Search

Objective: The purpose of this study was to quantitatively compare the effectiveness of unilateral and bilateral botulinum toxin A (BTX-A) injections for mitigating undesirable weak/breathy voice quality and dysphagia for patients with adductor spasmodic dysphonia and/or essential tremor of voice (ETV)., Methods: Data were collected from the medical records of 319 patients, yielding three treatment cohorts: patients who received an equal dose bilateral injection regimen (BL=) throughout their course of treatment at VUMC, patients who switched to a unilateral injection regimen (UL), and patients who switched to an unequal dose bilateral injection regimen (BL≠). Changes in length of improvement, duration of weak/breathy voice, and dysphagia severity were compared., Results: The BL = treatment group reported the longest duration of improved voice. Shorter periods of improved voice were reported at baseline by patients who later switched to UL or BL ≠ injection regimens. Patients receiving UL injections reported significantly reduced weak/breathy voice and dysphagia. Patients receiving BL ≠ injections reported increased length of improved voice; however, dysphagia symptoms increased. Ninety-two percent of patients with ETV switched to a UL regimen, with 61% of patients transitioning within the first three injections., Conclusions: Patients with pronounced dysphagia and extended periods of weak/breathy voice may benefit from a UL injection approach to mitigate side effects from BTX-A without sacrificing improved voice outcomes. For patients seeking to extend their length of improved voice, a BL ≠ injection regimen may be effective provided the adverse side effects from BTX-A are minimal. Patients with ETV may benefit from a UL injection approach at the outset of their course of treatment with BTX-A., Level of Evidence: III., Competing Interests: The authors have no conflicts of interest to disclose., (© 2022 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.)

This article aims to contribute to the existing literature about liveability in rural areas by explicitly focusing on the level of residential satisfaction of older adults (55+) in four small Dutch villages. We strive not only to identify the key indicators of residential satisfaction among older villagers but also to better understand how these indicators affect their (daily) life. Moreover, in line with the person-environment fit tradition, we differentiate according to the capabilities and vulnerabilities of older villagers. To this end, we use a mixed-method approach, in which we combine survey data with qualitative data collected with photovoice in the four villages. The findings indicate that older adults' perceptions of spatial, social and functional aspects of the living environment are related to the degree of residential satisfaction overall. However, these perceptions appear to be strongly intertwined, especially perceptions about spatial characteristics, local identity and connectedness. Older adults who are hindered by health problems in undertaking daily activities experience a lower level of person-environment fit, which is reflected in a lower level of residential satisfaction. However, this relationship between subjective health and residential satisfaction can only be partially explained by different perceptions of the spatial, social and functional environment.

Due to social, political, and demographic developments in Dutch healthcare, the pressure on informal carers of vulnerable, senior citizens living at home continues to increase. To relieve this pressure, people in the senior citizens' social network are looking for ways to share care tasks with others. However, many informal caregivers seem to experience a threshold in this respect. This pilot study focuses on understanding the considerations involved in sharing caregiving tasks with others. Therefore, semi-structured interviews were conducted with six informal caregivers of single, senior citizens living at home. This study shows that these considerations are characterised by a relationship between informal caregivers' workload, their shyness to ask others for help, and the perception of care recipients' demand, combined with informal caregivers' natural inclination to do it themselves. Feelings of being responsible for the care and behaviour of care recipients, and the choices that must be made for them seem to play an additional role. To develop adequate solutions that lead to sharing informal care with others, and relieving the pressure on informal caregivers, more insight into the (personal) mechanisms behind this sense of responsibility seems necessary.

Microbial community engineering aims for enrichment of a specific microbial trait by imposing specific cultivation conditions. This work demonstrates that things may be more complicated than typically presumed and that microbial competition can be affected by seemingly insignificant variables, like in this case the type of acid used for pH control. Aerobic bioreactors pulse fed with acetate operated with hydrochloric acid resulted in the enrichment of Plasticicumulans acidivorans, and changing the pH controlling agent to sulfuric acid shifted the community towards Zoogloea sp. Further research demonstrated that the change in community structure was not directly caused by the change in acid used for pH control, but resulted from the difference in corrosive strength of both acids and the related iron leaching from the bioreactor piping. Neither system was iron deficient, suggesting that the biological availability of iron is affected by the leaching process. Our results demonstrate that microbial competition and process development can be affected dramatically by secondary factors related to nutrient supply and bioavailability, and is way more complex than generally assumed in a single carbon substrate limited process., (© The Author(s) 2021. Published by Oxford University Press on behalf of FEMS.)