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Background: The adverse childhood experiences (ACEs) screening tool is a research measure that has not been frequently employed within the scientific literature addressing deaf and hard-of-hearing (DHH) populations., Objective: To evaluate whether those who are DHH are more likely to cross-sectionally report a high-risk number of ACEs than those who are not DHH., Methods: Data consisting of a weighted total of n = 24,797,770 US adults' responses to the 2021 BRFSS survey were utilized for this study., Results: The DHH-ACE association was effect modified by age group. In the 25-to-34 (aOR = 2.98; 95 % aOR CI: 1.81, 4.92; P < 0.0001), 35-to-44 (aOR = 3.17; 95 % aOR CI: 1.98, 5.08; P < 0.0001), 45-to-54 (aOR = 1.74; 95 % aOR CI: 1.23, 2.45; P = 0.0016), and 55-to-64-year-old (aOR = 1.85; 95 % aOR CI: 1.41, 2.42; P < 0.0001) age groups, those who are DHH were significantly more likely than their same-age hearing peers to report a high-risk number of ACEs. The findings for the 18-24 years and 65+ age groups were not statistically significant., Conclusion: The results of this study highlight the need for trauma-informed care and improved early intervention and ACEs screenings for the DHH population., (Copyright © 2024 Elsevier Inc. All rights reserved.)

This study explores the South Korean Deaf community's response to sign language interpreting during the COVID-19 (coronavirus disease 2019) health crisis, focusing on individual factors affecting the signers' comprehension. The data were collected from a mobile-based questionnaire survey conducted among 401 Deaf adults; binary probit modelling was adopted to analyse the data. The major findings are: (i) 59.9 per cent of the respondents understood less than 70 per cent of the interpreting; (ii) males and urban residents tend to understand better; (iii) younger people (less than 50 years) and signers with a Bachelor's degree or higher are likely to have lower comprehension; and (iv) Deaf adults who visited a doctor after the COVID-19 outbreak tended to have lower comprehension. The findings demonstrate that individual characteristics, including age, impact significantly on the extent to which Deaf individuals understand the sign language interpreting of COVID-19 information, indicating that steps are needed to achieve a Deaf-inclusive society during a health disaster., (© 2024 ODI.)

Aims: To assess the oral health status and related factors among hearing impaired schoolchildren., Methods: A cross-sectional study among 115 hearing impaired schoolchildren enrolled at the School of the Deaf in Jordan. The World Health Organization (WHO) methodology and criteria were applied to collect data on caries, gingival bleeding. The WHO classification modified by Andreasen et al. was used to record traumatic dental injuries (TDIs). Sociodemographic data, oral health practices, and oral health related quality of life information were collected using a structured questionnaire., Results: The prevalence of caries among the study sample was 84.3%, the dominating component was untreated dental caries. Mean decayed, missing, filled primary teeth (dmft) was 8 in the primary dentition and 3.62 in the mixed dentition, mean Decayed, Missing, Filled permanent Teeth (DMFT) was 1.38 in the mixed dentition and 2.87 in the permanent. The overall mean of gingival bleeding percentage among the whole study sample was 70.38%. the prevalence of TDIs was of 11.3% and mostly caused by falls., Conclusions: The prevalence of dental caries and caries experience, rate of gingival bleeding and dental trauma in children with hearing impaired individuals are high compared to figures observed in studies conducted among Jordanian schoolchildren with normal hearing. Dental diseases impact the quality of life of these individuals., (© 2024 Special Care Dentistry Association and Wiley Periodicals LLC.)

Background: Deaf and hard-of-hearing (DHH) people are at higher risk than their non-DHH counterparts of experiencing adverse birth outcomes. There is a lack of research focusing on social, linguistic, and medical factors related to being DHH which may identify groups of DHH people who experience more inequity., Objective: Examine difference in prevalence of cesarean and adverse birth outcomes among diverse sub-groups of DHH people., Methods: We conducted a cross-sectional survey of DHH birthing people in the U.S. who gave birth within the past 10 years. The sample was predominantly white, college educated, and married. We assessed cesarean birth and three adverse birth outcomes: preterm birth, low birthweight, and NICU admission post-delivery. DHH-specific variables were genetic etiology of hearing loss, preferred language (i.e., American Sign Language, English, or bilingual), severity of hearing loss, age of onset of hearing loss, and self-reported quality of perinatal care communication. We estimated prevalence, 95 % confidence intervals, and unadjusted prevalence ratios., Results: Thirty-one percent of our sample reported a cesarean birth. Overall, there were no significant differences in prevalence across the outcome variables with respect to preferred language, genetic etiology, severity, and age of onset. Poorer perinatal care communication quality was associated with higher prevalence of preterm birth (PR = 2.37) and NICU admission (PR = 1.91)., Conclusions: Our study found no evidence supporting differences in obstetric outcomes among DHH birthing people across medical factors related to deafness. Findings support the important role of communication access for DHH people in healthcare environments., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Approximately 80% of Deaf individuals live in low- and middle-income countries, where health systems often overlook their specific needs. This communication gap can result in misdiagnosis and inappropriate treatment, impacting their overall satisfaction with healthcare services., Objectives: This study aims to uncover barriers to healthcare access and preferences among the Deaf population in Ecuador, and the role of communication barriers in shaping satisfaction levels with healthcare services., Methods: The study gathered data from 386 participants through online surveys, focusing on demographic characteristics, healthcare experiences, communication methods, and levels of satisfaction. Descriptive statistics and association analyses were employed to analyze the data., Results: The study reveals that nearly all participants possessed an officially recognized disability (95.9%) and 53.9% reported hereditary deafness. Ecuadorian sign language was predominant (60.9%). Communication barriers were evident, with 65.0% having trouble understanding medical instructions, and 66.6% identifying a deficiency of tools for Deaf individuals in healthcare settings. Satisfaction levels were associated with the presence of interpreters during medical care, with 46.6% expressing a preference for interpreters over other communication methods. Additionally, private healthcare facilities were perceived as providing better services, despite being less frequently accessed (38.9%). Dissatisfaction was evident, particularly in aspects of communication and physician courtesy., Conclusions: This study underscores the importance of tailoring healthcare services to address the unique needs of the Deaf population. Communication barriers emerged as a central obstacle, necessitating the inclusion of sign language interpreters and improvement of resources. The study's implications extend to healthcare equity in developing nations, emphasizing the significance of patient-centered care and inclusive healthcare practices., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Hearing loss is increasingly prevalent among younger adults, impacting health and health care use. Deaf and hard of hearing (DHH) women have a higher risk of chronic diseases, pregnancy complications, and adverse birth outcomes compared with hearing women. Health care utilization patterns during the perinatal period remain not well understood. The objective of this study was to examine differences in antenatal emergency department and inpatient utilization among DHH and non-DHH women., Study Design: We conducted a retrospective cohort study design to analyze 2002 to 2013 Massachusetts Pregnancy to Early Life Longitudinal data to compare antenatal inpatient and emergency department use between DHH ( N  = 925) and hearing ( N  = 2,895) women with singleton deliveries. Matching was done based on delivery year, age at delivery, and birth parity in 1:3 case-control ratio. Demographic, socioeconomic, clinical, and hospital characteristics were first compared for DHH mothers and the matched control group using chi-squared tests and t -tests. Multivariable models were adjusted for sociodemographic and clinical characteristics., Results: Among DHH women ( N  = 925), 49% had at least one emergency department visit, 19% had an observational stay, and 14% had a nondelivery hospital stay compared with 26, 14, and 6%, respectively, among hearing women ( N  = 28,95) during the antenatal period (all p s < 0.001). The risk of nondelivery emergency department visits (risk ratio [RR] 1.58; p  < 0.001) and inpatient stays (RR = 1.89; p  < 0.001) remained higher among DHH women compared with hearing women even after adjustment. Having four or more antenatal emergency department visits (7 vs. 2%) and two or more nondelivery hospital stays (4 vs. 0.4%) were more common among pregnant DHH women compared with their controls (all p -values < 0.001)., Conclusion: The findings demonstrate that DHH women use emergency departments and inpatient services at a significantly higher rate than their hearing controls during the antenatal period. A systematic investigation of the mechanisms for these findings are needed., Key Points: · Antenatal emergency department use is significantly higher among deaf and hard of hearing women.. · Antenatal hospitalizations are significantly higher among deaf and hard of hearing women.. · Hearing loss screening may identify those at risk for adverse pregnancy and birth outcomes.., Competing Interests: None declared., (Thieme. All rights reserved.)

Deaf and hearing adults perceive faces differently. This study investigates whether these differences are acquired during childhood development. We characterized facial perception in deaf and hearing children aged 7-17 using a perceptual discrimination task. Configural and featural information was manipulated in the eye and mouth facial regions. Participants were asked whether two faces presented simultaneously were different. Deaf and hearing children performed better in featural than configural discriminations and in mouth than eye discriminations. Compared with children with typical hearing, deaf children performed better in featural and mouth judgments but had longer reaction times with strongest effects at 7-8 and 13-14 years old. Type and location contributed jointly in deaf children's face perception with different configural but similar featural discriminations in mouth and eye locations. However, children with typical hearing showed different featural and configural judgments in both locations. Thus, featural and configural information effects on location processing differ between the two groups., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Deaf and hard of hearing (d/DHH) students are often labeled with one or more educationally significant disabilities in addition to their hearing loss. According to the Gallaudet Research Institution's most recent Annual Survey of Deaf and Hard of Hearing Children and Youth (2013), almost 40% of d/DHH students nationwide receive special education services for one or more comorbid disabilities. However, relatively few prevalence rate estimates have been published over the last decade. Knowledge regarding the current prevalence of educationally significant disabilities among d/DHH students is therefore limited. The present study surveyed teachers of the deaf and hard of hearing (TODHHs) in a midwestern state regarding the number of d/DHH students on their caseloads with one or more comorbid disabilities. Within the sample population (N = 451), nearly 65% were reported to receive special education services for disabilities other than deafness or hearing impairment.

Objective/hypothesis: The goal of this scoping review is to evaluate and synthesize the published research regarding bullying and children who are deaf or hard-of-hearing (DHH)., Study Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping review (PRISMA-ScR) statement was used as the guideline for conducting this review., Methods: This review included studies assessing pediatric (0-21 years) DHH children. Seventy records underwent the initial title-abstract screening, 33 underwent full-text review, and 23 studies met inclusion criteria. During the data extraction process, an additional six were excluded, resulting in a total of 17 evaluated studies., Results: Of the 17 studies assessed, nine compared peer victimization of DHH children and their hearing peers. Of those, seven studies reported that hearing loss (HL) is significantly associated with increased victimization. Two studies found that HL is significantly associated with decreased bullying perpetration. Notably, bullying in DHH children was not associated with a visible sign of disability, such as a hearing assistive device. Rather, variables such as educational setting, parental, and peer support are more likely to mediate bullying in this population., Conclusions: DHH children have a higher risk of peer victimization and may bully others less often than their hearing peers. Studies described the health consequences of bullying in children who are DHH, including sleep issues and anxiety. These consequences may have implications for the patients' overall HL management. Additional research regarding bullying interventions and prevention in this population should be conducted., Level of Evidence: NA Laryngoscope, 131:1884-1892, 2021., (© 2021 The American Laryngological, Rhinological and Otological Society, Inc.)

Importance: Hearing impairment, a common treatable condition, may contribute to poorer physical function with aging., Objective: To assess whether hearing impairment is associated with poorer physical function, reduced walking endurance, and faster decline in physical function., Design, Setting, and Participants: In this cohort study, cross-sectional and longitudinal analyses were performed using data from the 2011 to 2019 period of the Atherosclerosis Risk in Communities study, a population-based study of community-dwelling adults at 4 sites in the US., Exposures: Hearing thresholds (per 10 dB) assessed with pure tone audiometry and categorized as normal hearing or mild, moderate, or severe hearing impairment., Main Outcomes and Measures: Physical function was assessed using the short physical performance battery (SPPB), with composite scores ranging from 0 to 12. A composite score of 6 or less and a score for each component (balance, gait speed, and chair stands) of 2 or less indicated poor performance. Walking endurance was assessed using a 2-minute fast-paced walk test. Tobit regression models adjusted for sociodemographic factors and medical history were used to calculate the mean differences in SPPB composite scores; logistic regression models, to estimate the odds ratios (ORs) of low SPPB composite and component scores; and linear mixed-effects models, to estimate the mean rate of change in SPPB composite scores over time., Results: Of the 2956 participants (mean [SD] age, 79 [4.6] years) who attended study visit 6 between 2016 and 2017, 1722 (58.3%) were women, and 2356 (79.7%) were White. As determined by pure tone audiometry, 973 (33%) participants had normal hearing, 1170 (40%) had mild hearing impairment, 692 (23%) had moderate hearing impairment, and 121 (4%) had severe hearing impairment. In the Tobit regression model, severe hearing impairment was associated with a lower mean SPPB score (β, -0.82; 95% CI, -0.34 to -1.30) compared with normal hearing. In fully adjusted logistic regression models, hearing impairment was associated with higher odds of low physical performance scores (severe impairment vs normal hearing: OR for composite physical performance, 2.51 [95% CI, 1.47-4.27]; OR for balance, 2.58 [95% CI, 1.62-4.12]; OR for gait speed, 2.11 [95% CI, 1.03-4.33]). Over time (2 to 3 visits; maximum, 8.9 years), participants with hearing impairment had faster declines in SPPB compared with those with normal hearing (moderate hearing impairment × time interaction, -0.34 [-0.52 to -0.16]). In adjusted models for walking endurance, participants with moderate or severe hearing impairment walked a mean distance of -2.81 m (95% CI, -5.45 to -0.17 m) and -5.31 m (95% CI, -10.20 to -0.36 m) than those with normal hearing, respectively, during the 2-minute walk test., Conclusions and Relevance: In this cohort study, hearing impairment was associated with poorer performance, faster decline in physical function, and reduced walking endurance. The results of the longitudinal analysis suggest that hearing impairment may be associated with poorer physical function with aging. Whether management of hearing impairment could delay decline in physical function requires further investigation.

Background: During the COVID-19 pandemic, there has been a rapid increase in the amount of information about the disease and SARS-CoV-2 on the internet. If the language used in video messages is not clear or understandable to deaf and hard of hearing (DHH) people with a high school degree or less, this can cause confusion and result in information gaps among DHH people during a health emergency., Objective: The aim of this study is to investigate the relationship between DHH people's perception of the effectiveness of physical distancing and contagiousness of an asymptomatic person., Methods: This is a cross-sectional survey study on DHH people's perceptions about COVID-19 (N=475). Items pertaining to COVID-19 knowledge were administered to US deaf adults from April 17, 2020, to May 1, 2020, via a bilingual American Sign Language/English online survey platform., Results: The sample consisted of 475 DHH adults aged 18-88 years old, with 74% (n=352) identifying as White and 54% (n=256) as female. About 88% (n=418) of the sample felt they knew most things or a lot about physical distancing. This figure dropped to 72% (n=342) for the question about the effectiveness of physical distancing in reducing the spread of COVID-19 and 70% (n=333) for the question about the contagiousness of an infected person without symptoms. Education and a knowledge of the effectiveness of physical distancing significantly predicted knowledge about the contagiousness of an asymptomatic individual. Race, gender, and age did not emerge as significant predictors., Conclusions: This results of this study point to the strong connection between education and coronavirus-related knowledge. Education-related disparities can be remedied by making information fully accessible and easily understood during emergencies and pandemics., (©Raylene Paludneviciene, Tracy Knight, Gideon Firl, Kaela Luttrell, Kota Takayama, Poorna Kushalnagar. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 25.02.2021.)

Objective: Compared to hearing women, Deaf female sign language users receive sub-optimal maternal health care and report more dissatisfaction with their prenatal care experiences. As healthcare providers begin to regularly screen for perinatal depression, validated screening tools are not accessible to Deaf women due to severe disparities in English literacy and health literacy., Design and Setting: We conducted a one-year, community-engaged pilot study to create an initial American Sign Language (ASL) translation of the Edinburgh Postnatal Depression Scale (EPDS); conduct videophone screening interviews with Deaf perinatal women from across the United States; and perform preliminary statistical analyses of the resulting pilot data., Participants: We enrolled 36 Deaf perinatal women between 5 weeks gestation up to one year postpartum., Measurements and Findings: Results supported the internal consistency of the full ASL EPDS, but did not provide evidence of internal consistency for the anxiety or depression subscales when presented in our ASL format. Participants reported a mean total score of 5.6 out of 30 points on the ASL EPDS (SD = 4.2). Thirty-one percent of participants reported scores in the mild depression range, six percent in the moderate range, and none in the severe range., Key Conclusions and Implications: Limitations included small sample size, a restricted range of depression scores, non-normality of our distribution, and lack of a fully-standardized ASL EPDS administration due to our interview approach. Informed by study strengths, limitations, and lessons learned, future efforts will include a larger, more robust psychometric study to inform the development of a Computer-Assisted Self-Interviewing version of the ASL EPDS with automated scoring functions that hearing, non-signing medical providers can use to screen Deaf women for perinatal depression., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2020. Published by Elsevier Ltd.)

Importance: Perceived everyday discrimination is a psychosocial stressor linked to adverse health outcomes, including mortality., Objective: To assess the association of vision impairment (VI), hearing impairment (HI), and dual sensory impairments (DSI) with everyday discrimination., Design, Setting, and Participants: Cross-sectional analysis of the Health and Retirement Study 2006 and 2008 surveys, a US population-based survey that included noninstitutionalized adults 51 years and older. Analyses were weighted to account for complex sample design and differential nonresponse. Data were analyzed between October 2019 and November 2019., Exposures: Participants rated their vision and hearing, using eyeglasses and/or hearing aids if applicable, on a Likert scale (poor, fair, good, very good, and excellent). Sensory impairment was defined as poor or fair ability in the relevant modality, and sensory impairment was categorized as neither sensory impairment (NSI), VI alone, HI alone, and DSI., Main Outcomes and Measures: Perceived everyday discrimination was measured on the validated 5-question Williams scale (range 0 to 5). Linear regression models estimated differences in discrimination scores by sensory categories, adjusting for age, sex, race, ethnicity, non-US birth, body mass index, relationship status, net household wealth, and number of chronic diseases (among diabetes, hypertension, heart disease, stroke, lung disease, nonskin cancer, and arthritis)., Results: The sample included 13 092 individuals. After weighting the sample to be representative of the US population, 11.7% had VI alone, 13.1% HI alone, and 7.9% DSI. In the fully adjusted model, participants with VI alone (β [change in discrimination score], 0.07; 95% CI, 0.02-0.13), HI alone (β = 0.07; 95% CI, 0.02-0.11), and DSI (β = 0.23; 95% CI, 0.16-0.29) perceived greater discrimination compared with participants with NSI. The DSI group perceived greater discrimination than VI alone or HI alone., Conclusions and Relevance: Older adults with VI or HI in the United States perceive greater everyday discrimination than older adults with NSI, and those with DSI perceive even more discrimination than those with either VI or HI alone. These results provide insight into the social impact of sensory loss and highlight a need to identify and address reasons for discrimination toward older adults with VI and HI.

Purpose: Many deaf children have limited access to language, spoken or signed, during early childhood - which has damaging effects on many aspects of development. There has been a recent shift to consider deafness and language deprivation as separate but related conditions. As such, educational plans should differentiate between services related to deafness and services related to language deprivation., Description: Many deaf children attend mainstream public schools, and the primary service offered to students who use American Sign Language (ASL) is generally a sign language interpreter., Assessment: We argue that while sign language interpreters can be an effective accommodation for deafness (i.e., students who are deaf and not language-deprived), there is no reason to believe they are an effective accommodation for language deprivation (i.e., students who are deaf and language-deprived)., Conclusion: Using interpreters instead of appropriate educational supports may exacerbate symptoms of language deprivation by prolonging the period of time a child goes with limited access to language.

The aim of this article is to increase awareness of language practices in the deaf community that affect communication needs and health outcomes, focusing particularly on the prevalence of bilingualism among deaf adults. Language deprivation and poor health outcomes in the deaf population are risks that cannot be addressed solely by hearing intervention. We propose that bilingualism acts as a protective measure to minimize the health risks faced by deaf individuals. Provision of culturally and linguistically appropriate services to deaf stakeholders, and particularly hearing families of deaf children, requires familiarity with the developmental and social ramifications of bilingualism.

Despite advances in hearing technology, a growing body of research, as well as early intervention protocols, deaf children largely fail to meet age-based language milestones. This gap in language acquisition points to the inconsistencies that exist between research and practice. Current research suggests that bimodal bilingual early interventions at deaf identification provide children language foundations that can lead to more effective outcomes. Recommendations that support implementing bimodal bilingualism at deaf identification include early intervention protocols, language foundations, and the development of appropriate bimodal bilingual environments. All recommendations serve as multifaceted tools in a deaf child's repertoire as language and modality preferences develop and solidify. This versatile approach allows for children to determine their own language and communication preferences.

Language deprivation syndrome (LDS) is a permanent and preventable disability affecting language, cognition, and behavior that is epidemic in the deaf population. Since 1990, systemic and technological changes in the health care of deaf children have created a new paradigm that perpetuates this crisis. Physicians and other professionals have been largely unaware of their roles in this recent epidemic. An evidenced based system of care that addresses the causes and potential solutions can reverse this trend and prevent early language deprivation in deaf children.

Objectives: Reproductive health education is essential for adolescents with hearing impairment. Since they communicate using specialized language (i.e., sign language), specialized reproductive health services in sign language is a necessity. This study aimed to describe the needs, availability, and expectations of reproductive health services among adolescents with hearing impairment., Methods: This study used a qualitative approach. It was carried out at a school for children with special needs in the city of Denpasar, Bali, Indonesia. Data were collected by in-depth interviews. The informants were 6 adolescents with hearing impairment aged 16-17 years and 4 other key informants, including school staff and health officers. The data were then analyzed using the thematic method., Results: We found that the informants had insufficient knowledge regarding reproductive health. There was no specific subject in the curriculum regarding this issue. Teachers did not specifically provide reproductive health information. The health service unit in the school had not been utilized well for this purpose. Furthermore, no reproductive health services were provided due to the limited number of healthcare workers who could use sign language., Conclusions: The awareness and intentions of adolescents with hearing impairment regarding access to reproductive health services remain low. Health service units at schools should be optimized to enable schools to provide reproductive health information and services for these adolescents.

The present study aimed to examine the prevalence of dual sensory impairment, and to identify its risk factors among community-dwelling older adults in Selangor., Methods: Secondary analysis was carried out on data collected by the Grand Challenge Project among older adults aged ≥65 years from Selangor. Data on sociodemographic information, medical history, cognitive function and functional performance were obtained through face-to-face interviews using standardized questionnaires. Visual acuity was measured using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart while hearing was assessed using pure-tone audiometry. Descriptive analysis was used to measure the prevalence of the impairments, and logistic regression analysis was used to identify the risk factors., Results: The prevalence of dual sensory impairment and hearing impairment were at 10.5% and 76.2% respectively. Multivariate logistic regression analysis revealed that participants with lower cognitive scores were associated with dual sensory impairment (odds ratio, 0.90; 95% confidence interval, 0.83-0.98), while smoking was found associated with hearing impairment (odds ratio, 6.58; 95% confidence interval, 1.51-28.65)., Conclusion: Dual sensory impairment is common among older adults in Selangor. The association between dual sensory impairment and cognitive function suggests the need to have visual and hearing screening on older adults for early detection particularly those at risk of cognitive impairment. The prevalence of hearing impairment was reported high among older adults and smokers appeared to be at higher risk of the impairment. Geriatr Gerontol Int 2020; 20: 911-916., (© 2020 Japan Geriatrics Society.)

Background: Adults who are deaf or hard of hearing (D/HoH) have lower levels of health literacy compared to their counterparts who can hear. It is unclear, however, whether or not this inequality manifests in adolescence., Objective or Hypothesis: This study aims to determine levels of health literacy among D/HoH adolescents and to identify barriers and misunderstandings they encounter as well as their expectations when applying for healthcare services., Methods: This descriptive study was conducted with 88 D/HoH adolescents over the age of 15. The Health Sciences Faculty granted approval for the study., Results: Of the adolescents, 70.5% had inadequate, 19.3% had limited, 2.3% had adequate and 8% had excellent health literacy levels. Those who had difficulty in communicating with the doctor (25%), those who misused the prescribed medication (13.6%) and those who could not use the medication without help (43.2%) had low THLS scores (<0.05). Those who stated that they did not understand what the nurses said (43.2%) or the health education materials (56.8%) and had significantly low THLS scores (<0.05). Of these adolescents, 55.7% expected their prescriptions or care procedures to be given to them in writing, and 87.5% expected that these would be explained to them in sign language. A significant relationship was observed between hearing disability and health literacy (R = 0.659, R2 = 0.434) (p < 0.01)., Conclusion: Most D/HoH adolescents have a significantly lower level of health literacy, which is more likely linked with poor communication and misunderstandings concerning medication instructions., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The ability of sepsis to induce acute phase hearing impairment has been evaluated in septic and sepsis-surviving mice. The relationship between septicemia and long-term hearing impairment remains unknown in humans.The data were obtained from the Taiwan Longitudinal National Health Insurance Database from 2000 to 2013. We identified patients suffering from septicemia after discharge, excluding those younger than 18 years old and older than 65 years old. The comparison group was matched based on age, sex, and comorbidities. The outcome was hearing impairment occurring after septicemia. The risk factors associated with hearing impairment were established using multivariate Cox proportional hazard regression.Our study found that septicemia associated with hearing impairment had an adjusted hazard ratio (HR) of 53.11 (95% confidence interval [CI]: 41.74-67.59). The other factors related to hearing impairment in young and middle-aged septicemia survivors included male sex (adjusted HR 1.31 [95% CI: 1.14-1.5]), chronic kidney disease (adjusted HR 1.63 [95% CI: 1.38-1.94]), and otoscleroisis (adjusted HR 231.54 [95% CI: 31.61-1695.8]).Our study revealed that septicemia was associated with increased development of hearing impairment in young and middle-aged humans in the long term. Clinicians should be aware of long-term septicemia-related hearing impairment and provide prevention strategies for otopathy in septicemia survivors.

Background: Dementia and behavioural and psychological symptoms of dementia affect older adults' care-need levels. With aging comes an increase in the incidence of sensory impairments, which promotes the development of dementia. We investigated the association between sensory impairments - visual impairment (VI), hearing impairment (HI), and dual sensory impairment (DSI), the behavioural and psychological symptoms of dementia, and dementia incidence., Methods: This was a retrospective study that used Japanese long-term care insurance certification data from 2010 to 2017 of City A. The 2190 older adults who did not have dementia in 2010 were classified into four impairment categories: VI, HI, DSI, and no sensory impairment. The incidence of dementia was examined using Kaplan-Meier survival analysis and log-rank testing. Cox proportional hazards analysis was used to investigate the risk of developing dementia associated with sensory impairments, compared to the risk for no sensory impairment. Pearson's χ 2 tests were used to compare the prevalence of behavioural and psychological symptoms of dementia among the four groups., Results: HI and DSI were associated with a higher cumulative dementia incidence compared to no sensory impairment (log-rank χ 2 = 10.42; P  < 0.001, and log-rank χ 2 = 39.92; P  < 0.001, respectively), and DSI showed higher cumulative dementia incidence than HI (log-rank χ 2 = 11.37; P  = 0.001). Cox proportional hazards analysis showed that DSI is the greatest risk factor for developing dementia among sensory impairments (hazard ratio, 1.45; 95% CI, 1.22-1.71; P < 0.001). Older adults with VI had a significantly higher prevalence of day-night reversal than the other groups., Conclusions: Our results indicate that older adults with sensory impairments have a high incidence of dementia, with DSI presenting the greatest risk. Older adults with VI were found to be more likely to have day-night reversal symptoms when dementia occurs., (© 2019 Japanese Psychogeriatric Society.)

Background: Hearing loss affects over 1.3 billion individuals worldwide, with the greatest burden among adults. Little is known regarding the association between adult-onset hearing loss and employment., Methods: Seven databases (PubMed, Embase, Cochrane Library, ABI/Inform Collection, Business Source Ultimate, Web of Science and Scopus) were searched through to October 2018. The key word terms used related to hearing loss and employment, excluding paediatric or congenital hearing loss and deaf or culturally deaf populations., Results: The initial search resulted in 13 144 articles. A total of 7494 articles underwent title and abstract screening, and 243 underwent full-text review. Twenty-five articles met the inclusion criteria. Studies were set in 10 predominantly high-income countries. Seven of the 25 studies analysed regionally or nationally representative datasets and controlled for key variables. Six of these seven studies reported associations between hearing loss and employment., Conclusion: The highest quality studies currently available indicate that adult-onset hearing loss is associated with unemployment. However, considerable heterogeneity exists, and more rigorous studies that include low- and middle-income countries are needed.

Objective: To determine if there are existing healthcare access inequities among the deaf Chilean population when compared to the general Chilean population., Methods: Data were obtained from a population-based national survey in Chile. In total, 745 prelingually deaf individuals were identified. The number of times the person used the healthcare system was dichotomized and analyzed using a multivariate logistic regression model., Results: Prelingually deaf people had lower incomes, fewer years of education, and greater rates of unemployment and poverty when compared with the general population. Moreover, they visited more general practitioners, mental health specialists, and other medical specialists. On average, they attended more appointments for depression but had fewer general checkups and gynecological appointments than the general population., Conclusions: Deaf people in Chile have a lower socioeconomic status than the rest of the Chilean population. The results from this study are similar to the findings reported for high-income countries, despite differences in the magnitude of the associations between being deaf and healthcare access. Further studies should be conducted to determine the health status of deaf people in Chile and other Latin American countries and what factors are associated with a significantly lower prevalence of gynecological appointments among deaf women when compared with non-deaf women.

This study aimed to explore emotional regulation, alexithymia, and interpersonal relations in a Spanish sample of 146 adult deaf participants and 146 typical hearing participants. For the deaf sample, the associations between type of language used and the above variables were also analyzed. Results showed that deaf participants scored higher on alexithymia and lower for positive relationships. However, no differences were found between deaf and typical hearing participants on emotional regulation. Regarding language use (Spanish Oral Language, SOL; Spanish Sign Language; or both), deaf participants used both languages in most contexts. Deaf participants who reported using SOL as their main mode of expression showed greater positive relationships than deaf participants who use both languages. Deaf participants who reported using both languages scored higher in emotional attention and emotional repair. These results evidence an association between the language use of deaf participants and alexithymia., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

While most research on transition outcomes focuses on education and employment, the transition to adulthood also includes social outcomes, such as group involvement and community service. The present study examined a broader set of outcomes for young deaf adults after postsecondary education. A secondary analysis of a large-scale data set, the National Longitudinal Transition Study (NLTS2), was conducted to compare the employment, income assistance, and social/community outcomes of three postsecondary education cohorts: graduates, noncompleters, and nonattendees. The findings indicate that young deaf adults with more postsecondary education have more positive outcomes, e.g., higher employment rates, higher wages, and greater civic and social participation. These findings further demonstrate the importance of postsecondary education for young deaf adults and can be used to inform transition planning for deaf students, supporting the need to consider exploration of various career pathways available through college or postsecondary career/technical education.

Background: Individuals with hearing loss experience unique barriers to employment frequently documented in the areas of communication and education. The purpose of this article is to contribute to extend this inquiry to the uniqueness of workplace discrimination involving persons with hearing loss., Objective: This study investigated differences in allegations of workplace discrimination filed by persons with hearing loss ("Hearing") compared to those filed by persons with other physical or neurological disabilities (General Disability, or "GENDIS") before and after the enactment of the 2008 Americans with Disabilities Act Amendments Act (2008 Amendments)., Methods: Using secondary data collected from the Equal Employment Opportunity Commission (EEOC) Integrated Mission System, we employ simple measures of proportion and odds ratios to describe differences between allegations derived from GENDIS and Hearing loss populations. These are population statistics, and not samples, of all allegations of discrimination reported to the EEOC through 2016. The comparisons involve Characteristics of the Charging Parties, Issues or discriminatory behaviors alleged, and closure statuses or Merit Rate of the EEOC's investigations - both before and after the 2008 Amendments., Results: Following the 2008 Amendments, Charging Parties changed dramatically on age and gender status. Reasonable Accommodation, Hiring, Harassment, and employment Terms and Conditions showed unique features between groups and/or time periods. The "veracity" (confirmed truthfulness or merit) of the EEOC allegation (or Merit) rate also changed following the Amendments: higher for GENDIS; lower for Hearing., Conclusions: Possible rationale for these findings are offered, and new research questions are raised. Finally, implications for the cross-disability movement are presented.

Purpose: To compare the acoustic and perceptual-auditory results of the hearing impaired children and adolescents with hearing pairs and to correlate these results with parents' reports regarding speech auditory perception., Method: The participants were divided into two groups: Group I, 20 hearing-impaired children and adolescents and Group II, 20 children and adolescents with normal hearing. Acoustic analysis of the vowel /a/ and perceptual-auditory assessment of the vowel /a/ and speech were performed. The speech auditory perception of the GI was assessed using the Infant-Toddler Meaningful Auditory Integration Scale and the Meaningful Auditory Integration Scale with adaptation for adolescent participants. The acoustic and perceptual-auditory voice results of the GI and GII were compared and these results were correlated with the performance in the auditory perception of the GI group., Results: The groups I and II presented similar results, differing statistically in the long-term frequency variation (vF0) and the long-term amplitude variation (vAm) parameters of the vowel /a/ and speech resonance parameter. It was found a negative correlation between auditory perception performance with jitter, vF0 and general degree of vowel /a/., Conclusion: The vocal quality in GI was similar to their hearing peers in almost all the vocal parameters that were analyzed. The auditory perception influenced jitter, vF0 and general degree of voice parameters, in which hearing-impaired children and adolescents who presented higher scores for auditory perception were also able to keep a more controlled vocal emission.

Objective: The purpose of the study was to investigate whether peer support and demographic characteristics predicted food security among deaf college students. Participants: The sample included 166 deaf college students at Gallaudet University. Methods: Participants completed a bilingual online survey in American Sign Language (ASL) and English. This survey included USDA's 6-item food security survey, questions about peer support and socio-demographic characteristics. Results: Out of 166 students (mean age =23; SD  = 6), 60.7% were food secure. About 26.4% were at-risk for low food security and another 12.9% had very low food security. The sample included respondents who identified as people of color (54%) and women (52%). Binary logistic regression revealed that compared to people who reported always receiving peer support, people who never received peer support were 16.3 times more likely to experience food insecurity (adj OR: 16.325, 95% CI 1.824-146.107). Conclusions: This study demonstrates a strong relationship between peer support and deaf college students' food security experiences.

Background: The spread of technology and dissemination of knowledge across the World Wide Web has prompted the development of apps for American Sign Language (ASL) translation, interpretation, and syntax recognition. There is limited literature regarding the quality, effectiveness, and appropriateness of mobile health (mHealth) apps for the deaf and hard-of-hearing (DHOH) that pose to aid the DHOH in their everyday communication and activities. Other than the star-rating system with minimal comments regarding quality, the evaluation metrics used to rate mobile apps are commonly subjective., Objective: This study aimed to evaluate the quality and effectiveness of DHOH apps using a standardized scale. In addition, it also aimed to identify content-specific criteria to improve the evaluation process by using a content expert, and to use the content expert to more accurately evaluate apps and features supporting the DHOH., Methods: A list of potential apps for evaluation was generated after a preliminary screening for apps related to the DHOH. Inclusion and exclusion criteria were developed to refine the master list of apps. The study modified a standardized rating scale with additional content-specific criteria applicable to the DHOH population for app evaluation. This was accomplished by including a DHOH content expert in the design of content-specific criteria., Results: The results indicate a clear distinction in Mobile App Rating Scale (MARS) scores among apps within the study's three app categories: ASL translators (highest score=3.72), speech-to-text (highest score=3.6), and hard-of-hearing assistants (highest score=3.90). Of the 217 apps obtained from the search criteria, 21 apps met the inclusion and exclusion criteria. Furthermore, the limited consideration for measures specific to the target population along with a high app turnover rate suggests opportunities for improved app effectiveness and evaluation., Conclusions: As more mHealth apps enter the market for the DHOH population, more criteria-based evaluation is needed to ensure the safety and appropriateness of the apps for the intended users. Evaluation of population-specific mHealth apps can benefit from content-specific measurement criteria developed by a content expert in the field., (©Ryan Lee Romero, Frederick Kates, Mark Hart, Amanda Ojeda, Itai Meirom, Stephen Hardy. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 30.10.2019.)

Studies have reported a higher level of unemployment among deaf and hard-of-hearing (DHH) adults compared to adults without hearing loss. However, little is known about factors explaining success in the labor market. This study presents the analysis of two data sets. The first was drawn from a survey of 804 DHH adults in Denmark. The second was a survey completed by 190 DHH adults with post-secondary qualification in the United States. In the Danish sample, among the spoken language users, higher ages, higher level of educational attainment, and no additional disabilities were associated with having a job. Among the sign language users, higher ages, higher level of educational attainment, earlier ages at hearing loss diagnosis, and not using cochlear implants were associated with having a job. In the US sample, male gender and better sign language skills were associated with having a job., (© The Author(s) 2019. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Introduction: No prevalence studies on cancer screening adherence among Deaf women have been conducted in the past decade. Current data on breast and cervical cancer screening are needed from Deaf women who adhered or did not adhere to the U.S. Preventative Services Task Force screening guidelines. The objectives of this study were to assess whether disparities for cancer screening adherence persist for Deaf women compared with the general population and whether racial and ethnic disparities for adherence exist among Deaf women., Methods: Data for adherence to Pap (n=529, Deaf women; n=1,119, hearing women) and mammogram screening (n=324, Deaf women; n=1,086, hearing women) were drawn from the Health Information National Trends Survey in American Sign Language (Deaf women; February-August 2017 and October 2017-May 2018) and the Health Information National Trends Survey 5, Cycle 1, data set (hearing women; January-May 2017). Data were analyzed in 2018. Propensity score model of the weighed samples estimated the probability of adherence among the entire sample and within the sample of Deaf women for each screening test., Results: About 78% (n=415) of age-eligible Deaf women and 85% (n=956) of age-eligible hearing women adhered to Pap screening recommendations (p<0.001). For breast cancer screening, the adherence rates for 245 Deaf women and 891 hearing women were 76% and 82%, respectively (p<0.01). After adjusting for correlates, for Deaf women, disparities remained for cervical cancer screening but not breast cancer screening. Race and ethnicity were not associated with cancer screening adherence., Conclusions: This is a call to action for targeted, accessible health promotion interventions for age-eligible Deaf women to increase adherence to cervical cancer screening., (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Young people with permanent hearing loss need to transition into adult services and engagement with the transition process is required to achieve this. Although there are clear national recommendations about the transition process and transfer to the adult services limited evidence has been published about the implementation and efficacy of transition programmes in young adults with permanent hearing loss. The primary aim of this quality improvement project was to significantly increase the number of teenagers with a clear transition protocol documented in their notes. The secondary aims were to ensure good medical and audiological outcomes based on all completing their medical investigations prior to transfer to the adult services and also based on a survey regarding attitudes to hearing aids use. A multiphase intervention programme was developed; (1) staff update with national transition protocols, (2) development of a clear transition protocol, (3) allocated key worker (4) access and (5) engagement. Through these interventions we increased the number of teenagers who had a clear transition protocol documented in their notes from 11% to 91%. 84% of our teenagers had completed their medical investigations, although documented discussion about the investigations had been done with 100% of the cohort. 9.2 % of adolescents felt pressurised to use hearing aids compared to 35% prior to the interventions. This project resulted in clear, measurable conclusions and we have shown that we better understand the needs of our patients and the improvement is sustainable., Competing Interests: Competing interests: None declared.

Study Objective: To describe knowledge and risk perception of human papillomavirus (HPV) among deaf adults who use American sign language (ASL) comparison with hearing adults in the United States., Design: Secondary HPV knowledge data for the deaf subset sample were drawn from the Health Information National Trends survey in ASL that was administered between 2015 and 2018. HPV knowledge data for the hearing subset sample were drawn from cycle 5 of the Health Information National Trends survey in English that was administered in 2017., Setting: Surveys are a nationally based survey of deaf ASL users in the United States and a nationally based survey of hearing non-ASL users in the United States., Participants: The age of the deaf and hearing subset samples was determined on the basis of catchup vaccine eligibility criteria as outlined by the Centers for Disease Control and Prevention that recommends catchup vaccination in women, men who have sex with men, immunocompromised individuals, and those who identify as transgender., Interventions and Main Outcome Measures: We examined HPV, HPV vaccine, and HPV-related cancer knowledge in deaf and hearing subsets., Results: Our sample consisted of 235 deaf and 115 hearing adults aged 18-26 years. Of the deaf participants 58% (136/235) reported knowledge of HPV compared with 84% (97/115) of hearing participants (P < .001). Hearing participants showed higher accuracy in risk perception of HPV relation to cervical cancer compared with deaf participants (P < .001). Hearing participants were more likely to have heard of the HPV vaccine as well as believe it is successful in preventing cervical cancer compared with deaf participants (P < .001)., Conclusion: Deaf ASL users are less likely to have knowledge of HPV, virus-related cancer risk, and preventative vaccination compared with hearing peers., (Published by Elsevier Inc.)

Background: Deaf sign language users have lower health literacy and poorer access to non-communicable disease prevention information as compared to the general population. The aim was to explore disease concepts embedded in signs, primary non-communicable disease prevention behaviour and communication barriers among members of a deaf community., Methods: A qualitative study with a social constructivist approach was conducted to explore perspectives of deaf sign language users.15 individuals, two with and 13 without history of diabetes were recruited for semi-structured in-depth interviews in sign language at a deaf community center. The interviews were video-recorded, translated and analyzed using thematic content analysis., Results: Diabetes as one of the main non-communicable diseases is conceptualized differently in the manual component of signs depending on how deaf sign language users construct diabetes pathophysiologically. The disease conceptualization is not represented in the mouthing component. Health information seeking behavior varies among deaf sign language users and depends on their individual spoken and written language literacy. Overcoming communication barriers is key for developing an understanding of diabetes and other non-communicable disease prevention activities., Conclusions: To develop barrier-free and inclusive non-communicable disease and diabetes prevention strategies for deaf sign language users, health professionals need to pay attention to sign language specific linguistic concepts. More studies are needed to better understand the specific needs of sign language users and effective strategies in health promotion contexts for sign language users.

Problem: Deaf professionals who use American Sign Language (ASL) are a growing population in academic medicine. Reasonable accommodations for this group include providing an ASL interpreter. Many institutions contract with external agencies to provide ad hoc interpreters, but this model has hidden costs for deaf professionals and institutions., Approach: The University of Rochester School of Medicine and Dentistry (URSMD) uses the designated interpreter model in which interpreters are on staff and embedded with deaf professionals so they can learn both the work environment and the deaf professionals' specialized science and medicine content. This model addresses many of the limitations of the external agency approach and better facilitates the inclusion of deaf professionals in the institution., Outcomes: This model has been in use at URSMD since 1990 but has seen exponential growth recently (increasing from 3 deaf professionals with designated interpreters in 2011 to a peak of 17 in 2016). Designated interpreters have worked in different research and clinical settings from dentistry and nursing to community and global health. This growth highlights the increasing number of deaf professionals in medicine and the need to train more designated interpreters., Next Steps: In response to this growing demand, URSMD is developing an ASL Interpreting in Medicine and Science program, a master's degree-level program to train interpreters who are bilingual in ASL and English to be designated interpreters. The designated interpreter model is one step toward creating an environment that is fully inclusive of deaf professionals to the benefit of the whole institution.

Objective: Although developmental stages and identity have been studied as part of aging, one category of both identity and biological difference that has received little attention in the medical and public health literature is that of older adults who were born deaf and/or who identify as part of the signing Deaf community., Research Method: Researchers conducted a systematic search of the literature for barriers to care access related to both aging and deafness., Results: Lack of cultural competence among providers, coupled with inconsistent access to interpreters in medical settings, puts deaf individuals at risk for treatment without adequate consent, or insufficient care due to communication barriers or misperceptions of expression or culture., Conclusions/implications: Individuals may face unusual challenges, indicating a serious public health crisis on the horizon as the demographic of deaf older adults continues to grow. This paper will discuss what is known about the intersection of aging, Deaf culture, and health care access, and suggest policy and practice recommendations for the future. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Purpose: To estimate the prevalence, causes, and risk factors for visual impairment (VI) among children of school for hearing-impaired (HI) in Guntur district of Andhra Pradesh, India., Methods: Children between 6 and 16 years of age available in all the 12 special schools for HI were examined. Visual acuity (VA) testing, ocular motility, and examination of anterior and posterior segment for all children were done. Those having VA of less than 6/12 in better eye underwent cycloplegic refraction. For definition of VI, as per World Health Organization (WHO), VA of better eye was considered. HI was also classified as mild, moderate, severe, and profound as per WHO definitions. Examination for systemic diseases and other associated disabilities was also done., Results: In all, 402 children underwent examination. Ophthalmic abnormality was seen in 64 children with a prevalence of 15.9% [95% confidence interval (CI) 14.9%-16.8%], and VI was seen in 29 children with a prevalence of 7.2% (95% CI 4.9%-10.2%). Refractive errors [29 (7.2%)], retinitis pigmentosa (RP) [16 (4%)], and squint [8 (2%)] were the major ophthalmic abnormalities. Thirty-five (54.7%) of the abnormalities were either preventable or treatable. The major cause of VI was refractive error (18) followed by RP (5). Twenty of them (69%) with VI in this study group were treatable. Twenty-two (75.9%) children with eye problem were newly diagnosed. The only risk factor for VI was being mentally challenged (odds ratio: 5.63; 95% CI: 1.89-16.8)., Conclusion: The prevalence of ophthalmic abnormalities and VI in school for HI was high, and the majority of them were not detected so far. As most of them are easily treatable, it is highly recommended to conduct regular eye examinations in these schools., Competing Interests: None

Purpose Children who are hard of hearing (CHH) have restricted access to acoustic and linguistic information. Increased audibility provided by hearing aids influences language outcomes, but the benefits of hearing aids are often limited by acoustic factors and distance. Remote microphone (RM) systems further increase auditory access by reducing the negative consequences of these factors. The purpose of this article was to identify factors that influence likelihood of RM system receipt and to investigate the effects of RM systems in home settings on later language outcomes. We used propensity score matching to compare language outcomes between children with and without access to personal RM systems in home settings. This article provides a description of how and why to perform propensity score-matching analyses with clinical populations. Method Participants were 132 CHH. Through parent report, we identified children who received RM systems for home use by 4 years of age. Logistic regression was used to determine factors that predict likelihood of RM system receipt in home settings. Propensity score matching was conducted on a subgroup of 104 participants. Performance on language measures at age 5 years was compared across propensity-matched children who did and did not receive RMs for personal use. Results Likelihood of RM receipt was associated with degree of hearing loss, maternal education, and location (recruitment site). Comparisons between matched pairs of children with and without RM systems in early childhood indicated significantly better discourse skills for children whose families owned RM systems, but no significant differences for vocabulary or morphosyntax. Conclusion Results provide preliminary evidence that the provision of personal RM systems for preschool-age CHH enhances higher-level language skills. The propensity score-matching technique enabled us to use an observational, longitudinal data set to examine a question of clinical interest.

Introduction: Prior studies have found that women with disabilities are less likely to receive adequate prenatal care than women without disabilities. However, little is known about differences in patterns of prenatal care by type of disability. Therefore, this study examined timing and frequency of prenatal care among women with physical, sensory, or intellectual/developmental disabilities compared with women without disabilities., Methods: This was a retrospective cohort study using linked maternal and infant hospital discharge and birth certificate data for all births in California in 2000-2012 (N=6,745,201). Analyses were conducted in 2017-2018. Modified Poisson regression analyses compared women with each type of disability with women without disabilities on trimester of prenatal care initiation and number of prenatal care visits., Results: Women with intellectual/developmental disabilities or with limited hearing had significantly higher RR of delaying prenatal care initiation until the second or third trimester (intellectual/developmental disabilities: adjusted RR=1.21, 95% CI=1.09, 1.33; hearing: adjusted RR=1.11, 95% CI=1.02, 1.21), whereas women with physical disabilities and limited vision had lower risk of delaying care (physical: adjusted RR=0.91, 95% CI=0.88, 0.94; vision: adjusted RR=0.85, 95% CI=0.73, 0.99). Women with limited hearing or vision or intellectual/developmental disabilities had higher risk of receiving fewer prenatal visits than recommended, compared with women without disabilities. Women with physical disabilities or intellectual/developmental disabilities had higher RR of receiving more than the typical number of visits., Conclusions: There were key differences in prenatal care utilization by disability type, reflective of particularly pronounced disparities for women with intellectual/developmental disabilities and women with limited hearing. Delays in receipt of prenatal care and low numbers of prenatal care visits may contribute to the poorer birth outcomes that have been observed previously in these groups. Targeted interventions are needed to improve uptake of prenatal care in these vulnerable populations., (Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

The author examined the experiences of first-generation Latino/a college students who graduated from college and those who did not graduate. It was found that the first-generation deaf Latino/a college graduates in the study had similar experiences growing up, attending high school, and attending college to those of first-generation hearing Latino/a college students. These experiences related to parents' education levels, the linguistic environment at home, parent-school interactions, preparation for college, and stress related to minority status. Data from the participants' interviews revealed other variables that possibly contributed to their academic success in college. These variables included having the expectation that they would pursue higher education; establishing goals; taking advantage of support services; and possessing the personal characteristics of assertiveness and independence. The author also describes how the study participants faced and overcame the academic challenges common to first-generation Latino/a college students.

There is increasing evidence that hearing-impaired (HI) individuals do not use the same listening strategies as normal-hearing (NH) individuals, even when wearing optimally fitted hearing aids. In this perspective, better characterization of individual perceptual strategies is an important step toward designing more effective speech-processing algorithms. Here, we describe two complementary approaches for (a) revealing the acoustic cues used by a participant in a /d/-/g/ categorization task in noise and (b) measuring the relative contributions of these cues to decision. These two approaches involve natural speech recordings altered by the addition of a “bump noise.” The bumps were narrowband bursts of noise localized on the spectrotemporal locations of the acoustic cues, allowing the experimenter to manipulate the consonant percept. The cue-weighting strategies were estimated for three groups of participants: 17 NH listeners, 18 HI listeners with high-frequency loss, and 15 HI listeners with flat loss. HI participants were provided with individual frequency-dependent amplification to compensate for their hearing loss. Although all listeners relied more heavily on the high-frequency cue than on the low-frequency cue, an important variability was observed in the individual weights, mostly explained by differences in internal noise. Individuals with high-frequency loss relied slightly less heavily on the high-frequency cue relative to the low-frequency cue, compared with NH individuals, suggesting a possible influence of supra-threshold deficits on cue-weighting strategies. Altogether, these results suggest a need for individually tailored speech-in-noise processing in hearing aids, if more effective speech discriminability in noise is to be achieved.

The auditory system allows the estimation of the distance to sound-emitting objects using multiple spatial cues. In virtual acoustics over headphones, a prerequisite to render auditory distance impression is sound externalization, which denotes the perception of synthesized stimuli outside of the head. Prior studies have found that listeners with mild-to-moderate hearing loss are able to perceive auditory distance and are sensitive to externalization. However, this ability may be degraded by certain factors, such as non-linear amplification in hearing aids or the use of a remote wireless microphone. In this study, 10 normal-hearing and 20 moderate-to-profound hearing-impaired listeners were instructed to estimate the distance of stimuli processed with different methods yielding various perceived auditory distances in the vicinity of the listeners. Two different configurations of non-linear amplification were implemented, and a novel feature aiming to restore a sense of distance in wireless microphone systems was tested. The results showed that the hearing-impaired listeners, even those with a profound hearing loss, were able to discriminate nearby and far sounds that were equalized in level. Their perception of auditory distance was however more contracted than in normal-hearing listeners. Non-linear amplification was found to distort the original spatial cues, but no adverse effect on the ratings of auditory distance was evident. Finally, it was shown that the novel feature was successful in allowing the hearing-impaired participants to perceive externalized sounds with wireless microphone systems.

Deaf and hard of hearing (d/Dhh) children frequently have delayed language; yet limited research exists on interventions to facilitate linguistic development in the classroom (Fung, Chow, & McBride-Chang, 2005). Dialogic reading is an evidence-based practice that has resulted in significantly improved language skills (Towson, Fettig, Fleury, & Abarca, 2017; Whitehurst, Arnold, et al., 1994). The present study used case study and design research methods with three elementary school teachers to identify challenges to implementing dialogic reading and necessary adaptations for d/Dhh students. Primary data sources were collaborative meetings with teachers and these meetings' transcripts. Additional sources were video-recordings of dialogic reading. Teachers were found to be hindered by insufficient knowledge about language delays and elements of implementation; specifically, adaptations for d/Dhh students competed with curricular responsibilities. It is concluded that teachers should receive better preparation and support for the complex, multifaceted task of instruction.

Introduction: There is little credible quantitative data on pregnancy histories and outcomes for disabled women in low-income and middle-income countries. The purpose of this study, based in Cape Town, South Africa, was to test the reliability and validity of maternal recall of pregnancy history and service use among a sample of Deaf women who use South African Sign Language (SASL)., Methods: We interviewed 42 signing Deaf women of childbearing age (18-49 years) in SASL using a structured questionnaire in July 2016. To assess reliability, seven participants (16% of the sample) were reinterviewed by different interviewers under the same conditions after 10-30 min. For the analysis we used (1) Cohen's kappa, an inter-rater statistical method, and (2) overall percentage agreement. Validity was explored by comparing the participants' pregnancy history to the Western Cape Provincial Health Data Centre (PHDC) database., Results: The reliability results showed that out of 19 questions 14 demonstrated substantial to perfect agreement kappa scores (kappa between 0.61 and 1) and 5 had the lowest kappa agreement scores (kappa <0.61). With respect to percentage agreement, participants provided identical responses in 87% cases. Overall, women provided more reliable responses to pregnancy outcomes compared with demographic information. Validity results showed that 29 out of 35 Deaf women provided survey responses that matched or nearly matched (83% agreement) the PHDC database for birth history and delivery location., Conclusion: This study suggests that for this sample of signing Deaf women recall of pregnancy history and service use is reliable and valid. Extending this approach to other similar populations will require further research, but it is important that methods to access hard-to-reach disabled populations are developed so that health system responsiveness to marginal populations can be based on robust evidence., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

While wide dynamic range compression (WDRC) is a standard feature of modern hearing aids, it can be difficult to fit compression settings to individual hearing aid users. The goal of the current study was to develop a practical test to learn the preference of individual listeners for different compression ratio (CR) settings in different listening conditions (speech-in-quiet and speech-in-noise). While it is possible to exhaustively test different CR settings, such methods can take many hours to complete, making them impractical. Bayesian optimization methods were used to find CR preferences in individual listeners in a relatively short amount of time. Using this practical preference learning test, individual differences in CR preference were examined across a relatively wide range of CR settings in different listening conditions. In experiment 1, the accuracy of the preference learning test in normal hearing listeners was verified. In experiment 2, it is shown that individual hearing impaired listeners differ in their CR preferences, and listeners tended to prefer the CR setting identified by the preference learning test over both linear gain or the National Acoustics Lab--Nonlinear 2 CR prescription based on their audiograms.

Cubick and Dau [(2016). Acta Acust. Acust. 102 , 547-557] showed that speech reception thresholds (SRTs) in noise, obtained with normal-hearing listeners, were significantly higher with hearing aids (HAs) than without. Some listeners reported a change in their spatial perception of the stimuli due to the HA processing, with auditory images often being broader and closer to the head or even internalized. The current study investigated whether worse speech intelligibility with HAs might be explained by distorted spatial perception and the resulting reduced ability to spatially segregate the target speech from the interferers. SRTs were measured in normal-hearing listeners with or without HAs in the presence of three interfering talkers or speech-shaped noises. Furthermore, listeners were asked to sketch their spatial perception of the acoustic scene. Consistent with the previous study, SRTs increased with HAs. Spatial release from masking was lower with HAs than without. The effects were similar for noise and speech maskers and appeared to be accounted for by changes to energetic masking. This interpretation was supported by results from a binaural speech intelligibility model. Even though the sketches indicated a change of spatial perception with HAs, no direct link between spatial perception and segregation of talkers could be shown.

This study aimed to describe the prevalence of visual, hearing, and motor impairments in the indigenous population in Brazil and to estimate the odds of presenting one of the three disabilities, separately, according to degree of severity. The data were obtained from the 2010 Population Census conducted by the Brazilian Institute of Geography and Statistics (IBGE). The methods included direct standardization for calculation of the prevalence rates and multinomial logistic regression models. According to the standardized results, indigenous men and women showed the highest prevalence in each of the three disabilities, except for mild visual impairment in women. The results of the multinomial regression models revealed a relative disadvantage for indigenous peoples in nearly all the types of disability.

Communication barriers between healthcare providers and patients contribute to health disparities and the effectiveness of health promotion messages. This is especially true regarding communication between providers and deaf and hard of hearing (HOH) patients due to lack of understanding of cultural and linguistic differences, ineffectiveness of various means of communication and level of health literacy within that population. This research aimed to identify American Sign Language (ASL) interpreters' perceptions of barriers to effective communication between deaf and HOH patients and healthcare providers. We conducted a survey of ASL interpreters attending the 2015 National Symposium on Healthcare Interpreting with an overall response rate of 25%. Results indicated a significant difference (p < 0.05) in all areas of preferred communication between providers and deaf/HOH patients as perceived by interpreters. ASL interpreters observed that patients did not understand provider instructions in nearly half of appointments. Eighty-one percent of interpreters said that providers "hardly ever" use "teach-back" methods with patients to ensure understanding. A focus on improving health care and health promotion efforts in the deaf/HOH community depends on improving communication, health literacy, and patient empowerment and involves holding health care organizations accountable for assuring adequate staffing of ASL interpreters and communication resources in order to reduce health disparities in this population.