Browsing by Author "Tucci, Debara"
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Item Open Access Geographic and Racial Disparities in Infant Hearing Loss.(Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 2018-10-09) Lantos, Paul M; Maradiaga-Panayotti, Gabriela; Barber, Xavier; Raynor, Eileen; Tucci, Debara; Hoffman, Kate; Permar, Sallie R; Jackson, Pearce; Hughes, Brenna L; Kind, Amy; Swamy, Geeta KObjective Approximately 1 to 2 of every 1000 American newborns has hearing loss identified by newborn screening. This study was designed to determine if infant hearing loss is more common in socioeconomically disadvantaged communities. Study Design In this retrospective study, we analyzed electronic medical record data using geostatistical models. Setting Infants were residents of Durham County, North Carolina, born in 2 hospitals of the Duke University Health System. This county includes the city of Durham and surrounding suburban and rural communities. Subjects and Methods Subjects were hearing-screened newborns, born between 2005 and 2016, whose residential address was in Durham County, North Carolina. This was a retrospective study using medical record data. We used Bayesian regression models with smoothing of coordinate date to identify both spatial and nonspatial predictors of infant hearing loss. Results We identified 19,348 infants from Durham County, of whom 675 had failed initial hearing screening and 191 had hearing loss confirmed on follow-up. Hearing loss was significantly associated with minority race (odds ratio [OR], 2.45; 95% confidence interval, 1.97-3.06), as well as lower gestational age and maternal sexually transmitted infections. We identified significant geographic heterogeneity, with a higher probability of hearing loss in poorer urban neighborhoods (local OR range, 0.59-1.39). Neighborhood disadvantage was a significant predictor of hearing loss, as was high local seroprevalence of cytomegalovirus (CMV) among pregnant women. Conclusions Urban, low-income neighborhoods have a high prevalence of infant hearing loss compared with more affluent surrounding communities, particularly among minorities. This distribution may be attributable to congenital CMV infection.Item Open Access Strategies to Scale-Up Global Access and Uptake of Hearing Screening: A Systematic Review(2023-04-18) Cionfolo, HaleyI. ABSTRACT Introduction: Although interventions to address hearing loss exist, access is inequitably distributed across geographic, socioeconomic, and racial axes globally. We sought to determine which scale-up strategies could be useful to bolster the uptake of hearing screening to reduce the global burden of hearing loss. We then provide targeted policy recommendations to aid the implementation of these strategies. Methods: After evaluating articles from five databases using our inclusion/exclusion criteria, we extracted qualitative and statistical evidence related to the uptake of neonatal, child, and adult hearing screening (NHS, CHS, and AHS), specifically their use, adherence, and satisfaction. Two reviewers independently assessed article quality using the Mixed Methods Appraisal Tool (2018). We then categorized and compared the success of interventions. Results: Of the 225 articles screened, 29 studies fit our inclusion criteria. Of the 29 articles, 18 describe findings targeting NHS scale-up interventions, five CHS, four AHS, one NHS/CHS, and one CHS/AHS. Interventions assessed were educational (n=3), policy and systemic (n=3), telehealth (n=2), financial and funding (n=2), expanded screening (n=6), and restructured screening programs (n=7). The evidence from these articles suggests that restructure screening programs, the most documented intervention type, could be the most effective in increasing uptake generally and across HIC and UMIC settings, with no null results. Discussion: We recommend policies and interventions that restructure screening programs or expand their reach as strong options to allocate resources toward in both high- and low-resource settings, relative to existing intervention types previously attempted. More research pertaining to scale-up, especially in lower-income settings, is necessary, however, to make the most appropriate recommendations.