Hearing Health Healthcare Disparities in Appalachia

Hearing loss is a global public health issue with disproportionate negative impacts on those who live in rural regions, such as Appalachia. This commentary provides an overview of hearing health and healthcare disparities in rural regions along with discussion of the significance of recent research findings which highlight the incidence of hearing loss and the shortage of hearing specialists in Appalachia

Promotion of Early Pediatric Hearing Detection Through Patient Navigation

Congenital hearing loss is the most common neonatal sensory disorder and it is crucial to diagnose hearing loss as soon as possible after birth in order to facilitate rapid treatment. Universal standards of infant hearing healthcare dictate that infant hearing screening should be completed by one month of age and abnormal screening tests should be followed with definitive audiological testing by three months of age. Obtaining diagnostic testing can be complicated by limited access to care in rural areas, breakdowns in communication, lack of parental support, and poor coordination of care. There is no established method to address appointment non-adherence in newborn hearing testing. Patient navigation (PN), which uses trained healthcare workers to educate patients and facilitate adherence to healthcare, is an evidence-based approach that has had widespread success in facilitating timely care in other healthcare settings but has not been studied in infant hearing testing. The objective of this dissertation is to 1) assess the effect of patient navigation on care delivery in healthcare inequity settings, 2) assess the efficacy of a PN intervention to decrease non-adherence to recommended infant audiological testing after failed newborn hearing screening, and 3) develop a method to implement patient navigation into the state hearing screening program. The original concept and development of PN stems from the findings of the American Cancer Society National Hearings on Cancer in the Poor in 1989, which revealed a host of barriers that underserved populations face in receiving timely and appropriate, care. Cancer treatment centers have utilized patient navigators (PNs) to address these barriers in the delivery of cancer care. In order to consider the potential of applying patient navigation in promoting timely infant hearing healthcare, a systematic review was performed to systematically assess the efficacy of patient navigation to improve diagnosis and treatment of diseases affecting medically underserved populations. Specific outcomes assessed in the review included the effect of PN on timing of definitive diagnosis and effect on initiation of treatment. The search strategy produced 1,428 articles and 16 were included for review. In the Oncology field, timing of initial contact with a patient navigator after diagnostic or screening testing was correlated to the effectiveness of the navigator intervention. The majority of the studies reported significantly shorter time intervals to diagnosis and to treatment with patient navigation. This review provided evidence to justify a PN efficacy trial in infant hearing healthcare. To investigate the efficacy of PN to decrease non-adherence to recommended infant audiological testing after failed newborn hearing screening, a randomized controlled trial was conducted in sixty-one guardian-infant dyads. All infants had abnormal newborn hearing screening and were recruited within the first week after birth. Dyads were randomized into a PN study arm or standard of care arm. PN was found to be efficacious as the percentage of participants with follow-up non-adherence was significantly lower in the PN arm compared with the standard of care arm (7.4% versus 38.2%, p=0.005). The timing of initial follow-up was significantly lower in the PN arm compared with the standard of care arm (67.9 days versus 105.9 days, p=0.010). Based on this efficacy data, the next objective of the research was to scale up PN to maximize public health impact by combining an effectiveness trial with implementation research. A hybrid effectiveness/implementation study was designed to investigate patient navigation within the state-funded EHDI (early hearing detection and intervention) system. Using a stepped wedge design this trial investigates the 1) effectiveness of PN to decrease non-adherence to hearing testing, 2) implementation factors using the Consolidated Framework of Implementation Research (CFIR), and 3) cost-effectiveness and sustainability of a PN program within a state-supported EHDI system

Defining Disparities in Cochlear Implantation through the Social Determinants of Health

Hearing loss is a global public health problem with high prevalence and profound impacts on health. Cochlear implantation (CI) is a well-established evidence-based treatment for hearing loss; however, there are significant disparities in utilization, access, and clinical outcomes among different populations. While variations in CI outcomes are influenced by innate biological differences, a wide array of social, environmental, and economic factors significantly impact optimal outcomes. These differences in hearing health are rooted in inequities of health-related socioeconomic resources. To define disparities and advance equity in CI, there is a pressing need to understand and target these social factors that influence equitable outcomes, access, and utilization. These factors can be categorized according to the widely accepted framework of social determinants of health, which include the following domains: healthcare access/quality, education access/quality, social and community context, economic stability, and neighborhood and physical environment. This article defines these domains in the context of CI and examines the published research and the gaps in research of each of these domains. Further consideration is given to how these factors can influence equity in CI and how to incorporate this information in the evaluation and management of patients receiving cochlear implants

Incorporating UTAUT Predictors for Understanding Home Care Patients’ and Clinician’s Acceptance of Healthcare Telemedicine Equipment

Telemedicine programs within health care are experiencing significant growth as healthcare organizations seek to reduce expenditures and improve efficiency. The high costs of treating chronic diseases, compounded by an aging population, has given focus to creating technology-enabled alternatives to support, enhance, or expand patient services. As investments in telemedicine products and services grow at a rapid pace, user technology acceptance has become a key issue in successful implementation. Drawing from the Unified Theory of Acceptance in Technology (UTAUT), this study investigated the predictors of behavioral intention to use Telehealth equipment by patients, clinicians, and agency personnel at Henry Ford e-Home Health Care. Survey data were provided by 126 participants recruited from an eligible population who were either currently using the Telehealth equipment or were familiar with it. Structural equation modeling was used to study the overall fit of the UTAUT model in predicting behavioral intention. Participant type, self-efficacy, anxiety and attitude were tested as moderators. Implications for increasing adoption of Telehealth technology are discussed

Lilliputian Hallucinations and Marijuana Dependence in a Bipolar Patient

Lilluputian hallucinations are rarely seen in manic patients. Here we present a case of isolated lilluputian hallucinations against a backdrop of psychosis and marijuana use. The phenomenon is interesting and worth following up with. The patient recovered and a brief literature search is included

Neonatal Abstinence Syndrome and Infant Hearing Assessment: A Kids’ Inpatient Database Review

Objective: Neonatal abstinence syndrome (NAS) has become an epidemic. This study assesses documented rates of failed newborn hearing screening (NBHS) or hearing loss diagnosis (HL) in NAS infants, and sociodemographic factors associated with abnormal inpatient hearing results. Methods: The 2016 HCUP/KID national database was used to identify a weighted sample of infants with failed NBHS/HL during birth hospitalization. Independent variables included diagnoses of NAS/in-utero opioid exposure, HL risk factor presence and sociodemographic data. Univariate analyses and multivariate logistic regression were used to determine associations between NAS and abnormal hearing assessment. Results:NAS infants had lower odds ratio (OR) of documented failed NBHS (OR=0.76, p Conclusion: NAS children have lower rates of inpatient documented failed NBHS and higher rates of HL diagnosis. The complex medical care of these infants could complicate NBHS, documentation, and subsequent follow-up. Certain sociodemographic factors result in a higher risk of hearing loss

Recommendations for reporting ion mobility Mass Spectrometry measurements

Here we present a guide to ion mobility mass spectrometry experiments, which covers both linear and nonlinear methods: what is measured, how the measurements are done, and how to report the results, including the uncertainties of mobility and collision cross section values. The guide aims to clarify some possibly confusing concepts, and the reporting recommendations should help researchers, authors and reviewers to contribute comprehensive reports, so that the ion mobility data can be reused more confidently. Starting from the concept of the definition of the measurand, we emphasize that (i) mobility values (K0) depend intrinsically on ion structure, the nature of the bath gas, temperature, and E/N; (ii) ion mobility does not measure molecular surfaces directly, but collision cross section (CCS) values are derived from mobility values using a physical model; (iii) methods relying on calibration are empirical (and thus may provide method‐dependent results) only if the gas nature, temperature or E/N cannot match those of the primary method. Our analysis highlights the urgency of a community effort toward establishing primary standards and reference materials for ion mobility, and provides recommendations to do so. © 2019 The Authors. Mass Spectrometry Reviews Published by Wiley Periodicals, Inc

Sociodemographic Factors influencing Pandemic-Era EHDI Use and Access

Objective: The COVID-19 pandemic impact on Early Hearing Detection and Intervention (EHDI) programs is unknown. This research evaluated sociodemographic factors influencing adherence to EDHI diagnostic testing and the incidence of infant hearing loss during the pandemic. Method: We evaluated EHDI adherence and incidence of hearing loss in Kentucky before and during the COVID-19 pandemic. Using univariate and multivariate analysis, we evaluated the association of these outcomes to sociodemographic variables. Results: There were 71,206 births and 1,385 referred infant hearing screening tests during the study period. Infants during the pandemic had a 24% lower odds of hearing testing adherence (OR = 0.76, p = 0.05, 95%CI: 0.57–1). Hispanic infants have 45% lower odds of EHDI adherence (OR = 0.55, p = 0.03, 95%CI: 0.31–0.96) and infants of Swahili speaking families have 90% lower odds of EHDI adherence (OR = 0.10, p = 0.001, 95%CI: 0.02–0.42). Infants of mothers with a high school degree had a higher odds of adherence (OR = 1.50, p = 0.02, 95%CI: 1.06–2.17), presented earlier for testing (p = 0.003, 95%CI: -15.73– -3.32), and had a higher odds of normal hearing (OR = 1.63, p= 0.03, 95%CI: 1.06–2.51). Conclusion: EHDI adherence is influenced by the COVID-19 pandemic and sociodemographic factors. EHDI programs are encouraged to use this data to promote timely and equitable access and use of diagnostic services

Assessment of Factors Involved in Non-Adherence to Infant Hearing Diagnostic Testing

Abstract Introduction: Delayed diagnosis of pediatric hearing loss can cause delays in cognitive and social development. This study described the sociodemographic factors associated with delayed timing of a final hearing diagnosis after an abnormal newborn hearing screening (NBHS). Methods: Parent-infant dyads were recruited after being referred for further audiologic testing on an abnormal result from the NBHS. Results: Of the 53 participants, 55% (n=29) did not receive a final diagnosis by the recommended 3 months of age. Of those with a delayed diagnosis, 45% (n=13) had their first appointment within 3 months, but a delay was caused by an inconclusive or abnormal auditory brainstem response (ABR), middle ear pathology, or the presence of risk factors requiring additional testing. In a univariate analysis, older parental age (OR: 0.90, 95% CI: [0.82, 0.99]) and more total children in the household ([OR: 0.66, 95% CI: {0.18, 2.49}] for 1 child vs. 2 and [OR: 0.14, 95% CI: {0.03, 0.69}] for 1 children vs. 3 or more) were shown to were shown to significantly increase the odds of a delayed diagnosis, whereas younger infant age at first appointment (OR: 0.95, 95% CI: [0.92, 0.99]) was shown to significantly decrease the odds of a delayed diagnosis. In multivariate analyses, delayed diagnosis was also decreased by younger infant age at the initial appointment (OR=0.94, 95% CI: [0.90, 0.99]). Conclusions: Parental age, number of total children in the household, and timing of first appointment may predict delayed diagnosis. Because many patients with a delayed diagnosis attended an appointment within 3 months, further standardization of the process and targeted interventions for families could improve chances of achieving a diagnosis within the first appointment