Verbal Autopsy: Reliability and Validity Estimates for Causes of Death in the Golestan Cohort Study in Iran

BACKGROUND: Verbal autopsy (VA) is one method to obtain valid estimates of causes of death in the absence of valid medical records. We tested the reliability and validity of a VA questionnaire developed for a cohort study in Golestan Province in northeastern Iran. METHOD: A modified version of the WHO adult verbal autopsy was used to assess the cause of death in the first 219 Golestan Cohort Study (GCS) subjects who died. The GCS cause of death was determined by two internists who independently reviewed all available medical records. Two other internists ("reviewers") independently reviewed only the VA answers and classified the cause of death into one of nine general categories; they repeated this evaluation one month later. The reliability of the VA was measured by calculating intra-reviewer and inter-reviewer kappa statistics. The validity of the VA was measured using the GCS cause of death as the gold standard. RESULTS: VA showed both good validity (sensitivity, specificity, PPV, and NPV all above 0.81) and reliability (kappa>0.75) in determining the general cause of death independent of sex and place of residence. The overall multi-rater agreement across four reviews was 0.84 (95%CI: 0.78-0.89). The results for identifying specific cancer deaths were also promising, especially for upper GI cancers (kappa = 0.95). The multi-rater agreement in cancer subgroup was 0.93 (95%CI: 0.85-0.99). CONCLUSIONS: VA seems to have good reliability and validity for determining the cause of death in a large-scale adult follow up study in a predominantly rural area of a middle-income country

Frequency Distribution of Hearing Disorders Among the Student of Public Elementary School in Neishaboor

Objectives: determining the frequency distribution of hearing disorders among the student of public elementary school by Otoscopy, Puretone Audiometry, Impedance Audiometiy and questionnaires. Methods and Materials: This study was carried out in a cross - sectional descriptive survey - on 1200 students (600 girls and 600 boys) among the student of primary school of Neishabbor, academic year 1376-77 Results: 1- Otoscopy examination; abnormal conditions of external ear canal was found in 14.1% of cases; mostly impacted ceruman (13.6%); Abnormal conditions of tympanic membrane (0.4%) and foreign body 0.16%. Abnormal conditions of external ear canal was statistically unmeaningful. (P V=0 .8) 2- Impedance Audiometiy: 5. 75% Abnormal tympanograms were observed, mostly type C (3.15%) 3- Pure Tone Audiometry: An overall 5.5% hearing loss was found in this population including 3% bilateral and 1.25% unilateral hearing loss. Only conductive hearing loss was found in this population (2.7% in right ear and 3.5% in left ear), PV=0.9. Hearing loss observed mostly in girls but the difference was slight. Family background showed no effects on the hearing disorders.9.8% of cases were in need of medical care and 0.3% were in need of rehabilitation services. Only 28.8% of parents, 36.3% of teachers and 40.9% of afflicted students were aware of the problem

A Comparison of Thresholds in Auditory Steady - State Response with Pure Tone Audiometry in Subjects with Normal Hearing and Those with Mild and Moderate Sensorineural Hearing los

Background and Aim: Among all auditory assessment tools, auditory steady state response (ASSR) is a modern test. Modulation frequency for this test is usually 80 Hz. The purpose of this study, was to examined adult subjects with 40 Hz and 80 Hz ASSR and compare the results.Materials and Methods: Thirty adult (60 ears) were evaluated by ASSR and PTA test, Results were divided into three groups: normal hearing, mild and moderate sensorineural hearing loss. Results: In all groups, forty hertz ASSR thresholds were relatively closer to behavioral threshold than those of 80 Hz ASSR(p<0.05). Besides, the more severe hearing loss, the lower the difference between those two thresholds. Correlation coefficients were also higher in 40 Hz ASSR(p<0.05). Conclusion: Frequency modulation thresholds with 40 Hz are more likely to be closer to the behavioral thresholds. Moreover, it has better results than the thresholds with 80 Hz

Effect Evaluation of Utterance Length on Speech Dysfluency in Stuttering and Nonstuttering Persian-Speaker Children

Background and Aim: The correlation of stuttering and different linguistic factors is assessed in many studies. The obtained results can pave the way to reach a better understanding of stuttering, as well as finding more appropriate treatments. This study investigates the effect of utterance length on speech dysfluency comparing stuttering Persian(Farsi) -speaking children and nonstuttering ones.Methods: Ten stuttering and ten nonstuttering Persian-speaking children between 4 and 6 years of age, matched by age and gender where included in this cross-sectional study. All individuals were investigated by ten sets of simple and complex sentences. Morphemes were added one by one to sentences in each set in order to assess the impact of utterance length on dysfluency. Data analysis was performed using SPSS software. Results: In practicing ten sets of sentences, the speech dysfluency shows significant enhance with increase of utterance length in both stuttering and nonstuttering children (p=0.001). Furthermore, while comparing two groups of simple and complex sentences, significant increase of speech dysfluency was observed by length enhance of utterance, in both stuttering and nonstuttering children (p<0.05). The comparison of stuttering and nonstuttering children showed significant difference between the two groups as well (p=0.001). Conclusions: The results of this study show that increase in utterance length in both simple and complex sentences lead to increase in dysfluency in stuttering and nonstuttering children. Stuttering children indicated more dysfluency than nonstuttering ones

Survey of Saccadic Parameters Using Videonystagmography in Patients with Idiopathic Parkinson's Disease and Normal Subjects

Background and Aim: Patients with Parkinson’s disease manifest oculomotor abnormalities. This is the consequence of basal ganglia impairment. The most common abnormalities include increased saccade latency, hypometric saccades and decreased saccade velocity. The purpose of this study was comparison of saccadic parameters using videonystagmography in patients with idiopathic Parkinson’s disease and normal subjects.Materials and Methods: In this cross sectional study, saccadic movements were investigated in thirty patients with idiopathic Parkinson’s disease and thirty age matched subjects were 35-70 years old. Saccade latency, velocity and accuracy were quantitatively analyzed. Results: Results of this study indicated increased saccade latency, reduction of saccade velocity and accuracy in patients with Parkinson’s disease(P<0.001).Conclusion: This study showed that patients with Parkinson’s disease manifest saccadic deficits. This suggests dopaminergic control of these ocular movements

Determination of Mismatch Negativity in 4 to 9-Year-Old Children by Tonal Stimulation

Background and Aim: Mismatch negativity (MMN) is one of the auditory evoked potentials that occurs about 100-250 ms after stimulus onset. The MMN waveform is elicited by a discriminable change in a sequence of repetitive homogenous stimuli. This change can be in intensity level, frequency, or duration of auditory stimuli. The purpose of this study was to obtain MMN waveform using tonal stimuli and to investigate its changes during changes in age. Materials and Methods: The study was prescriptive-analytic cross-sectional. The participants were sixty children aged 4 to 9 year. The stimuli were at 80 dB pe SPL. A 1000Hz tone and a 1500Hz tone were used as standard and deviant stimuli, respectively. Probability of deviant stimuli was 20%. Trials were recorded using surface electrode placed at four locations on the head. Results: The MMN waveform does not exist in 22.5% of the children. Also, determining of MMN peak in 22.5% was not exactly possible. In other subjects, a significant negative correlation was observed between latency of MMN and age, but not for age and amplitude for this negativity. Conclusion: This study confirms that the MMN may not be seen in normal people. Also there are maturational changes in MMN waveform

The Persian Vowel Formants in Normal, Moderate and Severe Hearing Impaired Students Age 7-9 Years in Isfahan

Background and Aim: Nowadays, auditory perception is not a complete method to assess vowels quality and we need to use more objective instruments.In this study we want to determine and compare the persian vowels formants in normal and hearing Impaired students in 7ـ9 year old children of Isfahan.Materials and Methods: This cross sectional study was performed on 64 normal and hearing impaired students. Background information was by interview and then, vowel production test was performed. First three formants of each vowel were obtained and recorded by speech studio soft ware and Dr. Speech device Data were compared between groups. Results: Mean F1 and F2, and F2/F1 and F3/F1 ratio of Persian vowels between these three studied groups were different significantly. Mean F3 of /o/, /e/ and /a/ in all groups was different significantly. Although we could not find such a significant differences for /u/, /i/ and /æ/ between these groups(p<0.05).Conclusion: The most important difference between normal and hearing impaired children is their vowel Space, and we found that, the more sever the hearing impairment is, the closer vowel space will be seen. The hearing impaired children rely mostly on their proprioceptive sense because of their hearing deficiency and it causes less movement of the tongue, so they usually substitute vowels which have similar F1 and F2

Comparison of Short Tone Burst-Evoked and Click-Evoked Vestibular Myogenic Potentials in Healthy Adults

Background and Aim: Vestibular evoked myogenic potential (VEMPs) is one of the clinical tools to evaluate vestibular function. The VEMPs can be recorded from sternocleidomastoid muscle by auditory stimulation with various sound stimuli and are thought to have saccular origin. The aim of this study was to compare the VEMP responses evoked by short (500 Hz) tone burst (STB) with those evoked by click stimuli in healthy young individuals.Materials and Methods: Thirty healthy volunteers (15 males, 15 females) with ages of 18 to 30 years were enrolled in this study. Subjects were instructed to sit on a chair and rotate their head to the opposite side of the recording muscle. The VEMPs was recorded using 500 Hz STB and then click sound stimuli to each ear. The p13 and n23 latencies, p13-n23 peak-to-peak amplitude and VEMPs thresholds were obtained for further analysis.Results: The VEMP responses were present in all subjects for STB and ware not recorded in one subject for click. The latencies of p13 and n23 of STB-VEMP were significantly longer, and the p13-n23 amplitudes were significantly greater for STB-VEMP (p 0.05).Conclusion: The VEMP responses were significantly different between the stimuli of STB and click, and the norms of different stimuli should be established for clinical interpretations. According to these data, we recommend STB stimuli in comparison with clicks for clinical diagnosis