Hearing Aid Uptake in Children with Unilateral Microtia and Canal Atresia: A Comparison between a Tertiary Center and Peripheral Centers.

OBJECTIVES: To review the trialing and uptake of hearing aids in children with unilateral microtia or canal atresia, known collectively as congenital unilateral conductive hearing loss (CUCHL), observed in a tertiary hospital and local peripheral services. MATERIALS AND METHODS: A retrospective review of medical records for patients with CUCHL was conducted using data from a shared audiology database at a tertiary children's hospital. RESULTS: We identified 45 patients with CUCHL and excluded seven of them due to missing data. Of the 38 patients, 16 (16/38, 42%) did not have any subjective hearing complaints. Furthermore, 32% (12/38) of patients attended audiology at a tertiary centre and 83% (10/12) from this group trialled a hearing aid. In comparison, 46% (12/46) whose audiology care was delivered peripherally trialled aiding. Of the patients from the tertiary center, 58% (7/12) are still using a hearing aid compared to 27% (7/26) of patients from peripheral centers. CONCLUSION: Our analysis shows that patients with CUCHL are more likely to try hearing aids and continue using them if their audiology care is in a tertiary center. Allowing for a small sample size, this may indicate a health inequality. Agreeing on minimum standards for the management of patients with CUCHL or managing them in a designated center could increase consistency.

Rehabilitation for disabling hearing loss: evaluating the need relative to provision of hearing aids in the public health care system.

Purpose: To determine the demand relative to supply of hearing rehabilitation through hearing aids for those with disabling hearing loss in a public health care setting in South Africa. Methods: Retrospective cross-sectional survey of medical records of all patients were seen at a public hospital (Polokwane Provincial Academic) during 2012-2014, was conducted. Audiological data from 3894 medical folders were accessed and reviewed; thereafter, results were analyzed using descriptive statistics. Results: Of the 3894 medical folders reviewed, two-third (62%, n = 2402) were diagnosed with hearing loss, mostly bilaterally (81%). More than 30% of all patients diagnosed with hearing loss were ≤10 years old. Sensorineural (permanent) hearing loss was diagnosed most often (38%, n = 913) and 74% (n = 1778) of hearing losses diagnosed were of moderate or worse severity (i.e., disabling loss). Hearing aids were fitted to only 15% (n = 272) of those diagnosed with disabling hearing loss and most hearing aid fittings were to low-income adult patients (≥25 years old) with more severe-profound hearing losses. Conclusions: This study showed that the need for hearing aids to provide hearing rehabilitation far exceeds the supply. Therefore, a multi-pronged approach that includes increased budget allocation and exploring low-cost interventions for developing countries to meet the demand for hearing aids. Furthermore, study highlighted a high prevalence of hearing loss in those younger than 10 years of age, and thus highlights the need for early intervention as well as intensifying efforts to reduce preventable causes of hearing loss. Implications for Rehabilitation Audiologists need to advocate for an increase in budget allocation for hearing rehabilitation devices. Study indicates need to explore low-cost hearing devices/rehabilitation interventions for developing countries. Health professionals should consider preventative measures to reduce prevalence of preventable hearing loss.

Effects of socioeconomic status on children with hearing loss.

OBJECTIVE: Health care disparities are noted between different socioeconomic groups; it is crucial to recognize and correct disparities, if present, that extend to children with hearing loss. The objective of the study is to evaluate the effect of socioeconomic status (SES) on access to hearing rehabilitation and speech and language therapy and outcomes in children with hearing loss. METHODS: Retrospective Chart Review of children diagnosed with hearing loss at 3 tertiary care academic centers from 2010 to 2012. Two hundred patients were then randomly selected from each institution for analysis. International and self-pay patients were excluded. They were separated into two groups based on SES using insurance coverage as proxy for financial status (private insurance versus Medicaid). Main outcome measures included number of hearing aid evaluations recommended andcompleted, compliance with hearing aids use, diagnosis on speech therapy evaluations, participation in speech therapy, and outcomes noted on the last speech therapy session in patients' medical record at time of study completion. RESULTS: 600 patients were identified by random selection out of total of 3679 patients. 18 were excluded because they were international pay or self-pay. Of 582 patients, 299 (51.4%) had private insurance and 283 (48.6%) had Medicaid. The pure tone average (PTA) at initial diagnosis did not differ between the two populations (left ear p = 0.74, right ear p = 0.68). There was no significant difference in the number of hearing aid evaluations recommended (p = 0.49), hearing aid evaluation completed (p = 0.68), or documented hearing aid compliance (p = 0.68) between the two populations. Similarly, there was no significant difference in the presence of speech delay (p = 0.62), the receipt of speech therapy (p = 0.49), or speech language outcomes between the two groups (p = 0.45). CONCLUSIONS: This study suggests that despite lower socioeconomic status, in children with hearing loss, Medicaid allows equivalent access to hearing rehabilitation and speech therapy as their privately insured counterparts and children achieve similar speech and language outcomes.

Comparison Of Health Insurance Coverage For Hearing Aids And Other Services In Alberta.

OBJECTIVES: Of the several barriers associated with uptake and adherence to hearing services, cost is the most commonly identified barrier in Canada. This study evaluated health insurance plans for hearing care coverage within Alberta, Canada, and subsequent out-of-pocket expenses that would result if an individual chose to pursue treatment. METHODS: An investigation of eight companies that provide supplementary health coverage in Alberta was conducted. Categories of health service coverage included hearing, vision, speech-language pathology (S-LP), physical therapy related (PT-R; including massage therapy and chiropractic therapy) and alternative medicine related (AM-R; including osteopathy, acupuncture and naturopathy). All coverage amounts were corrected to a four-year term for comparison purposes. RESULTS: For a four-year term, the coverage amounts for hearing services were CAD 300-750; for vision services were CAD 0-900; for S-LP services were CAD 0-2,400; for PT-R services were CAD 1,400-10,200; and for AM-R services were CAD 0-10,200 per four-year term. The expected out-of-pocket expense for vision ranged from CAD 0 to CAD 2,766, whereas for hearing, it ranged from CAD 250 to CAD 11,700. CONCLUSION: A considerable range and discrepancy were reported between hearing care and most paramedical services. In addition, the coverage amounts for hearing care were inconsistent with treatment costs, resulting in considerable out-of-pocket expenses for most consumers. The potential implications of such cost-related barriers on public health are an important consideration as our understanding of the impact of untreated hearing impairment continues to increase.

Reposição de próteses auditivas em programa de saúde auditiva / Replacement of hearing aids in hearing health program

RESUMO Objetivo Verificar os motivos e o tempo médio de reposição de próteses auditivas em usuários atendidos no sistema de alta complexidade em saúde auditiva, em um hospital no Sul do Brasil. Métodos Realizou-se consulta aos prontuários dos pacientes (crianças, adultos e idosos) que receberam próteses auditivas por meio do programa de saúde auditiva, no período de janeiro de 2010 a julho de 2017. Foi verificado o motivo da reposição, o número de reposições e o tempo de reposição para cada uma das orelhas. Os dados foram analisados de forma quantitativa, utilizando-se os testes qui-quadrado de Pearson ou exato de Fisher, com nível de significância de 0,05. Resultados Foram analisados 1.256 prontuários de crianças, adultos e idosos. O principal motivo de reposição foi por falha técnica. Nas crianças, o tempo médio da primeira reposição foi menor do que nos adultos e nos idosos. Adultos e idosos formaram o grupo que mais buscou o serviço para realização da primeira reposição de seus dispositivos. As crianças formaram o grupo que mais precisou da segunda e da terceira reposições. Conclusão Trezentos e quarenta e dois pacientes necessitaram repor, no mínimo uma vez, seus dispositivos, tendo como principal motivo a falha técnica. O tempo médio entre a adaptação e a primeira reposição foi de aproximadamente quatro anos.

ABSTRACT Purpose To verify the causes and the average time of hearing aids replacement of patients of a high complexity system in hearing health in a hospital in the south of Brazil. Methods Electronic charts of patients (children, adults and elders), who received hearing aids through the hearing health program from 2010 to 2017, were analyzed. It was verified the causes, the number, and the average time of replacement, in each of patients' ears. Data were analyzed quantitatively using Pearson's chi-square test or Fisher's exact test, with a significance level at 0.05. Results 1.256 charts of children, adults and elders were analyzed. The main cause of replacement was due to technical failure. In children the average time of replacement was shorter than in adults and the elders. Adults and elders were the groups that needed more replacements. Children's group was the group that needed more than one replacement. Conclusion Technical failure was the main reason why users seek the service to perform a replacement of their devices, and the average time between adaptation and the first replacement was of approximately four years.

Randomised controlled feasibility trial of the Active Communication Education programme plus hearing aid provision versus hearing aid provision alone (ACE to HEAR): a study protocol.

INTRODUCTION: Up to 30% of hearing aids fitted to new adult clients are reported to be of low benefit and used intermittently or not at all. Evidence suggests that additional interventions paired with service-delivery redesign may help improve hearing aid use and benefit. The range of interventions available is limited. In particular, the efficacy of interventions like the Active Communication Education (ACE) programme that focus on improving communication success with hearing-impaired people and significant others, has not previously been assessed. We propose that improved communication outcomes associated with the ACE intervention, lead to an increased perception of hearing aid value and more realistic expectations associated with hearing aid use and ownership, which are reported to be key barriers and facilitators for successful hearing aid use. This study will assess the feasibility of delivering ACE and undertaking a definitive randomised controlled trial to evaluate whether ACE would be a cost-effective and acceptable way of increasing quality of life through improving communication and hearing aid use in a public health service such as the National Health Service. METHODS AND ANALYSIS: This will be a randomised controlled, open feasibility trial with embedded economic and process evaluations delivered in audiology departments in two UK cities. We aim to recruit 84 patients (and up to 84 significant others) aged 18 years and over, who report moderate or less than moderate benefit from their new hearing aid. The feasibility of a large-scale study and the acceptability of the ACE intervention will be measured by recruitment rates, treatment retention, follow-up rates and qualitative interviews. ETHICS AND DISSEMINATION: Ethical approval granted by South East Coast-Surrey Research Ethics Committee (16/LO/2012). Dissemination of results will be via peer-reviewed research publications both online and in print, conference presentations, posters, patient forums and Trust bulletins. TRIAL REGISTRATION NUMBER: ISRCTN28090877.

Is centre-based provision of hearing aids better than community-based provision? A cluster-randomized trial among adolescents in Bangladesh.

PURPOSE: In response to the need for hearing aids in low-income countries, an approach to provide hearing aids through trained community workers was developed. This study compares the effectiveness of the community-based approach with that of a centre-based approach. METHODS: One hundred and forty adolescents (56% girls; 12-18 years; mean: 15 years) from eleven sub-districts participated in a cluster-randomized trial comparing a community-based service (n = 75) with a centre-based service (n = 65) in Bangladesh. The International Outcome Inventory for Hearing Aids (IOI-HA) was administered to the participants six weeks after fitting of a hearing aid, and its scores were analyzed by Mann-Whitney U-tests and an ordinal regression model. RESULTS: The community-based approach performed as well as the centre-based approach on five out of seven outcome measures. The latter approach performed statistically significantly better on Residual participation restrictions (p = .007) and Impact on others (p = .012), but the effect sizes were small. Controlling for sex, age, hearing loss, place of living and proxy responses did not change the results. CONCLUSIONS: The community-based approach is a viable and effective option for hearing aid delivery in low-resourced settings. The approach needs to be adapted to particular contexts, and possible down-sides may need to be counteracted by special interventions. Implications for Rehabilitation Hearing aid use can contribute to improved activity, participation and quality of life among adolescents in low-income countries. Community-based approaches to delivering hearing aids can be viable and effective options to centre-based services.

Assistive technology in resource-limited environments: a scoping review.

PURPOSE: It is estimated that only 5-15% of people in low and middle income countries (LMICs) who need assistive technologies (AT) have access to them. This scoping review was conducted to provide a comprehensive picture of the current evidence base on AT within LMICs and other resource limited environments. METHOD: The scoping review involved locating evidence, extracting data, and summarizing characteristics of all included research publications. RESULTS: Of the 252 publications included, over 80% focused on types of AT that address mobility (45.2%) and vision (35.5%) needs, with AT types of spectacles and prosthetics comprising over 50% of all publications. Evidence on AT that addresses hearing, communication, and cognition is the most underrepresented within the existing evidence base. The vast majority of study designs are observational (63%). CONCLUSIONS: Evidence on AT in resource-limited environments is limited in quantity and quality, and not evenly distributed across types of AT. To advance this field, we recommend using appropriate evidence review approaches that allow for heterogeneous study designs, and developing a common language by creating a typology of AT research focus areas. Funders and researchers must commit much greater resources to the AT field to ameliorate the paucity of evidence available. Implications for Rehabilitation An increase in the quality and quantity of research is required in resource limited environments, where 80% of the global population of people with disabilities reside. Improved and increased evidence is needed to identify and understand needs, inform policy and practice, and assess progress made in increasing access to and availability of appropriate AT. Over 80% of the existing research publications on assistive technologies in resource limited environments address mobility and vision. More research is needed on AT that address hearing, communication and cognition. The use of a common language would facilitate the advancement of the global AT research field. Specifically there is a need for researchers to use a common definition of AT (i.e., ISO 9999) and typology of AT research focus areas.

The Baltimore HEARS Pilot Study: An Affordable, Accessible, Community-Delivered Hearing Care Intervention.

Purpose of the Study: Age-related hearing loss negatively affects health outcomes, yet disparities in hearing care, such as hearing aid use, exist based on race/ethnicity and socioeconomic position. Recent national efforts highlight reduction of hearing care disparities as a public health imperative. This study a) describes a community engagement approach to addressing disparities, b) reports preliminary outcomes of a novel intervention, and c) discusses implementation processes and potential for wide-scale testing and use. Design and Methods: This was a prospective, randomized control pilot, with a 3-month delayed treatment group as a waitlist control, that assessed feasibility, acceptability, and preliminary efficacy of a community-delivered, affordable, and accessible intervention for older adults with hearing loss. Outcomes were assessed at 3 months, comparing immediate and delayed groups, and pooled to compare the cohort's pre- and 3-month post-intervention results. Results: All participants completed the study (n = 15). The program was highly acceptable: 93% benefited, 100% would recommend the program, and 67% wanted to serve as future program trainers. At 3 months, the treated group (n = 8) experienced fewer social and emotional effects of hearing loss and fewer depressive symptoms as compared to the delayed treatment group (n = 7). Pooling 3-month post-intervention scores (n = 15), participants reported fewer negative hearing-related effects (effect size = -0.96) and reduced depressive symptoms (effect size = -0.43). Implications: The HEARS (Hearing Equality through Accessible Research & Solutions) intervention is feasible, acceptable, low risk, and demonstrates preliminary efficacy. HEARS offers a novel, low-cost, and readily scalable solution to reduce hearing care disparities and highlights how a community-engaged approach to intervention development can address disparities.

A description of assistive technology sources, services and outcomes of use in a number of African settings.

Purpose statement: The article explores assistive technology sources, services and outcomes in South Africa, Namibia, Malawi and Sudan. METHODS: A survey was done in purposively selected sites of the study countries. Cluster sampling followed by random sampling served to identify 400-500 households (HHs) with members with disabilities per country. A HH questionnaire and individual questionnaire was completed. Country level analysis was limited to descriptive statistics. RESULTS: Walking mobility aids was most commonly bought/provided (46.3%), followed by visual aids (42.6%). The most common sources for assistive technology were government health services (37.8%), "other" (29.8%), and private health services (22.9%). Out of the participants, 59.3% received full information in how to use the device. Maintenance was mostly done by users and their families (37.3%). Devices helped a lot in 73.3% of cases and improved quality of life for 67.9% of participants, while 39.1% experienced functional difficulties despite the devices. CONCLUSION: Although there is variation between the study settings, the main impression is that of fragmented or absent systems of provision of assistive technology. Implications for rehabilitation Provision of assistive technology and services varied between countries, but the overall impression was of poor provision and fragmented services. The limited provision of assistive technology for personal care and handling products is of concern as many of these devices requires little training and ongoing support while they can make big functional differences. Rural respondents experienced more difficulties when using the device and received less information on use and maintenance of the device than their urban counterparts. A lack of government responsibility for assistive device services correlated with a lack of information and/or training of participants and maintenance of devices.

Users' perspectives on the provision of assistive technologies in Bangladesh: awareness, providers, costs and barriers.

PURPOSE: The purpose of this work was to contribute to a better understanding of challenges and solutions to equitable provision of assistive technologies in resource limited environments by (i) describing sources of awareness, types of providers and costs of assistive technologies; (ii) describing common reasons for not possessing assistive technologies; and (iii) comparing these sources, providers, costs and reasons among younger and older men and women living in urban and rural settings. METHODS: Descriptive and analytic statistics were used to analyze cross-sectional data from a total sample of 581 hearing aid users, wheelchair users, individuals with hearing impairments not using hearing aids and individuals with ambulatory impairments not using wheelchairs living in eight districts of Bangladesh. RESULTS: Major sources of awareness, types of providers and costs paid varied between users of different types of assistive technology. Lack of affordability was the main reason for not possessing assistive technology. Outcome differences were found between younger and older groups, men and women, and literate and illiterate respondents, while no differences related to place of living were identified. CONCLUSIONS: Age, gender, type of impairment and socioeconomic status need to be considered when planning and implementing equitable provision of assistive technologies. Implications for Rehabilitation Provision of assistive technologies needs to be made affordable as lack of affordability was the major reason for not possessing such technologies. To ensure equitable provision of assistive technology, services ought to consider age, gender, impairment and socioeconomic status of their target groups. This includes offering a range of products of different sizes provided by culturally appropriate personnel at affordable cost, which to many may be at no or reduced cost. To cater to the assistive technology needs among the most vulnerable groups, assistive technology providers may learn from CBR strategies, such as, awareness raising and service delivery at community level, the use of local resources, collaboration and coordination, and the consideration of cultural factors.

Service, training and outreach--the EARS Inc. Model for a self sustainable hearing program in action.

PURPOSE: EARS Inc. is a faith based not-for-profit organization established in 1998. As an organization, it has consistently maintained a goal to provide both short-term and long-term projects in low and middle income countries. One specific project undertaken by EARS Inc involved developing a hearing health program in the Dominican Republic. METHODS: This article is a review of the challenges and successes encountered on the road to establishing improved access and affordability of hearing aid technology for the hearing impaired in Domincan Republic. RESULTS: Despite the challenges, after 12 years of local programming, the hearing health services in the Dominican Republic were successfully implemented. The development of these services included the simultaneous development of a training program, earmould laboratory, hearing aid repair services as well as calibration services and sales of batteries and accessories. CONCLUSIONS: As demonstrated in this review, it is possible to develop sustainable and comprehensive diagnostic and rehabilitation hearing services in a developing country. It is clear that training, equipping and empowering local staffs are instrumental to the success of the program. IMPLICATIONS FOR REHABILITATION: A good hearing aid fitting is more than supplying technology. Patient education and the clinician fitting the hearing aid are important. Access to follow-up services including battery supplies, hearing aid adjustments and hearing aid repairs is essential for a hearing aid fitting program in low and middle income countries to be sustainable. Check the WHO guidelines for hearing aid provision in developing countries when planning a program. When working in a country, co-ordinate with local professionals involved in hearing health where available.

The importance of creating a social business to produce low-cost hearing aids.

UNLABELLED: The World Health Organization (WHO) estimates that about 280 million people worldwide have a bilateral hearing loss, mostly living in poor countries. Hearing loss causes heavy social burdens on individuals, families, communities and countries. However, due to the lack of accessibility and affordability, the vast majority of people in the world who need hearing aids do not have access to them. Low-income countries are thus pulled into a disability/poverty spiral. From this standpoint, the production of available, accessible and affordable hearing aids for the poorest populations of our planet should be one of the main issues in global hearing healthcare. Designing and producing a brand new low-cost hearing aid is the most effective option. Involving a large producer of hearing aids in the creation of a social business to solve the problem of access to affordable hearing aids is an essential step to reduce hearing disability on a large scale globally. Today's technology allows for the creation of a "minimal design" product that does not exceed $100-$150, that can be further lowered when purchased in large quantities and dispensed with alternative models. It is conceivable that by making a sustainable social business, the low cost product could be sold with a cross-subsidy model in order to recover the overhead costs. IMPLICATIONS FOR REHABILITATION: Social business is an economic model that has the potential to produce and distribute affordable hearing aids in low- and middle-income countries. Rehabilitation of hearing impaired children will be carried out in partnership with Sahic (Society of Assistance to Hearing Impaired Children) in Dhaka, Bangladesh and the ENT Department of Ospedale Burlo di Trieste, Dr. Eva Orzan.

Technology transfer aids hearing.

India is one of a growing number of countries looking at technology transfer to improve access to reliable, low-cost, digital hearing devices. Gary Humphreys reports.

Informe de audífonos para pacientes con hipoacusia / Hearing aid report for patients with hearing loss

INTRODUCCION: El presente Informe estructurado ha sido elaborado para ser utilizado en el proceso de evaluación de incorporación de nuevos equipamientos médicos en el ámbito hospitalario público. OBJETIVOS: Los objetivos del son: -Simplificar el análisis de la solicitud de incorporación de tecnologías a través de la organización de la información en distintos dominios. -Facilitar la elaboración de los juicios valorativos. -Armonizar la elaboración de las recomendaciones. PREPARACIÓN: El mismo debe ser elaborado por el Comité Evaluador para luego remitirse a los Comités provinciales y finalmente, a la DPGTBM. El Comité Evaluador deberá agotar las instancias para lograr una recomendación por consenso. Si se interpretara que la información provista resulta insuficiente, se recurrirá al soporte técnico de la DPGTBM, a fin de realizar las búsquedas de información necesarias a tal fin. El informe de evaluación considera los siguientes dominios: -adecuación a los objetivos estratégicos y al plan de salud provincial, -balance entre las ventajas e inconvenientes de adoptar la nueva tecnología, -capacidad del Hospital de asumir la propuesta. Cada uno de los ítems en la sección sobre información general y en cada uno de los dominios mencionados anteriormente debe ser completado. RECOMENDACIÓN FINAL: Se recomienda con modificaciones específicas. Explicitación de las modificaciones basadas en el análisis de los puntos realizado en cada dominio. La hipoacusia es un problema de salud prevalente, que afecta las posibilidades de comunicación, educación, inserción en el mercado laboral y relación en sociedad, impactando en la calidad de vida de los pacientes. Los audífonos son una tecnología segura y efectiva para la mayoría de los pacientes con hipoacusia. En Neuquén y Argentina no hay datos sobre la prevalencia de hipoacusicos que requieran ser equipados con audífonos. Si se sabe que en Argentina aproximadamente 3 de cada 1000 nacidos vivos presentaran hipoacusia. Extrapolando datos de otros países se obtienen estimaciones por edad de estos potenciales pacientes que sumándolos superarían en Neuquén los 8000 pacientes a cargo de salud pública que estarían al día de hoy en condiciones de recibir una indicación médica de audífonos. El impacto presupuestario de cubrir a toda esa población sería inicialmente iniciales (en el primer año) de $ 92.036.193 a $ 121.769.465, lo que obliga a establecer prioridades. La legislación vigente, así como las recomendaciones de la OMS apuntan a cubrir completamente a la población pediátrica. Si bien, en esta población actualmente son pocos los casos detectados y para los que se solicitan audífonos, los datos de otros países orientan a que puede existir una importante cantidad de pacientes no diagnosticados y/o que no han logrado acceder a un especialista. El impacto presupuestario de cubrir a toda la población potencial en edad pediátrica y hasta la formación universitaria sería de $ 4.211.620 a $5.790.978. Además de las limitaciones presupuestarias deben ser tenidas en cuenta las capacidades operativas para detectar y dar respuesta a estos pacientes potenciales, ya que actualmente solo se realizan pruebas de selección de audífonos en el hospital de mayor complejidad de la provincia, y podrían ser necesarios más recursos humanos y físicos (equipos de audiometría, etc.). Sería deseable contar con datos concretos sobre la efectividad del programa de screening neonatal de hipoacusia en toda la provincia. Para los casos en que las autoridades reconozcan la cobertura se recomienda: -Proveer equipo bilateral para todos los niños. -Cubrir equipos retro-auriculares que resultan adecuados para la mayoría de los casos. -Cubrir las pilas y los moldes, debido a que la falta de éstos puede motivar el no uso del audífono afectando la eficiencia. -Realizar convenios con los proveedores para garantizar la disponibilidad de diversos tipos y modelos al momento de efectuar las pruebas. De esta manera se evitan los monopolios (con precios abusivos) y se brinda al paciente la posibilidad de optar por un equipo que realmente vaya a usar, ya que como se mencionó es fundamental la opinión del usuario respecto a la mejoría de la audición, más allá de las especificaciones técnicas. -Realizar un seguimiento estricto de los pacientes equipados, monitoreando el uso de los equipos, la equidad en la accesibilidad según las zonas geográficas y la eficiencia global del programa.

Determinants of Department of Veterans Affairs hearing aid brand dispensing by individual audiologists.

Department of Veterans Affairs (VA) audiologists were surveyed regarding their perceptions and evaluations of hearing aid (HA) brands on seven factors previously published in peer-reviewed research as important to the HA brand preference decision of audiologists. One of the seven factors formed a distinct dimension of brand differentiation based on Contract Pricing (dimension 1). Brand perceptions for the other six factors were highly correlated with one another; this dimension of correlated perceptions was labeled Propensity to Dispense Based on a Gestalt Percept (dimension 2). That is, a direct relation exists between the collective perception of HA brand and its likelihood of being dispensed. These two dimensions accounted for 93.1% of the variance in the perceived differences among the HA brands surveyed. Joint-space mapping was used to model the effect of altering perceptions on VA HA brand dispensing. Results indicate that few VA audiologists (7.7%) dispense HA brands in majority association with contract pricing. Instead, the vast majority (77%) form brand preferences in majority association with their individualized perceptions.

Overview of newborn hearing screening activities in Latin America.

OBJECTIVE: Ascertain the status of early hearing detection and intervention services in Latin America. METHODS: Between June and November 2007, Gallaudet University, in collaboration with the U.S. Centers for Disease Control and Prevention Early Hearing Detection and Intervention Diversity Committee, disseminated a survey to 11 Latin American countries. It included questions about newborn hearing screening (NHS) procedures, the availability of intervention services for infants with hearing loss, and challenges in identifying infants with hearing loss. In addition, a literature review was conducted to help identify the status of NHS efforts in Latin America. RESULTS: Six countries (Chile, Costa Rica, Guatemala, Mexico, Panama, and Uruguay) and one U.S. territory (Puerto Rico) responded to the survey. Responses indicated that efforts to identify infants with hearing loss vary within and across countries in Latin America. In some countries, activities have been implemented at a national level; in others, activities have been implemented at a single hospital or region within a country. Common barriers to implementation of NHS programs include a lack of funding, screening and diagnostic equipment, public awareness, and personnel qualified to work with infants and young children. CONCLUSIONS: In spite of several barriers, NHS programs have been implemented in at least some facilities and regions in Latin America. Additional efforts are needed to expand NHS activities in Latin America.