Opportunistic assessment of hearing in elderly inpatients

Objective: To determine the prevalence of occult hearing loss in elderly inpatients, to evaluate feasibility of opportunistic hearing screening and to determine subsequent provision of hearing aids. Materials and methods: Subjects (>65 years) were recruited from five elderly care wards. Hearing loss was detected by a ward-based hearing screen comprising patient-reported assessment of hearing disability and a whisper test. Subjects failing the whisper test or reporting hearing difficulties were offered formal audiological assessment. Results: Screening was performed on 51 patients aged between 70 and 95 years. Of the patients, 21 (41%) reported hearing loss and 16 (31%) failed the whisper test. A total of 37 patients (73%) were referred for audiological assessment with 17 (33%) found to have aidable hearing loss and 11 were fitted with hearing aids (22%). Discussion: This study highlights the high prevalence of occult hearing loss in elderly inpatients. Easy two-step screening can accurately identify patients with undiagnosed deafness resulting in significant proportions receiving hearing aids.

Higher social distress and lower psycho-social wellbeing:examining the coping capacity and health of people with hearing impairment

Abstract
Purpose: The objectives of this paper are as follows: (1) propose an explanatory model as to how hearing disability may impact on health and (2) examine the model’s utility.
Methods: Data were collected on the psycho-social wellbeing, disability and physical health of farmers (n=56) participating in an intervention to manage the social impacts of hearing disability. Two models were proposed and examined using multiple hierarchical linear regression. Model 1 used self-rated quality of life and model 2 used capacity to manage hearing and listening impairments, as dependent variables.
Results: The analyses found that physical measures of hearing impairment (audiograms) were not correlated with physical or mental health outcomes. However, in model 1, self-confidence and self-rated ability to manage hearing impairment were most closely associated with reduced quality of life (anxiety and diastolic blood pressure were positively associated with quality of life). In model 2, higher anxiety and reduced self-confidence were associated with decreasing ability to successfully manage one’s hearing impairment.
Conclusions: The findings support the explanatory model that stress is higher and wellbeing lower when the fit between the person’s coping capacity and environmental demands is poor.

Problems with accessibility to health services by persons with disabilities in Sao Paulo, Brazil

Purpose. To describe the occurrence of self-reported problems of accessibility to health services used by persons with disabilities in terms of social and health services variables. Methods. We performed a cross-sectional household survey designed to assess problems with accessibility to health services faced by persons with disabilities. We interviewed 333 persons in Sao Paulo city, in 2007. Variables related to the presence of accessibility problems, disabilities, gender, age, family head income, ethnicity, use of health services and others were analysed using frequencies, percentages, chi(2)-test, ANOVA and Poisson regression models. Results. 15.92% of the interviewed persons reported problems with accessibility to health services. Persons having multiple (prevalence ratios; PR = 2.91) or mobility disability (PR = 6.46) had more problems with accessibility than persons with hearing disability. Persons younger than 78 years old had more problems with accessibility; those who needed help to go to the health service (PR = 3.01) also. Conclusions. Persons with multiple or mobility disability, younger than 78 years, and those who needed help of others to go to the health service were more likely to have problems with accessibility to health services. This information could be one of the first steps to the management and/or planning of appropriate health services for persons with disabilities.

Deficiência visual, auditiva e física: prevalência e fatores associados em estudo de base populacional

O estudo descreve as prevalências de deficiências segundo características demográficas e sócio-econômicas, bem como as suas causas. A pesquisa utilizou dados de inquéritos de base populacional realizados em áreas do Estado de São Paulo, Brasil, em 2002 e 2003, com amostragem estratificada por conglomerados. Os entrevistados que referiram deficiências foram a população estudada segundo as variáveis que compõem o banco de dados. A prevalência de alguma deficiência foi de 110,8 ; deficiência visual, 62 ; deficiência auditiva, 44 e a deficiência física de 13,3 . As prevalências das deficiências variaram com a idade; sexo e escolaridade. A prevalência de deficiências auditiva e física foi maior entre os homens. A principal causa das deficiências foi a doença. As causas externas também foram umas das principais causadoras de incapacidades. As deficiências aumentaram com a idade, foram mais prevalentes em mulheres e em pessoas com menor escolaridade, sendo sua principal causa as doenças e as causas externas.

Escala de atitudes sociais em relação à inclusão: versão específica para cada categoria de deficiência

An adequate understanding of social attitudes toward inclusion is part of the study of necessary conditions to the construction of an inclusive education. he aim of this study was to translate and atapt a simple scale used to measure social attitudes toward the inclusion of blind students. From the translation, it was developed a version for each of four disabilities categories: hearing disability, physical disability, intelectual disability and visual impairment. he 637 participants answered a version of this scale and one of the ELASI (Escala Likert de Atitudes Sociais em relação à Inclusão) forms. hese participants were students of several Special Education specialization courses given in the State of Paraná. Most of them were Basic Education teachers. he results indicated a high correlation between the form A ELASI scores and the scores of each of the speciic scale version. In form B there were no signiicant correlations found relating to the visual and hearing disabilities. Moreover, the scale was capable to identify diferences between the disabilities categories. More complete assessments and new studies are necessary to clarify the divergence found between the A and B forms of ELASI.

Escala de Atitudes em Relação à Inclusão: Versão Específica para cada Categoria de Deficiência

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Tarefas de triangulação com restrições perceptuais em pessoas com deficiência auditiva: um estudo por meio de gps

This study aimed to investigate how people with hearing disability perform tasks of distances estimation for locomotion and navigation when deprived of effective perceptual and proprioceptive information. For this, participants with hearing disability went three distances being the first and second 100 meters and the third 140 meters (triangulation) from a source point in an inverted L open field trajectory and then returned to the origin, and the first two were driven by a researcher guide with adapted GPS coordinates of the study, and the third being three free-form sessions, the first one without any perceptual and proprioceptive restriction, the second without visual perception, and the third on the wheel-chair, that is, without proprioception. The results showed that people with hearing disability without the knowledge of the path do not possess satisfactory accuracy but when they learn the way even with the restriction of visual perception and proprioception they can return to the starting point in a task of triangulation. The "t" students test with a significance level of 5% (2.131) indicates significant differences between the first task without any perceptual restriction and the third where they performed in the wheelchair. To achieve these results we used remote monitoring via GPS and the TrackMaker software.

Dificuldades na comunicação entre pessoas com deficiência auditiva e profissionais de saúde: uma questão de saúde pública

OBJETIVO: Descrever a ocorrência de relatos de pessoas com deficiência auditiva e múltipla (auditiva e visual e/ou mobilidade) quanto às dificuldades para ouvir e entender profissionais de saúde. MÉTODOS: Estudo transversal, do tipo inquérito de saúde, realizado com sujeitos selecionados a partir de outros dois estudos de base populacional. A coleta dos dados ocorreu de forma domiciliar, por meio de entrevistas realizadas por entrevistadores treinados, em São Paulo e região. Foram coletadas informações sobre a dificuldade de ouvir e entender o que os profissionais de saúde disseram no último serviço de saúde usado, além de dados demográficos (idade, gênero e raça), econômicos (renda do chefe da família), tipo de serviço de saúde procurado, uso de plano privado de saúde e necessidade de auxílio para ir ao serviço de saúde. RESULTADOS: Dos entrevistados, 35% relataram problemas para ouvir e entender os profissionais de saúde no último serviço visitado; 30,6% (IC95%: 23,4-37,8) para entender os médicos; 18,1% (IC95%: 12,0-24,1) para entender as enfermeiras; e 21,2% (IC95%: 14,8-27,6) para entender os outros funcionários. Não houve diferenças quando se considerou as variáveis demográficas, a necessidade de auxílio para tomar banho e se vestir, comer, levantar-se e/ou andar, possuir ou não plano privado de saúde e tipo de serviço de saúde visitado. CONCLUSÃO: Do total de pessoas entrevistadas, 35% relataram problemas para ouvir e entender o que foi dito por profissionais de saúde. Do total que relatou alguma dificuldade, 34,74% tinham deficiência auditiva e 35,38% deficiência múltipla.

Evaluation von Effektivität und Sicherheit der niederfrequenten, transkraniellen Ultraschalltherapie beim Schlaganfall

In den westlichen Ländern nimmt die Zahl der Schlaganfall-Patienten stetig zu und zählt mittlerweilernzu einer der häufigsten Todesursachen. Derzeit ist die Rekanalisationstherapie mit demrnFibrinolytikum rt-PA die einzig zugelassene Therapie. Die Rekanalisationsrate ist oftmals inkomplettrnund aufgrund von möglichen Blutungskomplikationen die Therapie nicht bei allen Patientenrnmöglich. Daher ist es wichtig, Alternativtherapieansätze (z.B. Ultraschallthrombolyse) zurnentwickeln. Blutgerinnsel können mit Hilfe von Ultraschall in Schwingung gebracht und sornlysiert oder die Wirkung von rt-PA verstärkt werden. Die vorliegende Arbeit hatte die Evaluationrnvon Bioeffekten von 60 kHz Ultraschall an gesundem und ischämischem Hirngewebe zum Ziel.rnNeben tierexperimentellen Methoden kamen auch molekular-biologische Techniken zur Anwendung.rnDie erste Studie beschäftigte sich mit der Wirkung von 60 kHz (Intensität: 0,2 W/cm2 undrnDuty Cycle 50%) auf ischämisches Hirngewebe (permanent ischämisch und nach Reperfusion).rnLediglich nach Reperfusion und Ultraschallbehandlung war das Läsionsvolumen signifikantrnerhöht, so dass von einer besonderen Vulnerabilität des Hirngewebes nach Reperfusionrnauszugehen ist (Penumbraschädigung). In der neurologischen Beurteilung der Tiere zeigte sichrnbei allen Tieren mit permanenter Okklusion und etwa einem Drittel der Tiere nach Reperfusionrnund Ultraschallbehandlung eine Hörminderung. In der anschließenden Studie wurde diernUltraschallintensität erniedrigt und der Duty Cycle variiert. In einer publizierten in vitro Studiernkonnte die zunehmende Lyserate mit steigendem Duty Cycle nachgewiesen werden. DiernAuswertung ergab eine Abhängigkeit des Läsionsvolumens von der Länge des Duty Cycles. Derrndritte Teil der Arbeit befasst sich mit der Wirkung von Ultraschall auf die Genexpression. Hierzurnwurden gesunde Ratten mit Ultraschall verschiedener Frequenzen (60 kHz, 488 kHz und 3 MHz)rntranskraniell behandelt und 4 h bzw. 24 h nach der Behandlung getötet. Proben von ischämischenrnTieren dienten als positive Kontrollen. Aufgrund von Literaturrecherchen wurden mehrerernKandidatengene ermittelt. Die Messung der Ischämieproben ergab eine weitgehende Übereinstimmungrnmit der Literatur. Die Messungen an den mit 60 kHz behandelten Proben ergabenrnkaum Anzeichen für eine differenzielle Genregulation. Die Frequenz von 488 kHz zeigte diernmeisten Regulationen, gefolgt von der Behandlung mit 3 MHz. Dieses Ergebnis lässt vermuten,rndass es sich bei den detektierten Veränderungen um protektive Mechanismen handelt, da diesernFrequenzen bislang im Tierversuch als nebenwirkungsarm beschrieben wurden. Die Auswertungrnvon 60 kHz-Proben mit Affymetrix Arrays ergab lediglich einige wenige differentiell regulierternGene. Die Array-Experimente konnten nicht durch qPCR-Messungen bestätigt werden.

Behavioural analysis of mouse mutants with altered neuronal and glial genes

Im ersten Teil dieser Doktorarbeit beabsichtigte meine Arbeit, die funktionelle Beteiligung des CB1 Rezeptors, einer Hauptkomponente des neuronalen Endocannabinoid-Systems (ECS), an der Ausbildung von verschiedenen Verhaltensphänotypen mit Hilfe von konditionalen Mausmutanten, denen der CB1 Rezeptor auf verschiedenen neuronalen Unterpopulationen fehlt, aufzuschlüsseln und zu untersuchen. Verschiedene Verhaltensmodelle wurden hierzu getestet. Dabei lag der Fokus dieser Arbeit auf der CB1f/f;D1-Cre Mauslinie, welche der CB1 Rezeptor auf den D1 Rezeptor exprimierenden Neuronen des Striatums fehlt. Ich konnte zeigen, dass der Verlust des CB1 Rezeptors auf diesen Neuronen keinen Einfluss auf basale neurologische Funktionen, Gewicht, Bewegung, Exploration, Sozialverhalten, Angst und Stressbewältigung der Tiere hat, jedoch eine Beteiligung an der Entwicklung von Suchtverhalten gegeben ist. Bei Betrachtung des Kokain-induzierten Suchtverhaltens zeigten die konditionalen Mausmutanten eine reduzierte Suchtanfälligkeit sowohl im Vergleich zu Tieren mit einem totalen CB1 Rezeptor Verlust in allen Körperzellen, als auch zu genetisch unveränderten Kontrollmäusen beider Linien.rnDes Weiteren zeigen die Ergebnisse dieser Studie eine große, aber gegensätzliche Beteiligung des ECS bei der Regulation von Exploration in Abhängigkeit des Verlustes des CB1 Rezeptors auf GABAergen Neuronen des Vorderhirns und kortikalen glutamatergen Neuronen, jedoch nicht auf striatalen Neuronen alleine. Zusätzlich war ich in der Lage, die Wichtigkeit des genetischen Hintergrunds von Mauslinien nicht nur auf die Ausbildung von spezifischen Verhaltensphänotypen, sondern auch auf die Genexpression zu zeigen.rnIn dem zweiten Teil dieser Arbeit, in dem ich mich auf die Funktion von Gliazellen konzentrierte, wurden ebenfalls Mausmutanten in verschiedenen Verhaltensmodellen getestet. Ein genetisches Auslöschen des NG2 Glykoproteins in Gliazellen sorgt in den Knock-out Mäusen für ein schlechteres Hörvermögen und ein reduziertes Depressionsverhalten im Vergleich zu ihren Wildtyp-Kontrollmäusen. Interessanterweise zeigten diese Tiere auch eine reduzierte Empfänglichkeit bei chemisch induzierten epileptischen Krämpfen, was eine Rolle des NG2 Glykoproteins bei der Kontrolle der glutamatergen Homöostase vorschlägt, die wahrscheinlich durch Strukturänderungen der Neuron-Glia-Synapse verursacht wird. rn

Web Interfaces Destined for People with Disabilities

One of the main characteristics of the world that we live in is the access to information and one of the main ways to reach the information is the Internet. Most Internet sites put accessibility problem on a secondary plan. If we try to define this concept (accessibility) we could say that accessibility it’s a way to offer access to information for the people with disabilities. For example blind people can’t navigate on the Internet like usual people. For that reason Internet sites have to put at their disposal ways to make their content known to this people. Accessibility does not refer only at blind people the web accessibility refers to all people who lost their ability to access the Internet sites. The web accessibility includes every disability that stops people with disabilities to access the web sites content like hearing disability, neurological and cognitive. People that have low speed Internet connection or with low performance computers can use the web accessibility.