Effects of increased levels of androgens on voice and vocal folds in women with congenital adrenal hyperplasia and female-to-male transsexual persons

Voice virilization in women may occur due to increased levels of androgens. Women with congenital adrenal hyperplasia (CAH) are at risk for voice virilization due to an enzyme deficiency that causes increased production of androgens and lack of cortisol. Female-to-male transsexual persons, trans men, are treated with testosterone, with virilization of the voice as a desired outcome. The overall aim of the project was to provide new knowledge on how female voice and vocal folds are affected by endogenous and exogenous androgen exposure, and the consequences virilization of the voice may have in a patient’s life. Study I: Thirty-eight women with CAH and 24 age-matched controls participated. Their voices were recorded and acoustically and perceptually analyzed. Theyanswered questions about subjective voice problems. Endocrine datawere obtained from medical journals. The results showed that women with CAH spoke with significantly lower mean fundamental frequency (F0), had darker voice quality, and rated higher on the statement “my voice is a problem in my daily life” than the controls. Voice virilization was associated with late diagnosis or problems with glucocorticoid medication, but not with severity of mutation. Proper treatment with glucocorticoids is important to avoid long periods of increased androgen levels to prevent irreversible voice virilization. Study II: Forty-two women with CAH and 43 age-matched controls filled out the Voice Handicap Index (VHI) and answered questions about voice function related to virilization. Endocrine data were obtained from medical journals. Women with CAH scored significantly higher than the controls on VHI when the results were divided into groups by voice handicap: none/mild, moderate, and severe. A virilized voice in women with CAH correlated with less voice satisfaction. Seven percent of the women with CAH had voice problems related to voice virilization. Voice virilization was associatedwith long periods of under-treatment with glucocorticoids and higher bone mineral density, confirming results and conclusions from study I. It is recommended that women with CAH who experience voice problems are referred for voice assessment. Study III: Four women with CAH and virilized voices, and 5 female and 4 male controls participated. A procedure for magnetic resonance imaging of the vocal folds was developed. The results showed that the cross-sectional area of the thyroarytenoid (TA) muscle was larger in women with virilized voices than in female controls, and smaller than in males. The larger TA area correlated with lower F0 values obtained from acoustic analysisof habitual speech range profiles. Thus, the anatomical explanation for voice virilization may be a larger crosssectional area of the TA muscle, suggesting androgen receptors in the vocal folds. These findings need to be confirmed in a larger study. Study IV: Fifty trans men participated in a longitudinal study. Voice assessments, performed before testosterone treatment started and regularly up to 24 months, included audiorecordings of speech and voice range profiles and self-ratings of voice function. A significant lowering of mean F0 was found after 3 months, after 6 months, and up to 12 months, when group data were congruent with reference data for males. No correlations were found between levels of testosterone, EVF, Hb, SHBG or LH, and F0 values. Lower F0 values correlated with greater satisfaction with the voice. A quarter of the participants had received voice therapy for problems associated with virilization, such as vocal fatigue or unstable voice. Voice assessment during testosterone treatment is important to detect the potentially large subgroup of trans men that needs voice therapy

Method-MS, final report 2010

Radiometric determination methods, such as alpha spectrometry require long counting times when low activities are to be determined. Mass spectrometric techniques as Inductively Coupled Plasma Mass Spectrometry (ICP-MS), Thermal Ionisation Mass Spectrometry (TIMS) and Accelerator Mass Spectrometry (AMS) have shown several advantages compared to traditional methods when measuring long-lived radionuclides. Mass spectrometric methods for determination of very low concentrations of elemental isotopes, and thereby isotopic ratios, have been developed using a variety of ion sources. Although primarily applied to the determination of the lighter stable element isotopes and radioactive isotopes in geological studies, the techniques can equally well be applied to the measurement of activity concentrations of long-lived low-level radionuclides in various samples using “isotope dilution” methods such as those applied in inductively coupled plasma mass spectrometry (ICP-MS). Due to the low specific activity of long-lived radionuclides, many of these are more conveniently detected using mass spectrometric techniques. Mass spectrometry also enables the individual determination of Pu-239 and Pu-240, which cannot be obtained by alpha spectrometry. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) are rapidly growing techniques for the ultra-trace analytical determination of stable and long-lived isotopes and have a wide potential within environmental science, including ecosystem tracers and radio ecological studies. Such instrumentation, of course needs good radiochemical separation, to give best performance. The objectives of the project is to identify current needs and problems within low-level determination of long-lived radioisotopes by ICP-MS, to perform intercalibration and development and improvement of ICP-MS methods for the measurement of radionuclides and isotope ratios and to develop new methods based on modified separation chemistry applied to new auxiliary equipment

Determination of actinides using ICP-SFMS

Interest in the determination of the actinides using ICP-MS has steadily increased with the development of systems capable of more sensitive and precise measurements. However, the analysis of less abundant actinides such as Pu and Am is not straightforward due to the need for chemical separation of these elements prior to determination. In many applications of mass- spectrometric actinide analysis, isotope ratio measurements are important, either for the analysis of the isotopic composition of, e.g., U or Pu in the sample, or for quantitative determinations using isotope dilution mass spectrometry. In order to achieve high precision and accuracy in an isotope ratio measurement, corrections for instrumentally induced systematic errors, e.g., due to dead-time and mass bias, need to be considered. In this thesis, different aspects of actinide analysis using ICP-SFMS have been addressed. In Papers I and III, separation procedures based on solid phase extraction for Pu, Am and U were developed and evaluated with respect to chemical yield and separation from elements causing spectral interferences. Applications of the analytical procedures developed comprised measurement of the 240Pu/239Pu ratio in environmental reference materials (Paper I), and age determination of Pu based on the 241Pu/241Am and 240Pu/236U ratios (Paper III). In the application of different separation procedures for Pu (Paper I), previously unidentified spectral interferences were discovered. In Paper II, these interferences were identified as lanthanide phosphate ions and the composition and formation of these species with respect to different instrumental parameters were further examined. Due to the importance of precise and accurate isotope ratio determination, a thorough investigation of the instrumental dead time of an ICP-SFMS system was performed. The dead time was evaluated via both isotope ratio and electronic measurements of the output from the detector amplifier. It was found that the overall uncertainty in ratio measurements can be significantly reduced by using an electronically determined dead time due to the inherently higher precision compared to traditional isotope ratio based approaches. However, this requires that an correct artificial dead-time is implemented in the pulse counting system (Paper IV).Godkänd; 2006; 20061205 (haneit

Interprofessionella teambesök i svensk barnhälsovård - en resurs att utveckla : En studie om teamarbete ur sjuksköterskors, läkares och psykologers perspektiv

Interprofessional teamwork has been described as a key method in promoting health and preventing illness in children. However, evidence-based knowledge about which form of teamwork in Child Healthcare Services (CHS) that enables a holistic view of the child in his or her family, considering medical, psychological and social circumstances, is required. This thesis aimed to produce evidence-based knowledge about teams and interprofessional teamwork that could be used in the Swedish CHS, as well as an understanding of influencing factors at the individual, organisational and societal levels based on nurses’, physicians’ and psychologists’ perceptions. The thesis includes four studies (I–IV) that used quantitative, qualitative and mixed method design to answer the overall purpose of the doctoral thesis. Together, these methods form an exploratory sequential mixed method design. For the quantitative studies (I and II) and the mixed study (III), a national cross-sectional study in the form of a web survey was answered by 1119 nurses, physicians and psychologists engaged in the Swedish CHS. In study IV, an explorative qualitative design was used, and data was obtained from seven digital focus group interviews with nurses, physicians, and psychologists engaged in CHS. Interprofessional teamwork within the CHS, in the form of physical meetings such as team-based visits and parental groups held by a team, where professionals, the child, and the parents are present at the same time, was found to be important to achieve the goals of the team and meet the unique needs of the child and his/her family. Team-based visits contribute to a holistic view of the child in his/her family where medical, psychological and social circumstances are considered. Healthcare professionals require team-based visits delivered by interprofessional teams, in line with proportionate universalism. However, perceived needs for targeted team-based visits exceed its existence, especially in cases of psychosocial or complex indications. Based on the findings, there are reasons to consider interprofessional team-based visits in the CHS as an important resource to be developed. For optimal team-based visits within CHS, factors at the individual, organisational and social level are required. These factors include: 1) placing the child at the centre, 2) physical meetings, 3) equality and equity, 4) continuity, 5) trust and confidence, 6) competence and learning, 7) communication, 8) goals and motivation, 9) responsibilities and roles, 10) flexibility, 11) safety and effectiveness and 12) well-being and meaningfulness

Interprofessionella teambesök i svensk barnhälsovård - en resurs att utveckla : En studie om teamarbete ur sjuksköterskors, läkares och psykologers perspektiv

Interprofessional teamwork has been described as a key method in promoting health and preventing illness in children. However, evidence-based knowledge about which form of teamwork in Child Healthcare Services (CHS) that enables a holistic view of the child in his or her family, considering medical, psychological and social circumstances, is required. This thesis aimed to produce evidence-based knowledge about teams and interprofessional teamwork that could be used in the Swedish CHS, as well as an understanding of influencing factors at the individual, organisational and societal levels based on nurses’, physicians’ and psychologists’ perceptions. The thesis includes four studies (I–IV) that used quantitative, qualitative and mixed method design to answer the overall purpose of the doctoral thesis. Together, these methods form an exploratory sequential mixed method design. For the quantitative studies (I and II) and the mixed study (III), a national cross-sectional study in the form of a web survey was answered by 1119 nurses, physicians and psychologists engaged in the Swedish CHS. In study IV, an explorative qualitative design was used, and data was obtained from seven digital focus group interviews with nurses, physicians, and psychologists engaged in CHS. Interprofessional teamwork within the CHS, in the form of physical meetings such as team-based visits and parental groups held by a team, where professionals, the child, and the parents are present at the same time, was found to be important to achieve the goals of the team and meet the unique needs of the child and his/her family. Team-based visits contribute to a holistic view of the child in his/her family where medical, psychological and social circumstances are considered. Healthcare professionals require team-based visits delivered by interprofessional teams, in line with proportionate universalism. However, perceived needs for targeted team-based visits exceed its existence, especially in cases of psychosocial or complex indications. Based on the findings, there are reasons to consider interprofessional team-based visits in the CHS as an important resource to be developed. For optimal team-based visits within CHS, factors at the individual, organisational and social level are required. These factors include: 1) placing the child at the centre, 2) physical meetings, 3) equality and equity, 4) continuity, 5) trust and confidence, 6) competence and learning, 7) communication, 8) goals and motivation, 9) responsibilities and roles, 10) flexibility, 11) safety and effectiveness and 12) well-being and meaningfulness

The heritage language classroom as a cultural bridge with two-way traffic

grantor: University of TorontoThe link between language and culture is well recognized among educators and language specialists. In the area of heritage language teaching, the culture in focus has typically been the one associated with the country or area where the heritage language is used as a first language by a majority of the population. It was, however, postulated by the present researcher that much of the cultural content taught in heritage language classrooms would also deal with the host country's culture. That would in no way be an undesirable situation, since it was seen as an excellent opportunity for young, recent arrivals to the host country to learn about the culture of their new country. The Ontario curriculum guidelines for heritage language programs state the students in these programs should also learn about Canada and the culture of this country. It would thus be reasonable to assume that heritage language instruction in Ontario would contain this kind of content to some extent, in addition to focusing on the heritage culture. That would, however, not be expected in heritage language education in Sweden, where the curriculum guidelines do not include instruction about the majority culture. If, on the other hand, this kind of learning still took place in the context of home language education, as it is referred to in the Swedish school system, one would expect this cultural information sharing to happen regardless of the curriculum guideline objectives. A case study was carried out in Sweden to investigate this issue. To allow for the possibility of different outcomes among ethnic groups, four different home languages participated in the study. They were Greek, Farsi, Spanish, and Vietnamese and were selected to represent cultures that were both very different from one another and from Swedish culture. The 477 students from participating school boards in the Stockholm and Gothenburg regions responded to 30 items on a questionnaire, each of which addressed a particular aspect of culture. In the analysis, the items were grouped into three cultural categories representing factual information, lifestyle, and cultural activities. The subjects were asked to indicate on a scale from 0 to 4 how much they felt they had learned about the heritage country and Sweden respectively for each of the 30 questions. The responses were then analyzed using pair-wise comparisons, frequencies, means, and factor analysis. Comparisons were made not only between the participating languages but also in terms of age and gender. School officials and teachers in Sweden were invited to provide feedback, as were heritage language coordinators at some Metropolitan Toronto school boards. The results show that the students perceive themselves to have learned about Sweden as well as their country of origin. This was most true for the factual information category. Among the language groups, the Greek students reported learning least about Sweden, while the Vietnamese students felt they had learned more about Sweden than about Vietnam. Of the other two groups, the Spanish speakers most often answered that they had learned equally much about both cultures. (Abstract shortened by UMI.)Ph.D

Kärnprocessen inom barnhälsovården

The core process is responsible for internal business development and is the process that runs through the organization and the results which creates a value for the customer. Some research suggests that identification of the client's conscious or unconscious needs clarifying the so-called core process in the organization and operations can thus be more effective. The study aims to identify and analyze the experience of the core process within child health care. The method has been interviews with nine managers and 10 clinic nurses in a county. The results show a lack of knowledge regarding core process and process work. However, the respondents have a sense of what the core process is, although the experience of the core process differs between managers and child health nurses in the study. The discussion describes the obstacles and supporting factors for a common core process.   Keywords: core process, child health care, core process management, process in health care, process management    Kärnprocessen står för verksamhetens inre utveckling och är den process som löper tvärs igenom organisationen och vars resultat skapar ett värde för kunden. Det finns forskning som tyder på att identifikation av kundens medvetna eller omedvetna behov tydliggör den så kallade kärnprocessen i organisationen. Genom processledning får medarbetarna en helhetssyn och kunskap om både interna och externa kunders behov. Det har en positiv inverkan på medarbetarnas arbetstrivsel och verksamhetens utveckling. Syftet med studien är att identifiera och analysera upplevelsen av kärnprocessen inom barnhälsovården. Metoden har varit kvalitativa intervjuer med nio verksamhetschefer och 10 BVC-sköterskor i ett av landets län. Resultatet visar på en kunskapsbrist beträffande kärnprocess och processarbete. Däremot har respondenterna en upplevelse av vad kärnprocessen är, även om upplevelsen av kärnprocessen skiljer sig mellan verksamhetscheferna och BVC-sköterskorna i studien. I diskussionen beskrivs hindrande och stödjande faktorer för en gemensam kärnprocess

First-time parents' experiencesin occupational balance andmeaningful activities

Syfte: Det är en stor omställning i livet att få en ny familjemedlem. Därför finns det ett behov av att undersöka förstagångsföräldrars erfarenhet av aktivitetsbalans samt vilka aktiviteter som anses vara meningsfulla. Men även undersöka om det finns något intresse av att få stöd i att strukturera aktiviteter under den första tiden hemma med barnet. Metod: Informationen samlades in genom semistrukturerade intervjuer, som sedan transkriberades. Meningsbärande enheter togs ut, kondenserades och kodades. Utifrån koderna gjordes en analys. Föräldrarna fick även skatta sin upplevda aktivitetsbalans på en skala mellan 1–10. Resultat: Av studien gick det att utläsa att det inte fanns ett uttalat behov av stöd under barnets första år, men att det utifrån beskrivningarna av situationen som uppstod efter barnets hemkomst, fanns ett visst behov av att få stöd i att hitta aktivitetsbalansen under den första tiden. Slutsats: Utifrån resultatet drogs slutsatsen att det fanns ett behov av stöd under den första tiden med barnet, då det beskrevs som en tid av osäkerhet. Det medförde en stor omställning vilket innebar att föräldrarnas vanor och rutiner ställdes på ända och de behövde hitta ett nytt aktivitetsmönster. Fortsatt forskning: För att få ett större underlag och inom ett bredare åldersspann på både föräldrar och barn, skulle det behövas kvantitativa studier. Men även fler kvalitativa studier vore nödvändigt för att kunna få en fördjupad förståelse för föräldrarnas erfarenheter och upplevelser.Purpose: It is a great change in life to get a new family member. Therefore there is a need to examine first-time parents' experiences of activity balance and which activities are considered meaningful. But also examine if there is any interest in getting support in structuring their activities during the first time at home with the child. Method: The information was collected through semi-structured interviews, which were then transcribed. Sentences were taken out, condensed and coded. Based on the codes, an analysis was made. The parents estimated their occupational balance on a scale between 1–10. Results: The study showed that there is no explicit need for support during the child's first year. But based on the descriptions of the situation that arose after the child's homecoming, there was a certain need to get support in finding the occupational balance during the first period with the child. Conclusion: Based on the result the conclusion showed that there was a need for support during the first time with the child, as it was described as a time of insecurity. This involves a major change, which includes that the parents' habits and routines where turned upside down. They had to find a new activity pattern. Further research: To obtain a larger basis and within a broader range of ages for both parents and children, quantitative studies would be needed. But even more qualitative studies would be necessary in order to gain an in-depth understanding of the parents' experiences