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Subjective and objective hearing tests are used for evaluation of hearing impairments. Objective methods include impedance measurement with tympanometry and stapedius reflex measurement, otoacoustic emissions (OAE), and auditory evoked potentials (AEP). Combined with statistical analysis, the introduction of auditory steady state responses (ASSR) has enabled objective hearing tests in newborn hearing screening and automated hearing threshold assessment. The type and degree of hearing loss can be determined using the abovementioned methods. Precise interpretation of the test results is helpful to distinguish an auditory synaptopathy/neuropathy from classical sensorineural hearing loss.

Aim To investigate the longitudinal bi-directionality of diabetes-related distress and depressive symptoms. Methods A total of 509 patients receiving intensified insulin therapy completed the Centre for Epidemiological Studies Depression scale questionnaire for the assessment of depressive symptoms as well as the Problem Areas in Diabetes questionnaire for the assessment of diabetes-related distress at baseline and at 6-month follow-up. Separate logistic and linear regression analyses for incidence and persistence were performed with demographic (age, gender, BMI) and medical (diabetes type, HbA1c, diabetes duration, late complications) control variables. Results Diabetes-related distress at baseline increased the risk of the incidence of elevated depressive symptoms by 2.56-fold (odds ratio 2.56; 95% CI 1.15–5.72; P = 0.02) when controlling for demographic and medical variables. In addition, diabetes-related distress at baseline doubled the chance of the persistence of elevated depressive symptoms (odds ratio 2.04, 95% CI 1.04–3.99; P = 0.04) when controlling for demographic and medical variables. The chance of having persistent elevated diabetes-related distress was increased 5.94-fold (odds ratio 5.94, 95% CI 2.60–13.59; P

The aim of this study was to evaluate the hearing results after surgery for T1 and T2 vestibular schwannomas (VS) via the middle cranial fossa (MCF) approach at one institution and to review outcomes in the recent literature.In our department, 208 consecutive patients have undergone surgery using the MCF approach between December 2005 and February 2015. Audiological testing included pure-tone audiometry, speech-discrimination-tests pre- and postoperatively, as well as a pre- and intraoperative brainstem evoked response audiometry (BERA). Hearing status was categorized according to the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) or Gardner-Robertson classification. Hearing preservation was assessed when postoperative values were still within class A + B.In 167 of the 208 patients, preoperative hearing levels corresponded to class A+B. In 78 tumors, extension of the VS was limited to the internal auditory canal (T1) and in 89 tumors there was an extrameatal growth without touching the brainstem (T2). In 109 patients (65 %), postoperative hearing was still in class A+B. In the group of intrameatal tumors, the hearing preservation rate was even 69 %. The analysis of the literature of the past 16 years revealed comparable results (46-82 %).Surgery for VS using the MCF approach is an established technique for reliable tumor removal with an adequate rate of hearing preservation. For small tumors without brainstem contact, particularly satisfying results can be achieved. This should be taken into account when discussing the possibility of early hearing preservation surgery.

Background Children living with juvenile idiopathic arthritis (JIA) have swollen, painful and stiff joints, which may have an impact on all spheres of their life, as well as their family. While children diagnosed in their preschool years may be at risk for worse physical outcomes than children diagnosed later in life, it is not clear whether they have worse psychological outcomes and whether these outcomes have an impact on their everyday life. The aim of this study was to examine the association between age at diagnosis and health outcomes in families of children with JIA. Methods Parents of children with JIA (n = 182) who attended rheumatology clinics at the Montreal Children's Hospital and British Columbia Children's Hospital completed measures assessing socio-demographic attributes, their child's health status, health-related quality of life and pain level, as well as their own level of psychological distress and coping behaviours. Regression models explored the association between age at diagnosis and health outcomes while adjusting for sex, age, severity and duration of the disease. Results Parents of children diagnosed with JIA before 5 years of age found their child to have a better health-related quality of life in terms of psychosocial functioning than parents of children diagnosed later [β = −0.91 (−1.63, −0.19)]. Children diagnosed younger were also found to be less limited in schoolwork or activities with friends because of emotional or behavioural problems than children diagnosed later [odds ratio = 0.07 (0.01, 0.42)]. Conclusions Children diagnosed younger seem to show good psychosocial adjustment, which may also be true for their caregivers. Perhaps more attention to psychosocial adjustment should be given to families of children who are diagnosed with the disease at an older age.

Background Intraoperative monitoring (IOM) of the cochlear nerve function during acoustic neuroma surgery is employed to assist in preserving hearing. So far, Auditory Brain-stem Response (ABR) is considered to be an optimal method for intraoperative monitoring in transtemporal approach. The aim of this study was to perform direct recording of the cochlear nerve action potential after resection of the tumor by using a ball-electrode and to evaluate the use of this method in predicting the postoperative hearing. The obtained data were compared to the simultaneous ABR results and to the postoperative hearing. Material and methods In 2009, 38 patients have undergone acoustic Neuroma Surgery at the ENT University hospital, Wuerzburg. In 33 patients an intraoperative ABR as well as a direct measurement from the cochlear nerve using a ball electrode were performed. In 5 patients the postoperative hearing was predicted using the direct measurement at the cochlear nerve only. Results The direct recording from the cochlear nerve gave very robust responses. Even in cases where ABR recording was not possible, the identification of clear cochlear nerve action potential could still be reached. Using the direct recordings from the cochlear nerve to predict the post operative hearing turned out to have a sensitivity of 100% and a specificity of 70%. Conclusions These results show that intraoperative monitoring with direct recording from the cochlear nerve via a ball-electrode in transtemporal approaches offers a valuable method to predict the postoperative hearing. Further investigation will be made to provide additional information.

Current evaluations used by occupational therapists to assess and treat feeding problems derive mainly from the domain of dysphagia. The purpose of this article is to familiarize the reader with tools used, in research, for children with pervasive developmental disorders (PDD) and to determine if any of these meet the needs of occupational therapists. The following data bases were searched: Medline, CINAHL, HAPI and PsyINFO, using the terms pervasive developmental disorder, autism, Asperger syndrome, pervasive developmental disorder not otherwise specified, eating behavior, eating disorder, food preference, food selectivity, feeding disorders, picky eater and child. All articles published between 1980 and 2006 (n=27) were reviewed. A total of 20 studies met our selection criteria. Assessment methods are compared using the Disability Creation Model (DCP). The DCP is the Quebec alternative to the International Classification of Functioning, Disability and Health (ICF). None of the evaluation tools reviewed met all factors that may influence eating in children with PDD. Implications for research and practice in occupational therapy are discussed.

Aims To compare the properties of the two most commonly used assessment tools for diabetes distress, the Problem Areas in Diabetes Scale (PAID) and the Diabetes Distress Scale (DDS), in order to discriminate their psychometric capabilities and functions. Methods Six hundred and twenty-eight people with diabetes (67% Type 1, 33% Type 2) were cross-sectionally assessed with the PAID, the DDS and further self-report scales regarding coping, quality of life, depressive symptoms and self-care, and medical data were gained. We analysed the PAID and DDS for areas of contentual/psychometric divergence in assessing diabetes distress and compared their associations with criteria of interest. Results Content analysis: The PAID covers a greater variety of emotional concerns and shows a stronger focus on food-related problems and complications. The DDS is more reflective of physician-related distress and problems concerning diabetes self-management. Psychometric analysis: Exploratory factor analyses revealed four-factor structures of both scales, explaining 60% (PAID) and 67% (DDS) of variance. Confirmatory factor analyses confirmed that single-factor and four-factor models fit the data. Total scales proved high and subscales mostly satisfactory reliability. Associations with criteria of interest: The PAID was significantly more strongly associated with dysfunctional coping styles, quality of life and depressive symptoms. The DDS showed significantly stronger associations with diabetes self-care and metabolic outcomes. Conclusion Our results support both PAID and DDS as good self-report measures of diabetes distress. The observed contentual/psychometric differences suggest that a justified choice with regard to the intended clinical or scientific purpose can improve the acquisition of the required data.

Background Early rehabilitation may minimize disability and complications. However, children often wait a long time to gain admission to rehabilitation centres. Objectives To describe waiting times for paediatric physical and occupational therapy and to determine factors associated with these waiting times. Research Design The study was a prospective cohort design. Patients were followed from 1 January 1999 to 1 March 2000. Subjects All children with physical disabilities, aged 0–18 years, referred in 1999 from the Montreal Children's Hospital to paediatric rehabilitation centres. Measures Data on date of referral, date of first appointment at the rehabilitation centre, age, gender, diagnosis, region and language were obtained from the rehabilitation transfer database. Primary family caregivers of children who were transferred to a rehabilitation facility participated in a telephone interview regarding their perceptions of the transfer process. Results There were 172 children referred to rehabilitation facilities. The mean age of the children was 2.5 years. Average waiting time was 157.4 days (SD 57.1) for occupational therapy and 129.4 days (SD 51.6) for physical therapy. Decreased waiting time was associated with living in the city as opposed to the suburbs (hazard ratio = 1.77; 95% confidence interval = 0.92–3.41) and inversely associated with age (hazard ratio = 0.46; 95% confidence interval = 0.34–0.62). Among the 41 primary family caregivers who participated in the survey, higher empowerment scores were associated with shorter waits for rehabilitation. Conclusion Waiting time for rehabilitation services needs to be reduced. Empowered parents appear to manoeuvre within the system to reduce waiting times for their children.

It is important that inflammatory arthropathies such as rheumatoid arthritis be diagnosed promptly so that treatment can be administered in a timely fashion. However, there is considerable evidence that this process of care is delayed in many people. The aim of the study is to assess wait times between primary care referral and rheumatology assessment for new-onset inflammatory arthropathies. We performed a retrospective review related to new rheumatology consultations (N = 202) between September and November 2008 within the McGill University Health Centre, Montreal, Canada. At this centre, no formal triaging of rheumatology referrals exists. Of the 202 charts reviewed, wait times could be calculated in 164 cases. Only consultations for new-onset conditions were analyzed (N = 161). The results showed that patients with inflammatory arthritis were seen approximately 34.6 days (median 26) post-referral. Wait times for individuals who were ultimately diagnosed with non-urgent conditions (osteoarthritis, fibromyalgia and soft-tissue rheumatism) averaged 41.0 days (median 29). In conclusions, compared to non-urgent cases, individuals with inflammatory arthritis were seen about 1 week sooner. Nevertheless, provisional diagnosis provided on referrals did not appear to expedite wait times for persons with suspected inflammatory arthritis. This suggested that other factors, such as the concern of the patient, may have an influence on referral wait times. Implementation of a rapid access program or triage system may be helpful to further decrease wait times for inflammatory arthropathies.

Fragestellung: Die Insulintherapie des Diabetes mellitus erfordert ein hohes Mas an Eigenverantwortlichkeit, da vom Patienten wichtige Therapiemasnahmen und -entscheidungen im Alltag selbststandig getroffen werden mussen. Das Ausmas an Selbstmanagement ist somit essentiell fur eine erfolgreiche Diabetestherapie. Hierfur ist die Uberzeugung, den Blutzuckerverlauf durch eigenes Handeln steuern zu konnen („Selbstwirksamkeit“) eine wesentliche Voraussetzung. In dieser Studie gingen wir der Frage nach, in wieweit ein etabliertes Messinstrument zur Messung der Selbstwirksamkeit zum Einsatz bei Menschen mit Diabetes geeignet ist und es relevante Zusammenhange mit der glykamischen Kontrolle gibt. Methode: 393 Patienten, die sich in Betreuung in diabetologischen Schwerpunktpraxen befanden (Alter 53,4 ± 14,2J.; 55% Typ-1-Diabetes; 57% mannlich; HbA1c 8,1 ± 1,3%; Diabetesdauer 16,7 ± 11J.), bearbeiteten den 10-Item umfassenden „Fragebogen zur Erfassung der Allgemeinen Selbstwirksamkeitserwartung (SWE)“. Zusatzlich wurden der HbA1c zu drei Messzeitpunkten (t0, nach 10 Wochen, nach 6 Monaten) erfasst und von den Patienten die Fragebogen WHO-5 (Lebensqualitat) und CES-D (Depression) beantwortet. Ergebnisse: Die Reliabilitat des Fragebogens war sehr gut (Cronbach Alpha = 0,92), ebenfalls die „mittlere Trennscharfe“ (r = 0,71). Bei einer Skala von ‚0' bis 3'‚ lag die „mittlere Itemschwierigkeit“ bei 2,24. Es ergaben sich erwartbare Korrelationen mit den Ausenkriterien: Je hoher die Selbstwirksamkeit, desto hoher wurde die Lebensqualitat (WH0 – 5) angegeben (r = 0,46), Patienten mit hoherer Selbstwirksamkeit wiesen weniger depressive Symptome auf (Korrelation mit CES-D r =-0,43). Bei Typ-1-Diabetikern zeigte sich ein signifikanter Einfluss der Selbstwirksamkeit auf den Therapieerfolg: Je hoher die Selbstwirksamkeit ausgepragt war, desto niedriger war der HbA1c zu t0 (r =-0,2), 10 Wochen spater (r =-0,18) und 6 Monate spater (r =-0,3). Dieser Effekt bleibt selbst dann signifikant, wenn der HbA1c zum Zeitpunkt t0 als Kontrollvariable mit einbezogen wird. Fur Typ-2-Diabetes ergaben sich hingegen keine signifikanten Zusammenhange zum HbA1c. Schlussfolgerung: Der SWE-Fragebogen ist ein reliables und valides Instrument zur Erfassung der Selbstwirksamkeit bei Typ-1 und Typ-2-Diabetikern mit einer ICT. Bei Typ-1-Diabetikern konnte gezeigt werden, dass ein hohes Ausmas an Selbstwirksamkeit mit einer guten glykamischen Kontrolle assoziiert ist. Aufgrund der Kurze und Qualitat des Fragebogens eignet sich der SWE fur den Einsatz in der klinischen Praxis.

Fragestellung: Bislang gibt es in Deutschland nur wenige Daten zur Schulungssituation. Im Rahmen einer Fragebogenbefragung wurde die aktuelle Schulungspraxis bei Typ-2-Diabetes in diabetologischen Schwerpunktpraxen (DSP) erhoben. Insbesondere wurden Daten zur Haufigkeit, Art, Inhalten und dem Setting von Schulungen erfragt Methodik: Insgesamt wurden deutschlandweit 1192 DSP zur Studienteilnahme eingeladen. 818 vollstandig ausgefullte Fragebogen konnten ausgewertet werden. Kategoriale Haufigkeitsangaben wurden ermittelt, indem der jeweilige kategoriale Mittelwert entsprechend der Anzahl der Nennungen gewichtet wurde. Ergebnisse: Pro Quartal werden in einer DSP im Mittel 627 Menschen mit Typ-2-Diabetes behandelt, ca. 83,5% der insgesamt behandelten Diabetiker pro Quartal. Von diesen hatten 70% bislang an einer strukturierten Gruppenschulung teilgenommen. Ca. 25% der Typ-2-Diabetiker hatten in den letzten 2 Jahren an einer strukturierten Schulung teilgenommen, bei ca. 50% lag die letzte Schulung mehr als 5 Jahre zuruck, bei ca. 20% mehr als 10 Jahre. Im Durchschnitt werden in einer Praxis 25,5 Gruppenschulungen fur Typ-2-Diabetiker pro Jahr durchgefuhrt. Die mittlere Gruppengrose liegt dabei bei 6 Teilnehmern pro Kurs. Die meisten DSP (65,4%) bieten die Kursstunden der Schulung ein- bis zweimal pro Woche an. Klassische „Blockschulungen“ werden in 10,6% der teilnehmenden Schwerpunktpraxen durchgefuhrt. Als wichtigster Effekt einer Schulung bei Typ-2-Diabetes werden auf einer Skala von 1 bis 10 die „Starkung der Motivation“ (9,4) angegeben, gefolgt von der „Verbesserung der Lebensqualitat“ (9,2), einer „hohen Therapiezufriedenheit“ (9,0) und der „Pravention von Folgeerkrankungen“ (8,9). Zu den wichtigsten Schulungsinhalten bei Menschen mit Typ-2-Diabetes mit Insulin zahlen „Ernahrungsempfehlungen“ (9,4), „Bedeutung nicht-medikamentoser Therapiemasnahmen“ (9,2), „Bewegungsempfehlungen“ (9,2), „Motivation“ (9,2), „Starkung des Selbstmanagements“ (9,0) und „Hypoglykamien“ (9,1). Schlussfolgerung: Die Ergebnisse geben einen interessanten Einblick in die Schulungssituation von Menschen mit Typ-2-Diabetes in Deutschland, die in einer DSP betreut werden. Immerhin 30% aller Typ-2-Diabetiker wurden bislang noch nie geschult, bei 20% lag die letzte Schulung schon mehr als 10 Jahre zuruck. Basierend auf diesen Daten ist daher aktuell von einem relativ grosen Schulungs- bzw. Nachschulungsbedarf bei Menschen mit Typ-2-Diabetes auszugehen. Die wichtigsten Effekte einer Typ-2-Schulung sehen die DSP eher in psychosozialen Variablen wie der Steigerung der Motivation sowie der Verbesserung der Lebensqualitat und Therapiezufriedenheit.

Fragestellung: Der Erhalt einer moglichst optimalen Lebensqualitat ist ein wichtiges Therapieziel bei der Behandlung des Diabetes. Folgeerkrankungen und Depressionen stehen diesem Ziel im Wege und stellen fur die Patienten eine grose Belastung dar. Ziel dieser Studie war es herauszufinden, wie gros der Einfluss einer erhohten Depressivitat und bestehender Folgeerkrankungen auf die Lebensqualitat von Patienten mit Typ-1-Diabetes ist. Methodik: 148 Patienten (45,2 ± 13,3 Jahre; 45% weiblich; HbA1c 8,0 ± 1,1%; 26% CSII) bearbeiteten den EQ-5D. Dieser Fragebogen misst gesundheitsbezogene Lebensqualitat und ermittelt einen sog. „Utility Score“. Mithilfe des Utility Scores lassen qualitatsadjustierten Lebensjahre (QALY) bestimmen. Ein Score von „1“ bedeutet ein Jahr bei perfekter Gesundheit. Des Weiteren bearbeiteten die Patienten den CES-D Bogen zur Messung der Depressivitat, dabei wurde ein Cut-off Wert von 16 verwendet, um eine erhohte Depressivitat festzustellen. Zusatzlich wurden die Folgeerkrankungen der Patienten erfasst. Ergebnisse: Patienten, die eine erhohte Depressivitat aufweisen, haben einen signifikant niedrigeren Utility Score als Patienten, die nicht depressiv sind (0,77 ± 0,25 vs. 0,93 ± 0,15; p 0,05). Jedoch wird die Interaktion zwischen Depressivitat und Folgeerkrankungen signifikant (F(2,142)= 3,3; p 0,05). Schlussfolgerungen: Die Ergebnisse zeigen, dass sowohl Folgeerkrankungen als auch Depressionen einen substantiellen Einfluss auf die Lebensqualitat von Patienten mit Typ-1-Diabetes haben. Zudem konnte gezeigt werden, dass Depressionen die Auswirkungen von Folgeerkrankungen auf die Lebensqualitat beeinflussen konnen. Die Wichtigkeit der Erfassung depressiver Storungen wird durch diese Ergebnisse untermauert.

Children living with juvenile idiopathic arthritis (JIA) have swollen, painful and stiff joints, which may have an impact on all spheres of their life, as well as their family. While children diagnosed in their preschool years may be at risk for worse physical outcomes than children diagnosed later in life, it is not clear whether they have worse psychological outcomes and whether these outcomes have an impact on their everyday life. The aim of this study was to examine the association between age at diagnosis and health outcomes in families of children with JIA.Parents of children with JIA (n = 182) who attended rheumatology clinics at the Montreal Children's Hospital and British Columbia Children's Hospital completed measures assessing socio-demographic attributes, their child's health status, health-related quality of life and pain level, as well as their own level of psychological distress and coping behaviours. Regression models explored the association between age at diagnosis and health outcomes while adjusting for sex, age, severity and duration of the disease.Parents of children diagnosed with JIA before 5 years of age found their child to have a better health-related quality of life in terms of psychosocial functioning than parents of children diagnosed later [β = -0.91 (-1.63, -0.19)]. Children diagnosed younger were also found to be less limited in schoolwork or activities with friends because of emotional or behavioural problems than children diagnosed later [odds ratio = 0.07 (0.01, 0.42)].Children diagnosed younger seem to show good psychosocial adjustment, which may also be true for their caregivers. Perhaps more attention to psychosocial adjustment should be given to families of children who are diagnosed with the disease at an older age.

Ziele: In vielen Leitlinien, unter anderem auch denen der DDG, wird das Empowerment der Patienten als ein wichtiges Therapieziel beschrieben. Die vorliegende Studie uberpruft deshalb die psychometrischen Eigenschaften eines deutschsprachigen Fragebogens zur Erfassung des Empowerment bei Typ-1- und insulinbehandelten Typ-2-Diabetikern. Dieser Fragebogen wurde auf der Grundlage der englischsprachigen „Diabetes Empowerment Scale“ von Anderson et al (2000) entwickelt. Methodik: 409 Patienten bearbeiteten den Fragebogen (54,5% Typ-1-Diabetiker, 56,5% mannlich, Alter 53,7±14,2J., HbA1c 8,1±1,3%). 70,3% der Patienten haben bereits an einer strukturierten Schulung teilgenommen. Der Empowerment-Fragebogen besteht aus 11 Items, die mittels 4-stufiger Ratingskala eingestuft werden. Als Indikator der psychometrischen Qualitat wurden Itemcharakteristika (Trennscharfen und Schwierigkeitsindizes) und die Reliabilitat berechnet. Zur Bestimmung der Validitat wurde des Empowerment-Fragebogens wurden Korrelationsanalysen zwischen dem Empowerment-Fragebogen und diabetesbezogener Belastungen (PAID und DDS), der Diabetesdauer sowie dem HbA1c- Wert vorgenommen. Es wurde auch uberpruft, ob geschulte Diabetiker ein hoheres Empowerment aufweisen als ungeschulte Diabetiker. Ergebnisse: Der Empowerment- Fragebogen zeigte eine hohe Reliabilitat (Cronbach α=0,89). Die mittlere Trennscharfe lag bei rtt=0,61, der mittlere Schwierigkeitsindex betrug 74%. Im Sinne der Validitat sind die Ergebnisse der Korrrelationsanalysen zu werten: Je hoher das Empowerment ausgepragt war, desto niedriger waren diabetesbezogene Belastungen (PAID r=-0,38 und DDS r=-0,31) und der HbA1c (r=-0,13). Mit langerer Diabetesdauer nahm das Empowerment zu (r=0,18). Alle Korrelationen waren statistisch signifikant (p

Intraoperative monitoring (IOM) of the cochlear nerve function during acoustic neuroma surgery is employed to assist in preserving hearing. So far, Auditory Brain-stem Response (ABR) is considered to be an optimal method for intraoperative monitoring in transtemporal approach. The aim of this study was to perform direct recording of the cochlear nerve action potential after resection of the tumor by using a ball-electrode and to evaluate the use of this method in predicting the postoperative hearing. The obtained data were compared to the simultaneous ABR results and to the postoperative hearing.In 2009, 38 patients have undergone acoustic Neuroma Surgery at the ENT University hospital, Wuerzburg. In 33 patients an intraoperative ABR as well as a direct measurement from the cochlear nerve using a ball electrode were performed. In 5 patients the postoperative hearing was predicted using the direct measurement at the cochlear nerve only.The direct recording from the cochlear nerve gave very robust responses. Even in cases where ABR recording was not possible, the identification of clear cochlear nerve action potential could still be reached. Using the direct recordings from the cochlear nerve to predict the post operative hearing turned out to have a sensitivity of 100% and a specificity of 70%.These results show that intraoperative monitoring with direct recording from the cochlear nerve via a ball-electrode in transtemporal approaches offers a valuable method to predict the postoperative hearing. Further investigation will be made to provide additional information.

Patients with rheumatoid arthritis (RA) who have contact with a rheumatologist have better health outcomes than those who do not.1 We found that only 27% of newly suspected cases of RA consulted with a rheumatologist.2 However, this study was based on physician billing data; quality control of diagnostic coding and absence of severity indicators limit the conclusions. We pursued this issue further with patients who had a confirmed diagnosis and were in an early arthritis cohort. We hypothesised that this group would represent a “best case scenario” where the majority would have consulted a rheumatologist within the 3-month recommended window.3 We also explored factors that may be associated with referral, including patient characteristics such as laboratory results (C-reactive protein (CRP), rheumatoid factor),4 5 sociodemographic factors and disease severity,2 6 …