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Background: The impact of hearing impairment is typically studied in terms of its effects on speech perception, yet this fails to account for the interactive nature of communication. Recently, there has been a move towards studying the effects of age‐related hearing impairment on interaction, often using referential communication tasks; however, little is known about how interaction in these tasks compares to everyday communication. Aims: To investigate utterances and requests for clarification used in one‐to‐one conversations between older adults with hearing impairment and younger adults without hearing impairment, and between two younger adults without hearing impairment. Methods & Procedures: A total of 42 participants were recruited to the study and split into 21 pairs, 10 with two younger adults without hearing impairment and 11 with one younger adult without hearing impairment and one older participant with age‐related hearing impairment (hard of hearing). Results from three tasks—spontaneous conversation and two trials of a referential communication task—were compared. A total of 5 min of interaction in each of the three tasks was transcribed, and the frequency of requests for clarification, mean length of utterance and total utterances were calculated for individual participants and pairs. Outcomes & Results: When engaging in spontaneous conversation, participants made fewer requests for clarification than in the referential communication, regardless of hearing status/age (p ≤ 0.012). Participants who were hard of hearing made significantly more requests for clarification than their partners without hearing impairment in only the second trial of the referential communication task (U = 25, p = 0.019). Mean length of utterance was longer in spontaneous conversation than in the referential communication task in the pairs without hearing impairment (p ≤ 0.021), but not in the pairs including a person who was hard of hearing. However, participants who were hard of hearing used significantly longer utterances than their partners without hearing impairment in the spontaneous conversation (U = 8, p < 0.001) but not in the referential communication tasks. Conclusions & Implications: The findings suggest that patterns of interaction observed in referential communication tasks differ to those observed in spontaneous conversation. The results also suggest that fatigue may be an important consideration when planning studies of interaction that use multiple conditions of a communication task, particularly when participants are older or hard of hearing. WHAT THIS PAPER ADDS: What is already known on this subject: Age‐related hearing impairment is known to affect communication; however, the majority of studies have focused on its impact on speech perception in controlled conditions. This indicates little about the impact on everyday, interactive, communication. What this study adds to the existing knowledge: We investigated utterance length and requests for clarification in one‐to‐one conversations between pairs consisting of one older adult who is hard of hearing and one younger adult without hearing impairment, or two younger adults without hearing impairment. Results from three tasks (two trials of a referential communication task and spontaneous conversation) were compared. The findings demonstrated a significant effect of task type on requests for clarification in both groups. Furthermore, in spontaneous conversation, older adults who were hard of hearing used significantly longer utterances than their partners without hearing impairment. This pattern was not observed in the referential communication task. What are the potential or actual clinical implications of this work?: These findings have important implications for generalizing results from controlled communication tasks to more everyday conversation. Specifically, they suggest that the previously observed strategy of monopolizing conversation, possibly as an attempt to control it, may be more frequently used by older adults who are hard of hearing in natural conversation than in a more contrived communication task. [ABSTRACT FROM AUTHOR]

The purpose was to evaluate the psychometric properties of physical activity measures in persons with multiple sclerosis (PwMS). Adults with multiple sclerosis were recruited, n = 30 (validation) and n = 57 (test–retest). Steps measured with PiezoRX, Yamax SW200 and ActiGraph GT9X Link (AGlink) and time in different positions measured with AGlink were validated against data from video analysis. Psychometric properties of the Physical Activity and Disability Survey – Revised Swedish version (PADS-R(Sw)) was evaluated. The most valid measures were AGlink using the low-frequency extension filter, and PiezoRX with median absolute percentage errors (MeAPEs) of 0.9–3.1% and 1.3–3.3%. The MeAPEs were higher for Yamax SW200 (2.9–21.0%), AGlink display (3.6–44.8%) and AGlink normal filter (8.9–48.9%), indicating low validity. AGlink was not valid in measurements of sitting (MeAPE 12.0–12.5%) or lying (MeAPE 31.0–41.7%). The correlation between PADS-R(Sw) and AGlink steps was r = 0.492 (p =.009). The relative reliability of PADS-R(Sw) was ICC2,1 0.85 (CI 0.76–0.91), and absolute reliability was SEM 0.54. AGlink and PiezoRX were valid measures of steps in PwMS. The questionnaire PADS-R(Sw) was valid, with high relative reliability, but its absolute reliability was unsatisfactory. [ABSTRACT FROM AUTHOR]

Purpose: Deep brain stimulation (DBS) is often successful in alleviating motor symptoms of essential tremor (ET); however, DBS may also induce adverse speech effects. The caudal zona incerta (cZi) is a promising DBS target for tremor, but less is known about the consequences of cZi DBS for speech. This preliminary study examined how habitual cZi DBS and cZi stimulation at high amplitudes may affect speech function in persons with ET. Method: Fourteen participants with ET were evaluated: off stimulation, on habitual cZi DBS, and with unilateral cZi stimulation at increasing stimulation amplitudes. At each stimulation condition, the participants read three 16-word sentences. Two speech-language pathologists made audioperceptual consensus ratings of overall speech function, articulation, and voice using a visual sort and rate method. Rated functions when off stimulation, on habitual cZi DBS, and at maximal-amplitude stimulation were compared using Friedman nonparametric tests. For participants with bilateral habitual DBS (n = 5), the effects of bilateral and unilateral stimulation were described in qualitative terms. Results: Habitual cZi DBS had no significant group-level effect on any of the investigated speech parameters. Maximal-amplitude stimulation had a small but significant negative effect on articulation. Participants with reduced articulatory precision (n = 9) had more medially placed electrodes than the nonaffected group (n = 5). Bilateral and unilateral left stimulation had comparable effects on speech. Conclusions: Findings from this preliminary study of cZi DBS indicate that speech is generally not affected by stimulation at habitual levels. High-amplitude cZi stimulation may, however, induce adverse effects, particularly on articulation. Instances of decreased articulatory function were associated with stimulation of more medial electrode contacts, which could suggest cerebello-rubrospinal involvement. [ABSTRACT FROM AUTHOR]

This study explores patients' perspectives on sharing their personal health data, which is traditionally shared through discussions with peers and relatives. However, other possibilities for sharing have emerged through the introduction of online services such as Patient Accessible Electronic Health Records (PAEHR). In this article, we investigate strategies that patients adopt in sharing their PAEHR. Data were collected through a survey with 2587 patients and through 15 semi-structured interviews with cancer patients. Results show that surprisingly few patients share their information, and that older patients and patients with lower educational levels share more frequently. A large majority of patients trust the security of the system when sharing despite the high sensitivity of health information. Finally, we discuss the design implications addressing identified problems when sharing PAEHR, as well as security and privacy issues connected to sharing. [ABSTRACT FROM AUTHOR]

Background: Cardiopulmonary bypass and postoperative cardiac dysfunction cause splanchnic hypoperfusion resulting in intra-abdominal anaerobic metabolism and risk for gastrointestinal complications. The intra-abdominal metabolism can be monitored by intraperitoneal measurement of relevant metabolites using microdialysis. The aim of this study was to investigate the intraperitoneal metabolism using microdialysis during and after cardiopulmonary bypass at 34°C. Methods: In six patients undergoing elective coronary artery bypass grafting or aortic valve replacement under cardiopulmonary bypass, microdialysis was used to measure intraperitoneal and subcutaneous glucose, lactate, pyruvate, glycerol and glutamate concentrations, intraoperatively and up to 36 hours postoperatively. Arterial and central venous blood gases were analysed as were haemodynamics and the development of complications. Results: All patients had an ordinary perioperative course and did not develop gastrointestinal complications. The arterial, intraperitoneal and subcutaneous lactate concentrations changed during the perioperative course with differences between compartments. The highest median (interquartile range) concentration was recorded in the intraperitoneal compartment at 1 hour after the end of cardiopulmonary bypass (2.1 (1.9–2.5) mM compared to 1.3 (1.2–1.7) mM and 1.5 (1.0–2.2) mM in the arterial and subcutaneous compartments, respectively). In parallel with the peak increase in lactate concentration, the intraperitoneal lactate/pyruvate ratio was elevated to 33.4 (12.9–54.1). Conclusion: In cardiac surgery, intraperitoneal microdialysis detected changes in the abdominal metabolic state, which were more pronounced than could be shown by arterial blood gas analysis. Despite an uneventful perioperative course, patients undergoing low-risk surgery under cardiopulmonary bypass might be subjected to a limited and subclinical intra-abdominal anaerobic state. [ABSTRACT FROM AUTHOR]

Background: Tinnitus sufferers commonly report concentration difficulties. Despite several previous studies investigating this, the underlying cause and the role of hearing status remains unclear. Purpose: To investigate whether there are any differences between normal hearing individuals with and without tinnitus in terms of working memory capacity, and whether working memory capacity correlates with high-frequency hearing thresholds. Research Design: Participants had their hearing thresholds measured (0.125-16 kHz) and performed a visual n-back test. All participants completed the Hospital Anxiety and Depression Scale, in addition tinnitus participants filled out the Tinnitus Questionnaire. Study Sample: Sixty-two individuals participated, 31 had tinnitus (tinnitus group) and 31 did not have tinnitus (control group). Groups were age- and sex matched, and all participants had normal hearing thresholds (20 dB HL or better at 0.125-8 kHz). Data Analysis: Friedman test of differences among repeated measures was conducted on the collected data of n-back performance, and Mann-Whitney U-test was used to compare groups. Age-corrected correlations were calculated for high-frequency hearing and each n-back condition. Results: We found no significant differences between the groups in terms of n-back task performances, except for the 2-back condition where the tinnitus group performed significantly better than the controls (p = 0.007). Furthermore, we found high-frequency hearing thresholds of the best ear (10-16 kHz) to correlate with performances at more demanding n-back conditions (p = 0.029 for 1-back and p = 0.015 for 2-back). Conclusion: This suggests that presence of tinnitus might not imply poorer working memory capacity and that deteriorated high-frequency hearing thresholds. [ABSTRACT FROM AUTHOR]

Abstract: Mental health inpatient milieus have repeatedly been found to be associated with passivity, social disengagement, and low levels of interaction with staff. However, little is known about patients’ experiences related to different ward activities. In the present study, we aimed to study the reports of activities and associated experiences of patients admitted to acute psychiatric inpatient wards. Disengaged, inactive, and solitary activities were hypothesized to be associated with less reward and more distress than their counterparts. We also aimed to investigate if such activities predicted distress, and if they were associated with clinical severity. Participants (n = 102) recorded their activities along with concurrent ratings of reward and distress in a structured 1‐day diary, and nurses provided clinical severity ratings. On average, 3.74 of the 11 hours assessed (34%) were spent doing nothing, only 0.88 hours (8%) were spent with staff, and most of the time was spent in solitude. Doing nothing, being alone, and passivity were associated with the greatest levels of distress and lowest levels of reward, whereas informal socializing demonstrated the opposite pattern. Distress was not predicted by activity or reward when adjusting for baseline distress. Clinical severity was not associated with the amount of time spent alone or the experience of reward during activity. In conclusion, the risk for passivity and social disengagement during admission prevails. This activity pattern could have detrimental emotional consequences and warrants action, but more studies are needed to determine if activity actually precedes emotional experience. [ABSTRACT FROM AUTHOR]

Aim To compare different levels of self-rated pain and determine if they predict anticipated early physical recovery in patients undergoing general and orthopaedic surgery. Background Previous research has indicated that average self-rated pain reflects patients' ability to recover the same day. However, there is a knowledge gap about the feasibility of using average pain ratings to predict patients' physical recovery for the next day. Design Descriptive, quantitative repeated measures. Methods General and orthopaedic inpatients ( n = 479) completed a questionnaire (October 2012-January 2015) about pain and recovery. Average pain intensity at rest and during activity was based on the Numeric Rating Scale and divided into three levels (0-3, 4-6, 7-10). Three out of five dimensions from the tool 'Postoperative Recovery Profile' were used. Because few suffered severe pain, general and orthopaedic patients were analysed together. Results Binary logistic regression analysis showed that average pain intensity postoperative day 1 significantly predicted the impact on recovery day 2, except nausea, gastrointestinal function and bladder function when pain at rest and also nausea, appetite changes, and bladder function when pain during activity. High pain ratings ( NRS 7-10) demonstrated to be a better predictor for recovery compared with moderate ratings ( NRS 4-6), day 2, as it significantly predicted more items in recovery. Conclusion Pain intensity reflected general and orthopaedic patients' physical recovery postoperative day 1 and predicted recovery for day 2. By monitoring patients' pain and impact on recovery, patients' need for support becomes visible which is valuable during hospital stays. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate cytokine levels in the masseter muscle, their response to experimental tooth-clenching and their relation to pain, fatigue and psychological distress in patients with temporomandibular disorders (TMD) myalgia. Methods: Forty women, 20 with TMD myalgia (Diagnostic Criteria for TMD) and 20 age-matched healthy controls participated. Intramuscular microdialysis was performed to sample masseter muscle cytokines. After 140 min (baseline), a 20-minute tooth-clenching task was performed (50% of maximal voluntary contraction force). Pain (Numeric rating scale 0-10) and fatigue (Borg's Ratings of Perceived Exertion 6-20) were assessed throughout microdialysis, while pressure-pain thresholds (PPT) were assessed before and after microdialysis. Perceived stress (PSS-10) and Trait Anxiety (STAI) were assessed before microdialysis. Results: The levels of IL-6, IL-7, IL-8 and IL-13 were higher in patients than controls (Mann Whitney U-test; P's < 0.05) during the entire microdialysis. IL-6, IL-8 and IL-13 changed during microdialysis in both groups (Friedman; P's < 0.05), while IL-1β, IL-7 and GM-CSF changed only in patients ( P's < 0.01). IL-6 and IL-8 increased in response to tooth-clenching in both groups (Wilcoxon test; P's < 0.05), while IL-7, IL-13 and TNF increased only in patients ( P's < 0.05). Patients had higher pain and fatigue than controls before and after tooth-clenching ( P < 0.001), and lower PPTs before and after microdialysis ( P < 0.05). There were no correlations between cytokine levels, pain or fatigue. Also, there were no differences in stress or anxiety levels between groups. Conclusions: In conclusion, the masseter levels of IL-6, IL-7, IL-8 and IL-13 were elevated in patients with TMD myalgia and increased in response to tooth-clenching. Tooth-clenching increased jaw muscle pain and fatigue, but without correlations to cytokine levels. This implies that subclinical muscle inflammation may be involved in TMD myalgia pathophysiology, but that there is no direct cause-relation between inflammation and pain. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to follow the symptom trajectory of community-dwelling older people with multimorbidity and to explore the effect on symptom burden from an ambulatory geriatric care unit, based on comprehensive geriatric assessment. Background Older community-dwelling people with multimorbidity suffer from a high symptom burden with a wide range of co-occurring symptoms often resulting to decreased health-related quality of life. There is a need to move from a single-disease model and address the complexity of older people living with multimorbidity. Design Secondary outcome data from the randomized controlled Ambulatory Geriatric Assessment Frailty Intervention Trial ( AGe- FIT). Methods Symptom trajectory of 31 symptoms was assessed with the Memorial Symptom Assessment Scale. Data from 247 participants were assessments at baseline, 12 and 24 months, 2011-2013. Participants in the intervention group received care from an ambulatory geriatric care unit based on comprehensive geriatric assessment in addition to usual care. Results Symptom prevalence and symptom burden were high and stayed high over time. Pain was the symptom with the highest prevalence and burden. Over the 2-year period 68-81% of the participants reported pain. Other highly prevalent and persistent symptoms were dry mouth, lack of energy and numbness/tingling in the hands/feet, affecting 38-59% of participants. No differences were found between the intervention and control group regarding prevalence, burden or trajectory of symptoms. Conclusions Older community-dwelling people with multimorbidity had a persistent high burden of symptoms. Receiving advanced interdisciplinary care at an ambulatory geriatric unit did not significantly reduce the prevalence or the burden of symptoms. [ABSTRACT FROM AUTHOR]

Clinical Trial Registration URL: . Unique Identifier: NCT00697359. Objectives To evaluate rhythm control up to two years after atrial fibrillation (AF) ablation and its relation to reported symptoms. Background The implantable loop recorder (ILR) continuously records the electrocardiogram (ECG), has an automatic AF detection algorithm, and has a possibility for patients to activate an ECG recording during symptoms. Methods Fifty-seven patients (mean age 57 ± 9 years, 60% male, 88% paroxysmal AF) underwent AF ablation following ILR implantation. Device data were downloaded at the ablation and three, six, 12, 18, and 24 months after ablation. Results Fifty-four patients completed the two-year follow-up. Thirteen (24%) patients had no AF episodes detected by ILR during follow-up. Ten of 41 patients (24%) with AF recurrence were only detected by ILR and AF recurrences were detected earlier by ILR (P < 0.001). The median AF burden in patients with AF recurrence was 5.7% (interquartile range 0.4-14.4) and was even lower in patients with AF only detected by ILR (P = 0.001). Forty-eight % of the patients indicated symptoms via the patient activator but 33% of those recordings were not due to AF. Early AF recurrence (within 3 months) was highly associated with later AF recurrence (P < 0.001). AF burden >0.5% and longest AF episode >6 hours before the ablation were independent predictors of AF recurrence during intermittent but not continuous monitoring. Conclusions After AF ablation, the AF burden was low throughout the 24 months follow-up. Nevertheless, symptoms were commonly indicated but one-third of patient-activated recordings did not show AF. Continuous monitoring was superior to intermittent follow-up in detecting AF episodes and assessing the AF burden. [ABSTRACT FROM AUTHOR]

Women are overrepresented among the group people suffering from long-term illness. In addition to their illness, suffering long-term sick leave leads to economical restraints as well social distress. There are gaps in our understanding of the challenges these women face. There is also lack of knowledge about how these challenges can be effectively addressed in rehabilitation. This deficiency is problematic from an ethical, justice and a caring perspective. In this study, changes in health-related quality of life ( HRQoL) among women on long-term sick leave were investigated during and after participating in a rehabilitation programme combining two validated methods, Garden Therapy and Supported Employment ( SE). The study also discusses difficulties in realising research related to vulnerable under-privileged people. From a population of 329 women who had reported their interest to participate, 245 were randomised to the programme. Of these 144 accepted participation in the research project and of these 123 women accepted to answer the SF-36 questionnaire. The participants were between 21 and 62 years with poor physical and mental health. They had received public financial support from <1 year to >10 years. The SF-36 measurement was carried out at baseline, after completion of Garden Therapy and after completion of SE. The results are based on data of respondents who participated at all the three occasions (n = 52). When comparing HRQoL baseline with the following occasions, the participants' General Health ( GH), Vitality ( VT), Social Functioning ( SF) and mental health had improved significantly. The Four Leaf Clover ( FLC) programme could be an appropriate method for reducing socially induced suffering. However, to conduct intervention studies where vulnerable persons are involved, it is off vital importance to consider whether the participants have the strength to complete the intervention. [ABSTRACT FROM AUTHOR]

Background Imitation, a key vehicle for both cognitive and social development, is often regarded as more difficult for children with autism spectrum disorders (ASD) than for children with Down syndrome (DS) or typically developing (TD) children. The current study investigates similarities and differences in observed elicited, spontaneous and deferred imitation using both actions with objects and gestures as imitation tasks in these groups. Methods Imitation among 19 children with autism was compared with 20 children with DS and 23 TD children matched for mental and language age. Results Elicited imitation resulted in significantly lower scores for the ASD group compared with the other two groups, an effect mainly carried by a low level of gesture imitation among ASD children. We observed no differences among the groups for spontaneous imitation. However, children with ASD or DS displayed less deferred imitation than the TD group. Proneness to imitate also differed among groups: only 10 (53%) of the children with autism responded in the elicited imitation condition compared with all children with DS and almost all TD children (87%). Conclusions These findings add to our understanding of the kind of imitation difficulties children with ASD might have. They also point to the necessity of not equating various imitation measures because these may capture different processes and be differently motivating for children with autism. [ABSTRACT FROM AUTHOR]

Aim To describe and compare general health and state anxiety before surgery and up to 6 months after surgery in patients with colorectal cancer undergoing elective rectal resection, abdominoperineal resection or colonic resection in an enhanced recovery context. Background Little is known about patient-reported health and anxiety after colorectal cancer surgery in an enhanced recovery context. Design A prospective cohort study. Methods Data were collected from October 2011-February 2013. The questionnaires - EuroQol 5-Dimensions 3-Levels and State-Trait Anxiety Inventory - were answered before surgery, at discharge and 1 and 6 months after surgery. Data were analysed using inferential statistics to describe differences between groups of patients (Kruskal-Wallis test) and between assessments within groups (Friedman's anova). Results Patients ( N = 105), divided into three groups based on surgical procedure, showed a high health index and a low state anxiety in all assessments without differences between the groups. Patients considered for abdominoperineal resection rated their pre-operative health as significantly higher than patients after rectal and colonic resections did. Within groups, patients recovering from abdominoperineal resection and rectal resection deteriorated significantly in health index 1 month after surgery. However, after 6 months they had improved again. After colonic resection, patients improved significantly in self-rated health and anxiety 1 month after surgery with no further discernible improvement after 6 months. Conclusion The study showed that patients generally had a high level of health and a low level of anxiety throughout the study period. Only a few differences occurred between assessments within groups. [ABSTRACT FROM AUTHOR]