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EHDI SYSTEMS IN THE EUROPEAN AREA Ferdinando Grandori European Project AHEAD II Quality of Life Programme – European Commission @polimi.it

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EHDI SYSTEMS IN THE EUROPEAN AREA Ferdinando Grandori European Project AHEAD II Quality of Life Programme European Commission [email protected] Slide 2 EHDI SYSTEMS IN THE EUROPEAN AREA EHDI programs are becoming a major focus in the health care systems of the vast majority of the 15 countries of the European Union (EU) and in the European area at largeEHDI programs are becoming a major focus in the health care systems of the vast majority of the 15 countries of the European Union (EU) and in the European area at large Slowly but steadily EHDI systems are being implemented in an increasing number of European countriesSlowly but steadily EHDI systems are being implemented in an increasing number of European countries Slide 3 Europe Milestones 1993 NIH Consensus Statement 1993 NIH Consensus Statement EC-Biomedical & Health Program - Project on Otoacoustic Emissions (CA-OAE) 1993-95 EC-Biomedical & Health Program - Project on Otoacoustic Emissions (CA-OAE) 1993-95 1995 World Health Organisation 1995 World Health Organisation EC-Biomedical & Health Program - Project AHEAD 1996-99 EC-Biomedical & Health Program - Project AHEAD 1996-99 1998 European Consensus Development Conference 1998 European Consensus Development Conference 1999 AAP Statement 1999 AAP Statement NHS 2000 Conference (October 12-14, 2000) NHS 2000 Conference (October 12-14, 2000) Slide 4 EHDI SYSTEMS IN THE EU Universal Newborn Hearing Screening is rapidly becoming a standard of care .. THOUGH assessment and early intervention are still far from being well established 1 + 3 + 6 10 Slide 5 EHDI SYSTEMS IN THE EUROPEAN AREA IN THE EUROPEAN AREA Methods of universal screening vary from hospital to hospital, for technology (TEOAE, DPOAE, ABR), for criteria and quality standards. Methods of universal screening vary from hospital to hospital, for technology (TEOAE, DPOAE, ABR), for criteria and quality standards. Nearly all recent UNHS programs makes use of AOAEs Nearly all recent UNHS programs makes use of AOAEs Slide 6 OAE-based screening protocol(s) (well-babies) OAE-based screening protocol(s) (well-babies) First OAE test Second OAE test fail pass STOP STOP ABR test fail pass STOP fail REFER Slide 7 Screening protocols for at-risk babies Several hospitals are using different protocols for well-babies and for babies at-risk ABR is used, alone or in combination with OAEs (still risk categories survive.) Slide 8 EHDI SYSTEMS IN THE EUROPEAN AREA The penetration of newborn screening differs greatly from country to country, and within the same country, from area to area The penetration of newborn screening differs greatly from country to country, and within the same country, from area to area About 10% of the newborns in the EU are currently (Feb 2002) screened for hearing About 10% of the newborns in the EU are currently (Feb 2002) screened for hearing Slide 9 EHDI SYSTEMS IN THE EUROPEAN AREA A bottom-up approach was followed in the largest majority of the European countries A bottom-up approach was followed in the largest majority of the European countries Universal hearing screening is mandated - or supported - by the central health authorities, in a number countries, or regions: Austria, Belgium (Flanders), Croatia, Czech Rep., Holland, Hungary, Lithuania, Luxembourg, Netherlands, 3 Laenders in Germany, several Regions of Italy (7 out of 20), 5 Commmunities of Spain Universal hearing screening is mandated - or supported - by the central health authorities, in a number countries, or regions: Austria, Belgium (Flanders), Croatia, Czech Rep., Holland, Hungary, Lithuania, Luxembourg, Netherlands, 3 Laenders in Germany, several Regions of Italy (7 out of 20), 5 Commmunities of Spain In the UK (England) legislation is expected soon (200+ hospitals are just starting) In the UK (England) legislation is expected soon (200+ hospitals are just starting) Slide 10 EHDI SYSTEMS IN THE EUROPEAN AREA Ambitious programs have been implemented in nearly all the other countries of the EU Ambitious programs have been implemented in nearly all the other countries of the EU However, some countries are still well behind such as France, Greece (public hospitals), Norway, Portugal However, some countries are still well behind such as France, Greece (public hospitals), Norway, Portugal In many countries of central and eastern Europe several EHDI programs already exist (Latvia, Romania, Russia, Slovenia) In many countries of central and eastern Europe several EHDI programs already exist (Latvia, Romania, Russia, Slovenia) Slide 11 EHDI SYSTEMS IN THE EUROPEAN AREA Infants hearing screening programs have been in place for many many (15+) years (Denmark, Germany, Hollands, Italy, Sweden, UK) with poor results. Infants hearing screening programs have been in place for many many (15+) years (Denmark, Germany, Hollands, Italy, Sweden, UK) with poor results. It is often more difficult to change mentality/procedures than establish new models.. It is often more difficult to change mentality/procedures than establish new models.. Slide 12 It is often more difficult to change mentality/procedures than establish new models It is often more difficult to change mentality/procedures than establish new models This is very clearly shown by the paradigmatic examples of the Scandinavian/Nordic countries, on the one hand.. This is very clearly shown by the paradigmatic examples of the Scandinavian/Nordic countries, on the one hand.. and on the other hand by central and eastern European countries that have entirely re-designed their health care systems during the past 5 to 10 years. and on the other hand by central and eastern European countries that have entirely re-designed their health care systems during the past 5 to 10 years. Slide 13 Poland (population: 30 mln annual births: 380,000) After about one year of planning, a non-profit Foundation The Great Orchestra of Christmas Charity has funded the start of EHDI programsAfter about one year of planning, a non-profit Foundation The Great Orchestra of Christmas Charity has funded the start of EHDI programs Dr. Jerzy Puzio, Dr. Marzanna Radziszewska, The Childrens Memorial Health Institute, Warsaw, PolandDr. Jerzy Puzio, Dr. Marzanna Radziszewska, The Childrens Memorial Health Institute, Warsaw, Poland 440 maternity departments 46 second level audiological centers 46 second level audiological centers 7 audiological centers for intervention 7 audiological centers for intervention ALL OUR BEST WISHES OF A SUCCESSFUL START Slide 14 EHDI SYSTEMS EHDI SYSTEMS IN THE EUROPEAN AREA Poland 400+ maternity departments 45+ second level audiological centers 45+ second level audiological centers 7 audiological centers for intervention 7 audiological centers for intervention OUR BEST WISHES! Slide 15 Slide 16 EHDI SYSTEMS IN THE EUROPEAN AREA England The National Screening Committee Trial 20 Sites, or Health Districts, incorporating 30+ hospitals The conception was a rather long lasting process, but a national EHDI system is under way now Slide 17 QUALITY STANDARDS OF SCREENING PROTOCOLS Quality standards are still lacking for the various screening protocols. Only very few screening devices have been clinically validated in large scale trials aimed at evaluating the performances of the new automatic algorithms. Slide 18 FUTURE RESEARCH FUTURE RESEARCH optimize screening technologies screening criteria for well- and at-risk babies strategies/technologies for early assessment (particularly methods for diagnostic ABR) strategies for early fitting criteria for implantation in very young infants (how young? bilateral? Brainstem?) Slide 19 FUTURE OF EHDI SYSTEMS IN THE EU FUTURE OF EHDI SYSTEMS IN THE EU Successful implementation of EHDI systems will crucially depend on availability of a new generation of professionals This is not surprising because EHDI systems were an undemanded need (Adrian Davis) Slide 20 Euro-survey: AHEAD II By Steering group F. Grandori (project leader) L. Collet (France) M. Moro (Spain) A. Parving (Denmark) K. Schorn (Germany) I. Uloziene (Lithuania) K. Welzl-Mller (Austria) LAST UPDATE: Nov. 2001 Slide 21 Objectives - to achieve information on: Age at identification of HI childrenAge at identification of HI children Assessment - methodsAssessment - methods Protocols for etiological evaluationProtocols for etiological evaluation National recommendations/guidelines on surveillance programmesNational recommendations/guidelines on surveillance programmes Links to educational systemLinks to educational system Employment of hearing therapists in EHDIEmployment of hearing therapists in EHDI Employment of physicians/audiologists in the educational systemEmployment of physicians/audiologists in the educational system Slide 22 Procedure: 221 questionaires mailed to delegates attending NHS-2000 Milan and to those in our mailing lists221 questionaires mailed to delegates attending NHS-2000 Milan and to those in our mailing lists N = 56 responses returned to A. ParvingN = 56 responses returned to A. Parving Descriptive analysisDescriptive analysis Slide 23 Responses: N=56~27 countries COUNTRYNIsrael3 Austria1Italy5 Belgium2Lithuania1 Croatia1Luxemburg1 Czech Rep. 5Norway2 Denmark2Poland1 England1Romania1 Finland1Slovakia1 France3Slovenia1 Germany1Spain5 Greece2Sweden1 Holland3Switzerland2 Hungary1Turkey1 Ireland2Wales1 Slide 24 Methods for assesment of hearing level/threshold BOA24 VRA25 Peep show 11 Play aud. 35 ECoG7 ABR44 OAE36 Perform: N=51 Slide 25 Time lapse from assesment to HA-fitting N% 1mths 1mths1223.5 2mths 2mths1631.4 3mths 3mths1121.6 Missing data: N=12~23.5% ( poor communication) Slide 26 Screening infancy/childhood YESNOnr Screening < 12 months 44(86.2%)4(7.8%)3(5.8%) Screening at 1-4 years 1-4 years25(49.0%)10(19.6%)16(31.3%) School entrance 31(60.8%)8(15.6%)12(23.5%) Screening later 19(37.2%)11(21.5%)21(41.1%) Slide 27 Habilitation before

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