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There has been a major growth in global health networks in recent decades to address health issues including tobacco use, alcohol abuse, and maternal mortality. Most conditions that incur high costs have provoked networks of advocates working to mitigate the impact, increase investment in research, and establish campaigns. Global health networks often work simultaneously across policy, knowledge creation, and advocacy. Until recently there has been limited activity in global health networks and advocacy addressing hearing loss and deafness which has contributed to its relatively low visibility with policymakers compared to other health conditions. This discussion paper reports on a global consultation that explored the views of advocacy groups and individuals on advocacy for the management of hearing loss, and cochlear implantation (CI). It focussed on stakeholders' views of current advocacy endeavours, opportunities and barriers, and the possible development of a global advocacy network to improve access to cochlear implantation and the supporting services. The subsequent development of a global health network, the Cochlear Implant International Community of Action (CIICA) is discussed and the conditions necessary for the successful development of health networks are explored. This paper will be of interest to those wishing to understand the factors influencing the development of health networks and advocacy. [ABSTRACT FROM AUTHOR]

This paper assesses the expressive spoken grammar skills of young deaf children using cochlear implants who are beginning formal education, compares it with that achieved by normally hearing children and considers possible implications for educational management. Spoken language grammar was assessed, three years after implantation, in 45 children with profound deafness who were implanted between ten and 36 months of age (mean age = 27 months), using the South Tyneside Assessment of Syntactic Structures (Armstrong and Ainley, 1983) which is based on the Language Assessment and Remediation Screening Procedure (Crystal et al., 1976). Of the children in this study aged between four and six years, 58 per cent (26) were at or above the expressive spoken language grammatical level of normally hearing three year olds after three years of consistent cochlear implant use: however, 42 per cent (19) had skills below this level. Aetiology of deafness, age at implantation, educational placement, mode of communication and presence of additional disorders did not have a statistically signifi cant effect (accepted at p < or = 0.05) on the development of expressive spoken grammar skills. While just over half of the group had acquired spoken language grammar skills equivalent to or above those of a normally hearing three year old, there remains a sizeable group who, after three years of cochlear implant use, had not attained this level. Spoken language grammar therefore remains an area of delay for many of the children in this group. All the children were attending school with hearing children whose language skills are likely to be in the normal range for four to six year olds. We therefore need to ensure that the ongoing educational management of these deaf children with implants addresses their spoken grammar delay in order that they can benefi t more fully from formal education. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

While cochlear implantation is an increasingly routine provision for profoundly deaf children in many countries, parents still require information about the procedure and likely outcomes in order to make an informed decision. Other parents can provide them with the insights of those who have undergone the process themselves and observed outcomes at first hand. The parents of 101 consecutively implanted children completed the questionnaire: Children with cochlear implants: parental perspectives. Average age at implantation was 4.7 years: range 1.3-12.4 years, with 86% percent congenitally deaf, and 14% acquired deafness. Parents responded to 74 statements on a Likert scale; the responses exploring the process of implantation have been reported in a previous paper. Those responses reporting the outcomes for children and families following implantation are analysed in this paper. Parents reported that they were largely satisfied with the outcomes from implantation: that their children developed greater confidence, were more independent, that the use of spoken language had developed greatly and that communication within the family had improved. The children did not need more support from their parents than before implantation and the support parents were giving was more productive. However, there still remained concerns: parents needed to be patient as progress took time, and a number remained concerned about future education and felt that outcomes from implantation had not met their expectations. The children were considered reliant on their implant systems and hence on the optimal functioning of the technology; this demands long-term management to ensure that those dealing with the technology on a daily basis have the skills and equipment to manage them optimally. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objectives: To examine the cost-effectiveness of pediatric cochlear implantation over time.Methods: A prospective study based on ninety-eight children implanted between 1989 and 1996 at Nottingham's Paediatric Cochlear Implantation Programme, UK. The influence of outcomes and other variables on total costs was examined using multivariate regression analysis.Results: Having controlled for potential confounding variables, total cost was negatively related to year of implant and positively related to the number of hours of rehabilitation (p=.000).Conclusions: Having controlled for outcomes (Categories of Auditory Performance and Speech Intelligibility Rating), the cost-effectiveness improved over time. This finding may be due to a learning curve and have policy implications. [ABSTRACT FROM AUTHOR]

Objective/hypothesis: The aim of this study was to explore the cost-utility of pediatric cochlear implantation, incorporating savings associated with education into the analysis. Methods: The costs of pediatric cochlear implantation were based on the full costs levied to purchasers, inclusive of complications and maintenance, by a large pediatric cochlear implant program in the United Kingdom. After implantation, profoundly hearing-impaired children have been found to develop hearing threshold levels equivalent to severely hearing-impaired children who wear hearing aids. An independent study calculated the educational costs for severely hearing-impaired and profoundly hearing-impaired children. From this study, savings in educational costs that would result from enabling the profoundly hearing-impaired to function as severely hearing-impaired were determined. Cost-utility was established conservatively by applying to children the known gains in utility reported by adults with cochlear implants. Results: The discounted costs of creating a pediatric cochlear implant user and of maintaining the child over the first 12 years were 48,757 pound silver($78,011). The discounted difference in education costs associated with a profoundly hearing-impaired child (HL >95 dB) as compared with a severely hearing-impaired child (HL 70-95 dB) over the same period was 26,781 pound silver($42,850). These represent the potential savings in educational costs associated with pediatric cochlear implantation. Assuming implantation at age 4 years, the discounted net average cost of pediatric cochlear implantation over compulsory school years (ages 4-16) was 21,976 pound silver ($35,162). Cochlear implants have been shown to improve the quality of life in adults by 0.23 points per annum (where quality of life is rated on a scale from 0 to 1). Applying this weight to children receiving implantation at age 4 years, and assuming a life expectancy of 74 years, the quality-adjusted life-year (QALY) gain is calculated to be 16.33. The cost per undiscounted QALY gain was estimated to be 1,345.70 pound silver ($2153.12) and per discounted QALY gain to be 10,341 pound silver ($16,545.60). Conclusion: This study provides evidence, based on conservative assumptions, to support the view that pediatric cochlear implantation is a cost-effective health care intervention in profoundly hearing-impaired young children. [ABSTRACT FROM AUTHOR]

The International Rescue Committee (IRC) in Atlanta and Community Organized Relief Effort (CORE) established a Community Health Response Team in May 2020. The team members represented refugee, immigrant and migrant populations and had expertise in health care and public health. These 18 individuals were recruited from IRC Atlanta's Career Development program, had a variety of backgrounds and spoke 20 languages. They implemented a community-centered COVID-response intervention model of pairing education and outreach efforts with testing and vaccination clinics. Due to their team makeup, the Community Health Response Team conducted tailored outreach and education that was culturally and linguistically congruent with their target communities. They administered over 16,000 COVID-19 tests at mobile community sites within the first 6 months. Once COVID-19 vaccinations were available, the Community Health Response Team coordinated a total of 834 vaccination events in communities with a high number of refugees and in partnership with refugee- and immigrant-trusted community-based organizations, resulting in 31,888 vaccinations. Hiring staff from refugee, immigrant and migrant populations created a sustainable staffing model. Also, embedding culturally specific strategies in their model of pairing education and outreach led to long-term relationships and greater trust with community members. This approach of engaging and empowering community members to create tailored public health responses should serve as guidance for future public health campaigns., Competing Interests: FB and OA were employed by International Rescue Committee. SA was employed by Community Organized Relief Effort. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Bekele, Yu, Archbold, Mann, Dawson-Hahn and Aziz.)

Background: Gas-related symptoms (GRS) are common in the general population (GPop) and among patients with disorders of gut-brain interactions but there is no patient-reported outcome evaluating these symptoms and their impact on daily life. We have previously developed a 43-item intestinal gas questionnaire (IGQ). The aim of the present study is to perform a psychometric validation of this instrument., Methods: Participants (119 from the GPop and 186 irritable bowel syndrome (IBS) patients) were recruited from 3 countries (UK, Spain, France). IBS patients fulfilled ROME IV criteria with an IBS severity score between 150 and 300. Participants completed the IGQ, the functional Digestive Disorders Quality of Life (FDDQL), and the EQ-5D. A subgroup (n = 90) repeated the IGQ completion after 7 days on paper or electronically., Results: From the original IGQ questionnaire, 26 items were deleted because of poor performance. Confirmatory factorial analysis on the remaining 17 items (7 symptom and 10 impact items) yielded a 6-factor structure accounting for 67% of the variance for bloating (6 items), flatulence (3), belching (2), bad breath (2), stomach rumbling (2), and difficult gas evacuation (2). Global score (0-100) was worse among IBS vs GPop (40 ± 15 vs 33 ± 17; p = 0.0016). At the second visit, the intraclass correlation coefficient of IGQ scores was between 0.71 and 0.86 (n = 67) for test-retest reliability and 0.61-0.87 (n = 64) for equivalence between electronic and paper versions of IGQ., Conclusion: The IGQ available in paper and electronic versions in 3 languages is a robust instrument for capturing and measuring GRS and their impact on daily life., (© 2021 The Authors. Neurogastroenterology & Motility published by John Wiley & Sons Ltd.)

Objectives: The COVID-19 pandemic significantly impacted on the provision of oesophageal physiology investigations. During the recovery phase, triaging tools were empirically recommended by national bodies for prioritisation of referrals amidst rising waiting lists and reduced capacity. We evaluated the performance of an enhanced triage process (ETP) consisting of telephone triage combined with the hierarchical 'traffic light system' recommended in the UK for prioritising oesophageal physiology referrals., Design: In a cross-sectional study of patients referred for oesophageal physiology studies at a tertiary centre, data were compared between patients who underwent oesophageal physiology studies 6 months prior to the COVID-19 pandemic and those who were investigated within 6 months after service resumption with implementation of the ETP., Outcome Measures: Adjusted time from referral to investigation; non-attendance rates; the detection of Chicago Classification (CC) oesophageal motility disorders on oesophageal manometry and severity of acid reflux on 24 hours pH/impedance monitoring., Results: Following service resumption, the ETP reduced non-attendance rates from 9.1% to 2.8% (p=0.021). Use of the 'traffic light system' identified a higher proportion of patients with CC oesophageal motility disorders in the 'amber' and 'red' triage categories, compared with the 'green' category (p=0.011). ETP also reduced the time to test for those who were subsequently found to have a major CC oesophageal motility diagnosis compared with those with minor CC disorders and normal motility (p=0.004). The ETP did not affect the yield or timing of acid reflux studies., Conclusion: ETPs can effectively prioritise patients with oesophageal motility disorders and may therefore have a role beyond the current pandemic., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective : To collect figures on the numbers of children and adults receiving cochlear implants across Europe, compare the figures for 2016 with those for 2010, and identify any trends. Materials and methods : In 2018 EURO-CIU invited their 23 member countries to conduct a survey collecting data on the number of CI recipients in 2016 and 2017. Data were received from 15 countries, representing more than 100 000 CI recipients in Europe. Results : For paediatric CI, there was an increase in nearly all European countries (except Denmark, the UK and Luxembourg) between 2010 and 2016. We found an annual figure of one CI per 1000 newborns common in most countries where reimbursement of paediatric CI's is available. Conversely the adult data reveals no increase between 2010 and 2016 and the data is less homogeneous than the paediatric data with huge differences across countries. Conclusion : There is little agreement on data on numbers of CI across Europe, which makes it difficult to plan public health policy, funding or services. In all European countries included in this study (except Germany) there needs to be work on raising more awareness of adult hearing loss and adult cochlear implantation to improve access.

This paper reports on a survey and interviews carried out with adults who have gone through the cochlear implantation pathway. It explores their experiences of current services, the assessment process for implantation, and the impact on their daily lives, including views and experiences on communication, independence and confidence. It also explores, in today's financially challenging climate, their awareness of current funding issues and the value of their implant to them.

Introduction: Undue attention in the allocation of healthcare resources can be given to expenditures as opposed to expenditures avoided. This can be particularly apparent when expenditures avoided fall across different budget holders and budgetary pressures are strained., Methods: The paper presents estimates of the potential savings attributable to the adoption of new hearing assistive technologies in Britain between 1992 and 2014 based on multivariate analyses of survey data., Results: The reduction in service use among the hearing impaired between 1992 and 2014 is estimated to amount to between £53 and £92 million per annum., Conclusion: Issues in estimating the impact of widening candidature for cochlear implants on costs exist related to potential savings. This research begins to lay a firmer evidence base for such work as well as identifying some of the challenges.

Purpose: The Internet has been a growing source of health information on hearing loss, but the information provided often varies in quality, readability, and usability. Additionally, the information is provided across a wide range of domains, making access challenging to those who need it. This research forum article describes the development of a new website, SoundSpace Online (Ng, Archbold, Mayer, & Mulla, 2014), which aims to tackle these issues and bring together information and resource s f or all those concerned with hearing loss., Method: The SoundSpace Online website’s current developmental state was reached through the following methods: (a) discussions with a group of individuals that included experts in e-learning, education, research, and hearing loss; (b) interviews with different target groups (e.g., users, families, and professionals); and (c) collaboration with contributors., Result: The website is structured to become a g o-to resource on various topics related to hearing loss, providing accurate, comprehensive, and functional information and resources at varying levels of complexity for the intended users., Conclusion: The literature and the range of interest have illustrated the need for an up-to-date website providing information and resources on hearing loss. Challenges include monitoring and keeping the website up to date; in this article, a plan of action is discussed. The website is currently in development, with plans for a launch in the near future.

Objective: The objective of this survey was to explore the perceptions of implant users/carers and professionals across the UK about current and future cochlear implant service delivery and the challenges., Methods: Data were collected via an online questionnaire consisting of totally 22 questions. The questionnaire contained both open- and close-ended questions., Results: Totally, seven hundred and forty-eight responses were received. In spite of the wide range of respondents, there was a broad consensus of opinion across groups. The majority of participants were satisfied with the service they currently receive, but wanted some changes. They reported their current experience of implant services to be mainly driven by decisions made by the implant team. For the future, they preferred the service to be mainly driven by decisions made jointly by the team and the user and/or parent/carer. The majority of participants wanted the cochlear implant services to be integrated into local audiology and other services such as education. Restrictions on number of candidates funded and political decisions and issues were seen as major challenges. Qualitative analysis of the open-ended responses supported the questionnaire responses., Conclusions: This research highlighted the benefits and limitations of the current cochlear implant service delivery as well as the potential implications for the long term. While respondents were generally happy with the current cochlear implant service provision, they expressed some concerns about the long-term sustainability and management, wanting integration into the local services, and more involvement of parents and users in decisions.

Objective: To explore the views of cochlear implant centre teams about the process of referral, assessment and rehabilitation for children with complex needs., Methods: An on-line survey of cochlear implant centres in the UK and in the Netherlands was carried out, with both quantitative and qualitative questions. The survey was designed and piloted by four professionals in each country, experienced in working in cochlear implant services, and with complex children. The open qualitative responses were analysed independently for the emergent themes., Results: Seven centres from Netherlands and eight from UK responded. The proportion of children reported with complex needs ranged from under 10% to between 40 and 60%. Children with complex needs were more likely to be later referred than the norm, and to take longer to assess. There was little agreement about the assessments used prior to implantation, or in follow-up. The most commonly seen additional disability was visual, followed by motor/physical challenges and autistic spectrum disorders. The most reported challenge was assessment, followed by parental expectations, and wearing the system. The least reported concern was educational management. The major goal was seen to be hearing and sensory input, rather than speech and language attainment. All centres commented on the importance of parental observation., Conclusion: There is a need for a consensus on the assessment of these children, with the development of more objective parent led observation measures to collect long-term data across centres. Closer collaboration with educators, particularly those with other expertise, would facilitate long-term management and asssessment. Data logging, now available, will help monitor wearing and use of system.

Objective: The objective of this study was to explore, by interview, the experiences of adults who have undergone assessment for cochlear implantation and were considered unsuitable., Methods: Ten adult participants were interviewed. Interviews were transcribed and thematic content analysis was carried out to analyse them. Six main themes and 16 subthemes were identified., Results: The findings from the study demonstrate that adults who underwent the assessment for cochlear implantation were significantly impacted socially and emotionally as well as at work as a result of their hearing loss. Most participants found the speech testing in the assessment process to be a poor representation of hearing challenges in everyday life. A range of expectations from implantation were noted; the most common one being improvement in speech and communication. The management of these expectations needed attention. After the refusal, participants reported a lack of ongoing support and advice. A number of other suggestions regarding the actual assessment process and aspects around it were highlighted., Conclusions: A need to revise audiological criteria and modify speech testing methods to resemble hearing challenges in everyday life is highlighted. The impact of hearing loss on social, emotional, and work aspects need to be addressed thoroughly. An awareness of available technology and other coping strategies should be part of the assessment protocol. Uniformity across different centres in terms of providing information pre-assessment needs to be achieved. Consideration of the individual and his hearing and communication needs in addition to formal hearing assessments before deciding/refusing implantation needs to be developed.

The Leaping on with Language programme provides a combination of strategies and activities to accelerate children's spoken language use from simple sentences to complex language. Using a conversational philosophy it expands the building blocks of language (vocabulary, grammar, speech), whilst emphasising the importance of developing independent social communication and acknowledging a child's developing self esteem and self identity between the ages of 4-11. Three pilot projects evaluated the programme with a total of 51 delegates. The outcomes were hugely positive. Changes in behaviour were reported from the 3rd pilot 1 month later. Comments regarding the length of training, practical strategies and more film clips were implemented. Leaping on with language is now a free to access resource available on line.

Objective: Audiologists routinely observe patients struggle with psycho-emotional difficulties associated with hearing loss, yet are often underprepared to manage this vital aspect of patient care. For this reason, a workshop was developed for audiologists interested in expanding their counselling skills. Since one-time workshops typically do not result in changes in practice, this program adopted a distributed-over-time learning model, consisting of 20 hours of participation across six weeks. The extended nature of the program provided multiple opportunities to learn several counselling strategies, and apply and evaluate the effectiveness of these strategies in clinical settings., Design: Learning objectives were assessed throughout the six-week program. However, at the conclusion of each program, it was unknown whether new knowledge carried over into sustained new skills. Therefore, we surveyed attendees six months after their program, to determine if the program had affected changes in their practice., Study Sample: Twenty clinicians (response rate = 91%) participated in the survey., Results: All respondents made some, and often many, changes in patient communication. They applied several counseling concepts to their work settings and reported positive changes in patient-clinician dynamics., Conclusion: Results suggest that a six-week program is effective in helping clinicians change their counseling skills within their practice.

Aims and Objectives: In October 2009, a multi-disciplinary group of UK clinicians met to review issues relating to bone-anchored hearing-aid (BAHA) development. The aim was to help define a model for BAHA services and service development via a process of widespread consultation with UK BAHA professionals., Methods: A modified Delphi technique was used. Statements were proposed by the lead group and sent out for consultation. Those with ≥90% agreement were approved without further discussion. Statements with 50-89% agreement were discussed by the lead group to determine whether they should be included in the final document. Any statement with <50% agreement was removed without discussion. A second consultation was then made, and the process repeated. This led to a final set of consensus statements., Results: The final consensus comprises 33 statements validated by the modified Delphi process. All of these statements achieved >75% agreement, with only six statements having <90% agreement. When these statements were presented to the UK BAHA Professionals group at their annual conference there was 89% agreement from the group for the consensus statements to be accepted., Discussion: The levels of agreement for the final questionnaire show that the mandate for the consensus statements was exceptionally high. Implementation of the consensus is discussed, as are each of the key areas of the consensus, such as funding and minimum assessment standards.