Volume 16, Issue 1

Introduction: Early clinical diagnosis of heart failure (HF) is challenging because the signs and symptoms are neither sensitive nor specific for diagnosis. B-type natriuretic peptide (BNP), a cardiac neurohormone is a useful biomarker for patients with HF. Objectives: The purpose of this review is to evaluate the role of BNP in HF as a diagnostic, prognostic, and therapeutic marker in both outpatient care and urgent care settings. Methodology: An extensive literature review was conducted for this study. Findings: Determination of BNP is particularly useful as a rule-out test for suspected cases of HF in patients with dyspnoea. HF is very unlikely in patients with levels of BNP <100 pg/mL whereas BNP levels >400 pg/mL strongly support the diagnosis of HF. Elevated level of BNP indicates a worse prognosis in patients with HF. Conclusion: Although, it is recommended in the diagnostic pathways of guidelines for HF, it is not well established to recommend measurement of BNP to titrate HF medications because of lack of enough evidence. It requires further in-depth research.

Sexuality is an issue of equality, rights, and ethics, especially when it comes to the sexuality of people with intellectual and developmental disabilities (IDD). This paper offers a discussion of ethics related to the assessment and intervention supports of sexual behavior in people with IDD. A brief history of sexuality and disability is presented. Issues of sexual abuse of people with IDD and the laws related to sterilization, pornography, sexual rights, and consent are explored. Finally, specific ethical concerns related to intervention by behavior analysts in the realm of sexual behavior are examined.

A disabled person with acquired disability must manage to cope with social identity, reconstruct their identity and construct own biography from scratch. People with inborn disability create their identity of a disabled person from the beginning. They are educated to play a role of a person with disabilities in society. The stigma of disability remains with a disabled person forever. Disability becomes the central category determining the social identity of these individuals. The problems which were raised are connected with setting up the line between personal and social identity, between satisfying the need of being unique and the need to belong, between defining a person through the prism of stigma and perceiving them as representative of the specific type of personality. The mark of the person with disability that this disability imprints in their life is the best known only by the people who live with it. The article is an attempt to answer questions: Is it possible to manage the social identity or does the disabled person need to reconstruct their identity or construct their biography from scratch? What are the chances of dealing with disability stigma?

Background: Time is of the essence in treating autism spectrum disorders (ASD). Intensive and effective therapies can advance acquisition of adaptive and communication skills during the lag time until entry into a pre-school program. Objective: To jump start treatment in very young toddlers with ASD and good cognitive potential, therapeutic modifications of the Early Start Denver Model (ESDM) were examined. Method: The changes involved more intensive cooperative treatments, with two different therapists (“hybrid”), reinforcing behavioral manipulations with the children. The intensified therapies were to maximize gains over shorter periods of time, dictated by limitations of resources. Results: Thirty children (mean age 24 m., average duration 4.1 m.) improved on their goal attainment scale (GAS) ratings on nearly all functional measures, (p<0.001). Of 23 ADOS scores, 19 improved, the average pre-treatment ADOS score was 17.7 (SD 3.4) and post-treatment 13.3 (SD 5.34). The correlation between GAS and ADOS score improvement was significant (R=0.67, p<0.001). Conclusion: The acceleration in social communication and adaptive skill gains in the treatment of very young children using modifications in treatment therapies already in wide- scale use, indicates the as-yet untapped treatment potential for many young children with ASD.

Many studies have investigated whether elevated levels of physical activity and fitness improve academic performance in children, but only a few have examined whether it is physical fitness which varies with academic performance. The purpose of this study was to examine if academic performance is indeed an indicator for physical fitness. For this study, middle school students were recruited for the necessary values and information. The data acquired for academic performance were based off of a public honour roll list distributed within the school community and physical fitness was evaluated via mile-run time, resting, post-active blood pressure and heart rate. There were no differences in proportion across the academic cohorts for any measurements of physical fitness. There was no conclusion such as “students with higher academic performance are less physically fit”; all academic cohorts had relatively similar levels of physical fitness. This may be due to mandatory physical and health education classes, which all students attend; the physical fitness levels are similar due to similar training.

Problem-based learning (PBL) is a teaching and learning approach that is widely used in healthcare education. It has similarly been suggested that poetry writing offers students a way to express their feelings and emotions related to clinical issues, medical education, and their relationship with patients. The rhythmic structure and temporal organisation of poetry allow students to remember poetry more easily than prose, suggesting that important and detailed information could be better memorised through poetic text. To report on how poetry writing and reciting was used in a PBL class in nursing to enhance the students’ artistic ability, and on the students’ perspectives on artistry in their learning. This paper presented a part of results of a main educational study where data were collected through lesson observations, reflective notes, and a follow-up interview. A total of 17 Hong Kong students were encouraged to collaborate in groups and write English poems based on a clinical case. A content analysis was conducted on their reflective notes and narratives were extracted from an interview. Although the students learned about cooperation, creativity, thinking, stress management, how to make lively presentations, deep learning, long-term memory, and professional knowledge, they expressed that the above were indirectly related to artistry. Scholars from the fields of both health related disciplines and literature should collaborate in researching and developing some learning and teaching activities which can further enhance the students’ artistic ability so as to let them learn about empathy and understand patients’ sufferings and illness experiences.

Introduction: Hearing is the most important sense, as it controls an individual’s both comprehension and production. One of the most important aspects that disturbs the voice throughout speech is hearing as it provides essential feedback for control. The deficit of feedback can be substituted by the use of amplification in such patients with hearing loss (HL). Hence, the current study was aimed to study the effect of HL on vocal parameters in individuals with HL and to study the influence of hearing aid signal processing on vocal parameters. Method: Sixteen male subjects of the age range 18–70 years with sensorineural HL participated and underwent a preamplification voice evaluation using the Multi-Dimensional Voice Program (MDVP) software followed by different amplifications with different signal processing. Results: The results revealed that there is a significant difference in the voice parameters with and without a hearing aid for both 3-channel and ChannelFree™ (p<0.05). No significant difference was observed when the voice parameter was compared between the two hearing aids. Conclusion: The voice analysis from the current study revealed that amplification brought a change in the vocal parameters but on the negative side. This infers the importance of auditory feedback during vocalization. Also, acclimatization of the hearing aids plays a major role in influencing the changes in the voice parameters of the hearing aid individuals.

Tutoring is often a useful supplement to traditional classroom teaching in Canada. Cross-age tutoring, which involves a tutor a few years older than a tutee, has been reported to be more effective than same-age tutoring, as it promotes responsibility, empowerment and academic performance. However, the current same-age classroom teaching may act as a barrier to cross-age tutoring because the latter requires plenty of coordination, preparation and organization. At Crescent School, an all-boys independent school in Toronto, Canada, a pilot online cross-age peer-tutoring program was launched in September 2014, named Crescent School vLearning. The purpose of this study was to formally assess the program, and quantitatively gauge its success. Thirty-six questions were randomly selected from the vLearning website, examined for response time and response quality as assessed by students and teachers. The fast response times as well as the high-quality of responses have resulted in the program gaining traction in the school. As vLearning continues to catch-on with students, the team of Upper School tutors will soon need to be expanded to accommodate the increasing volume of questions.

Background: The second most common age-related chronic neurodegenerative disease after Alzheimer’s disease is Parkinson’s disease (PD). Objective: The focus of this study was to improve the functional capabilities of the participants with PD. Study groups: The PD participants were randomized into two groups: Feldenkrais and control. Methods: The Feldenkrais group underwent 50 sessions of an exercise program based on the Feldenkrais method. The control group received educational lectures during this period. Unified Parkinson’s Disease Rate Scale (UPDRS – session III), mini-mental state evaluation (MMSE), Hoehn and Yahr scale, and functional tests (figure-of-eight walk test, timed-up-and-go test, rollover task, 360 degrees turn-in-place, functional-reach test, sitting-and-standing test, Berg balance scale (BBS), and hip-flexion strength) were assessed in both groups. Procedures during the 50 sessions were conducted in an appropriate room, twice-a-week, on alternate days and lasted 60 min. Results: Thirty subjects were randomly divided into two groups: the Feldenkrais (n=15) and the control (n=15) group. The Feldenkrais group presented significantly better in functional tests (p<0.05) when compared to the control group. The control group received lower scores after the 50-session period in the sitting/standing test (p=0.02), 360 degrees turn-in-place (p=0.01), and rollover test (p=0.01). Results of the BBS demonstrated significantly higher scores in the Feldenkrais group after treatment (p=0.004) when compared to the control group (p=0.01). Conclusion: The Feldenkrais lessons produced specific changes in functional mobility in PD participants.

Introduction: The Convention on the Rights of Persons with Disabilities (CRPD) has been touted as a major breakthrough towards achieving equal rights for persons with disabilities. The promulgation of the convention provided clear guidelines for signatory countries to revise their legislation as well as to formulate policies that will take into consideration the needs of persons with disabilities. As Cameroon is a signatory to the convention, it is expected that disability-friendly policies have been implemented to enhance the living conditions of persons with disabilities. This study examined, from the perspectives of participants, the life experiences of persons with disabilities in the Buea Municipality 7 years after Cameroon signed the CRPD. Methods: The study adopted a qualitative method, involving focus-group discussions with 36 participants from three disability groups: hearing impaired, visually impaired, and physically impaired. Findings: The study found that persons with disabilities in the Buea Municipality faced many challenges in their daily endeavors. These challenges are a result of a lack of inclusive policies, leading to their exclusion from social and economic activities such as education, employment, and healthcare. Conclusion: Although the study is limited in scope, the findings suggest that persons with disabilities in the Buea Municipality were yet to benefit from the CRPD. It is, therefore, suggested that the government of Cameroon should formulate inclusive policies to address the numerous challenges facing persons with disabilities in the Buea Municipality.

Introduction: Unemployment is one of the major challenges facing persons with disabilities worldwide. Persons with disabilities experience significantly high rates of unemployment compared with the general population, and are often employed in low-paid jobs. This could indicate a missing link in identifying employment opportunities and impeding factors to the opportunities. This study examined access to employment opportunities for persons with disabilities in the Nairobi County in Kenya. Method: An exploratory study design, using qualitative methods, was conducted with three categories of persons with disabilities: the physically disabled, the visually impaired, and the hearing impaired. A convenient sampling was used to recruit 30 participants from five constituencies in Embakasi in the Nairobi County. Findings: The study found that access to employment for persons with disabilities in the study area was limited. Factors responsible for the high unemployment include inaccessible information on employment, negative attitudes, inaccessible physical environment, low educational attainment of persons with disabilities, and ineffective legislation on employment. Conclusion: The lack of employment opportunities for persons with disabilities in Kenya suggests that poverty reduction among persons with disabilities will be difficult. Therefore, efforts should be made through implementation of effective policies to remove barriers hindering access to employment for persons with disabilities in Kenya.

This study explored students’ perspectives on the abilities acquired through a subject called Health Management and Social Care (HMSC), which was launched under Hong Kong’s new senior secondary curriculum. The first public examination for the subject was conducted in 2012. A qualitative design was adopted in the present study, with focus group interviews carried out with 123 students recruited from seven schools. Two major themes were identified via content analysis: (i) critical thinking and creativity in HMSC; and (ii) applications of critical thinking and creativity in HMSC with two subthemes (a) health/social care promotions on campus and (b) social services in communities. Both the implications and limitations of the study for health-related subjects were discussed.

Early childhood teachers are a unique population of teachers and it is important to determine amendable factors that contribute to their stress. According to available research, challenging child behavior is associated with teacher stress and burnout in school-aged teachers. Given the lack of formal and coordinated in-service education and varied qualifications, early childhood teachers are particularly vulnerable to stress. Further, young children are more likely to have challenging behavior given their social-emotional developmental levels. The purpose of this study was to explore teacher characteristics and perceptions related to their stress, commitment, support, and challenging child behavior in their classrooms. Participants included 100 early childhood professionals. A teacher survey was utilized to determine their perceptions related to key variables. Regression analyses documented teacher commitment and challenging behavior in the classroom uniquely predicted variance in teacher ratings of stress and burnout. Commitment to their job was also a significant predictor to their perceptions of challenging behavior. However, only teacher stress/burnout predicted ratings of challenging behavior; thus, relationships among variables may be more complex. Teachers’ years of experience and education level were not related to other variables. For exploratory purposes, teacher professional development perceptions were also surveyed and results indicated that the vast majority of early childhood educators felt professional development was a good use of their time and that they wished more opportunities were available; however, most also indicated they felt training covered information they already knew.

Music has important consequences on the anatomo-functional organization of the brain. Learning and listening to music has various advantages beginning with relaxation, mind training and neural strengthening. Learning music when young has a wide influence on cognion, attention and listening thereby resulting in better performance in most tasks. Currently the practice of parents exposing their children from the womb through their children’s early years has not been researched and explored. Method: School going children who are undergoing music training for more than 2 years and an non-musical control group were tested for auditory processing abilities for pitch perception, gap detection and auditory processing performance scale. Result: The children in the school going amateur musical group out performed the non-musical trained group in the pitch pattern test, the random gap detection test and in the child auditory processing performance scale. Conclusion: Music training results in better temporal processing which can be shown in classroom activities. The improvement observed in amateur musicians over a short training duration, can be attributed to the pitch, loudness, and duration of the acrobatics that the musicians undergo. Studying these aspects and reporting the benefits help in designing training modules for children with various developmental disorders.

Purpose: This cross-sectional study evaluated the relationship between dysphagia post-total laryngectomy (TL) and quality of life (QoL) of people who reside in Greece. This is the first such report to be undertaken on the topic. Methods: Speech and language therapists typically use patient judgement to identify difficulties with swallowing. The Greek adaptations of the M.D. Anderson Dysphagia Inventory (MDADI) and the Eating Assessment Tool (EAT-10) were completed by members of the Hellenic Association of Laryngectomees (HAL). More than 400 questionnaires were sent, but only 23 were returned (18 males and 5 females). Results: The results revealed that dysphagia has a negative impact on the QoL of people who have undergone TL for treatment of laryngeal cancer. Conclusion: It appears that not only treatment (i.e. TL) of the primary disease, but also secondary problems as a result of the treatment, such as dysphagia, have a significant impact on the QoL of patients and must be taken into consideration when therapeutic decisions for laryngeal cancer are made. The qualitative measures used here provide a starting point to objectively describe QoL as perceived by TL patients. This is particularly pertinent in Greece where access to delivery and quality of health services has been challenging because of recent fiscal constraints.

This short communication suggests that there may be biological in addition to psychosocial reasons underlying the rise in suicide among older men. Testosterone, the major male sex hormone, has attracted interest as a putative biological mediator of suicide risk, but observational data have been mixed. Age stratification may reveal that high levels of testosterone in adolescents and young adults but low levels in the elderly may mediate suicide risk. A putative age-testosterone-suicide differential may be mediated by divergent central nervous system architecture between adolescents and the elderly. Whereas the prefrontal and prefontal-limbic connectivity underdevelopment observed in adolescents may render vulnerability to testosterone-mediated increases in impulsivity as a risk factor for suicide, declining function of dopaminergic striato-thalamic reward pathways in the aging cohort may render older men vulnerable to the loss of testosterone’s protective effects against anhedonia, thereby increasing suicide risk through a different biological pathway. Further research is needed regarding the role of hypotestosteronemia in elderly suicide.