Body composition of young laborers: the results of a bioelectrical impedance analysis

The aim of this study was to determine the changes caused by physical stress on the body composition of young males. In order to show these changes, the study was performed with 104 young male laborers who worked through their adolescence and who were currently working in workshops in the industrial sector (Group 1, mean age 18.48 +/- 0.61 years). For the control group, two groups of the same age but having a difference in terms of socioeconomic status were chosen. The first one of these was comprised of individuals who had the same socioeconomic status as the laborers (Group 2, n = 102, mean age 18.39 +/- 0.58 years) but were not laborers. The second control group was composed of individuals from the higher socioeconomic levels of society (Group 3, n = 103, mean age 18.43 +/- 0.67). Measurements of the height of the individuals were taken with a standard portable anthropometer, and their body weight and BIA measurements were taken with Tanita TBF-305 leg-to-leg body composition analysis equipment. The results of the analysis show that the weight, height, BMI and fat mass values of the laborers were significantly lower (P < 0.05-0.001) than those of Group 3, but were not statistically different from those of Group 2. These findings reveal that the effects of socioeconomic conditions on body composition outweigh those of working conditions.     

Does urban poverty increase body fluctuating asymmetry?

Perturbations during development leave enduring signs on the adult body. Fluctuating asymmetry (FA) is a good bio-indicator of stress during ontogeny. The aim of this study is to determine the effect of urban poverty on the fluctuating asymmetry of young Turkish males. Young males from a lower socioeconomic group (N = 140, Mean age = 18.17 +/- 0.61) were selected from slum areas of Ankara, the capital of Turkey, where urban poverty is intense. An upper socioeconomic group, on the other hand, consisted of students from two private colleges and included children from some of the richest families in Turkey (N = 120, Mean age = 18.08 +/- 0.54). Eight anthropometric traits of all subjects were measured. Considering the seven measurements demonstrate ideal FA, the individuals living in poor areas of the city displayed higher FA. The discrepancy between the two groups was even greater for a measure of composite FA. In conclusion, poor living conditions in Ankara, where urban poverty is intense, adversely impact the developmental stability of young Turkish males.     

Growth and nutritional status of male adolescent laborers in Ankara, Turkey

Undernutrition, pathogenic agents, and poor living conditions are of primary importance in the evaluation of adverse environmental conditions' effects on human growth; but child labor (an equally significant factor, especially in underdeveloped countries) is generally overlooked or ignored. The aim of this study is to focus on this subject and clarify the effects of labor on the physical growth and nutritional status of child and adolescent laborers. In this study, the height and weight of 532 male adolescent laborers aged 13.5-18.5 years and their non-laboring peers (n = 451) (the control group) were measured by standard anthropometric techniques and equipment. The individuals of both groups come from lower socioeconomic strata and share similar living conditions. Data were transformed to z-scores, using the US Center for Disease Control and Prevention's 2000 growth charts. The analyses show that the z-scores for height-for-age, weight-for-age, and body mass index (BMI)-for-age were negative in both groups. The z-scores of laborers' height-for-age and weight-for-age values lie below the controls', but there is no significant difference between the two groups' BMI-for-age scores. In the laboring group, the percentages of stunting (-2 SD of height-for-age), underweight (-2 SD of weight-for-age), and wasting (-2 SD of BMI-for-age) were 14.3, 2.6, and 0.2, respectively. These values suggest that malnutrition is not a common problem among adolescent laborers living in Ankara; but laboring is an important cause of faltering in growth, particularly in linear growth, in less or underdeveloped economic environments.     

Sleep Duration Trajectories and Body Composition in Adolescents: Prospective Birth Cohort Study

We aimed to estimate the association between sleep duration trajectories and body composition in adolescents. We used data from participants of the 1993 Pelotas (Brazil) Birth Cohort Study who were later followed up at age 18 years (response rate of 81.3%). At the time, 3974 adolescents had complete data on body composition, which was assessed by air displacement plethysmography. Sleep duration was self-reported by participants at ages 11 and 18 years. Analyses were sex-stratified. The mean sleep duration at 11 years was 9.7 (SD 1.4) and 8.4 (SD 1.9) at 18 years. Sleep duration was dichotomized as inadequate (<8 hours/day) or adequate (≥8 hours/day). Mean body mass, fat mass, and fat-free mass indices at 18 years were 23.4 kg/m² (SD 4.5), 6.1 kg/m² (SD 3.9) and 17.3 kg/m² (SD 2.5), respectively. Girls who reported inadequate sleep duration at 11 years of age, but adequate sleep duration at 18, on average experienced an increase in body mass index (β = 0.39 z-scores; 95% CI 0.13, 0.65), fat mass index (β = 0.30 z-scores; 95% CI 0.07, 0.53), and fat-free mass index (β = 0.24 z-scores; 95% CI 0.08, 0.39) compared to those who had adequate sleep duration at both time points. The results suggest that changes in sleep duration across adolescence may impact body composition in later adolescence and that this may differ by sex.     

Comparison of final height in monozygotic twins,one with idiopathic and isolated growth hormone deficiency treated with low dose of growth hormone

OBJECTIVE: We report final heights in a pair of monozygotic twins, one unaffected and the other affected with idiopathic and isolated growth hormone (GH) deficiency treated with human GH, and discuss the effect of GH dosage on the attainment of the genetic height potential in GH deficiency. PATIENTS: Male monozygotic twins were born at 35 weeks of gestation; birth weights were 1,876 g in the unaffected and 1,510 g in the affected twin. At 4.9 years of age, the affected twin was studied for short stature (-3.38 SD) and was diagnosed as having idiopathic and isolated GH deficiency, whereas the unaffected twin was normal in height (+/- 0 SD). GH treatment was started at the age of 5.7 years and continued throughout childhood and adolescence. The average dose of GH administered during the treatment period was 0.35 IU (0.12 mg)/kg/week. The affected twin appeared to grow normally without other hormone replacement and achieved a final height of 165.6 cm (-0.86 SD) compared with that of 166.4 cm (-0.71 SD) in the unaffected twin at 17.5 years of age. CONCLUSION: Our results indicate that a relatively low dose of GH treatment started at an early age may preserve genetic height potential in patients with isolated GH deficiency.     

A possibility of systematisation of anthropometric data of girls aged 12-15

The article describes an anthropometric cross-sectional study of 374 healthy schoolgirls aged 12-15 years from secondary schools of Tartu (Estonia). 29 body measurements and 9 skinfolds were measured. Mean skinfolds and 6 indices and ratios (including body mass index) were calculated. In each age group the data were systematized into 5 height-weight SD-classes according to the correspondence between body height and weight. The medium class lies between -0.5 SD and +0.5 SD of the respective age group mean (M +/- 0.5 SD); the other classes contain the respective outer values. All the subjects were assigned into one of the following five categories: three height/weight-concordant categories: I = small (small height-small weight), II = medium (medium height-medium weight), III = large (big height-big weight) and two height/weight-disconcordant categories: IV = so-called pyknomorphous, V = so-called leptomorphous. Categories IV and V thus contained three height/weight subclasses each. The body build categories differ significantly from each other within both groups (I-III and IV-V) in all age groups in all measured variables, except sternum length, abdomen length, trunk length, biacromial breadth, biiliocrystal breadth, femur breadth, ankle breadth, humerus breadth, wrist breadth, and head circumference for which no significant differences between pyknomorphous and leptomorphous categories were found. A multidimensional statistical model of body build might be used in girls going through puberty to systematize and compare morphological variables with other assessed characteristics in different applied studies, for example physiological, sociological, psychological, or nutritional.     

Extreme short stature after intrauterine growth retardation: factors associated with lack of catch-up growth

The factors associated with lack of catch-up growth after intrauterine growth retardation (IUGR) are unknown. OBJECTIVE: To identify these factors by analyzing the clinical features and growth hormone (GH)-insulin-like growth factor I (IGF-I) axis. METHODS: 95 patients with height <-3 SD after IUGR were assigned to group 1 without (n = 50) or group 2 with (n = 45) malformations. Twenty-one in group 1 and 19 in group 2 were treated with GH. RESULTS: They were seen at 5.3 +/- 0.5 and 4 +/- 0.5 year (p = 0.02) with heights at -3.4 +/- 0.1 and -3.9 +/- 0.2 SD (p = 0.03). Group 1 differed from group 2 in having a lower frequency of consanguinity (2 vs. 28.9%, p < 0.001), and higher frequencies of target heights (26.5 vs. 6.7%, p = 0.02) and mothers' heights (34.7 vs. 8.9%, p < 0.01) <-2 SD, multiparity (26 vs. 8.9%, p < 0.05), prematurity (36 vs. 15.5%, p < 0.05) and cesarean section birth (42 vs. 17.8%, p = 0.01). The GH-IGF-I axis data and the height increases after 3 years of GH treatment (1.6 +/- 0.2 in group 1 and 1.1 +/- 0.3 SD in group 2) were similar. CONCLUSION: The short height of the parents, particularly of the mother, is associated with factors limiting the catch-up growth after IUGR of children without malformations, while the high frequency of consanguinity in those with malformations suggests that transmitted fetal factors affect organogenesis or development.     

Occupational epidemiological study of workers in an acrylonitrile using factory with particular attention to cancers and birth defects

An occupational epidemiological study was organised among workers in an acrylonitrile using factory in Hungary. Of the 888 workers, 783 were included in the study and three groups were differentiated: Group A (N = 452) with direct and continuous exposure, Group B (N = 171) with direct but occasional exposure and Group C (N = 160) without direct exposure, as referent. There were two main objectives: to determine the occurrence of cancer in workers and congenital abnormalities in their liveborn infants. The study did not indicate a higher occurrence of cancer among workers: only one lung cancer patient was found, prostate cancer did not occur. Among congenital abnormalities, the group of specified multiple congenital abnormalities showed a higher rate than expected but characteristic defect-pattern was not found among seven multimalformed babies, though five had cardiovascular malformations. In conclusion, our study did not indicate the carcinogenic, mutagenic and teratogenic effect of acrylonitrile among workers using this chemical in the factory.     

Nutritional status of adults in rural Mali.

An anthropometric assessment was conducted of 441 adults from six rural villages in southern Mali. As is typical for human populations, females are shorter and lighter than males. Both females (N = 320) and males (N = 121) are shorter and lighter than their U.S. counterparts. Mean weight in the sample is 53.4 +/- 8.5 kilos for females and 58.8 +/- 6.5 kilos for males. Mean height is 160.4 +/- 5.7 cm for females and 171.3 +/- 6.6 cm for males. The data for height in males are very similar to those reported from other surveys in Mali, and show no evidence for a positive secular trend in height. Mean body mass index (BMI) is 20.8 for females and 20.0 for males. These are lower than U.S. averages, but well above suggested cutoff points for malnutrition in adults. Average arm circumference is 26.5 cm for females and 26.4 cm for males. Females have relatively large arm circumferences due, in part, to the heavy manual labor they perform. Average head circumference is 53.0 cm for females and 54.8 cm for males. For both sexes, these values are more than 1 standard deviation (SD) below the U.S. means. Adult values for anthropometric measurements reflect childhood stresses of malnutrition and disease, and a lifetime of accommodation to a high-carbohydrate, low-protein diet, and hard physical labor. Females are significantly closer to the U.S. standards than males for weight, height, BMI, and arm circumference; these findings support the idea that females are buffered from environmental stresses relative to males. In addition, females exhibit significantly more variability than males for weight, arm circumference, and head circumference, but not for height, suggesting that variability in adult height does not reflect the presence or absence of female buffering or the level of environmental adversity.     

A physical profile of elite female ice hockey players from the USA

Despite impressive numbers of hockey participants, there is little research examining elite female ice hockey players. Therefore, the purpose of this study was to describe the physical characteristics of elite female ice hockey players who were trying out for the 2010 US Women's Ice Hockey team. Twenty-three women participated in the study and were evaluated for body mass (kilograms), height (centimeters), age (years) vertical jump (centimeters), standing long jump (centimeters), 1RM front squat (kilograms), front squat relative to body mass (percent), 1RM bench press (kilograms), bench press relative to body mass (percent), pull-ups, and body composition (percent body fat). The athletes in this sample were 24.7 years of age (SD = 3.1) and 169.7 cm tall (SD = 6.9); on average, they weighed 70.4 kg (SD = 7.1) and reported 15.8% body fat (SD = 1.9). Mean vertical jump height was 50.3 cm (SD = 5.7) and standing long jump was 214.8 cm (SD = 10.9). Mean 1RM for the upper body strength (bench press) was 65.3 kg (SD = 12.2) (95.1 ± 15.5% of body mass), and 1RM for lower body (front squat) was 88.6 kg (SD = 11.2) (127.7 ± 16.3% of body mass). This study is the first to report the physical characteristics of elite female ice hockey players from the USA. Data should assist strength and conditioning coaches in identifying talent, testing for strengths and weaknesses, comparing future teams to these indicators, and designing programs that will enhance the performance capabilities of female ice hockey athletes.     

Serum insulin and serum lipid profiles of a selected group of Southern Ontario tannery workers with elevated serum and urine chromium concentrations

This study compares the serum insulin and lipid profiles of a group of Southern Ontario tannery workers, with elevated serum and urine Cr levels, with those of men not exposed to industrial chromium (III) oxide. Fasting blood samples were obtained from 72 male tannery workers (TW) (mean age±SD=36±12 y) and from 52 control subjects (CS) (mean age±SD=41±13 y), matched by age, sex, race, and socioeconomic group. There were no significant differences between the two groups for median serum insulin (TW=8 μM/mL vs CS=9 μM/mL), total cholesterol (TC) (TW=201 mg/dL vs CS 209 mg/dL), triglycerides (TG) (TW=131 mg/dL vs 114 mg/dL) and high density lipoprotein cholesterol (HDL-C) (TW=45 mg/dL vs CS=43 mg/dL), or, in the calculated median values for low density lipoprotein cholesterol (TW=117 mg/dL vs CS=134 mg/dL), percent HDL-C (TW=23% vs CS=22%), and the cholesterol atherogenic ratio (TC/HDL-C) (TW=4.3 vs CS=4.5). Results of this study, therefore, demonstrate that absorption of trivalent Cr compounds, arising from industrial exposure, has no significant effect on serum insulin and lipid profiles.     

Comparison of measured and parents' reported height and weight in children and adolescents

The objectives of this study were to (i) compare parent-reported height and weight to measured height and weight in children between ages 2 and 17 years, (ii) investigate correlations between magnitude of error of parent-reported data or refusal to estimate height and weight with gender, race/ethnicity, child's age, and age-specific BMI z-score, and (iii) determine sensitivity and specificity of identifying obese youth based on parent-reported data. The authors studied 1,430 consecutive outpatients between ages 2 and 17 years at an outpatient orthopedic clinic. At the initial visit, parents completed a questionnaire including their child's height and weight; height and weight were then measured. Mean height error was very small, with slight overestimation in boys and underestimation in girls. Mean weight error increased with age (P < 0.001), and girls had a larger mean weight error (1.29 kg, 95% confidence interval (CI): 0.65, 1.45) than boys (0.85 kg, 95% CI: 0.8: 0.58, 1.12). Mean weight error also increased with age-specific BMI z-score (r = 0.32, P < 0.001). Correlation between weight error and age-specific BMI z-score was higher among black children (r = 0.45, P < 0.001) than among Hispanic children (r = 0.37, P < 0.001) and was lowest among white children (r = 0.29, P < 0.001). Refusal or inability to estimate weight did not correlate with age-specific BMI z-score. Twenty-one percent of children who were obese would not be identified by using parent-reported data to calculate the BMI.     

Effect of onion and ginger consumption on platelet thromboxane production in humans

The effects of onion and ginger consumption on platelet thromboxane production were examined. Volunteers, all Danish women, consumed either 70 g raw onion or 5 g raw ginger daily for a period of 7 days. Each participant in each (onion or ginger) group served as her own control. TxB2 determination was made in serum obtained after blood clotting. The following are the results. TxB2 (pmol/ml serum): (i) onion group--before consumption 910 +/- 327, after consumption 1005 +/- 713 (Mean +/- SD, N = 5); (ii) ginger consumption 782 +/- 482, after consumption 498 +/- 164 (Mean +/- SD, N = 7).     

Causes of precocious puberty in children referred for evaluation in hospital conditions

INTRODUCTION: Symptoms of precocious puberty (PP) in children always arouse anxiety in their parents. Many children with PP are being hospitalized for the detailed diagnostic work-up. The aim of our study was to analyze the frequency of the variants of PP in children referred to our department. MATERIAL: Retrospective analysis of 119 children (103 girls and 16 boys) referred for hospitalization in the years 2003-2005 due to signs of precocious puberty was performed. RESULTS: Premature thelarche, benign variant of puberty, was diagnosed in 62 (53%) girls, in the mean age of 3.39 (+/- 2.33) years. Their mean height was within 0.7 +/- 1.1 SD. Premature pubarche was diagnosed 30 (25%) children--22 girls and 8 boys in the mean age was 7.24 (+/- 0.81) years. Their mean height was 1.3 +/- 1.0 SD and was significantly higher than normal (p < 0.0001). Premature menarche was diagnosed in 8 (7%) girls in the mean age 4.81 +/-2.26 years. Mean height in this group was normal for age (0.9+/-0.8 SD). PP was diagnosed in 19 (16%) children (11 girls and 8 boys) in the mean age 5.91 +/- 1.63 years. Mean height in this group was 1.6 +/- 0.7 SD, and was significantly higher than the mean for age (p<0.0005). GnRH-dependent type was present in 15 children, diagnosed as idiopathic in 9 girls and 1 boy. In 5 children (4 boys and 1 girl) pathology of central nervous system was found. In 4 children GnRH-independent precocious puberty was diagnosed--in 3 caused by congenital adrenal hyperplasia and in 1 boy by tumour of testis (leydigioma). CONCLUSIONS: Girls with precocious thelarche without growth acceleration present the benign variant of puberty and need clinical follow up only. Boys with clinical signs of precocious puberty should be carefully evaluated to rule out the organic cause.     

Assessment of race from the pelvis

Racial assessment of human postcranial skeletal remains has been a major concern for forensic and skeletal anthropologists. Materials (N = 400) of the present study are from the Terry Collection and consist of 100 black and white American pelves of both sex with known age and race. Measurements were taken from the articulated pelves. Results of discriminant function analysis indicate classificatory accuracy may be as high as 88%. Transverse pelvic breadth contributes more to the function than biiliac breadth and antero-posterior height. The females are more easily assessed racially than males. Although a highly reliable classification is produced, the results of the study should be employed with caution, as samples were of questionable nutritional status and of low socioeconomic class.     

Biomechanical pressures and upper extremity asymmetry: a study on young laborers

The purpose of this study is to reveal the impacts of biomechanical pressures of heavy working conditions on the upper extremities of young laborers. The study covers the examination of the upper extremities of 104 young laborers in the industrial workshops of Ankara, Turkey regarding bilateral asymmetry. The average age of the laborers was 18.48 +/- 0.61 years. The control group consisted of 102 non-laborers with an average age of 18.39 +/- 0.58 years. The laborers were measured with regard to width of elbows, wrists, and hands, and the length of hands. No significant difference between the groups was observed with the exception of average wrist width. However, while the labor group showed directional asymmetry in all measurements, the non-laborers exhibited directional asymmetry only in hand width and length. Consequently, the study revealed that biomechanical pressures tend to increase directional asymmetry in the upper extremities.     

Resemblance for age at menarche in female twins reared apart and together

Menarche is a significant developmental event in the lives of young females. Genetic and family environmental influences on the timing of its occurrence are explored in the first formal analysis using reared-apart and reared-together monozygotic (MZA, MZT) and dizygotic (DZA, DZT) twin pairs. Mean age at menarche was 12.50 years (SD = 1.67) for the reared-apart pairs and 12.86 years (SD = 1.49) for the reared-together pairs. Intraclass correlations for age at menarche were 0.56 for MZA twins, 0.16 for DZA twins, 0.70 for MZT twins, and 0.41 for DZT twins. The mean within-pair difference was 1.07 years (SD = 1.04) for MZA twins, 1.67 years (SD = 1.59) for DZA twins, 0.64 year (SD = 0.86) for MZT twins, and 1.43 years (SD = 1.34) for DZT twins. These results are consistent with genetic influence, although the lower correlations for reared-apart twins and their larger within-pair differences suggest that age at menarche is partly affected by common rearing environments. Feeling understood by one's father during the growing-up years was significantly associated with earlier age at menarche, and a comparable trend was found for feeling understood by one's mother. These findings are considered with reference to current theories of pubertal timing.     

Shift-specific associations between age,chronotype and sleep duration

The objective of this study was to examine the association of age with chronotype and sleep duration in day workers and rotating shift workers, including night shift work. Between October 2012 and February 2015, a cross-sectional study was conducted in a German chemical company. Using the “Munich ChronoType Questionnaire” (MCTQ), data about sleep onset and sleep offset during workdays and work-free days were retrieved and the chronotype was computed during regular voluntary occupational health check-ups. Associations between age and chronotype, as well as sleep duration, were assessed using linear regression analyses. Potential effect modification by the working time system was examined. Within the study period, 4,040 employees (82.3% and 17.7% were engaged in day work and rotating shift work, respectively) completed the questionnaire. Study participants were on average 41.8 years old (Min = 18.0, Max = 65.0, SD = 10.2) and predominantly male (75.4%). Mean chronotype and overall sleep duration was 03:22 (SD = 54 min) and 7.2 h (SD = 1.0 h) respectively. Older age was associated with earlier chronotype and reduced overall sleep duration in both day workers and rotating shift workers (p < 0.001 for all models). Compared to day workers, employees whom engaged in rotating shift work were later chronotypes and had overall a longer sleep duration. With older age, the difference between day and rotating shift workers regarding chronotype increased, while the difference regarding overall sleep duration decreased (p_interaction<0.005 for both models). This finding could indicate that both changes in circadian physiology and exposure to certain work schedules contribute to the age-related changes. Older rotating shift workers, with early chronotypes may have issues with night shifts, while day work and morning shifts may be best compatible to earlier chronotypes. Differences in sleep timing across age groups, might indicate that the same work hours will affect shift workers differently, dependent on their age, suggesting that more flexible and chronotype-adapted work hours could provide useful; especially for older employees. Sleep education in the form of courses and health campaigns could be a way to raise awareness of the importance of a healthy sleep pattern. This could be achieved by learning strategies to better adjust individual sleep patterns to work hours.     

Fatal Occupational Injuries among Hispanic Construction Workers of Texas, 1997 to 1999

Hispanic construction workers, particularly those born outside of the United States, are a growing segment of the Texas workforce and are increasingly the victims of on-the-job fatalities. This study examines occupational fatality characteristics among Hispanic construction workers utilizing records collected by the Texas Workers' Compensation Commission for the Bureau of Labor Statistics, Census of Occupational Fatal Injuries program. Of the 370 fatalities recorded from 1997 to 1999, 179 cases (46.5%) involved Hispanic workers — 109 of who were born in a foreign country. The fatality rate for Hispanic construction workers was 23.5 per 100,000 workers compared to 21.2 for non-Hispanic workers. Many fatally injured Hispanic construction workers shared similar characteristics including: low skill level, young age and foreign birthplace. Hispanic workers employed as construction laborers, helpers, and roofers had the highest number of fatalities. Businesses with fewer than 10 workers employed forty-two % of all Hispanic decedents, and businesses with more than 100 employees comprised twenty % of fatalities. The leading causes of Hispanic fatalities were: transportation incidents, falls, and exposure to harmful substances.     

Levator repositioning and palatal lengthening for submucous clefts

Submucous clefts of the palate may present with velopharyngeal incompetence (VPI) or a history of recurrent otitis media. Many surgeons have favored a pharyngeal flap as primary treatment of the velopharyngeal incompetence associated with this disorder. The increasing number of case reports of sleep apnea and airway compromise associated with pharyngeal flaps prompted the use of levator muscle repositioning with palatal lengthening as initial therapy in 15 patients in an attempt to correct the pathologic anatomy while avoiding the postoperative sequelae. Patients were divided into two groups: group A (N = 8) had surgery before age 2 (11.8 +/- 5.7 months), and group B (N = 7) had surgery after 2 years of age (64.3 +/- 24.2 months). No patient in group A required a secondary operative procedure for velopharyngeal incompetence. Normal speech was obtained in 75 percent (N = 6), and slight velopharyngeal incompetence not requiring secondary correction was obtained in 25 percent (N = 2). Group B obtained less dramatic speech results: normal in 14 percent (N = 1), slight velopharyngeal incompetence in 58 percent (N = 4), and no improvement or severe velopharyngeal incompetence requiring a secondary procedure in 28 percent (N = 2). Patients with preoperative otologic disorders (N = 10) obtained significant improvement in 90 percent of cases (p = 0.002). Early surgical intervention in patients with abnormal speech prior to age 2 appears to result in normal speech in the majority of instances. Late repair with levator repositioning and palatal lengthening provided improved speech in 72 percent of patients.