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Objective: The main purpose of this study was to examine the development regarding objective parameters of pause- and speech measures in patients with unilateral vocal fold paralysis after injection treatment. Furthermore, this thesis examines the development regarding maximum phonation time (MPT) and Voice Handicap Index (VHI) scores after injection treatment and relates these findings to the measures of pause and speech. Method: This thesis is a retrospective study based on voice recordings from 24 patients with unilateral vocal fold paralysis, recorded at the hospital Sjællands Universitetssygehus before and after injection with RenuVoice in local anaesthetics. Furthermore VHI score was collected before and after treatment. In this thesis the voice recordings were analyzed in the computer base programme Praat, and statistics were calculated in the computer based programme R-Comander. The examined measures of pauses were number of pauses, average pause length in milliseconds, and the pause ratio that expresses the amount used on pausing during an reading aloud task. The examined measures of breath groups were number of breath groups, average length of breath group in seconds, articulation speed in segments per second and speaking rate in segments per seconds. MPT was also determined based on spectral information in Praat. Results: The main results of this thesis is that injection treatment has an effect on the pause measures, pause frequency and pause ratio, and on all speech measures. The only measure that did not show significant improvement with injection treatment was pause length. Furthermore, injection treatment showed effect on MPT and VHI. The participant with shortest MPT preinjection experienced the largest and most significant effect of injection treatment on pause- and speech measures. MPT correlated with several pause- and speech measures, whereas we did not find any correlation between VHI and any of the examined measures. Conclusion

Objective: The main purpose of this study was to examine the development regarding objective parameters of pause- and speech measures in patients with unilateral vocal fold paralysis after injection treatment. Furthermore, this thesis examines the development regarding maximum phonation time (MPT) and Voice Handicap Index (VHI) scores after injection treatment and relates these findings to the measures of pause and speech. Method: This thesis is a retrospective study based on voice recordings from 24 patients with unilateral vocal fold paralysis, recorded at the hospital Sjællands Universitetssygehus before and after injection with RenuVoice in local anaesthetics. Furthermore VHI score was collected before and after treatment. In this thesis the voice recordings were analyzed in the computer base programme Praat, and statistics were calculated in the computer based programme R-Comander. The examined measures of pauses were number of pauses, average pause length in milliseconds, and the pause ratio that expresses the amount used on pausing during an reading aloud task. The examined measures of breath groups were number of breath groups, average length of breath group in seconds, articulation speed in segments per second and speaking rate in segments per seconds. MPT was also determined based on spectral information in Praat. Results: The main results of this thesis is that injection treatment has an effect on the pause measures, pause frequency and pause ratio, and on all speech measures. The only measure that did not show significant improvement with injection treatment was pause length. Furthermore, injection treatment showed effect on MPT and VHI. The participant with shortest MPT preinjection experienced the largest and most significant effect of injection treatment on pause- and speech measures. MPT correlated with several pause- and speech measures, whereas we did not find any correlation between VHI and any of the examined measures. Conclusion

In this study, weekly mean of vegetation health index (VHI) for Tigray region from 1982 to 2016 was compared with mean VHI during 2017. The Vegetation Health index (VHI) is based on a combination of products extracted from vegetation signals, namely the Normalized Difference Vegetation Index (NDVI) and from the brightness temperatures, both derived from the NOAA Advanced Very High-Resolution Radiometer (AVHRR) sensor. The data and images have 4 km spatial and 7-day composite temporal resolution. VH is calculated based on strong inverse correlation between NDVI and land surface temperature, since increasing land temperatures are assumed to act negatively on vegetation and consequently to cause stress. The VHI values range from 0 to 100, the low values representing stressed vegetation health conditions, middle values representing fair health conditions, and high values representing optimal or above-normal vegetation health conditions. Vegetative drought conditions were calculated using vegetation health conditions as proposed by Kogan. Extreme Drought<10 VHI, Severe Drought<20 VHI, Moderate Drought<30VHI, Mild Drought <40 VHI, No Drought>40 VHI. The results showed during 1985, 1990 – 91, 2009 and 2015-16 there was large area covered under drought conditions in Tigray Region. Drought conditions were found in Tigray region during 32nd week to 42nd week of 2017. Results shows eastern and south eastern part of Tigray has not been as much affected as western and central part of Tigray during 2017.

In this study, weekly mean of vegetation health index (VHI) for Tigray region from 1982 to 2016 was compared with mean VHI during 2017. The Vegetation Health index (VHI) is based on a combination of products extracted from vegetation signals, namely the Normalized Difference Vegetation Index (NDVI) and from the brightness temperatures, both derived from the NOAA Advanced Very High-Resolution Radiometer (AVHRR) sensor. The data and images have 4 km spatial and 7-day composite temporal resolution. VH is calculated based on strong inverse correlation between NDVI and land surface temperature, since increasing land temperatures are assumed to act negatively on vegetation and consequently to cause stress. The VHI values range from 0 to 100, the low values representing stressed vegetation health conditions, middle values representing fair health conditions, and high values representing optimal or above-normal vegetation health conditions. Vegetative drought conditions were calculated using vegetation health conditions as proposed by Kogan. Extreme Drought<10 VHI, Severe Drought<20 VHI, Moderate Drought<30VHI, Mild Drought <40 VHI, No Drought>40 VHI. The results showed during 1985, 1990 – 91, 2009 and 2015-16 there was large area covered under drought conditions in Tigray Region. Drought conditions were found in Tigray region during 32nd week to 42nd week of 2017. Results shows eastern and south eastern part of Tigray has not been as much affected as western and central part of Tigray during 2017.

In this study, weekly mean of vegetation health index (VHI) for Tigray region from 1982 to 2016 was compared with mean VHI during 2017. The Vegetation Health index (VHI) is based on a combination of products extracted from vegetation signals, namely the Normalized Difference Vegetation Index (NDVI) and from the brightness temperatures, both derived from the NOAA Advanced Very High-Resolution Radiometer (AVHRR) sensor. The data and images have 4 km spatial and 7-day composite temporal resolution. VH is calculated based on strong inverse correlation between NDVI and land surface temperature, since increasing land temperatures are assumed to act negatively on vegetation and consequently to cause stress. The VHI values range from 0 to 100, the low values representing stressed vegetation health conditions, middle values representing fair health conditions, and high values representing optimal or above-normal vegetation health conditions. Vegetative drought conditions were calculated using vegetation health conditions as proposed by Kogan. Extreme Drought<10 VHI, Severe Drought<20 VHI, Moderate Drought<30VHI, Mild Drought <40 VHI, No Drought>40 VHI. The results showed during 1985, 1990 – 91, 2009 and 2015-16 there was large area covered under drought conditions in Tigray Region. Drought conditions were found in Tigray region during 32nd week to 42nd week of 2017. Results shows eastern and south eastern part of Tigray has not been as much affected as western and central part of Tigray during 2017.

OBJECTIVE: The aim of this multicentric cross-sectional study was to examine the permanency of Montgomery thyroplasty (MTIS) results from a patient's perspective. DESIGN: The study consisted of collecting Voice Handicap Index (VHI-30) questionnaires from patients who had previously been operated with MTIS between 2 and 12 years before. Very long-term (>2 years) postoperative data were compared with the previously acquired preoperative and early postoperative VHI results. Influence of factors such as age, gender, size/side of the prosthesis and length of the follow-up were also analysed. SETTING: Multicentric study involving three tertiary European voice centres. PARTICIPANTS: Forty-nine unilateral vocal fold paralysis (UVFP) patients, treated by MTIS, were included in the study. MAIN OUTCOME MEASURES: The Voice Handicap Index-30 score. RESULTS & CONCLUSIONS: The median VHI was significantly different over time-points (Friedman's test P < .001), with a significant difference between preoperative and early postoperative time-points (median VHI: 70 vs 21, respectively; P < .001) and between preoperative and very long-term postoperative time-points (median VHI: 70 vs 16, respectively; P < .001). The median VHI did not differ for the early and very long-term postoperative time-points (median VHI: 21 vs 16; P = .470). Age differences, gender differences and size/side differences of the prostheses, centres where surgery took place and length of the follow-up showed no significant influence. Medialisation thyroplasty (MT) overall and MTIS, in particular, should be considered as a possible standard of care for UVFP when permanency of voice results is sought.

Background: Patients infected with HIV-AIDS often suffer from various diseases affecting the skin known as skin diseases, same that may be early signs of infection, it is estimated that the number of patients with HIV / AIDS will develop some form of skin manifestation varies, but ranges from 40 to 95%. Objective: Establish the prevalence of skin diseases in patients with HIV -AIDS in the service of Dermatology of the Vicente Corral Moscoso Hospital, in the period from January 2010 to July 2015. Methodology: Retrospective descriptive study with patients with HIV-AIDS who presented some dermatosis who attended the Department of Dermatology; being used for the collection of information and data processing SPSS 21 statistical program in the same analyzed with descriptive statistical analytical, exploratory research level. Results: It was found that the prevalence of skin diseases in the study population was 18.3%. He found a population with an average age of 10.7 ± 34.5 years DS, the most common age group was between 30 and 39 years of age (35.6%), being mostly men (63.3%), and 80% had a viral load <10,000 copies, the average CD4 cell count was 271.2 ± 185.1 DS. 50% of patients with skin diseases, receive combination antiretroviral therapy that is used more than one antiretroviral, of which 87.6% has a suggestive dermatosis HIV-AIDS. Conclusion: The prevalence of skin diseases in patients with HIV-AIDS, during the period 2010-2015 at the Vicente Corral Moscoso Hospital was 18.3%

Background: Patients infected with HIV-AIDS often suffer from various diseases affecting the skin known as skin diseases, same that may be early signs of infection, it is estimated that the number of patients with HIV / AIDS will develop some form of skin manifestation varies, but ranges from 40 to 95%. Objective: Establish the prevalence of skin diseases in patients with HIV -AIDS in the service of Dermatology of the Vicente Corral Moscoso Hospital, in the period from January 2010 to July 2015. Methodology: Retrospective descriptive study with patients with HIV-AIDS who presented some dermatosis who attended the Department of Dermatology; being used for the collection of information and data processing SPSS 21 statistical program in the same analyzed with descriptive statistical analytical, exploratory research level. Results: It was found that the prevalence of skin diseases in the study population was 18.3%. He found a population with an average age of 10.7 ± 34.5 years DS, the most common age group was between 30 and 39 years of age (35.6%), being mostly men (63.3%), and 80% had a viral load <10,000 copies, the average CD4 cell count was 271.2 ± 185.1 DS. 50% of patients with skin diseases, receive combination antiretroviral therapy that is used more than one antiretroviral, of which 87.6% has a suggestive dermatosis HIV-AIDS. Conclusion: The prevalence of skin diseases in patients with HIV-AIDS, during the period 2010-2015 at the Vicente Corral Moscoso Hospital was 18.3%

Background: Patients infected with HIV-AIDS often suffer from various diseases affecting the skin known as skin diseases, same that may be early signs of infection, it is estimated that the number of patients with HIV / AIDS will develop some form of skin manifestation varies, but ranges from 40 to 95%. Objective: Establish the prevalence of skin diseases in patients with HIV -AIDS in the service of Dermatology of the Vicente Corral Moscoso Hospital, in the period from January 2010 to July 2015. Methodology: Retrospective descriptive study with patients with HIV-AIDS who presented some dermatosis who attended the Department of Dermatology; being used for the collection of information and data processing SPSS 21 statistical program in the same analyzed with descriptive statistical analytical, exploratory research level. Results: It was found that the prevalence of skin diseases in the study population was 18.3%. He found a population with an average age of 10.7 ± 34.5 years DS, the most common age group was between 30 and 39 years of age (35.6%), being mostly men (63.3%), and 80% had a viral load <10,000 copies, the average CD4 cell count was 271.2 ± 185.1 DS. 50% of patients with skin diseases, receive combination antiretroviral therapy that is used more than one antiretroviral, of which 87.6% has a suggestive dermatosis HIV-AIDS. Conclusion: The prevalence of skin diseases in patients with HIV-AIDS, during the period 2010-2015 at the Vicente Corral Moscoso Hospital was 18.3%

OBJECTIVE: CO2 laser cordectomy for glottic carcinoma offers excellent oncologic control on a per stage basis as compared with primary radiotherapy. We aim to further investigate the fluctuations of postoperative vocal outcomes following extended laser cordectomy for glottic cancer. DESIGN: Single center retrospective cohort study. METHODS: Eleven patients with glottic squamous cell carcinoma (SCC) who received CO2 laser cordectomy European Laryngological Society type III-IV with complete datasets at preoperative, immediate postoperative (within 4 months), and delayed (greater than 6 months) time points were included. RESULTS: All patients (n = 11) received cordectomy as their primary treatment. Tumor stage was divided evenly between T1 and T2. One patient was referred for post-cordectomy thyroplasty. Mean Voice Handicap Index (VHI) scores increased in the immediate postoperative period (43.3-46.2) but did not reach significance (P > 0.05). Delayed postoperative VHI (23.3) demonstrated substantial improvement from both pre- and immediate postoperative levels (P = 0.047). Objective voice rating significantly declined initially (P = 0.03; Grade, P = 0.01; Breathiness) and recovered to similar preoperative levels. Maximum phonation time (MPT) showed substantial decreases at the initial postoperative period (P = 0.007). Although significant improvement was made at the delayed postoperative point (P = 0.009), MPT remained below the preoperative level (P = 0.028). No significant changes were seen in phonatory subglottic pressures. CONCLUSIONS: Patients undergoing extended CO2 laser cordectomy for glottic cancers can experience initial decline in voice quality; however, vocal function routinely returns to preoperative levels following the initial healing period. A small percentage of extended cordectomy patients may require further vocal interventions.

Conclusion: The frequency of operations, age at onset, gender and subtype of the human papilloma virus (HPV) may be used as factors to predict voice disability. Objectives: Patients with recurrent respiratory papillomatosis (RRP) are characterized by morbid consequences due to a lifelong repetitive influence on voice and breathing ability and the need for recurrent surgical treatments. The aim of the study was to measure the quality of voice and life using evaluated and validated questionnaires in a northern Sweden RRP population. Methods: A total of 27 consecutive patients with RRP (age 21-71 years, median 47 years) were evaluated 3 months postoperatively (CO2 laser treatment) using the voice handicap index (VHI) and SF-36 questionnaires to assess the impact on life and voice in an RRP population. The values were compared to historical normative data, VHI ≤ 20. Results: Patients that underwent more than one operation per year were younger (p = 0.028) than those treated less frequently. The mean VHItotal score in patients with RRP was 39.3, indicating a statistically significant impairment of voice quality (p < 0.001) as compared with normal subjects. Voice dysfunction was observed in 21 patients (78%). Significantly lower values than the normal population regarding the quality of life in patients with RRP were obtained in the domain of social functioning (p = 0.029). Females, patients with frequent surgical treatment sessions and patients with the high-risk HPV types scored significantly lower in several domains of the quality of life assessment as compared with normal subjects. The results should be interpreted with caution due to the limited number of subjects.

Bakgrund Kraven på evidensbaserad vård ökar ständigt. Att jämföra patienters självskattade besvär före och efter behandling är ett sätt att utvärdera behandlingseffekten. Rösthandikappindex (RHI) och VA-skala för röstbesvär är två verktyg för utvärdering av röstbehandling. Tidigare studier har visat att röstbehandling ger minskade självskattade röstbesvär. Syfte Syftet med denna studie var att med självskattningsformulär utvärdera effekten av logopedisk röstbehandling i Västerbottens läns landsting (VLL) och undersöka om behandlingseffekten påverkas av kön, diagnos, antal behandlingstillfällen och hur mycket tid patienten är beredd att lägga på behandling, samt att undersöka om det finns ett samband mellan självskattningsformuläret RHI och VA-skala för röstbesvär. Metod 102 patienter, 28 män och 74 kvinnor, som under perioden januari 2009 till september 2012 genomgått logopedisk röstbehandling inom VLL, deltog i studien. Deltagarna rekryterades retrospektivt. Genom dataanalys undersöktes huruvida det fanns någon signifikant skillnad i poäng på RHI efter behandling, om det fanns några signifikanta skillnader i självskattning beroende på kön, diagnos eller antal behandlingstillfällen samt om det fanns en korrelation mellan RHI-poäng och skattning på VA-skala. Resultat En signifikant minskning av RHI-poäng kunde ses för hela gruppen efter röstbehandling jämfört med före. Inga signifikanta skillnader sågs mellan könen eller mellan grupper indelade utifrån antal behandlingstillfällen. Det fanns inte heller någon skillnad mellan olika diagnoser. Däremot sågs signifikanta korrelationer mellan RHI och VA-skala för röstbesvär. Slutsats Studien visade att de självskattade besvären minskade efter behandling. Resultaten var inte beroende av kön, diagnos eller antal behandlingstillfällen. Utifrån detta dras slutsatsen att den logopediska röstbehandlingen i Västerbottens läns landsting ger effekt. Vad gäller de självskattningsverktyg som används i verksamheten sågs en korrelatio, Background The demand for evidence based health care is increasing. One way to evaluate the effect of treatment is to compare patients’ self-assessed malaise before and after treatment. Two useful tools for evaluating voice therapy administered by a speech-language pathologist is Voice Handicap Index (VHI) and a Visual Analogue Scale, VA-scale, for voice problems. Previous studies has found that voice therapy results in a decreased level of voice problems Aim The aim of this study was to evaluate the effect of voice treatment administered by speech-language pathologists in Västerbottens läns landsting (VLL) with help of the self-assessment tools VHI and VA-scale for voice problems and to investigate if there were any differences in the self-assessment due to gender, diagnosis, number of treatment sessions or the amount of time the patient was willing to spend on voice therapy. The aim was also to investigate if there was a correlation between the VHI and the VA-scale for voice problems. Method This retrospective study has analyzed self-assessment forms from 102 patients, 28 men and 74 women, who have been seeing a speech-language pathologist for voice therapy sometime between January 2009 and September 2012 in VLL. Data analysis was used to investigate if there was any significant difference in VHI points before and after voice therapy, if there was any significant differences in the self-assessment due to gender, diagnosis or number of therapy sessions and if there was a correlation between the points on VHI and self-assessed malaise on the VA-scale for voice problems. Results There was a significant decrease of VHI points for the whole group after

Bakgrund Kraven på evidensbaserad vård ökar ständigt. Att jämföra patienters självskattade besvär före och efter behandling är ett sätt att utvärdera behandlingseffekten. Rösthandikappindex (RHI) och VA-skala för röstbesvär är två verktyg för utvärdering av röstbehandling. Tidigare studier har visat att röstbehandling ger minskade självskattade röstbesvär. Syfte Syftet med denna studie var att med självskattningsformulär utvärdera effekten av logopedisk röstbehandling i Västerbottens läns landsting (VLL) och undersöka om behandlingseffekten påverkas av kön, diagnos, antal behandlingstillfällen och hur mycket tid patienten är beredd att lägga på behandling, samt att undersöka om det finns ett samband mellan självskattningsformuläret RHI och VA-skala för röstbesvär. Metod 102 patienter, 28 män och 74 kvinnor, som under perioden januari 2009 till september 2012 genomgått logopedisk röstbehandling inom VLL, deltog i studien. Deltagarna rekryterades retrospektivt. Genom dataanalys undersöktes huruvida det fanns någon signifikant skillnad i poäng på RHI efter behandling, om det fanns några signifikanta skillnader i självskattning beroende på kön, diagnos eller antal behandlingstillfällen samt om det fanns en korrelation mellan RHI-poäng och skattning på VA-skala. Resultat En signifikant minskning av RHI-poäng kunde ses för hela gruppen efter röstbehandling jämfört med före. Inga signifikanta skillnader sågs mellan könen eller mellan grupper indelade utifrån antal behandlingstillfällen. Det fanns inte heller någon skillnad mellan olika diagnoser. Däremot sågs signifikanta korrelationer mellan RHI och VA-skala för röstbesvär. Slutsats Studien visade att de självskattade besvären minskade efter behandling. Resultaten var inte beroende av kön, diagnos eller antal behandlingstillfällen. Utifrån detta dras slutsatsen att den logopediska röstbehandlingen i Västerbottens läns landsting ger effekt. Vad gäller de självskattningsverktyg som används i verksamheten sågs en korrelatio, Background The demand for evidence based health care is increasing. One way to evaluate the effect of treatment is to compare patients’ self-assessed malaise before and after treatment. Two useful tools for evaluating voice therapy administered by a speech-language pathologist is Voice Handicap Index (VHI) and a Visual Analogue Scale, VA-scale, for voice problems. Previous studies has found that voice therapy results in a decreased level of voice problems Aim The aim of this study was to evaluate the effect of voice treatment administered by speech-language pathologists in Västerbottens läns landsting (VLL) with help of the self-assessment tools VHI and VA-scale for voice problems and to investigate if there were any differences in the self-assessment due to gender, diagnosis, number of treatment sessions or the amount of time the patient was willing to spend on voice therapy. The aim was also to investigate if there was a correlation between the VHI and the VA-scale for voice problems. Method This retrospective study has analyzed self-assessment forms from 102 patients, 28 men and 74 women, who have been seeing a speech-language pathologist for voice therapy sometime between January 2009 and September 2012 in VLL. Data analysis was used to investigate if there was any significant difference in VHI points before and after voice therapy, if there was any significant differences in the self-assessment due to gender, diagnosis or number of therapy sessions and if there was a correlation between the points on VHI and self-assessed malaise on the VA-scale for voice problems. Results There was a significant decrease of VHI points for the whole group after

The objective of the study was to measure the subjective long-term effects of vocal therapy (more than 6 months) in 29 patients suffering from dysfunctional dysphonia. Four subjective measurements were used: one visual analog scale ranging from 0 (not efficient at all) to 100 (very efficient); one question "Is the speech therapy still efficient?," answered by yes or no; the GRB parameters of the GRBAS scale (evaluated by the patient); and the VHI-10. The results show that 76% of the patients consider that the vocal therapy they received is still efficient. On the vocal quality (G), roughness (R), and breathiness (B) parameters, we observe a high degree of satisfaction on the G parameter (median=77). The scores on the R and B parameters are lower (median R=12, S=5). Roughness is significantly correlated to the Grade (Spearman coefficient r=0.516, P=0.004), whereas breathiness is not (P=0.251, NS). The comparison of the results on the VHI-10 pre and post treatment shows a significant decrease in the grade of perceived handicap (medians 15 vs 11, P=0.017). The correlations between the judgment of the treatment's efficacy and the vocal quality is significant (r=0.623, P<0.001) as well as the correlation between the VHI-10 and the length of the treatment (r=0.416, P=0.035). The conclusion can be made that speech therapy plays an important role in long-term treatment of dysfunctional dysphonias.

Denna prospektiva studie har bedrivits på tämligen outforskad mark och handlar om patienters subjektiva bedömning av läkningsförloppet efter en stämvecksoperation. Den brist på forskning inom området som råder beror sannolikt på svårigheter att få fram en tydlig bild av behandlingens effekt. Vi kan endast fråga patienterna efter deras individuella och subjektiva åsikt kring deras egen röstfunktion och på så sätt skapa en bild av dess påverkan i vardagen. För att kartlägga läkningsprocessen efter fonokirurgi ombads en grupp patienter att fylla i två olika utvärderingsformulär före operation och vid givna tidpunkter under en tremånadersperiod postoperativt. Patienter råddes efter operation att använda rösten då det kändes bekvämt, men att inte överanstränga den. Det utvärderingsmaterial som användes var Röst- och Slemhinne/Sång-formuläret (RoS-formuläret) vilket består av fem delar som behandlar olika aspekter av röstfunktionen. Dessutom användes en för den här studien framtagen, kortare enkät med 9 frågor som besvaras på en VAS-skala. Den kortare enkäten är baserad på RoS-formulärets fem delar. Den femte delen (sångröstdelen) av RoS-formuläret samt en motsvarande fråga i VAS-enkäten föll senare bort på grund av för låg svarsfrekvens. Av 36 patienter som ingick i studien var det endast 18 st som hade fullföljt undersökningen efter tre månader. Dessa 18 patienter delades sedan in i grupper efter diagnos, för att kunna ta hänsyn till divergerande läkningsförlopp. Resultaten av både VAS-enkäten och RoS-formuläret visar på en märkbar generell förbättring efter tre månader för alla patienter inom samtliga områden. Dessutom visar de två enkättyperna på samstämmighet då resultaten från båda avslöjar att de största problemen ligger inom området fysiologiska besvär och att det område som påverkas minst är det emotionella. Vidare syns i resultatet att en försämring ofta sker innan patienterna känner sig bättre.