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Sommer CL, Aljaro KG, Palomares Aguilera M, Yu-Quibael V, Cordero K. Speech and Resonance Disorders in Children With Cleft Palate: Diagnostic Evaluation and Current Speech Therapy Modalities. J Craniofac Surg 2024:00001665-990000000-01674. [PMID: 38836795 DOI: 10.1097/scs.0000000000010363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 05/04/2024] [Indexed: 06/06/2024] Open
Abstract
This article will provide an overview of how speech and resonance can be impacted in children with cleft palate. The authors will outline evidence-based assessment and treatment approaches commonly used for children with cleft palate and provide information on current initiatives to provide speech therapy. The methods discussed will be the use of telehealth to provide access to speech therapy for patients in areas without speech-language pathologists and the use of speech therapy camps to offer intensive, limited-duration speech therapy for groups of children due to the lack of trained providers in certain geographical regions.
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Affiliation(s)
- Chelsea L Sommer
- Florida International University
- Nicklaus Children's Hospital, Miami, FL
| | | | - Mirta Palomares Aguilera
- Smile Train-South American Medical Advisory Council (SAMAC)
- Speech Therapy Unit, Alfredo Gantz Mann Foundation
- Speech Therapy Dr. Luis Calvo Mackenna Hospita, Santiago, Chile
| | | | - Kelly Cordero
- Phoenix Children's Center for Cleft and Craniofacial Care, Phoenix, AZ
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Ternes S, Lavin L, Vakkalanka JP, Healy HS, Merchant KA, Ward MM, Mohr NM. The role of increasing synchronous telehealth use during the COVID-19 pandemic on disparities in access to healthcare: A systematic review. J Telemed Telecare 2024:1357633X241245459. [PMID: 38646804 DOI: 10.1177/1357633x241245459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
INTRODUCTION The COVID-19 public health emergency led to an unprecedented rapid increase in telehealth use, but the role of telehealth in reducing disparities in access to care has been questioned. The objective of this study was to conduct a systematic review to summarize the available evidence on how telehealth during the COVID-19 pandemic was associated with telehealth utilization for minority groups and its role in health disparities. METHODS We conducted a systematic review focused on health equity and access to care by searching for interventional and observational studies using the following four search domains: telehealth, COVID-19, health equity, and access to care. We searched PubMed, Embase, Cochrane CENTRAL, CINAHL, telehealth.hhs.gov, and the Rural Health Research Gateway, and included any study that reported quantitative results with a control group. RESULTS Our initial search yielded 1970 studies, and we included 48 in our final review. The most common dimensions of health equity studied were race/ethnicity, rurality, insurance status, language, and socioeconomic status, and the telehealth applications studied were diverse. Included studies had a moderate risk of bias. In aggregate, most studies reported increased telehealth use during the pandemic, with the greatest increase in non-minority populations, including White, younger, English-speaking people from urban areas. DISCUSSION We found that despite rapid adoption and increased telehealth use during the public health emergency, telehealth did not reduce existing disparities in access to care. We recommend that future work measuring the impact of telehealth focus on equity so that features of telehealth innovation can reduce disparities in health outcomes.
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Affiliation(s)
- Sara Ternes
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Lauren Lavin
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA
| | - J Priyanka Vakkalanka
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Heather S Healy
- Hardin Library for the Health Sciences, University of Iowa, Iowa City, IA, USA
| | - Kimberly As Merchant
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Marcia M Ward
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, IA, USA
- Department of Anesthesia Critical Care, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Bouhadana G, Zammit D, Oiknine N, Cugno S. The Implementation of International Electives for Plastic Surgery Residents: Current State and Future Directions. J Craniofac Surg 2023; 34:2034-2039. [PMID: 37582277 DOI: 10.1097/scs.0000000000009602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 07/04/2023] [Indexed: 08/17/2023] Open
Abstract
INTRODUCTION Interest in international surgical missions has been rising exponentially, with the plastic surgery community being a leader in this endeavor. The role of residents in such missions remains a topic of debate. This systematic review aims to consolidate the literature relevant to the inclusion of plastic surgery residents on international surgical missions to devise an algorithm to facilitate resident participation. MATERIALS AND METHODS A comprehensive search of PubMed, Medline, and EMBASE was performed to identify studies relevant to plastic surgery resident involvement in the context of surgical missions. Relevant conclusions were retrieved from each study and compiled according to category. RESULTS Of 418 initial studies, 26 were retained for the qualitative synthesis. These were grouped into 3 categories: surveys (n=12), reflections (n=7), and reviews (n=7). The survey studies addressed the perceived value, educational impact, and long-term effect on participating residents. Three reflection studies were from the perspective of residents and 4 from staff, while all recounted the many benefits gained for participating residents. Review studies addressed the issue of accreditation and the ethics surrounding resident involvement. CONCLUSION This systematic review highlights the overwhelming support from residents and staff, the highly regarded educational value, and the positive global health effects associated with plastic surgery resident participation in international surgical missions. The authors hope this will encourage and facilitate the implementation of formal opportunities for residents within residency training programs.
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Affiliation(s)
| | - Dino Zammit
- Division of Plastic and Reconstructive Surgery, McGill University
| | - Noah Oiknine
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Sabrina Cugno
- Division of Plastic and Reconstructive Surgery, McGill University
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Huang KX, Oberoi MK, Caprini RM, Hu VJ, Malapati SH, Mirzaie S, Bedar M, Patel H, Lee JC. COVID-19 Pandemic Associated With Increased Self-reported Depressive Symptoms in Patients With Congenital Craniofacial Diagnoses. Cleft Palate Craniofac J 2023; 60:949-955. [PMID: 35469458 PMCID: PMC9047599 DOI: 10.1177/10556656221095715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The current study investigated the influence of the coronavirus (COVID-19) pandemic on patients with congenital craniofacial diagnoses. METHODS Patients (n = 66) with craniofacial diagnoses aged between 8 and 17 were prospectively evaluated with longitudinal psychosocial assessments using the anger, anxiety, depressive symptoms, and peer relationships instruments within the pediatric Patient-Reported Outcomes Measurement Information System (PROMIS). The COVID-19 cohort (n = 33) included patients with assessments within 2 years prior to the pandemic (t0) and during the pandemic (t1; March 2020 to March 2021). An age-matched comparison cohort (n = 33) with similar demographics and diagnoses included patients assessed twice over 3 years prior to the pandemic. RESULTS All PROMIS measures were in the average range clinically for both groups across time points. However, the COVID-19 group reported a significant increase in depressive symptoms during the pandemic (t1) compared to pre-pandemic (t0) scores (48.2 ± 10.1 vs 44.3 ± 9.4, P = .04, d = -0.37), while the comparison group did not demonstrate any differences in psychosocial functioning between t0 and t1. For the COVID-19 cohort, only the pandemic timeframe (r = 0.21, P = .03) was significantly associated with increased depressive symptom scores, and no other sociodemographic or medical variables were associated with depressive symptoms. CONCLUSIONS Self-reported depressive symptoms increased during the COVID-19 pandemic in patients with congenital craniofacial diagnoses. Longitudinal studies are needed to elucidate whether such changes will be persistent or compound known variables associated with psychosocial functioning.
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Affiliation(s)
- Kelly X. Huang
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Michelle K. Oberoi
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Rachel M. Caprini
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Vivian J. Hu
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Sri Harshini Malapati
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Sarah Mirzaie
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Meiwand Bedar
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Harsh Patel
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
| | - Justine C. Lee
- Division of Plastic and Reconstructive Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA, USA
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Mason KN, Kotlarek KJ. Where is the Care? Identifying the Impact of Rurality on SLP Caseloads and Treatment Decisions for Children with Cleft Palate. Cleft Palate Craniofac J 2023:10556656231189940. [PMID: 37488965 PMCID: PMC10805969 DOI: 10.1177/10556656231189940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Challenges providing cleft/craniofacial care in rural communities are often reported, leading to disparities in resources available to clinicians. The purpose of this study was to identify the impact of rurality on caseloads and practice patterns of speech-language pathologists (SLPs) regarding speech and velopharyngeal function for children with cleft lip and/or palate (CL/P). A national, survey of US-based SLPs (N = 359 respondents) investigated resources, comfort level, caseloads, and practice patterns for children with CL/P. Sub-county classifications that delineated levels of rurality were utilized. Descriptive statistics and chi-square analyses were conducted to determine the impact of population density on assessment and referral decisions. Nearly 83% of SLPs reported providing care for a child with CL/P and 41.4% of these SLPs reported five or more children with CL/P on caseload throughout their career. There were no significant differences in rurality of practice setting and the likelihood of treating a child with CL/P. Significant differences were present between rural, town, suburban, and metropolitan-based SLPs regarding available resources (p = 0.035). SLPs in rural settings reported feeling uncomfortable treating children with CL/P compared to those in metropolitan settings (p = 0.02). Distance to the cleft/craniofacial team and comfort levels impacted referral decisions. Most SLPs report having children with CL/P on caseload regardless of practice location. Rurality impacted assessment and referral decisions, especially surrounding access to resources and comfort levels engaging in team care. Findings have implications for developing support systems and reducing barriers for rural SLPs working with children born with CL/P.
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Affiliation(s)
- Kazlin N. Mason
- Department of Human Services, University of Virginia, Charlottesville, VA, 22903
| | - Katelyn J. Kotlarek
- Division of Communication Disorders, University of Wyoming, Laramie, WY, 82071
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Woolley KE, Bright D, Ayres T, Morgan F, Little K, Davies AR. Mapping Inequities in Digital Health Technology Within the World Health Organization's European Region Using PROGRESS PLUS: Scoping Review. J Med Internet Res 2023; 25:e44181. [PMID: 37115613 PMCID: PMC10182469 DOI: 10.2196/44181] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The use of digital technologies within health care rapidly increased as services transferred to web-based platforms during the COVID-19 pandemic. Inequalities in digital health across the domains of equity are not routinely examined; yet, the long-term integration of digitally delivered services needs to consider such inequalities to ensure equitable benefits. OBJECTIVE This scoping review aimed to map inequities in access, use, and engagement with digital health technologies across equity domains. METHODS We searched 4 electronic databases (MEDLINE, ASSIA, PsycINFO, and Scopus) for quantitative and mixed methods reviews and meta-analyses published between January 2016 and May 2022. Reviews were limited to those that included studies from the World Health Organization's European region. Extracted data were mapped against Cochrane's PROGRESS PLUS (place of residence, race, ethnicity, culture, and language, occupation, gender and sex, religion, education, socioeconomic status, social capital, and other characteristics) dimensions of equity. RESULTS In total, 404 unique citations were identified from the searches, and 2 citations were identified from other sources. After eligibility assessment, 22 reviews were included. Consistent evidence was found showing higher access to digital health technologies among patients who were of White ethnicity, were English speaking, and had no disability. There were no reviews that explored differences in access to digital health care by age, gender and sex, occupation, education, or homeless or substance misuse. Higher use of digital health technologies was observed among populations that were White, English speaking, younger, with a higher level of education, of higher economic status, and residents in urban areas. No clear evidence of differences in the use of digital technologies by occupation, gender and sex, disability, or homeless or substance misuse was found, nor was clear evidence found in the included reviews on inequalities in the engagement with digital technologies. Finally, no reviews were identified that explored differences by place of residence. CONCLUSIONS Despite awareness of the potential impact of inequalities in digital health, there are important evidence gaps across multiple equity domains. The development of a common framework for evaluating digital health equity in new health initiatives and consistency in reporting findings is needed.
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Affiliation(s)
- Katherine E Woolley
- Research and Evaluation Division, Public Health Wales, Cardiff, United Kingdom
- National Centre for Population Health and Well-being Research, Wales, United Kingdom
| | - Diana Bright
- Research and Evaluation Division, Public Health Wales, Cardiff, United Kingdom
| | - Toby Ayres
- Evidence Service, Public Health Wales, Cardiff, United Kingdom
| | - Fiona Morgan
- Evidence Service, Public Health Wales, Cardiff, United Kingdom
| | - Kirsty Little
- Evidence Service, Public Health Wales, Cardiff, United Kingdom
| | - Alisha R Davies
- Research and Evaluation Division, Public Health Wales, Cardiff, United Kingdom
- National Centre for Population Health and Well-being Research, Wales, United Kingdom
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Lucamba A, Grillo R, Bessa S, Hernández NMM, Filipe L, Naclério-Homem MDG. The importance of a local cleft mission and its spread. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101382. [PMID: 36649802 DOI: 10.1016/j.jormas.2023.101382] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/29/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Cleft lip or palate are very usual birth defects. This study aims to discuss a local cleft mission performed in Angola and some specifics on the topic. METHODS This retrospective study assessed the main features of a local cleft mission conducted in September 2022. The mission was carried out at the Hospital Josina Machel in Luanda, Angola. Data was retrieved and analyzed. The Shapiro-Wilkes test and Pearson correlation were used and considered significant only at 95% confidence interval. RESULTS Cleft missions are a difficult task. Logistical and financial problems are exacerbated by the extreme difficulty of recruiting patients, particularly in remote regions, far from major centers. Despite successful widespread, some surgeries have been postponed due to comorbidities, common in Africa. CONCLUSION The organizers of the mission must be aware of the difficulty of attracting patients and must use different media such as television and radio. The internet needs to be used to the maximum and could reach a higher number of prospects.
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Affiliation(s)
- Agnelo Lucamba
- Department of Oral & Maxillofacial Surgery, Hospital Josina Machel, Luanda, Angola
| | - Ricardo Grillo
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil; Department of Oral & Maxillofacial Surgery, Faculdade Patos de Minas, Brasília, Brazil.
| | - Suzana Bessa
- Department of Anesthesia, Hospital Josina Machel, Luanda, Angola
| | | | - Luzolo Filipe
- Department of Oral & Maxillofacial Surgery, Huambo Provincial Hospital, Huambo, Angola
| | - Maria da Graça Naclério-Homem
- Department of Oral & Maxillofacial Surgery, Traumatology and Prosthesis - Faculty of Dentistry of the University of São Paulo, Brazil
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Stoehr JR, Hamidian Jahromi A, Chu QD, Zibari GB, Gosain AK. Considerations for resuming global surgery outreach programs during and after the coronavirus disease 2019 (COVID-19) pandemic. Surgery 2021; 170:1405-1410. [PMID: 34130811 PMCID: PMC8148426 DOI: 10.1016/j.surg.2021.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/16/2021] [Accepted: 05/15/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The coronavirus disease 2019 pandemic has disrupted the delivery of safe surgical care worldwide. One specific aspect of global surgical care that has been severely limited is the ability for physicians and trainees to participate in global surgical outreach programs in low- and middle-income countries. METHODS A narrative review of the literature regarding global surgical outreach programs during the coronavirus disease 2019 pandemic was performed. Factors that must be considered in the reinstatement of global surgical outreach programs were identified, and suggestions to address them were provided based on the available literature and the experiences of the senior authors. RESULTS As global surgical outreach programs were canceled at the start of the pandemic, many academic surgeons turned to digital solutions to continue to engage with low- and middle-income country partners. With the advent of coronavirus disease 2019 vaccines and improved access to testing and treatment worldwide, the recommencement of global surgical outreach programs may begin to be considered. Important considerations before initiation include vaccine and testing availability for visiting providers, local staff, and patients, local hospital capacity, staff and equipment shortages, and the characteristics of the patient population and visiting providers. Region- and country-specific factors, including local infection rates and concomitant health crises, must also be taken into account. Expansion of digital collaborative efforts may further deepen international connections and promote sustainable models of care. CONCLUSION With careful consideration, global surgical outreach programs may begin to be safely restarted in the near future. The current article evaluates individual factors that must be considered to safely restart global surgical outreach programs as the coronavirus disease 2019 pandemic is better controlled.
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Affiliation(s)
- Jenna Rose Stoehr
- Feinberg School of Medicine, Northwestern University, Chicago, IL. https://twitter.com/JennaStoehr
| | | | - Quyen D Chu
- Division of Surgical Oncology, Department of Surgery, Louisiana State University Health-Shreveport, LA
| | - Gazi B Zibari
- John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, LA. https://twitter.com/ZibariGazi
| | - Arun K Gosain
- Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Plastic Surgery, Department of Surgery, Ann and Robert Lurie Children's Hospital, Chicago, IL.
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