Phonology, morphology and speech processing development in Greek-speaking children.

Α psycholinguistic framework for speech processing was adopted to investigate the development of phonological and morphological skills in children learning Greek. It was investigated whether morphological items pose specific challenges in terms of speech processing. Two groups of typically developing children aged 3.0-3.5 years (N = 16) and 4.6-5.0 years (N = 22), respectively, were assessed longitudinally at three assessment points 6 months apart. A range of phonologically based and morphologically based experimental speech processing tasks was administered to address the research question, along with language comprehension and production assessments to ensure that the children were developmentally typical. Stimuli of minimal phonological difference and minimal morphological difference, respectively, were used. Phonologically based experimental stimuli were used to assess performance differences across properties such as voicing, manner and place of articulation, in addition to variation in phonotactic structure. Morphologically based experimental stimuli were used to assess the impact of characteristics such as verb tense and possessive pronouns. Stimuli were incorporated into tasks of real word and nonword auditory discrimination and repetition, to assess input and output processing. Items were matched across tasks so that comparisons could be made. On most of the matched tasks, there was no significant difference in performance accuracy between morphological and phonological conditions. Moreover, a significant relationship was found between domains. It is suggested that morphological items, compared to phonological items, do not pose specific challenges in terms of speech processing. The clinical implications of these findings for assessment and intervention are discussed.

Patient-reported outcomes following flexible sigmoidoscopy screening for colorectal cancer in a demonstration screening programme in the UK.

OBJECTIVES: Flexible sigmoidoscopy (FS) screening for colorectal cancer will be introduced into the National Cancer Screening Programmes in England in 2013. Patient-reported outcome measures (PROMs) from trial participants indicate high acceptability and no adverse physical or psychological consequences, but this may not generalize to routine screening in the community. This study examined PROMs in a community-based FS screening programme. METHODS: Eligible adults aged 58-59 (n = 2016) registered at 34 London general practices were mailed a National Health Service-endorsed invitation to attend FS screening. Pain and side-effects were assessed in a 'morning-after' questionnaire, and satisfaction was assessed in a three-month follow-up questionnaire. Anxiety, self-rated health and colorectal symptoms were assessed at prescreening and follow-up. RESULTS: In total, 1020 people attended screening and were included in the current analyses, of whom 913 (90%) returned the morning-after questionnaire, and 674 (66%) the follow-up questionnaire. The prescreening questionnaire had been completed by 751 (74%) of those who attended. The majority (87%) of respondents reported no pain or mild pain, and the most frequent side-effect (wind) was only experienced more than mildly by 16%. Satisfaction was extremely high, with 98% glad they had the test; 97% would encourage a friend to have it. From prescreening to follow-up there were no changes in anxiety or self-rated health, and the number of colorectal symptoms declined. Satisfaction and changes in wellbeing were not moderated by gender, deprivation, ethnicity or screening outcome. CONCLUSIONS: PROMs indicate high acceptability of FS screening in 58-59 year olds, with no adverse effects on colorectal symptoms, health status or psychological wellbeing.

Assessing speech perception in children with language difficulties: effects of background noise and phonetic contrast.

Deficits in speech perception are reported for some children with language impairments. This deficit is more marked when listening against background noise. This study investigated the speech perception skills of young children with and without language difficulties. A speech discrimination task, using non-word minimal pairs in an XAB paradigm, was presented to 20 5-7-year-old children with language difficulties and 33 typically-developing (TD) children aged between 4- to 7-years. Stimuli were presented in quiet and in background noise (babble), and stimuli varied in phonetic contrasts, differing in either place of articulation or presence/absence of voicing. Children with language difficulties performed less well than TD children in all conditions. There was an interaction between group and noise condition, such that children with language difficulties were more affected by the presence of noise. Both groups of children made more errors with one voicing contrast /s z/ and there was some indication that children with language difficulties had proportionately greater difficulty with this contrast. Speech discrimination scores were significantly correlated with language scores for children with language difficulties. Issues in developing material for assessment of speech discrimination in children with LI are discussed.

Nurses' experiences of a colorectal cancer screening pilot.

This article describes a study that set out to explore the experience of endoscopy nurse practitioners participating in the Department of Health-funded UK Nurse-led Flexible Sigmoidoscopy Colorectal Cancer Screening Pilot. Semi-structured interviews were conducted with the three nurse practitioners involved and were analysed using Thematic Analysis, a qualitative method for analysing and reporting patterns (themes) within data. Nurse practitioners found that participating in the study improved their skills and provided job satisfaction despite the hard work it entailed. A varied workload consisting of diagnostic and screening procedures, in addition to the other duties of nurse practitioners, may be desirable for nurses working in the field of gastroenterology.

Flexible sigmoidoscopy screening for colorectal cancer: uptake in a population-based pilot programme.

OBJECTIVE: The aim of this study was is to examine uptake of population-based, flexible sigmoidoscopy (FS) screening delivered by nurses in a socioeconomically and ethnically diverse area of London, England. METHODS: All adults aged 58 and 59 years registered at 34 general practices in North London (n = 2260) were mailed an invitation to attend FS screening at the local hospital. RESULTS: In total, 45% (1024/2260) accepted the invitation and attended, 5% (114/2260) accepted the invitation but failed to attend, 5% (111/2260) accepted the invitation but were unable to attend within the time-frame of the pilot study, 7% (165/2260) declined the offer, 27% (602/2260) did not respond, and 11% (244/2260) were ineligible or did not receive the invitation. Among those eligible to be screened, the uptake rate was 51% (1024/2016). Uptake did not differ by gender, but people living in the most affluent quintile of areas had a substantially higher uptake rate (63%) than those living in the most deprived quintile (38%). CONCLUSION: Uptake of FS screening delivered as a population-based programme was over 50% among the eligible population in a socioeconomically and ethnically diverse area of London. Disparities in uptake should be addressed to avoid exacerbating health inequalities.

Assessing speech perception in young children and relationships with language skills.

Few materials are available to assess speech perceptual skills in young children without hearing impairments. However, children with a range of developmental conditions are at risk of speech discrimination deficits. Tasks that reliably assess speech perception skills are thus necessary for research and clinical practice. The development and application of two speech perception tests are described. Data were collected from 105 children, aged 4-5 years, attending mainstream schools, on two tasks, mispronunciation detection and non-word XAB, in quiet and in a background of multi-talker babble. Children's receptive language skills were also measured. Performance on mispronunciation detection was significantly better than on the XAB non-word task, and significantly better in quiet than in babble. Performance significantly improved with age, and speech discrimination was significantly related to receptive language abilities. Scores obtained in quiet and in babble were highly correlated and findings suggest there may be no advantage to testing in noise, except to avoid ceiling effects on performance. These tasks prove useful in the assessment of young children who may have speech discrimination deficits.

Uptake of population-based flexible sigmoidoscopy screening for colorectal cancer: a nurse-led feasibility study.

OBJECTIVE: To assess uptake of once-only flexible sigmoidoscopy (FS) in a community sample to determine whether FS would be viable as a method of population-based screening for colorectal cancer. METHODS: All adults aged 60-64 years registered at three General Practices in North West London, UK (510 men and women) were sent a letter of invitation to attend FS screening carried out by an experienced nurse, followed by a reminder if they did not make contact to confirm or decline the invitation. The primary outcome was attendance at the endoscopy unit for a FS test. RESULTS: Of the 510 people invited to attend, 280 (55%) underwent FS. Among non-attenders, 91 (18%) were ineligible for screening or did not receive the invitation, 19 (4%) accepted the offer of screening but were unable to attend during the study period, 52 (10%) declined the offer, 41 (8%) did not respond to the invitation, and 27 (5%) accepted the offer of screening but did not attend. Attendance among those eligible to be screened, who had received the invitation, was 67%. People from more socioeconomically deprived neighbourhoods were less likely to attend (odds ratio [OR] = 0.90; confidence interval [CI] = 0.84-0.96; P = 0.003). Women were more likely to attend than men (OR = 1.44; CI = 1.01-2.05; P = 0.041). CONCLUSIONS: Attendance rates in this pilot for nurse-led, population-based FS screening were higher than those reported in other FS studies, and comparable with adherence to fecal occult blood testing (FOBT) in the UK FOBT pilot. Having a female nurse endoscopist may have been responsible for increasing female uptake rates but this warrants confirmation in a larger study.

Speech-production skills in children aged 3-7 years.

BACKGROUND: In recent years, clinicians have been using a psycholinguistic approach to the assessment and remediation of children's developmental speech disorders. This requires the comparison of a child's performance across a range of speech-production tasks. AIMS: To describe the profile of performance across different speech-production tasks in normal development and to discuss the application of such data to clinical findings. METHODS & PROCEDURES: Three speech-production tasks, picture naming, word repetition and non-word repetition, were presented to 100 children with normal speech development, aged between 3 and 7 years of age. The speech-processing demands of the different tasks were considered using a developmental speech-processing model. Stimuli used in the three task paradigms were carefully matched so that children's performance across the tasks could be directly compared. OUTCOMES & RESULTS: Within the context of normal speech development, there were significant improvements in performance for all three tasks as children get older. There were also significant differences in performance across the three tasks, and the pattern of these relationships changed with age. Significant differences were found in the accuracy of production of words of increasing length. CONCLUSIONS: Profiles of speech-production task performance are presented within the context of normal development. Comparison of performance across three different speech-production tasks might provide useful insight into the nature of a child's speech disorder.

Cardiovascular effects at multi-detector row CT colonography compared with those at conventional endoscopy of the colon.

PURPOSE: To compare the cardiovascular effects of computed tomographic (CT) colonography and conventional endoscopy in a group of patients undergoing both procedures. MATERIALS AND METHODS: A total of 144 patients underwent CT colonography followed by flexible sigmoidoscopy (40 patients) or colonoscopy (104 patients). Pulse, blood pressure, and oxygen saturation were measured before, during, and after the procedures. Forty patients also underwent continuous Holter electrocardiographic (ECG) monitoring. Periprocedural pain was assessed by using a handheld counting device. Outcome variables were assessed by using a combination of paired t testing and multilevel linear regression. RESULTS: When a spasmolytic was not used, CT colonography was associated with only a small increase in oxygen saturation (P =.03), while use of a spasmolytic caused an increase in pulse (mean increase, 19.9 beats per minute; P <.001) and diastolic blood pressure (mean increase, 5 mm Hg; P <.001). Compared with that at CT, oxygen saturation decreased significantly during and after colonoscopy and sigmoidoscopy (mean decrease after colonoscopy with sedation, 1.0%; P <.001). Systolic and diastolic blood pressure also decreased during and after colonoscopy (mean systolic decrease after colonoscopy with sedation, 16.6 mm Hg, P <.001; mean diastolic decrease after colonoscopy with sedation, 7.5 mm Hg, P <.001). Patients were 30.3 times more likely to develop bradycardia after endoscopy (95% CI: 2.65, 346; P =.006). Ventricular couplets were significantly higher at endoscopy than at CT in patients with a history of cardiac disease (odds ratio: 72.5 and 95% CI: 4.56, 1,153 at CT vs odds ratio: 14.6 and 95% CI: 0.96, 222 at endoscopy; P =.002). Patients were 1.89 times more likely to register pain during colonoscopy than during CT (95% CI: 1.06, 3.38; P =.03). CONCLUSION: CT colonography had no significant cardiovascular effect other than spasmolytic-induced tachycardia. Endoscopy-and colonoscopy in particular-causes cardiovascular effects that are largely related to sedation. CT colonography is less painful than colonoscopy and is comparable to flexible sigmoidoscopy.

Acceptance by patients of multidetector CT colonography compared with barium enema examinations, flexible sigmoidoscopy, and colonoscopy.

OBJECTIVE: The purpose of this study was to compare patient acceptance of multidetector CT colonography, total colonoscopy, flexible sigmoidoscopy, and double-contrast barium enema to ascertain any overall preference. SUBJECTS AND METHODS. One hundred sixty-eight patients underwent CT colonography followed by either flexible sigmoidoscopy (n = 59) or colonoscopy (n = 109). A 25-point questionnaire with principal components relating to satisfaction, worry, and physical discomfort was administered after CT colonography and after endoscopy, and a follow-up questionnaire was administered 1 week after the procedures. Questionnaires were also completed by 140 patients undergoing double-contrast barium enema examinations. Responses were compared using Wilcoxon's matched pairs test and the Mann-Whitney test. RESULTS: Overall satisfaction was greater with colonoscopy (p = 0.01), but CT colonography caused less discomfort (p = 0.002), was better tolerated (p = 0.005), and was the preferred follow-up investigation of those expressing a preference (p = 0.003). Compared with flexible sigmoidoscopy, CT colonography caused less pain (p = 0.004), was more acceptable (p = 0.04), and was preferred as the follow-up investigation (p < 0.001). Tolerance of colonoscopy was significantly less in women (p = 0.03), but such was not the case for CT colonography (p = 0.58). Patients undergoing CT colonography were less worried (p < 0.001), were more satisfied (p = 0.001), and suffered less discomfort (p < 0.001) than those having barium enema. CONCLUSION: Patients' experiences with barium enema examinations were significantly worse than with any other test. Although patients were most satisfied with colonoscopy, they reported more pain during both colonoscopy and sigmoidoscopy than during CT colonography, and they also found CT more acceptable. In patients expressing a preference, CT colonography was the preferred follow-up investigation.