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Introduction: There is a substantial discrepancy between international and local prevalence rates for speech, language and communication needs (SLCN) amongst children in New Zealand. Reports of communication impairment are likely to be underestimates. Prevalence data can describe population characteristics and inform the scope and nature of services to adequately meet demand. Parents and other caregivers are central to the early identification of children with communication needs but they may not recognise their child's needs or act on their concerns., Method: Cross-sectional data were available for the Growing Up in New Zealand (GUiNZ) longitudinal study cohort at 24, 54 and 72 months of age, with 76% of whānau (families; n = 5241) completing three data waves. Descriptive and chi-square analyses were used to address: (1) What are the communication abilities of children in the first 5 years of life? (2) What do New Zealand parents understand of their children's communication? (3) Do New Zealand parents have concerns? (4) What are the trajectories of parental concern for children's communication in the first 6 years of life?, Results: At 24 months old, 16% of children had communication skills that were of concern to their parents. At 54 months, there were concerns for 12.6% of children. Although most parents were able to describe their child's expressive abilities, many parents remained unconcerned when their child demonstrated communication skills that did not met developmental expectations., Conclusion: Parents can offer valuable insights about their children, but in many cases their level of concern about SLCN did not align with a professional view which reflects a more nuanced understanding of children's speech and language and the impact on future communication skills and needs. Increased awareness through public health messaging specifically regarding lifelong influences of communication challenges will aid in prevention, early detection and intervention., What This Paper Adds: What is already known on this subject Parent's expectations of child speech and language development will inform how responsive they are to difficulties in their child. Appropriate parental concern is key to recognition of children with speech, language and communication needs that warrant referral to a professional. What this paper adds to existing knowledge Parents are aware of expressive language skills that children acquire and can accurately identify their children's skills but have less knowledge of the ages of acquisition. Some parents are not concerned, do not seek support despite recognisable difficulties, and demonstrate limited understanding of the future consequences for children with communication needs that are unmet. What are the potential or actual clinical implications of this work? Public health messaging should include both skills and age ranges for speech and language acquisition. Additionally, educating the public of the impact of speech, language and communication skills on children's futures is needed., (© 2024 The Authors. International Journal of Language & Communication Disorders published by John Wiley & Sons Ltd on behalf of Royal College of Speech and Language Therapists.)

Aim: Insertion of ventilation tubes (VTs) is a common surgical treatment for recurrent and persistent otitis media, but surgical practice varies internationally. The current study explored variations in practice within New Zealand by examining VT insertion rates. The aim of the study was to determine time trends and current variations in VT insertion rates by ethnicity and district health board (DHB), with a focus on comparison of two DHBs in Auckland (Counties Manukau and Auckland DHB) to national average data., Method: Data for surgical procedures were analysed in the Atlas of Healthcare Variation domain, available via the Health Quality & Safety Commission website. Publicly funded events for New Zealand residents over a 10-year period (2009-2018) were examined for 0-4-year-olds. Individuals were assigned to their DHB of residence. VT rates for each DHB are presented per 1,000 population, with upper and lower confidence intervals calculated to the 95% level., Results: There was a general decline in the rates of VT insertions for the 0-4-year-olds over the 2009-2018 decade. Analysis of the 2018 year showed variation by ethnicity and DHB. In CMDHB, ADHB and nationally, Asian and Pacific ethnic groups had the lowest rates of VT insertions compared to other ethnic groups. In CMDHB, the VT rates for Māori, Pacific and Asian children were less than half that of their respective groups in ADHB. The NZ European/Other ethnic group had the highest rates of VT insertions in CMDHB and nationally, but in ADHB, the rate for the NZ European/Other group was similar to that for Māori., Conclusion: These results are incongruent with evidence that Māori and Pacific children in New Zealand experience a greater burden of middle ear disease than NZ European children. The finding of persisting inequities in VT treatment for middle ear disease in 0-4-year-olds, with greatest impact on Pacific children, suggests that there may be a need for targeted middle ear screening for preschool children to detect pre-schoolers with ear disease, earlier than the 4-year-old B4 School Check., Competing Interests: Nil.

Aim: Childhood visual impairment has a life-long impact that, with early access to eyecare, is largely avoidable. We aimed to understand visual impairment and its correction among Pacific youth in Aotearoa New Zealand., Method: The Pacific Islands Families Study is a birth cohort study that tracks an original sample of 1,398 Pacific children born at Middlemore Hospital (Auckland). This analysis focuses on assessed visual acuity (at 9- and 18-years, using 0.3logMAR or 6/12 as the cut-off for visual impairment) and participants' self-reports about accessing eyecare services., Results: Less than a fifth of children (111/729, 15.2%) and teens (86/457, 18.8%) reported having sought eyecare. The percentage of participants with refractive correction was 3.6% (32/887) at 9-years and 14.3% (66/463) at 18-years. At 9-years, 1.9% of children (16/853) had visual impairment in one eye only, and 0.9% (8/853) had visual impairment impacting both eyes. By 18-years these values increased to 7.9% (36/456) and 4.2% (19/456), respectively. Among those with visual impairment, most children (15/24, 62.5%) and teens (32/55, 58.2%) reported they did not have refractive correction., Conclusion: Although prevalence of visual impairment is relatively low compared to non-Pacific youth, much of the reported impairment appears to be avoidable with improved eyecare., Competing Interests: Dr Tautolo, Dr Purdy, Dr Johnson, Dr Garrett and Dr Iusitini report grants from Health Research Council of New Zealand during the conduct of the study. Dr Tautolo and Dr Iusitini report grants from the Foundation for Research, Science and Technology during the conduct of the study. Dr Purdy reports other grants from University of Auckland during the conduct of the study.

Importance: Individuals with mental disorders are at an elevated risk of developing chronic age-related physical diseases. However, it is not clear whether psychopathology is also associated with processes of accelerated aging that precede the onset of age-related disease., Objective: To test the hypothesis that a history of psychopathology is associated with indicators of accelerated aging at midlife., Design, Setting, and Participants: This prospective cohort study was based on the Dunedin Multidisciplinary Health and Development Study, a population-representative birth cohort of 1037 individuals born between April 1, 1972, and March 31, 1973, in Dunedin, New Zealand. Members were followed up to age 45 years (until April 2019). Data were analyzed from January 6 to December 7, 2020., Exposures: Mental disorders were assessed in 6 diagnostic assessments from ages 18 to 45 years and transformed through confirmatory factor analysis into continuous measures of general psychopathology (p-factor) and dimensions of internalizing, externalizing, and thought disorders (all standardized to a mean [SD] of 100 [15])., Main Outcomes and Measures: Signs of aging (biological pace of aging; declines in sensory, motor, and cognitive functioning; and facial age) were assessed up to age 45 years using previously validated measures including biomarkers, clinical tests, and self-reports., Results: Of the original 1037 cohort participants, 997 were still alive at age 45 years, of whom 938 (94%) were assessed (474 men [50.5%]). Participants who had experienced more psychopathology exhibited a faster pace of biological aging (β, 0.27; 95% CI, 0.21-0.33; P < .01); experienced more difficulties with hearing (β, 0.18; 95% CI, 0.12-0.24; P < .01), vision (β, 0.08; 95% CI, 0.01-0.14; P < .05), balance (β, 0.20; 95% CI, 0.14-0.26; P < .01), and motor functioning (β, 0.19; 95% CI, 0.12-0.25; P < .01); experienced more cognitive difficulties (β, 0.24; 95% CI, 0.18-0.31; P < .01); and were rated as looking older (β, 0.20; 95% CI, 0.14-0.26; P < .01). Associations persisted after controlling for sex, childhood health indicators, maltreatment, and socioeconomic status and after taking into account being overweight, smoking, use of antipsychotic medication, and the presence of physical disease. Tests of diagnostic specificity revealed that associations were generalizable across externalizing, internalizing, and thought disorders., Conclusions and Relevance: In this cohort study, a history of psychopathology was associated with accelerated aging at midlife, years before the typical onset of age-related diseases. This link is not specific to any particular disorder family but generalizes across disorders. Prevention of psychopathology and monitoring of individuals with mental disorders for signs of accelerated aging may have the potential to reduce health inequalities and extend healthy lives.

Objectives: In New Zealand (NZ), permanent hearing loss is associated with higher levels of socioeconomic deprivation, and is more prevalent amongst Māori and Pacific than NZ European children. Many of these hearing losses are detected through newborn hearing screening, however there is a need to screen children again later, to look for childhood hearing losses that are either late-onset, progressive, or acquired. This study evaluated the feasibility of implementing an objective screening protocol that includes otoscopy, distortion product otoacoustic emission screening (DPOAEs), and tympanometry. It also evaluated the feasibility of using Early Learning Centres (ELCs) to contact families, recruit, and test 3-year-old children from an area of high socioeconomic deprivation in Auckland, New Zealand., Methods: Sixty-one 3-year-old children were recruited from ELCs within the Counties Manukau District Health Board (CMDHB) region which services the geographical area of South Auckland. The first part of the screening protocol consisted of otoscopy, DPOAEs, and tympanometry. Children identified with hearing loss and/or middle ear problems were either referred directly to Otolaryngology/Audiology at the local hospital or invited back for a re-screen 4-8 weeks later. Children who were referred from the screening were followed up to track and document their subsequent clinical pathway through the public health system., Results: Mean overall time for the screening protocol was 4.1 minutes. The combination of otoscopy, DPOAEs, and tympanometry was well accepted by the 3-year-old children. DPOAE amplitude and signal-to-noise ratio results significantly differentiated between different tympanometry results, providing support for this combination of measures to accurately screen for hearing loss and/or middle ear disease. Thirty-eight of the 61 children (62%) passed the screening protocol. Of the remaining 23 children, five were referred to the hospital after not passing the screening, but following more in-depth audiological testing, were discharged with normal hearing. Six children referred to the hospital were diagnosed with varying degrees of conductive hearing loss, and two of the six received grommet insertion surgery. The remaining 12 children who were referred to the hospital were lost to follow-up, highlighting challenges for the families to successfully navigate the current public health system., Conclusion: This study demonstrates that identifying hearing loss and ear disease in 3-year-old children in the pre-school setting is feasible. A number of barriers were identified in the current health system that contribute to a large proportion of children referred with suspected hearing loss and ear disease being unsuccessful in accessing Otolaryngology/Audiology clinical care through the local hospital., (Copyright © 2020. Published by Elsevier B.V.)

Purpose The current study was designed to investigate the differences in language input related to family factors (maternal level of education [MLE] and socioeconomic level of deprivation [SLD]) and their association with language outcomes in preschoolers. Method This study used New Zealand SLD and MLE classification systems to examine differences in language input related to these factors among 20 typically developing preschool children aged 2-5 years. The quantity of children's language input (adult words [AWs], conversational turns [CTs]) was calculated using the Language ENvironment Analysis audiotaping technology for two typical weekend days. Four 5-min Language ENvironment Analysis recording segments were transcribed and coded, and parental language strategies were classified as optimal language strategy, moderate language strategy, or sub-optimal language strategy (S-OLS) for child language outcomes. The receptive and expressive language of each child was assessed using the Preschool Language Scales-Fifth Edition. Results Mann-Whitney U tests showed significant differences between the quantity of language input (AWs/hr, CTs/hr) for high and low MLE and high and low SLD groups. Consistent with the literature, the use of S-OLSs was significantly lower for families with high MLE ( Mdn = .25, IQR = .14) and low SLD ( Mdn = .22, IQR = .13) than for families with low MLE ( Mdn = .41, IQR = .24) and high SLD ( Mdn = .41, IQR = .26). Spearman correlation coefficients indicated significant associations between language input (AWs/hr, CTs/hr, S-OLSs) and language outcomes. Conclusions Reduced language input and the frequent use of S-OLSs associated with low maternal education and high deprivation and low language outcomes for these children highlight the importance for all parents/families to learn optimal language strategies to support the development of strong language skills in their children in young age.

Purpose: Highly-experienced allied health professionals have the opportunity to perform at the expert-level by sharing knowledge and skills with more junior staff, with the aim of upskilling the workforce. The study explored the current motivators, aspirations and the role of work in the life of highly-experienced practitioners, revealing factors that hinder or support them to further develop their own expertise and be inspiring role-models and mentors for less experienced staff., Design/methodology/approach: Taking a grounded theoretical research design, we report on interviews with 45 allied health practitioners with at least seven years of professional experience from different professions and across organisational sectors. Transcripts were coded iteratively in conjunction with reviewing the literature, and cases were categorised to form a conceptual typology of work orientation., Findings: Four work orientations are characterised capturing the diversity of the allied health workforce, particularly in relation to two dimensions of personal fulfilment and future ambition. The relationship between the types and expert-level performance is discussed, leading to recommendations for support that can be implemented to develop and sustain expert-level performance within a community., Originality/value: A new view of work orientation is introduced that relates expert-level performance with meaningful work. The findings highlight a diversity of work orientation for highly-experienced allied health professionals, that all require managerial awareness. Once recognised, the four types would benefit from different supports that could develop and maintain expert-level performance in those that seek it. Alternatives are also available for those that do not. Implications for workforce policy are discussed., (© Emerald Publishing Limited.)

Objectives: Hearing impairment in childhood is a serious disability that can impose a heavy social and economic burden on individuals and families. It was hypothesized that hearing loss or middle ear disease in 11-year-old Pacific children living in New Zealand would be associated with higher levels of engagement in (1) delinquent behaviors, and (2) clinical level internalizing and externalizing problem behaviors than Pacific children with no hearing loss or middle ear disease. Based on earlier findings, peer pressure, self-perception, physical punishment (slapping), sex, and ethnicity were controlled for in the association between hearing difficulties and behavioral outcomes., Design: In the school setting, pure-tone audiometry and immittance audiometry assessments were used to establish the hearing level in 11-year-old Pacific children (n = 920). These children also completed multidisciplinary questionnaires, which included questions about involvement in delinquent behaviors, peer pressure, and self-perception. In the home setting, maternal reports were gathered on internalizing and externalizing problem behaviors in their offspring, their parenting style, and sociodemographic details., Results: A significant effect of hearing level was detected for the odds of reporting mild delinquency versus no delinquency (odds ratio: 1.02, 95% CI: 1.00 to 1.05), and odds of moderate delinquency versus no delinquency (odds ratio: 0.97, 95% CI: 0.94 to 1.00). No significant effect was detected for hearing level and severe delinquency or internalizing or externalizing behavioral problems in the clinical range. Middle ear disease (abnormal tympanogram in the worse ear) was not significantly associated with delinquency at any level or with internalizing behaviors in the clinical range. However, children with middle ear disease were significantly less likely than all other participants to exhibit disruptive externalizing behavior in the clinical range., Conclusions: Relatively young children with hearing loss reported engagement in moderate levels of delinquency that represent serious antisocial and potentially violent acts. This finding provides evidence of the significant effect that hearing loss has on child behavior. This association between hearing loss and moderate delinquency requires ethnic-specific interventions that are targeted for maximum benefit at appropriate times in childhood to mitigate potentially long-term health, educational, and behavioral risks.

Objective: This study aimed to determine the prevalence of hearing loss and ear problems in Pacific children, and investigate current and past demographic, health and social factors potentially associated with hearing and ear problems., Design: A cross-sectional observational study design nested within a birth cohort was employed., Study Sample: Nine-hundred-twenty Pacific children aged 11 years were audiologically assessed. Using average hearing thresholds at 500, 1k and 2k Hz, 162 (18%) right and 197 (21%) left ears had ≥20 dB hearing loss. Hearing loss was mild (20-39 dB) in most cases; 2% of ears had moderate to moderate-severe (40-69 dB) hearing loss. However, only 101 (11%) children had normal peripheral hearing defined by passing hearing threshold, tympanogram and distortion product otoacoustic emission assessments. Those with confirmed middle ear disease at age 2 years had significantly increased odds of a non-Type A tympanogram (adjusted odds ratio: 2.00; 95% confidence interval: 1.56, 2.50) when re-assessed at age 11 years., Conclusions: Hearing loss, abnormal tympanograms, and auditory processing difficulties were present in many Pacific children. Interventions are also urgently needed to mitigate the effect of the longstanding ear disease likely to be present for many Pacific children.

Background: Seven hundred children were recalled for hearing screening at age 2-3 years due to a problem with their newborn hearing screen. They had all been well babies with no identified risk factors for hearing loss and hence were not scheduled for targeted follow-up to retest hearing., Methods: There were 485 children (69%) that attended the recall. The average age was 36 months (SD 3.7). Family ethnicity was Pacific Island (36%), Asian (26%), NZ European (13%), and Māori (11%), and there was a high level of deprivation in the study population. Children were screened using distortion product otoacoustic emission (DPOAE) and a parent or caregiver completed a 14-item questionnaire about ear health. The children that did not pass screening were given appointments for audiology testing. Children with hearing loss and/or middle ear problems were referred for otolaryngology review and further hearing assessments., Results: About one third (36%; n = 176) of children did not pass DPOAE screening; 82 (17%) had abnormal type B tympanograms and hearing loss; 29 underwent insertion of ventilation tubes, and one had a perforated tympanic membrane. There was a significant association between failed tympanometry and hearing loss (Chi-squared = 16.67, p < .001). Five children had permanent sensorineural hearing loss (SNHL), two of whom required cochlear implants for idiopathic hearing loss, with no specific risk factors. Overall 380 of 485 children screened were deemed to have normal hearing (i.e. 22% failed hearing). From the questionnaire, 15% of the caregivers with no suspicion of hearing problems did have children with significant hearing loss. Regression analysis showed that Pacific/Māori ethnicity was significantly associated with risk of hearing loss, together with questionnaire items identifying hearing problems and breathing problems., Conclusions: There is a high proportion of children in South Auckland with unsuspected hearing loss; a different approach to hearing screening is warranted for this population with high rates of middle ear disease at age 3., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Aim: The aim of this study was to determine the factors that predict the timing and age at which preterm infants (born 32-36 weeks gestation) commenced and attained full oral feeding., Methods: We conducted a retrospective review of medical records of 647 preterm infants born 2005-2011. Infants were from six neonatal intensive care units in New Zealand, all World Health Organisation Baby-friendly Hospital Initiative accredited., Results: Median time to the first oral feed offered was one day, and median time to the time of full oral feeding was 12 days. No infants attained full oral feeding before 33(+3) weeks postmenstrual age. Gestational age, birthweight, medical conditions and location of the neonatal unit were significantly associated with the time taken to commence and attain full oral feeding., Conclusion: This study highlights the factors that are associated with the rate at which late preterm infants commence oral feeding and progress to full oral feeding. These findings offer important considerations not only for clinical practice but also discharge planning given the preference for preterm infants reaching full oral feeds before discharge from hospital. Prospective experimental research is required to confirm infant, maternal and environmental factors that influence feeding milestones in late preterm infants., (©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Objective: This study determined the prevalence and nature of voice problems in New Zealand (NZ) teachers using a national self-report questionnaire., Study Design: Epidemiological cross-sectional survey., Methods: Participants were 1879 primary and secondary teachers (72.5% females). Three prevalence timeframes were estimated. Severity of voice problems, recovery time, days away from work, symptoms, health assistance, and voice education were also investigated., Results: Prevalence of self-reported vocal problems was 33.2% during their teaching career, 24.7% over the teaching year, and 13.2% on the day of the survey. Primary teachers (P<0.001; odds ratio [OR]=1.74; confidence interval [CI]=1.33-2.40), females (P=0.008; OR=1.63; CI=1.13-2.37), and those aged 51-60 years (P=0.010; OR=1.45; CI=1.11-3.00) were more likely to report problems. Among teachers reporting voice problems during the year, 47% were moderate or severe; for 30%, voice recovery took more than 1 week. Approximately 28% stayed away from work 1-3 days owing to a vocal problem and 9% for more than 3 days. Women reported longer recovery times and more days away. Symptoms associated with voice problems (P<0.001) were voice quality alteration (OR=4.35; CI=3.40-5.57), vocal effort (OR=1.15; CI=0.96-1.37), voice breaks (OR=1.55; CI=1.30-1.84), voice projection difficulty (OR=1.25; CI=1.04-1.50), and throat discomfort (OR=1.22; CI=1.02-1.47). Of the teachers reporting voice problems, only 22.5% consulted a health practitioner. Only 38% of the teachers with chronic voice problems visited an otolaryngologist. Higher hours of voice training/education were associated with fewer self-reported voice problems., Conclusions: Voice problems are of concern for NZ teachers, as has been reported for teachers in other countries. There is still limited awareness among teachers about vocal health, potential risks, and specialized health services for voice problems., (Copyright © 2015 The Voice Foundation. Published by Elsevier Inc. All rights reserved.)

Objectives: This study investigated prosodic perception and musical pitch discrimination in adults using cochlear implants (CI), and examined the relationship between prosody perception scores and non-linguistic auditory measures, demographic variables, and speech recognition scores., Design: Participants were given four subtests of the PEPS-C (profiling elements of prosody in speech-communication), the adult paralanguage subtest of the DANVA 2 (diagnostic analysis of non verbal accuracy 2), and the contour and interval subtests of the MBEA (Montreal battery of evaluation of amusia)., Study Sample: Twelve CI users aged 25;5 to 78;0 years participated., Results: CI participants performed significantly more poorly than normative values for New Zealand adults for PEPS-C turn-end, affect, and contrastive stress reception subtests, but were not different from the norm for the chunking reception subtest. Performance on the DANVA 2 adult paralanguage subtest was lower than the normative mean reported by Saindon (2010) . Most of the CI participants performed at chance level on both MBEA subtests., Conclusion: CI users have difficulty perceiving prosodic information accurately. Difficulty in understanding different aspects of prosody and music may be associated with reduced pitch perception ability.

Primary Objective: This study investigated psychological disorders for patients receiving traumatic brain injury (TBI) rehabilitation within a community-based TBI service in New Zealand., Research Design: Cross-sectional study involving retrospective review of clinical notes for all referrals received in a 6-month period. This methodology was selected to gain a sample of individuals reflective of the range of patients seen in TBI rehabilitation services in New Zealand., Methods and Procedures: The clinical records for 279 patients were reviewed for formal psychiatric diagnoses and references to moderate or severe psychological symptoms., Main Outcomes and Results: Of the clinical records, 57.7% noted significant psychological problems post-injury (n = 161) and 8.6% had a psychiatric diagnosis recorded, with 10.8% reporting psychological disorders pre-injury. In comparison, 15.1% had input from a clinical psychologist and 2.2% had involvement from a mental health team., Conclusions: The rate of psychological symptoms was significantly higher post-TBI than pre-TBI and few of the patients reporting significant psychological symptoms were receiving intervention from mental health professionals. Further research is needed regarding the ability of TBI rehabilitation professionals in New Zealand to identify and respond to the psychological implications of TBI and on the ability of TBI and mental health teams to liaise effectively.

The World Health Organization (WHO) challenges health providers to commit to and champion interprofessional education (IPE) and interprofessional collaboration (IPC), arguing that IPE promotes IPC, which in turn improves health outcomes. Providing opportunities for students to engage in IPE, which occurs when current or future practitioners learn from, with, and about one another, ensures that health providers are in line with the WHO imperative of 2010. This paper describes the process of developing and implementing an undergraduate IPE initiative within a large New Zealand district health board, Counties Manukau Health, which provides clinical placements for over 500 students annually. This initiative involved 2 half-day interprofessional workshops attended by 123 students from seven disciplines. The impact of the interprofessional learning on students' perceptions and their confidence in relation to teamwork, communication, and interprofessional interaction were evaluated. Overall, students had a positive view of interprofessional communication and teamwork, and their opinion of relationships with other professionals improved following participation in the workshops.

Aim: This study was undertaken to determine if young Maori have more permanent bilateral hearing loss, or less severe and profound hearing loss than New Zealand (NZ) Europeans., Methods: Data include hearing-impaired children from birth to 19 years of age from the New Zealand Deafness Notification Database (DND) and covering the periods 1982-2005 and 2009-2013. These were retrospectively analysed, as was information on children and young people with cochlear implants., Results: Young Maori are more likely to be diagnosed with permanent hearing loss greater than 26 dB HL, averaged across speech frequencies, with 39-43% of hearing loss notifications listed as Maori. Maori have a lower prevalence of severe/profound losses (n=1571, chi squared=22.08, p=0.01) but significantly more bilateral losses than their NZ European peers (n=595, Chi-squared=9.05, p=0.01). The difference in severity profile is supported by cochlear implant data showing Maori are less likely to receive a cochlear implant., Conclusions: There are significant differences in the proportion of bilateral (compared to unilateral) losses and in the rates and severity profile of hearing loss among young Maori when compared with their NZ European peers. This has implications for screening and other hearing services in NZ.

Objective: The primary purpose of the study was to compare intervention approaches for children with auditory processing disorder (APD): bottom-up training including activities focused on auditory perception, discrimination, and phonological awareness, and top-down training including a range of language activities. Another purpose was to determine the benefits of personal FM systems., Design: The study is a randomized control trial where participants were allocated to groups receiving one of the two interventions, with and without personal FM, or to the no intervention group. The six-week intervention included weekly one-hour sessions with a therapist in the clinic, plus 1-2 hours per week of parent-directed homework., Study Sample: 55 children (7 to 13 years) with APD participated in the study. Intervention outcomes included reading, language, and auditory processing., Results: Positive outcomes were observed for both training approaches and personal FM systems on several measures. Pre-intervention nonverbal IQ, age, and severity of APD did not influence outcomes. Performance of control group participants did not change when retested after the intervention period., Conclusions: Both intervention approaches were beneficial and there were additional benefits with the use of personal FM. Positive results were not limited to the areas specifically targeted by the interventions.

Introduction: Hearing loss is a major cause of disability in the world. Occupational noise exposure is likely to contribute to a very high proportion of the cases of hearing loss in adults. Concern has been raised by the Accident Compensation Corporation (ACC) in New Zealand about the fact that the number of new cases of noise-induced hearing loss (NIHL) is not declining, despite the health and safety legislation and establishment of hearing conservation programmes in industry. To inform strategies for prevention, a review of the burden of NIHL in New Zealand was undertaken, particularly focusing on the trends in compensation claims and costs, and the associated sociodemographic patterns., Methods: A review of the peer-reviewed published literature was conducted to identify national and international estimates of NIHL prevalence. The ACC claims dataset (July 1995 to June 2006) was analysed to describe annual trends in new NIHL claims, cost to ACC, and claimants' age, gender and occupational group., Results: There is currently no reliable information regarding the overall incidence and prevalence of NIHL in New Zealand. ACC data reveals a substantial increase in the number of new NIHL claims annually, rising from 2823 in July 1995-June 1996, to 5580 in July 2005-June 2006. Together with ongoing claims the overall costs of NIHL claims increased by an average of 20% each year (a six-fold increase over the decade) resulting in a total cost to ACC of $193.82M over the review period. Collectively, agriculture and fisheries workers, trades workers, machine operators, and assemblers accounted for 53% of new claims. Most claims were lodged in middle age or later, with the vast majority of claimants (95%) being men. The relationship of age with the probability of making a claim changed significantly over the study period with rates in older age groups increasing faster than in younger., Conclusions: The substantial and increasing societal costs despite decades of NIHL control legislation suggests that current strategies addressing this problem are not effective, inadequately implemented, or both.