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Huntington’s disease (HD) is a neurodegenerative disease characterized by increasing dysphagia as the disease progresses. Specific characteristics of the HD dysphagia are not well defined.
To characterize the swallowing disturbances of HD patients, to evaluate the feasibility of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) in assessing dysphagia in HD patients, and to discern the relation between FEES findings and patients’ self-report on dysphagia symptoms and swallowing related quality of life (SWAL-QOL).
A retrospective case series in a tertiary referral center. All recruited HD patients underwent Bed Side Swallowing Evaluation (BSE), FEES, the Unified Huntington’s Disease Rating Scale (UHDRS), and the Montreal Cognitive Assessment (MoCA). All completed the Swallowing Disturbances Questionnaire (SDQ) and the SWAL-QOL questionnaire.
Fourteen HD patients were recruited. All were able to complete the FEES study. The FEES demonstrated delayed swallowing reflex, solid food residues, and pre/post swallowing spillage in most patients (50%, 53.5%, 83.3%, and 87.5%, respectively). The mean SDQ score was 13.2. Significant correlations were found between the SWAL-QOL fear of eating score; the SDQ oral, pharyngeal, and total scores; and the FEES parameters of pureed and solid food bolus flow time. Significant correlations were also found between the total UHDRS score, the volitional cough score, and the SWAL-QOL disease burden score.
HD patients exhibit prominent unique oropharyngeal dysphagia features that may serve as a marker of disease progression. The FEES and the SDQ are valuable tools for detecting these features in HD patients with swallowing disturbance.
This chapter explores the specific nature of dialogical relationships in the Indian self and society. Relationships among members of any group are guided by cultural, social and historical orientations that develop over centuries. In Indian communities, there exists a deep sense of relatedness with other people. Among Indians, reality itself is believed to be contingent upon context. Conversational interface among Indians is usually multiparty. Whether it is in childcare or social gatherings, there is a tendency to use strategies of multiparty discourse. The chapter presents ten illustrations which indicates how deeply (and differently) other people construct everyday conversations in the lives of Indians and one prevalent format for discourse is what can clumsily be called to everyone in general and no one in particular. It shows how social interactions guide the developing person towards active engagement with cultural reality while retaining individual agency.
Exposure to prolonged war stress is understudied. While there is debate regarding the empirical data of the dose-response model for post-traumatic stress disorder (PTSD), little is known about how weekly changes in external stress influences the level of PTSD symptoms. The purpose of this study was to measure the relation between objective external stress and PTSD symptoms across time, and thus, gain a deeper understating of the dose-response model.
The study hypothesis postulates that the more severe the external stressor, the more severe the exhibition of traumatic symptoms.
Thirteen special army administrative staff (SAAS) members from the Rambam Medical Center in Haifa attended seven intervention meetings during the war. These personnel answered a battery of questionnaires regarding demographics and PTSD symptoms during each session. A non-parametric test was used in order to measure the changes in PTSD symptoms between sessions. Pearson correlations were used in order to study the relationship between the magnitude of external stressors and the severity of PTSD symptoms.
The results suggested that there was a significant relationship between the magnitude of external stressors and the severity of PTSD symptoms. These results are in line with the dose-response model.
The results suggest that a pattern of decline in PTSD symptoms confirm the dose-response model for PTSD.
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