Deaf and hearing children: A comparison of face perception.

Deaf and hearing adults perceive faces differently. This study investigates whether these differences are acquired during childhood development. We characterized facial perception in deaf and hearing children aged 7-17 using a perceptual discrimination task. Configural and featural information was manipulated in the eye and mouth facial regions. Participants were asked whether two faces presented simultaneously were different. Deaf and hearing children performed better in featural than configural discriminations and in mouth than eye discriminations. Compared with children with typical hearing, deaf children performed better in featural and mouth judgments but had longer reaction times with strongest effects at 7-8 and 13-14 years old. Type and location contributed jointly in deaf children's face perception with different configural but similar featural discriminations in mouth and eye locations. However, children with typical hearing showed different featural and configural judgments in both locations. Thus, featural and configural information effects on location processing differ between the two groups.

Prevalence of Educationally Significant Disabilities Among Deaf and Hard of Hearing Students.

Deaf and hard of hearing (d/DHH) students are often labeled with one or more educationally significant disabilities in addition to their hearing loss. According to the Gallaudet Research Institution's most recent Annual Survey of Deaf and Hard of Hearing Children and Youth (2013), almost 40% of d/DHH students nationwide receive special education services for one or more comorbid disabilities. However, relatively few prevalence rate estimates have been published over the last decade. Knowledge regarding the current prevalence of educationally significant disabilities among d/DHH students is therefore limited. The present study surveyed teachers of the deaf and hard of hearing (TODHHs) in a midwestern state regarding the number of d/DHH students on their caseloads with one or more comorbid disabilities. Within the sample population (N = 451), nearly 65% were reported to receive special education services for disabilities other than deafness or hearing impairment.

Association of Age-Related Hearing Impairment With Physical Functioning Among Community-Dwelling Older Adults in the US.

Importance: Hearing impairment, a common treatable condition, may contribute to poorer physical function with aging. Objective: To assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function. Design, Setting, and Participants: In this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US. Exposures: Hearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment. Main Outcomes and Measures: Physical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time. Results: Of the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (ß, -0.82; 95% CI, -0.34 to -1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, -0.34 [-0.52 to -0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of -2.81 m (95% CI, -5.45 to -0.17 m) and -5.31 m (95% CI, -10.20 to -0.36 m) than those with normal hearing, respectively, during the 2-minute walk test. Conclusions and Relevance: In this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.

Perception of COVID-19 Physical Distancing Effectiveness and Contagiousness of Asymptomatic Individuals: Cross-sectional Survey of Deaf and Hard of Hearing Adults in the United States.

BACKGROUND: During the COVID-19 pandemic, there has been a rapid increase in the amount of information about the disease and SARS-CoV-2 on the internet. If the language used in video messages is not clear or understandable to deaf and hard of hearing (DHH) people with a high school degree or less, this can cause confusion and result in information gaps among DHH people during a health emergency. OBJECTIVE: The aim of this study is to investigate the relationship between DHH people's perception of the effectiveness of physical distancing and contagiousness of an asymptomatic person. METHODS: This is a cross-sectional survey study on DHH people's perceptions about COVID-19 (N=475). Items pertaining to COVID-19 knowledge were administered to US deaf adults from April 17, 2020, to May 1, 2020, via a bilingual American Sign Language/English online survey platform. RESULTS: The sample consisted of 475 DHH adults aged 18-88 years old, with 74% (n=352) identifying as White and 54% (n=256) as female. About 88% (n=418) of the sample felt they knew most things or a lot about physical distancing. This figure dropped to 72% (n=342) for the question about the effectiveness of physical distancing in reducing the spread of COVID-19 and 70% (n=333) for the question about the contagiousness of an infected person without symptoms. Education and a knowledge of the effectiveness of physical distancing significantly predicted knowledge about the contagiousness of an asymptomatic individual. Race, gender, and age did not emerge as significant predictors. CONCLUSIONS: This results of this study point to the strong connection between education and coronavirus-related knowledge. Education-related disparities can be remedied by making information fully accessible and easily understood during emergencies and pandemics.

Bullying and Children who are Deaf or Hard-of-hearing: A Scoping Review.

OBJECTIVE/HYPOTHESIS: The goal of this scoping review is to evaluate and synthesize the published research regarding bullying and children who are deaf or hard-of-hearing (DHH). STUDY DESIGN: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR) statement was used as the guideline for conducting this review. METHODS: This review included studies assessing pediatric (0-21 years) DHH children. Seventy records underwent the initial title-abstract screening, 33 underwent full-text review, and 23 studies met inclusion criteria. During the data extraction process, an additional six were excluded, resulting in a total of 17 evaluated studies. RESULTS: Of the 17 studies assessed, nine compared peer victimization of DHH children and their hearing peers. Of those, seven studies reported that hearing loss (HL) is significantly associated with increased victimization. Two studies found that HL is significantly associated with decreased bullying perpetration. Notably, bullying in DHH children was not associated with a visible sign of disability, such as a hearing assistive device. Rather, variables such as educational setting, parental, and peer support are more likely to mediate bullying in this population. CONCLUSIONS: DHH children have a higher risk of peer victimization and may bully others less often than their hearing peers. Studies described the health consequences of bullying in children who are DHH, including sleep issues and anxiety. These consequences may have implications for the patients' overall HL management. Additional research regarding bullying interventions and prevention in this population should be conducted. LEVEL OF EVIDENCE: NA Laryngoscope, 131:1884-1892, 2021.

Creating the Capacity to Screen Deaf Women for Perinatal Depression: A Pilot Study.

OBJECTIVE: Compared to hearing women, Deaf female sign language users receive sub-optimal maternal health care and report more dissatisfaction with their prenatal care experiences. As healthcare providers begin to regularly screen for perinatal depression, validated screening tools are not accessible to Deaf women due to severe disparities in English literacy and health literacy. DESIGN AND SETTING: We conducted a one-year, community-engaged pilot study to create an initial American Sign Language (ASL) translation of the Edinburgh Postnatal Depression Scale (EPDS); conduct videophone screening interviews with Deaf perinatal women from across the United States; and perform preliminary statistical analyses of the resulting pilot data. PARTICIPANTS: We enrolled 36 Deaf perinatal women between 5 weeks gestation up to one year postpartum. MEASUREMENTS AND FINDINGS: Results supported the internal consistency of the full ASL EPDS, but did not provide evidence of internal consistency for the anxiety or depression subscales when presented in our ASL format. Participants reported a mean total score of 5.6 out of 30 points on the ASL EPDS (SD = 4.2). Thirty-one percent of participants reported scores in the mild depression range, six percent in the moderate range, and none in the severe range. KEY CONCLUSIONS AND IMPLICATIONS: Limitations included small sample size, a restricted range of depression scores, non-normality of our distribution, and lack of a fully-standardized ASL EPDS administration due to our interview approach. Informed by study strengths, limitations, and lessons learned, future efforts will include a larger, more robust psychometric study to inform the development of a Computer-Assisted Self-Interviewing version of the ASL EPDS with automated scoring functions that hearing, non-signing medical providers can use to screen Deaf women for perinatal depression.

The perspective of deaf patients on health care / A perspectiva do paciente surdo acerca do atendimento à saúde

ABSTRACT Purpose: to learn the deaf people's perspective on the improvements needed in this population's health care. Methods: an observational, cross-sectional study conducted with 124 deaf people who answered a semi-structured questionnaire to characterize the sample (age, sex, and means of communication) and collect answers to the open question: "Do you have any suggestion to improve the health care for the deaf?" - which was answered either in writing or in the Brazilian Sign Language (Libras). A descriptive analysis was conducted to characterize the sample, as well as a quantitative and qualitative content analysis (thematic-categorical), to identify categories and occurrence frequency of the content in the answers to the open question. Results: the sample's mean age was 44 years (standard deviation 15, minimum 18, and maximum 70 years), 65% were women, and 78% used Libras to communicate. Most of the participants (83%) answered the open question in writing. Six theme categories were identified: 1) Needed improvements; 2) Communication barriers); 3) Health promotion; 4) Autonomy; 5) Achievements; and 6) Law. Conclusion: the results reveal a need for improvements in the health care of deaf people. The perspective of the studied deaf population is based on their desire to gain autonomy, overcome communication barriers, and have access to information, aiming at health promotion.

RESUMO Objetivo: conhecer a perspectiva do surdo quanto às melhorias necessárias no atendimento à saúde para essa população. Métodos: estudo observacional transversal realizado com 124 surdos que responderam a questionário semiestruturado, visando caracterizar amostra (idade, sexo e tipo de comunicação) e coletar resposta à questão aberta: "Você tem alguma sugestão para melhorar o atendimento de saúde ao surdo?, respondida nas modalidades escrita ou Língua Brasileira de Sinais (Libras). Realizou-se análise descritiva para caracterização da amostra e análise quanti-qualitativa de conteúdo (temático-categorial), para identificação de categorias e frequência de ocorrência dos conteúdos das respostas à questão aberta. Resultados: amostra apresentou média de idade de 44 anos (desvio padrão: 15, mínima de 18 e máxima de 70 anos), sendo 65% mulheres e 78% usuários de Libras. A maioria dos participantes (83%) respondeu à questão aberta na modalidade escrita. Foram identificadas seis categorias temáticas: 1) Necessidade de melhorias; 2) Barreiras de comunicação); 3) Promoção da saúde; 4) Autonomia; 5) Conquistas; e 6) Legislação. Conclusão: os resultados evidenciaram necessidade de melhorias no atendimento à saúde do usuário surdo. A perspectiva da população surda estudada é pautada no desejo de autonomia, de superação das barreiras de comunicação e de acesso à informação visando promoção da saúde.

Reproductive Health Services for Adolescents With Hearing Impairment in Indonesia: Expectations and Reality.

OBJECTIVES: Reproductive health education is essential for adolescents with hearing impairment. Since they communicate using specialized language (i.e., sign language), specialized reproductive health services in sign language is a necessity. This study aimed to describe the needs, availability, and expectations of reproductive health services among adolescents with hearing impairment. METHODS: This study used a qualitative approach. It was carried out at a school for children with special needs in the city of Denpasar, Bali, Indonesia. Data were collected by in-depth interviews. The informants were 6 adolescents with hearing impairment aged 16-17 years and 4 other key informants, including school staff and health officers. The data were then analyzed using the thematic method. RESULTS: We found that the informants had insufficient knowledge regarding reproductive health. There was no specific subject in the curriculum regarding this issue. Teachers did not specifically provide reproductive health information. The health service unit in the school had not been utilized well for this purpose. Furthermore, no reproductive health services were provided due to the limited number of healthcare workers who could use sign language. CONCLUSIONS: The awareness and intentions of adolescents with hearing impairment regarding access to reproductive health services remain low. Health service units at schools should be optimized to enable schools to provide reproductive health information and services for these adolescents.

Accesibilidad de las mujeres sordas al sistema público sanitario del País Vasco / Accessibility of deaf women to the public health system of the Basque Country (Spain)

OBJETIVO: Explorar cuáles son las percepciones y las vivencias de las mujeres sordas en relación con la accesibilidad al Sistema de Salud Público Vasco (Osakidetza). Como objetivo secundario, explorar la experiencia de estas mujeres acerca de la violencia de género. MÉTODO: Estudio cualitativo con diseño exploratorio. La selección de las informantes se realizó mediante muestreo intencional. Se invitó a participar a mujeres sordas a través de la Federación de Personas Sordas de Euskadi. Se desarrollaron cuatro grupos de discusión entre octubre de 2013 y julio de 2014, con una duración media de 90-120 minutos. Estos grupos fueron grabados en vídeo para su posterior transcripción literal, en la que participó el Servicio de Intérpretes de Lengua de Signos de Euskadi. Se realizó un análisis temático. RESULTADOS: Surgen tres categorías principales: 1) sentimientos de discriminación y limitación del principio de autonomía; 2) barreras y facilitadores en la accesibilidad al sistema sanitario; y 3) vulnerabilidad de las mujeres sordas como consecuencia de la falta de comunicación. CONCLUSIONES: Las mujeres sordas continúan presentando dificultades para el acceso al sistema sanitario en nuestro contexto. Los resultados de este estudio pueden ser un punto de partida para el desarrollo de políticas sanitarias y de protocolos institucionales

OBJECTIVE: To explore what are the perceptions and experiences of deaf women in relation to accessibility to the Basque Public Health System (Osakidetza). As a secondary objective, explore the experience of these women about gender violence. METHOD: A qualitative study with exploratory design is developed. The selection of the informants was carried out through intentional sampling. Deaf women were invited to participate through the Federation of Deaf People of the Basque Country. Four discussion groups were developed between October 2013 and July 2014, with duration of 90-120 minutes. The discussion groups were recorded in video for their later literal transcription in which the service of interpreters of sign language of Euskadi participated. Thematic analyses carried out. RESULTS: Three main categories arise: 1) feelings of discrimination and limitation of the principle of autonomy; 2) barriers and facilitators in the accessibility to the health system; and 3) vulnerability of deaf women as a result of the lack of communication. CONCLUSIONS: Nowadays, deaf women continue having difficulties in accessing to the health system in our context. The results of this study can be the starting point for the development of health policies and institutional protocols

Dual Sensory Impairment and Perceived Everyday Discrimination in the United States.

Importance: Perceived everyday discrimination is a psychosocial stressor linked to adverse health outcomes, including mortality. Objective: To assess the association of vision impairment (VI), hearing impairment (HI), and dual sensory impairments (DSI) with everyday discrimination. Design, Setting, and Participants: Cross-sectional analysis of the Health and Retirement Study 2006 and 2008 surveys, a US population-based survey that included noninstitutionalized adults 51 years and older. Analyses were weighted to account for complex sample design and differential nonresponse. Data were analyzed between October 2019 and November 2019. Exposures: Participants rated their vision and hearing, using eyeglasses and/or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, and excellent). Sensory impairment was defined as poor or fair ability in the relevant modality, and sensory impairment was categorized as neither sensory impairment (NSI), VI alone, HI alone, and DSI. Main Outcomes and Measures: Perceived everyday discrimination was measured on the validated 5-question Williams scale (range 0 to 5). Linear regression models estimated differences in discrimination scores by sensory categories, adjusting for age, sex, race, ethnicity, non-US birth, body mass index, relationship status, net household wealth, and number of chronic diseases (among diabetes, hypertension, heart disease, stroke, lung disease, nonskin cancer, and arthritis). Results: The sample included 13 092 individuals. After weighting the sample to be representative of the US population, 11.7% had VI alone, 13.1% HI alone, and 7.9% DSI. In the fully adjusted model, participants with VI alone (ß [change in discrimination score], 0.07; 95% CI, 0.02-0.13), HI alone (ß = 0.07; 95% CI, 0.02-0.11), and DSI (ß = 0.23; 95% CI, 0.16-0.29) perceived greater discrimination compared with participants with NSI. The DSI group perceived greater discrimination than VI alone or HI alone. Conclusions and Relevance: Older adults with VI or HI in the United States perceive greater everyday discrimination than older adults with NSI, and those with DSI perceive even more discrimination than those with either VI or HI alone. These results provide insight into the social impact of sensory loss and highlight a need to identify and address reasons for discrimination toward older adults with VI and HI.

Early Intervention Protocols: Proposing a Default Bimodal Bilingual Approach for Deaf Children.

Despite advances in hearing technology, a growing body of research, as well as early intervention protocols, deaf children largely fail to meet age-based language milestones. This gap in language acquisition points to the inconsistencies that exist between research and practice. Current research suggests that bimodal bilingual early interventions at deaf identification provide children language foundations that can lead to more effective outcomes. Recommendations that support implementing bimodal bilingualism at deaf identification include early intervention protocols, language foundations, and the development of appropriate bimodal bilingual environments. All recommendations serve as multifaceted tools in a deaf child's repertoire as language and modality preferences develop and solidify. This versatile approach allows for children to determine their own language and communication preferences.

Voice of hearing impaired children and adolescents and hearing peers: influence of speech auditory perception on vocal production. / Voz de crianças e adolescentes deficientes auditivos e pares ouvintes: influência da percepção auditiva da fala na produção vocal.

PURPOSE: To compare the acoustic and perceptual-auditory results of the hearing impaired children and adolescents with hearing pairs and to correlate these results with parents' reports regarding speech auditory perception. METHOD: The participants were divided into two groups: Group I, 20 hearing-impaired children and adolescents and Group II, 20 children and adolescents with normal hearing. Acoustic analysis of the vowel /a/ and perceptual-auditory assessment of the vowel /a/ and speech were performed. The speech auditory perception of the GI was assessed using the Infant-Toddler Meaningful Auditory Integration Scale and the Meaningful Auditory Integration Scale with adaptation for adolescent participants. The acoustic and perceptual-auditory voice results of the GI and GII were compared and these results were correlated with the performance in the auditory perception of the GI group. RESULTS: The groups I and II presented similar results, differing statistically in the long-term frequency variation (vF0) and the long-term amplitude variation (vAm) parameters of the vowel /a/ and speech resonance parameter. It was found a negative correlation between auditory perception performance with jitter, vF0 and general degree of vowel /a/. CONCLUSION: The vocal quality in GI was similar to their hearing peers in almost all the vocal parameters that were analyzed. The auditory perception influenced jitter, vF0 and general degree of voice parameters, in which hearing-impaired children and adolescents who presented higher scores for auditory perception were also able to keep a more controlled vocal emission.

Prevalence and risk factors of dual sensory impairment among community-dwelling older adults in Selangor: A secondary data analysis.

The present study aimed to examine the prevalence of dual sensory impairment, and to identify its risk factors among community-dwelling older adults in Selangor. METHODS: Secondary analysis was carried out on data collected by the Grand Challenge Project among older adults aged ≥65 years from Selangor. Data on sociodemographic information, medical history, cognitive function and functional performance were obtained through face-to-face interviews using standardized questionnaires. Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart while hearing was assessed using pure-tone audiometry. Descriptive analysis was used to measure the prevalence of the impairments, and logistic regression analysis was used to identify the risk factors. RESULTS: The prevalence of dual sensory impairment and hearing impairment were at 10.5% and 76.2% respectively. Multivariate logistic regression analysis revealed that participants with lower cognitive scores were associated with dual sensory impairment (odds ratio, 0.90; 95% confidence interval, 0.83-0.98), while smoking was found associated with hearing impairment (odds ratio, 6.58; 95% confidence interval, 1.51-28.65). CONCLUSION: Dual sensory impairment is common among older adults in Selangor. The association between dual sensory impairment and cognitive function suggests the need to have visual and hearing screening on older adults for early detection particularly those at risk of cognitive impairment. The prevalence of hearing impairment was reported high among older adults and smokers appeared to be at higher risk of the impairment. Geriatr Gerontol Int 2020; 20: 911-916.

Responsibility in the Current Epidemic of Language Deprivation (1990-Present).

Language deprivation syndrome (LDS) is a permanent and preventable disability affecting language, cognition, and behavior that is epidemic in the deaf population. Since 1990, systemic and technological changes in the health care of deaf children have created a new paradigm that perpetuates this crisis. Physicians and other professionals have been largely unaware of their roles in this recent epidemic. An evidenced based system of care that addresses the causes and potential solutions can reverse this trend and prevent early language deprivation in deaf children.

How Bilingualism Contributes to Healthy Development in Deaf Children: A Public Health Perspective.

The aim of this article is to increase awareness of language practices in the deaf community that affect communication needs and health outcomes, focusing particularly on the prevalence of bilingualism among deaf adults. Language deprivation and poor health outcomes in the deaf population are risks that cannot be addressed solely by hearing intervention. We propose that bilingualism acts as a protective measure to minimize the health risks faced by deaf individuals. Provision of culturally and linguistically appropriate services to deaf stakeholders, and particularly hearing families of deaf children, requires familiarity with the developmental and social ramifications of bilingualism.

Hearing impairment in young and middle-aged septicemia survivors.

The ability of sepsis to induce acute phase hearing impairment has been evaluated in septic and sepsis-surviving mice. The relationship between septicemia and long-term hearing impairment remains unknown in humans.The data were obtained from the Taiwan Longitudinal National Health Insurance Database from 2000 to 2013. We identified patients suffering from septicemia after discharge, excluding those younger than 18 years old and older than 65 years old. The comparison group was matched based on age, sex, and comorbidities. The outcome was hearing impairment occurring after septicemia. The risk factors associated with hearing impairment were established using multivariate Cox proportional hazard regression.Our study found that septicemia associated with hearing impairment had an adjusted hazard ratio (HR) of 53.11 (95% confidence interval [CI]: 41.74-67.59). The other factors related to hearing impairment in young and middle-aged septicemia survivors included male sex (adjusted HR 1.31 [95% CI: 1.14-1.5]), chronic kidney disease (adjusted HR 1.63 [95% CI: 1.38-1.94]), and otoscleroisis (adjusted HR 231.54 [95% CI: 31.61-1695.8]).Our study revealed that septicemia was associated with increased development of hearing impairment in young and middle-aged humans in the long term. Clinicians should be aware of long-term septicemia-related hearing impairment and provide prevention strategies for otopathy in septicemia survivors.

American Sign Language Interpreters in Public Schools: An Illusion of Inclusion that Perpetuates Language Deprivation.

PURPOSE: Many deaf children have limited access to language, spoken or signed, during early childhood - which has damaging effects on many aspects of development. There has been a recent shift to consider deafness and language deprivation as separate but related conditions. As such, educational plans should differentiate between services related to deafness and services related to language deprivation. DESCRIPTION: Many deaf children attend mainstream public schools, and the primary service offered to students who use American Sign Language (ASL) is generally a sign language interpreter. ASSESSMENT: We argue that while sign language interpreters can be an effective accommodation for deafness (i.e., students who are deaf and not language-deprived), there is no reason to believe they are an effective accommodation for language deprivation (i.e., students who are deaf and language-deprived). CONCLUSION: Using interpreters instead of appropriate educational supports may exacerbate symptoms of language deprivation by prolonging the period of time a child goes with limited access to language.

Hearing loss and employment: a systematic review of the association between hearing loss and employment among adults.

BACKGROUND: Hearing loss affects over 1.3 billion individuals worldwide, with the greatest burden among adults. Little is known regarding the association between adult-onset hearing loss and employment. METHODS: Seven databases (PubMed, Embase, Cochrane Library, ABI/Inform Collection, Business Source Ultimate, Web of Science and Scopus) were searched through to October 2018. The key word terms used related to hearing loss and employment, excluding paediatric or congenital hearing loss and deaf or culturally deaf populations. RESULTS: The initial search resulted in 13 144 articles. A total of 7494 articles underwent title and abstract screening, and 243 underwent full-text review. Twenty-five articles met the inclusion criteria. Studies were set in 10 predominantly high-income countries. Seven of the 25 studies analysed regionally or nationally representative datasets and controlled for key variables. Six of these seven studies reported associations between hearing loss and employment. CONCLUSION: The highest quality studies currently available indicate that adult-onset hearing loss is associated with unemployment. However, considerable heterogeneity exists, and more rigorous studies that include low- and middle-income countries are needed.

Health literacy of hearing-impaired adolescents, barriers and misunderstandings they encounter, and their expectations.

BACKGROUND: Adults who are deaf or hard of hearing (D/HoH) have lower levels of health literacy compared to their counterparts who can hear. It is unclear, however, whether or not this inequality manifests in adolescence. OBJECTIVE OR HYPOTHESIS: This study aims to determine levels of health literacy among D/HoH adolescents and to identify barriers and misunderstandings they encounter as well as their expectations when applying for healthcare services. METHODS: This descriptive study was conducted with 88 D/HoH adolescents over the age of 15. The Health Sciences Faculty granted approval for the study. RESULTS: Of the adolescents, 70.5% had inadequate, 19.3% had limited, 2.3% had adequate and 8% had excellent health literacy levels. Those who had difficulty in communicating with the doctor (25%), those who misused the prescribed medication (13.6%) and those who could not use the medication without help (43.2%) had low THLS scores (<0.05). Those who stated that they did not understand what the nurses said (43.2%) or the health education materials (56.8%) and had significantly low THLS scores (<0.05). Of these adolescents, 55.7% expected their prescriptions or care procedures to be given to them in writing, and 87.5% expected that these would be explained to them in sign language. A significant relationship was observed between hearing disability and health literacy (R = 0.659, R2 = 0.434) (p < 0.01). CONCLUSION: Most D/HoH adolescents have a significantly lower level of health literacy, which is more likely linked with poor communication and misunderstandings concerning medication instructions.

Access to healthcare for deaf people: a model from a middle-income country in Latin America.

OBJECTIVE: To determine if there are existing healthcare access inequities among the deaf Chilean population when compared to the general Chilean population. METHODS: Data were obtained from a population-based national survey in Chile. In total, 745 prelingually deaf individuals were identified. The number of times the person used the healthcare system was dichotomized and analyzed using a multivariate logistic regression model. RESULTS: Prelingually deaf people had lower incomes, fewer years of education, and greater rates of unemployment and poverty when compared with the general population. Moreover, they visited more general practitioners, mental health specialists, and other medical specialists. On average, they attended more appointments for depression but had fewer general checkups and gynecological appointments than the general population. CONCLUSIONS: Deaf people in Chile have a lower socioeconomic status than the rest of the Chilean population. The results from this study are similar to the findings reported for high-income countries, despite differences in the magnitude of the associations between being deaf and healthcare access. Further studies should be conducted to determine the health status of deaf people in Chile and other Latin American countries and what factors are associated with a significantly lower prevalence of gynecological appointments among deaf women when compared with non-deaf women.