Frequent Difficulties Research Articles

Understanding patient-centred readmission factors: a multi-site, mixed-methods study

ImportancePatient concerns at or before discharge inform many transitional care interventions; few studies examine patients’ perceptions of self-care and other factors related to readmission.ObjectivesTo characterise patient-reported or caregiver-reported factors contributing...

Difficulties encountered in the emergency department by patients with hereditary angioedema experiencing acute attacks.

Hereditary angioedema (HAE) is a rare, potentially life-threatening disease characterized by recurrent angioedema attacks. Abdominal symptoms of HAE typically mimic numerous abdominal emergencies, which may result in a delay of correct diagnosis and inappropriate treatments. We aimed to evaluate the difficulties experienced by patients with HAE in Turkish emergency departments (ED). We conducted face-to-face interviews with patients with HAE by using a questionnaire regarding the clinical and demographic data of the patients and difficulties encountered during ED admissions. The mean (standard deviation) age of 34 patients with HAE (25 women, 9 men) was 36.2 ± 11.5 years and the mean (standard deviation) delay in diagnosis was 17.2 ± 9.7 years. Inappropriate treatment for HAE attacks was administered to 88.2% (n = 30) of patients in the ED, despite their diagnosis of HAE. The most frequent difficulty was "not knowing how to administer C1 inhibitor concentrate" (n = 11 [32.4%]). Other difficulties encountered were as follows: ED staff being unaware of HAE (n = 6 [17.6%]), lack of C1 inhibitor concentrate in the ED (n = 3 [8.8%]), and kept waiting for the appropriate treatment in triage despite their having angioedema in the head-and-neck region (n = 2 [5.9%]). Patients with HAE encounter difficulties in the ED, and the delay in diagnosis could be due to a low level of awareness regarding HAE. Therefore, the management of HAE in EDs requires improvement.

Hypothyroidism in Childhood and Adolescence

Juvenile hypothyroidism is an unfrequent form of hypothyroidism that affects children. If not diagnosed and treated properly, it may cause severe neurological disorders during growth. The most frequent difficulties are found in school performance, difficulties in concentration, hyperactivity or fatigue and damage on the onset of puberty. Starting levothyroxine as a drug of choice is essential, and it should be made according to the age and weight of the child. Laboratory tests for control should be requested periodically, along with a strict control of the child’s development and growth. The family-doctor relationship, along with a clear guidance on the importance of treatment, is critical to achieve a successful treatment. This article is a review about the main clinical features of hypothyroidism in childhood, especially in developing countries, providing key aspects of adherence and characteristics of its follow-up.

Pattern of prostate cancer among a Nigerian population: A study in a single tertiary care centre

Prostate cancer has become a global health challenge because of its rising morbidity and mortality in males. It is the second cause of cancer death following lung cancer in men. It is rare under the age of 40 and its incidence has been shown to increase exponentially with age. Previously, Prostate cancer was thought to be a disease rare in blacks owing to the fact that not so much was known of the disease. The objective of the study was to review the prevalence, pattern of presentation and clinic-pathologic findings of prostate cancer in the Department of Radiotherapy, Lagos University Teaching Hospital (LUTH), between January 2001 to December 2010 in comparison to previous and recent studies globally. Data collection for all patients histologically diagnosed with Prostate cancer at the Department of Radiotherapy, LUTH, from 1st of January 2001 to 31st of December 2010 was done. A total of 144 cases with histologically confirmed Prostate cancer seen during the ten year study were analysed. The highest frequency was seen in the year 2010 with 34 cases. The age range was 41 to 81years with a mean of 66.19 ±7.30years.Adenocarcinoma was the commonest histological type with 98.6%.9(6.3%) patients had a positive family history of prostate cancer out of which 3(33.3%) had their brother affected the malignancy. 51(35.4%) patients presented with stage IV disease.18(12.5%) patients had a Gleason's score of 6,10(6.9%) patients had a Gleason's score of 7 and 2(1.4%) patients had a Gleason's score of 10. The most common presenting complaints were bone pains seen in 51(35.4%) patients, frequent night urine and difficulty with micturition seen in 50(34.7%) and 42(29.2%) patients respectively. This study showed that prostate cancer is not as rare as it used to be. Reasons attributed to its rarity then were lack of awareness, poor screening facilities and poor diagnosing technique.

Performance Improvement with Web Based Database on Library Information System of Smk Yadika 5

The difficulty in managing the data of books collection in the library is a problem that is often faced by the librarian that effect the quality of service. Arrangement and recording a collection of books in the file system of separate applications Word and Excel, as well as transaction handling borrowing and returning books, therehas been no integrated records. Library system can manage the book collection. This system can reduce the problems often experienced by library staff when serving students in borrowing books. There so frequent difficulty in managing the books that still in borrowed state. This system will also record a collection of late fees or lost library conducted by students (borrowers). The conclusion of this study is library performance can be better with the library system using web database.

The Danish PEP Registry: Experience with the use of post-exposure prophylaxis following blood exposure to HIV from 1999–2012

Background: The risk of occupational exposures to blood cannot be eliminated completely and access to post-exposure prophylaxis (PEP) to prevent HIV transmission is important. However, PEP administration has been associated with frequent adverse effects, low compliance and difficulties to ensure a proper risk assessment. This nationwide study describes 14 years of experience with the use of PEP following blood exposure in Denmark. Methods: A descriptive study of all PEP cases following non-sexual exposure to HIV in Denmark from 1999–2012. Results: A total of 411 cases of PEP were described. There was a mean of 29.4 cases/year, increasing from 23 cases in 1999 to 49 cases in 2005 and then decreasing to 16 cases in 2012. Overall 67.2% of source patients were known to be HIV-positive at the time of PEP initiation, with no significant change over time. The median time to initiation of PEP was 2.5 h (0.15–28.5) following occupational exposure. Adverse effects were reported by 50.9% with no significant difference according to PEP regimen. In 85.1% of cases with available data, either a full course of PEP was completed or PEP was stopped because the source was tested HIV-negative. Only 6.6% stopped PEP early due to adverse effects. Conclusions: PEP in Denmark is generally prescribed according to the guidelines and the annual number of cases has declined since 2005. Adverse effects were common regardless of PEP regimens used and new drug regimens should be considered.

Latino suicidal adolescent psychosocial service utilization: The role of mood fluctuations and inattention

BackgroundLittle is known about the specific factors related to whether or not Latino adolescents with suicide ideation (SI) will seek services. Utilizing Andersen's Behavior Model of Health Services Use (2008) the goal of this study is to identify the factors related to utilization of mental health services by Latino adolescents with SI to inform and improve suicide prevention efforts. MethodData from Wave 1 of the National Longitudinal Study of Adolescent Health was examined. Predispositional (gender, age), enabling/disabling (income, lack of insurance, difficulty obtaining medical care), and need (depressed mood, suicide attempt, perceived health, impulsivity, mood fluctuations, difficulties with attention, etc.) variables were examined via logistic regression as potential correlates of mental health service utilization. ResultsTwenty-eight percent of the Latino adolescents with suicidal ideation (SI) in our sample received mental health services. Need factors such as daily mood fluctuations within the past 12 months (OR=4.78) and frequent difficulty focusing attention within the past week (OR=4.96), but not impulsivity, were associated with an increased likelihood of receiving mental health services. No additional associations were observed. LimitationsThe current study is based on cross-sectional data. Therefore, statements about causality cannot be made. ConclusionsThese findings suggest that emotion regulation (e.g., daily mood fluctuations) and neurocognitive factors (e.g., difficulty with focusing attention) may be important factors to consider in the clinical assessment of Latino adolescents with SI.

Depression among people with epilepsy in Northwest Ethiopia: a cross-sectional institution based study.

BackgroundEpilepsy is the world’s most common neurological disorder, affecting approximately 50 million people worldwide and contributed to different psychiatric illness. Depression is one of the most frequent co morbid psychiatric disorders that affects the life of the patients’. This study aimed to assess the prevalence of depression and associated factors among epileptic patients attending the outpatient department of the University of Gondar Hospital, Northwest Ethiopia, 2014.MethodsInstitution based quantitative cross—sectional study was conducted among 405 individual with epilepsy. The participants were selected using systematic random sampling technique. Semistructured questionnaires were used to obtain socio-demographic and clinical data. Depression was measured using Beck’s Depression Inventory Binary logistic regression used for analysis.ResultsThe estimated, prevalence of depression was found to be 45.2 %. Out of these (29.6 %) were classified as mild, (14.8 %) as moderate and (0.8 %) were severely depressed. A lower educational status was associated with an increased prevalence of depression and the adjusted odds ratio (AOR) for the illiterate [can’t read and write] was 8.32 [95 % Confidence Interval (CI): 4.83, 14.29]. Perceived stress (AOR = 6.21, CI 3.69, 10.44), onset of illness <6 years (AOR = 5.29, CI 4.09, 15.89), seizure frequency of [1–11 per year (AOR = 1.34, CI 1.41, 4.36), ≥1 per month (AOR = 7.83, CI 3.52, 17.40)], poly-pharmacy (AOR = 7.63, CI 2.74, 21.26)] and difficulties of adherence to antiepileptic drugs (AOR = 4.80, CI 2.57, 8.96) were also found to be independently associated with depression.ConclusionOverall, the prevalence of depression was found to be high. Lower educational status, early onset of illness, seizure frequency, poly-pharmacy and difficulties of adherence to anti-epileptic drugs (AEDs) were factors statistically associated with depression. Strengthening the educational status of the patients on the effect of early onset of the illness, frequent seizure occurrence and difficulty of adherence to AEDs as a contributing factors for other co-morbid psychiatric disorder are suggested in the clinical care setting.

FORMULACIÓN PSICODINÁMICA DE CASO EN NIÑOS

La Formulación psicodinámica y dimensional de caso en niños resultará de capital importancia en función de la dificultad que se nos presenta con frecuencia de hacer diagnósticos categoriales en el período de la vida más caracterizado por los cambios. Para hacerla tomaremos especialmente en cuenta el nivel de desarrollo, el entorno en el que crece el niño, su desempeño en diferentes ámbitos y su relacionamiento tanto con pares como con diversos cuidadores. Todos estos aspectos sufrirán cambios permanentes correspondientes al crecimiento del niño y a la lenta adquisición de lo que serán sus rasgos de personalidad que definirán su sentido de sí mismo. Estos elementos, especialmente el acelerado nivel de cambio, generan en muchas ocasiones una dificultad para definir un diagnóstico y más aún para diferenciar lo reactivo, lo intrapsiquico, lo relacional, por lo cual, enfatizando el nivel, las características y condiciones de funcionamiento, consideraremos la formulación clínica como una foto tomada en un momento determinado que nos servirá de referencia para siguientes evaluaciones. Pondremos el énfasis en las herramientas con las que cuenta el niño y en el efecto que el manejo de las mismas podrá tener en el desarrollo. Detallaremos la forma de sistematizar esta información y ofrecemos a la vez ejemplos y una guía de preguntas que nos orienten en su realización.

Insomnia symptoms and mortality: a register‐linked study among women and men from Finland, Norway and Lithuania

Evidence on the association between insomnia symptoms and mortality is limited and inconsistent. This study examined the association between insomnia symptoms and mortality in cohorts from three countries to show common and unique patterns. The Finnish cohort comprised 6605 employees of the City of Helsinki, aged 40-60 years at baseline in 2000-2002. The Norwegian cohort included 6236 participants from Western Norway, aged 40-45 years at baseline in 1997-1999. The Lithuanian cohort comprised 1602 participants from the City of Palanga, aged 35-74 years at baseline in 2003. Mortality data were derived from the Statistics Finland and Norwegian Cause of Death Registry until the end of 2012, and from the Lithuanian Regional Mortality Register until the end of 2013. Insomnia symptoms comprised difficulties initiating sleep, nocturnal awakenings, and waking up too early. Covariates were age, marital status, education, smoking, alcohol, physical inactivity, obesity, diabetes, cardiovascular diseases, depression, shift work, sleep duration, and self-rated health. Cox regression analysis was used. Frequent difficulties initiating sleep were associated with all-cause mortality among men after full adjustments in the Finnish (hazard ratio 2.51; 95% confidence interval 1.07-5.88) and Norwegian (hazard ratio 3.42; 95% confidence interval 1.03-11.35) cohorts. Among women and in Lithuania, insomnia symptoms were not statistically significantly associated with all-cause mortality after adjustments. In conclusion, difficulties initiating sleep were associated with mortality among Norwegian and Finnish men. Variation and heterogeneity in the association between insomnia symptoms and mortality highlights that further research needs to distinguish between men and women, specific symptoms and national contexts, and focus on more chronic insomnia.

Repetitive sleep starts

Sleep starts, also known as hypnic or hypnagogic jerks, are a physiological accompaniment to falling asleep [1]. They are brief body jerks mainly bilateral and sometimes asymmetric. When sleep starts are excessive, they are considered a parasomnia and included in the category of sleep-wake transition parasomnias by the International Classification of Sleep Disorders [2]. They can cause frequent awakenings and sleep onset difficulty. The syndrome was first described by S Weir Mitchell [3]. This peculiar type of event consists of a massive myoclonic jerk in which the main muscles involved are the axial ones. Sleep starts can be accompanied by a dream, or the impression of falling. Epileptic seizures and parasomnias are the two major groups of sleep-related paroxysmal disorders in childhood. Epileptic seizures are usually characterized by random occurrence, stereotyped behavior, brief duration, and hypertonus or clonic jerks [4]. The pathogenesis of sleep starts is unknown. However, they involve partial activation of the central nervous system producing skeletal muscle activity. This could arise as a consequence of a synchronous volleys of pyramidal tract activity arising during the transition from wakefulness to sleep [5]. However, the involvement of axial muscles, the possible reflex origin, and

Thoracic endometriosis: clinicopathologic updates and issues about 18 cases from a tertiary referring center.

Thoracic endometriosis is defined as the ectopic presence of endometrial glands and stroma in lung or pleura and constitutes an uncommon cause of spontaneous pneumothorax in nonsmoker women in childbearing age. From 2000 to 2014, 18 (7.3%) women of 246 had a histologically proven endometriosis-related pneumothorax. The examination of thoracic samples was performed on formalin-fixed, paraffin-embedded hematoxylin and eosin-stained slides. Immunohistochemistry was carried out on all samples. The pathologic findings included endometriosis foci appearing as a triad of endometrial glands, stroma, and hemosiderin-laden macrophages in 8 patients. In the remaining 10 patients, minute nests of endometrial stroma were recognized at histologic examination and immunohistochemistry. One patient displayed diaphragmatic endometriosis and pulmonary lymphangioleiomyomatosis. Thoracic endometriosis is an uncommon cause of recurrent pneumothorax necessitating histologic confirmation. The histologic diagnosis of endometriosis may be challenging on small pleural or lung biopsies because endometriosis mostly appears as minute nests of endometrial stromal cells. Here, we present our experience on thoracic endometriosis: considering frequent interpretation difficulties of biopsy samples, we propose a multidisciplinary diagnostic algorithm.

The Co-occurring Syndrome—Coexisting Erectile Dysfunction and Benign Prostatic Hyperplasia and Their Clinical Correlates in Aging Men: Results From the National Health and Nutrition Examination Survey

To establish a descriptive profile of men with coexistent erectile dysfunction (ED) and/or benign prostatic hyperplasia (BPH), ED only or BPH only compared to those with neither condition and to identify the determinants of coexisting disease. Self-report and/or medication use measures defining ED and BPH were assessed in men aged ≥40 years (N = 2142) between 2001 and 2004 using the National Health and Nutrition Examination Surveys. Descriptive analyses examined the ED and/or BPH covariate distribution. Logistic regressions calculated odds ratios (ORs, 95% confidence interval) comparing men with ED and/or BPH, BPH only, or ED only to men with neither condition. Of 393 men with BPH, 57.8% had coexistent ED, confirming the moderately strong co-occurrence of the conditions (P <.0001). Coexisting ED and/or BPH occurred in 10.6% of participants, whereas 24.4% and 7.7% reported ED and BPH. After age 60, the odds of reporting ED, BPH, or ED/BPH vs neither almost tripled per decade of increasing age, corresponding to prevalence increases. The unadjusted odds of ED and/or BPH vs no disease increased 1.3 times per prostate-specific antigen unit (ng/mL) increase and 1.1 times per C-reactive protein unit (mg/dL) increase. Other predisposing factors for ED and/or BPH included higher body mass index (OR = 2.5), increased antidiabetic (OR = 2.9) or proton pump inhibitor use (OR = 2.3), increased healthcare visits (≥4; OR = 3.5), and more frequent urinary voiding difficulties (OR = 9.7). Co-occurring ED and/or BPH is evident in ~10% of men ≥40 years old and is associated with significant clinical correlates. Clinicians need to pay greater attention to this clinically important syndrome in aging men.

Scope of partial least-squares regression applied to the enantiomeric composition determination of ketoprofen from strongly overlapped chromatographic profiles.

Valuable quantitative information could be obtained from strongly overlapped chromatographic profiles of two enantiomers by using proper chemometric methods. Complete separation profiles where the peaks are fully resolved are difficult to achieve in chiral separation methods, and this becomes a particularly severe problem in case that the analyst needs to measure the chiral purity, i.e., when one of the enantiomers is present in the sample in very low concentrations. In this report, we explore the scope of a multivariate chemometric technique based on unfolded partial least-squares regression, as a mathematical tool to solve this quite frequent difficulty. This technique was applied to obtain quantitative results from partially overlapped chromatographic profiles of R- and S-ketoprofen, with different values of enantioresolution factors (from 0.81 down to less than 0.2 resolution units), and also at several different S:R enantiomeric ratios. Enantiomeric purity below 1% was determined with excellent precision even from almost completely overlapped signals. All these assays were tested on the most demanding condition, i.e., when the minor peak elutes immediately after the main peak. The results were validated using univariate calibration of completely resolved profiles and the method applied to the determination of enantiomeric purity of commercial pharmaceuticals.

Sleep problems in anxious and depressive older adults.

PurposeThe objective of this study was to identify the sleep problems most often encountered by the elderly according to the presence or absence of anxiety and mood disorders. The aim was also to determine whether groups of anxious, depressive, and asymptomatic individuals differ in relation to sleep onset latency; awakenings at night or early in the morning; subjective quality of sleep; taking of sleep medication; and daytime sleepiness.MethodsStructured interviews based on the DSM-IV-TR were administered to a sample of 2,759 seniors aged 65 years and older at the participants’ home by health professionals.ResultsAwakening was found to be the most common disturbance. Increased sleep onset latency was the second most frequent sleep difficulty. Taking more than 30 minutes to fall asleep was associated with the likelihood of meeting the diagnostic criteria for an anxiety disorder, and even reduced the risk of meeting the diagnostic criteria for a mood disorder rather than an anxiety disorder. Awakenings were associated with the probability of suffering from an anxiety disorder or a mood disorder. Quality of sleep, as perceived by the elderly, was not found to be associated with the probability of suffering from a mental disorder.ConclusionThese findings should help to facilitate the practitioner’s diagnosis and add further nuances to be considered when encountering symptoms of an anxious or depressive appearance. All of these data also add fuel to the ongoing debate about whether anxiety and depression are one or two distinct categories of disorders.

Chronic sleep difficulties in non-depressed young women: a longitudinal population-based investigation

Objectives/BackgroundYoung women are at a risk of poor sleep, but the extent to which their sleep difficulties remain chronic is not known. Little is also known about the frequency of seeking health care for sleep and satisfaction with that health care. This longitudinal study investigated these issues over nine years in women who reported sleep difficulties over the preceding 12 months. Patients/MethodsData from the Australian Longitudinal Study on Women's Health were analysed (N = 9683). Information on self-reported sleep difficulties, help seeking, and health-care satisfaction was obtained from four surveys collected from 2000 (aged 22–27 years) to 2009. Generalized estimating equations were conducted to calculate odds ratios (OR) for the likelihood of women who reported sleep difficulties in 2000 to report sleep difficulties at subsequent surveys. ResultsThe prevalence of self-reported sleep difficulties ‘often’ was consistent at 9.1–10.8%. Women who reported sleep difficulties ‘often’ in 2000 had a markedly increased risk of continued sleep difficulties ‘often’ over the subsequent 9 years [2003: OR (95% confidence interval, CI) = 11.07 (8.03–15.27); 2006: 12.19 (8.08–16.88); 2009: 10.70 (7.57–15.12)]. Of women who reported sleep difficulties ‘often’ in 2000 (N = 981), 45.1% had persistent sleep problems and 21.1% experienced relapse of symptoms. About one-third of women who reported sleep problems ‘often’ sought help. ConclusionSelf-reported frequent sleep difficulties in non-depressed young women strongly predicted a continuation of this level of sleep difficulty over a decade, even if help is sought. Current health practice may not be breaking the ongoing chronicity of sleep difficulties in young women.

RELACIÓN ENTRE EVALUACIÓN CLÍNICA DEL SUFRIMIENTO FETAL AGUDO, TIPO DE PARTO Y ESTADO DEL RECIÉN NACIDO

Se realizó un estudio en 1352 recién nacidos vivos, de 1344 partos habidos en el Hospital Nacional "Edgardo Rebagliati Martins" – IPSS - en Lima, entre el 1° y el 31 de Mayo de 1985, con la finalidad de determinar la incidencia de sufrimiento fetal agudo (SFA) compensado o descompensado. Se detectó 215 (15.90%) de SFA, 172 (12.72%) de los cuales pertenecieron al grupo A y 43 (3.18%) al grupo B, habiéndose encontrado una incidencia de sufrimiento fetal descompensado mayor a la reportada en la literatura. La enfermedad hipertensiva del embarazo fue la patología materna más frecuentemente relacionada a SFA. Se realizó cesárea en el 27% de la población con sufrimiento fetal. La cesárea y el parto instrumentado tuvieron una incidencia elevada en el grupo con SFA descompensado (55.81% y 27.91%, respectivamente), no registrándose diferencias estadísticamente significativas entre los grupos compensado y control. El Apgar en los recién nacidos con SFA fue menor que en el grupo control, en forma significativa. La morbilidad fue mayor en los RN con SFA que en el grupo control, con diferencias estadísticamente significativas: En el grupo A, el 26.16% presentó alguna patología, y en el B, el 34.88%, más frecuentes la hipoxia y el síndrome de dificultad respiratoria. El trauma obstétrico fue la patología más frecuentes en el grupo B. La mortalidad neonatal, evaluada en el período de estudio, fue 0.93% y la perinatal fue 3.73%. Las causas de muerte neonatal fueron, enterocolitis necrotizante y enfermedad hemorrágica del recién nacido.

Delayed sleep phase disorder risk is associated with absenteeism and impaired functioning

Study objectivesThe absence of a screening questionnaire for delayed sleep phase disorder (DSPD) remains a barrier to its detection and subsequent clinical evaluation. We developed a questionnaire to screen for DSPD risk and assessed its impact on self-reported absenteeism and functioning in work/school, social, and family life. DesignCross-sectional, with 13,844 individuals responding to a survey through an Internet survey provider, from which 1315 completed surveys were obtained from eligible participants. ParticipantsA total of 1315 individuals who self-identified as evening type (n=979) or as non-evening type (n=356). Measurements and resultsA total of 295 participants were at high risk for DSPD, which is 5.1% of the total eligible survey respondents and 22.4% of our final sample with completed surveys. Compared to those who were not at high risk for DSPD, those who were at high risk were more likely to report frequent absenteeism, frequent loss of productivity, disruption to work or school activities, disruption to social life or leisure activities, and disruption to family life or home responsibilities. Difficulty with daytime sleepiness was more common in those at high risk for DSPD than those who were not. Increased sleep deficit on nights before school or work was also associated with more frequent difficulties with daytime sleepiness; 15.4% of those with no sleep deficit reported always or usually having difficulties with daytime sleepiness compared to 55.7% of those with a sleep deficit of 3hours or more. ConclusionsDSPD risk is associated with increased absenteeism and impaired functioning in work/school, social, and family life.

The Quality of Life Burden Associated With Voice Disorders in Sjögren's Syndrome.

This study examined quality of life burden of voice disorders in Sjögren's syndrome (SS). Patients with SS (n = 101) completed interviews involving patient-reported histories of voice disorders, specific voice symptoms, SS disease severity, the Voice-Related Quality of Life (V-RQOL), and the general health-related quality of life Short Form 36 (SF-36) questionnaires. Relationships among voice symptoms, disease severity, and quality-of-life measures were examined and compared with patient-reported voice disorders. Significant correlations were observed among voice symptoms, disease severity, V-RQOL, SF-36, and patient-reported voice disorders (P < .05). Patients with SS who reported a voice disorder experienced a greater burden on general quality of life as compared with those without voice disorders. Specific voice symptoms significantly correlated with reduced SF-36 scores included frequent throat-clearing, throat soreness, difficulty projecting, and vocal discomfort. Despite the added burden of a voice disorder on quality of life in SS, voice-related treatment seeking was low (15.8%). However, the majority of patients who received voice treatment reported voice improvement. Individuals with SS frequently experience voice disorders and specific voice-related symptoms that are associated with reduced quality of life. These findings have important implications for voice referral practices and voice disorder symptom management in this population.

The Research of Highway Construction Safety Management Based on Fuzzy Evaluation

According to the situation of high frequent accidents and supervision difficulties in highway construction project. The fuzzy evaluation model for the affecting factors of highway construction accidents was established. Through safety analysis on many accidents, it was considered that highway construction accidents were commonly affected by workers’ unsafe behavior, unsafe condition, environmental risk and management. Then the weight of relative factors were determined. Finally the highway construction safety management evaluation was built. It shows that this method is reasonable and handled, which provides a good thought for the scientific, quantitative and available evaluation of highway construction safety management.