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1.
Dtsch Arztebl Int ; 121(5): 155-162, 2024 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-38377329

RESUMO

BACKGROUND: Approximately 9.9 % of children present with difficulties in language development (DLD), 7.6 % without serious additional impairments and 2.3 % associated with languagerelevant comorbidities, e.g., hearing loss. Notably, in a consensus statement by experts in German-speaking countries, in the guideline presented here, and further in this article, all of these disorders are referred to as "developmental language disorders" (DLD), whereas the international consortium CATALISE only refers to those without comorbidities as DLD. DLDs are among the most commonly treated childhood disorders and, if persistent, often reduce educational and socio-economic outcome. Children in their third year of life with developmental language delay (late talkers, LT) are at risk of a later DLD. METHODS: This German interdisciplinary clinical practice guideline reflects current knowledge regarding evidence-based interventions for developmental language delay and disorders. A systematic literature review was conducted on the effectiveness of interventions for DLD. RESULTS: The guideline recommends parent training (Hedges g = 0.38 to 0.82) for LTs with expressive language delay, language therapy (Cohen's d = -0.20 to 0.90) for LTs with additional receptive language delay or further DLD risk factors, phonological or integrated phonological treatment methods (Cohen's d = 0.89 to 1.04) for phonological speech sound disorders (SSDs), a motor approach for isolated phonetic SSDs (non-DLD), and for lexical-semantic and morpho-syntactic impairments combinations of implicit and explicit intervention approaches (including input enrichment, modeling techniques, elicitation methods, creation of production opportunities, metalinguistic- approaches, visualizations; Cohen's d = 0.89-1.04). Recom mendations were also made for DLD associated with pragmatic-communicative impairment, bi-/ multilingualism, hearing loss, intellectual disability, autism-spectrum disorders, selective mutism, language- relevant syndromes or multiple disabilities, and for intensive inpatient language rehabilitation. CONCLUSION: Early parent- and child-centered speech and language intervention implementing evidence-based intervention approaches, frequency, and settings, combined with educational language support, can improve the effectiveness of management of developmental language delay and disorders.


Assuntos
Transtornos do Desenvolvimento da Linguagem , Terapia da Linguagem , Humanos , Transtornos do Desenvolvimento da Linguagem/terapia , Transtornos do Desenvolvimento da Linguagem/diagnóstico , Alemanha , Terapia da Linguagem/métodos , Pré-Escolar , Criança , Masculino , Feminino , Guias de Prática Clínica como Assunto
2.
Clin Linguist Phon ; 36(2-3): 241-259, 2022 03 04.
Artigo em Inglês | MEDLINE | ID: mdl-34291705

RESUMO

Normative data on phonological acquisition of a language are a prerequisite for evaluating children's speech sound competences. To date, these data are not sufficiently available for Italian. This study, therefore, aimed to describe the phonological development of 183 typically developing monolingual Italian-speaking children aged 3;0-4;11 (four 6-months age bands). Participants were assessed through a picture naming task, and performances analysed in terms of number of phonological variations (Tokens), Types and percentage of occurrence of patterns, and number of infrequent variants (InfrVar) as a measure of stability in speech production. Two cut-off criteria to distinguish InfrVar from phonological patterns were applied. Results showed a gradual reduction of all measures with increasing age. Twenty-two patterns generally in line with previous Italian and cross-linguistic studies were observed, with only five patterns and two phonetic distortions occurring across all age groups. Eight patterns only emerged when applying the lower cut-off criterion, while further seven patterns only occurred with very low frequency or in isolated age groups. These findings highlight the influence of the selected cut-off criterion on the identification of patterns and raise the question of whether some patterns should rather be considered InfVar. Data on younger children are still needed to clarify whether low-frequency patterns are patterns of younger typically developing children that have almost resolved in the age groups assessed. At least half of the phonological variation Tokens fell into the category of InfrVar, indicating a need to pay more attention to this so far ignored measure.


Assuntos
Idioma , Fonética , Criança , Linguagem Infantil , Humanos , Itália , Fala , Medida da Produção da Fala
3.
J Commun Disord ; 95: 106168, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34864604

RESUMO

PURPOSE: The identification and differential diagnosis of children with speech sound disorders (SSD) is an important task of paediatric speech-language pathologists (SLPs). A correct identification requires valid and reliable assessment tools. Therefore, the aim of the present study was to investigate the diagnostic validity and accuracy as well as inter-rater reliability of the phonology test of LogoFova which was developed for Danish-speaking children. METHOD: Investigation was carried out on two Danish-speaking populations: 61 suspected typically developing (TD) children and 61 children with suspected speech sound disorder aged 2-6 years. All children were assessed with the single-word picture-naming test of LogoFoVa. In order to determine diagnostic validity, it was investigated whether the test differentiated TD children from children with SSD as well as subgroups of SSD via a phonetic and phonological pattern analysis. Two different cut-off criteria were applied for the definition of patterns. Sensitivity and specificity as well as likelihood ratios were additionally calculated. To determine inter-rater reliability, transcriptions, pattern analyses and subgrouping were compared across raters. RESULTS: Overall, diagnostic validity of the picture-naming test of LogoFoVa was good as differentiation between TD children and children with suspected SSD as well as amongst subgroups of SSD (articulation impairment, phonological delay and atypical speech development) was possible. However, accuracy of differentiation between TD children and children with SSD was affected by the cut-off criterion applied. Inter-rater reliability was found to be almost perfect for transcription and moderate for identification of phonological processes as well as for subgrouping. Again, agreement rates depended on the cut-off criterion chosen for the definition of a phonological pattern. CONCLUSION: LogoFoVa was found to be a reliable and valid clinical tool for the identification and subgrouping of children with SSD in Danish SLP practice if a new cut-off criterion was applied.


Assuntos
Transtorno Fonológico , Criança , Pré-Escolar , Dinamarca , Humanos , Idioma , Fonética , Reprodutibilidade dos Testes , Transtorno Fonológico/diagnóstico
4.
Am J Manag Care ; 27(10): 425-431, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34668671

RESUMO

OBJECTIVES: To evaluate the impact of a collaborative effort of a Medicare Advantage and prescription drug (MAPD) plan and community pharmacies to improve vaccination rates for pneumonia and influenza. STUDY DESIGN: This quasiexperimental, cluster-randomized intervention study used MAPD data to assess the impact of community pharmacists on vaccination rates. Pharmacies in specific regions (districts) were randomly assigned to intervention or control groups. Intervention pharmacies received reports of patients with a gap in influenza (aged 19-89 years) and/or pneumococcal (aged 65-89 years) vaccinations based on medical and pharmacy claims history. Vaccine-naïve patients were offered vaccinations. METHODS: The vaccination rates for the previously vaccine-naïve patients utilizing intervention and control pharmacies were compared 6 months post randomization. Inverse probability weighted hierarchical generalized linear models determined the odds of receiving pneumonia and influenza vaccinations for intervention and control groups, controlling for baseline clinical and demographic characteristics. RESULTS: Intervention and control groups had similar ages in the pneumococcal older-adult cohort (mean age, 73.0 vs 73.4 years, respectively; P = .1255). The intervention group was older than the control group in the influenza cohort (mean age, 67.7 vs 66.4 years, respectively; P = .0006). Slightly more than half of each cohort were women, and the proportion of women was not significantly different between the intervention and control groups in each cohort. In multivariable analyses, intervention pharmacies were associated with higher odds of delivering pneumococcal (odds ratio [OR], 1.91; 95% CI, 1.26-2.87) and influenza (OR, 2.18; 95% CI, 1.37-3.46) vaccinations than control pharmacies. CONCLUSIONS: A health plan-enabled, pharmacist-led intervention was effective in increasing the number of older adults receiving pneumococcal vaccination and individuals receiving influenza vaccination.


Assuntos
Serviços Comunitários de Farmácia , Influenza Humana , Medicare Part C , Farmácias , Farmácia , Idoso , Feminino , Humanos , Influenza Humana/tratamento farmacológico , Influenza Humana/prevenção & controle , Estados Unidos , Vacinação
5.
Clin Linguist Phon ; 35(2): 185-200, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32126852

RESUMO

Prelexical phonetic capacities have widely been described to be a precursor for later speech and language development. However, studies so far varied greatly in the measurements used for the detection of canonical babbling onset or the description of infants' phonetic capacities at one or more set time points. The comparability of results is, therefore, questionable. Thus, the aims of this study were to investigate the associations between (1) different measurements of CBO, (2) different aspects of phonetic capacity at the age of 9 months and (3) age of CBO and phonetic capacities at 9 months. A further aim (4) was to explore whether one of the measures would be suitable to predict the age of word onset (WO) in 20 healthy German-acquiring individuals. The data were derived from monthly recorded spontaneous speech samples between 0 and 18 months. It was found that the different applied prelexical measures equally well serve as valid estimators for the detection of CBO or of infants' phonetic capacities. Further, age of CBO and phonetic capacities at 9 months were significantly associated even though the age of CBO did not reliably predict phonetic capacities. Prelexical measures and WO were not related. Reasons for no indication of a significant association are discussed.


Assuntos
Fonética , Percepção da Fala , Humanos , Lactente , Idioma , Desenvolvimento da Linguagem , Fala , Distúrbios da Fala
6.
Curr Dev Disord Rep ; 6(3): 111-118, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31984204

RESUMO

PURPOSE OF REVIEW: To summarize findings about the emergence and characteristics of canonical babbling in children with late detected developmental disorders (LDDDs), such as autism spectrum disorder, Rett syndrome, and fragile X syndrome. In particular, we ask whether infants' vocal development in the first year of life contains any markers that may contribute to earlier detection of these disorders. RECENT FINDINGS: Only a handful studies have investigated canonical babbling in infants with LDDDs. With divergent research paradigms and definitions applied, findings on the onset and characteristics of canonical babbling are inconsistent and difficult to compare. Infants with LDDDs showed reduced likelihood to produce canonical babbling vocalizations. If achieved, this milestone was more likely to be reached beyond the critical time window of 5-10 months. SUMMARY: Canonical babbling appears promising as a potential marker for early detection of infants at risk for developmental disorders. In-depth studies on babbling characteristics in LDDDs are warranted.

7.
Clin Linguist Phon ; 32(10): 913-931, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29781753

RESUMO

This study reports on the developmental patterns of /ʃC/ clusters in 145 normally developing monolingual German-speaking children between 2;00 and 2;11. All children completed a picture naming task to allow a systematic qualitative analysis of the production patterns. Children's reductions of target /ʃC/clusters are examined and are evaluated with respect to two models, 'factorial typology' and 'headedness', to account for them. The results reveal expected patterns of C2 retention for '/ʃ/+[-continuant]' (e.g. '/ʃ/+stop' and '/ʃ/+nasal') targets, and a rather indeterminate pattern for /ʃl/ and /ʃʁ/. The results for /ʃv/, a clear-cut preference of C2 retention, were rather unexpected, as the C2 is a [+continuant]. The explanation offered for the retention of /v/ is related to a place constraint. The study also examines the data from children who reached an advanced stage of cluster formation with differential targets. More specifically, in several children, one target, /ʃv/, is found to have stayed behind in the reduction phase while all others have advanced to the 'cluster stage'. Neither the type nor the token frequencies seem satisfactory in accounting for the specific behaviour of /ʃv/. The explanation offered for the uniqueness of this target may be its non-abidence to the Sonority Sequencing Principle (SSP) because of its flat sonority and the Obligatory Contour Principle (OCP) [continuant], because of the unchanging 'continuance' which is demanded by the OCP. Theoretical and clinical implications are discussed.


Assuntos
Desenvolvimento da Linguagem , Fonética , Testes de Articulação da Fala , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Idioma , Masculino , Fonação
8.
Clin Linguist Phon ; 31(6): 440-458, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28430531

RESUMO

Detailed knowledge about speech development in children acquiring different languages provides important information from a clinical and a theoretical perspective: First, it provides a baseline for the evaluation of whether a child shows typical, delayed or deviant speech development. Further, differences in speech development across languages can help to understand how the phonological systems of ambient languages affects children's speech acquisition. To date, little is known about Danish. It was suggested, however, that the acquisition process might be slower for Danish-speaking children due to the "blurry" sound structure of Danish. The aim of the current study was, therefore, to investigate typical speech development in 443 Danish-speaking children, i.e. types and age of occurrence of children's phonological processes as well as on the acquisition of phones and clusters. The results showed that Danish-speaking children, in contrast to the expectations, were not delayed but advanced compared to children acquiring other languages.


Assuntos
Linguagem Infantil , Desenvolvimento da Linguagem , Fonética , Medida da Produção da Fala/métodos , Fala/fisiologia , Pré-Escolar , Estudos Transversais , Dinamarca , Feminino , Humanos , Masculino
9.
Int J Speech Lang Pathol ; 19(5): 476-489, 2017 10.
Artigo em Inglês | MEDLINE | ID: mdl-27882773

RESUMO

PURPOSE: The aim of this study was to explore cluster acquisition in typically developing German-speaking 2-year-olds. METHOD: Data from four cross-sectional studies (n = 145, aged 2;00-2;11) and one eight-month longitudinal study were analysed (n = 6, aged 2;01-2;04). Two different percentages of consonant clusters correct were calculated to allow a more detailed analysis. RESULT: Findings showed that the majority of children produced clusters, although they could not be considered to be fully acquired. Correct production significantly correlated with age. Only /gl/ and /kl/ were shown to be phonetically and phonemically acquired (75% criterion) in the older age group. Three-element clusters were acquired at the same time as 2-element clusters and /∫/-clusters were acquired to the same or larger extent as non-/∫/ clusters when fronting/backing of /∫/ was accepted. Younger children produced more reductions than simplifications but this effect was less strong for the /∫/-clusters. Developmental realisation patterns varied depending on cluster type. Inter- and intra-individual developmental patterns could be observed which changed depending on the time of testing. CONCLUSION: Findings on cluster acquisition in 2-year-old German-speaking children revealed language-specific differences but also similarities in comparison with results from other languages. All but two children produced clusters. However, individual variation between children was high.


Assuntos
Linguagem Infantil , Desenvolvimento da Linguagem , Pré-Escolar , Feminino , Alemanha , Humanos , Masculino
10.
J Am Pharm Assoc (2003) ; 55(6): 634-641, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26547597

RESUMO

OBJECTIVE: To user-test and evaluate a performance information management platform that makes standardized, benchmarked medication use quality data available to both health plans and community pharmacy organizations. SETTING: Multiple health/drug plans and multiple chain and independent pharmacies across the United States. EVALUATION: During the first phase of the study, user experience was measured via user satisfaction surveys and interviews with key personnel (pharmacists, pharmacy leaders, and health plan leadership). Improvements were subsequently made to the platform based on these findings. During the second phase of the study, the platform was implemented in a greater number of pharmacies and by a greater number of payers. User experience was then reevaluated to gather information for further improvements. RESULTS: The surveys and interviews revealed that users found the Web-based platform easy to use and beneficial in terms of understanding and comparing performance metrics. Primary concerns included lack of access to real-time data and patient-specific data. Many users also expressed uncertainty as to how they could use the information and data provided by the platform. CONCLUSION: The study findings indicate that while information management platforms can be used effectively in both pharmacy and health plan settings, future development is needed to ensure that the provided data can be transferred to pharmacy best practices and improved quality care.


Assuntos
Serviços Comunitários de Farmácia/normas , Gestão da Informação em Saúde/normas , Sistemas de Informação em Saúde/normas , Seguro Saúde/normas , Farmacêuticos/normas , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Acesso à Informação , Atitude do Pessoal de Saúde , Atitude Frente aos Computadores , Pesquisa sobre Serviços de Saúde , Humanos , Entrevistas como Assunto , Farmacêuticos/psicologia , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
11.
Health Aff (Millwood) ; 33(8): 1444-52, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25092847

RESUMO

Improving medication adherence across the health care system is an ingredient that is vital to improving patient outcomes and reducing downstream health care costs. The Pennsylvania Project, a large-scale community pharmacy demonstration study, evaluated the impact of a pharmacy-based intervention on adherence to five chronic medication classes. To implement the study, 283 pharmacists from a national community pharmacy chain were assigned to the intervention group. Collectively, they screened 29,042 patients for poor adherence risk and provided brief interventions to people with an elevated risk. Compared to a control group of 295 pharmacists who screened 30,454 patients, the intervention significantly improved adherence for all medication classes, from 4.8 percent for oral diabetes medications to 3.1 percent for beta-blockers. Additionally, there was a significant reduction in per patient annual health care spending for patients taking statins ($241) and oral diabetes medications ($341). This study demonstrated that pharmacist-provided intervention is a cost-effective tool that may be applied in community pharmacies and health care sites across the country.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Adesão à Medicação , Farmacêuticos , Doença Crônica/tratamento farmacológico , Educação em Farmácia , Feminino , Custos de Cuidados de Saúde , Humanos , Masculino , Educação de Pacientes como Assunto , Pennsylvania , Honorários por Prescrição de Medicamentos , Papel Profissional , Fatores de Risco
12.
Clin Linguist Phon ; 23(6): 404-30, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-19504399

RESUMO

The development of phonological awareness (PA), the ability to reflect on the sound structure of words independent of their meaning, has been extensively explored in English-speaking children. However, this is not the case for other languages. The aim of this study was to develop a comprehensive PA test battery for German-speaking preschool children, considering psycholinguistic, linguistic, and cognitive aspects and to carry out analyses of its psychometric properties. Cross-sectional data from a sample of 55 children (CA 4;0-6;11 years) were collected. Preliminary findings confirm validity and reliability of the test battery, and support previous findings that PA develops from larger to smaller linguistic units. Phoneme-level tasks were consistently associated with letter knowledge. The new instrument is a promising tool for basic research (e.g. cross-linguistic comparisons of PA development) as well as for clinical and educational practice (e.g. planning speech and language therapy or literacy-oriented intervention).


Assuntos
Linguagem Infantil , Testes de Linguagem , Fonética , Fatores Etários , Criança , Pré-Escolar , Cognição , Estudos Transversais , Feminino , Humanos , Idioma , Masculino , Psicolinguística , Psicometria/métodos , Leitura , Reprodutibilidade dos Testes , Fatores Sexuais
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