Prolonged exposure to loud music can induce hearing loss. Adolescents are increasingly exposed to loud music. What This Study AddsWhen using MP3 players, adolescents are much more likely to engage in risky behaviors than protective behaviors. Frequent use of MP3 players indicates the prevalence of MP3 player-related risky behaviors and the absence of preventive behaviors. ABSTRACTOBJECTIVE. The goal was to assess risky and protective listening behaviors of adolescent users of MP3 players and the association of these behaviors with demographic characteristics and frequency of use.METHODS. In 2007, 1687 adolescents (12-19 years of age) in 68 classes in 15 Dutch secondary schools were invited to complete questionnaires about their music-listening behaviors.RESULTS. Ninety percent of participants reported listening to music through earphones on MP3 players; 32.8% were frequent users, 48.0% used high volume settings, and only 6.8% always or nearly always used a noise-limiter. Frequent users were Ͼ4 times more likely to listen to high-volume music than were infrequent users, and adolescents in practical prevocational schools were more than twice as likely to listen to high-volume music as were those attending preuniversity education.CONCLUSIONS. When using MP3 players, adolescents are very likely to engage in risky listening behaviors and are unlikely to seek protection. Frequent MP3 player use is an indicator of other risky listening behaviors, such as listening at high volumes and failing to use noise-limiters. Pediatrics 2009;123:e953-e958 T HE HUGE INCREASE in the popularity of portable MP3 players has increased young people's exposure to high sound levels dramatically. [1][2][3] Various studies reported that increasing numbers of adolescents and young adults now experience symptoms indicative of poor hearing, such as distortion, tinnitus, hyperacusis, or threshold shifts. [4][5][6] The Hearing Alliance of America reported that levels of hearing loss in 15% of college graduates are now equal to or greater than those of their parents, largely because of listening to music at high volumes. 7 Currently, use of MP3 players may be the most important risk factor for music-induced hearing loss in young people.The rapid development of digital technology has led to the production of new kinds of portable music players whose sound quality at higher volumes is much better, because the sound is no longer distorted. 3 Because the music players are equipped with improved earphones, sound leakage is almost absent, which means that the music players can be played at hazardous high volumes in most environments without disturbing other people. 3,8 The use of earbud-style earphones increases the volume level by another ϳ5.5 dB, 3,9 because of the smaller ear canal volume. Also, the recordings are made with much stronger compression, which allows for an average sound level closer to the maximal output level.In noisy environments, listeners are especially likely to choose high volume settings, 10 which, over longer periods, are potent...

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Objective To determine the effectiveness of helmet therapy for positional skull deformation compared with the natural course of the condition in infants aged 5-6 months.Design Pragmatic, single blinded, randomised controlled trial (HEADS, HElmet therapy Assessment in Deformed Skulls) nested in a prospective cohort study.Setting 29 paediatric physiotherapy practices; helmet therapy was administered at four specialised centres.Participants 84 infants aged 5 to 6 months with moderate to severe skull deformation, who were born after 36 weeks of gestation and had no muscular torticollis, craniosynostosis, or dysmorphic features. Participants were randomly assigned to helmet therapy (n=42) or to natural course of the condition (n=42) according to a randomisation plan with blocks of eight.Interventions Six months of helmet therapy compared with the natural course of skull deformation. In both trial arms parents were asked to avoid any (additional) treatment for the skull deformation. Main outcome measuresThe primary outcome was change in skull shape from baseline to 24 months of age assessed using plagiocephalometry (anthropometric measurement instrument). Change scores for plagiocephaly (oblique diameter difference index) and brachycephaly (cranioproportional index) were each included in an analysis of covariance, using baseline values as the covariate. Secondary outcomes were ear deviation, facial asymmetry, occipital lift, and motor development in the infant, quality of life (infant and parent measures), and parental satisfaction and anxiety. Baseline measurements were performed in infants aged between 5 and 6 months, with follow-up measurements at 8, 12, and 24 months. Primary outcome assessment at 24 months was blinded. ResultsThe change score for both plagiocephaly and brachycephaly was equal between the helmet therapy and natural course groups, with a mean difference of −0.2 (95% confidence interval −1.6 to 1.2, P=0.80) and 0.2 (−1.7 to 2.2, P=0.81), respectively. Full recovery was achieved in 10 of 39 (26%) participants in the helmet therapy group and 9 of 40 (23%) participants in the natural course group (odds ratio 1.2, 95% confidence interval 0.4 to 3.3, P=0.74). All parents reported one or more side effects.Conclusions Based on the equal effectiveness of helmet therapy and skull deformation following its natural course, high prevalence of side effects, and high costs associated with helmet therapy, we discourage the use of a helmet as a standard treatment for healthy infants with moderate to severe skull deformation.Trial registration Current Controlled Trials ISRCTN18473161.

Context Newborn screening for cystic fibrosis (CF) is included in many routine programmes but current strategies have considerable drawbacks, such as falsepositive tests, equivocal diagnosis and detection of carriers.Objective To assess the test performance of two newborn screening strategies for CF. Design, setting and participants In 2008 and 2009, CF screening was added to the routine screening programme as a prospective study in part of the Netherlands.Interventions Two strategies were performed in all newborns. In the first strategy, concentrations of immunoreactive trypsinogen (IRT) and pancreatitisassociated protein (PAP) were measured. In the second method, samples with IRT $60 mg/litre were analysed for 36 CFTR mutations, followed by sequencing when a single mutation was detected. Tests were positive only with two identified CFTR mutations. Main outcome Sensitivity, specificity and positive predictive value (PPV) of both screening strategies. Results 145 499 infants were screened. The IRT/PAP approach showed a sensitivity of 95.0%, a specificity of 99.897% and a PPV of 12.3%. Test properties for the IRT/ DNA/sequencing strategy were respectively 100%, 100% and 64.9%. Combining both strategies (IRT/PAP/ DNA/sequencing) led to a sensitivity of 95.0%, a specificity of 100% and a PPV of 87.5%.

Adolescents often exceeded current occupational safety standards for noise exposure, highlighting the need for specific safety standards for leisure-time noise exposure.