Significant Handicap Research Articles

Does long term use of piracetam improve speech disturbances due to ischemic cerebrovascular diseases?

Aphasia causes significant disability and handicap among stroke survivors. Language therapy is recommended for aphasic patients, but not always available. Piracetam, an old drug with novel properties, has been shown to have mild beneficial effects on post-stroke aphasia. In the current study, we investigated the effects of 6 months treatment with piracetam on aphasia following stroke. Thirty patients with first-ever ischemic strokes and related aphasia were enrolled in the study. The scores for the National Institutes of Health Stroke Scale (NIHSS), Barthel Index (BI), modified Rankin Scale (mRS), and Gülhane Aphasia Test were recorded. The patients were scheduled randomly to receive either 4.8 g piracetam daily or placebo treatment for 6 months. At the end of 24 weeks, clinical assessments and aphasia tests were repeated. The level of improvement in the clinical parameters and aphasia scores was compared between the two groups. All patients had large lesions and severe aphasia. No significant difference was observed between the piracetam and placebo groups regarding the improvements in the NIHSS, BI and mRS scores at the end of the treatment. The improvements observed in spontaneous speech, reading fluency, auditory comprehension, reading comprehension, repetition, and naming were not significantly different in the piracetam and placebo groups, the difference reached significance only for auditory comprehension in favor of piracetam at the end of the treatment. Piracetam is well-tolerated in patients with post-stroke aphasia. Piracetam taken orally in a daily dose of 4.8 g for 6 months has no clear beneficial effect on post-stroke language disorders.

Handicaps in Job Assignment: Insiders, Outsiders and Gender

In this study, I use personnel data from a large German company in order to analyze handicaps in job assignment. First, I compare the productivity-relevant characteristics (university degree and work experience) and wages between insiders and outsiders as well as between men and women, who have been assigned to jobs at the same hierarchical level. Second, I estimate promotion probabilities and duration models for the time until the next promotion. The overall findings indicate a significant handicap in job assignment for outsiders with respect to schooling and little evidence that women are handicapped. While gender differences in wages within job levels and promotion probabilities are small, women have, on average, significantly less work experience than men at the same job level.

Palmar fasciitis with polyarthritis syndrome in a patient with breast cancer

Palmar fasciitis and polyarthritis syndrome (PFPAS) is a rare paraneoplastic syndrome often associated with ovarian and pancreatic cancers, and rarely lung and breast cancers. A 39-year-old patient with breast cancer underwent neoadjuvant chemotherapy, radical mastectomy, and radiation therapy. Subsequently, the patient developed PFPAS coinciding with progression of the breast cancer. The rheumatological symptoms were severe causing significant distress and handicap. The patient had a partial response to treatment with corticosteroids. A literature review of PFPAS and its relation to breast cancer is discussed.

Personality pathology recorded by severity: national survey

Current classifications of personality disorders do not classify severity despite clinical practice favouring such descriptions. To assess whether an existing measure of severity of personality disorder predicted clinical pathology and societal dysfunction in a community sample. UK national epidemiological study in which personality status was measured using the screening version of the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) and reclassified to five levels using a modified severity index. Associations between levels of severity of personality pathology and social, demographic and clinical variables were measured. Of 8391 individuals interviewed and their personality status assessed, only a minority (n = 1933, 23%) had no personality pathology. The results supported the hypothesis. More severe personality pathology was associated incrementally with younger age, childhood institutional care, expulsion from school, contacts with the criminal justice system, economic inactivity, more Axis I pathology and greater service contact (primary care and secondary care, all P<0.001). Significant handicap was noted among people with even low levels of personality pathology. No differences contradicted the main hypothesis. A simple reconstruction of the existing classification of personality disorder is a good predictor of social dysfunction and supports the development of severity measures as a critical requirement in both DSM-V and ICD-11 classifications.

BAHA in Single-Sided Deafness

Despite most patients with single-sided deafness (SSD) after operation for acoustic neuroma (AN) perceiving a significant hearing handicap, less than 25% are interested in bone-anchored hearing aid (BAHA) implantation. We evaluated the treatment compliance of BAHA in SSD and the effect of BAHA on the subjective handicap. Part 1: It was determined, from our first study, how many of the SDD patients after operation for AN (n = 59) and interested in BAHA (n = 14) had been implanted. Part 2: Of 23 BAHA-implanted patients with SSD due to various causes, including the implanted patients from the previous study, 21 answered a questionnaire on the BAHA treatment compliance and the subjective handicap with and without BAHA. Part 1: Of the 14 patients from our first study who were interested in implantation for BAHA, 11 had been implanted (18.6% of all 59 patients). Part 2: Of the 21 patients with SSD, 95% still used BAHA, and of these, 81% used it more than 8 hours a day. Of the patients, 90% considered BAHA a moderate to significant aid; it reduced the subjective hearing handicap from 7.4 to 2.3 arbitrary units on a visual analog scale. Despite the subjective handicap perception among most patients with SSD after AN surgery, less than 20% chose treatment with BAHA. Conversely, patients with SSD choosing implantation had high treatment compliance and felt that BAHA reduced their handicap. Thus, when selected by the patients after testing, BAHA is effective in SSD and results in a high patient compliance.

Near Infrared Spectroscopy: Guided Tilt Table Testing for Syncope

Syncope is transient loss of consciousness. Neurocardiogenic syncope (NCS) is the most common cause of syncope. Head-up tilt-table test (HUTT) has been used to demonstrate physiologic events during graded orthostatic challenge in individuals with significant handicap from NCS. Near-infrared spectroscopy (NIRS) provides a noninvasive, continuous method to monitor trends of regional tissue oxygenation (rSO2). We hypothesize that multisite NIRS monitoring will show differential desaturation patterns in the brain and renal vascular beds during postural stresses. All patients age 7-21 years old scheduled to undergo HUTT were recruited. Two probes for NIRS monitoring were placed on the forehead and above the left paravertebral level at the T10 to L1 space. These leads were attached to the Somanetics monitor (Somanetics, Troy MI). Tissue saturations (rSO2) obtained at two sites were recorded at rest, during the test, and throughout a 5-min recovery period. All data routinely obtained in HUTT were included in the research study database. Thirteen patients were recruited. The average age was 12.9 years. Five patients had a positive tilt-table test. The patients with syncope had rSO2 trends distinctly different from the normal subjects. In these patients, cerebral rSO2 showed a sudden decreasing trend from hypoperfusion, soon followed by various clinical symptoms. The cerebral rSO2 trend, which showed a dramatic increase, was paralleled by renal rSO2. These rSO2 trends were progressive until the patient was brought back to the supine position, which resulted in the rSO2 in both beds returning to baseline. Multisite NIRS-guided HUTT shows differential trends in the different vascular beds during postural gravitational stresses, and these patterns underlie the systemic oxygen consumption to flow-coupling dynamics observed during syncope.

LigaSure versus clamp-and-tie in thyroidectomy: a single-center experience

LigaSure (ValleyLab, CO, USA) is a bipolar diathermy system that seals vessels with reduced thermal spread. The device has been used successfully in abdominal surgery and has been introduced as a new method for hemostasis during thyroidectomy. This study compares the efficacy and advantages of LigaSure, when used for thyroidectomy in benign nodular thyroid disease, with the conventional clamp-and-tie technique. Between December 2003 and December 2008, 410 patients underwent thyroid surgery (333 with the conventional clamp-and-tie technique and 77 with LigaSure). Nine patients did not sign the ethical approval document and so were excluded from the study; the results of 68 LigaSure patients were evaluated. The main outcomes measured were age, sex, operating time, postoperative hypocalcemia, recurrent laryngeal nerve palsy, and drain use. Statistical analysis consisted of the chi-squared test and Student's t-test. The mean operating time was significantly shorter in the LigaSure group by 24.1+/-1.7 minutes for a total thyroidectomy (P<0.0001) and 7.6+/-0.1 minutes for one side total plus other side sub- total thyroidectomy (P<0.0001). Bleeding during surgery was significantly lower in the LigaSure group (P<0.0001). There were no significant differences between the study groups in terms of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy, and postthyroidectomy hemorrhage. The LigaSure vessel sealer is a safe, effective alternative for thyroid surgery that reduces the overall operating time. However, its higher cost is a significant handicap for its use in surgery in developing countries.

Expanded Newborn Screening: Outcome in Screened and Unscreened Patients at Age 6 Years

Tandem mass spectrometry is widely applied to routine newborn screening but there are no long-term studies of outcome. We studied the clinical outcome at six years of age in Australia. In a cohort study, we analyzed the outcome at 6 years for patients detected by screening or by clinical diagnosis among >2 million infants born from 1994 to 1998 (1,017,800, all unscreened) and 1998 to 2002 (461,500 screened, 533,400 unscreened) recording intellectual and physical condition, school placement, other medical problems, growth, treatment, diet, and hospital admissions. Results were analyzed separately for medium-chain acyl-CoA dehydrogenase deficiency (MCADD) and other disorders, and grouped patients as those who presented clinically or died in the first 5 days of life; patients presented later or diagnosed by screening, and those with substantially benign disorders. Inborn errors, excluding phenylketonuria, were diagnosed in 116 of 1,551,200 unscreened infants (7.5/100,000 births) and 70 of 461,500 screened infants (15.2/100,000 births). Excluding MCADD, 21 unscreened patients with metabolic disorders diagnosed after 5 days of life died or had a significant intellectual or physical handicap (1.35/100,000 population) compared with 2 of the screened cohort (0.43/100,000; odds ratio: 3.1 [95% CI: 0.73-13.32]). Considering the likely morbidity or mortality among the expected number of never-diagnosed unscreened patients, there would be a significant difference. Growth distribution was normal in all cohorts. Screening by tandem mass spectrometry provides a better outcome for patients at 6 years of age, with fewer deaths and fewer clinically significant disabilities.

An evidence‐based approach to the child who drools saliva

Drooling is a common dysfunction in children with cerebral palsy and may also affect neurologically unimpaired children. It causes significant social handicap to both children and their families. The data in this article are supported by a Medline search (November 2008) utilising the keywords drooling, sialorrhea, botulinum toxin, salivary duct ligation and also by the use of the personal bibliographies of the senior authors. The majority of the published literature for drooling is of level III/IV evidence. Multiple therapeutic interventions are available for paediatric drooling. These are most appropriately introduced in a stepwise progression from behaviour therapy, to pharmacotherapy to surgical procedures.

Novel SOX2 partner-factor domain mutation in a four-generation family

Anophthalmia (no eye), microphthalmia (small eye) and associated ocular developmental anomalies cause significant visual handicap. In most cases the underlying genetic cause is unknown, but mutations in some genes, such as SOX2, cause ocular developmental defects, particularly anophthalmia, in a subset of patients. Here, we describe a four-generation family with a p.Asp123Gly mutation in the highly conserved partner-factor interaction region of the SOX2 protein, which is important for cell-specific actions of SOX2. The proband in this family has bilateral anophthalmia and several other family members have milder ocular phenotypes, including typical optic fissure coloboma. Expression studies indicate that Sox2 is expressed in the eye at the site of closure of the optic fissure during development. The SOX2 mutation in this family implicates the partner-factor interaction region of SOX2 in contributing to the specificity of SOX2 action in optic fissure closure. Our findings indicate that investigation of SOX2 in a broad range of eye anomaly patients aids in the determination of particular functions of SOX2 in development.

Body dysmorphic disorder et chirurgie esthétique : réévaluation de 24 sujets ayant un défaut minime de l’apparence 5 ans après leur demande de chirurgie esthétique

To evaluate the effect of cosmetic surgery in patients with a minimal defect in appearance, with and without body dysmorphic disorder (BDD), 5 years after their request for plastic surgery. Thirty patients requesting cosmetic surgery with a minimal defect in appearance, 12 diagnosed with BDD and 18 not, were contacted 5 years later for a telephone interview about their cosmetic surgery, their satisfaction with it, BDD diagnosis, handicap, and psychiatric comorbidity. Of the 30 patients, we were able to re-evaluate 24 subjects (80%), 10 with BDD and 14 without. Seven BDD subjects had undergone cosmetic surgery compared with 8 without BDD. Patient satisfaction with the intervention was high in both groups. Nevertheless at follow-up, 6 of the 7 BDD patients who had surgery still had a BDD diagnosis and showed higher levels of handicap and psychiatric comorbidity than their non-BDD counterparts. Moreover, 3 non-BDD patients had developed BDD at follow-up. The high level of satisfaction with their surgery expressed by BDD patients was surprising and in contrast to the literature. It may explain, together with the patients' strong insistence, why plastic surgeons do not fully agree with psychiatrists on the contraindication of plastic surgery for BDD patients. Nevertheless in our study, most of the BDD patients were still diagnosed with BDD 5 years after surgery, with a significant handicap. The BDD diagnosis at follow-up in patients initially without BDD might be related to the presence of sub-threshold symptoms at the initial evaluation. This prospective study confirms that cosmetic surgery is not effective against BDD despite patients' reported satisfaction. Cosmetic surgery had no significant effects on BDD diagnosis, handicap or psychiatric comorbidity in BDD patients 5 years after surgery. Furthermore, BDD appeared at follow-up in some subjects not initially diagnosed. Patients' reported satisfaction with surgery may help explain why some plastic surgeons do not consider BDD a complete contraindication to cosmetic surgery.

Hearing Aid Outcomes for Listeners With High-Frequency Hearing Loss

To determine whether listeners with primarily high-frequency sensorineural hearing loss (HF SNHL) perceived benefit from amplification provided by completely-in-the-canal (CIC) hearing aids. The Hearing Handicap for the Elderly-Screening version, the Abbreviated Profile of Hearing Aid Benefit, and the Satisfaction With Amplification in Daily Life questionnaires were mailed to 2 groups of listeners (n = 79) who matched preset criteria, including threshold at 2000 Hz and use of CIC amplification. Sixty-seven percent (n = 53) of the questionnaires were returned and were divided into 2 groups. Group I (n = 26) consisted of listeners with normal hearing through 2000 Hz, and Group II (n = 27) consisted of listeners with normal hearing only through 1000 Hz. Results revealed that both groups perceived significant hearing handicap, hearing aid benefit, and hearing aid satisfaction. Differences between the 2 groups on the 3 measures, however, were not statistically significant. Listeners with HF SNHL perceived benefit and satisfaction from amplification with CIC hearing aids. Individuals with SNHL limited to the high frequencies should be considered candidates for amplification.

Rodiče na trhu práce: mezi prací a péčí

In this article the authors map the theoretical arguments on the gender dimension of the welfare state. They propose three integral dimensions of conceptualising the exercise of parenthood in Czech society in relation to gender equality in the labour market that co-determine the position of parents in the labour market. The authors analyse these dimensions using data from two representative sociological surveys. 1) The right to be a parent (to care for one's child) and the right to work: the measures provided in the Czech welfare state are based on the myth that there are two separate worlds of work and care in conformity with the gender principle, even though there are no significant differences between Czech men and women in terms of the value of work in their lives. 2) Equality or non-discrimination in parenthood: the right to work of mothers of young children is violated in the context of generally increasing gender inequalities in the labour market. 3) The opportunity to achieve a work/life balance: in Czech society flexible forms of employment are uncommon, working hours tend to have a fixed start and finish, or there is negative flexibility, which renders a work/life balance impossible. The way in which state policy defines and employers apply the conditions of parenthood in relation to the labour market and in the context of the gender structure of Czech society makes parenthood a significant handicap for the social inclusion of women who are mothers of young children in the Czech Republic.

Clinical and radiological findings in Schinzel–Giedion syndrome

The absence of a definitive genetic test for the autosomal recessive condition Schinzel-Giedion syndrome is a significant handicap to the recognition of this disorder. Radiological features have been an important aspect of many of the published cases. In a series of six cases, we now establish a consistency among many of the radiological features in affected cases which will be an important diagnostic aid in identifying future cases. This is confirmed by reference to an extensive review of previously published instances of the syndrome. Moreover, the clinical data, including previously unpublished photographs, which we detail from our patients will assist in enhanced diagnosis in the future.

Clinical profile of special children at asha centre

Background: The care of special children suffering from cerebral palsy, deaf mutism, mental retardation (MR) and post encephalitic sequelae etc. is done in the armed forces at “ASHA” centre supported by Army Wives Welfare Association (AWWA). Methods: The clinical profile and underlying etiological factors in these children were studied. Result: Out of 30 children studied, majority were males. The commonest disability was cerebral palsy, seen in 13 (43%) cases followed by mental retardation in six (20%) and post encephalitic sequlae in four (13%) cases. Convulsions were noticed in 12 (40%) cases. The delayed speech was a significant handicap observed in 27 (90%) cases. Conclusion: Among the etiological factors, natal causes and infections are leading factors in these children and there is an urgent need to strengthen the existing maternal and child health services in our country.

Factors associated with perception of singing voice handicap

This study will determine factors that influence the self-perceived handicap associated with singing voice problems. A prospective cohort. Singers presenting to a voice clinic prospectively completed the Singing Voice Handicap Index (SVHI) before evaluation and treatment. Demographic data, singing style, professional status, duration of symptoms, medical problems, and diagnosis were collected. Univariate and multivariate analysis was performed. One hundred seventy-one singers completed the SVHI. The duration of symptoms, being an amateur singer or singing teacher, benign vocal fold lesions, and neurologic voice disorders were associated with increased SVHI scores (P < 0.05, multiple linear regression). Age greater than 50 years and gospel singing were predictive of increased SVHI scores only on univariate analysis (P < 0.05, t test). Singers experience significant handicap as a result of their singing problems with certain factors associated with greater impairment. Targeting interventions at patients more severely affected may improve outcomes.

The nature and severity of voice disorders in lung cancer patients

This study examines the nature and severity of voice disorders in a set of lung cancer patients. Patients’ concern for their voice, relative to other lung cancer symptoms, will also be examined. Voice assessment included both the patients’ view (Voice Handicap Index) and expert clinicians’ perceptual rating of voice quality (GRBAS). Additionally, visual analogue scales measured how much patients were concerned by their symptoms relative to other symptoms. The Medical Research Council dyspnoea and Eastern Cooperative Oncology Group performance status scales were completed. The majority of lung cancer patients (90%) were perceptually dysphonic. However, a smaller proportion of patients (27.5%), were concerned by their voices and perceived significant handicap from it. These patients report comparable levels of voice handicap to other dysphonic patient groups in the literature.

The trait of human language: lessons from the canal boat children of England

To fully understand human language, an evolved trait that develops in the young without formal instruction, it must be possible to observe language that has not been influenced by instruction. But in modern societies, much of the language that is used, and most of the language that is measured, is confounded by literacy and academic training. This diverts empirical attention from natural habits of speech, causing theorists to miss critical features of linguistic practice. To dramatize this point, I examine data from a special population––the canal boat children of early twentieth century England––whose language developed without academic influence, but was evaluated using instruments designed primarily for academic use. These data, taken together with related research, suggest that formal instruction can convert language from a purely biological trait that was selected, to a talent that was instructed, while altering the users of language themselves. I then review research indicating that formal instruction can also mask or distort inter-sexual differences in the social applications of language, a significant handicap to evolutionary theorizing. I conclude that if biological theories of language are to succeed, they must explain the spontaneous speaking practices of naturally behaving individuals.

The Contribution of Intermittent Hypoxemia to Late Neurological Handicap in Mice with Hyperoxia-Induced Lung Injury

Bronchopulmonary dysplasia (BPD) is considered by many to be an independent risk factor for poor neurodevelopment in premature infants. However, infants with BPD experience intermittent hypoxic episodes. This study was undertaken to determine whether intermittent hypoxic stress associated with BPD contributes to the development of neurological deficit. The model of BPD was produced in neonatal mice by exposure to hyperoxia (65% O₂) for 4 weeks. Arterial blood gases, pulmonary mechanics, and histopathology were used to define the degree of lung injury. The mice were subjected to brief (10 min/day) and intermittent (10 days) hypoxic stress (8% O₂) at different stages of the development of hyperoxia-induced lung injury. At 8 weeks of life, the neurofunction was assessed by water maze and rota-rod tests followed by cerebral morphological analysis using Nissl, bromodeoxyuridine, and caspase-3 immunostaining. Data were compared to naïve normoxic littermates and those mice that were exposed only to hyperoxia or intermittent hypoxia alone. Mice with BPD subjected to brief/intermittent hypoxia demonstrated a significantly poorer navigational memory performance as compared with normoxic mice and mice with BPD that were not subjected to intermittent hypoxia. The neurofunctional handicap in these mice was associated with significantly decreased brain weight and increased cerebral expression of caspase-3. Our results suggest that intermittent hypoxia associated with hyperoxia-induced lung injury, but not lung injury itself, results in significant neurological handicap in neonatal mice with BPD.

Hearing Handicap Among Adult Residents of an Urban Homeless Shelter

This retrospective study was undertaken to identify the prevalence of hearing loss in the homeless population and its implications for vocational rehabilitation. Audiometric threshold data for adult residents of an urban homeless shelter were collected and reported. Subjects with hearing loss were identified and defined by their binaural high-frequency pure tone average (B-HFPTA). Those subjects were assigned a predicted Hearing Handicap Inventory for Adults-Screener (HHIA-S) score. Their HHIA-S scores, in turn, were used to predict hearing handicap and hearing aid candidacy. Significant hearing handicap was predicted for 35.6% of subjects; 10.6% were identified as hearing aid candidates. These findings have implications for vocational rehabilitation that have not been previously addressed.