Screen11: validating a screening instrument for voice disorders in accordance with the COSMIN framework.

PURPOSE: Although numerous patient-reported outcome measures have been developed and validated to quantify the impact of voice problems on different aspects of life, to our knowledge no screening instrument exists that specifically captures voice disorders in a retrospective fashion. The aim of the present study was to examine the psychometric properties and diagnostic validity of a retrospective voice screening method, Screen11, according to the COSMIN framework for health-related, patient-reported outcome measures. The items in Screen11 have been used to establish the prevalence of voice disorders in both general and occupation-specific populations in the Nordic countries. However, the instrument has not been validated. METHODS: The voice patient group (n = 54) in this study comprised of patients from the Turku University Central Hospital phoniatric outpatient clinic seeking help for their voice problems. For these voice patients, we recruited voice-healthy controls (n = 61) who matched in terms of gender, age, and occupation. The participants responded to the Screen11 questionnaire along with the VHI and the VAPP. RESULTS: The results of the initial exploratory factor analysis showed that all the Screen11 items loaded on a common underlying latent factor. Furthermore, Screen11 had high internal consistency (α = .93) and correlated sufficiently with other voice questionnaires. CONCLUSIONS: The results indicate that Screen11, which screens for possible voice disorders at an early stage, was successfully validated. With respect to its diagnostic validity, the Screen11 sum score is preferable. A threshold of ≥ 15 should be used for differentiating patients with possible voice disorders from those with healthy voices.

Strategy use and its evolvement in word list learning: a replication study.

Spontaneous strategy employment is important for memory performance, but systematic research on strategy use and within-task evolvement is limited. This online study aimed to replicate three main findings by Waris and colleagues in Quarterly Journal of Experimental Psychology (2021): in word-list learning, spontaneous strategy use (1) predicts better task performance, (2) stabilizes along the task, and (3) increases during the first two task blocks. We administered a shortened version of their original real-word list-learning task to 209 neurotypical adults. Their first finding was partly replicated: manipulation strategies (grouping, visualization, association, narrative, other strategy) but not maintenance strategies (rehearsal/repetition, selective focus) were associated with superior word recall. The second finding on the decrease in strategy changers over task blocks was replicated. The third finding turned out to be misguided: neither our nor the original study showed task-initial increase in strategy use in the real-word learning condition. Our results confirm the important role of spontaneous strategies in understanding memory performance and the existence of task-initial dynamics in strategy employment. They support the general conclusions by Waris and colleagues: task demands can trigger strategy use even in a familiar task like learning a list of common words, and evolution of strategy use during a memory task reflects cognitive skill learning.

Self-reported strategy use in working memory tasks.

Mnemonic strategies can facilitate working memory performance, but our knowledge on strategy use as a function of task characteristics remains limited. We examined self-reported strategy use in several working memory tasks with pretest data from two large-scale online training experiments. A three-level measure of strategy sophistication (no strategy, maintenance, manipulation) was coded based on participants' open-ended strategy reports. A considerable portion of participants reported some memory strategy, and strategy sophistication was associated with objective task performance. We found a consistent effect of stimulus type: verbal stimuli (letters or digits) elicited higher strategy sophistication than nonverbal ones (colours or spatial positions). In contrast, the association between task paradigm and strategy sophistication was less consistent in the two experiments. The present results highlight the importance of self-generated strategies in understanding individual differences in working memory performance and the role of stimulus characteristics as one of the task-related determinants of strategy use.

Spontaneous memory strategies in a videogame simulating everyday memory tasks.

People can use different internal strategies to manage their daily tasks, but systematic research on these strategies and their significance for actual performance is still quite sparse. Here we examined self-reported internal strategy use with a 10-block version of the videogame EPELI (Executive Performance in Everyday LIving) in a group of 202 neurotypical adults of 18-50 years of age. In the game, participants perform lists of everyday tasks from memory while navigating in a virtual apartment. Open-ended strategy reports were collected after each EPELI task block, and for comparison also after an EPELI Instruction Recall task and a Word List Learning task assessing episodic memory. On average, 45% of the participants reported using some strategy in EPELI, the most common types being grouping (e.g., performing the tasks room by room), utilising a familiar action schema, and condensing information (e.g., memorising only keywords). Our pre-registered hypothesis on the beneficial effect of self-initiated strategy use gained support, as strategy users showed better performance on EPELI as compared with no strategy users. One of the strategies, grouping, was identified as a clearly effective strategy type. Block-by-block transitions suggested gradual stabilisation of strategy use over the 10 EPELI blocks. The proneness to use strategies showed a weak but reliable association between EPELI and Word List Learning. Overall, the present results highlight the importance of internal strategy use for understanding individual differences in memory performance, as well as the potential benefit for internal strategy employment when faced with everyday memory tasks.

Structural Stigma and Sexual Minority Victimization Across 28 Countries: The Moderating Role of Gender, Gender Nonconformity, and Socioeconomic Status.

OBJECTIVE: Country-level structural stigma toward sexual minority individuals (i.e., discriminatory laws and policies and prejudicial attitudes) shows robust associations with sexual minority individuals' mental health and individual-level stigma processes, such as identity concealment. Whether structural stigma is also associated with interpersonal-level stigma processes, such as victimization, is rarely studied. Whether the association between structural stigma and sexual minority individuals' interpersonal mistreatment varies across gender, gender nonconformity, and socioeconomic status also remains to be determined. METHODS: In 2012, sexual minority adults (n = 86,308) living in 28 European countries responded to questions assessing past-12-month victimization experiences (i.e., physical or sexual attack or threat of violence). Country-level structural stigma was objectively indexed as an aggregate of national laws, policies, and population attitudes negatively affecting sexual minority individuals. RESULTS: Country-level structural stigma was significantly associated with victimization (adjusted odds ratios [AOR]: 1.13, 95% confidence interval [CI]: 1.04-1.22; p = .004). However, this effect varied by gender, gender nonconformity, and socioeconomic status. For both sexual minority men and women, gender nonconformity and lower socioeconomic status were associated with increased risk of victimization. The strongest association between country-level stigma and victimization was found among gender nonconforming men with lower socioeconomic status (AOR: 1.32, 95% CI: 1.14-1.52; p < .001). CONCLUSIONS: A much larger proportion of sexual minorities living in higher stigma countries reports victimization than those living in lower stigma countries. At the same time, the association between country-level structural stigma and victimization is most heavily concentrated among gender nonconforming men with lower socioeconomic status.

Stimulus novelty, task demands, and strategy use in episodic memory.

Cognitive task performance is a dynamic process that evolves over time, starting from the first encounters with a task. An important aspect of these task dynamics is the employment of strategies to support successful performance and task acquisition. Focusing on episodic memory performance, we: (1) tested two hypotheses on the effects of novelty and task difficulty on strategy use, (2) replicated our previous results regarding strategy use in a novel memory task, and (3) evaluated whether repeated open-ended strategy queries affect task performance and/or strategy use. The present pre-registered online study comprised 161 adult participants who were recruited through the Prolific crowdsourcing platform. We employed two separate 5-block list learning tasks, one with 10 pseudowords and the other with 18 common nouns, and collected recall performance and strategy reports for each block. Using Bayesian linear mixed effects models, the present findings (1) provide some support for the hypothesis that task-initial strategy development is not triggered only by task novelty, but can appear also in a familiar, moderately demanding task; (2) replicate earlier findings from an adaptive working memory task indicating strategy use from the beginning of a task, associations between strategy use and objective task performance, and only modest agreement between open-ended versus list-based strategy reports; and (3) indicate that repeated open-ended strategy reports do not affect objective recall. We conclude that strategy use is an important aspect of memory performance right from the start of a task, and it undergoes development at the initial stages depending on task characteristics. In a larger perspective, the present results concur with the views of skill learning and adaptivity in cognitive task performance.

Spontaneous strategy use during a working memory updating task.

Cognitive skill learning postulates strategy generation and implementation when people learn to perform new tasks. Here we followed self-reported strategy use and objective performance in a working memory (WM) updating task to reveal strategy development that should take place when faced with this novel task. In two pre-registered online experiments with healthy adults, we examined short-term strategy acquisition in a ca 20-30-minute adaptive n-back WM task with 15 task blocks by collecting participants' strategy reports after each block. Experiment 1 showed that (a) about half of the participants reported using a strategy already during the very first task block, (b) changes in selected strategy were most common during the initial task blocks, and (c) more elaborated strategy descriptions predicted better task performance. Experiment 2 mostly replicated these findings, and it additionally showed that compared to open-ended questions, the use of repeated list-based strategy queries influenced subsequent strategy use and task performance, and also indicated higher rates of strategy implementation and strategy change during the task. Strategy use was also a significant predictor of n-back performance, albeit some of the variance it explained was shared with verbal productivity that was measured with a picture description task. The present results concur with the cognitive skill learning perspective and highlight the dynamics of carrying out a demanding cognitive task.

Beginning of the Pandemic: COVID-19-Elicited Anxiety as a Predictor of Working Memory Performance.

Increasing evidence indicates that the coronavirus disease 2019 (COVID-19) pandemic is associated with adverse psychological effects, including heightened levels of anxiety. This study examined whether COVID-19-related anxiety levels during the early stage of the pandemic predicted demanding working memory (WM) updating performance. Altogether, 201 healthy adults (age range, 18-50) mostly from North America and the British Isles were recruited to this study via the crowdsourcing site www.prolific.co. The results showed that higher levels of COVID-19-related anxiety during the first weeks of the pandemic outbreak were associated with poorer WM performance as measured by the n-back paradigm. Critically, the unique role of COVID-19-related anxiety on WM could not be explained by demographic factors, or other psychological factors such as state and trait anxiety or fluid intelligence. Moreover, across three assessment points spanning 5-6 weeks, COVID-19-related anxiety levels tended to decrease over time. This pattern of results may reflect an initial psychological "shock wave" of the pandemic, the cognitive effects of which may linger for some time, albeit the initial anxiety associated with the pandemic would change with habituation and increasing information. Our results contribute to the understanding of cognitive-affective reactions to a major disaster.

Disentangling the Role of Working Memory in Parkinson's Disease.

Working memory (WM) represents a core cognitive function with a major striatal contribution, and thus WM deficits, commonly observed in Parkinson's disease (PD), could also relate to many other problems in PD patients. Our online study aimed to determine the subdomains of WM that are particularly affected in PD and to clarify the links between WM and everyday cognitive deficits, other executive functions, psychiatric and PD symptoms, as well as early cognitive impairment. Fifty-two mild-to-moderate PD patients and 54 healthy controls performed seven WM tasks tapping selective updating, continuous monitoring, or maintenance of currently active information. Self-ratings of everyday cognition, depression, and apathy symptoms, as well as screenings of global cognitive impairment, were also collected. The data were analyzed using structural equation modeling. Of the three WM domains, only selective updating was directly predictive of PD group membership. More widespread WM deficits were observed only in relation to global cognitive impairment in PD patients. Self-rated everyday cognition or psychiatric symptoms were not linked to WM performance but correlated with each other. Our findings suggest that WM has a rather limited role in the clinical manifestation of PD. Nevertheless, due to its elementary link to striatal function, the updating component of WM could be a candidate for a cognitive marker of PD also in patients who are otherwise cognitively well-preserved.

Do Individual Differences in Cognition and Personality Predict Retrieval Practice Activities on MOOCs?

Online quizzes building upon the principles of retrieval practice can have beneficial effects on learning, especially long-term retention. However, it is unexplored how interindividual differences in relevant background characteristics relate to retrieval practice activities in e-learning. Thus, this study sought to probe for this research question on a massive open online course (MOOC) platform where students have the optional possibility to quiz themselves on the to-be-learned materials. Altogether 105 students were assessed with a cognitive task tapping on reasoning, and two self-assessed personality measures capturing need for cognition (NFC), and grittiness (GRIT-S). Between-group analyses revealed that cognitively high performing individuals were more likely to use the optional quizzes on the platform. Moreover, within-group analyses (n = 56) including those students using the optional quizzes on the platform showed that reasoning significantly predicted quiz performance, and quiz processing speed. NFC and GRIT-S were unrelated to each of the aforementioned retrieval practice activities.

Strategy mediation in working memory training in younger and older adults.

Working memory (WM) training with the N-Back task has been argued to improve cognitive capacity and general cognitive abilities (the Capacity Hypothesis of training), although several studies have shown little or no evidence for such improvements beyond tasks that are very similar to the trained task. Laine et al. demonstrated that instructing young adult participants to use a specific visualisation strategy for N-back training resulted in clear, generalised benefits from only 30 min of training (Strategy Mediation Hypothesis of training). Here, we report a systematic replication and extension of the Laine et al. study, by administering 60 younger and 60 older participants a set of WM tasks before and after a 30-min N-back training session. Half the participants were instructed to use a visualisation strategy, the others received no instruction. The pre-post test battery encompassed a criterion task (digit N-back), two untrained tasks N-back tasks (letters and colours), and three structurally different WM tasks. The instructed visualisation strategy significantly boosted at least some measures of N-back performance in participants of both age groups, although the strategy generally appeared more difficult to implement and less beneficial for older adults. However, the strategy did not improve performance on structurally different WM tasks. We also found significant associations between N-back performance and the type and level of detail of self-generated strategies in the uninstructed participants, as well as age group differences in reported strategy types. WM performance appeared to partly reflect the application of strategies, and Strategy Mediation should be considered to understand the mechanisms of WM training. Claims of efficient training should demonstrate useful improvement beyond task-specific strategies.

Training working memory updating in Parkinson's disease: A randomised controlled trial.

Frontostriatal dysfunction in Parkinson's disease (PD) increases the risk for working memory (WM) impairment and depression, calling for counteractive measures. Computerised cognitive rehabilitation is a promising option, but targeted training protocols are lacking and lab-based training can be demanding due to the repeated visits. This study tested the feasibility and efficacy of home-based computerised training targeting mainly WM updating in PD. Fifty-two cognitively well-preserved PD patients were randomised to a WM training group and an active control group for five weeks of training (three 30-min sessions per week). WM training included three computerised adaptive WM tasks (two updating, one maintenance). The outcomes were examined pre- and post-training with trained and untrained WM tasks, tasks tapping other cognitive domains, and self-ratings of executive functioning and depression. Home-based training was feasible for the patients. The training group improved particularly on the updating training tasks, and showed posttest improvement on untrained WM tasks structurally similar to the trained ones. Moreover, their depression scores decreased compared to the controls. Our study indicates that patients with mild-to-moderate PD can self-administer home-based computerised WM training, and that they yield a similar transfer pattern to untrained WM tasks as has been observed in healthy older adults.

The early effects of external and internal strategies on working memory updating training.

The mechanisms underlying working memory training remain unclear, but one possibility is that the typically limited transfer effects of this training reflect adoption of successful task-specific strategies. Our pre-registered randomized controlled trial (N = 116) studied the early effects of externally given vs. internally generated strategies in an updating task (n-back) over a 5-day period with a single 30-minute training session. Three groups were employed: n-back training with strategy instruction (n = 40), n-back training without strategy instruction (n = 37), and passive controls (n = 39). We found that both external and internal strategy use was associated with significantly higher posttest performance on the trained n-back task, and that training with n-back strategy instruction yielded positive transfer on untrained n-back tasks, resembling the transfer pattern typically seen after the ordinary uninstructed 4-6-week working memory training. In the uninstructed participants, the level of detail and type of internally generated n-back strategies at posttest was significantly related to their posttest n-back performance. Our results support the view that adoption of task-specific strategies plays an important role in working memory training outcomes, and that strategy-based effects are apparent right at the start of training.