An exploration of the perspectives of help-seekers prescribed hearing aids

Aim - This pilot study uses qualitative methods to learn about the psycho-social needs of people who seek help with hearing loss. Background - There has been some emphasis in health policy to reduce the number of appointments required between assessment of hearing loss and fitting of hearing aids. This may respond to audiological needs but may not address the psycho-social needs. This study piloted a phenomenological approach to identify the patient's perspective. Methods - A phenomenological approach was taken to provide description of patient perspectives. Findings - Six patients reported that help-seeking was primarily influenced by the need to appease social partners and to improve hearing performance. Hearing aids were not regarded as acceptable treatments. Conclusions - Service providers need to consider the psycho-social consequences of hearing-aid issue alongside audiological needs.

A qualitative investigation of decision making during help-seeking for adult hearing loss

Objective: The Any Qualified Provider framework in the National Health Service has changed the way adult audiology services are offered in England. Under the new rules, patients are being offered a choice in geographical location and audiology provider. This study aimed to explore how choices in treatment are presented and to identify what information patients need when they are seeking help with hearing loss. Design: This study adopted qualitative methods of ethnographic observations and focus group interviews to identify information needed prior to, and during, help-seeking. Observational data and focus group data were analysed using the constant comparison method of grounded theory. Study sample: Participants were recruited from a community Health and Social Care Trust in the west of England. This service incorporates both an Audiology and a Hearing Therapy service. Twenty seven participants were involved in focus groups or interviews. Results: Participants receive little information beyond the detail of hearing aids. Participants report little information that was not directly related to uptake of hearing aids. Conclusions: Participant preferences were not explored and limited information resulted in decisions that were clinician-led. The gaps in information reflect previous data on clinician communication and highlight the need for consistent information on a range of interventions to manage hearing loss.

Desenho de defici��ncia visual: uma experi��ncia no ensino de artes visuais na perspectiva da educa����o inclusiva

Over the past 30 years, Art Education in interface with disabilities has been a subject of increasing interest in research in academia, especially with regard to Special Education, but still has some shortages in terms of socialization studies to discuss this type of teaching from the perspective of inclusive education. In this scenario, this paper presents an analysis from the field of teaching Visual Arts in the context of school inclusion, with emphasis on teaching drawing to the visually impaired. The conducted literature indicates a number of authors who discuss teaching drawing to people with visual disabilities, who are dedicated primarily to the Special Education context. In this sense, the shortage of research that discuss this teaching from the perspective of inclusive education, this research aimed at the inclusive approach to teaching drawing in the school context. Thus, the aim of this study was to develop a proposal for a pedagogical intervention in Visual Arts, with reference to drawing and its construction process, with the participation of seeing and unseeing students. Therefore, the methodological approach, which was qualitative, was the intervention research, in the light of the Bakhtinian principles of dialogism and otherness, with exploratory study characteristics. The locus of the research was the State School Admiral Newton Braga Faria, which is located in Alecrim, on the East Zone of Natal / RN and is near the Institute for Education and Rehabilitation of the Blind - IERC / RN. The class chosen for intervention was the 7th grade ���C��� afternoon shift, which had children aged 12 to 16, with 27 students enrolled, three students with disabilities: 02 blind girls and 01 deafblind boy with light hearing and visual loss. As interlocutors of the research, we could also count on the Art teacher who served as a collaborator, as well as teacher in the school���s Multifunction Resource Room. The instruments and research procedures were observation, semi-structured interview, field diary and the photo / video recording. In the development of research, we conducted 10 workshops with multisensory teaching sequences, articulating the physical, tactile and graphical expressions as intrinsic to the reading and production of drawing for both seeing and unseeing students. The process and data built on research allowed for a reflection on cultural experiences with drawing in the school context and on the interactions between seeing and unseeing students in the production and analysis of tactile-visual drawings. They also point out the construction of a teaching approach to drawing, in the context of the common class, from educational workshops that enable artistic and aesthetic interactions from the perspective of school inclusiveness. Thus, we argued that the mobilization of the tactile, physical and graphical expressions can be adopted in a multisensory approach that enables a pedagogical focus that involves all students and is not restricted to the presence of students with visual impairment.

Place, policy and practitioners: on rehabilitation, independence and the therapeutic landscape in the changing geography of care provision to older people in the United Kingdom

A growing body of literature in geography and other social sciences considers the role of place in the provision of healthcare. Authors have focused on various aspects of place and care, with particular interests emerging around the role of the psychological, social and cultural aspects of place in care provision. As healthcare stretches increasingly beyond the traditional four walls of the hospital, so questions of the role of place in practices of care become ever more pertinent. In this paper, we examine the relationship between place and practice in the care and rehabilitation of older people across a range of settings, using qualitative material obtained from interviews and focus groups with nursing, care and rehabilitation staff working in hospitals, clients��� homes and other sites. By analysing their testimony on the characteristics of different settings, the aspects of place which facilitate or inhibit rehabilitation and the ways in which place mediates and is mediated by social interaction, we consider how various dimensions of place relate to the power-inscribed relationships between service users, informal carers and professionals as they negotiate the goals of the rehabilitation process. We seek to demonstrate how the physical, psychological and social meanings of place and the social processes engendered by the rehabilitation encounter interact to produce landscapes that are more or less therapeutic, considering in particular the structuring role of state policy and formal healthcare provision in this dynamic.

Association of SNPs in LCP1 and CTIF with hearing in 11 year old children:findings from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort and the G-EAR consortium

BACKGROUND: The genetic basis of hearing loss in humans is relatively poorly understood. In recent years, experimental approaches including laboratory studies of early onset hearing loss in inbred mouse strains, or proteomic analyses of hair cells or hair bundles, have suggested new candidate molecules involved in hearing function. However, the relevance of these genes/gene products to hearing function in humans remains unknown. We investigated whether single nucleotide polymorphisms (SNPs) in the human orthologues of genes of interest arising from the above-mentioned studies correlate with hearing function in children. METHODS: 577 SNPs from 13 genes were each analysed by linear regression against averaged high (3, 4 and 8 kHz) or low frequency (0.5, 1 and 2 kHz) audiometry data from 4970 children in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth-cohort at age eleven years. Genes found to contain SNPs with low p-values were then investigated in 3417 adults in the G-EAR study of hearing. RESULTS: Genotypic data were available in ALSPAC for a total of 577 SNPs from 13 genes of interest. Two SNPs approached sample-wide significance (pre-specified at p���=���0.00014): rs12959910 in CBP80/20-dependent translation initiation factor (CTIF) for averaged high frequency hearing (p���=���0.00079, �����=���0.61 dB per minor allele); and rs10492452 in L-plastin (LCP1) for averaged low frequency hearing (p���=���0.00056, �����=���0.45 dB). For low frequencies, rs9567638 in LCP1 also enhanced hearing in females (p���=���0.0011, �����=���-1.76 dB; males p���=���0.23, �����=���0.61 dB, likelihood-ratio test p���=���0.006). SNPs in LCP1 and CTIF were then examined against low and high frequency hearing data for adults in G-EAR. Although the ALSPAC results were not replicated, a SNP in LCP1, rs17601960, is in strong LD with rs9967638, and was associated with enhanced low frequency hearing in adult females in G-EAR (p���=���0.00084). CONCLUSIONS: There was evidence to suggest that multiple SNPs in CTIF may contribute a small detrimental effect to hearing, and that a sex-specific locus in LCP1 is protective of hearing. No individual SNPs reached sample-wide significance in both ALSPAC and G-EAR. This is the first report of a possible association between LCP1 and hearing function.

Newborn Hearing Screening And Early Diagnostic In The Nicu.

The aim was to describe the outcome of neonatal hearing screening (NHS) and audiological diagnosis in neonates in the NICU. The sample was divided into Group I: neonates who underwent NHS in one step and Group II: neonates who underwent a test and retest NHS. NHS procedure was automated auditory brainstem response. NHS was performed in 82.1% of surviving neonates. For GI, referral rate was 18.6% and false-positive was 62.2% (normal hearing in the diagnostic stage). In GII, with retest, referral rate dropped to 4.1% and false-positive to 12.5%. Sensorineural hearing loss was found in 13.2% of infants and conductive in 26.4% of cases. There was one case of auditory neuropathy spectrum (1.9%). Dropout rate in whole process was 21.7% for GI and 24.03% for GII. We concluded that it was not possible to perform universal NHS in the studied sample or, in many cases, to apply it within the first month of life. Retest reduced failure and false-positive rate and did not increase evasion, indicating that it is a recommendable step in NHS programs in the NICU. The incidence of hearing loss was 2.9%, considering sensorineural hearing loss (0.91%), conductive (1.83%) and auditory neuropathy spectrum (0.19%).

Hearing Preservation And Cochlear Implants According To Inner Ear Approach: Multicentric Evaluation.

Electroacoustic stimulation is an excellent option for people with residual hearing in the low frequencies, who obtain insufficient benefit with hearing aids. To be effective, the subject's residual hearing should be preserved during cochlear implant surgery. To evaluate the hearing preservation in patients that underwent implant placement and to compare the results in accordance with the approach to the inner ear. 19 subjects underwent a soft surgical technique, and the electrode MED-EL FLEX��� EAS, designed to be atraumatic, was used. We evaluated pre- and postoperative tonal audiometric tests with an average of 18.4 months after implantation, to measure the rate of hearing preservation. 17 patients had total or partial preservation of residual hearing; 5 had total hearing preservation and two individuals had no preservation of hearing. The insertion of the electrode occurred through a cochleostomy in 3 patients, and in 2 of these there was no hearing preservation; the other 16 patients experienced electrode insertion through a round window approach. All patients benefited from the cochlear implant, even those who are only using electrical stimulation. The hearing preservation occurred in 89.4% of cases. There was no significant difference between the forms of inner ear approach.

An��lise do desempenho muscular do quadr��ceps e dos isquiotibiais em fun����o da s��rie temporal e da amplitude de movimento de atletas amadoras de futsal feminino = : Analysis of muscle performance of the quadriceps and hamstrings as a function of the times series and range of motion of amateurfemale futsal athletes

Universidade Estadual de Campinas . Faculdade de Educa����o F��sica

Tradu����o, adapta����o cultural e valida����o da escala Moorong Self-Efficacy Scale (MSES) para o portugu��s no Brasil = : Translation, cultural adaptation and validation of Moorong Self-Efficacy Scale (MSES) into Brazilian Portuguese

Universidade Estadual de Campinas . Faculdade de Educa����o F��sica

Timing and sequence of primary tooth eruption in children with cleft lip and palate

OBJECTIVE: To determine the timing and sequence of eruption of primary teeth in children with complete bilateral cleft lip and palate. MATERIAL AND METHODS: This cross-sectional study was conducted at the Hospital for Rehabilitation of Craniofacial Anomalies of the University of S��o Paulo, Bauru, SP, Brazil, with a sample of 395 children (128 girls and 267 boys) aged 0 to 48 months, with complete bilateral cleft lip and palate. RESULTS: Children with complete bilateral clefts presented a higher mean age of eruption of all primary teeth for both arches and both genders, compared to children without clefts. This difference was statistically signifcant for all teeth, except for the maxillary first molar. Mean age of eruption of most teeth was lower for girls compared to boys. The greatest delay was found for the maxillary lateral incisor, which was the eighth tooth of children with clefts of both genders. Analyzing by gender, the maxillary lateral incisor was the eighth tooth to erupt in girls and the last in boys. CONCLUSION: The results suggest an interference of the cleft on the timing and sequence of eruption of primary teeth.

Percep����es de escolares com defici��ncia visual em rela����o ao seu processo de escolariza����o

A promo����o da inclus��o escolar de pessoas com defici��ncia visual demanda que os profissionais conhe��am as percep����es que estes alunos t��m a respeito de suas limita����es e possibilidades. Neste estudo, foram identificadas caracter��sticas e percep����es de escolares com defici��ncia visual em rela����o ao seu processo de reabilita����o. Foi realizado um estudo descritivo transversal com escolares de 12 anos e mais, inseridos no sistema p��blico de um munic��pio do Estado de S��o Paulo. Aplicou-se question��rio mediante entrevista. Obteve-se popula����o de 26 alunos, sendo 46,2% com vis��o subnormal e 53,8% com cegueira, com m��dia de idade de 17,1 anos. A repet��ncia escolar foi declarada por 73,1%. Entre as dificuldades escolares decorrentes da cegueira, sobressaiu-se a leitura de livros did��ticos e, entre as decorrentes da vis��o subnormal, a visualiza����o da lousa. O n��vel de escolaridade mostrou-se baixo em rela����o �� m��dia de idade. Evidenciaram-se percep����es coerentes em rela����o �� problem��tica da inclus��o escolar.

Uso de medicamentos por pessoas com defici��ncias em ��reas do estado de S��o Paulo

OBJETIVO: Analisar o consumo de medicamentos e os principais grupos terap��uticos consumidos por pessoas com defici��ncias f��sicas, auditivas ou visuais. M��TODOS: Estudo transversal em que foram analisados dados do Inqu��rito Multic��ntrico de Sa��de no Estado de S��o Paulo (ISA-SP) em 2002 e do Inqu��rito de Sa��de no Munic��pio de S��o Paulo (ISA-Capital), realizado em 2003. Os entrevistados que referiram defici��ncias foram estudados segundo as vari��veis que comp��em o banco de dados: ��rea, sexo, renda, faixa et��ria, ra��a, consumo de medicamentos e tipos de medicamentos consumidos. RESULTADOS: A percentagem de consumo entre as pessoas com defici��ncia foi de: 62,8 por cento entre os visuais; 60,2 por cento entre os auditivos e 70,1 por cento entre os f��sicos. As pessoas com defici��ncia f��sica consumiram 20 por cento mais medicamentos que os n��o-deficientes. Entre as pessoas com defici��ncia visual, os medicamentos mais consumidos foram os diur��ticos, agentes do sistema renina-angiotensina e analg��sicos. Pessoas com defici��ncia auditiva utilizaram mais analg��sicos e agentes do sistema renina-angiotensina. Entre indiv��duos com defici��ncia f��sica, analg��sicos, antitromb��ticos e agentes do sistema renina-angiotensina foram os medicamentos mais consumidos. CONCLUS��ES: Houve maior consumo de medicamentos entre as pessoas com defici��ncias quando comparados com os n��o-deficientes, sendo os indiv��duos com defici��ncia f��sica os que mais consumiram f��rmacos, seguidos de deficientes visuais e auditivos

The role of heritage in revalorization politicos of urban space

Certain areas of the city of Sao Paulo, as many others around the world, including in Lisbon, Barcelona and Buenos Aires, have been going through a process of requalification, in special the ones commonly known as old and/or traditional city. Regarding Sao Paulo, some exceptional actions have been taken downtown with investments in rehabilitation/requalification of areas that concentrated the historical, urbanistic and cultural heritages, such as Praca da S and its cathedral, as well as the revaluation/rehabilitation projects of other squares like Praca da Republica, other areas as the previously called Cracolandia (due to high consumption/deal of crack), known today as Nova Luz, besides propositions to reevaluate areas already modified, such as Vale do Anhangabau. In all propositions to modify sites, it is firstly underlined its deterioration, litter and the presence of low-income populations (passer-bys, street vendors or residents), generally stigmatized as ""potential suspects"", emphasizing danger and lack of security in those places. This belief, which has become consensual, results in that: public as well as private companies promote the rehabilitation of the areas basing their reasoning in the necessity of adding value to the existing urban heritage, although, as it will be discussed in this paper, part of this heritage might be destroyed in this very process, under the allegation that upon completion, the action would allow the social, cultural and economical revaluation/requalification of the area. This paper is intended to provide a contribution to this discussion.

Reduced transcription of TCOF1 in adult cells of Treacher Collins syndrome patients

Background: Treacher Collins syndrome (TCS) is an autosomal dominant craniofacial disorder caused by frameshift deletions or duplications in the TCOF1 gene. These mutations cause premature termination codons, which are predicted to lead to mRNA degradation by nonsense mediated mRNA decay (NMD). Haploinsufficiency of the gene product (treacle) during embryonic development is the proposed molecular mechanism underlying TCS. However, it is still unknown if TCOF1 expression levels are decreased in postembryonic human cells. Methods: We have estimated TCOF1 transcript levels through real time PCR in mRNA obtained from leucocytes and mesenchymal cells of TCS patients (n = 23) and controls (n = 18). Mutational screening and analysis of NMD were performed by direct sequencing of gDNA and cDNA, respectively. Results: All the 23 patients had typical clinical features of the syndrome and pathogenic mutations were detected in 19 of them. We demonstrated that the expression level of TCOF1 is 18-31% lower in patients than in controls (p < 0.05), even if we exclude the patients in whom we did not detect the pathogenic mutation. We also observed that the mutant allele is usually less abundant than the wild type one in mesenchymal cells. Conclusions: This is the first study to report decreased expression levels of TCOF1 in TCS adult human cells, but it is still unknown if this finding is associated to any phenotype in adulthood. In addition, as we demonstrated that alleles harboring the pathogenic mutations have lower expression, we herein corroborate the current hypothesis of NMD of the mutant transcript as the explanation for diminished levels of TCOF1 expression. Further, considering that TCOF1 deficiency in adult cells could be associated to pathologic clinical findings, it will be important to verify if TCS patients have an impairment in adult stem cell properties, as this can reduce the efficiency of plastic surgery results during rehabilitation of these patients.

New Source of Muscle-Derived Stem Cells with Potential for Alveolar Bone Reconstruction in Cleft Lip and/or Palate Patients

Cleft lip and palate (CLP), one of the most frequent congenital malformations, affects the alveolar bone in the great majority of the cases, and the reconstruction of this defect still represents a challenge in the rehabilitation of these patients. One of the current most promising strategy to achieve this goal is the use of bone marrow stem cells (BMSC); however, isolation of BMSC or iliac bone, which is still the mostly used graft in the surgical repair of these patients, confers site morbidity to the donor. Therefore, in order to identify a new alternative source of stem cells with osteogenic potential without conferring morbidity to the donor, we have used orbicular oris muscle (OOM) fragments, which are regularly discarded during surgery repair (cheiloplasty) of CLP patients. We obtained cells from OOM fragments of four unrelated CLP patients (CLPMDSC) using previously described preplating technique. These cells, through flow cytometry analysis, were mainly positively marked for five mesenchymal stem cell antigens (CD29, CD90, CD105, SH3, and SH4), while negative for hematopoietic cell markers, CD14, CD34, CD45, and CD117, and for endothelial cell marker, CD31. After induction under appropriate cell culture conditions, these cells were capable to undergo chondrogenic, adipogenic, osteogenic, and skeletal muscle cell differentiation, as evidenced by immunohistochemistry. We also demonstrated that these cells together with a collagen membrane lead to bone tissue reconstruction in a critical-size cranial defects previously induced in non-immunocompromised rats. The presence of human DNA in the new bone was confirmed by PCR with human-specific primers and immunohistochemistry with human nuclei antibodies. In conclusion, we showed that cells from OOM have phenotypic and behavior characteristics similar to other adult stem cells, both in vitro and in vivo. Our findings suggest that these cells represent a promising source of stem cells for alveolar bone grafting treatment, particularly in young CLP patients.