exemestane is a drug of great interest for breast cancer prevention, because it inhibits estrogen production. Estrogen may operate by increasing breast density, a well-established biomarker for increased breast cancer risk. The NCIC CTG MAP.2 trial examined the efficacy of exemestane in decreasing breast density. Menopausal health-related quality of life (HRQL) and adverse events were also carefully monitored during the study. Purpose: To elucidate the impact of exemestane on menopausal HRQL and to examine the relationship between clinician and participant methods of reporting side effects. Methods: 98 postmenopausal women with increased breast density were randomized to exemestane or placebo daily for one year. HRQL was measured with the MENQOL questionnaire, which has four domains. Mean changes in MENQOL domain scores from baseline were compared between treatment groups using the Wilcoxon rank-sum test. The difference between groups in the proportion of women with a clinically meaningful decline was compared by domain with the Chi-square test; change scores were considered worsened if increased by ≥ 0.5 points. The association between time-to-decline in menopausal HRQL and treatment was evaluated using Cox PH regression. The kappa statistic quantified the level of agreement between participant-reported and clinician-reported symptoms. Kaplan-Meier estimates of time-to-decline as communicated by clinicians and participants were compared, using three thresholds to define meaningful change. Results: No significant differences in mean change scores were detected, however, a significantly greater proportion of women on exemestane experienced a clinically meaningful decline in physical menopausal HRQL at three months (absolute difference=19%, p= 0.03), while the absolute difference approached significance for vasomotor menopausal HRQL at six months (21%, p= 0.05), and at nine months (21%, p=0.06). The rate of decline in physical menopausal HRQL was 2.08 times greater (95% CI 1.10-3.94) in the exemestane group compared to the placebo group. Agreement between raters was low for all symptoms except hot flashes; in general participants detected symptoms more rapidly than clinicians, regardless of the defined cut-off for meaningful change on the MENQOL. Conclusions: A subset of women on exemestane experienced significant declines in physical and vasomotor symptoms. Generally, participants reported symptoms more frequently and faster than clinicians. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-06-06 23:55:24.011

Background: Research points in different directions when looking at possible increases in mental health problems among adolescents. Findings in favor of an increase are questioned due to methodological problems. Aim: Investigating whether mental health problems among young adolescents are increasing over time in Europe and North America. If so, does the trend apply both to mean levels of symptoms and to the proportion of adolescents with substantial problems? Are the time-trends similar over sex and age-categories?                                                                                                    Method: A total of 401 089 adolescents from a total of 38 countries are included in the analysis. Based on the eight health variables on self-rated health provided by the HBSC study, a measurement of mental health problems was created using factor analysis in SPSS. Results: Increases of mental health problems were found in Europe and North America. Increases were found both in terms of mean levels of symptoms and to the proportion of adolescents with substantial problems. Increases were seen in all age groups and among both girls and boys. Conclusion: Reasons behind the discovered increases are not known and should be further investigated as extensive research point to severe consequences of mental health problems in adolescence for later life.       Key words   Adolescents, mental health problems, trends, self-reported health (SRH), psychological health complaints (PHC)

Physical activity in youth has many benefits, but parallel to these benefits, sport related injuries pose considerable risks.  It is important to public health to address sport related injuries, particularly those affecting young people, who comprise the majority of participants in organised sport in Sweden.  The first study in this research showed that inspections of local sport environments, where injuries often occur, did not occur uniformly. Two additional studies pointed out the need for better surveillance of injuries, and described the use of ambulance attendance reports as a possible improvement to current surveillance systems, with a possibility to improve safety for youth and other sport participants. Two other studies identify risk factors that were specific to football and climbing sports, which can be used to guide targeted safety interventions for the young participants of these sports.  The studies, taken as a whole, provide new information about the factors associated with sport related injuries, particularly for young people, and point out the need for better sport injury surveillance, improved inspection strategies for fields maintained by organised sport clubs in local communities, and the need to address risk factors specific to different sport activities.

Background: Wind turbines are a form of renewable energy, which generate electricity from wind energy, a practice dating back over 100 years. More recently, large-scale wind energy developments have started to employ one or several industrial wind turbines, which produce the majority of wind energy in Ontario. The production of electricity from the movement of industrial wind turbine motor blades creates both mechanical and aerodynamic noise. This type of environmental noise is a growing public health concern, especially for residents living close to industrial wind turbines. A body of evidence now exists to suggest that industrial wind turbine noise can impair health and contribute to annoyance and sleep disturbance. However, in Ontario, little is known about how industrial wind turbines impact people living in their vicinity. Objectives: This investigation was a cross-sectional study involving eight Ontario communities that contain greater than ten industrial wind turbines. The objectives of this study were to explore the association between proximity to industrial wind turbines and self-reported health effects, specifically quality of life (both physical and mental health) and sleep disturbance, in residents living close to wind turbines. Dose-response relationships were also explored in an attempt to investigate acceptable exposure levels and appropriate setback distances for industrial wind turbines. Methods: Eight wind farms in Ontario were selected for analysis. For this cross-sectional study, the ???Quality of Life and Renewable Energy Technologies Study??? survey was used to measure the impact of industrial wind turbines on health. Using Canada Post???s Unaddressed Admail Service, surveys were sent to 4,876 residences near industrial wind turbines in these eight communities. Survey responses were sent back to the University of Waterloo and data from the surveys were used for analysis. Descriptive analyses were performed and multiple regression models were run to investigate the effect of the main independent variable of interest (distance to nearest industrial wind turbine) on the various outcome variables. Descriptive statistics, including means and standard deviations were performed on a number of dependent and independent variables including age, sex, time in home, number of industrial wind turbines within 2,000 meters and sleep and health outcomes. Results: In total, 412 surveys were returned (8.45% response rate); 16 of these survey respondents did not provide their home address. Therefore, 396 surveys were included in the analysis. The mean self-reported distances of survey respondents to wind farms was 2,782 meters +-3,950 meters (range: 0.40-55,000 meters). The mean calculated distance from residence to the closest industrial wind turbine was 4,523 meters +-4,420 meters (range: 316-22,661 meters). The difference between the calculated and perceived distance measurements was statistically significant (P<0.001) with survey respondents reporting that they live, on average, 1,741 meters closer to wind farms than they actually do. The relationship between Pittsburgh Sleep Quality Index and ln(distance) was found to be statistically significant (P=0.01) when controlling for age, gender and county, meaning that as distance increased (move further away from an industrial wind turbine), Pittsburgh Sleep Quality Index decreased (i.e. sleep improved) in a logarithmic relationship. Among the eight Wind Turbine Syndrome index variables, the relationship between vertigo and ln(distance) was statistically significant (P<0.001) when controlling for age, gender, and county. Additionally, the relationship between tinnitus and ln(distance) approached statistical significance (P=0.08) when controlling for age, gender and county. Both vertigo and tinnitus were worse among participants living closer to industrial wind turbines. Conclusion: Study findings suggest that industrial wind turbines could have an impact on health. Using a sample of rural Ontario residents (although not necessarily representative of the target population), this study explored the quality of life (both physical and mental health) and sleep disturbance of residents living in the vicinity of industrial wind turbines. However, because of study limitations, there are many questions still to be answered before firm conclusions can be drawn. Based on the findings of this study it is recommended that further studies be carried out to examine the effects of low-level stressors, such as industrial wind turbine noise, on health. Specifically, study findings suggest that future research should focus on the effects of industrial wind turbine noise on sleep disturbance and symptoms of inner ear problems. Although the study findings could suggest that there is a possible association between various health outcomes and how far someone lives from an industrial wind turbine, it is important to remember that there are limitations to these conclusions.

Objective: To explore the measurement of subsyndromal mood symptoms in relation to studies of maintenance therapy for bipolar disorder. Methods: Literature review of the Medline database using the following selection criteria: (1) ‘bipolar disorder’ plus ‘inter-episode or interepisode or subsyndromal or subclinical or residual or subthreshold’ and (2) ‘bipolar disorder’ plus ‘maintenance or prophylaxis or longitudinal’. Studies of children or adolescents and non-English-language reports were excluded. Results: Of the studies published between 1987 and October 2007, 77 articles about subsyndromal mood symptoms and 257 studies of maintenance therapy agents were found. Only 11 of the 257 studies of maintenance therapy agents discussed subsyndromal mood symptoms. Of the 77 articles, two thirds were published after 2000. Inconsistent definitions of subsyndromal mood symptoms and different evaluation tools and methodologies were used in the studies. Conclusions: There is a need to standardize definitions and validate measuring approaches for subsyndromal mood symptoms. However, when measured in both naturalistic studies and clinical trials, subsyndromal mood symptoms were frequently reported by patients receiving maintenance therapy and were associated with poor functioning. As with other chronic illnesses, knowledge of the patient’s perspective of daily morbidity is important for improving the clinical outcome. Studies of maintenance therapy for bipolar disorder, regardless of the approach, should measure subsyndromal mood symptoms as an additional outcome. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

This thesis is an investigation of talk in a therapeutic setting. It takes discursive psychology as the main influence theoretically, and also draws on the rigorous analytical techniques of conversation analysis (CA). The data was collected in various family therapy settings in the U.K., both residential and non-residential videotapes made during those sessions These recordings were made by therapists for their own use initially, and were not produced especially for this project. Videotapes were transcribed according to standard CA conventions, and subsequently analysed. One of the primary research questions has been to examine empirically mental state language as used in the therapeutic setting. Secondly, it has been to examine accounting practices and the production of versions of events as 'fact'. Thirdly, the aim has been to consider the practical implications of asymmetry as a participants' concern. As a unifying and over-arching analytic interest the use of reported speech in each of these other aspects has been investigated to assess its role in their production. The conclusions of the thesis demonstrate that participants themselves orient to one another's minds as accessible and reportable entities, and that speech is treated as reflective of inner thought. Furthermore, where speech is reported in the therapeutic setting, it is frequently used to validate and to evidence claims about other people's 'psyche'.

This thesis features a qualitative study of student source use and speech representation in two corpora of review essays that acknowledges the complexity of classroom writing contexts and the rhetorical nature of school genres. It asks how students engage with the texts they review, for what reasons, and in response to what aspects of the writing context. When considered as a distinct genre of student assignment, review essays make for a particularly interesting study of source engagement because they challenge students to maintain an authoritative voice as novices evaluating the work of an expert. In addition, citation issues in the review assignment might not be as obvious to students or their instructors as they would be, for instance, in a research paper for which multiple sources are consulted and synthesized. The review essays interrogated in this study were collected with appropriate ethics clearance from two undergraduate history courses. The analysis is extended to a small corpus of published reviews assigned as model texts in one of these courses. The study features a robust method that combined applied linguistics and discourse analysis to tease out connections between the grammatical structures of speech reports and their argumentative roles. This method involved a recursive process of classifying speech reports using Swales’ (1990) concepts of integral and non-integral citation, Thompson and Yiyun’s (1991) classifications of speech act verbs, and Vološinov (1929/1973) and Semino and Short’s (2004) models of speech reporting forms. In addition, the analysis considered the influence of the writing context on the students’ citation practices and took into account theories of rhetorical genre and student identity. The results show connections between assignment instructions and the effective and problematic ways students engaged with the texts they reviewed, such as a correlation between a directive to reduce redundancy and the absence of in-text attributions. Most notably, this study offers a fluid set of descriptors of the forms and functions of speech reports in student coursework that can be used by students, educators, plagiarism adjudicators, as well as scholars of rhetoric and composition, to illuminate some of the methods and motives of student source use.

Ce travail se propose d’étudier la postposition totale ou partielle de l'énoncé rapportant dans le discours rapporté direct et indirect. L’approche grammaticale, dite "classique" du discours rapporté (DR) en général et des incises en particulier se heurte à l’extrême diversité des données empiriques à ce sujet. Envisager les incises sous l’angle formel d’un phénomène grammatical, c’est à la fois en dessiner les contours, mais également poser les limites inhérentes à toute forme. Confrontés à la réalité des incises, les contours rassurants de la forme se distendent jusqu’à en donner une image déformée voire paradoxale sous certains aspects, bien loin des clichés véhiculés par l’emploi métalinguistique de ce terme en français. Il s’agit de s’intéresser au fonctionnement spécifique des incises de DR en anglais, de réhabiliter, en quelque sorte, la position incise dont elles tirent leur nom. Cette réhabilitation de nature textuelle, fondée sur l’étude de leur métamorphose au fil des textes, permettrait d'envisager les incises comme un lieu de stratégie narrative plus qu'un élément de rupture énonciative. / This thesis investigates the use of reporting clauses and reporting parentheticals in final and medial position in direct and indirect (reported) speech. Traditional grammatical models seem to offer no satisfactory explanation as regards to final and medial positions of the reporting clause or parenthetical within the sentence. Though grammatical descriptions give formal structure to the phenomenon, they also tend to limit its scope and need to be stretched to accommodate the reality of reporting clauses and parentheticals in literary texts.Analysing medial and final reporting clauses within the framework of French théorie de l’énonciation shows that they blur the frontier between reported and non-reported speech more often than not. From a literary point of view, medial and final positions can be considered as choices made for stylistic reasons, in which case the emphasis is put on reporting clauses as creating textual cohesion rather than causing rupture within the narrative.