Stuttering affects 1% of schoolchildren – early intervention is recommended, within 1 year of onset

Stuttering, also known as stammering, is a common speech disorder of neural speech processing that typically begins during the first 3-4 years of life. A review of 44 studies shows a prevalence of around 1% for schoolchildren.

Stuttering is a movement disorder of speech, with effects on the:

- jaw

- mouth
- facial muscles
- sometimes upper limbs
People who stutter are at risk of developing social anxiety or mental health problems. Educational, occupational, and social problems are common if chronic stuttering is not treated early

It is not possible to predict who will recover spontaneously. The window of opportunity is to treat children within one year of onset.

Early intervention is recommended, preferably within one year of onset of stuttering. Speech restructuring can rehabilitate speech in people with chronic stuttering

References:

Clinical management of stuttering in children and adults. BMJ 2011; 342:d3742 doi: 10.1136/bmj.d3742 (Published 24 June 2011).

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5 factors define happiness at work

Research on psychological well-being at work (PWBW) is challenging.

Factor analysis revealed that psychological well-being at work can be conceptualized through 5 dimensions:

- Interpersonal Fit
- Thriving
- Feeling of Competency
- Desire for Involvement
- Perceived Recognition

This also applies to the training of medical residents and fellows. It is important to create an environment that promotes collaboration and personal growth, while avoiding exhaustion and finger pointing.

References:

What is Psychological Well-Being, Really? A Grassroots Approach from the Organizational Sciences. Véronique Dagenais-Desmarais and André Savoie. Journal of Happiness Studies, 2011.

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Accessibility Extensions for Chrome Browser – Text-to-Speech and More

ChromeVox is just one of the Google Accessibility extensions. Be sure to check out ChromeVis, ChromeShades, and ChromeLite as well. The text-to-speech (TTS) programs convert text or web documents to human speech. Does it sound like a human voice? Not really, it is a computer-generated voice but it is as close to human as it gets. You can adjust the speed, repeat, or change the pitch of the voice.

ChromeVox

The ChromeVox screen reader is an extension to Chrome that brings the speed, versatility, and security of Chrome to visually impaired users.

Using Google Document List with ChromeVox that provides accessibility features for vision impaired users of Google Docs.

Other text-to-speech extensions include:
Chrome Speak - select to speak with offline TTS engine.
SpeakIt! Select text you want to read and listen to it. SpeakIt converts text into speech so you no longer need to read.

SpeakIt reads selected text using Google TTS (Text-to-Speech) with language auto-detection.

Balabolka

If you are not a Chrome user, Balabolka is a free and portable Text-To-Speech (TTS) program that is browser-independent. No installation is required.

You don't have to be visually impaired to benefit from TTS programs. For example, I use Balabolka several times a week to convert long articles from medical journals or newspapers to standard MP3 files. The files are then uploaded to Google Docs and I download them when I have some time to listen to the articles.

ChromeVis

Magnify and change the color of any selected text. Use the mouse or the keyboard to move the selection around the page.

How ChromeVis works.

ChromeShades

ChromeShades is an easy tool to help you make your site more accessible to blind users.

References:

Hear Web Text with Google Chrome Speak
New Text-to-Speech API for Chrome extensions

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Anatomy of the Penis: Penile and Foreskin Neurology – Video

Ken McGrath, Senior Lecturer in Pathology at the Faculty of Health, Auckland University of Technology and Member of the New Zealand Institute of Medical Laboratory Scientists discusses his research into the neural anatomy of the human penis and the physical damages caused by circumcision. McGrath is author of The Frenular Delta: A New Preputial Structure published in Understanding Circumcision: A Multi-Disciplinary Approach to a Multi-Dimensional Problem, Proceedings of the Sixth International Symposium on Genital Integrity: Safeguarding Fundamental Human Rights in the 21st Century, held December 7-9, 2000, in Sydney Australia. Abstract: Textbooks and papers referring to penile function state that the source of penile sensation is solely the glans and often justify the existence of the prepuce by stating it protects the 'sensitive' glans.

Read more here:
Anatomy of the Penis: Penile and Foreskin Neurology - Video

Neurological and autoimmune disorders after influenza vaccination: no change in risk for Guillain-Barré syndrome, MS, type 1 diabetes, or RA

This Swedish retrospective cohort study, published in BMJ, examined the risk of neurological and autoimmune disorders in people vaccinated against pandemic influenza A (H1N1) with Pandemrix (GlaxoSmithKline) compared with unvaccinated people over 8-10 months.


Image of the H1N1 Influenza Virus, CDC.

One million people were vaccinated against H1N1 and 900,000 remained unvaccinated.

Excess risks among vaccinated people were of low magnitude, but present, for:

- Bell’s palsy (hazard ratio 1.25)
- paresthesia (1.11)
- inflammatory bowel disease (IBD)

Risks for Guillain-Barré syndrome, multiple sclerosis, type 1 diabetes, and rheumatoid arthritis remained unchanged.

The risks of paresthesia and inflammatory bowel disease (IBD) among those vaccinated in the early phase (within 45 days) of the vaccination campaign were significantly increased; the risk being increased within the first 6 weeks after vaccination.

The risks were small but significant among more than one million vaccinated, but only in high risk groups targeted for early vaccination and who were likely to have earlier comorbidity.

The absolute risk of Bell’s palsy was low, 6.4 cases per 100?000 vaccinated population.

References:

Neurological and autoimmune disorders after vaccination against pandemic influenza A (H1N1) with a monovalent adjuvanted vaccine: population based cohort study in Stockholm, Sweden. BMJ 2011; 343:d5956 doi: 10.1136/bmj.d5956 (Published 12 October 2011).

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Standard American Diet (Yes, it’s SAD)

The average American consumes 45 gallons of soft drinks annually. This does not include noncarbonated sweetened beverages, which add up 17 gallons a person per year. Chips and Coke are a common breakfast.

Nearly a third of American children are overweight or obese. In our inner cities a prevalence of obesity of more than 50% is not uncommon. Too many calories in, too little energy out. An 18% tax on pizza and soda can decrease U.S. adults' weight by 5 pounds (2 kg) per year, according to some researchers.

Here are some ideas how to promote healthy diet from from the NYTimes:

- taxing unhealthy food would reduce consumption and generate billions of dollars annually. That money could be used to subsidize the purchase of staple foods like seasonal greens, vegetables, whole grains, dried legumes and fruit. Sell those staples cheap - let’s say for 50 cents a pound - and almost everywhere: drugstores, street corners, convenience stores, bodegas, supermarkets, liquor stores, even schools, libraries and other community centers.

- convert refrigerated soda machines to vending machines that dispense grapes and carrots, as has already been done in Japan

References:

The solution: Tax Soda, Subsidize Vegetables? NYTimes.
Timeline of the Standard American Diet in the NYTimes.
18% tax on pizza and soda can decrease U.S. adults' weight by 5 pounds (2 kg) per year
Image source: Soft drinks, Wikipedia, public domain.

Comments from Twitter:

@drjohnm (John Mandrola, MD): Call me simple, even progressive; yet it's hard 2 oppose a soda tax.
@DrJonathan (Jonathan,DO,MS,NCC): I'm against soda as much as anyone. But, this is America. People should have the right to make their own food/beverage choices.

Comments from Google Plus:

Jamie Rauscher - Mark Bittman makes some excellent points. Taxing unhealthy foods may help (studies have shown cigarette taxes can discourage smoking) but it is not the complete solution. We must continue to educate people too about the importance of eating at home. The amount of time people spend preparing meals continues to decline. (See report "Who has time to cook?" by US Economic Research Service) Many people also no longer know how to cook. Finally we need to teach nutrition to children and adults. I recently completed a nutrition class in a graduate program at Boston University. It was a real eye opener--and I thought I was pretty knowledgeable going into the class.

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