Behavioural, emotional and social development of children who stutter

Purpose: Developmental stuttering may be associated with diminished psychological well-being which has been documented from late childhood onwards. It is important to establish the point at which behavioural, emotional and social problems emerge in children who stutter. Methods: The study used data from the Millennium Cohort Study, whose initial cohort comprised 18,818 children. Analysis involved data collected when the cohort members were 3, 5 and 11 years old. The association between parent-reported stuttering and performance on the Strengths and Difficulties Questionnaire was determined in regression analyses which controlled for cohort members’ sex, verbal and non-verbal abilities, maternal education, and family economic status. Results: Compared with typically-developing children, those who stuttered had significantly higher Total Difficulties scores at all three ages; in addition, scores on all of the sub-scales for 5-year-olds who stuttered indicated poorer development than their peers, and 11-year-olds who stuttered had poorer development than peers in all areas except prosocial skills. At ages 5 and 11, those who stuttered were more likely than peers to have scores indicating cause for clinical concern in almost all areas. Conclusion: Children who stutter may begin to show impaired behavioural, emotional and social development as early as age 3, and these difficulties are well established in older children who stutter. Parents and practitioners need to be aware of the possibility of these difficulties and intervention needs to be provided in a timely fashion to such difficulties in childhood and to prevent the potential development of serious mental health difficulties later in life

Lattice width directions and Minkowski's 3^d-theorem

We show that the number of lattice directions in which a d-dimensional convex body in R^d has minimum width is at most 3^d-1, with equality only for the regular cross-polytope. This is deduced from a sharpened version of the 3^d-theorem due to Hermann Minkowski (22 June 1864--12 January 1909), for which we provide two independent proofs.Comment: 1 figure, 10 page

Exercise intervention in pregnancy: A feasibility study in Thailand

Background: Exercise during pregnancy can increase physical fitness, decrease risk of non-communicable diseases (NCDs) and control gestational weight gain (GWG) including association to enhance psychological well-being. Pregnant women generally have lower exercise behaviour than in the pre-pregnancy period. Objectives: The objectives were to determine the acceptability of a programme based on Thai Government guidance for exercise in pregnancy, and assess preliminary effects of the exercise programme. Methods: A total of 61 women between 12-16 weeks gestation were randomly allocated to the 10 week exercise intervention (n = 31) or control group (n = 30). Baseline measures were collected before intervention and preliminary effects data after completion of intervention and two weeks after expected date of delivery (EDD). Results: Analysis of Covariance (ANCOVA) showed the exercise group had lower gestational weight gain than control group after controlling for maternal age, pre-pregnancy body mass index (BMI), gestational age, and baby birth weight (p <.001). The study indicated significant increases over time in physical activity after controlling for maternal age, and pre-pregnancy BMI (p <.001). Conclusion: The study demonstrated feasibility of conducting a larger RCT with an intervention to improve exercise behaviour in pregnant women

Stuttering, alcohol consumption and smoking

Purpose: Limited research has been published regarding the association between stuttering and substance use. An earlier study provided no evidence for such an association, but the authors called for further research to be conducted using a community sample. The present study used data from a community sample to investigate whether an association between stuttering and alcohol consumption or regular smoking exists in late adolescence and adulthood. Methods: Regression analyses were carried out on data from a birth cohort study, the National Child Development Study (NCDS), whose initial cohort included 18,558 participants who have since been followed up until age 55. In the analyses, the main predictor variable was parent-reported stuttering at age 16. Parental socio-economic group, cohort member’s sex and childhood behavioural problems were also included. The outcome variables related to alcohol consumption and smoking habits at ages 16, 23, 33, 41, 46, 50 and 55. Results: No significant association was found between stuttering and alcohol consumption or stuttering and smoking at any of the ages. It was speculated that the absence of significant associations might be due to avoidance of social situations on the part of many of the participants who stutter, or adoption of alternative coping strategies. Conclusion: Because of the association between anxiety and substance use, individuals who stutter and are anxious might be found to drink or smoke excessively, but as a group, people who stutter are not more likely than those who do not to have high levels of consumption of alcohol or nicotine

Cognitive bias modification for social anxiety in adults who stutter: a feasibility study of a randomised controlled trial

Objective: To determine the feasibility and acceptability of a computerised treatment for social anxiety disorder for adults who stutter including identification of recruitment, retention and completion rates, large cost drivers and selection of most appropriate outcome measure(s) to inform the design of a future definitive trial. Design: Two-group parallel design (treatment vs placebo), double-blinded feasibility study. Participants: 31 adults who stutter. Intervention: Attention training via an online probe detection task in which the stimuli were images of faces displaying neutral and disgusted expressions. Main outcome measures Psychological measures: Structured Clinical Interview Global Assessment of Functioning score; Liebowitz Social Anxiety Scale; Social Phobia and Anxiety Inventory; State-Trait Anxiety Inventory; Unhelpful Thoughts and Beliefs about Stuttering. Speech fluency: percent syllables stuttered. Economic evaluation: resource use questionnaire; EuroQol three-dimension questionnaire. Acceptability: Likert Scale questionnaire of experience of trial, acceptability of the intervention and randomisation procedure. Results: Feasibility of recruitment strategy was demonstrated. Participant feedback indicated that the intervention and definitive trial, including randomisation, would be acceptable to adults who stutter. Of the 31 participants who were randomised, 25 provided data at all three data collection points. Conclusions: The feasibility study informed components of the intervention. Modifications to the design are needed before a definitive trial can be undertaken. Trial registration number I SRCTN55065978

A prospective cohort study assessing clinical referral management & workforce allocation within a UK regional medical genetics service

Abstract Ensuring patient access to genomic information in the face of increasing demand requires clinicians to develop innovative ways of working. This paper presents the first empirical prospective observational cohort study of UK multi-disciplinary genetic service delivery. It describes and explores collaborative working practices including the utilisation and role of clinical geneticists and non-medical genetic counsellors. Six hundred and fifty new patients referred to a regional genetics service were tracked through 850 clinical contacts until discharge. Referral decisions regarding allocation of lead health professional assigned to the case were monitored, including the use of initial clinical contact guidelines. Significant differences were found in the cases led by genetic counsellors and those led by clinical geneticists. Around a sixth, 16.8% (109/650) of referrals were dealt with by a letter back to the referrer or re-directed to another service provider and 14.8% (80/541) of the remaining patients chose not to schedule an appointment. Of the remaining 461 patients, genetic counsellors were allocated as lead health professional for 46.2% (213/461). A further 61 patients did not attend. Of those who did, 86% (345/400) were discharged after one or two appointments. Genetic counsellors contributed to 95% (784/825) of total patient contacts. They provided 93.7% (395/432) of initial contacts and 26.8% (106/395) of patients were discharged at that point. The information from this study informed a planned service re-design. More research is needed to assess the effectiveness and efficiency of different models of collaborative multi-disciplinary working within genetics services. Keywords (MeSH terms) Genetic Services, Genetic Counseling, Interdisciplinary Communication, Cohort Studies, Delivery of Healthcare, Referral and Consultation

A Solar Prominence Model

We propose a model for solar prominences based on converging flow observed in the chromosphere and photosphere. In contrast with existing models we do not apply a shearing motion along the neutral line. Instead we assume that bipolar loops approaching on different sides of the neutral line have a non-vanishing magnetic helicity of the SAME sign. In the converging flow the individual loops kink and develop a skew. For loops of the same helicity the skew is in the same sense. As a result the `chiral' symmetry of an aligned distribution of loops is broken and the reconnecting loop system forms a filament with the observed magnetic orientation and anchoring of the barbs in regions of parasytic polarity. The filament consists of a number of individual strands of coaxial coronal electric currents each of which is current neutralised. The filament material is suspended in dips in the magnetic field and the transverse field direction coincides with that in the Kuperus-Raadu model. Above the filament a cavity forms with an overlying arcade consisting of the outer portions of the reconnected loops.Comment: 17 pages, Late

Anxiety and cognitive bias in children and young people who stutter

Psychologists recognise various forms of anxiety, such as generalized anxiety disorder, separation anxiety and social phobia. People who stutter are at risk of elevated levels of anxiety, especially social phobia. Recent research has suggested that anxiety may be caused and maintained by cognitive biases such as preferentially allocating attention towards threat stimuli. These biases can be re-trained using cognitive bias modification with resulting improvements in levels of anxiety. In the present study, we measured different forms of anxiety and attentional bias for faces among 8-18 year olds attending the Michael Palin Centre for treatment for stuttering. The clients and their parent(s) completed the child and parent versions, respectively, of the Screen for Childhood Anxiety Related Emotional Disorders (SCARED), which provides an overall anxiety score and sub-scores, with clinical cut-offs, for generalized anxiety disorder, separation anxiety, social phobia, school avoidance and panic. The clients also performed a computerised measure of attentional bias for faces, using schematic stimuli. Levels of anxiety were higher than in the general population, and prevalence increased with age. There was a significant correlation between SCARED scores produced by clients and their parents. Socially anxious participants showed a bias towards sad faces

Incidence of Hospitalization for Heart Failure and Case-Fatality Among 3.25 Million People With and Without Diabetes Mellitus

Background: Recent clinical trials of new glucose-lowering treatments have drawn attention to the importance of hospitalisation for heart failure as a complication of diabetes. However, the epidemiology is not well described, particularly for type 1 diabetes. We examined the incidence and case-fatality of heart failure hospitalisations in the entire population aged 30 and older resident in Scotland during 2004 to 2013. Methods: Date and type of diabetes diagnosis were linked to heart failure hospitalisations and deaths using the national Scottish registers. Incidence rates and case-fatality were estimated in regression models (quasi-Poisson and logistic regression respectively). All estimates are adjusted for age, sex, socio-economic status and calendar-year. Results: Over the 10-year period of the study, among 3.25 million people there were 91,429, 22,959 and 1,313 incident heart failure events among those without diabetes, with type 2, and type 1 diabetes respectively. The crude incidence rates of heart failure hospitalisation were therefore 2.4, 12.4 and 5.6 per 1000 person-years for these three groups. Heart failure hospitalisation incidence was higher in people with diabetes, regardless of type, than in people without. Relative differences were smallest for older men, in whom the difference was nonetheless large (men aged 80, rate ratio 1.78; 95% CI 1.45 to 2.19). Rates declined similarly, by 0.2% per calendar-year, in people with type 2 diabetes and without diabetes. Rates fell faster, however, in those with type 1 diabetes (2.2% per calendar-year, RR for type 1/calendar-year interaction 0.978; 95% CI 0.959 to 0.998). 30-day case-fatality was similar among people with type 2 diabetes and without diabetes, but was higher in type 1 diabetes for men (OR 0.96; 95% CI 0.95 to 0.96) and women (OR 0.98; 95% CI 0.97 to 0.98). Case-fatality declined over time for all groups (3.3% per calendar-year, OR per calendar-year 0.967; 95% CI 0.961 to 0.973). Conclusions: Despite falling incidence, particularly in type 1 diabetes, heart failure remains around 2-fold higher than in people without diabetes, with higher case-fatality in those with type 1 diabetes. These findings support the view that heart failure is an under-recognised and important complication in diabetes, particularly for type 1 disease