Outcome of a universal newborn hearing-screening programme based on multiple transient-evoked otoacoustic emissions and clinical brainstem response audiometry

CONCLUSION

This universal newborn hearing-screening (UNHS) programme revealed high efficacy. The proportion of congenital sensorineural hearing loss was higher in left ears and in males than in right ears and females, which was in line with the systematic ear asymmetries and sex differences in transient-evoked otoacoustic emission (TEOAE) pass percentage.

OBJECTIVES

To study the long-term outcome of a UNHS programme based on multiple TEOAEs and clinical click-evoked auditory brainstem response (ABR).

METHOD

The study included all the newborns that were screened during a 6-year period (n = 31 092). TEOAE pass/fail was analysed in detail. In an assessment performed 10 years after the start of the 6-year UNHS, prevalence, degree and type of congenital hearing loss were studied.

RESULTS

The proportion of screened newborns was high, i.e. 98%. Multiple TEOAE recordings minimized the need for clinical ABR. Fifty-seven (0.18%) subjects showed bilateral hearing loss (exceeding ≈ 30 dB HL); median ABR threshold = 60 dB nHL (at 2.5 months of age). Bilateral and unilateral sensorineural hearing loss was found in 0.17% (n = 52; 56% males) and 0.06% (n = 18; 61% left ears, 56% males) of the screened newborns, respectively. Higher TEOAE pass percentages (p < 0.01) were demonstrated in right ears and in females than in left ears and males.

Utilization of health care resources after stroke. A population-based study of 258 hospitalized cases followed during the first year

In a prospective population-based study the cumulative utilization of health care resources (and the rehabilitation outcome) was followed in consecutive stroke patients 3, 6 and 12 months after the onset of the disease. The study group comprised 258 patients diseased during the period February 1st 1986-January 31th 1987. The pattern of various forms of hospital beds and non-hospital facilities in open care utilized during the first post-stroke year was analysed at 1986 year's cost level. The mean utilization of acute hospital beds during the initial phase was 15 days; at an expenditure cost of 26,670 SEK ($3,683). The mean utilization of acute hospital and of geriatric beds during the first year was 19 and 59 days respectively. Thus the total hospital bed days amounted to a mean of 78 days; at a mean expenditure of 87,0000 SEK ($12,000); 70% of the patients were discharged from hospital care to independent living after 36 days. The acute care hospital provided 36% and geriatric care 64% of the beds needed before discharge. The expenditure of non-hospital facilities was mean 19,000 SEK ($2600); thus total expenditure for health care amounted to 106,000 SEK ($14,600). The relation between non-hospital and hospital care was approximately 1 to 5. Severity of the stroke influenced markedly the pattern and the total utilization of both hospital and non-hospital care. Patients with major stroke utilized health care resources at an expenditure 3.5 times that used by patients with minor stroke. Age of the patient also influenced health care utilization.(ABSTRACT TRUNCATED AT 250 WORDS)

Rehabilitation and achieved health quality after stroke. A population-based study of 258 hospitalized cases followed for one year

In a prospective population-based study rehabilitation outcome and achieved health quality was followed in consecutive hospitalized stroke patients after 3, 6 and 12 months. The study group comprised 258 patients (125 men and 133 women) admitted during the period February 1st 1986-January 31st 1987. Most (76%) had major stroke and 24% had minor stroke. Stroke occurred predominantly among the elderly; 74% were greater than or equal to 70 years and 38% greater than or equal to 80 years. The case-fatality rate was 11% during the acute phase and 27% after one year. Of all patients 49% returned to their own homes, 2% moved into an old people's home and 38% were referred to institutions. Age of the patient and severity of the stroke influenced on the survival rates and on the discharge pattern. The amount of patients living in their own homes increased steadily with time. At discharge and after 3, 6 and 12 months 49, 54, 58, 56% of all patients and 54, 66, 73 and 77% of the survivors respectively were living at home, whereas 38, 22, 15 and 10% of all patients and 43, 27, 19 and 14% of the survivors were in institutions at the corresponding time periods. The remaining survivors were living in an old people's home. The major recovery of functional ability occurred within the first 3-6 months. At 3, 6 and 12 months 80, 82 and 81% of the surviving patients were able to walk indoors independently.

Survival following stroke. A prospective population-based study of 438 hospitalized cases with prediction according to subtype, severity and age

In a prospective population-based study analyses were performed to estimate the survival prognosis following stroke, in relation to age of the patient as well as to subtype, severity and occurrence of the stroke diagnosis. The statistical technique of stepwise regression analysis was used to discriminate the isolated importance of these factors on survival outcome. A total of 438 patients, consecutively admitted to the Department of Neurology during the period Feb. 1st 1986-September 30th 1987 were followed 15 days, 3, 6, and 12 months after the acute stroke. The one-year survival rate was 75% compared with 93% for a control group matched for age, sex, residence and calendar year. Mortality after stroke occurred predominantly within the first 3 months, after 3 months survival prognosis was no different from that of the general population. Statistical analysis identified 2 factors that gave significant isolated prediction on survival outcome. These factors were in order of importance age and severity of stroke diagnosis, whereas sex, subtype and occurrence of stroke were of no discriminative value.

Outcome after stroke in patients discharged to independent living

In a prospective, population-based study, we evaluated rehabilitation outcome, place of residence, and functional ability 3, 6, and 12 months after stroke onset in 129 consecutive patients discharged from the hospital to independent living, either in their own homes or in an old people's home. The study group comprised 50% of all patients admitted for acute stroke between February 1, 1986, and January 31, 1987. Of the 129 patients, 125 returned to their own homes and four moved into an old people's home. Once they returned home, only minor changes occurred in the patients' place of residence or functional capacity. The majority of the patients (90%) were still living in their own homes after 12 months; 99% could walk independently indoors, 92-95% could climb a staircase, and 90% could manage their daily hygiene. Eight patients (6%) died during follow-up, and one fourth of the patients were hospitalized again. The average number of days of rehospitalization during the 12 months was 23. Our study may serve as a guide to the planning of stroke programs and to a more effective and efficient use of available health resources.