Identification of neonatal hearing impairment: hearing status at 8 to 12 months corrected age using a visual reinforcement audiometry protocol.

OBJECTIVES: 1) To describe the hearing status of the at-risk infants in the National Institutes of Health-Identification of Neonatal Hearing Impairment study sample at 8 to 12 mo corrected age (chronologic age adjusted for prematurity). 2) To describe the visual reinforcement audiometry (VRA) protocol that was used to obtain monaural behavioral data for the sample. DESIGN: All neonatal intensive care unit infants and well babies with risk factors (including well babies who failed neonatal tests) were targeted for follow-up behavioral evaluation once they had reached 8 mo corrected age. Three thousand one hundred and thirty-four (64.4%) of the 4868 surviving infants returned for at least one behavioral hearing evaluation, which employed a well-defined VRA protocol. VRA thresholds or minimum response levels (MRLs) were determined for speech and pure tones of 1.0, 2.0, and 4.0 kHz for each ear using insert earphones. RESULTS: More than 95% of the infants were reliably tested with the VRA protocol; 90% provided complete tests (four MRLs for both ears). Ninety-four percent of the at-risk infants were found to have normal hearing sensitivity (MRLs of 20 dB HL) at 1.0, 2.0, and 4.0 kHz in both ears. Of the infants, 2.2% had bilateral hearing impairment, and 3.4% had impairment in one ear only. More than 80% of the impaired ears had losses of mild-to-moderate degree. CONCLUSIONS: This may be the largest study to attempt to follow all at-risk infants with behavioral audiometric testing, regardless of screening outcome, in an effort to validate the results of auditory brain stem response, distortion product otoacoustic emission, and transient evoked otoacoustic emission testing in the newborn period. It is one of only a few studies to report hearing status of infants at 1 yr of age, using VRA on a clinical population. Successful testing of more than 95% of the infants who returned for the VRA follow-up documents the feasibility of obtaining monaural behavioral data in this population.

The Rhode Island Hearing Assessment Program: experience with statewide hearing screening (1993-1996)

OBJECTIVE: The objective of this study was to evaluate key outcomes of a universal hearing screen/rescreen program for all births with transient evoked otoacoustic emissions in all 8 maternity hospitals in the state of Rhode Island over a 4-year period. STUDY DESIGN: This was a retrospective analysis of the hearing screen/rescreen refer data collected prospectively for 53,121 survivors born in Rhode Island between January 1, 1993, and December 31, 1996. Primary outcomes included the first-stage refer rates, rescreen compliance, diagnostic referral rates, identification rates, and the age of amplification. RESULTS: During this 4-year time period 11 infants were identified with permanent hearing loss, resulting in an impairment rate of 2 per 1000. The mean age of hearing loss confirmation decreased from 8.7 months to 3.5 months, and the age at amplification declined from 13.3 months to 5.7 months. CONCLUSION: We conclude that time and experience are important factors in the development and refinement of a universal hearing screen program. Hearing screen outcome data collected over a 4-year period in Rhode Island reveal a steady improvement in the percent of infants completing the 2-stage screen process, the stage 1 and stage 2 refer rates, compliance with rescreen and diagnostic testing, and significant improvement in the age of identification and age of amplification.

The subculture of adolescence: beliefs about care, health and individuation within Leininger's theory.

The purpose of this ethnonursing investigation, which was part of a larger study, was to describe and explain the meanings and experiences of adolescents in relation to their care and health within their peer subculture and family contexts. Data were collected using observation-participation and interviews with adolescents in southwestern Ontario, Canada. Interviews were tape recorded, coded and entered on to a computer. The following themes were abstracted from the verbatim descriptors and patterns. (a) Care for adolescents meant "being there' for listening in confidence, helping, gift giving, humour and demonstrating love in time of need. (b) Health for adolescents meant well-being, absence of illness, being fit, dealing with problems, and taking responsibility. (c) The adolescents valued family, friends, education, money, sports, and honesty. (d) Clothes, hair and music were metaphors for adolescents' emerging identities.

The promotion and measurement of healthy coping.

Contemporary society is failing to meet the developmental needs of its youth. Social and cultural changes have created an urgent need for nursing interventions that promote healthy development in young people struggling with role ambiguity, the breakdown of family and social support networks, and a future that seems vague or even nonexistent. A nursing intervention that seems to be effective is peer counseling. Peer leaders with specific training and continued supervision by nurse counselors can have an impact on healthy development. In order to examine the outcome of peer counseling on coping patterns, a group of 102 adolescents who had received peer counseling was compared with two control groups (n = 134 and 104) not having received peer counseling. There were 209 young women and 131 young men in the study. Both male and female subjects were included in the study in the interest of gender-fair research (Grady, 1981). The A-COPE, a reliable and valid instrument developed by Patterson and McCubbin (1983) was administered to the 340 young people. Analysis of variance and the Scheffé test of statistical analysis of the data revealed significantly different coping patterns among the counseled and control groups.