A country-wide health policy in Chile for deaf adults using cochlear implants: Analysis of health determinants and social impacts.

BACKGROUND: Post-lingual deafness represents a critical challenge for adults' well-being with substantial public health burdens. One treatment of choice has been cochlear implants (CI) for people with severe to profound hearing loss (HL). Since 2018, Chile has implemented a high-cost policy to cover CI treatment, the "Ley Ricarte Soto" (LRS) health policy. However, wide variability exists in the use of this device. To date, no related study has been published on policy evaluation in Chile or other Latin American countries. OBJECTIVES: This study aimed to evaluate the impact of the LRS policy on the treatment success and labour market inclusion among deaf or hard of hearing (DHH) adults using CI. We examined and characterised outcomes based on self-reports about treatment success and occupation status between 2018 and 2020. DESIGN: We performed a prospective study using hospital clinical records and an online questionnaire with 76 DHH adults aged >15 who had received CIs since the introduction of the LRS policy in 2018. Using univariate and multivariate regression models, we investigated the relationship between demographic, audiological, and social determinants of health and outcomes, including treatment success for social inclusion (International Outcome inventory for Hearing Aids and CIs assessment: IOI-HA) and occupation status for labour market inclusion. RESULTS: Our study showed elevated levels of treatment success in most of the seven sub-scores of the IOI-HA assessment. Similarly, around 70% of participants maintained or improved their occupations after receiving their CI. We found a significant positive association between treatment success and market inclusion. Participants diagnosed at younger ages had better results than older participants in both outcomes. Regarding social determinants of health, findings suggested participants with high social health insurance and a shorter commute time to the clinic had better results in treatment success. For labour market inclusion, participants with high education levels and better pre- CI occupation had better post-CI occupation status. CONCLUSIONS: In evaluating the LRS policy for providing CIs for DHH adults in Chile, we found positive effects relating to treatment success and occupation status. Our study supports the importance of age at diagnosis and social determinants of health, which should be assessed by integrating public services and bringing them geographically closer to each beneficiary. Although evidence-based guidelines for candidate selection given by the LRS policy might contribute to good results, these guidelines could limit the policy access to people who do not meet the requirements of the guidelines due to social inequalities.

Adaptación transcultural al español chileno de las escalas CAP-II y SIR en formato online para padres de niños(as) con audífonos o implantes cocleares / Chilean spanish transcultural adaptation of CAP-II and SIR scales in an online format for parents of children with hearing aids or cochlear implants

La adquisición de lengua oral representa un desafío para niñas/os sordas/os o con pérdida auditiva (NSPA) que utilizan audífonos o implante coclear (CI). Tomar decisiones a tiempo durante el tratamiento con dispositivos es esencial y requiere de evaluaciones adecuadas. Dos instrumentos usados en la toma de decisiones son las escalas "Categories of Auditory Performance Index II" (CAP-II) y "Speech Intelligibility Rating Scale" (SIR). Estas escalas han mostrado ser útiles para la evaluación continua del desarrollo de habilidades auditivas y de la lengua oral en variados idiomas, pero estas no están disponibles para el español chileno. El objetivo de este estudio es crear traducciones en español chileno de las escalas CAP-II y SIR, las que puedan ser usadas como auto-reporte online por padres y cuidadores con el fin de asistir a profesionales en el monitoreo del progreso de niños/as NSPA, considerando las restricciones impuestas por el COVID-19. El método usado en el proceso comienza con la traducción de una propuesta de auto-reporte de las versiones originales en inglés de las escalas CAP-II y SIR. Finalmente, las versiones en español chileno fueron testeadas en 107 padres-cuidadores de niñas/os NSPA con CI. Los resultados sugieren que estos instrumentos serían adecuados para su uso en el contexto chileno.

Spoken language acquisition is challenging for very young deaf or hard-of-hearing children (DHH) who wear hearing aids or cochlear implants (CI). Timely decision-making for treatment is essential for these children and requires suitable assessments. Two such assessments are the Categories of Auditory Performance Index II (CAP-II) and the Speech Intelligibility Rating Scale (SIR). These have been shown to be helpful for the ongoing evaluation of developing speech perception and spoken language skills in various languages, but they are not available in Chilean Spanish. This study aimed to create a Chilean Spanish translation of the CAP-II and SIR, appropriate for online self-administration by parents-caregivers in Chile, to assist professionals in monitoring DHH children's progress, considering the COVID-19 restrictions. The methods used in the process started with translating a self-report proposal from the original English versions of the CAP-II and SIR scales. Finally, the Chilean Spanish versions were tested in 107 Chilean parents-caregivers of DHH children with CIs. The results suggest these instruments are suitable for use in a Chilean context.

Acquisition age of lateral and rhotic phonemes: the opinion of Speech and Language Therapists from Santiago, Chile / Edades de adquisición de fonemas lateral y róticos en niños: un estudio de opinión de fonoaudiólogos de Santiago de Chile

ABSTRACT Purpose: to describe at which age do speech and language therapists consider the / l /, / ɾ /, / r / phonemes should be acquired; to describe the criteria used by speech and language therapists to consider a phoneme as acquired; and to investigate the diagnostic criteria used by these professionals. Methods: this is an analytical cross-sectional study in which an online questionnaire was completed by 151 speech and language therapists from the Metropolitan region of Chile. The questionnaire included questions regarding the aims of this study. Results: around a 30% of respondents considered the /l/ phoneme to be acquired between 3,6-4,6 years, a 72% agreed on the /ɾ/ phoneme to be acquired from 4,0 to 4,11 and a 40% declared the acquisition of the /r/ phoneme between 5,6-5,11. When determining a phoneme as acquired, a 46.3% of interviewees referred to do it only when it was produced always and a 30% declared to consider as such when produced more than 50% of the times. When exposed to a real case, respondents provided three different diagnostic options. Conclusion: results showed a wide age range in which speech and language therapists consider the lateral and rhotic phonemes to be acquired, showing no consensus. There are diverse criteria to determine when each phoneme is acquired. Similarly, different opinions were evidenced regarding when a disorder would be defined as phonologic or articulatory.

RESUMEN Objetivo: describir la edad en que consideran que deben estar adquiridos los fonemas / l /, / ɾ /, / r /; describir el criterio que utilizan fonoaudiólogos para considerar un fonema adquirido; e indagar sobre los criterios diagnósticos que utilizan estos profesionales. Métodos: se realizó un estudio transversal analítico mediante un cuestionario validado, presentado de manera online, a 151 fonoaudiólogos de la Región Metropolitana de Chile, con preguntas referidas a los objetivos presentados. Resultados: aproximadamente un 30% de los encuestados consideró que el fonema /l/ se adquiría entre 3,6-4,6 años, /ɾ/ entre 4,0-4,11 un 72% y /r/ entre 5,6-5,11 un 40%. El 46,3% considera que un fonema está adquirido cuando se dice siempre y un 30% cuando lo dice más del 50% de las veces. Ante el relato de un caso, los encuestados eligieron tres opciones diagnósticas diferentes Conclusión: se observa que existe una amplia variedad de rango etario en la que los fonoaudiólogos creen que deben adquirirse los fonemas lateral y róticos no encontrándose un consenso. Existe una alta variedad de criterios respecto a cuándo considerar un fonema como adquirido. También existen distintas concepciones sobre cuándo un trastorno se considerará articulatorio o fonológico.

Therapeutic approaches for deaf children at intervention centers in Chile's metropolitan region: access to health and education / Enfoques terapéuticos en centros de intervención para niños sordos en la región metropolitana de Chile: acceso en salud y educación

ABSTRACT Aim: to characterize the health or education centers that work with deaf children from an early age. Methods: a survey of those in charge of centers for people with hearing loss (N=5), special schools for the deaf (N=3) and hospitals in which therapeutic intervention for people with hearing impairments (N=6) was carried out in Santiago, Chile in 2014. It consulted the characteristics of the people attended, the intervention method used at each center and information about the professionals making up each team of workers. In addition, information was compiled about whether the institution had inclusion programmes for normal or special education. Results: the majority of the institutions indicated that they had an oral focus or a variation on this. Only one used the bilingual intercultural model and another indicated that did not use oral models. The results varied concerning access to education and even to professionals, at centers of the same kind. Conclusion: the majority of the institutions indicated that they worked using the oral intervention methodology, providing fewer options for the early inclusion of bilingual intercultural education or other intervention methodologies.

RESUMEN Objetivo: caracterizar a los centros de Salud o Educación que trabajan con niños sordos a temprana edad. Métodos: se ejecutó un cuestionario a encargados de centros de atención de personas con hipoacusia(N=5), escuelas especiales de sordos (N=3) y hospitales en los que se realizaba intervención terapéutica en personas con discapacidad auditiva (N=6) en Santiago, Chile, durante 2014. Se consultó sobre características de usuarios atendidos, método de intervención adscrito en cada centro, e información de profesionales que conformaban cada equipo de trabajo. Además, se recogió información acerca de si la institución contaba con programas de inclusión en educación regular o especial. Resultados: las instituciones mayoritariamente declararon seguir un enfoque oral o variantes de este. Sólo uno adscribe al modelo intercultural bilingüe, y otro señala no considerar modelos orales. Existe variabilidad de resultados en torno a acceso a la educación y profesionales incluso en centros del mismo tipo. Concusión: la mayoría de las instituciones expresó trabajar bajo la metodología de intervención oral, dejando pocas opciones a la inserción temprana de educación intercultural bilingüe u otra metodología de intervención.