Characterization of newborn hearing screening failures in multigestational births.

OBJECTIVE: To define the rate and characterize the type of newborn hearing screening failures in multigestational births. METHODS: Retrospective chart review of all multigestational births that occurred in a 10-year period (2002-2012) in which at least one newborn failed newborn hearing screening at two tertiary care hospitals in the Northwell Health System. RESULTS: Out of 125,405 total births, we identified 2961 multigestational births, of which 59 (2.0%) newborns failed newborn hearing screening. None of their 66 twin/triplet siblings failed their newborn hearing screens. Of 43 newborns that returned for follow-up, 56.0% (24/43) had confirmed hearing loss, resulting in an overall rate of 0.81% in all multigestational newborns with hearing loss. Of 19 infants that passed repeat testing, two were judged to need myringotomy tube placement. Twenty-four infants had a confirmed hearing loss, 11 of which had sensorineural hearing loss (0.37%), and 13 with a conductive or mixed hearing loss (0.44%). CONCLUSIONS: We identified a greater than expected risk of conductive hearing loss, not attributable to otitis media, than sensorineural hearing loss in this population. These observations are consistent with the increased risk of birth defects in multigestational births.

Factors Related to Not Following Up with Recommended Testing in the Diagnosis of Newborn Hearing Loss.

Children's hearing is a public health concern, and universal newborn hearing screenings are the first step in detecting and treating congenital hearing loss. Despite the high rate of participation in such programs, loss to follow-up (LTF) with additional recommended diagnosis and treatment has been a persistent problem. The current research seeks to expand the knowledge base at the point of diagnosis, where there is a large drop-off in parents following through with recommended care. This research was organized around the following question: What biopsychosocial factors are associated with LTF between screenings and diagnostic evaluations? A prospective quantitative longitudinal study tracked 203 families whose newborns were referred for additional testing at discharge from the hospital after birth. Binary logistic regression was used to determine what constellation of factors best predicted LTF. Psychosocial factors related to being lost to follow-up at diagnosis included race and ethnicity and access to health care professionals, with African American babies being most at risk for LTF; however, the impact of race and ethnicity declined when parents believed they had more health care professionals with whom to consult.

Lupus (SLE): Existence and Impact of Depressive Symptomatology.

The purpose of this cross-sectional study (N = 84) is to: (1) further identify the unique psychosocial challenges facing those living with Systemic Lupus Erythematosus (SLE) and (2) discern the validity of the depression dimension of the System Lupus Erythematosus Needs Questionnaire (SLENQ) (by including the Beck Depression Inventory [BDI-II]). Utilizing the BDI-II, this study replicates and confirms the validity of studies that employed the SLENQ, establishing that those who have manifested signs of depression in the SLENQ, are equally likely to show signs of depression in the BDI-II. Authors identify and confirm that patients who experience SLE-related depression are significantly more likely to forget taking or stop taking their SLE medications. The authors review relevant research, discuss findings, and provide evidence-based recommendations for social workers providing mental health care to patients living with Lupus.

Understanding the relationship between school-based health center use, school connection, and academic performance.

School-based health centers (SBHCs) benefit the overall health of underserved communities. In fact, there is an abundance of evidence suggesting the positive effects that SBHCs have on physical and mental health. However, research related to understanding the relationship of SBHCs to academic outcomes such as performance and school connectedness is sparse. The purpose of the current study was to (a) compare differences between elementary, middle, and high school student SBHC users and nonusers on school connectedness and (b) test the pathways between SBHC usage and academic performance. A structural equation model was tested and found significant pathways between SBHCs, school connectedness, and academic performance.

The moderating effect of school type on the relationship between school-based health centers and the learning environment.

School-Based Health Centers (SBHCs) have improved access to primary and preventive health care for underserved children and youth by bringing comprehensive health services into the schools while addressing critical health problems that make it difficult for students to learn. Despite the findings on the positive effects of SBHCs on health outcomes, the literature investigating the relationship between SBHCs and the learning environment is scant. This study utilizes a quasi experimental study to investigate the moderating effects of school type on the relationship between school based health centers and the learning environment. Findings indicate that SBHCs in middle and elementary schools are associated with greater levels of school engagement and satisfaction with the learning environment than those in high schools.

Locus of control and lupus: patients' beliefs, perspectives, and disease activity.

Patients with lupus often experience a high degree of psychological symptoms such as anxiety, depression, and mood disorders that can influence their beliefs and perceptions of their illness. The purpose of the study was to examine how a patient's self-reported psychosocial needs (depression and anxiety) and beliefs about how much control they have over their health (health locus of control) influences their perception of disease chronicity and acuity. The study findings were based on a survey of 378 patients self-diagnosed with lupus.

PTSD and HIV in women: the role of gender in this dual diagnosis.

This article is based on the authors findings from a cross-sectional descriptive study of men (n = 116) and women (n = 68) who were receiving HIV/AIDS counseling from four different community centers across New York state from March-July 2010. To ascertain the prevalence of post-traumatic stress in this population, a checklist (PCL) was employed. The responses from females and males were compared to detect gender differences in the common dual diagnosis of HIV and PTSD. The genders differed regarding several manifestations of PTSD: (1) women reported a significantly higher mean score on "feeling very upset when something reminded" them of a stressful experience from the past; (2) while not statistically significant, but noteworthy, men reported they were more likely to feel "distant or cut off" depending on their employment status. These and other findings suggested that the genders may manifest PTSD differently. Implications for those in the health care field and the trauma field are provided.

Psychosocial dimensions of SLE: implications for the health care team.

BACKGROUND: The purpose of this exploratory study was threefold, ie, to clarify the unique psychosocial challenges facing those living with systemic lupus erythematosus (SLE), to distinguish which sociodemographic variables impact the lives of SLE patients, and generate knowledge regarding the way patients perceive SLE medication regimens. METHODS: This was a cross-sectional exploratory study in 378 patients diagnosed with SLE and receiving services from the SLE Lupus Foundation in New York City. In addition to sociodemographic variables, the instrument used consisted of two scales, ie, the Systemic Lupus Erythematosus Needs Questionnaire (SLENQ) and the Multidimensional Health Locus of Control Scale, as well as questions regarding subjective perceptions of side effects from SLE medication. RESULTS: The highest general cause of self-reported depressive and anxious feelings was changes in appearance due to SLE, and limitations in physical abilities due to SLE (primarily from muscle and joint pain). The higher the sense of control over SLE, the less likely respondents were to report feeling depressed and anxious. African-American and Hispanic SLE patients reported a higher level of unmet psychological needs due to SLE than did their other ethnic counterparts. Weight gain and hair loss were the most likely medication side effects and also the most likely causes of SLE-related depression and anxiety. CONCLUSION: Those living with SLE are at risk for feelings of depression and anxiety. African-American and Hispanic women are at higher risk for these emotional states. Comprehensive assessment across the disciplines should screen this group of patients for depression and anxiety, and be prepared to refer them to patient education and social work counseling as indicated.

What social workers in health care should know about lupus: a structural equation model.

This article reports on findings from a cross-sectional study (N=378) of patients living with systemic lupus erythematosus (SLE). The purpose of this study was to identify and clarify the unique psychosocial challenges for those living with lupus. The specific analysis will help to develop a model to determine how different factors influence SLE patients' psychosocial needs. Key findings indicate that the highest general causes of depressive and anxious feelings were changes in appearance due to SLE and limitations in physical abilities due to SLE. The more chronic the symptoms, the more likely it was that feelings of depression would ensue. The more education subjects had, the less likely they were to report feeling depressed or anxious about their SLE challenges. Those with no health care insurance reported the highest levels of depressive and anxious feelings, those with Medicaid reported the second highest, and those with Medicare reported the least SLE-related depression and anxiety. The great majority of SLE patients on medications experienced a wide range of side effects, the most prominent being hair loss. These findings can inform policy and programs as well as clinical initiatives for those affected by SLE.

Electrical compound action potentials recorded with automated neural response telemetry: threshold changes as a function of time and electrode position.

OBJECTIVE: Since the introduction of neural response telemetry (NRT) for the Nucleus 24 cochlear implant (CI24), researchers and clinicians have investigated the feasibility of using the electrically evoked compound action potential (ECAP) threshold to objectively predict psychophysical measurements that are used in the programming of the speech processor. The ability to substitute objective for behavioral measurements, particularly measurements made at the time of surgery, would greatly facilitate programming the MAP for young children and other individuals who are not able to provide reliable behavioral data required for MAP programming. There have been a number of studies that have examined characteristics of the ECAP measured at the time of surgery and postoperatively; however, all the available published data are based on the CI24. With the introduction of the Nucleus Freedom device, an automated NRT (AutoNRT) program became available, which was capable of measuring ECAP thresholds at lower levels than was previously possible with NRT software associated with the CI24 device. It was hypothesized that the enhancements to the NRT program may improve the predictability of postoperative measurements from intraoperatively recorded ECAP thresholds. The purpose of this study was to track ECAP thresholds obtained using AutoNRT as a function of time and electrode position. DESIGN: ECAP thresholds were recorded from 71 children and adults implanted with the Nucleus Freedom device using the AutoNRT test protocol. ECAP thresholds were obtained at the time of surgery, at initial stimulation, and 3 mos poststimulation. Five electrodes located at basal, middle, and apical positions in the cochlea were tested at each time interval and thresholds were compared. RESULTS: Significant differences were found in ECAP thresholds measured with AutoNRT as a function of both time and electrode position. Basal electrodes had higher ECAP thresholds than apical electrodes and that relationship was consistent for each time period. Thresholds for all electrodes decreased between surgery and initial stimulation and remained relatively stable at 3 mos poststimulation. ECAP thresholds were consistently lower for children compared with adults at each time point. Mid-array electrodes (11 and 16) showed the least amount of change over time. CONCLUSIONS: AutoNRT thresholds demonstrated significant change over time, limiting the ability to use intraoperatively recorded ECAP thresholds to predict postoperative measurements. In this study, electrodes 11 and 16 showed the least amount of change in ECAP threshold over time and therefore would be the best choices for estimating postoperative ECAP thresholds. Although not an ideal solution, mid-array ECAP thresholds obtained intraoperatively may prove to be helpful in creating a first MAP when no other behavioral or electrophysiological data are available.

Post-traumatic stress disorder and HIV: a snapshot of co-occurrence.

Although the medical advances in the area of human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) have undoubtedly improved the length and quality of life for those who are HIV-affected and medication adherent, there are still many psychosocial obstacles to effective HIV/AIDS medication adherence. Recent research has focused on one such obstacle. The significant link between post-traumatic stress disorder (PTSD) and HIV. This article reports on the nature of this relationship with a cross-sectional study of active clients (n = 186) who were receiving HIV services from community-based settings in the New York City area. With the use of the PTSD Checklist (PCL), this study determined that more than half of the sample tested positively for PTSD. Policy and clinical implications of this and other findings are discussed.

The value of the presence of social work in emergency departments.

The value of the presence of social work in emergency rooms is supported by directly examining the hospitalization rates of patients seen by social workers. It utilizes a 3-year-long data set of social work self-reports on medical emergency room outcomes at a large, teaching hospital in the New York Metropolitan area with a sample size of 3370. The study findings suggest that social workers in this acute care hospital's emergency room often are referred the most complex cases. The data on this site indicate that the majority of social work dispositions were to home (54%) or a nursing facility (8.4%). Only 16% of the patients seen by social work were admitted to the hospital. These findings support the cost-effective nature of social work in the emergency room setting and the importance of finding alternatives to hospital admissions. The results of a logistic regression suggest that the criteria used by social workers to assess patients are based on sound psychosocial factors. Patients who were assessed as having "Environmental" (p = .00) or "Relationship" problems (p = .00) were much less likely to be admitted. Conversely, patients with "Care/ADL" problems (p = .00) and behavior problems (p = .00) had a heightened chance of being admitted. Being African American has less effect but was still relevant.

HIV/AIDS prevention in New York City: identifying sociocultural needs of the community.

New York City has always been and remains at the epicenter of the country's AIDS epidemic, with more than 100,000 people living with HIV/AIDS. More than Los Angeles, San Francisco, and Miami combined (CDC, 2007b). Each year there may be as many as 4,800 people in New York City who are newly diagnosed with HIV and 1,700 who die from the disease (NYC Commission on HIV/AIDS, 2005; NYC AIDS Institute, 2006g). Recent research indicates that these HIV infection rates are actually significantly higher (perhaps by as much as 40%), with the "virus spreading in NY at three times the national rate" making it evident that HIV education and prevention efforts are not effectively reaching New Yorkers (Altman, 2008, p. 1). This article reports on the findings of a quantitative study (n = 98) that sought to identify the unique sociocultural needs of NYC residents who seek HIV/AIDS care. Key questions were aimed at who gets HIV tested and why, what HIV education services were reported as most effective, and identifying the unique sociocultural obstacles to getting HIV tested. Some of the statistically significant findings include: (1) the most helpful HIV education was found to be support groups and the second most helpful was reading material offered in community based settings; (2) most residents choose to get tested under the direct advice of a physician; (3) Latinos tend to hold more HIV/AIDS Stigma than their African-American counterparts. Culturally competent implications are provided for policy, program development and direct care for those providing HIV education services in urban communities.

Workforce retention issues in voluntary child welfare.

Unlike many studies focused on retention and turnover in public child welfare, this study examined issues of job satisfaction and retention in voluntary child welfare. Although three-fourths of the 1,624 workers surveyed intended to remain in child welfare, 57.3% had thought about leaving their agencies during the past year. All respondents were dissatisfied with their level of pay, but those thinking of leaving were significantly less satisfied with the contingent rewards they received.

How older Hispanic immigrants in New York City cope with current traumatic stressors: practice implications.

Older minority immigrant groups in the United States may be at increased risk for traumatic stress in an age of terrorism and of civil and political unrest. This exploratory study investigated how older Hispanic immigrants in New York City coped in response to current traumatic stressors, and whether they differed from a comparison group of older US-born non-Hispanics. We administered the Impact of Events Scale-Revised (IES-R) and the Brief COPE instruments to 24 older Hispanic immigrants and 15 older non-Hispanics, born in the United States, at 2 senior centers. Hispanic immigrants showed greater symptomatic response to current stressors as measured by significantly higher scores on the hyperarousal and avoidance subscales of the IES-R. Both groups used passive coping strategies. Older Hispanic immigrants may be at increased risk for negative psychological consequences caused by a current stressor. Practitioners should encourage older Hispanic immigrants to use active coping strategies to deal with those stressors.

Nursing homes as reservoirs of MRSA: myth or reality?

OBJECTIVE: To determine the prevalence and risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) colonization among residents of a long-term care facility (LTCF) and to investigate the association of prior antibiotics use and MRSA colonization. DESIGN: Cross-sectional analysis. SETTING: A large, 320-bed suburban long-term care facility in New York. PARTICIPANTS: A representative sample of 160 nursing home residents. MEASUREMENTS: We obtained nasal swabs to screen for MRSA colonization and reviewed the medical charts for clinical and demographic data. RESULTS: A total of 160 residents participated. MRSA colonization was identified in 44 residents (27.5 %). Only 5 variables were statistically significantly associated with MRSA colonization, namely race, renal insufficiency, increased use of antibiotics, prior MRSA infection during the previous year, and prior hospitalization within 3 years. Sharing a room with a MRSA carrier did not increase the risk for colonization. CONCLUSION: This study found a large reservoir of MRSA within this LTCF population. Nursing home residents with renal insufficiency, prior MRSA infection, prior hospitalization, and higher use of antibiotics were found to be at risk for MRSA colonization . These findings demonstrate that LTCFs need to be proactive in implementing appropriate antibiotics restriction practices and should give high priority to the development of more effective infection control policies.

From hospital to nursing facility: factors influencing decisions.

This study addresses the factors influencing decisions to send medicine-surgical (med-surg) patients home or to nursing facilities (NFs). The sample (n = 7,852) was taken from a large, urban, teaching, med-surg unit where discharges were documented and data collected over a two-and-a-half-year period. Using logistical regression, the factors found to most influence the decision were age (z = 26.99, p = .000; odds = 1.06); patients diagnosed with "musculoskeletal system" problems (z = 11.07, p = .000; odds = 5.36); and needing skilled professional care (z = -15.03, p = .000; odds = .21) or nonprofessional personal care (z = 6.62,p = .000; odds = 2.32). Having less effect, but important information for discharge planners, was being an African American (z = 3.82, p = .000; odds = .76) or Latino (z = -3.96, p = .000; odds = .54). A review of the literature found limited knowledge of the factors that influence hospital patients, family members, and professionals, including social workers, to make the decision to recommend home care or NF care.

Do geriatricians practice what they preach?: geriatricians' personal establishment of advance directives.

Previous research has been conducted regarding preferences of physicians for life-sustaining treatments for themselves, but there is a dearth of data on personal use of advance directives (ADs) by geriatricians specifically. Using a phone survey, we contacted all graduates of the geriatric fellowship program to assess their personal use of advance directives and their personal preferences for life-sustaining treatment. Of the 124 living graduates of the Parker Jewish Institute for Health Care and Rehabilitation, 70 agreed to participate. One third of respondents had established ADs for themselves, with higher rates in women than men (p = .054). Older geriatricians were significantly more likely to have advance directives (exact trend test yields, p < .0001). In general, respondents did not inform their health care providers about their desires for end-of-life care. This study revealed that the majority of fellowship-trained geriatricians did not formally establish advance directives for themselves. Further research is needed to determine whether physicians who establish advance directives for themselves are more likely to encourage their patients to do so.

Newborn hearing screening follow-up: factors affecting hearing aid fitting by 6 months of age.

PURPOSE: To determine the extent to which the goal of hearing aid fitting by 6 months of age is being achieved and to identify barriers to achieving that goal. METHOD: Screening and follow-up records from 114,121 infants born at 6 hospitals were collected over a 6-year period. Infants diagnosed with permanent hearing loss requiring amplification were categorized as fit on time, fit late, or lost to follow-up. Seven factors were empirically identified as potential barriers to timely intervention. RESULTS: Ninety-one percent of referred infants returned for follow-up evaluation. Hearing aids were fit on 107 of the 192 infants requiring amplification. Thirty-nine percent were fit on time, and 61% were fit late or lost to follow-up. Unilateral hearing loss and late diagnosis were statistically significant (p < .0001) predictors for late fitting and loss to follow-up. Conductive hearing loss and coverage by Medicaid were also statistically significant (p < .0001) predictors for loss to follow-up. CONCLUSION: High return rate for follow-up does not ensure hearing aid fitting by 6 months of age. Infants with unilateral hearing loss are at particular risk of being lost to follow-up.