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Naunheim MR, DeVore EK, Huston MN, Song PC, Franco RA, Bhattacharyya N. Increasing Prevalence of Voice Disorders in the USA: Updates in the COVID Era. Laryngoscope 2024; 134:3713-3718. [PMID: 38525993 DOI: 10.1002/lary.31409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/03/2024] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE To estimate the current prevalence of voice disorders among adults in the United States; to determine the association of individual factors with voice disorders. METHODS The 2022 National Health Interview Survey (NHIS) was analyzed to identify adults reporting voice problems in the past 12 months. Demographics were assessed, as well as the duration, severity, and resolution of the voice problem. The relationship between voice problems, gender, lost workdays, and long COVID was investigated. A comparison to the 2012 NHIS was made to determine changes in voice disorder prevalence. RESULTS 29.9 million Americans (95%CI[28.3-31.5]) annually report a voice problem, representing 12.2% of the population (95%CI[11.7-12.8%]). Overall, 26.8% and 13.2% reported the severity of their voice problem as moderate or severe, respectively. Only 5.1% (95%CI[4.3-6.0%]) of respondents sought treatment. Most voice problems were resolved within 1 week (53.0%,95%CI[50.9-55.1%]). Females were more likely than males to report a voice problem (14.4% vs. 10.0%,95%CI[13.7-15.1] and [9.3-10.7], respectively). The 17.6 million Americans with long COVID symptoms were more likely to have voice complaints than those without (21.1% vs. 11.6%,95%CI[18.9-23.5%] and [11.1-12.1%], respectively). Lost workdays were not significantly higher for those with voice disorders compared to those without (17.1 vs. 12.9 days,95%CI[12.0-22.1] and [11.0-14.8], respectively). CONCLUSIONS Voice problems affect approximately 1 in 8 adults in the U.S. annually, demonstrating an alarming increased prevalence since 2012 using the same survey methodology. Relatively few individuals seek care for their voice problem, despite significant self-reported impact. Further study is required regarding the impact of COVID and changes in voice use patterns on voice disorders. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3713-3718, 2024.
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Affiliation(s)
- Matthew R Naunheim
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Elliana K DeVore
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Molly N Huston
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, U.S.A
| | - Phillip C Song
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Ramon A Franco
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
| | - Neil Bhattacharyya
- Harvard Medical School, Boston, Massachusetts, U.S.A
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, U.S.A
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Shi Y, Heien HC, Orvidas LJ, Sangaralingham LR, Halbauer M, Warner DO, Phelan S. Racial and Ethnic Disparities in Otolaryngology Office Visit and Tympanostomy Tube Placement in Children with Otitis Media. Laryngoscope 2024; 134:3846-3852. [PMID: 38450789 DOI: 10.1002/lary.31380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/22/2024] [Accepted: 02/22/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Racial disparities are pervasive in access to pediatric surgery. The goal of this study was to test the hypotheses that, compared with White children, non-White and Hispanic children: (1) were less likely to attend evaluations by otolaryngologists after a diagnosis of otitis media (OM) eligible for surgical referral, and (2) these children were less likely to receive tympanostomy tube (TT) after surgical consultation. METHODS The OptumLabs Data Warehouse is a de-identified claims database of privately insured enrollees. Guidelines on the management of OMs suggest that children should be evaluated for surgery if they have recurrent acute OM or chronic OM with effusion. A cohort of children who were diagnosed with OM were constructed. For Hypothesis 1, the primary outcome was otolaryngology office visit within 6 months of a diagnosis of recurrent or chronic OM. For Hypothesis 2, the outcome was TT placement within 6 months following the otolaryngology office visit. Cox regression models were used to determine the relationship between race/ethnicity and the primary outcomes. RESULTS Among 187,776 children with OMs, 72,774 (38.8%) had otolaryngology visits. In a multivariate Cox model, the hazard ratios of attending otolaryngology visit for Black, Hispanic, and Asian children were 0.93 (95% CI,0.90, 0.96), 0.86 (0.83, 0.88), and 0.74 (0.71, 0.77), compared with White children. Among the children evaluated by otolaryngologists, 46,554 (63.97%) received TT. Black, Hispanic, and Asian children with recurrent acute OM had lower likelihood of receiving TT. CONCLUSIONS Racial disparities in attending otolaryngology office visit contributed to the disparities in receiving TT. QUALITY OF EVIDENCE Level 3 Laryngoscope, 134:3846-3852, 2024.
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Affiliation(s)
- Yu Shi
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Herbert C Heien
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Laura J Orvidas
- Department of Otolaryngology, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Lindsey R Sangaralingham
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
- OptumLabs, Cambridge, Massachusetts, U.S.A
| | - Moira Halbauer
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - David O Warner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Sean Phelan
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
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Cwalina TB, Xu JR, Pham J, Jella TK, Otteson T. Measuring food insecurity among a national sample of children with recurrent acute otitis media. Am J Otolaryngol 2024; 45:104186. [PMID: 38101136 DOI: 10.1016/j.amjoto.2023.104186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Acute otitis media is one of the most common reasons for pediatric medical visits in the United States. Additionally, past studies have linked food insecurity and malnutrition with increased infections and worse health outcomes. However, there is a lack of information on the risk factors for food insecurity in specific patient populations, including the pediatric recurrent acute otitis media (RAOM) population. METHODS The 2011 to 2018 National Health Interview Survey (NHIS) datasets were used to obtain a national estimate of the presentation of food insecurity within pediatric patients with RAOM. Relevant sociodemographic information and prevalence were identified. A multivariable logistic regression model was used to determine sociodemographic risk factors. Calculations were conducted using R with the "survey" package to account for the clustering and sampling of the NHIS. RESULTS Of 3844 children with RAOM who responded to the food insecurity module, 20.8 % (19.0-22.6 %) were food insecure. Age, race/ethnicity, percentage of federal poverty level status, insurance status, and self-reported health status were significant and were not independent of food insecurity status. Using multivariable regression, this study found the following sociodemographic risk factors: age 6-10 and age > 10 (reference: age 0-2); Black (reference: Non-Hispanic White); 100 % to 200 % and <100 % federal poverty level (reference: >200 % federal poverty level); public insurance or uninsured status (reference: private insurance); and poor to fair self-reported health status (reference: good to excellent). DISCUSSION Children with RAOM who were older, Black, less insured, living in lower-income households, and of poorer health had a greater association with being food insecure. Due to the frequency of RAOM pediatric visits, identifying at-risk groups as well as incorporating food insecurity screening and food referral programs within clinical practice can enable otolaryngologists to reduce disparities and improve outcomes in a targeted approach.
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Affiliation(s)
- Thomas B Cwalina
- Case Western Reserve University School of Medicine, Cleveland, OH, United States of America; University Hospitals Cleveland Medical Center, Department of Otolaryngology, Cleveland, OH, United States of America
| | - James R Xu
- Case Western Reserve University School of Medicine, Cleveland, OH, United States of America; University Hospitals Cleveland Medical Center, Department of Otolaryngology, Cleveland, OH, United States of America.
| | - Jessica Pham
- Case Western Reserve University School of Medicine, Cleveland, OH, United States of America; University Hospitals Cleveland Medical Center, Department of Otolaryngology, Cleveland, OH, United States of America
| | - Tarun K Jella
- Case Western Reserve University School of Medicine, Cleveland, OH, United States of America; University Hospitals Cleveland Medical Center, Department of Otolaryngology, Cleveland, OH, United States of America
| | - Todd Otteson
- Case Western Reserve University School of Medicine, Cleveland, OH, United States of America; University Hospitals Cleveland Medical Center, Department of Otolaryngology, Cleveland, OH, United States of America
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Pershad AR, Knox EC, Shah RK, Zalzal HG. Disparities in the prevalence and management of otitis media: A systematic review. Int J Pediatr Otorhinolaryngol 2024; 176:111786. [PMID: 37984128 DOI: 10.1016/j.ijporl.2023.111786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/30/2023] [Accepted: 11/09/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Alisha R Pershad
- School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA.
| | - Emily C Knox
- School of Medicine and Health Sciences, The George Washington University, Washington, D.C, USA
| | - Rahul K Shah
- Division of Otolaryngology-Head and Neck Surgery, Children's National Medical Center, Washington, D.C, USA
| | - Habib G Zalzal
- Division of Otolaryngology-Head and Neck Surgery, Children's National Medical Center, Washington, D.C, USA
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Tomic D, Craig ME, Magliano DJ, Shaw JE. Reasons for hospitalisation in youth with type 1 diabetes, 2010-2019. Diabet Med 2024; 41:e15218. [PMID: 37652152 DOI: 10.1111/dme.15218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
AIMS To determine the incidence of hospitalisation for all diagnoses among Australian youth with type 1 diabetes. METHODS We linked Australians aged under 20 years with type 1 diabetes on the National Diabetes Services Scheme (n = 45,685) to hospital admission data from 2010 to 2019. We determined relative risks (RR) of hospitalisation among those with type 1 diabetes in the states of Victoria and Queensland (n = 21,898) compared to the general population for 2010-2017 using Poisson regression. RESULTS Australian youth with type 1 diabetes had increased risk for almost all reasons for hospitalisation compared to the general population, especially infections such as anogenital herpesviral infections (RR 54.83, 95% CI 33.21-90.53), and mental health disorders including personality disorders (RR 9.70, 95% CI 8.02-11.72). Among those with type 1 diabetes, over 60% of hospitalisations were directly related to diabetes, almost half of which were for ketoacidosis. Approximately 15% of ketoacidosis admissions occurred within 3 months of diabetes diagnosis. One quarter of those with admissions for ketoacidosis were readmitted for ketoacidosis within 12 months. Residence in areas of high socio-economic disadvantage was an independent risk factor for admission and readmission for ketoacidosis. CONCLUSIONS Youth with type 1 diabetes are susceptible to a wide range of complications. Clinicians should consider screening and prevention for conditions such as infections and mental health disorders. Targeted support and education around glycaemic management should be considered in those at high risk for ketoacidosis admission including those living in areas of high socio-economic disadvantage.
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Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Maria E Craig
- School of Medicine, University of New South Wales, Kensington, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Fattahi CB, Purkayastha A, Roychowdhury P, Kamil SH, Sobin L. Impacts of health insurance on tympanostomy tube outcomes in the pediatric population. Int J Pediatr Otorhinolaryngol 2023; 173:111715. [PMID: 37659379 DOI: 10.1016/j.ijporl.2023.111715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/23/2023] [Accepted: 08/28/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVES Tympanostomy tube (TT) placement is a common surgical procedure for treating pediatric patients with chronic otitis media with effusion (COME) with or without recurrent acute otitis media (rAOM). Prior work suggests children from low-income families face significant disparities in access to care for rAOM or COME. The impact of these health disparities in the care of children with rAOM or COME has yet to be investigated in a state with an expanded public health insurance model. We seek to examine differences in care for patients with rAOM and COME based on insurance status and socioeconomic status (SES) in Massachusetts. METHODS Retrospective review of 560 pediatric patients referred for TT insertion at a tertiary academic medical center between 2017 and 2019. Demographic data collected included age, ethnicity, insurance type (public, private, none) and zip code. Otologic history collected included prior AOM episodes, time to postoperative follow-up, postoperative "no-show" appointments, and number of postoperative audiograms. Multinomial logistic regression was used to isolate the effects of race and ethnicity. RESULTS We found no major differences in preoperative outcome measures between cohorts. Postoperatively, public insurance was independently associated with decreased odds of undergoing an audiogram (OR 0.35, 95% Cl 0.16-0.76) and increased odds of "no-showing" for an appointment (OR 3.1, 95% CI 1.8-5.3). SES was not independently associated with differences in postoperative outcomes. CONCLUSION In a state with an early expanded public health insurance model, access to care for rAOM and COME is comparable despite differences in insurance type and SES. However, enrollment in public health insurance is associated with worse measures of follow up care. Despite improvements in access to care with expanded health insurance models, retention continues to be a challenge for vulnerable populations.
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Affiliation(s)
- Cameron B Fattahi
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Chan Medical School, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Ayan Purkayastha
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Chan Medical School, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Prithwijit Roychowdhury
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Chan Medical School, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Syed H Kamil
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Chan Medical School, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | - Lindsay Sobin
- Department of Otolaryngology-Head and Neck Surgery, University of Massachusetts Chan Medical School, University of Massachusetts Memorial Medical Center, Worcester, MA, USA.
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Nationwide disparities in transportation related delays to care experienced by children with frequent ear infections. Int J Pediatr Otorhinolaryngol 2022; 157:111115. [PMID: 35500331 DOI: 10.1016/j.ijporl.2022.111115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 02/20/2022] [Accepted: 03/16/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Acute otitis media (AOM), or ear infection, is the most common reason for pediatric medical visits in the United States [1]. Additionally, transportation barriers are a significant driver of missed and delayed care across medical specialties [2,3]. Yet, the role of transportation barriers in impeding access for children with frequent ear infections (FEI) has not been investigated. Assessing the prevalence of transportation barriers across sociodemographic groups may help clinicians improve outcomes for children with FEI. METHODS A retrospective analysis of the U.S. National Health Interview Survey was completed to examine associations between sociodemographic characteristics among children with FEI and transportations barriers to seeking care between 2011 and 2018. RESULTS Multivariable logistic regression found that income level, insurance status, and health status were linked to disparities in transportation barriers among children with FEI. Those in the middle (aOR 3.00, 95% CI 1.77-5.08, p < 0.001) and lowest income brackets (aOR 6.33, 95% CI 3.80, p < 0.001), who were publicly insured (aOR 3.24, 95% CI 2.00-5.23, p < 0.001) or uninsured (aOR 3.46, 95% CI 1.84-6.51, p < 0.001), and with Poor to Fair health status were more likely to face transportation delays than patients who were in the highest income bracket, privately insured, or had Good to Excellent health status. CONCLUSION Children with FEI from families that were lower-income, less insured, and less healthy faced more transportation barriers when accessing care than their counterparts. Future interventions to improve health-related transportation should be targeted toward these patient subgroups to reduce gaps in outcomes.
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Fricker ZP, Mukthinuthalapati VVPK, Akinyeye S, Chalasani N, Attar BM, Balakrishnan M, Ghabril M, Long MT. MELD-Na Is More Strongly Associated with Risk of Infection and Outcomes Than Other Characteristics of Patients with Cirrhosis. Dig Dis Sci 2021; 66:247-256. [PMID: 32100160 PMCID: PMC7222109 DOI: 10.1007/s10620-020-06164-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS The nature and outcomes of infection among patients with cirrhosis in safety-net hospitals are not well described. We aimed to characterize the rate of and risk factors for infection, both present on admission and nosocomial, in this unique population. We hypothesized that infections would be associated with adverse outcomes such as short-term mortality. METHODS We used descriptive statistics to characterize infections within a retrospective cohort characterized previously. We used multivariable logistic regression models to assess potential risk factors for infection and associations with key outcomes such as short-term mortality and length of stay. RESULTS The study cohort of 1112 patients included 33% women with a mean age of 56 ± 10 years. Infections were common (20%), with respiratory and urinary tract infections the most frequent. We did not observe a difference in the incidence of infection on admission based on patient demographic factors such as race/ethnicity or estimated household income. Infections on admission were associated with greater short-term mortality (12% vs 4% in-hospital and 14% vs 7% 30-day), longer length of stay (6 vs 3 days), intensive care unit admission (28% vs 18%), and acute-on-chronic liver failure (10% vs 2%) (p < 0.01 for all). Nosocomial infections were relatively uncommon (4%), but more frequent among patients admitted to the intensive care unit. Antibiotic resistance was common (38%), but not associated with negative outcomes. CONCLUSION We did not identify demographic risk factors for infection, but did confirm its morbid effect among patients with cirrhosis in safety-net hospitals.
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Affiliation(s)
- Zachary P. Fricker
- grid.38142.3c000000041936754XDivision of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis St, 8th Floor, Boston, MA 02215 USA
| | - V. V. Pavan Kedar Mukthinuthalapati
- grid.257413.60000 0001 2287 3919Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN USA ,grid.428291.4Division of Gastroenterology, Cook County Health, Chicago, IL USA
| | - Samuel Akinyeye
- grid.412332.50000 0001 1545 0811Division of Gastroenterology, Hepatology and Nutrition, Ohio State University Medical Center, Columbus, OH USA
| | - Naga Chalasani
- grid.257413.60000 0001 2287 3919Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN USA
| | - Bashar M. Attar
- grid.428291.4Division of Gastroenterology, Cook County Health, Chicago, IL USA
| | - Maya Balakrishnan
- grid.39382.330000 0001 2160 926XSection of Gastroenterology and Hepatology, Baylor College of Medicine, Houston, TX USA
| | - Marwan Ghabril
- grid.257413.60000 0001 2287 3919Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN USA
| | - Michelle T. Long
- grid.189504.10000 0004 1936 7558Section of Gastroenterology, Evans Department of Medicine, Boston University School of Medicine, Boston, MA USA
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Maharjan M, Phuyal S, Shrestha M, Bajracharya R. Chronic otitis media and subsequent hearing loss in children from the Himalayan region residing in Buddhist Monastic schools of Nepal. J Otol 2020; 15:144-148. [PMID: 33293915 PMCID: PMC7691833 DOI: 10.1016/j.joto.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022] Open
Abstract
Objectives The main objective of the study was to ascertain the prevalence of chronic otitis media and determine the corresponding hearing loss in children from Nepal’s Himalayan region now residing in Buddhist Monastic schools of Nepal. Methods The study was conducted among children at Buddhist monastic school in different parts of Nepal. A total of 3174 children aged between 5 and 15 years, who were originally from the Himalayan region of Nepal and were currently residing in monastic schools, were screened for ear problems and hearing loss. They were examined by otoscope to diagnose chronic otitis media. Hearing was evaluated by pure tone audiometer, and 0.5–4 kHz air conduction hearing threshold was measured and documented. Results Of the total of 3174 children who were screened for ear diseases and hearing loss, monks constituted 76.21% (n = 2419) and Nuns 23.78% (n = 755). Chronic otitis media was the most common otoscopic finding during the screening, and it affected a total of 344 (10.83%) children. Out of these 344, hearing loss of varying degrees was observed in 5.42% (n = 172) children. Conclusion There is high prevalence of chronic otitis media in children belonging to the Himalayan region of Nepal, and it is the main cause of avoidable hearing loss. Timely diagnosis and treatment of chronic otitis media could prevent unnecessary hearing loss in these children.
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Chang JE, Shapiro NL, Bhattacharyya N. Do demographic disparities exist in the diagnosis and surgical management of otitis media? Laryngoscope 2018; 128:2898-2901. [DOI: 10.1002/lary.27396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Janice Erica Chang
- Department of Head and Neck Surgery; University of California, Los Angeles, David Geffen School of Medicine; Los Angeles California
| | - Nina Lisbeth Shapiro
- Department of Head and Neck Surgery; University of California, Los Angeles, David Geffen School of Medicine; Los Angeles California
| | - Neil Bhattacharyya
- the Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
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Jabbour J, Robey T, Cunningham MJ. Healthcare disparities in pediatric otolaryngology: A systematic review. Laryngoscope 2017; 128:1699-1713. [DOI: 10.1002/lary.26995] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/28/2017] [Accepted: 10/10/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Jad Jabbour
- Department of Otolaryngology and Communication Sciences; Medical College of Wisconsin; Milwaukee Wisconsin U.S.A
| | - Thomas Robey
- Department of Otolaryngology and Communication Sciences; Medical College of Wisconsin; Milwaukee Wisconsin U.S.A
- Division of Pediatric Otolaryngology; Children's Hospital of Wisconsin; Milwaukee Wisconsin U.S.A
| | - Michael J. Cunningham
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Otolaryngology and Communication Enhancement; Boston Children's Hospital; Boston Massachusetts U.S.A
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Gestro M, Condemi V, Bardi L, Fantino C, Solimene U. Meteorological factors, air pollutants, and emergency department visits for otitis media: a time series study. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1749-1764. [PMID: 28466414 DOI: 10.1007/s00484-017-1356-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 03/07/2017] [Accepted: 04/11/2017] [Indexed: 06/07/2023]
Abstract
AbstractOtitis media (OM) is a very common disease in children, which results in a significant economic burden to the healthcare system for hospital-based outpatient departments, emergency departments (EDs), unscheduled medical examinations, and antibiotic prescriptions. The aim of this retrospective observational study is to investigate the association between climate variables, air pollutants, and OM visits observed in the 2007-2010 period at the ED of Cuneo, Italy. Measures of meteorological parameters (temperature, humidity, atmospheric pressure, wind) and outdoor air pollutants (particulate matter, ozone, nitrous dioxide) were analyzed at two statistical stages and in several specific steps (crude and adjusted models) according to Poisson's regression. Response variables included daily examinations for age groups 0-3, 0-6, and 0-18. Control variables included upper respiratory infections (URI), flu (FLU), and several calendar factors. A statistical procedure was implemented to capture any delayed effects. Results show a moderate association for temperature (T), age 0-3, and 0-6 with P < 0.05, as well as nitrous dioxide (NO2) with P < 0.005 at age 0-18. Results of subsequent models point out to URI as an important control variable. No statistical association was observed for other pollutants and meteorological variables. The dose-response models (DLNM-final stage) implemented separately on a daily and hourly basis point out to an association between temperature (daily model) and RR 1.44 at age 0-3, CI 1.11-1.88 (lag time 0-1 days) and RR 1.43, CI 1.05-1.94 (lag time 0-3 days). The hourly model confirms a specific dose-response effect for T with RR 1.20, CI 1.04-1.38 (lag time range from 0 to 11 to 0-15 h) and for NO2 with RR 1.03, CI 1.01-1.05 (lag time range from 0 to 8 to 0-15 h). These results support the hypothesis that the clinical context of URI may be an important risk factor in the onset of OM diagnosed at ED level. The study highlights the relevance of URI as a control variable to be included in the statistical analysis in association with meteorological factors and air pollutants. The study also points out to a moderate association of OM with low temperatures and NO2, with specific risk factors for this variable early in life. Further studies are needed to confirm these findings, particularly with respect to air pollutants in larger urban environments.
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Affiliation(s)
- Massimo Gestro
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy
| | - Vincenzo Condemi
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy.
| | - Luisella Bardi
- Cuneo Department, Environmental Protection Agency of Piedmont, Turin, Italy
| | - Claudio Fantino
- S. Croce and Carle Hospital of Cuneo, SOC ORL Unit, Cuneo, Italy
| | - Umberto Solimene
- Department of Biomedical Science for Health, Centre for Research in Medical Bioclimatology, Thermal and Complementary Medicine, and Wellness Sciences, Milan State University, Via Cicognara, 7, 20129, Milan, Italy
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13
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Kaur R, Morris M, Pichichero ME. Epidemiology of Acute Otitis Media in the Postpneumococcal Conjugate Vaccine Era. Pediatrics 2017; 140:peds.2017-0181. [PMID: 28784702 PMCID: PMC5574724 DOI: 10.1542/peds.2017-0181] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To study the epidemiology of acute otitis media (AOM), especially the otitis-prone condition, during the pneumococcal conjugate vaccines 7 and 13 era. METHODS Six hundred and fifteen children were prospectively managed from 6 to 36 months of life during a 10-year time frame (June 2006-June 2016). All clinical diagnoses of AOM were confirmed by tympanocentesis and bacterial culture of middle ear fluid. RESULTS By 1 year of age, 23% of the children experienced ≥1 episode of AOM; by 3 years of age, 60% had ≥1 episodes of AOM, and 24% had ≥3 episodes. The peak incidence occurred at 6 to 12 months of life. Multivariable analysis of demographic and environmental data revealed a significantly increased risk of AOM associated with male sex, non-Hispanic white race, family history of recurrent AOM, day care attendance, and early occurrence of AOM. Risk factors for stringently defined (tympanocentesis-confirmed) otitis proneness, in which children suffered at least 3 episodes of AOM in a 6-month period or at least 4 within a year, were male sex, day care attendance, and family history of AOM, whereas breastfeeding in the first 6 months of life was protective. Stringently defined otitis prone children were also likely to experience their first AOM episode at a younger age. The proportion of Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis causing AOM had dynamic changes during the past decade. CONCLUSIONS We conclude that the epidemiology but not the risk factors for AOM have undergone substantial changes since the introduction of pneumococcal conjugate vaccines.
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Affiliation(s)
- Ravinder Kaur
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York
| | - Matthew Morris
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York
| | - Michael E. Pichichero
- Center for Infectious Diseases and Immunology, Rochester General Hospital Research Institute, Rochester, New York
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14
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Ruben RJ. The trajectory of Pediatric Otolaryngology. Int J Pediatr Otorhinolaryngol 2016; 89:179-82. [PMID: 27401025 DOI: 10.1016/j.ijporl.2016.06.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Robert J Ruben
- Albert Einstein College of Medicine, Montefiore Medical Center, United States.
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15
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Pediatric otolaryngologic conditions: Racial and socioeconomic disparities in the United States. Laryngoscope 2016; 127:746-752. [DOI: 10.1002/lary.26240] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/16/2016] [Accepted: 07/12/2016] [Indexed: 01/05/2023]
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16
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Nieman CL, Tunkel DE, Boss EF. Do race/ethnicity or socioeconomic status affect why we place ear tubes in children? Int J Pediatr Otorhinolaryngol 2016; 88:98-103. [PMID: 27497394 PMCID: PMC4988399 DOI: 10.1016/j.ijporl.2016.06.029] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/04/2016] [Accepted: 06/08/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Despite recent concerns about potential overuse of tympanostomy tube (TT) placement to treat otitis media in children, utilization of this common procedure in the U.S. has been shown to be relatively less common among minority children. It is not known if the indications for TT differ by child race/ethnicity and/or socioeconomic status (SES). Our objective is to analyze the association of patient- and neighborhood-level demographics and SES with clinical indications for TT. METHODS We conducted a retrospective chart review of children who underwent TT at single urban academic tertiary pediatric care center in a 6-month period (8/2013-3/2014). Children with congenital anomalies or syndromic diagnoses were excluded (50/137 children, 36.5%). Children were grouped by primary TT indication, recurrent acute otitis media (RAOM) or chronic otitis media with effusion (OME). Group characteristics were compared using t-tests and chi-square analyses, and logistic regression was performed to assess the association between demographics and TT indication. RESULTS 87 children were included in this analysis (mean age = 2.8 years, 1-6 years). The most common indication for TT was RAOM (53%), and these children had a mean of 6 AOM episodes/year. Indications for TT varied significantly by the patient's neighborhood SES (median neighborhood income $70,969.09-RAOM vs $58, 844.95-OME, p-value = 0.009). Those undergoing TT for RAOM were less likely to live in a high-poverty neighborhood (OR = 0.36,p-value = 0.02), whereas children who underwent TT for OME were more likely to live in a high-poverty neighborhood. There was no significant difference in indication by race/ethnicity or insurance type. CONCLUSIONS In this population, TT indications differed by SES. Among children receiving tubes, those from high poverty areas were more likely than those from low poverty neighborhoods to receive tubes for the indication of OME as opposed to RAOM. This finding suggests that concerns for appropriate use of TT in the setting of RAOM may be specific to a more affluent population. Future prospective patient-centered research will evaluate cultural and economic influences for families pursuing TT placement, as well as factors considered by physicians who make surgical recommendations.
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Affiliation(s)
- Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., 6th Floor, Baltimore, MD 21287, USA.
| | - David E Tunkel
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., 6th Floor, Baltimore, MD 21287, USA; Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, 601 N. Caroline St., 6th Floor, Baltimore, MD 21287, USA.
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline St., 6th Floor, Baltimore, MD 21287, USA; Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, Johns Hopkins University School of Medicine, 601 N. Caroline St., 6th Floor, Baltimore, MD 21287, USA; Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, 750 E Pratt St, 15th Floor, Baltimore, MD 21202, USA.
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17
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Niclasen J, Obel C, Homøe P, Kørvel-Hanquist A, Dammeyer J. Associations between otitis media and child behavioural and learning difficulties: Results from a Danish cohort. Int J Pediatr Otorhinolaryngol 2016; 84:12-20. [PMID: 27063746 DOI: 10.1016/j.ijporl.2016.02.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 02/13/2016] [Accepted: 02/16/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Findings from studies investigating early childhood episodes of otitis media (OM) and developmental outcomes are inconclusive. This may in part be because large-scale prospective studies controlling for relevant confounding factors are sparse. The present study investigates associations between OM in early childhood and later behavioural and learning difficulties controlling for relevant confounding factors. METHODS The study applied data from the Aarhus Birth Cohort's 10-12-year-old follow-up (N=7578). Associations between retrospective parent-reported OM (no OM; 1-3 episodes of OM with/without tympanostomy tubes; 4+ OM episodes without tympanostomy tubes and; 4+ OM episodes with tympanostomy tubes) one the one hand, and parent- and teacher-reported scores on the Strengths and Difficulties Questionnaire (SDQ) and parent-reported academic difficulties on the other hand, were investigated. The following variables were controlled for: parental educational level, maternal and paternal school problems, parental post-natal smoking, breastfeeding, and age at which the child started walking. All analyses were stratified by gender. RESULTS Large differences in background characteristics were observed for the group of children with 4+ OM episodes with tympanostomy tubes compared to the no OM group. After controlling for relevant confounders, negative associations were consistently observed for the group of children with 4+ episodes of OM with tympanostomy tubes compared to the group of children without OM. This was particularly so for girls. CONCLUSION The findings suggest an association between 4+ episodes of early OM with tympanostomy tubes and behavioural and learning difficulties later in childhood. The large inter-group differences, i.e. impact of residual and unmeasured confounding factors, may in part explain the observed associations and underline the need to include these in future studies.
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Affiliation(s)
- J Niclasen
- Department of Psychology, University of Copenhagen, Denmark.
| | - C Obel
- Department of Public Health, Institute of General Medical Practice, Aarhus University, Denmark
| | - P Homøe
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - A Kørvel-Hanquist
- Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Denmark
| | - J Dammeyer
- Department of Psychology, University of Copenhagen, Denmark
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18
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Bhattacharyya N. Healthcare disparities in revisits for complications after adult tonsillectomy. Am J Otolaryngol 2015; 36:249-53. [PMID: 25484366 DOI: 10.1016/j.amjoto.2014.11.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Determine if disparities exist for revisit complications after adult tonsillectomy. METHODS Cases of adult tonsillectomy were extracted from the state ambulatory surgery databases and linked to the state emergency department databases and inpatient databases for California, Iowa, Florida and New York for 2010 and 2011. Revisits within 14days for diagnoses of: post-tonsillectomy bleeding, acute pain and nausea/vomiting/dehydration were determined and analyzed for associations of these complications with age, sex, race, median household income and comorbidity score. RESULTS Among 17,836 tonsillectomies (63.7% female; mean age, 29.0years), revisit rates for post-tonsillectomy bleeding, acute pain and fever/dehydration were 5.1, 2.8 and 1.5%, respectively. On multivariate analysis, only female sex was associated with a lower post-tonsillectomy bleeding rate (odds, 0.48, p<0.001). Decreasing household income, female sex, black and Hispanic race were associated with increased revisits for acute pain (odds, 1.21, 1.49, 2.03 and 1.32, p≤0.002). Female sex was associated with an increased odds of a revisit for FNVD (odds, 1.94, p<0.001). CONCLUSIONS Significant disparities with respect to income and race exist in the incidence of revisits and potentially avoidable complications after adult tonsillectomy.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
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19
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Bhattacharyya N. The prevalence of pediatric voice and swallowing problems in the United States. Laryngoscope 2014; 125:746-50. [PMID: 25220824 DOI: 10.1002/lary.24931] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 08/12/2014] [Accepted: 08/25/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Determine the prevalence of pediatric voice and swallowing problems in the United States. METHODS The 2012 National Health Interview Survey pediatric voice and language module was analyzed, identifying children reporting a voice or swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for voice or swallowing problems, diagnoses given, and severity of voice or swallowing problem were analyzed. RESULTS An estimated 839 ± 89 thousand children (1.4% ± 0.1%) reported a voice problem. Overall, 53.5% ± 1.9% were given a diagnosis for the voice problem and 22.8% ± 4.6% received voice services. Laryngitis (16.6% ± 5.5%) and allergies (10.4% ± 4.0%) were the most common diagnoses. A total of 16.4% graded the voice problem as a "big" or "very big" problem. An estimated 569 ± 63 thousand children (0.9% ± 0.1%) reported a swallowing problem. A total of 12.7% ± 3.8% received swallowing services and 13.4% ± 1.6% were given a diagnosis for their swallowing problem. Neurological problems were the most common diagnoses (11.1% ± 4.5%). A total of 17.9% graded the swallowing problem as a "big" or "very big" problem. CONCLUSION These data provide the first insight into the prevalence of childhood voice and swallowing problems, which affect approximately 1% of children annually. A relative minority seek care for their problem, despite the disease impact.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otology and Laryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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20
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Abstract
OBJECTIVE To determine the prevalence of dysphagia, reported etiologies, and impact among adults in the United States. STUDY DESIGN Cross-sectional analysis of a national health care survey. SUBJECTS AND METHODS The 2012 National Health Interview Survey was analyzed, identifying adult cases reporting a swallowing problem in the preceding 12 months. In addition to demographic data, specific data regarding visits to health care professionals for swallowing problems, diagnoses given, and severity of the swallowing problem were analyzed. The relationship between swallowing problems and lost workdays was assessed. RESULTS An estimated 9.44 ± 0.33 million adults (raw N = 1554; mean age, 52.1 years; 60.2% ± 1.6% female) reported a swallowing problem (4.0% ± 0.1%). Overall, 22.7% ± 1.7% saw a health care professional for their swallowing problem, and 36.9% ± 0.1.7% were given a diagnosis. Women were more likely than men to report a swallowing problem (4.7% ± 0.2% versus 3.3% ± 0.2%, P < .001). Of the patients, 31.7% and 24.8% reported their swallowing problem to be a moderate or a big/very big problem, respectively. Stroke was the most commonly reported etiology (422,000 ± 77,000; 11.2% ± 1.9%), followed by other neurologic cause (269,000 ± 57,000; 7.2% ± 1.5%) and head and neck cancer (185,000 ± 40,000; 4.9% ± 1.1%). The mean number of days affected by the swallowing problem was 139 ± 7. Respondents with a swallowing problem reported 11.6 ± 2.0 lost workdays in the past year versus 3.4 ± 0.1 lost workdays for those without a swallowing problem (contrast, +8.1 lost workdays, P < .001). CONCLUSION Swallowing problems affect 1 in 25 adults, annually. A relative minority seek health care for their swallowing problem, even though the subjective impact and associated workdays lost with the swallowing problem are significant.
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Affiliation(s)
- Neil Bhattacharyya
- Department of Otology & Laryngology, Harvard Medical School, Boston, Massachusetts, USA
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21
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Bhattacharyya N. The prevalence of voice problems among adults in the United States. Laryngoscope 2014; 124:2359-62. [DOI: 10.1002/lary.24740] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/12/2014] [Accepted: 04/26/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Neil Bhattacharyya
- Department of Otology and LaryngologyHarvard Medical SchoolBoston Massachusetts U.S.A
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22
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Ambrosio A, Brigger MT. Surgery for Otitis Media in a Universal Health Care Model: Socioeconomic Status and Race/Ethnicity Effects. Otolaryngol Head Neck Surg 2014; 151:137-41. [PMID: 24627410 DOI: 10.1177/0194599814525570] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/05/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES (1) To determine the association between socioeconomic status (SES), race/ethnicity, and other demographic risk factors in surgically managed otitis media within a model of universal health care. 2) To determine quality of life (QOL) outcomes of surgically managed otitis media in this model. SETTING Tertiary academic medical center. STUDY DESIGN Prospective cohort study. METHODS A prospective study was conducted between June 2011 and December 2012 with dependent children of military families. TRICARE provides equal access to care among all beneficiaries regardless of a wide range of annual incomes. Caretakers of children scheduled for bilateral myringotomy and tympanostomy tube (BMT) placement were administered a demographic survey, as well as OM-6 QOL instrument preoperatively and 6 weeks postoperatively. A control group who did not undergo BMT was also administered both the survey and OM-6 for comparison. RESULTS Two hundred forty patients were enrolled (120 surgical patients and 120 controls). Logistic regression demonstrated age younger than 6 years old (P < .001), day care attendance (P < .001), and non-Hispanic Caucasian race (P = .022) to be associated with surgery. Surgical QOL outcomes demonstrated a significant improvement in otitis media-6 (OM-6) scores after surgical management from 3.00 (95% confidence interval [CI], 2.79-3.20) to 1.35 (95% CI, 1.22-1.47). CONCLUSION In a universal health care model serving more than 2 million children, previously reported proxies of low SES as well as minority race/ethnicity were not associated with surgically managed otitis media contrary to reported literature. Caucasian race, young age, and day care attendance were associated with surgery. Surgery improved QOL outcomes 6 weeks postoperatively.
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Affiliation(s)
- Art Ambrosio
- Department of Otolaryngology-Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Matthew T Brigger
- Department of Otolaryngology-Head & Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
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23
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Sidell D, Shapiro NL, Bhattacharyya N. Obesity and the risk of chronic rhinosinusitis, allergic rhinitis, and acute otitis media in school-age children. Laryngoscope 2013; 123:2360-3. [PMID: 23918707 DOI: 10.1002/lary.24038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 12/22/2012] [Accepted: 01/14/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine if obesity is a significant risk factor for acute otitis media (AOM), allergic rhinitis (AR), or chronic rhinosinusitis (CRS) in children and to understand the potential otolaryngological implications of childhood obesity. STUDY DESIGN Cross-Sectional Analysis. METHODS The 2006 and 2008 the Medical Expenditure Panel Survey was utilized to identify school-aged children with AOM, AR, and/or CRS. Risk factors for the diagnoses extracted included standard demographics and the presence or absence of obesity. Multivariate analyses were conducted for associations between childhood obesity and AOM, AR, and CRS. RESULTS 42.1 million (95% CI, 40.4-44.2) school-age children (unweighted N = 10623) were sampled in 2006 and 2008. There was a slight male predominance (51.0% [95% CI, 49.8-52.2]). Of these patients, 2.2 million (95% CI 1.9-2.4) received a diagnosis of AOM, 4.0 million (95% CI 3.6-4.4) received a diagnosis of AR, and 1.7 million (95% CI 1.4-1.9) received a diagnosis of CRS. Approximately 9.3 million (95% CI 8.7-10.0) children were obese, representing 22.2% (95% CI 21.0-23.3) of the U.S. population (age 6-17). Utilizing an adjusted multivariate model, childhood obesity was found to be associated with AOM (odds ratio, 1.44; [95% CI 1.08-1.93]; P = 0.033). Significant associations between obesity and AR (OR 1.14; [95% CI 0.88-1.47]; P = 0.60) or obesity and CRS (OR0.73; [95% CI 0.48-1.10]; P = 0.79) were not identified. CONCLUSION Childhood obesity appears to be associated with the development of AOM; however, an association between obesity and AR or CRS was not demonstrated. Given that in the United States nearly one-fourth of all children seeking health care are obese, these data may have important preventative care implications. LEVEL OF EVIDENCE 2C.
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Affiliation(s)
- Douglas Sidell
- Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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24
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Hoffman HJ, Daly KA, Bainbridge KE, Casselbrant ML, Homøe P, Kvestad E, Kvaerner KJ, Vernacchio L. Panel 1: Epidemiology, natural history, and risk factors. Otolaryngol Head Neck Surg 2013; 148:E1-E25. [PMID: 23536527 DOI: 10.1177/0194599812460984] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The First International Symposium on Recent Advances in Otitis Media (OM) with Effusion was held in Columbus, Ohio, in 1975. The symposium has been organized in the United States every 4 years since, followed by a research conference to (a) assess major research accomplishments, (b) identify important research questions and opportunities, (c) develop consensus on definitions and terminology, and (d) establish priorities with short- and long-term research goals. One of the principal areas reviewed quadrennially is Epidemiology, Natural History, and Risk Factors. OBJECTIVE To provide a review of recent literature on the epidemiology, natural history, and risk factors for OM. DATA SOURCES AND REVIEW METHODS A search of OM articles in English published July 2007 to June 2011 was conducted using PubMed and related databases. Those with findings judged of importance for epidemiology, public health, and/or statistical methods were reviewed. RESULTS The literature has continued to expand, increasing understanding of the worldwide burden of OM in childhood, complications from treatment failures, and comorbidities. Novel risk factors, including genetic factors, have been examined for OM susceptibility. Population-based studies in Canada, the United States, and other countries confirmed reductions in OM prevalence. Although most studies concentrated on acute OM (AOM) or OM with effusion (OME), a few examined severe chronic suppurative OM (CSOM), a major public health problem in developing countries and for certain indigenous populations around the world. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Recent publications have reinforced earlier epidemiological findings, while extending our knowledge in human population groups with high burden of OM.
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Affiliation(s)
- Howard J Hoffman
- Epidemiology and Statistics Program, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health, Bethesda, Maryland 20892, USA.
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Ahmed S, Shapiro NL, Bhattacharyya N. Incremental health care utilization and costs for acute otitis media in children. Laryngoscope 2013; 124:301-5. [PMID: 23649905 DOI: 10.1002/lary.24190] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 03/04/2013] [Accepted: 04/16/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS Determine the incremental health care costs associated with the diagnosis and treatment of acute otitis media (AOM) in children. STUDY DESIGN Cross-sectional analysis of a national health-care cost database. METHODS Pediatric patients (age < 18 years) were examined from the 2009 Medical Expenditure Panel Survey. From the linked medical conditions file, cases with a diagnosis of AOM were extracted, along with comorbid conditions. Ambulatory visit rates, prescription refills, and ambulatory health care costs were then compared between children with and without a diagnosis of AOM, adjusting for age, sex, region, race, ethnicity, insurance coverage, and Charlson comorbidity Index. RESULTS A total of 8.7 ± 0.4 million children were diagnosed with AOM (10.7 ± 0.4% annually, mean age 5.3 years, 51.3% male) among 81.5 ± 2.3 million children sampled (mean age 8.9 years, 51.3% male). Children with AOM manifested an additional +2.0 office visits, +0.2 emergency department visits, and +1.6 prescription fills (all P <0.001) per year versus those without AOM, adjusting for demographics and medical comorbidities. Similarly, AOM was associated with an incremental increase in outpatient health care costs of $314 per child annually (P <0.001) and an increase of $17 in patient medication costs (P <0.001), but was not associated with an increase in total prescription expenses ($13, P = 0.766). CONCLUSIONS The diagnosis of AOM confers a significant incremental health-care utilization burden on both patients and the health care system. With its high prevalence across the United States, pediatric AOM accounts for approximately $2.88 billion in added health care expense annually and is a significant health-care utilization concern.
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Affiliation(s)
- Sameer Ahmed
- UCLA Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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26
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Gerber JS, Prasad PA, Localio AR, Fiks AG, Grundmeier RW, Bell LM, Wasserman RC, Rubin DM, Keren R, Zaoutis TE. Racial differences in antibiotic prescribing by primary care pediatricians. Pediatrics 2013; 131:677-84. [PMID: 23509168 PMCID: PMC9923585 DOI: 10.1542/peds.2012-2500] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether racial differences exist in antibiotic prescribing among children treated by the same clinician. METHODS Retrospective cohort study of 1,296,517 encounters by 208,015 children to 222 clinicians in 25 practices in 2009. Clinical, antibiotic prescribing, and demographic data were obtained from a shared electronic health record. We estimated within-clinician associations between patient race (black versus nonblack) and (1) antibiotic prescribing or (2) acute respiratory tract infection diagnosis after adjusting for potential patient-level confounders. RESULTS Black children were less likely to receive an antibiotic prescription from the same clinician per acute visit (23.5% vs 29.0%, odds ratio [OR] 0.75; 95% confidence interval [CI]: 0.72-0.77) or per population (0.43 vs 0.67 prescriptions/child/year, incidence rate ratio 0.64; 95% CI 0.63-0.66), despite adjustment for age, gender, comorbid conditions, insurance, and stratification by practice. Black children were also less likely to receive diagnoses that justified antibiotic treatment, including acute otitis media (8.7% vs 10.7%, OR 0.79; 95% CI 0.75-0.82), acute sinusitis (3.6% vs 4.4%, OR 0.79; 95% CI 0.73-0.86), and group A streptococcal pharyngitis (2.3% vs 3.7%, OR 0.60; 95% CI 0.55-0.66). When an antibiotic was prescribed, black children were less likely to receive broad-spectrum antibiotics at any visit (34.0% vs 36.9%, OR 0.88; 95% CI 0.82-0.93) and for acute otitis media (31.7% vs 37.8%, OR 0.75; 95% CI 0.68-0.83). CONCLUSIONS When treated by the same clinician, black children received fewer antibiotic prescriptions, fewer acute respiratory tract infection diagnoses, and a lower proportion of broad-spectrum antibiotic prescriptions than nonblack children. Reasons for these differences warrant further study.
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Affiliation(s)
- Jeffrey S. Gerber
- Division of Infectious Diseases,,The Center for Pediatric Clinical Effectiveness,,Department of Pediatrics, and,Address correspondence to Jeffrey S. Gerber, MD, PhD, Division of Infectious Diseases, The Children’s Hospital of Philadelphia, 3535 Market St, Ste 1518, Philadelphia, PA 19104. E-mail:
| | - Priya A. Prasad
- Division of Infectious Diseases,,The Center for Pediatric Clinical Effectiveness
| | - A. Russell Localio
- The Center for Pediatric Clinical Effectiveness,,PolicyLab,,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Alexander G. Fiks
- The Center for Pediatric Clinical Effectiveness,,PolicyLab,,Division of General Pediatrics, and,Department of Pediatrics, and
| | - Robert W. Grundmeier
- Division of General Pediatrics, and,The Center for Biomedical Informatics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania;,Department of Pediatrics, and
| | - Louis M. Bell
- Division of Infectious Diseases,,The Center for Pediatric Clinical Effectiveness,,Division of General Pediatrics, and,Department of Pediatrics, and
| | - Richard C. Wasserman
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont
| | - David M. Rubin
- PolicyLab,,Division of General Pediatrics, and,Department of Pediatrics, and,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Ron Keren
- The Center for Pediatric Clinical Effectiveness,,Division of General Pediatrics, and,Department of Pediatrics, and,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Theoklis E. Zaoutis
- Division of Infectious Diseases,,The Center for Pediatric Clinical Effectiveness,,Department of Pediatrics, and,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; and
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27
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Abstract
OBJECTIVE To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents. DATA SOURCE Secondary data analysis of the 2003 National Survey of Children's Health. The survey focus was children 0-17 years old. STUDY DESIGN Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/Pacific Islander, American Indian/Alaskan Native, and multiracial adolescents 10-17 years old (n = 48,742) to identify disparities in 40 measures of health and health care. PRINCIPAL FINDINGS Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/Alaska Natives; and not receiving all needed dental care in multiracial youth. CONCLUSIONS U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents.
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Affiliation(s)
- May Lau
- Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, USA.
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28
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Otitis media exposure associates with dietary preference and adiposity: a community-based observational study of at-risk preschoolers. Physiol Behav 2012; 106:264-71. [PMID: 22333318 DOI: 10.1016/j.physbeh.2012.01.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 01/18/2012] [Accepted: 01/31/2012] [Indexed: 01/28/2023]
Abstract
Chronic exposure to otitis media (OM) has been linked to risk of overweight/obesity. Here we tested if dietary behaviors explained some of the OM-adiposity relationship among 485 racially-diverse, low-income preschoolers (253 girls, mean age=45±7 months) enrolled in government-supported urban preschool programs. From measured weight/height, 4% were underweight, 17% were overweight and 13% were obese. OM exposure according to parent report varied across nearly equal quartiles-low (never, once) to high (3-5 times, 6+ times) exposure categories. Boys were more likely to be in the high exposure categories. Parents rated their child's liking/disliking of foods (high-fat/added sugar, fruits/juice, vegetables) and non-food activities. In analysis of covariance (ANCOVA), mean liking for vegetables and fruits/juice fell as OM exposure increased, with significant differences between lowest and highest exposure categories (p<.05). Food neophobic versus non-neophobic preschoolers also liked vegetables and fruits less (p<.001). In a two-way ANCOVA, main effects of OM and food neophobia independently predicted vegetable and fruit liking; preschoolers with more OM exposure and neophobia had the lowest liking. Although ANCOVA failed to reveal OM effects on mean liking for fat/sugar foods, the relative ranking of liking for these foods differed by OM category. Fat/sugar foods were ranked as most preferred for the high OM children, particularly the boys, surpassing the ranking of pleasurable non-food items. Conversely, low OM children ranked pleasurable non-food items and fruits/juice as more pleasurable than high OM children. BMI percentile varied with OM exposure, but not neophobia: preschoolers with the greatest exposure averaged the highest percentiles. In multiple regression analyses, liking for vegetables or fruits failed to associate significantly with BMI percentile. There was a small but significant association between greater fat/sugar liking and higher BMI percentile. Overall these findings confirm associations between high OM exposure and elevated adiposity in preschoolers. They also suggest this relationship is explained through lower affinity for vegetables and fruits and greater affinity for fat/sugar foods.
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29
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Sidell D, Shapiro NL, Bhattacharyya N. Demographic Influences on Antibiotic Prescribing for Pediatric Acute Otitis Media. Otolaryngol Head Neck Surg 2011; 146:653-8. [DOI: 10.1177/0194599811431228] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. To understand the epidemiologic antibiotic treatment patterns and the potential impact of race and insurance status on the medical management of acute otitis media (AOM). Study Design. Cross-sectional analysis of a national database. Setting. National ambulatory care setting. Methods. Cases of isolated AOM in children ≤16.0 years were extracted from the National Ambulatory Medical Care Survey (2006-2008). The frequency and type of antibiotic prescribed were extracted. A multivariate logistic regression model incorporating age, sex, race, ethnicity, and insurance type was used to determine the influence of these demographic variables on antibiotic prescribing patterns. Results. A total of 15.8 ± 1.5 million cases of AOM were studied (mean age, 3.6 ± 0.3 years; 55.1% ± 2.9% male). Of the children, 15.0% ± 2.8% were Hispanic and 10.4% ± 3.1% were black. Medicaid/State Children’s Health Insurance Program and private insurance covered 30.6% ± 4.4% and 69.4% ± 4.4% of children, respectively. Overall, 83.1% ± 2.2% of children received an antibiotic prescription. The most commonly prescribed antibiotics were amoxicillin (6.5 ± 0.9 million), beta-lactamase inhibitors (2.6 ± 0.4 million), and third-generation cephalosporins (2.3 ± 0.4 million prescriptions). On multivariate analysis, insurance status, ethnicity, race, age, and sex did not influence the likelihood of an antibiotic being prescribed during the visit ( P = .884, .909, .849, .102, and .931 respectively). Conclusions. Most children receiving medical treatment for AOM receive an antibiotic prescription during their visit. Ethnicity, race, and insurance type do not significantly influence antibiotic prescribing rates for AOM, and nearly all patients have medical insurance.
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Affiliation(s)
- Douglas Sidell
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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30
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Abstract
During most of recorded history, the application of knowledge to the care of individual patients was founded on the experience of individual medical practitioners; when published, it basically took the form of case reports. Not until the middle of the 20th Century did randomized controlled trials (RCTs) come to be the gold standard. By the beginning of the 21st Century, however, the limitations of RCTs and their syntheses, the meta-analyses, have come to be recognized, and their applicability to the individual patient questioned and, indeed, challenged. The intense increase in our knowledge base and in accompanying technology has made possible the personalization of medicine beyond the possibilities of earlier periods. The approach of personalized medicine requires evaluation of four parameters: the individual patient’s intrinsic susceptibility, intrinsic morbidity, extrinsic susceptibility, and extrinsic morbidity. The characteristics of the disease agent—how much (duration) and how virulent—also must be factored in. These individualized data define the appropriate intervention: high susceptibility and/or morbidity or low susceptibility and/or morbidity and the aggregate of the intrinsic and extrinsic risk factors are cofactored in medical decision making.
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Affiliation(s)
- Robert J. Ruben
- Departments of Otorhinolaryngology–Head and Neck Surgery and Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
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31
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Bhattacharyya N, Shapiro NL, Vakharia KT. Influence of race and ethnicity on access to care among children with frequent ear infections. Otolaryngol Head Neck Surg 2010; 143:691-6. [DOI: 10.1016/j.otohns.2010.06.911] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 06/01/2010] [Accepted: 06/16/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Determine the impact of racial/ethnic disparities on access to care for children with frequent ear infections (FEI). Identify disparities to target for intervention. STUDY DESIGN Cross-sectional analysis of national database. SETTING Academic medical center. SUBJECTS AND METHODS The National Health Interview Survey (1997 to 2006) was utilized to identify children with FEI (defined as three or more ear infections in the preceding year). Age, sex, race/ethnicity, income level, and insurance status were extracted. Access to care was measured by ability to afford medical care and prescription medications, specialist visitation, and emergency department visits. Multivariate analysis determined the influence of demographic variables on the ability to access health care resources. RESULTS An annualized population of 4.65 ± 0.08 million children reported FEI. Overall, 3.7 percent could not afford care, 5.6 percent could not afford prescriptions, and only 25.8 percent saw a specialist. A larger percentage of the black (42.7%) and Hispanic children (34.5%) with FEI were below the poverty level, versus white children (12.4%; P < 0.001); 18.2 percent of Hispanic children were uninsured, versus 6.5 percent of white children ( P < 0.001). On multivariate analysis, children with FEI that were black or Hispanic had increased odds ratios relative to white children for 1) not being able to afford prescription medications (odds ratios [OR] 1.76 and 1.47, respectively; P < 0.002); 2) not being able to see a specialist (OR 1.62 and 1.86, respectively; P < 0.001); and 3) visiting the emergency department (OR 2.50 and 1.32, respectively; P < 0.001). CONCLUSION Racial/ethnic disparities among children with FEI significantly influence health care resource access and utilization. These disparities should be targeted for intervention.
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Affiliation(s)
- Neil Bhattacharyya
- From the Division of Otolaryngology–Head and Neck Surgery, Brigham and Women's Hospital, and Department of Otology and Laryngology, Harvard Medical School, Boston, MA
| | - Nina L. Shapiro
- and the Division of Otolaryngology–Head and Neck Surgery, University of California, Los Angeles, Los Angeles, CA
| | - Kalpesh T. Vakharia
- and the Department of Otology and Laryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, MA
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