Reliability and effectiveness of screening for hearing loss in high risk neonates.

OBJECTIVE--To establish the reliability and effectiveness of screening for hearing loss by brainstem auditory evoked potential testing in high risk neonates. DESIGN--Seven year investigation of newborn babies admitted to a special care baby unit and monitored through a regional children's audiology unit. SETTING--Special care baby unit and children's audiology department, Belfast. SUBJECTS--405 neonates admitted to the baby unit, during 1 October 1982 to 31 March 1987. MAIN OUTCOME MEASURES--Presence of hearing impairment, type and severity of hearing impairment, mortality. RESULTS--85 children failed the screening test, 62 of whom were followed up. Five children had severe bilateral sensorineural impairment and 12 had conductive impairment requiring surgical intervention. A further 18 had severe neurological disorder detected. The sensitivity of screening was 100% and specificity was 88%. If the procedure was introduced into routine clinical practice the mean age at diagnosis for all children with severe perinatal hearing impairment would be 11 (median 1) months. The mean age at diagnosis with the health visitor screening service was 23 (19) months (difference 10 months, 95% confidence interval 6 to 16 months; p < 0.0001). CONCLUSION--Screening for hearing loss in high risk neonates is highly reliable and cost effective. It also provides valuable neurophysiological information. Routine testing of these infants would result in over half of all children with severe bilateral perinatal sensorineural hearing impairment being identified by 2 months of age. This would make an important contribution to the habilitation of this socially, emotionally, and educationally vulnerable group

To Have and to Hold: Codependency as a Mediator or Moderator of the Relationship Between Substance Abuse in the Family or Origin and Adult-Offspring Medical Problems

This pilot study explored the putative role of codependency as a mediator or moderator of the relationship between substance abuse in the family of origin (SAFO) and offspring medical problems in a counterbalanced multiple-treatment experiment with a heterogenous sample of adult males and females. Codependent attitude and behavior were moderators that attenuated the relationship between SAFO and two measures of acute offspring medical problems, but codependent behavior amplified the relationship between SAFO and chronic medical problems. Challenging replications are called for