Relationships among speech perception, production, language, hearing loss, and age in children with impaired hearing.

Eighty-seven primary-school children with impaired hearing were evaluated using speech perception, production, and language measures over a 3-year period. Forty-seven children with a mean unaided pure-tone-average hearing loss of 106 dB HL used a 22-electrode cochlear implant, and 40 with a mean unaided pure-tone-average hearing loss of 78 dB HL were fitted with hearing aids. All children were enrolled in oral/aural habilitation programs, and most attended integrated classes with normally hearing children for part of the time at school. Multiple linear regression was used to describe the relationships among the speech perception, production, and language measures, and the trends over time. Little difference in the level of performance and trends was found for the two groups of children, so the perceptual effect of the implant is equivalent, on average, to an improvement of about 28 dB in hearing thresholds. Scores on the Peabody Picture Vocabulary Test (PPVT) and the Clinical Evaluation of Language Fundamentals showed an upward trend at about 60% of the rate for normally hearing children. Rates of improvement for individual children were not correlated significantly with degree of hearing loss. The children showed a wide scatter about the average speech production score of 40% of words correctly produced in spontaneous conversations, with no significant upward trend with age. Scores on the open-set Consonant-Nucleus-Consonant (CNC) monosyllabic word test and the Bench-Kowal-Bamford (BKB) sentence test were strongly related to language level (as measured by an equivalent age on the PPVT) and speech production scores for both auditory-visual and auditory test conditions. After allowing for differences in language, speech perception scores in the auditory test condition showed a slight downward trend over time, which is consistent with the known biological effects of hearing loss on the auditory periphery and brainstem. Speech perception scores in the auditory condition also decreased significantly by about 5% for every 10 dB of hearing loss in the hearing aid group. The regression analysis model allows separation of the effects of language, speech production, and hearing levels on speech perception scores so that the effects of habilitation and training in these areas can be observed and/or predicted. The model suggests that most of the children in the study will reach a level of over 90% sentence recognition in the auditory-visual condition when their language becomes equivalent to that of a normally hearing 7-year-old, but they will enter secondary school at age 12 with an average language delay of about 4 or 5 years unless they receive concentrated and effective language training.

Increased awareness and health care provider endorsement is required to encourage pregnant women to be vaccinated.

Maternal immunization is an important strategy recommended to protect both mothers and infants from serious infectious diseases; however uptake of maternal immunization is poor in Australia. This study aimed to gain an in-depth understanding of the decision making process and factors influencing a pregnant woman's decisions about recommended immunizations. This qualitative study used semi-structured interviews with open-ended questions to interview pregnant women. Data were analyzed using thematic analysis techniques and drew on the Health Belief Model. Pregnant women (n = 17) were asked about their attitudes toward immunization during pregnancy and their perceptions about risk during pregnancy. Women were also asked to detail their decision making process and factors influencing their decisions about immunizations in relation to pregnancy. Most of the participants were not aware of the immunizations recommended during pregnancy, in pregnancy planning or after delivery. In addition to endorsement by their health care provider (HCP), perception of risk and benefit, including risk of infection, previous vaccination experiences and assessing cost benefit play a vital role in women's decisions whether to be immunized while pregnant. Although the role of the healthcare provider in advising pregnant women about immunizations was identified as vitally important, the majority of women had not been advised of recommended vaccines by their healthcare provider. Healthcare providers are key to ensuring pregnant mothers are informed about recommended vaccines and these need to be more proactively supported and encouraged by healthcare providers. This is likely to have a positive effect on acceptance and uptake of immunization by pregnant women.