Brit accents vex US hearing-impaired elderly

Older Americans with some hearing loss shouldn't feel alone if they have trouble understanding British TV sagas like "Downton Abbey." A small study from the University of Utah suggests hearing-impaired senior citizens have more trouble than young people comprehending British accents when there is background noise.

"The older hearing-impaired had just a little more trouble understanding British accents than American accents when they were in quiet surroundings," says Sarah Hargus Ferguson, senior author of the study and an associate professor of communication science and disorders. "They had a lot more trouble understanding both accents with background noise, but the British was harder to understand than the American."

"When young, normal-hearing listeners were in quiet, they did just as well with British English as with American English," she adds. "When they had background noise, they had more trouble understanding both."

That was among several studies presented this week by Ferguson and her students during the Acoustical Society of America's 171st meeting at the Salt Lake Marriott Downtown at City Creek. Among other findings by Ferguson and students:

-- People perceive clear speech as more feminine than conversational speech. So transgender women who want to sound more feminine might speak more clearly to do so. Clear speech is how people speak when they believe the listener is hearing-impaired - more slowly and loudly than normal, and with a higher-than-usual voice pitch.

-- Older people hear less anger than younger people, but it isn't due to hearing loss, but to some other aspect of aging.

-- Fast talking makes speech less intelligible, more so if women rather than men are speaking quickly.

The common theme of the studies and of Ferguson's research "is that things about the talker affect how other people perceive their speech," she says. "Those include how clearly they are speaking, their gender and if they have an accent."

Older hearing-impaired Americans confused by British accents

The study of British accents was led by Caroline Champougny, a neurolinguist and visiting scholar at the University of Utah. The study involved 14 older people with hearing impairment and 14 young-adult university students with normal hearing.

Each participant listened to recordings of Basic English Lexicon sentences - a list of simple sentences used for research - read by one American and one British talker. They heard them in quiet, and again with recorded background babble of 12 Americans.

"In background noise, the scores for British English were lower for older adults than younger adults," Ferguson says. "They do about the same in quiet, but much worse in noise. They do have more trouble in noise than younger adults."

"An older, hearing-impaired adult listening to American speech might be struggling, but most of the time they're going to get the message," Champougny says. "With British speech, they are struggling if there is background noise. They are impaired in their understanding of British English."

Ferguson adds: "So if you're watching 'Downton Abbey' and you're having trouble understanding, it will help if you turn up the volume and eliminate background noise," or even used closed captions.

Ferguson says the study grew from the observation that older, hearing-impaired patients in audiology clinic said "they couldn't understand British accents anymore - they used to enjoy Masterpiece Theatre, but now it's too hard for them to understand."

Helping transgender women sound feminine

Jaime Booz is a University of Utah master's student in speech-language pathology and a transgender man. He says he intends to study "the relationship between communication and quality of life for transgender individuals."

"Transgender women say sometimes they are doing fine in public until they open their mouth, because the voice is low," Booz says. "That can be a safety issue because it opens them up to harassment and discrimination." So he wanted to learn if "adopting a clear speaking style may be a means by which someone can sound more feminine."

Booz and Ferguson used a recorded database of 41 talkers in conversational speech and clear speech - the slower, louder, higher-pitched way we talk to people with impaired hearing. Clear speech qualities overlap with feminine vocal qualities.

Seventeen participants - eight men and nine women - listened to 656 gender-neutral sentences (no male sports talk, for example) in conversational speech and in clear speech. The listeners rated each sentence on a 0 to 100 scale of masculine-sounding to feminine-sounding (not whether the listeners thought the speaker was male or female.)

"We found there was a small but statistically significant effect of clear speech on ratings on femininity," Booz says. "When a talker used a clear speaking style, they were rated more feminine than when they used their regular conversational speaking style. The effect was slightly larger for male talkers than for female talkers."

The study was small and clear speech had a small effect on femininity ratings, so Booz isn't yet ready to make recommendations. But the possible implication is clear.

"I wanted to see if a speech-language pathologist could tell a transgender woman who is trying to sound more feminine to use a clear speaking style, and if that would increase her perceived vocal femininity. Based on my study, the answer is maybe."

Does hearing loss impair the ability to hear anger?

Previous research has shown that both older hearing-impaired people and younger people with normal hearing are more likely to perceive anger in clear speech than in normal, conversational speech. University of Utah audiology doctoral student Shae Morgan ran a study suggesting the reason is not hearing loss, but another aspect of aging.

Morgan used Ferguson's recorded database of people speaking in conversational speech and in clear speech. Recordings were played of four male and four female talkers reading 14 emotionally neutral sentences.

Forty-four participants (ages 18 to 32) listened to the sentences. Of the 44, 22 listened to recordings that were processed digitally to simulate hearing loss by reducing high frequencies in the recordings. The other 22 listened to recordings that also were processed (in case that had an effect) but so that there was no simulated hearing loss.

All listeners were asked to select the emotion, if any, that they heard in each sentence: anger, fear, disgust, sadness, happiness or neutral.

There was no difference between the normal hearing group and the simulated hearing-loss group: Both were about four times more likely to perceive anger in clear speech than in conversational speech.

"We didn't know if hearing loss or aging resulted in older adults hearing less anger," Morgan says. "This study tested whether it was hearing loss, and there was no effect of hearing loss on judgements of anger. The conclusion is that differences in perceiving anger between young adults with normal hearing and older adults with hearing loss must be due to the aging, not the hearing loss."

What about aging? "There is a 'positivity effect' in older adults," he says. "This is based on a theory that older adults show preference for positive stimuli and avoid negative information."

Morgan says there is good news in the finding that reduced perception of anger isn't due to hearing loss: Wearing hearing aids "won't make things sound angrier."

Are faster-talking women tougher for older people to understand?

When older adults complain of hearing loss, they often say they have particular difficulty understanding female voices. Yet young listeners with normal hearing usually find women more intelligible than men.

Eric Johnson, a University of Utah doctoral student in audiology, wanted to determine how fast people talk was a factor. He found it was.

Johnson and Ferguson used recordings of sentences from two male and two female speakers in the Utah Speaking Style Corpus, a collection of recordings of Utah residents speaking in clear and conversational styles.

Thirty-two student participants "listened to 60 sentences spoken by one of the four talkers," Johnson says. "That talker was either a male or a female, and the speech was either 50 percent faster than normal or the normal rate of speech." A computer program was used so the sped-up speech did not have a higher pitch, but was just 50 percent faster at the normal pitch.

"When we sped up the speech, it made it harder to understand regardless of whether the talker was male or female," Johnson says. "However the negative effect on intelligibility was stronger for female talkers; men and women both became less intelligible when the rate of speech was increased, but women became even less so."

"The results also imply that audiologists should counsel communication partners of patients to avoid speaking excessively fast, especially in noise and especially if the patient complains of difficulty understanding women's voices," Johnson concludes.

Prenatal fruit consumption boosts babies' cognitive development

Most people have heard the old adage "an apple a day keeps the doctor away." It's an old truth that encompasses more than just apples--eating fruit in general is well known to reduce risk for a wide variety of health conditions such as heart disease and stroke. But now a new study is showing the benefits of fruit can begin as early as in the womb.

The study, published in the journal EbioMedicine, found that mothers who consumed more fruit during pregnancy gave birth to children who performed better on developmental testing at one year of age. Piush Mandhane, senior author of the paper and associate professor of pediatrics at the University of Alberta's Faculty of Medicine & Dentistry, made the discovery using data from the Canadian Healthy Infant Longitudinal Development (CHILD) Study--a nationwide birth cohort study involving over 3,500 Canadian infants and their families. Mandhane leads the Edmonton site of the study.

"We wanted to know if we could identify what factors affect cognitive development," Mandhane explains. "We found that one of the biggest predictors of cognitive development was how much fruit moms consumed during pregnancy. The more fruit moms had, the higher their child's cognitive development."

The study examined data from 688 Edmonton children, and controlled for factors that would normally affect a child's learning and development such as family income, paternal and maternal education, and the gestational age of the child.

Using a traditional IQ scale as a model, the average IQ is 100 and the standard deviation is 15; two thirds of the population will fall between 85 and 115. Mandhane's study showed that if pregnant mothers ate six or seven servings of fruit or fruit juice a day, on average their infants placed six or seven points higher on the scale at one year of age.

"It's quite a substantial difference--that's half of a standard deviation," Mandhane explains. "We know that the longer a child is in the womb, the further they develop--and having one more serving of fruit per day in a mother's diet provides her baby with the same benefit as being born a whole week later."

To further build on the research, Mandhane teamed with Francois Bolduc, an associate professor in the Faculty of Medicine & Dentistry's Division of Pediatric Neurology, who researches the genetic basis of cognition in humans and fruit flies. Both researchers believe that combining pre-clinical models and epidemiological analysis is a novel approach that may provide useful new insights into future medical research.

"Flies are very different from humans but, surprisingly, they have 85 per cent of the genes involved in human brain function, making them a great model to study the genetics of memory," says Bolduc. "To be able to improve memory in individuals without genetic mutation is exceptional, so we were extremely interested in understanding the correlation seen between increased prenatal fruit intake and higher cognition."

According to Bolduc, fruit flies have a long track record in the field of learning and memory. Several genes known to be necessary in fly memory have now been found to be involved in intellectual disability and autism by Bolduc and others. In a subsequent series of experiments, he showed that flies born after being fed increased prenatal fruit juice had significantly better memory ability, similar to the results shown by Mandhane with one-year-old infants. He believes it suggests that brain function affected by fruit and the mechanisms involved have been maintained through evolution, and conserved across species.

While the findings are encouraging, Mandhane cautions against going overboard on fruit consumption as potential complications such as gestational diabetes and high birthweight--conditions associated with increased intake of natural sugars--have not been fully researched. Instead, he suggests that expectant mothers meet the daily intake recommended in Canada's Food Guide and consult with their doctors.

Mandhane also says he will continue work in the field, with plans to examine if the benefits of prenatal fruit consumption persist in children over time. He will also be looking to determine if fruit can influence childhood development related to executive functioning--in areas such as planning, organizing and working memory.

Breast cancer risk: healthy lifestyle choices can mitigate genetic, family history

Women with a high risk of developing breast cancer based on family history and genetic risk can still reduce the chance they will develop the disease in their lifetimes by following a healthy lifestyle, new research led by the Johns Hopkins Bloomberg School of Public Health suggests.

White women who are at high risk but who had a low body mass index (a marker for obesity), who did not drink or smoke and who did not use hormone replacement therapy, had roughly the same risk as an average white women in United States, the researchers found. The average chance that a 30-year-old, white woman will develop breast cancer before she is 80 is about 11 percent.

The researchers found that roughly 30 percent of breast cancer cases could be prevented by modifying known risk factors - say, by drinking less alcohol, losing weight and not taking hormone replacement therapy. More importantly, the study found that a larger fraction of total preventable cases would occur among women at higher levels because of genetic risk factors, family history and a few other factors that cannot be modified.

The findings, published May 26 in JAMA Oncology, are a first step in understanding how advances in the field of genetics can be used for developing precision prevention strategies to help women improve their odds of avoiding breast cancer. Breast cancer remains the most common form of malignancy diagnosed in women in western developed countries, with an estimated 232,000 new cases diagnosed in the United States in 2014. Roughly 40,000 women die in the United States from breast cancer each year.

The findings could be particularly useful as the price of genetic testing continues to fall and more women are able to afford the tests, which typically are not covered by insurance. They may also help scientists develop better guidelines for when and how frequently women should be screened for breast cancer, a calculation that is currently based on age, but that could be based on individual risk factors for each individual woman.

"People think that their genetic risk for developing cancer is set in stone," says the study's senior author Nilanjan Chatterjee, PhD, a Bloomberg Distinguished Professor in the Department of Biostatistics at the Bloomberg School. "While you can't change your genes, this study tells us even people who are at high genetic risk can change their health outlook by making better lifestyle choices such as eating right, exercising and quitting smoking."

Chatterjee and his colleagues from more than a dozen institutions around the world developed a model predicting risk of breast cancer by analyzing records on more than 17,000 women with breast cancer and nearly 20,000 women without the disease from the Breast and Prostate Cancer Cohort Consortium and about 6,000 women participating in the 2010 National Health Interview Study. The researchers combined individual-level data on risk factors such as age, weight and smoking status with data on almost 100 common gene variations, each of which are known to have a modest association with breast cancer but in combination they can lead to substantially elevated risk. They further combined this information with population incidence rates from the National Cancer Institute-Surveillance, Epidemiology and End Results Program. The findings are currently applicable only to white women because further studies are needed to understand the association of the genetic variants with risk of breast cancer for other ethnic groups.

The common gene variations studied by the researchers are quite different from the well known rare mutations in genes like BRCA1 and BRCA2, where having a single variant can mean a very high risk of developing breast cancer.

Chatterjee says the findings may add to the process of creating better screening models for breast cancer. Current recommendations in the U.S. do not call for routine mammograms for breast cancer until the age of 50, though previous recommendations suggested age 40.

While getting older is the No. 1 risk factor for developing breast cancer, other factors - such as family history - already come into play and more specific genetic risks may one day prove to also play a role. The model shows that, for example, 16 percent of 40-year-old women in the population had the risk of an average 50-year-old woman and thus possibly could benefit by screening earlier. At the same time, 32 percent of 50 year olds had the risk of 40 year olds and they should at least be carefully counseled so that they understand there may be harm associated with screening those at low risk of developing the disease.

While mammograms can detect early-stage breast cancers, there are risks of false-positive results which can add potentially unnecessary pain, cost and distress. So finding a way to screen those at the highest risk more often - and those at lower risk less often - could be beneficial. "We aren't saying there will be less screening, just smarter screening," Chatterjee says.

The model is still several years from being ready for routine medical use. First, Chatterjee says, the model needs to be validated in other studies. Second, he says, the cost of widespread genetic testing, while falling precipitously over the last decade, is still a little too high. But he sees the costs continuing to fall in coming years to a level where such testing can become commonplace. Also, he says, a model needs to be developed for other ethnic populations and for specific subtypes of breast cancer which may have different causes and prognostic outlooks.

Chatterjee says he hopes that once women understand that their genes do not completely predict their cancer destiny, they will work even harder to make lifestyle changes that can potentially reduce the risk they will develop the deadly disease.

"Everyone should be doing the right things to stay healthy but motivating people is often hard," he says. "These findings may be able to help people better understand the benefits of a healthy lifestyle at a more individualized level."

Exercise, future anticancer therapy?

At age 70, Alfred Roberts plays hockey twice a week. Nothing special, right? Except that for three years he has had advanced prostate cancer, which has spread to his bones. "I've always been active. Hockey keeps me in shape and keeps my mind off things. I've got friends that have played until age 80, and my goal is to beat them!" said the veteran stick handler.

Several studies have demonstrated the benefits of exercise to improve the quality of life of people with cancer. But Dr. Fred Saad, urologist-oncologist and researcher at the University of Montreal Hospital Research Centre (CRCHUM), goes further. He believes that physical exercise has a direct effect on cancer, as effective as drugs, for treating patients with prostate cancer, even in advanced stages of the disease.

"Typical patients with metastases often become sedentary. It is thought that this affects cancer progression," he said. Together with Robert Newton, professor at the Edith Cowan University Exercise Medicine Research Institute in Australia, Dr. Saad is leading the first international study which aims to demonstrate that exercise literally extends the life of patients with metastatic prostate cancer.

"Normally, patients at this stage have a life expectancy of two to three years. We want to reduce mortality by at least 22%, which represents about six months of longer survival. This is the equivalent benefit of a new drug. Exercise could therefore supplement available treatments, inexpensively," said Dr. Saad, who is also professor at the University of Montreal's Department of Surgery.

Dr. Saad will present an overview of this Phase 3 clinical trial at the American Society of Clinical Oncology (ASCO) Annual Meeting, which will take place in Chicago from June 3 to 7. The study, which is supported by the Movember Foundation, has already started in Ireland and Australia. In the coming weeks, some sixty hospitals across the world will begin recruiting patients. In total, nearly 900 men with advanced prostate cancer will participate.

"We will study exercise as if it were a drug added to standard treatments. All patients will be treated within the latest scientific knowledge for this type of cancer. They will continue to follow their therapies and take their medications. But half of the patients will receive psychosocial support with general recommendations on physical exercise. The other half will also follow a high intensity exercise program," he explained.

The exercise medicine expert Professor Robert Newton has designed a specific strength and cardiovascular training program for patients in the "exercise" group. "They will have an hour of aerobic and resistance training three times a week. An exercise specialist will supervise them for the first 12 months, and then they will continue without direct supervision. We will evaluate quality of life, appetite, and treatment tolerance in relation to their improved physical condition," said Professor Newton, who is co-director of the Edith Cowan University, Exercise Medicine Research Institute.

Blood samples and muscle biopsies will help scientists better understand the benefits of exercise. "People with cancer develop all sorts of complications related to metastases, such as fractures or severe pain. It is hoped that exercise will strengthen muscles and bones," said Dr. Saad.

The hypothesis is that exercise has a direct impact on cancer progression in addition to helping patients better tolerate therapy. Ultimately, they will live longer. The results of this large study, which involves some one hundred researchers in Canada, the US, Australia, Ireland, the Netherlands, and the UK, will not be known for five years. Could the findings be extended to other types of cancer? It is too early to tell, but researchers are betting that exercise could well become the next anticancer therapy. Alfred Roberts is also convinced that exercise helps defy the odds: "As long as I can skate, I'll play hockey!"

Artificial sweeteners may have negative health effects

Artificial sweeteners help individuals with obesity to cut calories and lose weight but may have negative health effects, according to researchers at York University's Faculty of Health.

"Our study shows that individuals with obesity who consume artificial sweeteners, particularly aspartame, may have worse glucose management than those who don't take sugar substitutes," says Professor Jennifer Kuk, obesity researcher in the School of Kinesiology and Health Science.

Normally, weight loss is associated with several improvements in health. Artificial sweeteners are often used to help individuals cut calories and manage their weight as they are not digested by the body. However, the recent study suggests that the bacteria in the gut may be able to break down artificial sweeteners, resulting in negative health effects.

"We didn't find this adverse effect in those consuming saccharin or natural sugars," says Kuk. "We will need to do future studies to determine whether any potentially negative health effects of artificial sweeteners outweigh the benefits for obesity reduction."

Currently, there are many new sugar substitutes that are used in foods. The researchers note that further investigation is needed to determine if there are any health effects of using these sweeteners.

For the study, data from 2856 U.S. adults from the Third National Health and Nutrition Survey (NHANES III) was used. Individuals reported their diet over the past 24 hours and were categorized as consumers of artificial sweeteners (aspartame or saccharin), or high or low consumers of natural sugars (sugar or fructose). Diabetes risk was measured as the ability to manage blood sugars using an oral glucose tolerance test.

Acupuncture used in clinical settings reduced symptoms of menopause

Acupuncture treatments can reduce the number of hot flashes and night sweats associated with menopause by as much as 36 percent, according to researchers at Wake Forest Baptist Medical Center. The findings are published in the June issue of the journal Menopause.

"Although acupuncture does not work for every woman, our study showed that, on average, acupuncture effectively reduced the frequency of hot flashes and results were maintained for six months after the treatments stopped," said Nancy Avis, Ph.D., professor of public health sciences at Wake Forest Baptist and lead author of the study. 

The study, which was funded by National Institutes of Health, included 209 women ages 45 to 60 who had not had a menstrual period for at least three months and had on average at least four hot flashes or night sweats per day in the previous two weeks. Participants received a baseline assessment and were then randomized to one of two groups. 

The first group received acupuncture treatments during the first six months. They were then followed without receiving acupuncture for the second six months. The second group did not receive any acupuncture during the first six months, but did receive acupuncture for the second six months. 

The participants were allowed up to 20 treatments within six months provided by licensed, experienced acupuncturists in the community. All participants kept a daily diary on the frequency and severity of their hot flashes. They also answered questionnaires about other symptoms every two months. 

Avis said the study was designed to make it more "real world" by leaving the frequency and number of the acupuncture treatments up to the study participants and their acupuncturists. After six months, the first group reported an average 36.7 percent decline in frequency of hot flashes compared to baseline measurements. After a year, the benefits persisted, with the group members maintaining an average 29.4 percent reduction from baseline. 

The second group reported a 6 percent increase in symptom frequency during the six months when they were not getting acupuncture, but had similar results - an average 31 percent reduction in frequency - to the first group after receiving acupuncture during the latter part of the trial.

"There are a number of non-hormonal options for treating hot flashes and night sweats that are available to women," Avis said. "None of these options seem to work for everyone, but our study showed that acupuncture from a licensed acupuncturist can help some women without any side effects. Our study also showed that the maximum benefit occurred after about eight treatments." 

Avis cautioned that the effect shown in the study could be due to non-specific effects such as the additional care and attention the study participants received or the expectation of a benefit. She also said that additional research is needed to identify individual differences in response to acupuncture.

Grill with caution: Wire bristles from barbecue brushes can cause serious injuries

While many people view Memorial Day weekend as the unofficial start of the summer grilling season, they may not be aware of the dangers of eating food cooked on grills cleaned with wire-bristle brushes. A new study conducted at the University of Missouri School of Medicine identified more than 1,600 injuries from wire-bristle grill brushes reported in emergency rooms since 2002. Loose bristles can fall off the brush during cleaning and end up in the grilled food, which, if consumed, can lead to injuries in the mouth, throat and tonsils. Researchers advise individuals to inspect their food carefully after grilling or consider alternative grill-cleaning methods.

"Wire-bristle brush injuries are a potential consumer safety issue, so it is important that people, manufacturers and health providers be aware of the problem," said David Chang, M.D., associate professor of otolaryngology at the MU School of Medicine. "If doctors are unaware that this problem exists, they may not order the appropriate tests or capture the correct patient history to reach the right diagnosis."

Chang reviewed consumer injury databases to determine the number of emergency department visits caused by wire-bristle injuries between 2002 and 2014. He observed that 1,698 injuries were reported by emergency departments in that time. The most common injuries reported were in patients' oral cavities, throats and tonsils, with some injuries requiring surgery. 

"One little bristle unrecognized could get lodged in various areas of the body, whether in the throat, tonsil or neck region," Chang said. "If the bristle passes through those regions without lodging itself, it could get stuck further downstream in places like the esophagus, stomach or the intestine. The biggest worry is that it will lodge into those areas and get stuck in the wall of the intestine. The bristles could migrate out of the intestine and cause further internal damage."

Chang said that the number of injuries found from wire-bristle brushes could be even larger than his 1,698 estimate, since his study did not include injuries treated at urgent care facilities or other outpatient settings. This data could lead to better protective measures from individuals and wire-bristle brush manufacturers, he said.

Chang recommends the following tips for individuals this grilling season:

1. Use caution when cleaning grills with wire-bristle brushes, examining brushes before each use and discarding if bristles are loose. 
2. Inspect your grill's cooking grates before cooking, or use alternative cleaning methods such as nylon-bristle brushes or balls of tin foil. 
3. Inspect grilled food carefully after cooking to make sure bristles are not stuck to the food.

"If cautionary measures fail and individuals do experience problems with swallowing or pain after eating something that has been barbecued or grilled, they should seek advice from a physician or an emergency department and let the physician know that they were just at a barbecue event or they just grilled food," Chang said. 

The study, "Epidemiology of Wire-Bristle Grill Brush Injury in the United States, 2002-2014," recently was published in Otolaryngology-Head and Neck Surgery. Research reported in this publication was supported by the MU School of Medicine and the MU Department of Otolaryngology. The researchers have no conflicts of interest to declare related to this study.