Development and Psychometric Evaluation of Speech and Language Pathology Evidence-Based Practice Questionnaire (SLP-EBPQ)

Background: To date, there is no specific instrument to measure evidence-based practice (EBP) in Speech and Language Pathology (SLP). Therefore, it is essential to design a valid and reliable instrument in the EBP field for SLP. Aim: To develop a speech and language pathology evidence-based practice questionnaire (SLP-EBPQ) for the Iranian context and evaluate its psychometric properties. Method: This study was performed in two stages, first development of the instrument based on the literature review and semi-structured interviews with 14 speech and language pathologists and second the evaluation of the psychometric properties. Content validity of the instrument was assessed by SLP experts who were experienced in the field of EBP. Furthermore, exploratory factor analysis (EFA) and comparison of the recognized groups were conducted to determine the initial construct validity of the SLP-EBPQ. The reliability of the questionnaire was determined using internal consistency and test-retest reliability. A total of 280 speech and language pathologists completed SLP-EBPQ to evaluate construct validity and internal consistency. Furthermore, 30 speech and language pathologists completed the SLP-EBPQ after 2 weeks for test-retest reliability. Results: The developed instrument was a questionnaire with 77 items. The results of EFA demonstrated that the SLP-EBPQ contained nine factors with appropriate internal consistency (α=0.635-0.885). Moreover, the Intra-class Correlation coefficient of the factors was (r=0.814-0.966) in the test-retest reliability. Implications for Practice: The SLP-EBPQ is a valid and reliable instrument and can be applied to evaluate EBP among speech and language pathologists for educational, clinical, or research purposes

The global burden of adolescent and young adult cancer in 2019 : a systematic analysis for the Global Burden of Disease Study 2019

Background In estimating the global burden of cancer, adolescents and young adults with cancer are often overlooked, despite being a distinct subgroup with unique epidemiology, clinical care needs, and societal impact. Comprehensive estimates of the global cancer burden in adolescents and young adults (aged 15-39 years) are lacking. To address this gap, we analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, with a focus on the outcome of disability-adjusted life-years (DALYs), to inform global cancer control measures in adolescents and young adults. Methods Using the GBD 2019 methodology, international mortality data were collected from vital registration systems, verbal autopsies, and population-based cancer registry inputs modelled with mortality-to-incidence ratios (MIRs). Incidence was computed with mortality estimates and corresponding MIRs. Prevalence estimates were calculated using modelled survival and multiplied by disability weights to obtain years lived with disability (YLDs). Years of life lost (YLLs) were calculated as age-specific cancer deaths multiplied by the standard life expectancy at the age of death. The main outcome was DALYs (the sum of YLLs and YLDs). Estimates were presented globally and by Socio-demographic Index (SDI) quintiles (countries ranked and divided into five equal SDI groups), and all estimates were presented with corresponding 95% uncertainty intervals (UIs). For this analysis, we used the age range of 15-39 years to define adolescents and young adults. Findings There were 1.19 million (95% UI 1.11-1.28) incident cancer cases and 396 000 (370 000-425 000) deaths due to cancer among people aged 15-39 years worldwide in 2019. The highest age-standardised incidence rates occurred in high SDI (59.6 [54.5-65.7] per 100 000 person-years) and high-middle SDI countries (53.2 [48.8-57.9] per 100 000 person-years), while the highest age-standardised mortality rates were in low-middle SDI (14.2 [12.9-15.6] per 100 000 person-years) and middle SDI (13.6 [12.6-14.8] per 100 000 person-years) countries. In 2019, adolescent and young adult cancers contributed 23.5 million (21.9-25.2) DALYs to the global burden of disease, of which 2.7% (1.9-3.6) came from YLDs and 97.3% (96.4-98.1) from YLLs. Cancer was the fourth leading cause of death and tenth leading cause of DALYs in adolescents and young adults globally. Interpretation Adolescent and young adult cancers contributed substantially to the overall adolescent and young adult disease burden globally in 2019. These results provide new insights into the distribution and magnitude of the adolescent and young adult cancer burden around the world. With notable differences observed across SDI settings, these estimates can inform global and country-level cancer control efforts. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.Peer reviewe

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

BACKGROUND: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. METHODS: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING: Bill & Melinda Gates Foundation

Parents’ Perceptions of the Problems in Children With Autism Spectrum Disorders: A Qualitative Study

Objectives: Parents of children with autism spectrum disorder (ASD) have valuable experiences of the possible developmental problems and other issues of their children as the primary caregivers. The present study aimed to obtain proper information by considering these experiences using a qualitative approach to explain the parents’ perception of problems in their children with ASD.  Methods: This study with a qualitative design was performed on 35 parents of children with ASD (33 mothers and 2 fathers) who were selected via purposive sampling. The study data were collected using semi-structured interviews, and all sessions were recorded and immediately transcribed verbatim. We followed the Graneheim and Lundman (2003) content analysis approach (a step-by-step extraction of meaning unit, initial codes, subtheme, and theme). Results: We extracted 5 main themes of developmental, language comprehension and expression, social communication, behavioral, and general health problems. Each of these mentioned themes has several subthemes. Discussion: According to the results, the parents’ perceptions and experiences of their ASD children’s problems were similar to the findings reported by experts in a few related studies. Given the lived experiences of the parents of children with ASD, they could help enrich the references regarding the problems of children with ASD. Such data should be considered during the assessment and intervention for this group of children

Effects of Children’s Communication Disorders on the Quality of Life of Their Parents in Iran

Objectives: Communication disorders in children can change the parents’ lives. Some quantitative studies have investigated the effects of children’s disorders on parents’ quality of life (QoL) using questionnaires. These quantitative studies cannot comprehensively determine the extent of the impacts of such disorders in children on parents’ QoL. Quantitative studies have investigated the QoL using a few limited questions. However, qualitative studies can explore aspects of reality using a full, comprehensive, and in-depth way that may not be quantified by questionnaires. Therefore, this study qualitatively explains the effects of communication disorders in children on parents’ QoL. Methods: In this original research, 14 parents who had children with communication disorders consented to participate in semi-structured interviews. The participants were selected purposefully and the sampling was continued until the data was saturated. The interviews were transcribed and then analyzed through qualitative content analysis. Results: Qualitative content analysis of the interviews extracted five main themes, including physical effects, psychological effects, economic effects, family dynamics effects, and job-educational effects. Each of these themes consists of several subthemes. Discussion: The study revealed the depth of the negative influences of children’s communication disorders on the parents’ QoL. Screening for parental QoL and providing family support systems for parents of children with communication disorders are warranted based on these findings. Moreover, the findings of the current study can be used for the development of new instruments for measuring QoL or caregiver burden among parents of children with communication disorders

Comparing disfluency on words and nonwords in children who stutter

Introduction: Stuttering is a multidimensional disorder which may be affected by many factors including linguistic aspects. The aim of this study was to investigate the frequency of disfluencies over words and nonwords in children who stutter. Materials and Methods: 15 children with stuttering, whose age ranged from 4 to 5 years, participated in this descriptive-analytical study. They were asked to repeat words and non-words that they heard while their utterances were recorded. The statistical analysis was conducted in SPSS. Results: Disfluency frequency was significantly higher on repeating words than on repeating nonwords (P < 0.05). Common disfluencies were of repetition and block types. Conclusion: According to the results of the present study, linguistic complexities can increase the occurrence of disfluency frequency. Keywords: Words, Nonwords, Disfluency, Children who stutte

Investigating the Development and Evaluation of the Psychometric Properties of the Stuttering Related Quality of Life Questionnaire

Objectives: People who stutter (PWS) experience many problems in their lives in addition to speech fluency disorder. Meanwhile, stuttering reduces their quality of life (QoL). QoL depends on different social, economic, and cultural conditions of societies. Considering that there is no specific questionnaire to investigate the QoL in Iranian PWS; this study develops and evaluates the psychometric properties of a stuttering related QoL questionnaire (SRQoLQ). Methods: First, by interviewing 11 PWS, with the help of 10 speech-language pathologists in the stuttering field, in addition to reviewing the literature, initial items were developed and a preliminary version of the SRQoLQ was designed. The content validity of the SRQoLQ was evaluated using two qualitative and quantitative methods (determining content validity ratio and content validity index) using the opinions of 12 experts. The qualitative method was also used to determine the face validity and interviews were conducted with 10 PWS. Finally, the reliability of the SRQoLQ was investigated through internal consistency and test re-test reliability with the participation of 83 and 30 PWS, respectively. Results: Interviews with PWS and experts in addition to literature review led to the development of a questionnaire with 40 items. After determining content and face validity, the number of items in the SRQoLQ was reduced to 32. The results of calculating the Cronbach α coefficient showed the appropriate reliability of the SRQoLQ (0.96). The intraclass correlation coefficient of the SRQoLQ items in the test re-test phase ranged from 0.6 to 0.95. Moreover, the intraclass correlation coefficient value of the SRQoLQ was 0.95. Discussion: A suitable tool was developed to evaluate the QoL of PWS, and its psychometric properties were investigated. Based on the results, the SRQoLQ for PWS is a valid and reliable tool with 32 items that can be used for clinical or research purposes in the field of stuttering

A New Persian Version of Language Assessment, Remediation, and Screening Procedure (P-LARSP)

Objectives: In 1998, the Persian form of Language Assessment, Remediation, & Screening Procedure (P-LARSP) was introduced. However, this adapted version remained on library shelves and was not used by Iranian speech and language pathologists (SLPs). The present study aimed to explore the barriers to using P-LARSP, resolve the possible issues, and provide a preliminary grammatical sketch from typical children aged 2-5.  Methods: The study started with two surveys in two different populations to find the possible barriers and then, continued with the cross-cultural adaptation of the LARSP through international guidelines (forward and backward translations, cognitive interviewing, and pretesting). Finally, by the new P-LARSP, 120 language samples obtained from children (aged 2-5) in a free-play context were analyzed and data were processed in SPSS software, version 21. Results: Our surveys showed that Iranian SLPs had little familiarity with the P-LARSP, and they found it unclear, and difficult to understand the framework. While most of the participants recognized the P-LARSP as a relevant framework to analyze language samples, few numbers of participants used the P-LARSP with clinical or research aims. Through cross-cultural adaptation, a simple, clear, relevant, comprehensive, and applicable Persian profile along with a published manual was obtained and introduced to the SLPs through social media, workshops, and national congresses. Quantitative and qualitative analysis of 120 language samples showed grammatical structures have significant changes by age in terms of numbers and varieties of clauses, phrases, inflectional morphemes, and general syntactic indices. Discussion: The present study revealed why the P-LARSP remained unknown. We removed the barriers by introducing a new version of P-LARSP fully in Persian and increasing its simplicity, clarity, and understandability with a proper manual. Introducing the new version through proper channels to the target population was another taken step to increase the familiarity of the Iranian SLPs. In addition, the preliminary data indicated that the new P-LARSP with its manual is applicable to the language samples taken from typically developing children