HEALTH

Clinician develops new hearing aid adjustment program

BY Michael Johnsen

COLUMBIA, Mo. — More than half of older adults have some form of hearing loss, impacting everyday life and significantly affecting their health and safety if left untreated.

Hearing aids are the most common treatment for hearing loss; however, many adults fail to adjust to hearing aids and, as a result, stop using them. Now, a new hearing aid adjustment program created by Kari Lane, assistant professor in the Sinclair School of Nursing at the University of Missouri, might significantly improve hearing aid wear time among older adults.

"Often, when older adults start using a hearing aid, everything is overwhelming," Lane said. "They can't tolerate the noise, or they can't adjust to it. Older adults tend to wait 10 to 15 years before trying a hearing aid for the first time. When they do put it on, they are bombarded with sounds they haven't heard in a while."

To help adults adjust to hearing aid use, Lane developed the Hearing Aid Reintroduction (HEAR) program. HEAR is a systematically gradual method to support adjustment to hearing aids. With HEAR intervention, the duration of hearing aid use increases slowly from one hour on day one to 10 hours on day 30. In addition, sound complexity also increases, beginning with sounds the house makes such as fans and the dishwasher to complex listening situations such as a restaurant or theater. The intervention currently is supported through a workbook that provides instructions, tips and encouragement. Patients are able to record their progress in a journal as well as questions or concerns for their audiologist.

To test the success of the HEAR intervention, Lane enlisted individuals who have previously tried hearing aids but failed to adjust and those who were trying hearing aids for the first time.

"We found an 80% increase in patients' hearing aid wear time due to the intervention," Lane said. "The patients also were able to tolerate more complex noises and reported more satisfaction with their hearing aids."

This data will be used to help Lane create a complementary app, which will allow patients and audiologists to communicate more effectively regarding hearing aid use. Patients will be able to input their progress, which will be saved to their digital health records for their audiologist to view. In turn, the audiologist will be able to answer questions and send encouragement.

"Patients may not be aware of how many times they need to visit their audiologist," Lane said. "Many patients only meet with their audiologist twice, but they need to meet with them as many as eight times when first receiving a hearing aid. That may be why many patients give up on their hearing aids. Communicating with an audiologist through an app may ease that."

The study, "Older Adults and Hearing Aids," recently was published in the Journal of Phonetics and Audiology.

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Vast majority of pregnant women lack optimal nutrition in their diet

BY Michael Johnsen

PITTSBURGH — Women who are pregnant are not likely to have a diet optimal to that pregnancy, according to a study published Friday in the Journal of the Academy of Nutrition and Dietetics and led by the University of Pittsburgh Graduate School of Public Health.

Many healthy maternal diets have been linked to reduced risks of preterm birth, fetal growth restriction, preeclampsia and maternal obesity.

"Unlike many other pregnancy and birth risk factors, diet is something we can improve," stated lead author Lisa Bodnar, associate professor and vice chair of research in Pitt Public Health's Department of Epidemiology. "While attention should be given to improving nutritional counseling at doctor appointments, overarching societal and policy changes that help women to make healthy dietary choices may be more effective and efficient."

Bodnar and her colleagues analyzed the results of questionnaires completed by 7,511 women who were between six and 14 weeks pregnant and enrolled in The Nulliparous Pregnancy Outcomes Study: Monitoring Mothers to Be, which followed women who enrolled in the study at one of eight U.S. medical centers.

The women reported on their dietary habits during the three months around conception.

The diets were assessed using the Healthy Eating Index-2010, which measures 12 key aspects of diet quality, including adequacy of intake for key food groups, as well as intake of refined grains, salt and empty calories (all calories from solid fats and sugars, plus calories from alcohol beyond a moderate level).  When scores were broken down into the 12 aspects of diet, fewer than 10% of the women met the dietary guideline for the whole grains, fatty acids, sodium or empty calories categories.

Approximately 34% of the calories the women consumed were from empty calories. Top sources of energy were sugar-sweetened beverages, pasta dishes and grain desserts.

"Our findings mirror national nutrition and dietary trends," Bodnar suggested. "The diet quality gap among non-pregnant people is thought to be a consequence of many factors, including access to and price of healthy foods, knowledge of a healthy diet and pressing needs that may take priority over a healthy diet," she said. "Future research needs to determine if improving pre-pregnancy diet leads to better pregnancy and birth outcomes. If so, then we need to explore and test ways to improve the diets for everyone, particularly women likely to become pregnant."
 

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Vitamin D deficiency cripples elite athletes, study finds

BY Michael Johnsen

SAN DIEGO — More than half of college football athletes participating in the NFL Combine had inadequate levels of vitamin D, and this left them more susceptible to muscle injuries, according to a study at Hospital for Special Surgery.

"Vitamin D has been shown to play a role in muscle function and strength," stated Scott Rodeo, senior investigator and co-chief emeritus of the Sports Medicine and Shoulder Service at HSS. "While most prior studies have focused on the aging population as the group most likely to experience the harmful effects of inadequate vitamin D, few reports have looked at the impact on muscle injury and function in the high performance athlete."

Rodeo and colleagues set out to determine if there was a relationship between serum vitamin D levels and lower extremity muscle strains and core muscle injury, or "sports hernia," in college football players. The study included athletes participating in the National Football League Scouting Combine, where coaches, general managers and scouts evaluate top college football players hoping to make it into the big leagues.  

The study, presented at the American Academy of Orthopaedic Surgeons Annual Meeting on March 16, included 214 college athletes who took part in the 2015 combine. Baseline data was collected, including age, body mass index, injury history and whether they had missed any games due to a lower extremity muscle strain or core muscle injury.  

The average age of the athletes was 22. Their vitamin D levels were determined with a blood test. A total of 126 players (59%) were found to have an abnormal serum vitamin D level, including 22 athletes (10%) with a severe deficiency.  Researchers found a significantly higher prevalence of lower extremity muscle strain and core muscle injury in those who had low vitamin D levels. Fourteen study participants reported missing at least one game due to a strain injury, and 86% of those players were found to have inadequate vitamin D levels.

"Our primary finding is that NFL combine athletes at greatest risk for lower extremity muscle strain or core muscle injury had lower levels of vitamin D. This could be related to physiologic changes that occur to muscle composition in deficient states," Rodeo explained. "Awareness of the potential for vitamin D inadequacy could lead to early recognition of the problem in certain athletes. This could allow for supplementation to bring levels up to normal and potentially prevent future injury."

While the findings are significant for high performing athletes, there may be a message for the general population as well, according to Rodeo. Adequate vitamin D is essential for musculoskeletal structure, function and strength. But by some estimates, more than 40% of the U.S. population is deficient in vitamin D.

Sometimes called the "sunshine vitamin," it is produced by the skin when exposed to sunlight. Sun avoidance and the use of sunscreen may in part account for low vitamin D levels in the population. Milk and fortified foods, including orange juice and some cereals, can also provide vitamin D, but one would need to consume a large amount of these foods. When individuals are found to have a deficiency, vitamin D supplements are usually recommended.

"Although our study looked at high performance athletes, it's probably a good idea for anyone engaging in athletic activities to give some thought to vitamin D," Rodeo said. "Indeed, adequate levels of vitamin D are important to maintain good muscle and bone health in people of all ages."

 

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