The objective of this work was to determine the factors associated with hearing loss in NHSEI program. Methods: Analytical cross-sectional study was performed. The variables were: age from one to 28 days, sex, gestational age and perinatal history. Data was analyzed with descriptive statistics and binary logistic regression. El objetivo de este trabajo fue determinar los factores asociados a hipoacusia en neonatos, basados en el programa TANIT. Keywords: Hearing loss; Newborn infant; Straining.
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Medwave se preocupa por su privacidad y la seguridad de sus datos personales. Palabras clave: universal newborn hearing screening program, parental knowledge, qualitative research. This study describes the process of the program from the epistemological perspective of women whose children participated in the program, evaluating it under the sustenance of the constructivist-respondent model in search of aspects that could help explain its results.
We elected the 14 women who participated in the study through trial and number until theoretical saturation. After signing an informed consent form and respecting the confidentiality and anonymity, these women underwent semi-structured interviews that were audio-recorded and transcribed as were conducted.
The researchers separately analyzed and coded categories and conjointly summarized categories and subcategories. Validity and reliability were obtained through the credibility, transferability and triangulation.
RESULTS From the speeches, we obtained the general profile of the interviewed, evolution of their children in the program process and four categories with 15 subcategories related to the reconstruction of the process: knowledge, needs, feelings and attitudes. One was evaluated as favorable, six without agreement and eight as unfavorable. The latter refer to our own context. Attention from public policies could improve this feature.
With the establishment of the program, children with deafness are diagnosed and treated at a lower age than before the program.
The creation of universal neonatal hearing screening programs started in developed countries between and Also, there are five diagnostic confirming units, and eight surgical treatment units. In the states of the Mexican Republic, almost maternal-infantile hospitals from the Health Secretariat, and 49 diagnostic medical units were considered for the inform. The published results, contrasting the objectives and the indicators percentage of infants screened, diagnosed, and treated showed a low coverage as well as inconsistencies in the information  ,  ; and at the moment, the reports on those activities are only available through journalist notes and a few published articles  ,  , .
The activity of evaluating programs and systems started in the United States 50 years ago in the areas of work training and education, and later in some health programs addictions, family planning, reproductive health, and recently, public health .
In general, the evaluation consists in making judgments about the object, situation or process but these should be systematic and should use procedures which can guarantee the validity and reliability with methods used for social research .
The constructivist-respondent assessment model proposed by E. Guba and I. Lincoln in belongs to the 4th generation of evaluative models.
It has a qualitative approach and follows a paradigm with an ontology that presents the reality by means of multiple mental constructions based on the social experience and local nature which can be shared by different individuals and cultures. It has a transactional and subjectivist epistemology links the researchers with the objects of study.
The findings are built as a result of the research advancing; and its methodology is characterized by being: holistic — the study of the reality from a global perspective; inductive — the categories, patterns, and interpretations are based on the data obtained from the participants, and not from previous theories or hypotheses; and ideographic — the interpretation of social phenomena is based on hermeneutical and dialectical tools.
Its social and individual constructions are variables produced and refined through the interaction among the researchers and the objects of study. Young, A. This study was carried out with the objective of qualitatively assessing this global process from the parental perspective, looking for aspects which could help explain its results.
The model used was the constructivist-respondent. Also, a quantitative analysis of the characteristics of the participants, and the evolution of their infants in any or all four program stages was carried out. Design This is a mixed study in which the qualitative focus is based on the constructivist-respondent evaluative model of Guba and Lincoln, and the quantitative aspect is based on the description of demographic characteristics of the participants and the evolution of their infants during the program.
The participants were selected by convenience  with an informant profile based on the following criteria: women whose children were born in or later in any of the child and maternal hospitals included in the Neonatal Hearing Screening Program, or who were included in any of the stages of this program. The number of interviewed was determined according to the theoretical saturation criteria . The main researcher has a year experience on the topic which includes theoretical and practical knowledge related to the programs of hearing screening.
The relation with the participants was respectful allowing freedom to express any emotions. Considering that the process of the program is carried out in different medical units, it was necessary to visit several of them in the City of Mexico upon authorization of the corresponding personnel responsible of the audiology areas and screening procedures of two maternal-child hospitals, one general hospital, and an institute of third level of attention belonging to the Health Secretariat.
With the informed-consents, we visited the waiting wards, the screening rooms, and the language therapy rooms. Fourteen women were semi-structurally interviewed through a guide without a specific order. Each interview lasted approximately minutes. The interviews were performed between August and March All interviews were recorded and transcribed as expressed EMIC.
The participants who were taking their infants to language therapy had the opportunity to confirm or rejected their statements ETIC. Separately, each researcher carried out a latent content analysis in order to identify, code, and categorize primary patterns related to process of the program.
Alphabet letters were used to ensure the participants anonymity, confidentiality, and privacy. Categories and sub-categories were tagged according to respondent model in: problems — when there was not an agreement among the interviewed in relation to some aspects of the process; worries — when the aspects were assessed as not favorable; and agreements when the aspects were considered favorable.
Descriptive statistics were used to analyze and present the demographic profile of the 14 women interviewed. The hospitals were they were attended are located in the state of Mexico 6 , other states 4 , and the City of Mexico 4.
Table 1. General profile of the fourteen participants of the qualitative assessment related to the evaluating research on the process of the Program of Neonatal Hearing Screening. The data related to the infants were: age at the moment of this study: between one month and four years, average 1.
See Table 2. Table 2. General profile of the evolution if the infants participating in the process of the Program of Neonatal Hearing Screening.
The qualitative analysis of the constructions made from the parental perspective about the process of the program of hearing screening, under the assessment criteria of the constructivist model, showed the emergence of four categories: knowledge, necessities, feelings, and attitudes, with three, seven, three, and two sub-categories respectively, seven corresponding to hearing screening stage, one to the diagnosis, four to the treatment, and three to the general program.
From the total, eight were organized as unfavorable worries where five correspond to the screening stage, and two to the treatment stage, these last related to our context in Mexico. All this is shown in Table 3. Table 3. Categories and sub-categories aspects about the process of the Neonatal Hearing Screening Program. The category Knowledge included 3 sub-categories, the first linked to knowledge obtained from the information given to the interviewed about what is the neonatal hearing screening and its sequence.
The results showed lack of agreement because some said having received complete information with brochures and chats in some hospitals of the City of Mexico and the state of Mexico, but others were not informed, a situation which even resulted in their infants not being screened:. The second sub-category did not have agreement either. It was related to the knowledge of what is the hearing screening.
The information was given in special rooms, but only to some of them, the others just received instructions that the screening was to be performed. The third was related to the lack of knowledge on the conditions in which the infant should come to the hearing screening.
This was considered unfavorable because none of the informants were given information on the issue. During the procedure, the babies become nervous because their ears are covered. The procedure lasts about 10 to 15 minutes if they are docile. They explain you how to manage the baby. The second category was Necessities.
Seven sub-categories were identified; six were linked, one to the program, three with the screening procedure, and three with the treatment.
The first is concerned to the need of the hearing screening program in other hospitals and locations. The related issues to hearing screening practice were: the necessity to widen the age of screening because of the indication which some received that the procedure should be performed in the 4th or 5th day after being born. Some interviewed commented that they were hospitalized for diverse causes, but that they did not receive the screening. The sub-categories related to the treatment were: the need to widen the language therapy service, and also increase it in frequency and duration.
The objective is that she speaks. The prosthetic treatment was also regarded. They mentioned that there is a need to have economical support for all children to obtain their audition devices and cochlear implants, and that some are simply more fortunate than others. The third category was Feelings, and it included three sub-categories involved with feelings towards the results of the screenings and diagnoses.
The first was linked to the explanation of the screening results. It generated feelings of anguish, anxiety and desperation. The second was linked to positive feelings in some interviewed when they were told about the advantages of the screening confidence and security , but then negative feelings due to the explanation of the results.
The third sub-category is about the impact of a definitive diagnosis result, and it reflected negative feelings such as blame, pain, and lack of hope. The fourth category was Attitudes and it included two sub-categories, the first one reflecting the program in general without agreement and some interviewed considered it as good, but others considered that the medical personnel is insensible while giving the results.
The second sub-category reflects the results of the treatments in the final stage of the process. It was assessed as favorable in front of the results of the language development and the behavior changes in the children.
Few studies have included the experience of the parents indirect beneficiaries of programs like this in an evaluation, which critically describe the programs and the practice of the hearing screening . Fortunately, the vision of the parents has been considered as an epistemological contribution. It is also recognized that few are the assessing studies based on a qualitative-focused model . Taking in consideration the obtained results in the present research, which was developed within the ontological, epistemological, and methodological criteria of the constructivist-respondent assessing model, we obtained a global view of the process of the program of neonatal hearing screening and early intervention, which corresponds to its holistic character.
Methodologically, the categories, patterns, and interpretations were built upon the discourses of the interviews, which in turn were derived and refined hermeneutically and dialectically between the responsible researcher and the participants.
The findings were credited as the result of the interaction between the evaluator and the evaluated object. Three sub-categories of this stage were assessed as necessities, the limited age of the baby for the screening only in the first week and the problems related to the handling of the equipment, and the unclear explanations of the results.
These situations provoked contrasted feelings because, while some participants had good results, others became confused and even abandoned the sequence of the program, delaying the diagnosis and treatments.
In the diagnosis stage, only negative feelings that always accompany these cases were identified, reflects a need of more support from the health personnel . The treatment stage is related with the necessities to acquire de hearing devices, and the low coverage of language therapy services in our country. The general opinion of the program was contradictory and depended on the obtained results .
The unfavorable results in the sub-categories of the screening stage can be influencing the low coverage of the program, the lack of knowledge, the failures in the practice, the confusion, and also the limited time to carry out the screenings, all these delay the process towards an early diagnosis and treatment, which was found to be unequal in terms of support opportunities; and considering also the difficulties to have an adequate language therapy service, all these provoke that children lose opportunities to receive proper treatments including cochlear implants just for being too old.
The profiles of the interviewed told us about the territorial diversity in the practice of the hearing screening, while the chronological analysis of the children indicated that the age for diagnosis and treatment initiation has somewhat improved, but not enough to achieve the international standards in the universal neonatal hearing screening . In fact, before these programs, children were first assessed at 3 or 4 years old  , .
In the City of Mexico, in , the detection of auditory incapacity, in relatively marginalized populations was at 2.
Consenso Latinoamericano sobre el Tamiz Auditivo Neonatal
The evaluation of social programs was launched internationally in the decade of in education, and later on spread into other areas, including health. In the last 50 years, it has been qualitative. The universal Program of N Full description.
Early Hearing Detection and Intervention (EHDI) in Latin America
Medwave se preocupa por su privacidad y la seguridad de sus datos personales. Palabras clave: universal newborn hearing screening program, parental knowledge, qualitative research. A ellas, previa firma de consentimiento informado, respetando la confidencialidad y anonimato; se les aplicaron entrevistas semi estructuradas. Estas fueron audio grabadas y transcritas tal como se expresaron. El modelo evaluativo constructivista respondente, propuesto en por E. Guba e I.
Tamiz auditivo neonatal e intervención temprana: documento de postura