Biomedical subjects

Paula C Stacey

Publications and source records attributed to Paula C Stacey.

6 recordsLinked to original sources

PubMed2006

An exploration of demographic bias in a questionnaire survey of hearing-impaired children: implications for comparisons of children with and without cochlear implants.

OBJECTIVES: Responders to questionnaire surveys, who are self-selecting, are generally accepted to be unrepresentative of the total available population, at least in demographic terms. Since demographic and other variables are known to be predictive of outcome, it is important to understand the extent of that unrepresentativeness when using survey data to report comparisons of outcome. This paper aims (i) to evaluate the extent to which a sample of hearing-impaired children surveyed by postal questionnaire was representative of the population of hearing-impaired children in the United Kingdom (UK), and (ii) to identify demographic differences between children with and without cochlear implants. METHODS: Data from a previously reported total ascertainment of hearing-impaired children in the UK which identified 17,160 with permanent bilateral hearing impairment >40 dB HL were compared with data collected by postal questionnaire for a sample of 3224 children, including 527 with cochlear implants. RESULTS: The sampled children were similar to the ascertained population in gender, age at onset of hearing impairment, and number of additional disabilities, but came from more recent birth cohorts and from more affluent families. Compared with profoundly impaired non-implanted children, implanted children had greater degrees of hearing loss, fewer additional disabilities, a later age of onset, were younger, came from more affluent families, were more likely to use spoken language at home, and to be taught using spoken language only. CONCLUSIONS: Comparisons of outcomes and generalisation of results require adjustment for relevant variables to avoid confounding estimates of the effectiveness of interventions including cochlear implantation.

Adolescent↗

PubMed2006

Hearing-impaired children in the United Kingdom, II: Cochlear implantation and the cost of compulsory education.

OBJECTIVE: The objective of this study was to estimate the impact of cochlear implantation on the cost of compulsory education of hearing-impaired children in the United Kingdom. STUDY DESIGN: In a cross-sectional survey, teachers were asked to report the school placement of, and amount of support provided to, a representative sample of hearing-impaired children. Costs of school placement were obtained from published sources. Costs of support were calculated from a survey of 11 special education services. The annual education cost (in euros at 2001/2002 levels) of each child was calculated by summing the placement and support costs. Linear regression analyses calculated the association between annual education cost and possession of an implant while controlling nine other variables: average (unaided, preoperative) hearing level (AHL), age at onset of hearing impairment, age, gender, the number of additional disabilities, parental occupational skill level, ethnicity, parental hearing status, and academic achievement. RESULTS: Data were received for 2241 children, 383 of whom had cochlear implants. Mean annual education cost ranged from 15,745 euros for children with moderate hearing impairments to 30,071 euros for nonimplanted children with profound hearing impairments and was 28,058 euros for implanted children. A lower annual education cost was associated with a more favorable AHL, a later age at the onset of hearing impairment, female gender, a younger age, fewer additional disabilities, and a higher level of academic achievement. When these variables were controlled, costs were lower on average for implanted compared with nonimplanted children for the subset of children whose AHLs exceeded 111 dB. At the mean AHL of the implanted children (115 dB), implantation was associated with a reduction of 3105 euros (95% confidence interval, 1105 euros to 5106 euros) in annual education costs. CONCLUSIONS: Pediatric cochlear implantation is sufficiently effective to influence resource-allocation decisions in the education sector. The health-service cost of implantation is partly offset by savings in the cost of education. These savings occur without detriment to academic achievements.

Adolescent↗

PubMed2006

Hearing-impaired children in the United Kingdom, I: Auditory performance, communication skills, educational achievements, quality of life, and cochlear implantation.

OBJECTIVES: The objectives of this study were to identify variables that are associated with differences in outcome among hearing-impaired children and to control those variables while assessing the impact of cochlear implantation. STUDY DESIGN: In a cross-sectional study, the parents and teachers of a representative sample of hearing-impaired children were invited to complete questionnaires about children's auditory performance, spoken communication skills, educational achievements, and quality of life. Multiple regression was used to measure the strength of association between these outcomes and variables related to the child (average hearing level, age at onset of hearing impairment, age, gender, number of additional disabilities), the family (parental occupational skill level, ethnicity, and parental hearing status), and cochlear implantation. RESULTS: Questionnaires were returned by the parents of 2858 children, 468 of whom had received a cochlear implant, and by the teachers of 2241 children, 383 of whom had received an implant. Across all domains, reported outcomes were better for children with fewer disabilities in addition to impaired hearing. Across most domains, reported outcomes were better for children who were older, female, with a more favorable average hearing level, with a higher parental occupational skill level, and with an onset of hearing-impairment after 3 years. When these variables were controlled, cochlear implantation was consistently associated with advantages in auditory performance and spoken communication skills, but less consistently associated with advantages in educational achievements and quality of life. Significant associations were found most commonly for children who were younger than 5 years when implanted, and had used implants for more than 4 years. These children, whose mean (preoperative, unaided) average hearing level was 118 dB, were reported to perform at the same level as nonimplanted children with average hearing levels in the range from 80 dB to 104 dB, depending on the outcome measure. CONCLUSIONS: When rigorous statistical control is exercised in comparing implanted and nonimplanted children, pediatric cochlear implantation is associated with reported improvements both in spoken communication skills and in some aspects of educational achievements and quality of life, provided that children receive implants before 5 years of age.

Adult↗

PubMed2006

Hearing-impaired children in the United Kingdom, III: cochlear implantation and the economic costs incurred by families.

OBJECTIVES: This article addresses two questions. First, are there differences in the economic costs incurred by families of hearing-impaired children depending on whether or not children have cochlear implants? Second, are these differences important when assessed from the perspective of society? METHODS: In a cross-sectional survey, parents of a representative sample of hearing-impaired children provided data about annual resources used by the family because of their child's hearing impairment. The data yielded estimates of two variables: out-of-pocket expenditure and time away from normal activities by parents. The economic cost of the two variables was estimated in euros at 2001/2 price levels, and summed to estimate the overall economic cost incurred by the family. Linear regression was used to estimate the association between costs and implantation, while controlling for average (unaided, preoperative) hearing level, age at onset of hearing impairment, age, gender, the number of additional disabilities, parental occupational skill level, ethnicity, and parental hearing status. The cumulative economic cost incurred by the families of implanted children, between implantation and age 16 yr, was calculated from estimates of the overall economic cost associated with implantation and compared with estimates of the incremental health-sector cost of implantation. RESULTS: Data were provided by the families of 2858 children, 468 of whom had received a cochlear implant. Compared with the families of nonimplanted children, out-of-pocket expenditure was estimated to be significantly higher for families when children were implanted before the age of 5 yr and had used their implant for less than 2 yr, as was lost productivity when children had used their implants for less than 2 yr. Overall economic cost was estimated to be significantly higher for the families of implanted children who had used their implants for less than 2 yr. The cumulative economic cost was estimated to be 3355 euros for a family whose child was implanted at age 3 yr and 949 euros for a child implanted at age 6 yr. These costs correspond, at most, to 3% of the incremental health-sector costs of implantation. CONCLUSIONS: Compared with families of nonimplanted children, families of implanted children incur additional costs in the 2 yr after implantation. These costs are small in relation to the health-sector costs of providing implantation.

Adult↗

PubMed2006

Hearing-impaired children in the United Kingdom, IV: cost-effectiveness of pediatric cochlear implantation.

OBJECTIVE: To estimate the cost-effectiveness of pediatric cochlear implantation by conducting a cost-utility analysis from a societal perspective. DESIGN: In a cross-sectional survey, the parents of a representative sample of hearing-impaired children assessed the health utility of their child using a revised version of the Health Utilities Index Mark III questionnaire. Linear regression was used to estimate the gain in health utility associated with implantation while controlling for eight potentially confounding variables: average (4-frequency, unaided, preoperative) hearing level (AHL), age at onset of hearing-impairment, age, gender, number of additional disabilities, parental occupational skill level, ethnicity, and parental hearing status. The gain in health utility was accumulated to estimate the number of quality-adjusted life years (QALYs) that would be gained from implantation over 15 yr and over a child's lifetime. The incremental societal cost of implantation, calculated in euros at 2001/2 levels, was estimated by summing the incremental costs of implantation that are incurred in the health sector, in the education sector, and by the child's family. The cost-effectiveness of cochlear implantation was estimated by calculating the incremental societal cost per QALY gained and was compared with an upper limit of acceptability of 50,000 euros per QALY. RESULTS: The parents of 403 implanted children, and 1863 nonimplanted children, completed the health utility questionnaire. Higher health utility was associated with a more favorable AHL, an older age at onset of hearing impairment, female gender, having fewer additional disabilities, having parents with a greater occupational skill level, white ethnicity, and implantation. The gain in health utility associated with implantation was estimated to be higher for children with a worse preoperative AHL and who were implanted when younger. Over 15 yr, for a child implanted at age 6 with a preoperative loss of 115 dB, 2.23 QALYs were estimated to be gained, compared with a mean incremental societal cost of 57,359 euros, yielding a mean cost per QALY of 25,629 euros. Cost-effectiveness was more favorable: (1) when estimated over a child's lifetime rather than 15 yr, (2) for children with a worse preoperative AHL, and (3) for children who were implanted when younger. CONCLUSIONS: The mean cost of gaining a QALY for the children in the present sample falls within acceptable limits. The strategy of giving highest priority for implantation to children with the greatest loss of hearing, and who are younger, maximizes benefit for a given cost.

Age Factors↗

PubMed2005

Face processing and familiarity: evidence from eye-movement data.

How is information extracted from familiar and unfamiliar faces? Three experiments, in which eye-movement measures were used, examined whether there was differential sampling of the internal face region according to familiarity. Experiment 1 used a face familiarity task and found that whilst the majority of fixations fell within the internal region, there were no differences in the sampling of this region according to familiarity. Experiment 2 replicated these findings, using a standard recognition memory paradigm. The third experiment employed a matching task, and once again found that the majority of fixations fell within the internal region. Additionally, this experiment found that there was more sampling of the internal region when faces were familiar compared with when they were unfamiliar. The use of eye fixation measures affirms the importance of internal facial features in the recognition of familiar faces compared with unfamiliar faces, but only when viewers compare pairs of faces.

Adolescent↗