Medical indications for primary cesarean delivery in women with and without disabilities.

Background: Prior research has found that women with disabilities are more likely to deliver by cesarean than are women without disabilities. It is not clear whether all of the cesarean deliveries among women with disabilities are medically necessary.Objectives: To examine the associations between maternal disability status and type, mode of delivery, and medical indications for cesarean delivery in California deliveries.Study design: Retrospective cohort study of all nulliparous births in California between 2000 and 2012. We classified births as to whether or not women underwent a trial of labor and determined if medical indications for cesarean delivery were present. Multivariable logistic regression models examined the association of disability with trial of labor and indications for cesarean delivery.Results: Women with disabilities had lower odds of having a labored delivery, compared to women without disabilities (adjusted odds ratio (aOR) = 0.45, 95% confidence interval (CI) 0.41-0.49). In the sample of women who labored (90.5% of total), women with disabilities were more likely to have a medical indication for cesarean delivery (aOR = 1.15, 95% CI 1.10-1.21) and were more likely to have a cesarean delivery (aOR = 1.46, 95% CI = 1.38-1.54). In the subsample of unlabored cesarean deliveries, women with disabilities were less likely to have documented medical indications for cesarean delivery (aOR = 0.45, 95% CI = 0.41-0.50).Conclusions: Women with disabilities were less likely to labor, and these unlabored cesarean deliveries were less likely to have a medical indication for cesarean, compared to women without disabilities.

Índice de inteligibilidade (SII) e variação da intensidade do sinal de fala em crianças com deficiência de audição / Speech Intelligibility Index (SII) and variation of speech signal intensity in hearing impaired children

RESUMO Objetivo Comparar valores do índice de inteligibilidade de fala amplificado, para diferentes entradas de sinal de fala (75, 65 e 55 dBNPS), gerados no processo de verificação dos aparelhos de amplificação sonora, nos diferentes graus e configurações de perdas auditiva. Métodos Foram selecionadas 41 crianças com idades entre 3 e 80 meses, totalizando 78 orelhas (quatro orelhas foram excluídas). As perdas auditivas foram classificadas conforme grupos de audibilidade e intervalos do índice de inteligibilidade de fala. Foram analisados 234 valores do índice de inteligibilidade de fala para os estímulos de fala e estes foram também analisados, em relação aos grupos e intervalos de audibilidade. Resultados Os grupos de audibilidade se deslocaram entre os intervalos do índice de inteligibilidade de fala, indicando a variação, conforme o nível de apresentação do sinal de entrada. Duas equações foram geradas para prever valores do índice de inteligibilidade de fala a partir do valor deste índice para o sinal de entrada de 65. Conclusão Menores níveis de pressão sonora do estímulo de fala produzem menores índices de inteligibilidade de fala. Esta diferença é mais acentuada nos deficientes auditivos, que apresentam valores do índice de inteligibilidade de fala de 65 entre 36% e 55%.

ABSTRACT Purpose To compare aided speech intelligibility index (SII) values in different speech signal inputs (75, 65, and 55 dBNPS), generated from the verification process of hearing aids, under different hearing loss severities and configurations. Methods 41 children aged between three and 80 months old were selected, totalizing 78 ears (after exclusion of four ears). Hearing loss was classified according to audibility groups and SII intervals. Two hundred and thirty-four (234) SII values were analyzed as per speech stimulus and with regard to groups and audibility intervals. Results Movement of audibility groups along SII intervals was observed, which indicates variation associated with the input signal intensity, as well as with the distance between the sound source and the hearing aid microphone. Two equations were generated to predict SII values from input signal SII65. Conclusion Lower levels of speech stimulus sound pressure produce lower levels of speech intelligibility. This difference is more pronounced in hearing-impaired persons, who present SII values between 36 and 55%.

Canadians vulnerable to workplace noise.

BACKGROUND: Health and safety legislation is designed to protect workers from hazards, including excessive noise. However, some workers are not required to use hearing protection when exposed to loud noise and may be vulnerable to adverse outcomes, including hearing difficulties and tinnitus. DATA AND METHODS: Data for 19- to 79-year-olds (n=6,571) were collected from 2012 through 2015 as part of the Canadian Health Measures Survey. People exposed to loud workplace noise were defined as those who had to raise their voices to communicate at arm's length. Vulnerable workers were defined as those who were not required to use hearing protection when working in noisy environments and who only used hearing protection sometimes, rarely or never. RESULTS: An estimated 11 million Canadians (43%) have worked in noisy environments, and over 6 million of them (56%) were classified as vulnerable to workplace noise. Although the percentage of vulnerable women (72%) was greater than that of men (48%), men outnumbered women in these circumstances at 3.7 million, compared with 2.4 million. The self-employed were more likely than employees to be vulnerable, as were those in white-collar versus blue-collar occupations. Vulnerable workers were more likely to report hearing difficulties and tinnitus than those who had never worked in a noisy environment. DISCUSSION: A large percentage of workers exposed to noisy workplaces were vulnerable because hearing protection was neither required nor routinely used. Further work is required to assess whether this reflects gaps in health and safety legislation or its implementation.

Principais dificuldades e obstáculos enfrentados pela comunidade surda no acesso à saúde: uma revisão integrativa de literatura / Main difficulties and obstacles faced by the deaf community in health access: an integrative literature review

RESUMO Buscou-se identificar na literatura os principais obstáculos e dificuldades enfrentadas por pessoas surdas quanto ao acesso à saúde. Trata-se de uma revisão integrativa de literatura, considerando estudos publicados entre 2006 e 2016, utilizando combinações de descritores controlados. As bases de dados virtuais utilizadas foram: LILACS, PUBMED e SciELO, incluindo artigos publicados em Inglês, Português e Espanhol. A amostra final foi composta por 24 artigos, selecionados após análise dos títulos, resumos e textos na íntegra. Os estudos selecionados foram categorizados quanto às principais temáticas e dificuldades enfrentadas pela comunidade surda, sendo principalmente relacionadas à barreira comunicacional existente entre ouvintes e surdos. Tal fato culmina em interferências na relação profissional-paciente, compreensão deficitária das pessoas surdas quanto ao processo saúde-doença e as dificuldades de integração da pessoa surda na comunidade. Na maioria dos estudos analisados, evidenciou-se que as dificuldades enfrentadas pelas pessoas surdas quando buscam atendimento em saúde são ligadas à comunicação, bem como desconhecimento de Língua Brasileira de Sinais (LIBRAS) por grande parte dos profissionais de saúde. Além disso, também há a necessidade de familiar ou intérprete presente durante a consulta e a falta de compreensão de grande parte da comunidade surda como sujeitos bilíngues e multiculturais.

ABSTRACT The main obstacles faced by deaf people in access to healthcare services were investigated in the literature. This is an integrative literature review, considering studies published between 2006 and 2016, using combinations of controlled descriptors. The virtual databases used were: LILACS, PUBMED and SciELO, including articles published in English, Portuguese and Spanish. The final sample was composed of 24 articles, selected after analysis of titles, abstracts and full texts. The elected studies were categorized according to themes and to the presented difficulties, mainly concerning communication obstacles between deaf and normally hearing people. This fact interferes on the doctor-patient relationship, producing a poor understanding by the deaf community about the health-disease process and causing a challenging integration of those people in the society. The majority of the analyzed studies indicated that the main obstacles faced by the deaf regarding the access to healthcare services are communication related, especially the healthcare professionals unfamiliarity with the Brazilian Sign Language (LIBRAS). In addition, there is also the need for a family member or interpreter to be present during the consultation. Furthermore, the lack of perception on the hearing society part, of the deaf community as bilingual and multicultural subjects, was verified.

[Perception of hearing problems in the older population]. / Wahrnehmung von Hörproblemen bei älteren Menschen.

BACKGROUND: Age-related hearing loss is one of the most common chronic sensory impairments in the older population. This chronic condition is associated with bio-psychosocial consequences such as cognitive decline, depression, withdrawal, isolation, and reduced wellbeing. OBJECTIVE: This study aimed to investigate the perception of hearing problems among older women and men (≥55 years) with age-related hearing loss. Furthermore, the association between functional hearing loss and perceived hearing problems was examined. Lastly, this study undertook a detailed investigation of subjective experiences in order to better understand the consequences of age-related hearing loss for daily life. MATERIALS AND METHODS: With the aid of mixed methods, quantitative data were gathered from 65 participants with age-related hearing impairment in Austria using the Hearing Handicap Inventory for the Elderly (HHIE). Moreover, qualitative data regarding experiences with hearing problems were collected by performing semi-structured problem-centered interviews and analyzing the results of a further 14 older adults with hearing loss. RESULTS: On average, participants assessed their hearing handicap as mild and perceived consequences on emotional, social, and communication levels. Moreover, feelings of insecurity were evident. In addition, the findings indicate a relationship but also a discrepancy between hearing loss and hearing handicap, i. e., not all participants perceived a hearing handicap. CONCLUSION: Patient-centered care encompassing (1) objective and self-report measures for assessing hearing problems, (2) involvement of family members and significant others, (3) counseling and exchange of information, and (4) a shared decision-making approach could enhance quality of life and quality of care.

Ensino de comportamento verbal por múltiplos exemplares em uma criança com desordem do espectro da neuropatia auditiva: estudo de caso / Verbal behavior teaching by multiple exemplars in a child with auditory neuropathy spectrum disorder: a case study

RESUMO A Desordem do Espectro da Neuropatia Auditiva (DENA) é caracterizada pela dificuldade no estabelecimento do comportamento verbal nas modalidades de ouvinte e de falante, por uma dessincronia na condução nervosa da estimulação sonora recebida, ocasionando perdas auditivas. O implante coclear tem sido uma alternativa que estabiliza a detecção sonora, porém, discriminar e reconhecer o que se ouve e estabelecer relações com a fala irá requerer aprendizagem. Um procedimento de reconhecida eficácia no estabelecimento de repertórios verbais em crianças com pouca ou nenhuma linguagem é o Multiple Exemplar Instruction (MEI). O objetivo deste estudo foi verificar a replicabilidade dos resultados obtidos com o MEI com outras populações no ensino e integração entre os repertórios de ouvir e de falar em uma criança de seis anos com DENA e implante coclear bilateral. O ensino foi conduzido com três conjuntos de estímulos, e consistiu na apresentação rotativa de respostas de ouvinte, baseadas na seleção de figuras mediante palavra ditada e, de falante, após uma palavra ditada (ecoico) e mediante a nomeação de uma figura (tato). Repetidas sondas avaliaram o desempenho nos conjuntos de estímulos. Ainda que com alguma variabilidade no responder, as respostas de seleção foram estabelecidas primeiro e as respostas de falante, gradativamente, ao longo de sucessivas sessões. As condições sob as quais o repertório de falante pode ser refinado e a generalização dos resultados para outros participantes com DENA devem ser investigadas.

ABSTRACT Auditory Neuropathy Spectrum Disorder (ANSD) is characterized by a difficulty in establishing verbal behavior in the speaker and listener modalities due to an asynchrony in the nervous conduction of sound stimuli, leading to hearing loss. Cochlear implants are an alternative that stabilizes sound detection; however, discriminating and recognizing what is heard and establishing relations to speech requires learning. A procedure with recognized efficacy in establishing verbal repertoires in children with little or no language is Multiple Exemplar Instruction (MEI). The objective of this study was to verify replicability of results obtained from MEI with other populations for teaching and integrating listener and speaker behaviors on a six year-old child with ANSD and bilateral cochlear implants. The study was conducted with three sets of stimuli and consisted in a rotated presentation of listener responses, based on figure selection from dictated words, and of speaker responses, after a dictated word (echoic) and figure naming (tact). Repeated probes evaluated performance on the set of stimuli. Even though there is some variability in responding, selection responses were established first and speaker responses occurred gradually throughout successive sessions. The conditions under which a speaker’s repertoire may be refined, and generalization of these results to other participants with ANSD should be further investigated.

Analysis of hearing test results of 438 metal smelting workers / 中国基层医药

Objective To investigate the auditory performance of noise -exposed workers in a metal smelting factory,and to analyze the relationship between different noise -age,hearing protection and noise damage, and to provide the basis for the prevention and control of noise.Methods According to GBZ188 -2014 Occupational Health Surveillance Technical Specification,the pure tone audiometry test results of 438 workers in a special metal smelter in this city were analyzed statistically.Results The detection rate of hearing impairment was 25.6%.The incidence of hearing impairment in different occupational groups was statistically significant( 10 years 40.0%)(χ2 =15.10,P <0.01).The incidence of hearing loss was compared between the hearing protection with wearing earplugs group(the earplug group)and without wearing earplugs group (the control group),the difference was statistically significant(20.0% in the earplug group and 31.2% in the control group,χ2 =20.15,P <0.01),and the noise detection rate was significantly higher in the earplug group than in the control group(4% in the earplug group and 12% in the control group,χ2 =9.14,P <0.01).Conclusion Noise in the special metal smelting factory is more than that of the workers,so it is necessary to perfect the hearing protection measures as soon as possible.

Satisfaction with Hearing Aids Based on Technology and Style among Hearing Impaired Persons.

INTRODUCTION: Hearing loss is one of the most disabling impairments. Using a hearing aid as an attempt to improve the hearing problem can positively affect the quality of life for these people. This research was aimed to assess satisfaction of hearing impaired patients with their hearing aids regarding the employed technology and style. MATERIALS AND METHODS: This descriptive-analytic cross-sectional research was conducted on 187 subjects with hearing loss who were using a hearing aid. The subjects were over 18 years of age and were using a hearing aid for at least 6 months. The Persian version of Satisfaction with Amplification in Daily Life (SADL) questionnaire was the instrument which was used for assessing satisfaction with the hearing aid. Cronbach's alpha was calculated to be 0.80 for instrument reliability. RESULTS: A significant difference was observed among satisfaction subscales' mean scores with hearing aid technology. Also a significant difference was observed between the total satisfaction score and the hearing aid model. With respect to the analysis of satisfaction with the hearing aid and its style, cost and services was the only subscale which showed a significant difference (P=0.005). CONCLUSION: Respondents using hearing aids with different technology and style were estimated to be quite satisfied. Training audiologists in using more appropriate and fitting hearing aids in addition to using self-reporting questionnaires like SADL for estimating patients' social condition and participation in their life can essentially change their disability condition and countervail their hearing loss.

A inclusão de surdos no trânsito / The inclusion of deaf in the traffic

RESUMO: Objetivo: investigar como se dá o processo de inclusão de surdos no cenário do trânsito. Métodos: participaram do estudo 20 sujeitos, divididos em três grupos: G1, composto por 10 surdos; G2 composto por cinco profissionais de uma instituição de referência em assistência a sujeitos com necessidades educacionais específicas e G3 composto por cinco profissionais de um Departamento Estadual de Trânsito. Foram aplicadas entrevistas gravadas em áudio e vídeo, cujas respostas foram analisadas por meio do software Qualiquantisoft e aquelas com sentido semelhante foram reunidas para a construção de discursos do sujeito coletivo, tendo como base o método proposto por Lefèvre e Lefèvre. Resultados: os discursos do sujeito coletivo apontam para dificuldades na acessibilidade de surdos no trânsito e no processo de obtenção e renovação da carteira nacional de habilitação. De uma forma geral, todos os grupos apontaram sugestões como: a necessidade de intérprete para mediar o processo, a capacitação de profissionais para atenderem surdos e a realização da prova teórica em Libras, utilizando recursos de vídeo. Conclusão: embora haja avanços, há inúmeras falhas no que se trata da acessibilidade de pessoas surdas tanto no processo de obtenção/renovação da carteira nacional de habilitação quanto no trânsito. Portanto, é urgente que seja discutida a realidade enfrentada por essa população, visando soluções que possam garantir aos surdos não apenas o acesso ao trânsito, mas também a construção e adequada execução de políticas públicas que venham a lhes fornecer acessibilidade e segurança.

ABSTRACT: Purpose: to investigate how the process of including deaf people happen in traffic scenario. Methods: the study involved 20 subjects, divided into three groups: G1, composed by 10 deaf; G2 composed by five professionals from a reference institution in assistance to individuals with special educational needs and G3 composed by five professionals from a State Traffic Department. Interviews were applied recorded in audio and video, whose answers were analyzed using the software Qualiquantisoft and those with similar meaning were gathered for the construction of collective subject discourse, based on the method proposed by Lefèvre and Lefèvre. Results: the collective subject discourses point to difficulties in accessibility of deaf in traffic and in the process of obtaining and renewing of the national driver’s license. In general, all groups pointed suggestions as: the need of the interpreter to mediate the process, the training of professionals to serving deaf and the realization of the theoretical test in Libras, using video. Conclusion: although there have been advances, there are numerous flaws with regards to accessibility for deaf people both in the process of obtaining/renewing a Brazilian driving license and on the road. It is therefore urgent that the reality faced by this population be discussed with the aim of finding solutions that can guarantee not only deaf people's access onto the road, but also the construction and suitable execution of public policies that provide them with accessibility and safety.

Prevalence of hearing loss among Canadians aged 20 to 79: Audiometric results from the 2012/2013 Canadian Health Measures Survey.

BACKGROUND: In Canada, population-level estimates of hearing loss have been based on self-reported data, yielding estimates of 4% or 5%. Self-reported hearing difficulties may result in underestimates of hearing loss, particularly among people with mild loss and among older adults. DATA AND METHODS: The 2012/2013 Canadian Health Measures Survey (cycle 3) collected audiometric and self-reported data to estimate the prevalence of hearing loss and limitations in a population-based sample of Canadians aged 20 to 79. Weighted frequencies and cross-tabulations were used to calculate measured and self-reported hearing levels by sociodemographic characteristics. All estimates were weighted at the person-level to represent the population. RESULTS: Based on a pure-tone average of four frequencies that are important in speech, 19.2% of Canadians aged 20 to 79 had measured hearing loss in at least one ear; 35.4% had high-frequency hearing loss. These levels exceeded the self-reported estimate of hearing difficulty--3.7%--derived from responses to questions from the Health Utilities Index Mark 3. The prevalence of measured hearing loss rose with age from no more than 10% among people younger than 50 to 65% at ages 70 to 79. Men were more likely than women to have a hearing loss, a difference that emerged around age 60. Canadians with low household income and/or educational attainment were more likely than those in higher income/education households to have a hearing loss. INTERPRETATION: This analysis presents the first population-based audiometric data on the prevalence of hearing loss among the adult household population of Canada, and highlights the disparity between measured and self-reported outcomes.

Dual sensory loss: A major age-related increase of comorbid hearing loss and hearing aid ownership in visually impaired adults.

AIM: Despite increasing interest in visual and hearing impairment in the older population, little attention has been paid to concurrent hearing and vision loss, also known as dual sensory loss. The aim of the present study was to investigate the prevalence of comorbid hearing disability and hearing aid ownership in visually impaired older adults. METHODS: In a cross-sectional survey, a self-report hearing disability screener was administered to 1396 visually impaired patients (aged ≥ 50 years) of outpatient low vision rehabilitation centers in the Netherlands and Belgium. RESULTS: Of all participants, 44.8% (95% CI 42.2-47.5) had insufficient or poor hearing; the prevalence increased quadratically with age. Of all dual sensory impaired participants, 31.2% in the Netherlands and 55.7% in Belgium did not own hearing aids. CONCLUSIONS: The high prevalence of dual sensory loss calls for more awareness of related problems in these patients. Differences between the Netherlands and Belgium regarding hearing aid ownership might be due to different criteria used for hearing aid referral and insurance policies. For patients with dual sensory loss, specialized care implemented in low vision rehabilitation seems warranted.

La comunicación desde la lectura del lenguaje gestual en jóvenes en situación de discapacidad auditiva / Communication from body language reading in young persons with hearing disabilities / A comunicação desde a leitura da linguagem gestual em jóvens em situação de deficiência auditiva

Objetivo: Interpretar la estructura del lenguaje no verbal desde los niveles sintáctico, semántico y pragmático de la comunicación y los modelos de la misma para determinar la acción del gesto como signo en jóvenes en situación de discapacidad auditiva. Materiales y Métodos: Estudio de corte semiótico que plantea el reconocimiento de las reglas subyacentes al lenguaje codificado, en este caso se profundizó en la naturaleza del fenómeno gestual; se aplicaron protocolos de observación y se realizó un registro fílmico que fue sometido al microanálisis de cada escena y secuencias individuales, lo que llevó a descripciones más detalladas de aquellos gestos que ayudaron a responder la pregunta de investigación. Resultados: La comunidad de no oyentes se comunica de manera tan fluida como lo hacen los oyentes utilizando un sistema diferenciado –lenguaje de señas– que implica así mismo el uso de signos alternos capaces de enriquecer el proceso de transmisión y recepción de mensajes. Conclusiones: El signo en la comunicación del no oyente toma diferentes formas; el lenguaje codificado es una de ellas siendo este la estructura gramatical del lenguaje de señas o manual; los sonidos fónicos, la lectura labio facial y el gesto hacen parte del lenguaje no codificado, elementos que se exponen de manera espontánea durante la comunicación

Objective: To interpret the structure of non-verbal language from syntactic, semantic and pragmatic levels of communication and its models for determining the action of a gesture as a sign in Young persons with hearing disabilities. Material and Methods: The semiotic study presents recognition of underlying rules to encoded languages. In this research the nature of the gestural phenomenon was studied in depth; observation protocols were applied and records on film were carried out and submitted to microanalysis of each scene and individual sequences which resulted in more detailed descriptions of those gestures that helped to answer the research question. Results: The non-hearing community communicates in a way as fluent as hearing people do using a differentiated system –sign language– that also implies the use of alternate signs that are able to enrich the transmission process and message reception. Conclusion: The sign in communication of the deaf people takes different forms; encoded languages is one of them, being this one the grammatical structure of the manual or sign language; phonic sounds, lip-reading and body language make part of the non-encoded language, elements that are exposed in a spontaneous way during communication

Objetivo: Interpretar a estrutura da linguagem no verbal desde os níveis sintáticos, semântico e pragmático da comunicação e os modelos da mesma parte determinar a ação do gesto como signo em jovens em situação de deficiente auditivo. Materiais e Métodos e Materiais: Estudo de corte semiótico que projeta o reconhecimento das regras subjacentes à linguagem codificado, neste caso se afundou na natureza do fenômeno gestual; aplicaram se protocolos de observação e se realizou um registro fílmico que foi submetido ao microanalise de cada cena e sequencias individuais, o que levou a descrições mais detalhado de aqueles gestos que ajudaram a responder a pergunta de pesquisa. Resultados: A comunidade de não ouvintes se comunica de maneira tão fluida como o fazem os ouvintes utilizando um sistema diferenciado – linguagem de senhas- que envolve assim mesmo o uso de signos alternos capazes de enriquecer o processo de transmissão e recepção de mensagens. Conclusões: O signo na comunicação do não ouvinte toma diferentes formas; a linguagem codificada é uma delas sendo este a estrutura gramatical da linguagem de senhas ou manual; os sons fônicos, a leitura lábio facial e o gesto fazem parte da linguagem não codificada, elementos que se expõem de maneira espontânea durante a comunicação

Relação entre limiares audiométricos, handicap e tempo para procura de tratamento da deficiência auditiva / Relationship between hearing thresholds, handicap and the time taken to seek treatment for hearing loss

OBJETIVO: Verificar a relação entre limiares audiométricos, autopercepção do handicap e tempo para procura de tratamento em indivíduos atendidos em um serviço público de saúde auditiva. MÉTODOS: Trata-se de estudo retrospectivo, com análise de prontuários de 152 idosos e 48 adultos deficientes auditivos. As médias de limiares audiométricos ISO (500 Hz a 4 kHz) e de altas frequências (2 a 6 kHz), os limiares de reconhecimento de fala e a pontuação total e das subescalas social e emocional dos Questionários de Handicap Auditivo para Adultos (HHIA) e Idosos (HHIE) foram comparados com o tempo compreendido entre o início da queixa auditiva e o momento da procura por tratamento. RESULTADOS: O tempo médio para procura do tratamento foi de 7,6 anos. Não houve diferença entre adultos e idosos para as médias dos limiares ISO e de alta frequência, pontuação total e das subescalas do HHIA/E, e tempo para procura do tratamento. Correlações negativas fracas, porém significativas, foram observadas entre os limiares audiométricos e o tempo para procura de tratamento. Não foram encontradas relações entre o tempo para procura de tratamento e as variáveis referentes à escolaridade, nível sócio econômico e percepção do handicap. CONCLUSÃO: Os limiares audiométricos parecem influenciar a procura pelo tratamento. A despeito dos avanços tecnológicos e mudanças no acesso à informação e ao tratamento, o tempo de procura pelo tratamento é similar ao encontrado há 30 anos.

PURPOSE: To investigate the relationship between audiometric thresholds, self-perception of handicap, and time taken to seek treatment in patients treated at a public health care service. METHODS: This retrospective study analyzed the records of 152 elderly and 48 adult patients with hearing impairment. The mean ISO audiometric thresholds (500 Hz to 4 kHz) and the mean high frequencies thresholds (2 to 6 kHz), the speech recognition thresholds, and the total, social and emotional scores from the Hearing Handicap Inventory for the Adults (HHIA) and Elderly (HHIE) were compared with the time elapsed from the onset of hearing complaints and the treatment seeking. RESULTS: The mean time for seeking treatment was 7.6 years. No difference was found between adults and elderly for ISO and high frequency mean thresholds, HHIA/E scores, and time for treatment seeking. Weak but significant negative correlations were observed between auditory thresholds and time taken for treatment seeking. No relationship was found between the time taken for treatment seeking and the variables related to educational and socioeconomic levels and perception of handicap. CONCLUSION: Search for treatment seems to be influenced by auditory thresholds. Despite technological advances and changes in the access to information and treatment, the time taken for treatment seeking was similar to that reported 30 years ago.

Influência do tipo de estímulo visual na produção escrita de surdos sinalizadores sem queixas de alterações na escrita / Influence of the type of visual stimulus in the written production of deaf signers without complaints of writing impairments

OBJETIVO: Analisar a influência do tipo de estímulo visual sobre a produção escrita de surdos sinalizadores sem queixas de alterações na escrita. MÉTODOS: Participaram 14 surdos, de ambos os gêneros, com idades entre 8 e 13 anos, usuários da Língua Brasileira de Sinais, alunos da terceira e quarta séries do Ensino Fundamental de uma escola especial para surdos. Foram avaliados por meio de produções escritas baseadas em dois tipos de estímulos: uma sequência de quatro figuras e uma figura de ação. Cada produção foi pontuada de acordo com critérios adaptados da teoria das Competências Comunicativas (Genérica, Enciclopédica, e Linguística). RESULTADOS: Na análise da Competência Genérica não houve diferença entre as produções a partir da sequencia ou da figura de ação. Entretanto, notou-se que a figura de ação propiciou mais produções de gênero narrativo, enquanto as figuras em sequência eliciaram mais descrições. Quanto às Competências Enciclopédica e Linguística, ambos os estímulos visuais proporcionaram resultados semelhantes nas produções escritas. Tanto na Competência Enciclopédica quanto na Linguística, o desempenho dos surdos foi aquém do esperado para a faixa de escolaridade, demonstrando conhecimento parcial sobre a língua portuguesa escrita. No entanto, observou-se que as figuras sequenciadas propiciaram organização de ideias e coesão global um pouco mais elaboradas. CONCLUSÃO: Nenhum dos tipos de estímulo visual, seja figura de ação ou sequência de figuras, propicia melhores desempenhos de produção escrita de surdos sinalizadores sem queixas de alterações na escrita para a maior parte dos aspectos analisados.

PURPOSE: To analyze the influence of the type of visual stimulus on the written production of deaf signers without complaints of writing impairments. METHODS: Participants were 14 deaf subjects, of both genders, with ages between 8 and 13 years, students of third and fourth grades of Elementary School at a special school for deaf children, who were users of the Brazilian Sign Language. They were assessed by means of written productions based on two types of stimuli: a short sequence of four pictures, and a picture of an action. Each production was scored according to criteria adapted from the Communicative Competences theory (Generic, Encyclopedic and Linguistic). RESULTS: In the analysis of the Generic Competence, no difference was found between the written productions based on the sequence of pictures or on the picture of an action. However, the picture of an action provided more narrative productions, whereas the sequence of pictures elicited more descriptive productions. Regarding the Encyclopedic and the Linguistic Competences, both visual stimuli provided similar results in written production. Both in the Linguistic and Encyclopedic Competences, the performance of the subjects was lower than expected for the level of education, demonstrating partial knowledge regarding the written Portuguese language. Nevertheless, it was observed that the sequence of pictures allowed a bit more elaborated organization of ideas and overall cohesion. CONCLUSION: None of the visual stimuli, whether sequence of pictures or picture of an action, provided better performance in the written production of deaf signers without complaints of writing impairments, for most of the aspects analyzed.

Pronto atendimento a usuários de dispositivos de amplificação sonora / Emergency care to users of hearing aids

OBJETIVO: Estabelecer características demográficas e audiológicas de sujeitos usuários de aparelhos de amplificação sonora individuais (AASI) que solicitaram retorno em um Serviço de Saúde Auditiva e identificar e analisar os motivos do retorno e condutas geradas durante o Pronto Atendimento (PA). MÉTODOS: Os participantes foram 440 sujeitos de idade superior a três anos, com diagnóstico e concessão do AASI no serviço onde foi realizada a pesquisa. Características demográficas, audiológicas e referentes ao uso do AASI foram coletadas em prontuários e ficha específica para o PA. Os dados obtidos foram analisados por meio de estatística descritiva e inferencial. RESULTADOS: O grupo estudado foi caracterizado, em sua maioria, por indivíduos do gênero feminino, idosos, grau de escolaridade no ensino fundamental incompleto, perda auditiva de grau moderado e perda auditiva do tipo neurossensorial bilateral. Quanto ao uso do AASI, a maioria dos sujeitos utilizava aparelho do tipo retroauricular com adaptação binaural. Quanto ao tempo de uso, mais de 70 por cento utilizava o AASI pela primeira vez, 38 por cento o fazia por um período de até 12 meses, e mais de 65 por cento por um período maior que oito horas diárias. As condutas ajuste do AASI e orientação foram mais frequentes para sujeitos com menor tempo de uso do aparelho, enquanto as condutas assistência técnica e reposição, foram mais comuns para os sujeitos com maior tempo de uso. CONCLUSÃO: Conhecer características de pacientes usuários de AASI, assim como os motivos do retorno e condutas geradas, contribui para melhor organização e qualidade do serviço prestado.

PURPOSE: To establish the demographic and audiological characteristics of subjects users of hearing aids (HA) that requested a return at a Hearing Health Service, and to identify and analyze the reasons for the return and conducts generated during the Emergency Care (EC). METHODS: Participants were 440 subjects older than three years, with diagnosis and provision of hearing aids at the service where the research was conducted. Demographic and audiological characteristics and the reason for the use of hearing aids were collected from medical records and specific form used at the EC. Data were analyzed using descriptive and inferential statistics. RESULTS: The studied group was characterized mostly by female individuals, elderly, with incomplete elementary school education, moderate hearing loss, and bilateral sensorineural hearing loss. Most subjects used hearing aids with binaural BTE. As for the time of use, more than 70 percent used the hearing aid for the first time, 38 percent did so for a period inferior or equal to 12 months, and more than 65 percent for more than eight hours a day. The conducts hearing aid adjustment and orientation were more frequent for subjects with shorter use of the device, while the conducts technical assistance and replacement were more common for subjects with longer use. CONCLUSION: To identify the characteristics of patients users of HA, as well as the reasons of the return and conducts generated by the demand, contributes to better organization and quality of the service provided.

Communication difficulties and strategies used by the nurses and their team in caring for the hearing impaired / Dificuldades de comunicação e estratégias utilizadas pelos enfermeiros e sua equipe na assistência ao deficiente auditivo

Objectives: To identify communication difficulties faced by the nursing staff and to learn the strategies developed for non-oral communication. Methods: This is a descriptive, exploratory, level I study with a quantitative approach. The sample group comprised 37 registered nurses and 63 licensed practical nurses of a private hospital who, after undergoing the ethical-legal procedures, answered a questionnaire to identify difficulties faced and strategies used in the care for hearing-impaired patients. Results: Difficulty in explaining matters of interest to the patient was reported by 66% of professionals; and 32% reported difficulties in understanding patients in their way of communicate. The strategy adopted by 100% of respondents was mimicry, followed by lip reading, used by 94% of respondents; help from a person accompanying the patient was used by 65%, and written communication by 42% of respondents. Only 1% used communication via the Brazilian Sign Language (LIBRAS). Conclusions: The difficulties found and the strategies adopted by the nursing staff in communicating with hearing-impaired patients justify the need to train these professionals to deliver a more humanized care, developing a more inclusive society for those with special needs.

Objetivo: Identificar as dificuldades de comunicação da equipe de enfermagem com os deficientes auditivos no decorrer da assistência de enfermagem e conhecer as estratégias desenvolvidas na comunicação não verbal. Métodos: Trata-se de um estudo de caráter descritivo, exploratório, de nível I, com abordagem quantitativa. A amostra foi constituída por 37 enfermeiros e 63 técnicos em enfermagem de um hospital privado que, depois de cumprirem os procedimentos ético-legais, responderam a um questionário para identificar dificuldades e estratégias utilizadas no atendimento ao deficiente auditivo. Resultados: Dificuldade em explicar assunto de interesse do paciente foi relatada por 66% dos profissionais e, para 32%, dificuldade em entender o paciente a partir da sua forma de comunicação. A estratégia de comunicação utilizada por 100% dos pesquisados foi mímica, seguida por leitura labial, usada por 94%, auxílio do acompanhante por 65% e escrita por 42%. Somente 1% comunicou-se por meio de LIBRAS. Conclusões: As dificuldades encontradas e as estratégias utilizadas pela equipe de enfermagem na comunicação com pacientes deficientes auditivos justificam a necessidade de capacitar esses profissionais para promover uma assistência humanizada no contexto de uma sociedade mais inclusiva para portadores de necessidades especiais.

Toxoplasmose congênita: evolução da função auditiva e da linguagem emcrianças diagnosticadas e tratadas precocemente / Congenital toxoplasmosis: auditory and language outcomes inearly diagnosed and treated children

A cross-sectional study included all children diagnosed with congenital toxoplasmosis, through the Minas Gerais State Neonatal Screening Program, from September 2006 to March 2007. All children received early treatment, initiated before the age of 2.5 months, and were periodically assisted by a team of specialists including pediatricians, ophthalmologists and speech-language therapists and audiologists. Hearing function was evaluated with the following procedures: tympanometry, transient evoked otoacoustic emissions, distortion product otoacoustic emissions, behavioral observation audiometry, and brainstem auditory evoked potentials. Hearing function and sensitivity was estimated and audiological results were classified as normal, conductive hearing loss, sensory-neural hearing loss and central dysfunction. Language performance was assessed and classified as normal or abnormal, according to test results. The following variables were studied: audiological results, neurological and ophthalmological conditions, language performance and presence of risk indicator for hearing loss other than congenital toxoplasmosis. Univariate analysis was conducted using the chi-square or Fisher?s Exact test. Results: From September 2006 to March 2007, 106 children were diagnosed with congenital toxoplasmosis through the neonatal screening program, and were included in the study. Data analysis showed normal hearing in 60 children (56.6%), while 13 children (12.3%) had conductive hearing loss, four children (3.8%) had sensory-neural hearing loss and 29 children (27.4%) presented central hearing dysfunction. There was association between hearing problems and language deficits. The comparison between children with additional risks for hearing loss other than toxoplasmosis and children who only presented toxoplasmosis as a risk factor showed no differences. This finding suggests that audiological problems were due to congenital toxoplasmosis alone.

Um estudo transversal descritivo incluiu todas as crianças diagnosticadas com toxoplasmose congênita (TC) pelo Prog. Est. de Tria. Neonatal de MG entre set. 2006 e mar. de 2007. Todas as crianças foram submetidas ao protocolo de tratamento com pirimetamina e sulfadiazina iniciado antes dos 2,5 meses de idade e com duração de 12 meses, tendo realizado acompanhamento pediátrico, oftalmológico e fonoaudiológico periódico. Para avaliar a audição foram usados, como instrumentos diagnósticos, medidas de imitância acústica, emissões otoacústicas evocadas por estímulo transiente e produto de distorção, potencial evocado auditivo de tronco encefálico e observação do comportamento auditivo. Foi avaliada a acuidade auditiva e as alterações auditivas foram classificadas em condutivas, neurossensoriais e retrococleares. O desempenho de ling. foi avaliado usando-se um instrumento de aval. do desenvolvimento da ling., e os resultados foram classificados como normais ou alterados. As seguintes variáveis foram estudadas: resultados audiológicos, condições neurológicas e oftalmológicas, linguagem e presença de fator de risco para perda auditiva além da TC. Foi realizada análise univariada pelo qui-quadrado ou teste exato de Fisher. Resultados: entre set. 2006 e mar. 2007, 106 crianças foram diagnos. com TC pelo programa de triagem neonatal, sendo incluídas no estudo. A análise dos dados mostrou que 60 crianças apresentavam audição normal (56,6%) e 46 crianças apresentavam audição alterada, sendo 13 crianças (12,3%) com alteração condutiva, 4 (3,8%) com perda auditiva neurossensorial e 29 (27,4%) com comprometimento retrococlear. Houve associação entre presença de alteração auditiva e déficit de linguagem. A comparação entre crianças que apresentavam outro fator de risco além da TC e crianças que apresentavam somente a toxoplasmose como fator de risco para alteração auditiva não mostrou diferenças.

Relação do paciente surdo com o médico: [revisão] / The relation between deaf patients and the doctor: [revisio]

A comunicação não-verbal é importante no atendimento aos pacientes surdos e permite a excelência do cuidar em saúde. OBJETIVO: Analisar os aspectos legais e socioculturais da relação entre o paciente surdo e o médico. MÉTODO: Foram utilizadas as bases de dados informatizados para a coleta de dados, no período de 1996 a 2006, tendo como palavras-chave "paciente", "surdo", "comunicação" e "saúde". Realizou-se também busca não-sistemática em publicações científicas. RESULTADOS: Foram agrupados em duas categorias: a comunicação do paciente surdo com o médico ouvinte que trata das barreiras no atendimento ao paciente surdo e a importância da comunicação não-verbal na assistência à saúde. O surdo, sua língua e a relação médico-paciente que aborda as características da Língua de Sinais, tendo como respaldo constitucional a Lei Federal nº 10.436/02. CONCLUSÃO: Quando os pacientes surdos e os médicos se encontram, se deparam com barreiras comunicativas que comprometem o vínculo a ser estabelecido e a assistência prestada, podendo interferir no diagnóstico e no tratamento. Ficou clara a necessidade de as instituições públicas oportunizarem programas que visem à formação dos profissionais para adequada assistência aos pacientes surdos.

Non-verbal communication is important when caring for deaf patients, fostering excellence in health care. AIM: an analysis of the legal and sociocultural aspects of the relation between deaf patients and physicians. METHODS: Computerized databases for the period between 1996 and 2006 were used for collecting data; the keywords "patient", "deaf person", "communication" and "health" were used. A non-systematic search was made in scientific publications. RESULTS: These studies were grouped into two categories: communication between deaf patients and physicians, who has to deal with communication barriers when caring for deaf patients, and the importance of non-verbal communication in healthcare. Deaf persons, their language, and their relation with physicians show the importance of sign language, endorsed by the Federal Law 10.436/02. CONCLUSIONS: When deaf patients and physicians meet, they need to overcome communication barriers that may hinder the necessary bond in healthcare and the care that is provided; this may also affect the diagnosis and treatment. It is clear that public institutions should create programs for training healthcare professionals in the appropriate care of deaf patients.

Quantitation of mitochondrial DNA A1555G mutation by real time amplification refractory mutation system quantitative PCR / 中华检验医学杂志

Objective To develop a real time amplification refractory system(RT-ARMS-qPCR) quantitative PCR method with SYBR Green I to assess the mtDNA A1555G mutation. Methods A specific fragment flanking mtDNA 1555 site was amplified with PCR and ligated into a pGEM Easy T vector. Serial dilutions of the plasmid DNA were quantified the actual copy numbers were assessed using RF-ARMS-qPCR with SYBR Green I. RF-ARMS-qPCR was established with mismatched base pairs at 3' in the primer todetect the copy number of mtDNA containing wild or mutant mtDNA. The specificity of amplified products was checked by melting curve analysis. Results The intra- and interassay variation was 1.34% and 1.96%, respectively when the assay was used to detect 1 copy/ul recombinant template of plasmid. Thequantitative standard curve showed that the assay had good linear correlation from 102 copies/ul to108 copies/ul. This assay could be served for the quantification of other samples. There was significantcorrelation between frequency of mutant mtDNA and phenotype (r=0.771, P = 0.003) in hearing lossgroup. Conclusions The established assay can be used to detect quantitatively mtDNA A1555G mutation byRF-ARMS-qPCR. This assay is specific, stable and accurate. There is significant correlation betweenquantification of mtDNA AI555G and the severity of hearing loss.

Aspectos da comunicação da enfermeira com o deficiente auditivo / Aspects of nurses' communication with hearing impaired persons

Indivíduos com limitação auditiva têm seu processo comunicativo prejudicado. Procurou-se explorar aspectos da comunicação da enfermeira com os deficientes auditivos. Estudo descritivo-exploratório, realizado em hospitais de Fortaleza de maio a junho de 2004 mediante entrevistas abertas analisadas qualitativamente. As enfermeiras percebem que é difícil a comunicação com o deficiente auditivo, embora algumas tenham desempenho satisfatório. Nesse processo, algumas referem utilizar tanto a comunicação não verbal, por mímica e leitura labial, como a comunicação verbal oral e escrita. Outras utilizam o acompanhante, quebrando o sigilo da consulta. Para aperfeiçoar a comunicação, sugerese o preparo profissional na graduação e cursos de LIBRAS. Conforme se conclui, existe dificuldade da enfermeira ao se comunicar com o deficiente auditivo.

The communicative process of individuals with hearing limitation is jeopardized. This article is aimed at exploring nurses' communication aspects with hearing impaired persons. It is a descriptive-exploratory study conducted in hospitals in Fortaleza, State of Ceará, from May to June of 2004 through open interviews that were analyzed qualitatively. The nurses perceived communication with hearing impaired persons as difficult, although some had a satisfactory performance. In the process, some mention the use of both nonverbal communication, such as mimics and lip reading, and verbal oral and written communication. Others resorted to the person that accompanies the patient, thus breaking the confidentiality of the consultation. To enhance communication, professional preparation in the undergraduate course and through Libras courses is suggested. The conclusion is that it is difficult for nurses to communicate with hearing impaired persons.

Individuos con limitación auditiva tienen su proceso comunicativo perjudicado. Se buscó explorar aspectos de la comunicación de la enfermera con los deficientes auditivos. Estudio descriptivo y exploratorio, realizado en hospitales de Fortaleza, de mayo a junio de 2004, mediante entrevistas abiertas analizadas cualitativamente. Las enfermeras notan que es difícil la comunicación con el deficiente auditivo, aunque algunas tengan desempeño satisfactorio. En ese proceso, algunas se han referido en utilizar tanto la comunicación no verbal, por mímica y lectura labial, como la comunicación verbal oral y escritura. Otras utilizan el acompañante, rompiendo el sigilo de la consulta. Para perfeccionar la comunicación, se sugiere el preparo profesional en la graduación y cursos de LIBRAS. Conforme se concluye, existe dificultad de la enfermera para comunicarse con el deficiente auditivo.