Analysis of a 3-months measles outbreak in western Liguria, Italy: Are hospital safe and healthcare workers reliable?

BACKGROUND: From January 2017 to June 2018 more than 7000 measles cases were reported in Italy, of which more than 400 among unvaccinated healthcare workers. We described a measles outbreak occurred in Western Liguria, Italy, characterized by a high involvement of healthcare workers and hospital visitors. METHODS: Suspected measles cases and data regarding vaccination status and clinical management of the patients were collected by reviewing 3 different surveillance systems: the routine mandatory notification system, the National Integrated Surveillance System for Measles and Rubella and the regional reference laboratory for measles diagnosis. RESULTS: Thirty-six cases were reported, with a median age of 31 years and >95% in unvaccinated subjects. One death occurred, 15 cases were hospitalized. Hospital transmission was confirmed or suspected in 12 cases; amongst this cases, 5 were healthcare workers (a gynaecologist, an obstetric nurse, a radiologist, a physiotherapist and a nurse working in an infectious disease ward), all certified unvaccinated. Phylogenetic analysis revealed the circulation of a single B3 genotype variant. CONCLUSIONS: Our experience highlighted the key role of nosocomial transmission and the need for targeted strategies, in particular (i) to implement a measles catch-up immunization campaign in susceptible groups, especially in healthcare workers, (ii) to intensify the check of immunisation status of healthcare workers and to offer vaccination for those who need it, (iii) to improve timeliness and completeness of surveillance systems. Efforts are needed to guarantee the safety of the hospital and the reliability of the healthcare workers. Only high vaccination coverage among HCWs can prevent the diffusion of measles in the hospital setting.

Effectiveness of the trivalent MF59 adjuvated influenza vaccine in preventing hospitalization due to influenza B and A(H1N1)pdm09 viruses in the elderly in Italy, 2017 - 2018 season.

Background: Evidence on influenza vaccine effectiveness (VE) in preventing mortality and morbidity in the elderly is weak. Our aim was to measure the VE against severe outcomes in the elderly. Methods: We conducted a multicentre hospital-based test-negative design (TND) case-control study, during the 2017/18 season, in four Italian hospitals. The study population included individuals aged ≥65 years hospitalized with Severe Acute Respiratory Infections (SARI). Patients were classified as cases and controls based on the results of the PCR influenza testing. We estimated VE by virus subtypes and specific VE for the trivalent adjuvanted vaccine (TIVadj). Results: 502 patients with SARI were enrolled: 118 (23.5%) tested positive (cases) and 384 (76.5%) tested negative (controls) for influenza. The adjusted VE of 48.5% for all vaccines was comparable to the adjusted VE for the TIVadj vaccine (48.3%). Adjusted VE for the TIVadj vaccine was 67.5% for A(H1N1)pdm09 and 44.5% for B viruses. Conclusion: We show a moderate adjusted VE of the TIVadj against all viruses, a good adjusted VE against A(H1N1)pdm09 strains and a moderate adjusted VE against B strains, despite a mismatch between the B circulating lineage and the lineage included in the vaccine. This is likely due to the cross-protection among B strains induced by the TIVadj in elderly patients.

Research about suppression effect and auditory processing in individuals who stutter. / Pesquisa do efeito de supressão e do processamento auditivo em indivíduos que gaguejam.

PURPOSE: To verify the auditory processing abilities and occurrence of the suppression effect of Otoacoustic Emissions (OAE) in individuals who stutter. METHODS: The study sample comprised 15 adult individuals who stutter, aged 18-40 years, with stuttering severity ranging from mild to severe, paired according to gender, age, and schooling with individuals without speech complaint or disorder. All participants underwent conventional clinical evaluation, specific stuttering assessment, and basic (audiometry, imitanciometry, and measurement of acoustic reflexes) and specific (auditory processing evaluation and measurement of suppression effect of OAEs) audiological assessments. Data were statistically analyzed with application of the Fisher's Exact Test and the Mann-Whitney Test. RESULTS: The group of individuals who stutter (Study Group - SG) presented higher incidence of auditory processing disorders. The auditory processing assessments used to differentiate the groups of stutterers and non-stutterers (Control Group - CG) were the Nonverbal Dichotic Test and the Frequency Pattern Test. The SG presented higher incidence of absence of suppression effect of OAEs, indicating abnormal functioning of the efferent medial olivocochlear system. CONCLUSION: The auditory processing abilities investigated in this study differentiate individuals who stutter from non-stutterers, with greater changes in the first. Functioning of the efferent medial olivocochlear system showed a deficit in stutterers, indicating difficulties in auditory discrimination, especially in the presence of noise.

Pesquisa do efeito de supressão e do processamento auditivo em indivíduos que gaguejam / Research about suppression effect and auditory processing in individuals who stutter

RESUMO Objetivo Verificar as habilidades do processamento auditivo e a ocorrência do efeito de supressão das emissões otoacústicas em indivíduos com gagueira. Método Participaram 15 adultos com gagueira, de 18 a 40 anos, com grau de severidade variando de leve a severo, pareados por gênero, faixa etária e escolaridade com indivíduos sem queixa ou alteração de comunicação. Todos passaram por avaliação fonoaudiológica convencional, avaliação específica da gagueira, avaliação audiológica básica (audiometria, imitanciomentria e pesquisa dos reflexos acústicos) e específica (avaliação do processamento auditivo e pesquisa do efeito de supressão das emissões otoacústicas). Os dados foram submetidos à análise estatística, com aplicação do Teste Exato de Fisher e do Teste de Mann-Whitney. Resultados O grupo de gagos apresentou maior ocorrência de alterações de processamento auditivo. Os testes do processamento auditivo que diferenciaram os grupos de gagos e não gagos foram o Teste Dicótico não Verbal e o Teste Padrão de Frequência. O grupo de gagos apresentou maior ocorrência de ausência do efeito de supressão das emissões otoacústicas, indicando anormalidade do funcionamento do sistema eferente olivococlear medial. Conclusão: As habilidades do processamento auditivo investigadas neste estudo diferem indivíduos gagos e não gagos, com maior alteração nos gagos. O funcionamento do sistema eferente olivococlear medial mostrou-se deficitário nos indivíduos gagos, indicando dificuldade de discriminação auditiva, principalmente na presença de ruído.

ABSTRACT Purpose To verify the auditory processing abilities and occurrence of the suppression effect of Otoacoustic Emissions (OAE) in individuals who stutter. Methods The study sample comprised 15 adult individuals who stutter, aged 18-40 years, with stuttering severity ranging from mild to severe, paired according to gender, age, and schooling with individuals without speech complaint or disorder. All participants underwent conventional clinical evaluation, specific stuttering assessment, and basic (audiometry, imitanciometry, and measurement of acoustic reflexes) and specific (auditory processing evaluation and measurement of suppression effect of OAEs) audiological assessments. Data were statistically analyzed with application of the Fisher's Exact Test and the Mann-Whitney Test. Results The group of individuals who stutter (Study Group – SG) presented higher incidence of auditory processing disorders. The auditory processing assessments used to differentiate the groups of stutterers and non-stutterers (Control Group – CG) were the Nonverbal Dichotic Test and the Frequency Pattern Test. The SG presented higher incidence of absence of suppression effect of OAEs, indicating abnormal functioning of the efferent medial olivocochlear system. Conclusion The auditory processing abilities investigated in this study differentiate individuals who stutter from non-stutterers, with greater changes in the first. Functioning of the efferent medial olivocochlear system showed a deficit in stutterers, indicating difficulties in auditory discrimination, especially in the presence of noise.

Habilidades fonológicas em crianças com gagueira / Phonological abilities in children with stuttering

Objetivo : estudar as características de desenvolvimento fonológico de crianças gagas e não-gagas, e investigar possível associação entre a presença de gagueira e a de processos fonológicos.Métodos : foram selecionadas 20 crianças (10 gagas), do sexo feminino e masculino, entre 04 a 08 anos de idade, pareadas por sexo e idade. As crianças do grupo de estudo tiveram diagnóstico de Gagueira e foram classificadas quanto a gravidade da patologia por meio do Stuttering Severity Instrument-3. Foram excluídas aquelas que apresentaram evidência de surdez, doenças neurológicas e/ou psiquiátricas. As crianças de ambos os grupos foram submetidas à avaliação fonoaudiológica e à aplicação das provas de Fonologia do Teste de Linguagem Infantil- ABFW.Resultados : no grupo de estudo foram observados 60% de processos fonológicos não esperados para a idade, enquanto que no grupo controle foram apenas 10%. As diferenças entre os grupos não foram estatisticamente significantes quanto à incidência de processos fonológicos. Há indícios de que o grupo de crianças gagas esteja mais predisposto à presença de pelo menos um processo fonológico.Conclusão : conclui-se que a metodologia utilizada na investigação dos processos fonológicos foi eficaz, mas devido à amostra reduzida não foi possível o aprofundamento da questão, ou seja, verificar se há uma diferenciação no desempenho de crianças gagas quanto aos processos fonológicos quando comparadas com as não-gagas.

Purpose : to study the phonological development characteristics of stuttering and non-stuttering children, and to investigate possible association between stuttering and phonological processes.Methods : 20 children (10 stuttering), female and male, between 4 to 8 years old, matched by gender and age. Children in the experimental group diagnosed with Stuttering and classified to severity of disease through the Stuttering Severity Instrument-3. Those who had evidence of deafness, neurological diseases and/ or psychiatric disorders were excluded. Children in both groups underwent speech and phonology evaluations by ABFW – Child Language Test.Results : 60% of phonological processes not expected for age were observed in the experimental group. Moreover, in the control group were only 10%. Differences between groups were not statistically significant on the incidence of phonological processes. There is evidence that the group of stuttering children is more likely the presence of at least one phonological process.Conclusion : the methodology applied in the investigation of phonological processes was effective, but due to small sample not been possible to develop the issue and verify if there is a difference in performance as the stuttering children phonological processes when compared to non-stuttering.

Comparison of pausing behavior in children who stutter and children who have Asperger syndrome.

PURPOSE: The objective of this research was to compare the number and types of grammatical and non-grammatical silent pauses presented by stutterers and subjects with Asperger syndrome in their narratives. METHOD: Ten children who stutter and four participants with Asperger syndrome (mean ages of both groups 10 years) were assessed at the Speech and Language Disorders Department of the Universidade Federal de São Paulo/Brasil. They narrated a story based on a pre-selected sequence of pictures. They were filmed and their productions were analyzed using version 5.0.47 of Praat (http://www.fon.hum.uva.nl/praat/download_win.html). Silent intervals in the speech that ranged from 0.25 to 4s were considered pauses. The pauses were classified as grammatical and non-grammatical, depending on the words that preceded and followed them. RESULTS: Both groups presented grammatical and non-grammatical pauses and the former predominated. The children with Asperger syndrome produced a greater number of pauses than the stutterers. EDUCATIONAL OBJECTIVES: The reader will be able to: (1) characterize the use of pauses in the oral narrative; (2) distinguish a grammatical pause from a non-grammatical pause regarding the use and function; (3) recognize the pattern of pause found in the two populations.

Duração do onset vocálico da fala fluente de gagos / Voice onset duration of stutterers' fluent speech

OBJETIVO: Comparar a duração da emissão da fala fluente de adultos com diferentes graus de gagueira em tarefa de repetição de frases. MÉTODOS: Seis adultos gagos, com grau de severidade variando de leve a severo, foram pareados com indivíduos sem nenhuma alteração de linguagem. O corpus foi composto pelas palavras cavalo, pipoca e tapete, inseridas em frases-veículo Digo......baixinho. As frases foram emitidas pela pesquisadora e repetidas três vezes pelos indivíduos. A fala foi gravada diretamente em computador, tendo sido desconsideradas as emissões disfluentes. Posteriormente, foram realizadas as medidas de duração acústica das amostras, através do programa Praat 4.3. As frases foram divididas em segmentos delimitados por dois onsets vocálicos consecutivos. Os dados foram tabulados e analisados estatisticamente através do Teste-t e da ANOVA (Analysis of variance). RESULTADOS: Os gagos levaram mais tempo para emitir todas as unidades estudadas, com exceção da unidade [ib]. Na comparação entre os diferentes graus de severidade da gagueira, verificou-se que os gagos leves e moderados apresentam medidas de duração semelhantes e diferentes da dos gagos severos. CONCLUSÃO: Os parâmetros acústicos de duração delimitados pela medida dos onset vocálicos demonstraram que os gagos diferem dos não-gagos, além destas medidas diferenciarem os graus de severidade da gagueira.

PURPOSE: To compare utterance duration of fluent speech of adults with different degrees of stuttering on a phrase repetition task. METHODS: Six adult stutterers, with severity degrees varying from mild to severe, were matched to individuals with no communication problems. The corpus was constituted by the words horse, popcorn and carpet introduced into the vehicle-phrase I say......quietly. Each phrase was uttered by the researcher and repeated aloud three times by the participants. The speech sample was recorded on a computer, and phrases containing disfluencies were rejected. After that, measurements of the acoustic duration of each sample were carried out using the software Praat 4.3. The phrases were divided into segments delimited by two consecutive voice onsets. Data were tabulated and statistically analyzed using t-test and Analysis of Variance (ANOVA). RESULTS: Stutterers took longer to produce all the units analyzed, except for the unit [ib]. The comparison among different stuttering severities showed that mild and moderate stutterers had similar duration measures, which was significantly different from severe stutterers. CONCLUSION: The analysis of acoustic duration parameters of units delimited by consecutive voice onsets demonstrated that stutterers differed from non-stutterers; moreover, these measures were able to differentiate among stuttering severity degrees.

Speech rate according to stuttering severity.

BACKGROUND: Speech duration has been the subject of acoustic studies due to its relationship with rhythm and speech rate. The speech analysis of stutterers has revealed data which often differs from that found in non-stutterers. These differences most likely stem from timing disturbances related to speech motor control. OBJECTIVE: To compare the speech rates of individuals presenting different stuttering severity levels. METHOD: Participants were 6 adult stutterers with the following severity levels: 2 with mild stuttering; 2 with moderate stuttering and 2 with severe stuttering. The words 'cavalo' (horse), 'pipoca' (popcorn) and 'tapete' (carpet) were introduced in a carrier phrase, 'Digo......baixinho' (Say ......in a low voice). Each phrase was uttered by the researcher and then repeated aloud 3 times by the participants while being recorded in a computer. Utterances containing speech disruptions were discarded. Subsequently, timing measurements were made, using the Praat 4.2 software. Utterances were divided into segments delimited by two consecutive voice onsets, and speech rate was then calculated (number of vowel-vowel segments divided by the total sum of duration of the segments). The data were analyzed statistically using ANOVA. RESULTS: The group with mild/moderate stuttering presented higher and similar speech rates, differing statistically from the group with severe stuttering, therefore indicating that the higher the severity of stuttering, the lower the speech rate. This difference seems to be related to difficulties in motor programming, affecting mainly the rhythm and the timing of discourse. CONCLUSIONS: The rate of fluent speech during a repetition task differentiated the studied individuals according to the severity of stuttering.

Taxa de elocução de fala segundo a gravidade da gagueira / Speech rate according to stuttering severity

INTRODUÇÃO: o aspecto da duração da fala tem sido investigado acusticamente por estar relacionado ao ritmo e taxa de elocução. A análise da fala de gagos tem revelado dados, por vezes, diferentes daqueles encontrados nos não-gagos, devido às perturbações temporais no controle motor da fala do gago. OBJETIVO: comparar as taxas de elocução de indivíduos com diferentes gravidades de gagueira. MÉTODO: foram selecionados seis adultos gagos, tendo dois deles gagueira de grau leve, dois de grau moderado e dois grave. As palavras "cavalo", "pipoca" e "tapete" foram introduzidas na frase-veículo "Digo...... baixinho". Cada frase foi emitida pela pesquisadora e repetida em voz alta três vezes pelos indivíduos, com gravação em computador. Foram desconsideradas as frases em que ocorreram disfluências. Posteriormente, foram realizadas as medidas de duração, no programa Praat 4.2. As frases foram divididas em segmentos delimitados por dois onsets vocálicos consecutivos, e então, foram calculadas as taxas de elocução (número de segmentos vogal-vogal dividido pela soma total da duração dos segmentos). Os dados foram analisados através de ANOVA. RESULTADOS: o grupo com gagueira de grau leve e moderado apresentou taxas de elocução semelhantes e maiores, diferenciando-se estatisticamente do grupo com gagueira grave, indicando que quanto maior a gravidade, menor a taxa de elocução. A diferença parece dever-se às dificuldades na programação motora que afetam principalmente o ritmo e a temporalidade do discurso. CONCLUSÕES: a taxa de elocução de fala fluente, durante tarefa de repetição, diferenciou os indivíduos estudados segundo a gravidade da gagueira

BACKGROUND: speech duration has been the subject of acoustic studies due to its relationship with rhythm and speech rate. The speech analysis of stutterers has revealed data which often differs from that found in non-stutterers. These differences most likely stem from timing disturbances related to speech motor control. OBJECTIVE: to compare the speech rates of individuals presenting different stuttering severity levels. METHOD: participants were 6 adult stutterers with the following severity levels: 2 with mild stuttering; 2 with moderate stuttering and 2 with severe stuttering. The words "cavalo" (horse), "pipoca" (popcorn) and "tapete" (carpet) were introduced in a carrier phrase, "Digo......baixinho" (Say ......in a low voice). Each phrase was uttered by the researcher and then repeated aloud 3 times by the participants while being recorded in a computer. Utterances containing speech disruptions were discarded. Subsequently, timing measurements were made, using the Praat 4.2 software. Utterances were divided into segments delimited by two consecutive voice onsets, and speech rate was then calculated (number of vowel-vowel segments divided by the total sum of duration of the segments). The data were analyzed statistically using ANOVA. RESULTS: the group with mild/moderate stuttering presented higher and similar speech rates, differing statistically from the group with severe stuttering, therefore indicating that the higher the severity of stuttering, the lower the speech rate. This difference seems to be related to difficulties in motor programming, affecting mainly the rhythm and the timing of discourse. CONCLUSIONS: the rate of fluent speech during a repetition task differentiated the studied individuals according to the severity of stuttering

Caracterização dos aspectos de duração da fala de indivíduos fluentes e gagos / Characterization of duration aspects of the speech of stutterers and non-stutterers

Caracterizar os aspectos de duração da emissão de fonemas plosivos e de logatomos do Português Brasileiro em uns indivíduos gagos e não gagos. Métodos: participaram do estudo quatro indivíduos com diagnóstico de gagueira e quatro indivíduos fluentes. Para a composição do corpus da pesquisa, selecionamos logatomos do tipo CVCV (consoante-vogal-consoante-vogal), sendo a consoante um dos seis fonemas plosivos do Português brasileiro e a vogal, a central [a] (Ex: kaka). A palavra-estímulo foi inserida em uma frase-veículo do tipo: “Digo_____baixinho”. Cada frase foi lida pelos sujeitos em voz alta cinco vezes em ordem aleatória em um total de 30 estímulos gravados em fita cassete. As medidas acústicas de duração foram realizadas com base em critérios formulados a partir de forma da onda e do espectrograma do sinal de fala digitalizado, sendo o aspecto visual o principal critério para o corte entre os segmentos acústicos, e o auditivo usado apenas para confirmação. A análise acústica dos dados foi realizada através do programa Praat, versão 4.2. Resultados: os indivíduos gagos apresentaram maior duração na emissão de todos os fonemas e logatomos, com exceção do fonema /t/ e do logatomo /tata/ que não apresentaram significância estatística. Conclusão: os indivíduos gagos, mesmo na fala fluente, apresentaram maior duração na produção dos fonemas e logatomos, quando comparados aos indivíduos do grupo controle.

Perda auditiva progressiva em freqüências altas decorrentes de meningite bacteriana - raciocínio clínico fonoaudiológico / Progressive hearing loss in high frequencies after bacterial meningitis: decision making process in speech, language and hearing science

A meningite bacteriana é uma das principais causas de deficiência neurossensorial no período pré-lingüístico. Ainda não se sabe ao certo suas características quanto ao tempo entre a manifestação da doença e a instalação dos sintomas. O presente estudo visa relatar um caso de uma criança do sexo masculino, oito anos, vitimada de meningite aos oito meses. A constatação da deficiência auditiva ocorreu aos sete anos, sendo que entre os três anos e esta última idade existe a hipótese da instalação da perda auditiva. Após realizar avaliação fonoaudiológica foram levantadas hipóteses diagnósticas de manifestação, estas foram discutidas e teoricamente fundamentadas. Ao longo do artigo há questões em aberto norteando a leitura do texto, bem como a linha de raciocínio clínico fonoaudiológico seguido pelas autoras.

Fatores de risco auditivo em indivíduos gagos / Auditory risks in stutters

O propósito deste estudo é verificar a presença de indicadores auditivos de risco em uma população de gagos. Para tanto, selecionamos protocolos de avaliação fonoaudiológica de indivívuos diagnosticados como gagos (49 indivíduos de ambos os sexos) no Ambulatório de Avaliação e diagnóstico Fonoaudiólogico da Disciplina dos Distúrbios da Comunicação Humana da UNIFESP, avaliados entre 1996 e 2002. Para caracterização dos antecedentes auditivos de risco utilizamos a Lista de checagem de Problemas Auditivos proposta por Fisher. Os resultados obtidos mostraram a presença de indicadores auditivos de risco em 47 (95,92%) indivíduos da população estudada. A análise dos resultados confirmou a influência destes fatores no desenvolvimento da gagueira. Deste modo, consideramos de extrema importância a detecção de fatores de riscos auditivos para melhor compreensão da natureza destes processos e a gagueira.