Pallidal deep brain stimulation in primary Meige syndrome: clinical outcomes and psychiatric features.

OBJECTIVES: To study the efficacy and safety of bilateral globus pallidus internus deep brain stimulation (GPi-DBS) in refractory Meige syndrome (MS) and evaluate the psychiatric disorders before and after surgery. METHODS: Twenty-two patients with MS treated with bilateral GPi-DBS were retrospectively analysed before surgery and after continuous neurostimulation. Before surgery, patients were assessed by the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Self-Rating Depression Scale, Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) and Pittsburgh Sleep Quality Index (PQSI), which corresponded to motor symptoms, depressive state, quality of life and sleep quality, respectively. The implantable pulse generator of each patient was activated at 1 month after surgery. At 1 month, 3 months, 6 months and 12 months after continuous neurostimulation, all patients were evaluated by the same scales above. RESULTS: The BFMDRS movement scores decreased from 15.0±5.3 before surgery to 3.5±4.5 at 12 months after neurostimulation, with a mean improvement of 78% (p<0.001). The BFMDRS disability scores improved from 7.4±4.9 before surgery to 4.0±4.6 at 12 months after neurostimulation, with a mean improvement of 56% (p<0.001). The postoperative SF-36 scores had the remarkable improvement compared with baseline scores. Impaired sleep quality was found in 82% of patients and depression in 64% before surgery, which didn't neither obtained amelioration after continuous neurostimulation. CONCLUSIONS: Bilateral pallidal neurostimulation is a beneficial therapeutic option for refractory MS, which could improve the motor symptoms except for depression and sleep quality.

Prevalence of Phonological Articulation Disorders in Preschool Children in the City of Skopje.

INTRODUCTION: Speech communication is a complex process based on the function of the central nervous system, and also on the speech mechanisms conditioned and controlled by auditory perception, verbal memory, intellectual activity and peripheral speech apparatus.The aim of this study was to determine the prevalence of the most common phonological articulation disorders in preschool children, from 4-6 years old. MATERIALS AND METHODS: A cross-sectional study was conducted during 2018, on a representative sample of 550 preschool children aged 4 - 6 years, who attend preschool institutions-kindergartens in the city of Skopje. The study used standardized articulation tests: The Global Articulation Test (GAT) and the Triple Test (vocals, plasia, affricative, fricative, nasal, and lateral), and a questionnaire filled out by a social worker at the kindergarten about the socioeconomic status and the child's health condition. RESULTS: Using GAT, we found that 260 (47.3%) children didn't manifest any phonological articulation disorders, but 290 (52.7%) had disorders. The analysis of gender-based data showed a higher percentage of speech disorders in 57% of boys and 46.9% of girls. The highest percentage of speech disorder is sigmatism with 24.5% in boys and 20.4% in girls, rhotacismus was found in 17.8% in boys and 16.5% in girls. Lambdacism with 8.3% was found in boys and 4.2% in girls. A mixed form (sigmatism, rotacism, and lambdacism) was also found in 2.4% of boys and 3.5% of girls. CONCLUSIONS: The calculated prevalence of phonological articulation disorders in preschool children aged 4-6 years is 52.7%, (57.9% in boys and 46.9% in girls), or every second child in kindergarten has some form of speech disorder. These findings indicate that the treatment of speech disorders should begin in the appropriate services as soon as possible, because the early detection and treatment of speech disorders enable child's normal intellectual development. The treatment should be started in the preschool period, to allow the start of the educational process without any speech problems.

Three-dimensional ultrasound evaluation of tongue posture and its impact on articulation disorders in preschool children with anterior open bite.

Background Tongue posture plays an important role in the etiology of anterior open bite (AOB) and articulation disorders, and is crucial for AOB treatment planning and posttreatment stability. Clinical assessment of tongue posture in children is unreliable due to anatomical limitations. The aim of the study was to present functional diagnostics using three-dimensional ultrasound (3DUS) assessment of resting tongue posture in comparison to clinical assessment, and the associations between the improper tongue posture, otorhinolaryngological characteristics, and articulation disorders in preschool children with AOB. Patients and methods A cross-sectional study included 446 children, aged 3-7 years, 236 boys and 210 girls, examined by an orthodontist to detect the prevalence of AOB. The AOB was present in 32 children. The control group consisted of 43 children randomly selected from the participants with normocclusion. An orthodontist, an ear, nose and throat (ENT) specialist and a speech therapist assessed orofacial and ENT conditions, oral habits, and articulation disorders in the AOB group and control group. Tongue posture was also assessed by an experienced radiologist, using 3DUS. The 3DUS assessment of tongue posture was compared to the clinical assessment of orthodontist and ENT specialist. Results The prevalence of AOB was 7.2%. The AOB group and the control group significantly differed regarding improper tongue posture (p < 0.001), and articulation disorders (p < 0.001). In children without articulation disorders from both groups, the improper tongue posture occured less frequently than in children with articulation disorders (p < 0.001). After age adjustment, a statistical regression model showed that the children with the improper tongue posture had higher odds ratios for the presence of AOB (OR 14.63; p < 0.001) than the others. When articulation disorders were included in the model, these odds ratios for the AOB became insignificant (p = 0.177). There was a strong association between the improper tongue posture and articulation disorders (p = 0.002). The 3DUS detected the highest number of children with improper resting tongue posture, though there was no significant difference between the 3DUS and clinical assessments done by orthodontist and ENT specialist. Conclusions The 3DUS has proved to be an objective, non-invasive, radiation free method for the assessment of tongue posture and could become an important tool in functional diagnostics and early rehabilitation in preschool children with speech irregularities and irregular tongue posture and malocclusion in order to enable optimal conditions for articulation development.

Short-term adaptation to sound statistics is unimpaired in developmental dyslexia.

Developmental dyslexia is presumed to arise from phonological impairments. Accordingly, people with dyslexia show speech perception deficits taken as indication of impoverished phonological representations. However, the nature of speech perception deficits in those with dyslexia remains elusive. Specifically, there is no agreement as to whether speech perception deficits arise from speech-specific processing impairments, or from general auditory impairments that might be either specific to temporal processing or more general. Recent studies show that general auditory referents such as Long Term Average Spectrum (LTAS, the distribution of acoustic energy across the duration of a sound sequence) affect speech perception. Here we examine the impact of preceding target sounds' LTAS on phoneme categorization to assess the nature of putative general auditory impairments associated with dyslexia. Dyslexic and typical listeners categorized speech targets varying perceptually from /ga/-/da/ preceded by speech and nonspeech tone contexts varying. Results revealed a spectrally contrastive influence of the preceding context LTAS on speech categorization, with a larger magnitude effect for nonspeech compared to speech precursors. Importantly, there was no difference in the presence or magnitude of the effects across dyslexia and control groups. These results demonstrate an aspect of general auditory processing that is spared in dyslexia, available to support phonemic processing when speech is presented in context.

Prevalence of communication, swallowing and orofacial myofunctional disorders in children and adolescents at the time of admission at a cancer hospital. / Prevalência de distúrbios da comunicação, deglutição e motricidade orofacial em crianças e adolescentes no momento da matrícula em um hospital oncológico.

PURPOSE: Describe the prevalence of communication, swallowing and orofacial myofunctional disorders in a group of children and adolescents at the time of registration at a cancer hospital. METHODS: A cross-sectional study conducted with children aged ≥2 and adolescents, of both genders, admitted to the Pediatric Oncology Section of the Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) from March 2014 to April 2015 for investigation and/or treatment of solid tumors. A protocol was used to record the sociodemographic and clinical information and findings of the speech-language pathology clinical evaluation, which included aspects of the oral sensorimotor system, swallowing, speech, language, voice, and hearing. RESULTS: Eighty-eight children/adolescents (41.3%) presented some type of speech-language disorder. The most frequent speech-language disorders were orofacial myofunctional disorder, dysphonia, and language impairments, whereas the less frequent ones were dysacusis, tongue paralysis, and trismus. Site of the lesion was the clinical variable that presented statistically significant correlation with presence of speech-language disorders. CONCLUSION: High prevalence of speech-language disorders was observed in children and adolescents at the time of admission at a cancer hospital. Occurrence of speech-language disorders was higher in participants with lesions in the central nervous system and in the head and neck region.

OBJETIVO: Descrever a prevalência dos distúrbios da comunicação, deglutição e motricidade orofacial em um grupo de crianças e adolescentes, no momento da matrícula hospitalar em um instituto oncológico. MÉTODO: Estudo transversal, com a inclusão de crianças com dois anos ou mais e adolescentes de ambos os gêneros, matriculados na Seção de Oncologia Pediátrica do Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) no período de março de 2014 a abril de 2015 para investigação e/ou tratamento de tumores sólidos. Foi utilizado um protocolo para registro das informações sociodemográficas e clínicas e os achados da avaliação clínica fonoaudiológica, que contemplava aspectos do sistema sensório-motor oral, deglutição, fala, linguagem, voz e audição. RESULTADOS: Oitenta e oito crianças/adolescentes (41,3%) avaliados apresentavam algum tipo de distúrbio fonoaudiológico. As alterações fonoaudiológicas mais frequentes foram o distúrbio miofuncional orofacial, a disfonia e os transtornos de linguagem. Os menos frequentes foram a disacusia, a paralisia de língua e o trismo. A variável clínica que teve associação estatisticamente significante com a presença de alterações fonoaudiológicas foi o local da lesão. CONCLUSÃO: O estudo demonstrou uma alta prevalência de alterações fonoaudiológicas em crianças e adolescentes no momento da matrícula hospitalar em um hospital oncológico. A ocorrência de transtornos fonoaudiológicos foi maior nos grupos de participantes com lesões localizadas no sistema nervoso central e na região da cabeça e pescoço.

Prevalência de distúrbios da comunicação, deglutição e motricidade orofacial em crianças e adolescentes no momento da matrícula em um hospital oncológico / Prevalence of communication, swallowing and orofacial myofunctional disorders in children and adolescents at the time of admission at a cancer hospital

RESUMO Objetivo Descrever a prevalência dos distúrbios da comunicação, deglutição e motricidade orofacial em um grupo de crianças e adolescentes, no momento da matrícula hospitalar em um instituto oncológico. Método Estudo transversal, com a inclusão de crianças com dois anos ou mais e adolescentes de ambos os gêneros, matriculados na Seção de Oncologia Pediátrica do Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) no período de março de 2014 a abril de 2015 para investigação e/ou tratamento de tumores sólidos. Foi utilizado um protocolo para registro das informações sociodemográficas e clínicas e os achados da avaliação clínica fonoaudiológica, que contemplava aspectos do sistema sensório-motor oral, deglutição, fala, linguagem, voz e audição. Resultados Oitenta e oito crianças/adolescentes (41,3%) avaliados apresentavam algum tipo de distúrbio fonoaudiológico. As alterações fonoaudiológicas mais frequentes foram o distúrbio miofuncional orofacial, a disfonia e os transtornos de linguagem. Os menos frequentes foram a disacusia, a paralisia de língua e o trismo. A variável clínica que teve associação estatisticamente significante com a presença de alterações fonoaudiológicas foi o local da lesão. Conclusão O estudo demonstrou uma alta prevalência de alterações fonoaudiológicas em crianças e adolescentes no momento da matrícula hospitalar em um hospital oncológico. A ocorrência de transtornos fonoaudiológicos foi maior nos grupos de participantes com lesões localizadas no sistema nervoso central e na região da cabeça e pescoço.

ABSTRACT Purpose Describe the prevalence of communication, swallowing and orofacial myofunctional disorders in a group of children and adolescents at the time of registration at a cancer hospital. Methods A cross-sectional study conducted with children aged ≥2 and adolescents, of both genders, admitted to the Pediatric Oncology Section of the Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) from March 2014 to April 2015 for investigation and/or treatment of solid tumors. A protocol was used to record the sociodemographic and clinical information and findings of the speech-language pathology clinical evaluation, which included aspects of the oral sensorimotor system, swallowing, speech, language, voice, and hearing. Results Eighty-eight children/adolescents (41.3%) presented some type of speech-language disorder. The most frequent speech-language disorders were orofacial myofunctional disorder, dysphonia, and language impairments, whereas the less frequent ones were dysacusis, tongue paralysis, and trismus. Site of the lesion was the clinical variable that presented statistically significant correlation with presence of speech-language disorders. Conclusion High prevalence of speech-language disorders was observed in children and adolescents at the time of admission at a cancer hospital. Occurrence of speech-language disorders was higher in participants with lesions in the central nervous system and in the head and neck region.

It takes two: the role of family-centered practices in communication intervention / Se necesitan 2: el papel de las prácticas centradas en la familia en intervención de la comunicación

Based on an ever-growing body of research, family-centered practices are a recommended, evidence-based principle of early childhood intervention provided by speech-language pathologists and audiologists, as well as by all other disciplines involved in providing supports and services to young children with delays and disabilities and their families. Despite this, research also suggests that (1) the concept of family-centered practices is often misunderstood, and (2) a gap continues to exist between recommended and the actual use of family-centered practices across all disciplines. In this article, we describe the evidence behind family-centered practices, how and why family-centered practices have become a key aspect of evidence-based early childhood communication intervention, and the defining characteristics and components of family-centered practices. In order to accomplish this goal the authors did an extensive research review of the literature. As a result of findings from the studies revised, the role of the SLP in early childhood intervention is calling for a shift from direct work with an individual child to teaching, supporting, and building the capacity of the child's communication partners, with the ultimate goal of the child becoming more successful in how he/she participates and communicates in interactions and routines throughout the day and within natural contexts. These recommendations have been incorporated by important scientific and professional organizations such as the American Speech-Language-Hearing Association in their guidelines for providing early evidence-based communication intervention. Concluding we underlined the importance of viewing family centered practices as a capacity-building endeavor required for quality EI practices (AU)

Apoyadas en un cuerpo cada vez mayor de investigación, las prácticas centradas en la familia y basadas en la evidencia constituyen un principio de intervención recomendado para la logopedia y audiología y otras disciplinas que intervienen proporcionando apoyos y servicios a niños con retrasos y discapacidad y a sus familias. Sin embargo, la investigación sugiere que 1) el concepto de prácticas centradas en la familia es a menudo mal entendido, y 2) continúa existiendo un desfase entre las recomendaciones y el uso real de las prácticas centradas en la familia en todas las disciplinas. En este artículo se describe la evidencia detrás de las prácticas centradas en la familia, cómo y por qué estas prácticas se han convertido en un aspecto clave para la intervención en la comunicación en la primera infancia, y las características que la definen y componen. Con el fin de lograr este objetivo los autores hicieron una extensa revisión de la literatura. Como resultado de los hallazgos de los estudios revisados se está pidiendo un cambio en el papel de los logopedas de atención temprana, que va desde un trabajo directo con un niño a la enseñanza, apoyo y fortalecimiento de la capacidad de comunicación de los padres, con el objetivo final de que el niño tenga cada vez más éxito en la forma en que él/ella participa y se comunica en las interacciones y las rutinas durante el día y en los contextos naturales. Estas recomendaciones han sido incorporadas por las organizaciones científicas y profesionales más importantes, tales como la Asociación Americana de Habla, Lenguaje y Audición, quien las incluye en sus guías para proporcionar intervención temprana basada en la evidencia en la comunicación. Para concluir, se ha subrayado la importancia de considerar las prácticas centradas en la familia como un esfuerzo de construcción de capacidades requerido para una práctica de intervención temprana de calidad (AU)

Perspectiva de las prácticas de atención temprana centradas en la familia desde la logopedia / Speech pathologist perspective in family centered practices

En España, en los últimos años, la atención temprana está viviendo un proceso de transformación. Se empiezan a conocer experiencias que van haciendo la transición desde un modelo de intervención ambulatorio, clínico, centrado fundamentalmente en el niño, a uno más social, en el cual la familia y el entorno cobran especial relevancia y protagonismo. En este proceso de cambio los logopedas tienen un papel relevante. Por un lado, por el mero hecho de ser parte integrante de los equipos de intervención. Por otro, por ser los responsables de velar por el desarrollo de capacidades fundamentales en la evolución del niño como son la comunicación, el habla y el lenguaje. Por este motivo es necesario llevar a cabo una reflexión acerca de cómo se está produciendo esta transformación de los servicios, lo que implica y cómo debe ser asumida por los logopedas. En este artículo se delimita el concepto de prácticas centradas en la familia en atención temprana, se repasan los elementos clave que las han impulsado desde su aparición, así como los componentes que las caracterizan y diferencian de otras prácticas que también pueden incluir la participación familiar. A partir de todo ello, se resalta la importancia del logopeda en los equipos transdisciplinares de atención temprana que han de desarrollar las prácticas centradas en la familia (AU)

In Spain, in recent years, early intervention is undergoing a process of transformation. Experiences begin to be known that are making the transition from a model of outpatient intervention, clinical, focused primarily on the child; towards one more social, where the family and the environment are particularly relevant and prominent. In this process of change, speech therapists play an important role. On the one hand, by the mere fact of being an integral part of the intervention teams. On the other, being responsible for ensuring the development of core competencies in the development of the child as is communication, speech and language. It is therefore necessary to carry out a reflection on how this transformation is occurring in services, what it means, and how it should be assumed by speech therapists. This article defines the concept of family-centered in Early Care Practices, outlines the key elements that have driven it since its inception, and it also reviews components that characterize and differentiate it from other practices that may also include family involvement. From all this, the importance of the speech therapist in transdisciplinary early intervention teams, where they must develop family-centered practices, is highlighted (AU)

ARTICULATION OF SPEECH SOUNDS OF SERBIAN LANGUAGE IN CHILDREN AGED SIX TO EIGHT.

INTRODUCTION: Phonetic and phonological system of the healthy members of one linguistic community is fully formed around 8 yedrs of age. The auditory and articulatory habits are established with age and tend to be more difficult to be upgraded and completed later. MATERIAL AND METHODS: The research was done as a cross-sectional study, conducted at the preschool institution "Radosno detinjstvo" and primary school "Branko Radicevic" in Novi Sad. It included 66 children of both genders, aged 6 to 8. The quality of articulation was determined according to the Global Articulation Test by working with each child individually. RESULTS: In each individual vowel, plosive, nasal, lateral and fricative, the quality of articulation was statistically significantly better in the first graders compared to the preschool children (p<0.01). In each affricate, except for the sound /c/, the quality of articulation was statistically significantly better in the first graders than in the preschool children (p<0.01). The quality of articulation of all speech sounds was statistically significantly better in the first graders than in the preschool children (p<0.01). DISCUSSION AND CONCLUSION: The most common disorder of articulation is distortion, while only substitution and substitution associated with distortion are less common. Omission does not occur in children from 6 to 8 years of age. Girls have slightly better quality of articulation. The articulatory disorders are more common in preschool children than in children who are in the first grade of primary school. The most commonly mispronounced sounds belong to the group of affricates and fricatives.

ARTICULATION DISORDERS IN SERBIAN LANGUAGE IN CHILDREN WITH SPEECH PATHOLOGY.

INTRODUCTION: Articulation is the result of speech organs and it means clean, clear and distinct pronunciation of voices in words. MATERIAL AND METHODS: A prospective study included 24 children between 5 and 15 years of age, of both sexes. All children were monolingual, Serbian being their native language. The quality of articulation was tested with Triage articulation test. RESULTS: Neither omission nor distortion of plosives was observed in any of them, whereas substitution of plosives occurred in 12% of patients. Omission of affricates was not observed in any of the subjects, but substitution and distortion occurred in 29%, and 76% of subjects, respectively. Omission of fricatives was found in 29% subjects, substitution in 52%, and distortion in 82% of subjects. Omission and distortion of nasals was not recorded in any of the subjects, and substitution occurred in 6% of children. Omission of laterals was observed in 6%, substitution in 46% and distortion in 52% of subjects with articulation disorders. Discussion and CONCLUSION: Articulation disorders were observed not only in children diagnosed with dyslalia but in those with dysphasia and stuttering as well. Children with speech disorders articulate vowels best, then nasals and plosives. Articulation of fricatives and laterals was found to be most severely deviated, including all three disorders, i.e. substitution, omission and distortion. Spasms of speech muscles and vegetative reactions were also observed in this study, but only in children with stuttering.

Prevalence of dyslalias in 8 to 16 year-old students with anterior open bite in the municipality of Envigado, Colombia.

BACKGROUND: Anterior open bite AOB is the most common malocclusion associated with speech disorders and the literature has shown that problems of occlusion involve all oral functions. AOB not only produce aesthetic and occlusal problems for the patient and modifies the union of the lips, tongue, teeth, palate, palatal rugae and oropharynx, and thus affecting the ability to communicate well with their surroundings. The prevalence of AOB in children and adolescent in our population is unknown. Furthermore, the most frequent type of dyslalias in children with this malocclusion is also unknown. Therefore, the aim of the study was to describe the frequency and types of dyslalia in students between 8-16 years with AOB, as well as the difference in the types of dyslalia according to the magnitude of AOB. METHODS: A cross-sectional study was conducted. Clinical assessment of AOB in students from the municipality of Envigado, Colombia, was performed. Students from 8 to 16 years of age were examined during the second semester of 2011 and first semester of 2012. Phonoaudiological assessment was carried out in students in the mixed or permanent dentition. Exclusion criteria included children with history of systemic disease, altered skeletal development, neurological and psychiatric disorders, and residents in other departments. In addition, students undergoing orthodontic treatment at the time of evaluation or with history of previous orthodontic treatment, as well as those who did not cooperate with the oral cavity evaluation, were excluded. RESULTS: Six thousand one hundred sixty five children were evaluated. One hundred sixty six presented AOB (prevalence: 2.7 %; 95 % CI: 2.28-3.10). Thirty four students were excluded. 26.5 % of the sample presented mild AOB, 66.7 % moderate, and 6.8 % severe. Some type of dyslalia was found in 77.4 % of the students, being distortion (75.8 %) the most common. The most frequently altered phonemes were: / d / t / s / ch / ñ /. No significant association between different types of dyslalia and AOB severity (p-value = 0.974) was found. CONCLUSION: Prevalence of AOB in Envigado is low (2.7 %). Phonation alterations are very common in children with AOB (77.8 %), and distortion is the most frequent type of dyslalia (75.8 %). In order to diagnose and treat occlusal and phonetic problems, and to avoid possible recurrence, interdisciplinary approach is recommended.

Gestational syphilis and stillbirth in the Americas: a systematic review and meta-analysis / Sífilis gestacional y mortinatalidad en la Región de las Américas: una revisión sistemática y metanálisis

OBJECTIVE: To perform a systematic review and meta-analysis of reported estimates of the association between gestational syphilis (GS) and stillbirth in the Americas region. METHODS: Cochrane Library, Embase, LILACS, MEDLINE/PubMed, PLOS, and ScienceDirect were searched for original research studies quantifying the relationship between GS and stillbirth in the region. A final sample of eight studies was selected. A cumulative meta-analysis plus four subgroup meta-analyses of study data on the association between maternal syphilis during pregnancy and stillbirth were conducted. The four meta-analyses were based on 1) definition of cases and the control; 2) syphilis treatment (presence or absence, effective or ineffective); 3) definition of stillbirth as "showing no signs of life at birth"; and 4) definition of stillbirth based on low birth weight and gestational age. Random-effects metaanalyses were used to calculate pooled estimates of stillbirth with exposure to GS, and each subgroup analysis was tested for heterogeneity. RESULTS: Women with GS had increased odds of stillbirth (pooled odds ratio (OR): 6.87; 95% confidence interval: 2.93, 16.08). There was considerable heterogeneity across the eight studies (percentage of variance (I²) = 95). The funnel plot was not statistically significant, pointing to a lack of publication bias. Increased odds of stillbirth among pregnant women with syphilis were also seen in all four subgroup meta-analyses. CONCLUSIONS: GS is a major contributing factor for stillbirths in the Americas. Interventions targeting GS are highly cost-effective and, along with high-quality point-of-care testing, should be implemented across the region to help reach the goal of eliminating congenital syphilis.

OBJETIVO: Llevar a cabo una revisión sistemática y metanálisis de los cálculos notificados de la asociación entre sífilis gestacional (SG) y mortinatalidad en la Región de las Américas. MÉTODOS: Se realizó una búsqueda en Cochrane Library, Embase, LILACS, MEDLINE/PubMed, PLOS y ScienceDirect de estudios de investigación originales que cuantificaran la relación entre la SG y la mortinatalidad en la Región de las Américas. Se seleccionó una muestra final de ocho estudios. Se efectuaron un meta-nálisis acumulativo y cuatro metanálisis de subgrupo de los datos de estudio sobre la asociación entre sífilis materna durante el embarazo y mortinatalidad. Los cuatro metanálisis se basaron en 1) la definición de casos y del control; 2) el tratamiento de la sífilis (presencia o ausencia, eficaz o ineficaz); 3) la definición de mortinatalidad como "ausencia de signos de vida al nacer"; y 4) la definición de mortinatalidad basada en el bajo peso al nacer y la edad gestacional. Se emplearon metanálisis de efectos aleatorios para calcular las estimaciones acumuladas de mortinatalidad con exposición a la SG, y se comprobó la heterogeneidad de cada uno de los análisis de subgrupo. RESULTADOS: Las mujeres con SG presentaron mayores probabilidades de mortinatalidad (razón de posibilidades [OR] acumulada: 6,87; IC de 95%: 2,93-16,08). Se observó una heterogeneidad considerable en los ocho estudios (porcentaje de variación [I2] = 95). El gráfico en embudo no fue estadísticamente significativo, lo que indica una ausencia de sesgo de publicación. En los cuatro metanálisis de subgrupo, también se observaron mayores probabilidades de mortinatalidad en las mujeres embarazadas con sífilis. CONCLUSIONES: La SG es un importante factor contribuyente a la mortinatalidad en la Región de las Américas. Las intervenciones dirigidas a la SG son altamente eficaces en función de los costos y deben ejecutarse en toda la región, junto con las pruebas diagnósticas de alta calidad en el lugar de asistencia, para ayudar a alcanzar la meta de eliminación de la sífilis congénita.

Speech sound disorder at 4 years: prevalence, comorbidities, and predictors in a community cohort of children.

AIM: The epidemiology of preschool speech sound disorder is poorly understood. Our aims were to determine: the prevalence of idiopathic speech sound disorder; the comorbidity of speech sound disorder with language and pre-literacy difficulties; and the factors contributing to speech outcome at 4 years. METHOD: One thousand four hundred and ninety-four participants from an Australian longitudinal cohort completed speech, language, and pre-literacy assessments at 4 years. Prevalence of speech sound disorder (SSD) was defined by standard score performance of ≤79 on a speech assessment. Logistic regression examined predictors of SSD within four domains: child and family; parent-reported speech; cognitive-linguistic; and parent-reported motor skills. RESULTS: At 4 years the prevalence of speech disorder in an Australian cohort was 3.4%. Comorbidity with SSD was 40.8% for language disorder and 20.8% for poor pre-literacy skills. Sex, maternal vocabulary, socio-economic status, and family history of speech and language difficulties predicted SSD, as did 2-year speech, language, and motor skills. Together these variables provided good discrimination of SSD (area under the curve=0.78). INTERPRETATION: This is the first epidemiological study to demonstrate prevalence of SSD at 4 years of age that was consistent with previous clinical studies. Early detection of SSD at 4 years should focus on family variables and speech, language, and motor skills measured at 2 years.

Prevalencia de las patologías del habla, del lenguaje y de la comunicación. Un estudio a lo largo del ciclo vital / Prevalence of speech, language and comunication disorders. A study throughout the life cycle

Se presenta un estudio epidemiológico de las patologías en el ámbito de la comunicación oral y escrita —trastornos del lenguaje, habla, audición y voz— mediante el análisis de 911 historias clínicas. Los resultados obtenidos muestran que las categorías diagnósticas que se dan con mayor prevalencia son: retrasos en la adquisición del lenguaje oral, dificultades de aprendizaje del lenguaje escrito, dificultades articulatorias y alteraciones de la voz. La demanda asistencial se produce fundamentalmente hasta los 15 años, confirmándose la variación de diagnósticos en función de la edad, así como un claro predominio del sexo masculino frente al femenino en todas las patologías, a excepción de los trastornos de la voz. Así mismo, se observa que el motivo de consulta está relacionado tanto con exigencias escolares como de carácter social y/o laboral. Se destaca la importancia de realizar este tipo de investigaciones epidemiológicas, dado que permiten conocer las necesidades específicas, tanto de la población infantil como adulta, con el fin de facilitar un mejor ajuste académico y psicosocial. Además, es de esperar que pueda orientar la toma de decisiones de las diferentes Administraciones dirigida a hacer más acorde la respuesta asistencial a la demanda real (AU)

We carried out an epidemiological study of language, speech, hearing and voice disorders by means of an analysis of 911 clinical histories. Both written and oral language were included. The most frequent diagnostic categories were as follows: Delays in Oral Language Acquisition, Difficulties in Learning Written Language, Delays in Speech and Voice Disorders (Dysphonia). Healthcare demand is produced mainly up to the age of 15 years. Diagnoses varies according to age. All disorders except voice disorders affect males more than females. Consultations are motivated as much by school requirements as by social and/or workplace requirements. The evidence highlights the importance of conducting epidemiological research on prevalence, which would allow specific needs to be determined during both childhood and adulthood. In turn, this would facilitate better academic and psychosocial adjustment. In addition, such knowledge could guide government decisions aimed at bringing healthcare response into line with current demand (AU)

Articulación compensatoria en niños chilenos con fisura labiopalatina / Compensatory articulation in cleft lip and palate Chilean children

La articulación compensatoria es una alteración específica del paciente con fisura labiopalatina en la cual este modifica fonemas orales de alta presión produciéndolos cerca de las cuerdas vocales. Afecta la inteligibilidad y si no se resuelve conlleva múltiples problemas. Diversos factores se han relacionado con su instauración. Aún se discute su origen fonético-fonológico. La prevención y detección temprana resultan cruciales. Objetivo: determinar la frecuencia de articulación compensatoria en menores chilenos (nacidos entre junio de 2005 y junio de 2007) con diagnóstico de fisura con compromiso velar operados en la Fundación Gantz y relacionarla con factores intervinientes. Metodología: Revisión de fichas clínicas, aplicación de exclusiones y relación de datos y análisis estadístico de algunos de ellos. Resultados: 53 por ciento de los pacientes entre cinco y siete años presentaron articulación compensatoria (29 de 55). Este grupo fue intervenido del paladar en promedio a los doce meses e ingresó a fonoaudiología a los diez meses, presentando un 83 por ciento de asociación con dificultades de lenguaje. Solo un 32 por ciento de ellos presentó insuficiencia velofaríngea. Conclusiones: se encontró una alta frecuencia de articulación compensatoria que inicialmente se relacionaría con la fisura palatina e insuficiencia velofaríngea. Entre los aspectos críticos, se destaca la edad de cierre del velo, la edad del niño y los objetivos de la estimulación prelingüística y la asociación con retrasos/trastornos de lenguaje, principalmente del nivel fonológico.

Compensatory articulation is a specific alteration of cleft-palate patients in which the production of high pressure phonemes is changed: they are produced near the vocal cords. This change affects intelligibility and when not solved it causes several problems. Different factors have been linked to this phenomenon. Its phonetic-phonological cause is still discussed and both the prevention and early detection are vital. Objective: To determine the frequency of compensatory articulation in Chilean children born between June 2005 and June 2007 with diagnosis of cleft velum and operated in Gantz Foundation and relate it to the factors that intervene it. Method: The medical records of the children were reviewed and exclusion criteria were applied. Data gathered from the medical records were statistically analysed. Results: 53 percent of the children aged between 5 and 7 presented compensatory articulation. These children were operated on at the age of about 12 months and had had in speech therapy at the age of 10 months. They presented an 83 percent of association with language difficulties. Only 32 percent of the children showed velopharyngeal insufficiency. Conclusions: It was found a high compensatory articulation frequency, which would be initially related to the cleft palate and velopharyngeal insufficiency. Among the critical aspects, it can be highlighted the age of closure of the velum, age and the pre-linguistic stimulation objectives, and association with delays/language impairment, mainly, at the phonological level.

Development of reading and phonological skills of children at family risk for dyslexia: a longitudinal analysis from kindergarten to sixth grade.

The main focus of this article is to develop a better understanding of the developmental trajectories of literacy and phonological skills within Dutch-speaking children. Children at high and low risk for dyslexia were followed and compared at four different moments: kindergarten and first, third and sixth grades. Three groups were then compared: (1) dyslexic readers; (2) normal readers at high risk for dyslexia; and (3) normal readers at low risk for dyslexia. Children diagnosed with dyslexia scored lower than high-risk normal readers on phonological awareness (PA), rapid automatized naming (RAN), verbal short-term memory and literacy skills. Normal readers at high risk scored between both groups, confirming that dyslexia is to be considered as a continuum rather than an all-or-none condition. Growth analyses showed that the three groups evolved similarly on all measures except for phoneme deletion and literacy measures. Finally, solely PA and RAN explained a significant amount of variance in the evolution of reading skills.

Prevalence and types of articulation errors in Saudi Arabic-speaking children with repaired cleft lip and palate.

OBJECTIVES: The purpose of this study was to assess prevalence and types of consonant production errors and phonological processes in Saudi Arabic-speaking children with repaired cleft lip and palate, and to determine the relationship between frequency of errors on one hand and the type of the cleft. Possible relationship between age, gender and frequency of errors was also investigated. METHODS: Eighty Saudi children with repaired cleft lip and palate aged 6-15 years (mean 6.7 years), underwent speech, language, and hearing evaluation. The diagnosis of articulation deficits was based on the results of an Arabic articulation test. Phonological processes were reported based on the productivity scale of a minimum 20% of occurrence. Diagnosis of nasality was based on a 5-point scale that reflects severity from 0 through 4. All participants underwent intraoral examination, informal language assessment, and hearing evaluation to assess their speech and language abilities. The Chi-Square test for independence was used to analyze the results of consonant production as a function of type of CLP and age. RESULTS: Out of 80 participants with CLP, 21 participants had normal articulation and resonance, 59 of participants (74%) showed speech abnormalities. Twenty-one of these 59 participants showed only articulation errors; 17 showed only hypernasality; and 21 showed both articulation and resonance deficits. CAs were observed in 20 participant. The productive phonological processes were consonant backing, final consonant deletion, gliding, and stopping. At age 6 and older, 37% of participants had persisting hearing loss. CONCLUSIONS: Despite early age at time of surgery (mean 6.7 months) for the studied CLP participants in this study, a substantial number of them demonstrated articulation errors and hypernasality. The results showed desirable findings for diverse languages. It is especially interesting to consider the prevalence of glottal stops and pharyngeal fricatives in a population for whom these sound are phonemic.

Speech abilities in preschool children with speech sound disorder with and without co-occurring language impairment.

PURPOSE: The authors compared preschool children with co-occurring speech sound disorder (SSD) and language impairment (LI) to children with SSD only in their numbers and types of speech sound errors. METHOD: In this post hoc quasi-experimental study, independent samples t tests were used to compare the groups in the standard score from different tests of articulation/phonology, percent consonants correct, and the number of omission, substitution, distortion, typical, and atypical error patterns used in the production of different wordlists that had similar levels of phonetic and structural complexity. RESULTS: In comparison with children with SSD only, children with SSD and LI used similar numbers but different types of errors, including more omission patterns ( p < .001, d = 1.55) and fewer distortion patterns ( p = .022, d = 1.03). There were no significant differences in substitution, typical, and atypical error pattern use. CONCLUSIONS: Frequent omission error pattern use may reflect a more compromised linguistic system characterized by absent phonological representations for target sounds (see Shriberg et al., 2005). Research is required to examine the diagnostic potential of early frequent omission error pattern use in predicting later diagnoses of co-occurring SSD and LI and/or reading problems.

Análisis de la fluencia lectora en pacientes con la enfermedad de Alzheimer y controles asintomáticos / Oral reading fluency analysis in patients with Alzheimer disease and asymptomatic control subjects

Introducción: Numerosos estudios han puesto de manifiesto que la alteración en la capacidad comunicativa es uno de los síntomas característicos de la enfermedad de Alzheimer (EA). Objetivo: Estudiar la organización temporal del habla en una tarea de lectura en un grupo de pacientes con EA y otro de controles sanos, utilizando un procedimiento semiautomático, así como valorar su capacidad para discriminar entre ambos grupos. Sujetos y método: Se aplicó una prueba de lectura a 70 sujetos: 35 con EA y otros tantos controles. Antes del registro del habla, los sujetos fueron sometidos a una batería de pruebas neuropsicológicas. Los grupos no diferían en edad, sexo o nivel de estudios. Resultados: Todas las variables analizadas se mostraron alteradas en el grupo con EA. Los resultados señalan que la lectura de los pacientes con EA se caracteriza por una reducida velocidad de elocución y articulación, una baja efectividad del tiempo de fonación, así como en un incremento del número y la proporción de las pausas. Los algoritmos de procesamiento de la señal aplicados a las grabaciones de fluidez lectora demostraron su capacidad para discriminar entre ambos grupos con una precisión del 80% (especificidad 74,2%; sensibilidad 77,1%) mediante la velocidad de elocución. Conclusión: El análisis de la fluidez de lectura oral puede representar una herramienta potencial para el análisis objetivo y la cuantificación de los déficits del lenguaje en la EA (AU)

Introduction: Many studies highlight that an impaired ability to communicate is one of the key clinical features of Alzheimer disease (AD). Objective: To study temporal organisation of speech in an oral reading task in patients with AD and in matched healthy controls using a semi-automatic method, and evaluate that method's ability to discriminate between the 2 groups. Subjects and methods: A test with an oral reading task was administered to 70 subjects, comprising 35 AD patients and 35 controls. Before speech samples were recorded, participants completed a battery of neuropsychological tests. There were no differences between groups with regard to age, sex, or educational level. Results: All of the study variables showed impairment in the AD group. According to the results, AD patients’ oral reading was marked by reduced speech and articulation rates, low effectiveness of phonation time, and increases in the number and proportion of pauses. Signal processing algorithms applied to reading fluency recordings were shown to be capable of differentiating between AD patients and controls with an accuracy of 80% (specificity 74.2%, sensitivity 77.1%) based on speech rate. Conclusion: Analysis of oral reading fluency may be useful as a tool for the objective study and quantification of speech deficits in AD (AU)

Relationships among cognitive deficits and component skills of reading in younger and older students with developmental dyslexia.

Processing speed deficits along with phonological awareness deficits have been identified as risk factors for dyslexia. This study was designed to examine the behavioral profiles of two groups, a younger (6-8 years) and an older (10-15 years) group of dyslexic children for the purposes of (1) evaluating the degree to which phonological awareness and processing speed deficits occur in the two developmental cohorts; (2) determining the strength of relationships between the groups' respective mean scores on cognitive tasks of phonological awareness and processing speed and their scores on component skills of reading; and (3) evaluating the degree to which phonological awareness and processing speed serve as concurrent predictors of component reading skills for each group. The mean scaled scores for both groups were similar on all but one processing speed task. The older group was significantly more depressed on a visual matching test of attention, scanning, and speed. Correlations between reading skills and the cognitive constructs were very similar for both age-groups. Neither of the two phonological awareness tasks correlated with either of the two processing speed tasks or with any of the three measures of reading. One of the two processing speed measures served as a concurrent predictor of word- and text-level reading in the younger, however, only the rapid naming measure functioned as a concurrent predictor of word reading in the older group. Conversely, phonological processing measures did not serve as concurrent predictors for word-level or text-level reading in either of the groups. Descriptive analyses of individual subjects' deficits in the domains of phonological awareness and processing speed revealed that (1) both linguistic and nonlinguistic processing speed deficits in the younger dyslexic children occurred at higher rates than deficits in phonological awareness and (2) cognitive deficits within and across these two domains were greater in the older dyslexic children. Our findings underscore the importance of using rapid naming measures when testing school-age children suspected of having a reading disability and suggest that processing speed measures that do not reply on verbal responses may serve as predictors of reading disability in young children prior to their development of naming automaticity.