Early identification of young children with hearing loss in federally qualified health centers.

OBJECTIVE: While newborn hearing screening has improved outcomes for children diagnosed with hearing loss, the screening protocol is incomplete in the critical early developmental years, particularly among underserved populations. To address this gap, 7 federally qualified health centers (FQHCs) implemented a periodic, objective infant-toddler hearing screening program during well-child visits. The study aimed to determine the ability of these primary care providers to implement the hearing screening protocol and to identify children in need of audiologic follow-up. METHOD: This study represents a prospective chart review. Children aged 0 to 3 years presenting to participating clinics for well-child care visits were offered the hearing screen, which included a brief risk factor questionnaire, otoacoustic emissions (OAEs), and tympanometry. Main outcome measures were time to screen, accuracy of physician interpretation of the tympanogram results, and screening results requiring immediate audiology follow-up. RESULTS: Among 1965 OAE screens, 75% took <10 minutes, and 205 patients (10%) failed OAEs in at least 1 ear; based on tympanometry, middle ear effusions were present in 102 of these cases (50%), while 45 cases (22%) raised concerns for sensorineural hearing loss. Physicians accurately interpreted tympanogram results in 89% of cases. There were 5 patients identified with confirmed permanent sensorineural hearing loss. CONCLUSION: Findings demonstrate that infant-toddler hearing screening in FQHCs is feasible to conduct, and it may effectively identify cases of postnatal hearing loss. This is one of the first studies in a primary care setting using OAE technology coupled with tympanometry, allowing physicians to better triage patients for immediate audiology referral.

Closing the gap in mammogram screening: an experimental intervention among low-income Hispanic women in community health clinics.

A low rate of mammogram screening exists among low-income Hispanic women. To address this disparity, an experimental intervention containing audiovisual and written media was conducted using the health belief model as a framework. The purpose of this study was to determine if low-income Hispanic women, more than 40 years of age, who received targeted cancer prevention education (n = 105) had a significantly greater perceived threat of breast cancer, greater benefits and lower barriers to screening, and stronger intentions to obtain mammograms compared to a control group (n = 105). Intervention participants reported significantly greater perceived benefits, self-efficacy, and mammogram screening intentions than the control group. Predictors of mammogram screening intentions, when controlling for covariates, included receiving the intervention, and having greater perceived benefits, self-efficacy, and lower barriers. Results demonstrate the effectiveness of a low-cost, theory-based intervention aimed at increasing mammogram screening to assist in the monitoring of Healthy People 2020 objectives.