Services for children with hearing loss in urban and rural Australia.

OBJECTIVE: To report satisfaction with services for children with hearing loss in urban and rural Australia. DESIGN: Mixed-method approach using surveys and semi-structured interviews. SETTING: Australian organisations that serve children with hearing loss. PARTICIPANTS: One hundred parents of children with hearing loss and 91 professionals that serve children with hearing loss completed surveys. Seven parents and eight professionals were interviewed. MAIN OUTCOME MEASURES: Comparison of satisfaction with services in rural and urban areas. RESULTS: Timing of initial hearing services was similar in rural and urban areas. Children with hearing loss in rural areas had less satisfaction with services than children in urban areas. Parents of children with hearing loss in rural areas had higher costs, mainly linked to travel, than parents in urban areas. Parents and professionals were concerned that advantaged parents received more services for their child than disadvantaged parents. Parents and professionals in urban and rural areas were satisfied with mainstream education, but less satisfied with education for children with hearing loss and additional disability. Professional satisfaction was lower in rural areas than urban areas. CONCLUSIONS: This small-scale study adds to research citing reduced services in rural areas. An exception is the newborn hearing screening program, with the limited data presented indicating the program is effectively overcoming the barrier of distance. However, children with hearing loss in rural areas have reduced access to ongoing services.

Service accessibility for children with hearing loss in rural areas of the United States and Canada.

OBJECTIVES: Children in rural areas have difficulty accessing the same services as their urban peers, which is a particular challenge in large countries such as the U.S. and Canada. Despite known problems providing services in rural areas, there is limited research investigating services for children with hearing loss living in rural areas. This scoping review examines the accessibility of services for children with hearing loss in rural U.S. and Canada. METHODS: The search strategy included four databases and gray literature from 2008-2018. Eight government documents and 16 articles met the inclusion criteria and the main findings in the literature were themed. RESULTS: Children with hearing loss, experienced difficulties accessing specialized services which influenced the timing of diagnosis of hearing loss, receiving hearing technology and accessing ongoing support. Families in rural areas also had access to less information about hearing loss than urban families. Managing funding and health insurance was also a challenge for families in rural areas. CONCLUSION: The limited research in this area indicates that children with hearing loss in rural areas can experience barriers when accessing the same services as their urban peers. Limited service provision can negatively influence outcomes for children with hearing loss. Alternate service delivery such as teleintervention and visiting specialists can improve service provision in rural areas. Comprehensive research of the experience of children with hearing loss across states, provinces and territories would guide improvements to services for children with hearing loss in rural areas of the U.S. and Canada.

A Systematic Review of Services to DHH Children in Rural and Remote Regions.

Children in regional, rural and remote areas have less access to services than those living in urban areas. Practitioners serving children with a hearing loss have attempted to address this gap, however there are few studies investigating service access and experiences of non-metropolitan families and professionals. This systematic review evaluates the literature on service provision to children with a hearing loss living in regional, rural and remote areas of Australia. A search of five databases, the gray literature and a prominent author located 37 relevant documents. The journal articles were rated for quality and the findings of all documents were themed. The evidence from this review indicates that children with a hearing loss living in regional, rural and remote Australia experience reduced quality and frequency of service. Further investigation is needed to identify the accessibility and suitability of services for children with a hearing loss in non-metropolitan areas.

Raising a child with Down's syndrome: perspectives from South African urban care-givers.

OBJECTIVES: This study addresses a gap from a South African urban perspective on the knowledge and emotional responses of caregivers with children diagnosed with Down's syndrome (DS). The study is an initial step towards informing health professionals who adopt a biopsychosocial approach, in an effort to improve interventions for both caregivers and children. METHODS: A simple descriptive survey was utilized with 57 participants who were caregivers of children with DS. Data was analyzed descriptively using the Statistical Package for Social Scientists (SPSS) (version 21). RESULTS: The caregivers' initial reactions when discovering that the child had DS included shock, sadness and anxiety. When considering the etiology of Down's syndrome, findings reflected that caregivers understood DS as a medical condition relating to chromosomal abnormalities rather than attribution of the syndrome to a fault of their own. Despite the immediate reactions, the caregivers' initial emotions toward the child rather than the situation were positive and unchanged by the subsequent challenges in caring for the child. The caregivers indicated feelings of love toward the child notwithstanding the diagnosis. CONCLUSION: This study allowed for the subjective experience, perceptions and attitudes of caregivers to be investigated, and raised further questions into the deeper meanings and experiences of caregivers towards assisting practitioners in understanding the dynamics surrounding care-giving that may influence holistic interventions.

Epidemiology of National Collegiate Athletic Association Women's Gymnastics Injuries, 2009-2010 Through 2013-2014.

CONTEXT: Recent injury-surveillance data for collegiate-level women's gymnastics are limited. In addition, researchers have not captured non-time-loss injuries (ie, injuries resulting in restriction of participation <1 day). OBJECTIVE: To describe the epidemiology of National Collegiate Athletic Association (NCAA) women's gymnastics injuries during the 2009-2010 through 2013-2014 academic years. DESIGN: Descriptive epidemiology study. SETTING: Aggregate injury and exposure data collected from 11 women's gymnastics programs providing 28 seasons of data. PATIENTS OR OTHER PARTICIPANTS: Collegiate student-athletes participating in women's gymnastics during the 2009-2010 through 2013-2014 academic years. INTERVENTION(S): Women's gymnastics data from the NCAA Injury Surveillance Program (ISP) during the 2009-2010 through 2013-2014 academic years were analyzed. MAIN OUTCOME MEASURE(S): Injury rates; injury rate ratios; injury proportions by body site, diagnosis, and apparatus; and injury proportion ratios were reported with 95% confidence intervals (CIs). RESULTS: The ISP captured 418 women's gymnastics injuries, a rate of 9.22/1000 athlete-exposures (AEs; 95% CI = 8.33, 10.10). The competition injury rate (14.49/1000 AEs) was 1.67 times the practice injury rate (8.69/1000 AEs; 95% CI = 1.27, 2.19). When considering time-loss injuries only, the injury rate during this study period (3.62/1000 AEs) was lower than rates reported in earlier NCAA ISP surveillance data. Commonly injured body sites were the ankle (17.9%, n = 75), lower leg/Achilles tendon (13.6%, n = 57), trunk (13.4%, n = 56), and foot (12.4%, n = 52). Common diagnoses were ligament sprain (20.3%, n = 85) and muscle/tendon strain (18.7%, n = 78). Overall, 12.4% (n = 52) of injuries resulted in time loss of more than 3 weeks. Of the 291 injuries reported while a student-athlete used an apparatus (69.6%), most occurred during the floor exercise (41.9%, n = 122) and on the uneven bars (28.2%, n = 82). CONCLUSIONS: We observed a lower time-loss injury rate for women's gymnastics than shown in earlier NCAA ISP surveillance data. Safety initiatives in women's gymnastics, such as "sting mats," padded equipment, and a redesigned vault table, may have contributed to minimizing the frequency and severity of injury.

Perceived barriers and facilitators to physical activity for children with disability: a systematic review.

AIM: The aim of this systematic review was to investigate the perceived barriers and facilitators to physical activity among children with disability. METHODS: 10 electronic databases were searched from the earliest time available to September 2010 to identify relevant articles. Articles were included if they examined the barriers or facilitators to physical activity for children with disability and were written in English. Articles were excluded if they included children with an acute, transient or chronic medical condition, examined sedentary leisure activities, or societal participation in general. Two reviewers independently assessed the search yields, extracted the data and assessed trial quality. Data were analysed descriptively. RESULTS: 14 articles met the inclusion criteria. Barriers included lack of knowledge and skills, the child's preferences, fear, parental behaviour, negative attitudes to disability, inadequate facilities, lack of transport, programmes and staff capacity, and cost. Facilitators included the child's desire to be active, practising skills, involvement of peers, family support, accessible facilities, proximity of location, better opportunities, skilled staff and information. CONCLUSION: Personal, social, environmental, and policy and programme-related barriers and facilitators influence the amount of activity children with disability undertake. The barriers to physical activity have been studied more comprehensively than the facilitators.