Concepts of Illness Causation and Responsibility: Some Preliminary Data from a Sample of Working-Class Mothers

Purpose The purpose of this study is to examine the frequency and type of speech disfluencies (stuttering-like and nonstuttering-like) in bilingual Spanish–English (SE) children who stutter (CWS) to SE children who do not stutter (CWNS) during narrative samples elicited in Spanish and English to provide further diagnostic information for this population and preliminary data toward an expansion of this study. Method Participants included six bilingual SE children (three CWS, three CWNS) ranging in age from 5 years to 7;5 (years;months) and recruited from the surrounding Houston, Texas area. Participants provided a narrative sample in English and Spanish. The frequency of speech disfluencies was tabulated, and mean length of utterance was measured for each sample. Results Results indicate that both talker groups exceed the diagnostic criteria typically used for developmental stuttering. Regardless of the language being spoken, CWS participants had a frequency of stuttering-like speech disfluencies that met or exceeded the diagnostic criteria for developmental stuttering that is based on monolingual English speakers. The CWNS participants varied in meeting the criteria depending on the language being spoken, with one of the three CWNS exceeding the criteria in both languages and one exceeding the criteria for percentage of stuttering-like speech disfluencies in one language. Conclusion Findings from this study contribute to the development of more appropriate diagnostic criteria for bilingual SE-speaking children to aid in the reduction of misdiagnoses of stuttering in this population.

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Sleep Impairment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2009.mayjun04 ◽

2009 ◽

Vol 14 (3) ◽

pp. 7-10

Author(s):

Craig Uejo ◽

Stephen Demeter

Keyword(s):

Rotator Cuff ◽

Distal Clavicle ◽

Rotator Cuff Disease ◽

Degenerative Arthritis ◽

Sixth Edition ◽

Cuff Tear ◽

Shoulder Region ◽

Illness Causation ◽

Traumatic Rotator Cuff Tear ◽

Distal Clavicle Resection

Abstract In the AMAGuides to the Evaluation of Permanent Impairment (AMA Guides), Sixth Edition, distal clavicle resection (resection arthroplasty of the acromioclavicular joint [ACJ]) results in ratable impairment, but only a single diagnosis within a region may be rated. Therefore, if another impairing condition is present in the shoulder region (eg, impingement syndrome or rotator cuff disease) only that resulting in the greatest causally related impairment is rated. In the setting of an occupational or other compensable injury or illness, causation of the impairment often is a key issue because, typically, only impairment that is causally related to the injury can be rated. For example, assume that a lifting injury at work caused a tear in a rotator cuff tendon that was already attenuated by repetitive impingement on inferiorly projecting spurs from longstanding degenerative arthritis of the ACJ. If surgery was performed for a traumatic rotator cuff tear and the distal clavicle also was resected due to preexisting ACJ arthritis, the latter surgery is not considered to be related to the injury. In other words, because the ACJ arthritis was neither caused nor worsened by the injury, this condition is not rated. The distal clavicular resection may have been warranted to diminish pain due to ACJ arthritis and/or eliminate the distal clavicle as a source of impingement.

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Case Exercise: Toxic Exposure-Related Illness: Causation, Diagnosis, and Permanent Impairment

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2007.marapr02 ◽

2007 ◽

Vol 12 (2) ◽

pp. 4-8

Author(s):

Frederick Fung

Keyword(s):

Concentration Level ◽

Treatment Plan ◽

Toxic Exposure ◽

Dose Response Relationship ◽

Specialty Board ◽

History Of ◽

Subjective Complaints ◽

Based Medicine ◽

Illness Causation ◽

Rule Out

Abstract A diagnosis of toxic-related injury/illness requires a consideration of the illness related to the toxic exposure, including diagnosis, causation, and permanent impairment; these are best performed by a physician who is certified by a specialty board certified by the American Board of Preventive Medicine. The patient must have a history of symptoms consistent with the exposure and disease at issue. In order to diagnose the presence of a specific disease, the examiner must find subjective complaints that are consistent with the objective findings, and both the subjective complaints and objective findings must be consistent with the disease that is postulated. Exposure to a specific potentially causative agent at a defined concentration level must be documented and must be sufficient to induce a particular pathology in order to establish a diagnosis. Differential diagnoses must be entertained in order to rule out other potential causes, including psychological etiology. Furthermore, the identified exposure at the defined concentration level must be capable of causing the diagnosis being postulated before the examiner can conclude that there has been a cause-and-effect relationship between the exposure and the disease (dose-response relationship). The evaluator's opinion should make biological and epidemiological sense. The treatment plan and prognosis should be consistent with evidence-based medicine, and the rating of impairment must be based on objective findings in involved systems.

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