Objective: To investigate differences in immune activity based on the presence of multiple organ involvement in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) and whether hearing outcomes are different between patients with AAV localized to the ear and patients with systemic AAV. Study Design: Retrospective case review. Setting: University hospital. Patients: Twenty patients with otitis media with AAV (OMAAV) who met the criteria proposed by the OMAAV study group in Japan. Main Outcome Measure(s): Serum levels of C-reactive protein, ANCA titer, soluble interleukin-2 receptor levels, and hearing outcome. Results: Thirteen patients had disease involvement of organs other than the ear (systemic OMAAV group); involvement was localized to the ear in seven patients (localized OMAAV group). Serum levels of C-reactive protein, ANCA titer, and soluble interleukin-2 receptor were not significantly different between the groups. Hearing levels at diagnosis and in remission were significantly worse in the localized OMAAV group compared with the systemic OMAAV group. Hearing gain was not significantly different between groups. Conclusion: It is suggested that immune activity in patients with AAV localized to the ear is equivalent to activity in patients with systemic AAV. Therefore, we may need treatment for OMAAV equal in intensity to that for systemic AAV. As the hearing level at diagnosis was worse in patients with AAV localized to the ear than in patients with systemic AAV, earlier diagnosis may be needed to improve hearing outcome. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Πέμπτη 7 Σεπτεμβρίου 2017
Assessing Readability and Reliability of Online Patient Information Regarding Vestibular Schwannoma.
Hypothesis: The aim of this study is to objectively assess the quality and readability of websites related to vestibular schwannomas. Background: Patients are increasingly seeking information on confirmed or suspected diagnoses through the Internet. Clinicians are often concerned regarding the accuracy, quality, and readability of web-based sites. Methods: Online information relating to vestibular schwannoma was searched using the three most popular search engines. The terms "acoustic neuroma" and "vestibular schwannoma" were used. The top 50 results from each site were assessed for readability using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and the Gunning-Fog Index. Quality of website information was scored using the DISCERN tool. Results: Of 300 search results analyzed, 58 separate appropriate websites were identified. The mean readability score using Flesch-Kincaid Grade Level was 10.27 (95% confidence interval [CI] 9.84-10.70). The mean Flesch Reading Ease Score was 48.75 (95% CI 46.57-50.92). The Gunning-Fog Index was 13.40 (95% CI 12.92-13.89). These scores equate to someone finishing secondary school/first year university student. DISCERN scores were highly variable but consistently demonstrated great variability in quality of information. Conclusion: Online patient information on vestibular schwannoma is highly variable in quality. Although there are a wide range of different websites easily available to patients on their condition and its treatment options, the information is written at a difficult level which may exceed the understanding level of many patients as it is written at a higher than average level of expected reading ability. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company
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Comparison of an Electromagnetic Middle Ear Implant and Hearing Aid Word Recognition Performance to Word Recognition Performance Obtained Under Earphones.
Objective: To report the results of patients with the Maxum middle ear implant (MEI) and compare word recognition scores (WRS) and speech perception gap (SP Gap) of Maxum versus optimally fit hearing aids (HA). Study Design: Case series with chart review. Setting: Single, private otology clinic. Patients: Eleven ears, in nine adult patients (two women; average age 62.7 yr). Interventions: Twelve consecutive ears with moderate to severe (SNHL) underwent implantation of the Maxum system. One patient was not included due to inadequate preoperative testing. Main Outcome Measures: Primary outcome measures included word recognition score (WRS) and SP Gap (maximum word understanding [PB max] - WRSaided) improvement compared with HAs. Results: The average Maxum WRS was 64.7% (range, 28-94%), a 41.6% improvement (range, 10-66%) over HAs (p
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Progressive Tinnitus Management Level 3 Skills Education: A 5-Year Clinical Retrospective
Purpose
The primary purpose of this study was to determine whether progressive tinnitus management Level 3 skills education workshops conducted at the Bay Pines and Boston Veterans Affairs hospitals result in consistent use of the presented tinnitus management strategies by patients 1–5 years after completing the workshops.
Method
In fiscal year (FY) 2015, the tinnitus workshop follow-up form was mailed to all veterans who completed the Level 3 workshops between FY 2010 and FY 2014. Data were compiled to determine which, if any, of the skills taught in the workshops were being used 1–5 years after completion of the workshops and the impact on quality-of-life indicators.
Results
All self-management skills were being utilized up to 5 years postcompletion; therapeutic sound was utilized the most. The majority of patients reported an improved ability to manage reactions to tinnitus and improved quality-of-life indicators. Over 90% of patients from both sites recommended the program to others with tinnitus.
Conclusion
The self-management skills taught in the progressive tinnitus management Level 3 workshops are sustained over time even when limited resources prevent the full complement of workshops or the involvement of mental health services. The workshops can also be successfully implemented through remote delivery via videoconferencing (telehealth).
Supplemental Materials
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Progressive Tinnitus Management Level 3 Skills Education: A 5-Year Clinical Retrospective
Purpose
The primary purpose of this study was to determine whether progressive tinnitus management Level 3 skills education workshops conducted at the Bay Pines and Boston Veterans Affairs hospitals result in consistent use of the presented tinnitus management strategies by patients 1–5 years after completing the workshops.
Method
In fiscal year (FY) 2015, the tinnitus workshop follow-up form was mailed to all veterans who completed the Level 3 workshops between FY 2010 and FY 2014. Data were compiled to determine which, if any, of the skills taught in the workshops were being used 1–5 years after completion of the workshops and the impact on quality-of-life indicators.
Results
All self-management skills were being utilized up to 5 years postcompletion; therapeutic sound was utilized the most. The majority of patients reported an improved ability to manage reactions to tinnitus and improved quality-of-life indicators. Over 90% of patients from both sites recommended the program to others with tinnitus.
Conclusion
The self-management skills taught in the progressive tinnitus management Level 3 workshops are sustained over time even when limited resources prevent the full complement of workshops or the involvement of mental health services. The workshops can also be successfully implemented through remote delivery via videoconferencing (telehealth).
Supplemental Materials
http://ift.tt/2wNal8Afrom #Audiology via ola Kala on Inoreader http://article/doi/10.1044/2017_AJA-16-0085/2653949/Progressive-Tinnitus-Management-Level-3-Skills
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Progressive Tinnitus Management Level 3 Skills Education: A 5-Year Clinical Retrospective
Purpose
The primary purpose of this study was to determine whether progressive tinnitus management Level 3 skills education workshops conducted at the Bay Pines and Boston Veterans Affairs hospitals result in consistent use of the presented tinnitus management strategies by patients 1–5 years after completing the workshops.
Method
In fiscal year (FY) 2015, the tinnitus workshop follow-up form was mailed to all veterans who completed the Level 3 workshops between FY 2010 and FY 2014. Data were compiled to determine which, if any, of the skills taught in the workshops were being used 1–5 years after completion of the workshops and the impact on quality-of-life indicators.
Results
All self-management skills were being utilized up to 5 years postcompletion; therapeutic sound was utilized the most. The majority of patients reported an improved ability to manage reactions to tinnitus and improved quality-of-life indicators. Over 90% of patients from both sites recommended the program to others with tinnitus.
Conclusion
The self-management skills taught in the progressive tinnitus management Level 3 workshops are sustained over time even when limited resources prevent the full complement of workshops or the involvement of mental health services. The workshops can also be successfully implemented through remote delivery via videoconferencing (telehealth).
Supplemental Materials
http://ift.tt/2wNal8Afrom #Audiology via ola Kala on Inoreader http://article/doi/10.1044/2017_AJA-16-0085/2653949/Progressive-Tinnitus-Management-Level-3-Skills
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The Risk of Hearing Loss for Dementia
A new meta-analysis published by the Lancet Commission focused on the rising rates of dementia globally. Currently, an estimated 47 million people worldwide suffer from dementia, with that number expected to triple by 2050. The global cost of dementia in 2015 was estimated to $818 billion, with nearly 85 percent of that total attributed to family and social costs, rather than medical care.
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Inclusive Competitive Game Play Through Balanced Sensory Feedback.
| Related Articles |
Inclusive Competitive Game Play Through Balanced Sensory Feedback.
Stud Health Technol Inform. 2017;242:961-968
Authors: Westin T, Söderström D, Karlsson O, Peiris R
Abstract
While game accessibility has improved significantly the last few years, there are still barriers for equal participation and multiplayer issues have been less researched. Game balance is here about making the game fair in a player versus player competitive game. One difficult design task is to balance the game to be fair regardless of visual or hearing capabilities, with clearly different requirements. This paper explores a tentative design method for enabling inclusive competitive game-play without individual adaptations of game rules that could spoil the game. The method involved applying a unified design method to design an unbalanced game, then modifying visual feedback as a hypothetical balanced design, and testing the game with totally 52 people with and without visual or hearing disabilities in three workshops. Game balance was evaluated based on score differences and less structured qualitative data, and a redesign of the game was made. Conclusions are a tentative method for balancing a multiplayer, competitive game without changing game rules and how the method can be applied.
PMID: 28873912 [PubMed - in process]
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Methods of Early Prenatal Diagnosis: A Systematic Review
Methods of Early Prenatal Diagnosis: A Systematic Review
Book. 2007 12
Authors: Swedish Council on Health Technology Assessment
Abstract
Background This report presents the scientific evidence for the methods currently used, or in the process of being adopted, to detect fetal chromosomal and structural abnormalities during early pregnancy. Medical, social, psychological, ethical, health economic, quality assurance and safety aspects of early prenatal diagnosis were analysed. This summary reviews the questions addressed and the most important conclusions reached in each chapter of the report. In the first section SBU’s main conclusions are presented. Conclusions: A combined test of ultrasound nuchal translucency measurement and maternal serum biochemistry (biochemical screening) in early pregnancy (10–14 gestational weeks), along with maternal age, is the clinically evaluated method of assessing the probability of fetal Down syndrome that gives the best balance between the percentage of detected cases and false-positive results (strong scientific evidence). Maternal serum biochemistry with four markers (quadruple test) is the clinically evaluated method of assessing the probability of fetal Down syndrome that in the second trimester gives the best balance between the percentage of detected cases and false-positive results (strong scientific evidence). All the methods (nuchal translucency measurement, maternal serum biochemistry in the second trimester and the combined test) for assessing the probability of fetal Down syndrome examined by this report and evaluated in clinical practice gives a better balance between the percentage of detected cases and false-positive results than maternal age alone. Thus, the use of these methods requires fewer amniocenteses and chorionic villus samplings per detected cases of Down syndrome than maternal age alone (strong scientific evidence). Use of the interphase fluorescence in situ hybridization (FISH) test or quantitative fluorescent polymerase chain reaction (QF- PCR) is essentially as accurate as full karyotyping for detecting aneuploidies in chromosomes 13, 18, 21, x and y (strong scientific evidence). Normal results on the rapid FISH test or QF-PCR in prenatal diagnosis leave a residual possibility of fetal chromosomal abnormalities. In approximately 0.9% of all amniocenteses and chorionic villus samplings a full karyotype analysis will detect a chromosomal abnormality missed by the rapid FISH test or QF-PCR. For chromosomal abnormalities of clinical significance, the figure is 0.4% (strong scientific evidence). Fewer congenital abnormalities, including heart defects, appear to be detected when a routine ultrasound examination is performed at 12 instead of 18 gestational weeks. That is the case even if the 12-week examination includes nuchal translucency measurement and if increased nuchal translucency or greater probability of chromosomal abnormalities according to nuchal translucency is an indication for a comprehensive fetal anatomy at 18–22 gestational weeks. However, the scientific evidence is insufficient to draw a reliable conclusion in this regard. No detrimental impact of ultrasound exposure during the second trimester has been demonstrated on children’s growth, vision or hearing – or their neurological, cognitive or speech development. No correlation has been demonstrated between prenatal ultrasound exposure and childhood malignancies (strong scientific evidence). A meta-analysis of randomized trials have not shown any difference with respect to the frequency of non-right handedness (left handedness or no clear preference) between controls and groups assigned to in utero exposure to ultrasound. Analyses of subpopulations and two Swedish registry studies have found a correlation between such exposure and non-right handedness in boys. However, the scientific evidence is insufficient to draw a reliable conclusion. Invasive tests (amniocentesis and chorionic villus sampling) increase the risk of fetal loss. The best available estimate, which concerns fetal loss after late amniocentesis (15 or more completed gestational weeks), indicates a 1 percentage point increase in the risk. Most of these losses are miscarriages (moderately strong scientific evidence). Pregnant women prefer individual to group information. Audio or video information appears to improve their knowledge and understanding somewhat more effectively than letters and brochures. However, most studies reveal inadequacies when it comes to providing information to women prior to prenatal diagnosis. The women are not sufficiently knowledgeable, particularly with respect to the purpose and the potential implications of the results, to make a well-founded decision about whether or not to undergo testing. It is especially difficult for them to understand that nuchal translucency measurement with ultrasound and an evaluation of markers is part of a probability assessment rather than a final diagnosis (strong scientific evidence). Most pregnant women want to obtain early information and prefer screening in the first trimester (strong scientific evidence). Greater knowledge does not make pregnant women more anxious. The information required to minimize their stress and anxiety levels should be communicated in the same way as that which is provided prior to other medical interventions. Increased anxiety prior to prenatal diagnosis, while waiting for the results or after obtaining notification of detected (or of increased probability of) abnormalities is a natural reaction on the part of the woman and/or her partner (strong scientific evidence).
PMID: 28876771
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Inclusive Competitive Game Play Through Balanced Sensory Feedback.
| Related Articles |
Inclusive Competitive Game Play Through Balanced Sensory Feedback.
Stud Health Technol Inform. 2017;242:961-968
Authors: Westin T, Söderström D, Karlsson O, Peiris R
Abstract
While game accessibility has improved significantly the last few years, there are still barriers for equal participation and multiplayer issues have been less researched. Game balance is here about making the game fair in a player versus player competitive game. One difficult design task is to balance the game to be fair regardless of visual or hearing capabilities, with clearly different requirements. This paper explores a tentative design method for enabling inclusive competitive game-play without individual adaptations of game rules that could spoil the game. The method involved applying a unified design method to design an unbalanced game, then modifying visual feedback as a hypothetical balanced design, and testing the game with totally 52 people with and without visual or hearing disabilities in three workshops. Game balance was evaluated based on score differences and less structured qualitative data, and a redesign of the game was made. Conclusions are a tentative method for balancing a multiplayer, competitive game without changing game rules and how the method can be applied.
PMID: 28873912 [PubMed - in process]
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Methods of Early Prenatal Diagnosis: A Systematic Review
Methods of Early Prenatal Diagnosis: A Systematic Review
Book. 2007 12
Authors: Swedish Council on Health Technology Assessment
Abstract
Background This report presents the scientific evidence for the methods currently used, or in the process of being adopted, to detect fetal chromosomal and structural abnormalities during early pregnancy. Medical, social, psychological, ethical, health economic, quality assurance and safety aspects of early prenatal diagnosis were analysed. This summary reviews the questions addressed and the most important conclusions reached in each chapter of the report. In the first section SBU’s main conclusions are presented. Conclusions: A combined test of ultrasound nuchal translucency measurement and maternal serum biochemistry (biochemical screening) in early pregnancy (10–14 gestational weeks), along with maternal age, is the clinically evaluated method of assessing the probability of fetal Down syndrome that gives the best balance between the percentage of detected cases and false-positive results (strong scientific evidence). Maternal serum biochemistry with four markers (quadruple test) is the clinically evaluated method of assessing the probability of fetal Down syndrome that in the second trimester gives the best balance between the percentage of detected cases and false-positive results (strong scientific evidence). All the methods (nuchal translucency measurement, maternal serum biochemistry in the second trimester and the combined test) for assessing the probability of fetal Down syndrome examined by this report and evaluated in clinical practice gives a better balance between the percentage of detected cases and false-positive results than maternal age alone. Thus, the use of these methods requires fewer amniocenteses and chorionic villus samplings per detected cases of Down syndrome than maternal age alone (strong scientific evidence). Use of the interphase fluorescence in situ hybridization (FISH) test or quantitative fluorescent polymerase chain reaction (QF- PCR) is essentially as accurate as full karyotyping for detecting aneuploidies in chromosomes 13, 18, 21, x and y (strong scientific evidence). Normal results on the rapid FISH test or QF-PCR in prenatal diagnosis leave a residual possibility of fetal chromosomal abnormalities. In approximately 0.9% of all amniocenteses and chorionic villus samplings a full karyotype analysis will detect a chromosomal abnormality missed by the rapid FISH test or QF-PCR. For chromosomal abnormalities of clinical significance, the figure is 0.4% (strong scientific evidence). Fewer congenital abnormalities, including heart defects, appear to be detected when a routine ultrasound examination is performed at 12 instead of 18 gestational weeks. That is the case even if the 12-week examination includes nuchal translucency measurement and if increased nuchal translucency or greater probability of chromosomal abnormalities according to nuchal translucency is an indication for a comprehensive fetal anatomy at 18–22 gestational weeks. However, the scientific evidence is insufficient to draw a reliable conclusion in this regard. No detrimental impact of ultrasound exposure during the second trimester has been demonstrated on children’s growth, vision or hearing – or their neurological, cognitive or speech development. No correlation has been demonstrated between prenatal ultrasound exposure and childhood malignancies (strong scientific evidence). A meta-analysis of randomized trials have not shown any difference with respect to the frequency of non-right handedness (left handedness or no clear preference) between controls and groups assigned to in utero exposure to ultrasound. Analyses of subpopulations and two Swedish registry studies have found a correlation between such exposure and non-right handedness in boys. However, the scientific evidence is insufficient to draw a reliable conclusion. Invasive tests (amniocentesis and chorionic villus sampling) increase the risk of fetal loss. The best available estimate, which concerns fetal loss after late amniocentesis (15 or more completed gestational weeks), indicates a 1 percentage point increase in the risk. Most of these losses are miscarriages (moderately strong scientific evidence). Pregnant women prefer individual to group information. Audio or video information appears to improve their knowledge and understanding somewhat more effectively than letters and brochures. However, most studies reveal inadequacies when it comes to providing information to women prior to prenatal diagnosis. The women are not sufficiently knowledgeable, particularly with respect to the purpose and the potential implications of the results, to make a well-founded decision about whether or not to undergo testing. It is especially difficult for them to understand that nuchal translucency measurement with ultrasound and an evaluation of markers is part of a probability assessment rather than a final diagnosis (strong scientific evidence). Most pregnant women want to obtain early information and prefer screening in the first trimester (strong scientific evidence). Greater knowledge does not make pregnant women more anxious. The information required to minimize their stress and anxiety levels should be communicated in the same way as that which is provided prior to other medical interventions. Increased anxiety prior to prenatal diagnosis, while waiting for the results or after obtaining notification of detected (or of increased probability of) abnormalities is a natural reaction on the part of the woman and/or her partner (strong scientific evidence).
PMID: 28876771
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[Modification factors associated with maternally inherited non-syndromic hearing loss].
 |
Related Articles |
[Modification factors associated with maternally inherited non-syndromic hearing loss].
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Jun 07;52(6):472-477
Authors: Hong WJ, Zheng BJ, Qian JF, Wu H, Jin H, Zhu YT
Abstract
Mutations in the mitochondrial DNA have been certified to be one of the most important causes of maternally inherited sensorineural hearing loss. Among these, mitochondrial 12S rRNA1555A>G, 1494C>T and other mutations are associated with both nonsyndromic and drug induced hearing loss caused by aminoglycosides. Individuals carrying 1555A>G or 1494C>T mutation have a variety of clinical manifestations, which implies that the 1555A>G or 1494C>T mutation is a chief factor underlying the development of deafness but insufficient to produce the clinical phenotype. Therefore other modifier factors, such as aminoglycosides, mitochondrial haplotypes, secondary mutation or nuclear modifier genes, may play an important role in the phenotypic expression of the deafness-associated mitochondrial 12S rRNA1555A>G or 1494C>T mutation. In this review, the modifier factors for the phenotypic expression of deafness-associated mitochondrial 12S rRNA1555A>G or 1494C>T mutations were summarized and proposed the pathogenesis of maternally inherited deafness.
PMID: 28635225 [PubMed - indexed for MEDLINE]
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Mitochondrial Sirtuins and Molecular Mechanisms of Aging.
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Related Articles |
Mitochondrial Sirtuins and Molecular Mechanisms of Aging.
Trends Mol Med. 2017 Apr;23(4):320-331
Authors: van de Ven RAH, Santos D, Haigis MC
Abstract
Advancing age is the major risk factor for the development of chronic diseases and is accompanied by changes in metabolic processes and mitochondrial dysfunction. Mitochondrial sirtuins (SIRT3-5) are part of the sirtuin family of NAD(+)-dependent deacylases and ADP-ribosyl transferases. The dependence on NAD(+) links sirtuin enzymatic activity to the metabolic state of the cell, poising them as stress sensors. Recent insights have revealed that SIRT3-5 orchestrate stress responses through coordinated regulation of substrate clusters rather than of a few key metabolic enzymes. Additionally, mitochondrial sirtuin function has been implicated in the protection against age-related pathologies, including neurodegeneration, cardiopathologies, and insulin resistance. In this review, we highlight the molecular targets of SIRT3-5 and discuss their involvement in aging and age-related pathologies.
PMID: 28285806 [PubMed - indexed for MEDLINE]
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Successful communication does not drive language development: Evidence from adult homesign.
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Related Articles |
Successful communication does not drive language development: Evidence from adult homesign.
Cognition. 2017 Jan;158:10-27
Authors: Carrigan EM, Coppola M
Abstract
Constructivist accounts of language acquisition maintain that the language learner aims to match a target provided by mature users. Communicative problem solving in the context of social interaction and matching a linguistic target or model are presented as primary mechanisms driving the language development process. However, research on the development of homesign gesture systems by deaf individuals who have no access to a linguistic model suggests that aspects of language can develop even when typical input is unavailable. In four studies, we examined the role of communication in the genesis of homesign systems by assessing how well homesigners' family members comprehend homesign productions. In Study 1, homesigners' mothers showed poorer comprehension of homesign descriptions produced by their now-adult deaf child than of spoken Spanish descriptions of the same events produced by one of their adult hearing children. Study 2 found that the younger a family member was when they first interacted with their deaf relative, the better they understood the homesigner. Despite this, no family member comprehended homesign productions at levels that would be expected if family members co-generated homesign systems with their deaf relative via communicative interactions. Study 3 found that mothers' poor or incomplete comprehension of homesign was not a result of incomplete homesign descriptions. In Study 4 we demonstrated that Deaf native users of American Sign Language, who had no previous experience with the homesigners or their homesign systems, nevertheless comprehended homesign productions out of context better than the homesigners' mothers. This suggests that homesign has comprehensible structure, to which mothers and other family members are not fully sensitive. Taken together, these studies show that communicative problem solving is not responsible for the development of structure in homesign systems. The role of this mechanism must therefore be re-evaluated in constructivist theories of language development.
PMID: 27771538 [PubMed - indexed for MEDLINE]
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Planning early childhood audiologic intervention programs on a regional scale: introduction to an Italian study.
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Related Articles |
Planning early childhood audiologic intervention programs on a regional scale: introduction to an Italian study.
Acta Otorhinolaryngol Ital. 2016 Feb;36(1):3-9
Authors: Orzan E, Ciciriello E
Abstract
Non-uniform, late, or inappropriate care of childhood with permanent hearing impairment (PHI) predisposes many children to develop communicative- behaviour problems and impaired psychosocial adjustment that can persist in adolescence and adulthood.In March 2014, the CCM (Centro Controllo Malattie or Disease Control Centre) of the Italian Ministry of Health funded a project entitled " Preventing Communication Disorders: a Regional Program for Early Identification, Intervention and Care of Hearing Impaired Children". The project involved 5 tertiary centres with UNHS programs formally approved by the Region. The main purpose of the project is to define and launch an integrated regionally-based public health model for identification, diagnosis and intervention of childhood PHI. The first phase of the project investigated the state of art and produced recommendations for positive changes in identification, diagnosis, therapy and care of childhood PHI in Italy, taking into account diagnostic and treatment innovations, family empowerment, treatment alliance and an interdisciplinary approach. Recommendations drawn from this initial phase will represent the basis for a regional system for early intervention that is validated, integrated and shared between the five regions.
PMID: 27054384 [PubMed - indexed for MEDLINE]
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