Short-term hearing aid benefit in a large group.

Short-term benefit in a very large group (N = 4,584) following hearing aid treatment was estimated using a revised version of the Self-Assessment of Communication (SAC-Hx). A total of 4,584 veterans with adult-onset hearing loss and mean audiometric findings consistent with a mild to severe, sloping, symmetrical, sensorineural hearing impairment were fitted with hearing aids. Responses to the SAC-Hx were gathered prior to and then 6 weeks following hearing aid fitting. Benefit was defined as the difference between the baseline and the posttreatment SAC-Hx scores. Hearing aid treatment resulted in robust and statistically significant benefit in each category of self-perceived communication consequences. Prior experience influenced benefit: New hearing aid users demonstrated the greatest magnitude of benefit, but even previously satisfied and dissatisfied users obtained significant benefit after new hearing aid fitting. Duration of experience did not have a remarkable effect on the magnitude of benefit: All groups with various durations of experience obtained comparable benefit. Severity of the baseline scores paralleled degree of hearing impairment when impairment was defined using a better ear pure tone average at 1,000, 2,000, 3,000, and 4,000 Hz. Also, severity of perceived communication consequences paralleled poorer monosyllabic word recognition. Hearing aid treatment provided a functional, robust, and statistically significant benefit to individuals in all categories of hearing impairment (normal, mild, moderate, severe, and profound). This report demonstrates the feasibility of the SAC-Hx as a tool to efficiently assess outcome domains in hearing aid fitting.

Effect of body mass index on insulin resistance and lipids in prepubertal and postpubertal children: SCHOOL observations.

As part of the School Children Have Early Onset of Leading Risk Factors for Cardiovascular Disease and Diabetes Mellitus (SCHOOL) project, this study examines the effect of elevated body mass index on metabolic parameters and its relationship to insulin resistance in prepubertal and postpubertal students from the Wausau School District in central Wisconsin. Two hundred forty-seven nondiabetic students were randomly selected (125 prepubertal [2nd graders] and 122 postpubertal [11th graders]). Waist/hip ratio and body mass index corrected for age and sex were calculated. Fasting insulin, glucose, and nuclear magnetic resonance lipid profiles were measured. Relative insulin resistance was defined as quantitative insulin sensitivity check index > 1 SD below the mean of normal-weight children. Twenty-eight percent of 2nd graders and 33% of 11th graders were overweight. Relative insulin resistance was present in 47% of overweight 2nd graders and 51 % of overweight 11th graders and was associated with higher triglycerides, lower high-density lipoprotein, smaller low-density lipoprotein particles and, in 11th graders, higher waist/hip ratio. Relative insulin resistance prevalence is high among overweight children and adolescents. Biomarkers of increased risk of adverse cardiovascular outcomes are already present in overweight school children.

Detecting symptom- and test-coached simulators with the test of memory malingering.

The ability of the Test of Memory Malingering (TOMM; Tombaugh, 1996) to detect feigned-memory impairment was explored. The TOMM was administered to three groups: (a) a control group instructed to perform optimally, (b) a symptom-coached group instructed to feign memory problems after being educated about traumatic brain injury symptomatology, and (c) a test-coached group instructed to feign memory problems after being educated about test-taking strategies to avoid detection. The recommended cutoff scores (Tombaugh, 1996) on Trial 2 and the Retention Trial produced overall classification accuracy rates of 96%, with high levels of sensitivity and specificity. Although the symptom-coached group performed more poorly on the TOMM relative to the test-coached group, the test was equally sensitive in detecting suboptimal effort across the different coaching paradigms.