Cause-specific mortality risk among male alcoholics residing in the Osaka metropolitan area

We evaluated the mortality risk among 306 male alcoholics living in Osaka, Japan, at the time of initial diagnosis between 1972 and 1983, with regard to the cause of death, length of time from diagnosis, and participation in an alcohol abstinence self-help group. By the closing date on 1 March 1992, 110 of the 306 alcoholics had died, yielding an observed-to-expected (O/E) ratio of 4.5 [95% confidence interval (CI) = 3.7-5.4]. The alcoholics had significantly elevated mortality risks from all malignant neoplasms (O/E = 2.1, 95%CI = 1.2-3.3), esophageal cancer (O/E = 8.4, 95%CI = 1.7-24.5), diseases of the circulatory system (O/E = 4.4, 95%CI = 3.0-6.2), liver cirrhosis (O/E = 15.9, 95%CI = 10.2-23.6), diseases of the genitourinary system (O/E = 6.3, 95%CI = 1.3-18.5), and external death (O/E = 10.3, 95%CI = 6.3-15.8). The mortality risk from all causes still remained significantly high beyond the tenth year following initial diagnosis (O/E = 2.6, 95%CI = 1.0-6.2). The mortality risks from liver cirrhosis and external death (such as suicide) were highest within the first year following diagnosis, and were still high beyond the tenth year. A significantly high mortality risk from diseases of the circulatory system was observed between the first and ninth years, and the mortality risk from all malignant neoplasms was significantly elevated beyond 10 years following diagnosis. Alcoholics who did not join a self-help group soon after the initial institutional treatment had different cause-specific and time-specific mortality risks from those who did join a self-help group. These findings show the importance of long-term clinical follow-up of male alcoholics, taking into consideration the cause-specific mortality.     

助听器配戴者音调、音质异常干预的个案研究

目的本研究通过对音调异常的测量和实时矫治,探索男声女调的有效矫治方法。方法采用喉部按摩、降调训练、哈欠叹息法、重读治疗法等方法进行矫治,每周一次,并在矫治前后对其音调和音质进行测量,监控对比疗效。采用单一被试法进行统计分析。结果经过两个月的矫治,患者的音调降至成年男性正常范围,音质恢复正常。结论本矫治方法是有效的,不仅能大大降低男声女调患者的音调,而且可以改善其音质的异常;可以将喉部按摩和发声训练的方法相结合,对男声女调患者进行综合治疗。     

Enhancing employee capacity to prioritize health insurance benefits

OBJECTIVE: To demonstrate that employees can gain understanding of the financial constraints involved in designing health insurance benefits. BACKGROUND: While employees who receive their health insurance through the workplace have much at stake as the cost of health insurance rises, they are not necessarily prepared to constructively participate in prioritizing their health insurance benefits in order to limit cost. DESIGN: Structured group exercises. SETTING AND PARTICIPANTS: Employees of 41 public and private organizations in Northern California. INTERVENTION: Administration of the CHAT (Choosing Healthplans All Together) exercise in which participants engage in deliberation to design health insurance benefits under financial constraints. MAIN OUTCOME MEASURES: Change in priorities and attitudes about the need to exercise insurance cost constraints. RESULTS: Participants (N = 744) became significantly more cognizant of the need to limit insurance benefits for the sake of affordability and capable of prioritizing benefit options. Those agreeing that it is reasonable to limit health insurance coverage given the cost increased from 47% to 72%. CONCLUSION: It is both possible and valuable to involve employees in priority setting regarding health insurance benefits through the use of structured decision tools.     

Hearing rehabilitation with osseointegrated hearing implant in bilateral congenital external auditory canal atresia

Introduction and objectivesCongenital atresia of the external auditory canal (EAC) is a congenital defect present in one in every 10,000–20,000 births. It causes conductive hearing loss, with an air-bone gap of 50–60 dB. Early amplification is essential in bilateral cases to ensure normal language development. The aim of this study is to present the osseointegrated hearing implant as a treatment for bilateral EAC atresia, reviewing the audiometric results and the rate of complications.Material and methodsRetrospective analysis of patients diagnosed with bilateral congenital EAC atresia under follow-up in the pediatric ENT clinic of the ENT and Head and Neck Surgery department of a Portuguese Tertiary Hospital, between 2003 and 2019. We reviewed the medical records and collected information on the assessment of the initial audiometric status. In the cases submitted for implantation with an osseointegrated hearing implant, we analyzed the details of follow-up, including immediate and long-term post-operative complications, as well as the audiometric results.ResultsWe present 8 pediatric patients, 6 girls and 2 boys, with a diagnosis of bilateral congenital EAC atresia. The audiometric assessment revealed moderate to severe bilateral conductive hearing loss with a mean speech recognition threshold (SRT) of 51 dB. Six patients underwent osseointegrated hearing implantation. All 6 patients showed good audiometric results, with an average SRT of 20 dB and closure of the air-bone gap.ConclusionsThe osseointegrated hearing implant was an effective treatment option in these patients, without significant morbidity or complications. Osseointegrated hearing implantation should be considered first line treatment for children with bilateral congenital EAC atresia, as it presents good functional results and a high level of patient satisfaction.     

急救护理技能综合训练的应用与实践

目的 急救技能综合训练应用创设临床急症教学情境,培养学生的急救意识、综合急救能力和解决实际问题的能力.方法 在学生急救技能项目训练达标的基础上,设置临床急症病例,以小组为单位进行模拟临床抢救综合训练.结果 急救技能综合训练有利于激发学生的学习兴趣,培养学生分析和解决问题的能力,提高学生的观察能力和思维能力及提高学生的团队协作精神.     

Selection of test-setup parameters to target specific signal-to-noise regions in speech-on-speech intelligibility testing

Objective: To investigate the magnitude of the change in speech-reception threshold (SRT) provided by altering four different test-setup parameters. Furthermore, to determine whether these changes in SRT are of a sufficient magnitude, such that they can be used to design a test-setup in future experiments that target a predefined signal-to-noise ratio (SNR) region. This could be particularly important if the test contrast investigated is confounded with test SNR. Design: The investigated test-setup parameters were: Spatial separation between target (0°) and maskers (±15°, ±30°, ±45°, or ±75°), number of maskers (two, four or six), scoring method (scoring percent-correct words or sentences) and masker gender (same or opposite to target). Twenty SRTs were measured per test subject. Study sample: Twenty hearing-impaired test subjects participated over two visits. Results: Alteration of masker gender, spatial separation between target and masker (±15°, ±30°, ±?45°), and scoring method was shown to offer SRT changes of a sufficient magnitude. The different test setups resulted in average SRTs ranging from ?4.0 to 3.3?dB. Conclusion: Deliberately selecting test setup parameters can change the overall difficulty of the test by up to 7.3?dB SRT. Thus, a future experiment can, to this extent, be designed to target a specific SNR region.     

Representations of workers with hearing loss in Canadian newspapers: a thematic analysis

Objective: Participation in the labour force with a hearing impairment presents a number of challenges. This study describes how Canadian newspapers represent workers with hearing loss. Design: Taking a critical framing theory approach, thematic analysis was performed through coding relevant articles, abstracting and hierarchically categorising themes. Study sample: Seven English-language Canadian newspapers were searched for publications between 1995 and 2016. Twenty-six articles met our criteria: discussing paid workers with hearing loss who used English rather than sign language on the job and making reference to workers’ competence. Results: We identified a global theme, Focussing on a good worklife or focussing on a limited worklife, composed of three organising themes (1) Prominent individuals struggle, take action, and continue despite hearing loss, (2) Workers with hearing loss in the community create their best day themselves, and (3) Workers with hearing loss, as a generalised whole, are portrayed as either competent or limited. Conclusions: The dominant framing portrays individual workers as ingenious, determined, and successful. Negative framings were predominantly generalisations to these workers as a group. To generate more positive framings, professionals can build relationships with consumer groups and, when contacted by the media, direct journalists to interview workers with hearing loss.