The impact of digital inequities on laryngeal cancer disparities in the US.

OBJECTIVES: To develop and implement a novel, comprehensive tool, the Digital Inequity Index (DII), that quantifiably measures modern-technology access in the US to assess the impact of digital inequity on laryngeal cancer (LC) care nationwide. METHODS: DII was calculated based on 17 census-tract level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure-access (i.e., electronic device ownership, type of broadband, internet provider availability, income-broadband subscription ratio) or sociodemographic (i.e., education, income, disability status), ranked and then averaged into a composite score. 22,850 patients from 2008 to 2017 in SEER were assessed for regression trends in long-term follow-up, survival, prognosis, and treatment across increasing overall digital inequity, as measured by the DII. This methodology allows for us to assess the independent contribution of digital inequity adjusted for socioeconomic confounders. RESULTS: With increasing overall digital inequity, length of long-term follow-up (p < 0.001) and survival (p = 0.025) decreased. Compared to LC patients with low DII, high DII was associated with increased odds of advanced preliminary staging (OR 1.06; 95 % CI 1.03-1.08), treatment with chemotherapy (OR 1.06; 95 % CI 1.04-1.08), and radiation therapy (OR 1.02; 95 % CI 1.00-1.04), as well as decreased odds of surgical resection (OR 0.96; 95 % CI 0.94-97). CONCLUSIONS: Digital inequities are associated with detrimental trends in LC patient outcomes in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national sociodemographic trends of the impact of online access on informed care.

The Impact of Digital Inequities on Esophageal Cancer Disparities in the US.

BACKGROUND: There is currently no comprehensive tool that quantifiably measures validated factors of modern technology access in the US for digital inequity impact on esophageal cancer care (EC). OBJECTIVE: To assess the influence of digital inequities on esophageal cancer disparities while accounting for traditional social determinants. METHODS: 15,656 EC patients from 2013-2017 in SEER were assessed for significant regression trends in long-term follow-up, survival, prognosis, and treatment with increasing overall digital inequity, as measured by the Digital Inequity Index (DII). The DII was calculated based on 17 census tract-level variables derived from the American Community Survey and Federal Communications Commission. Variables were categorized as infrastructure access or sociodemographic, ranked, and then averaged into a composite score. RESULTS: With increasing overall digital inequity, significant decreases in the length of long-term follow-up (p < 0.001) and survival (p < 0.001) for EC patients were observed. EC patients showed decreased odds of receiving indicated surgical resection (OR 0.97, 95% CI 0.95-99) with increasing digital inequity. They also showed increased odds of advanced preliminary staging (OR 1.02, 95% CI 1.00-1.05) and decreased odds of receiving indicated chemotherapy (OR 0.97;95% CI 0.95-99). CONCLUSIONS: Digital inequities meaningfully contribute to detrimental trends in EC patient care in the US, allowing discourse for targeted means of alleviating disparities while contextualizing national, sociodemographic trends of the impact of online access on informed care.

Total Thyroidectomy and Subsequent Weight Gain in Pediatric Populations.

OBJECTIVE: To evaluate weight gain in children post-thyroidectomy and identify predictors. METHODS: Charts from patients at a tertiary health care facility who underwent total thyroidectomy from 2014 to 2020 were reviewed for Body Mass Index z-scores (BMIz) at the time of thyroidectomy and at 1 and 2-year post-operation intervals. Patient demographic information, comorbidities, pre- and postoperative thyroid stimulating hormone, and postoperative free T4 levels were also extracted. Patients with other known endocrine abnormalities, chronic kidney disease, or without sufficient follow-up were excluded. RESULTS: A total of 56 patients (ages 3-17 years old) met the inclusion criteria (n = 17 Graves' disease; n = 39 presumed cancer). Over the first year, average BMIz significantly increased in patients with Graves' disease (∆BMIz = 0.45 ± 0.77, p = 0.03), Hispanic ethnicity (∆BMIz = 0.43 ± 0.68, p = 0.004), Medicaid/no insurance coverage (∆BMIz = 0.33 ± 0.74, p = 0.038), age <13 years at thyroidectomy (∆BMIz = 0.35 ± 0.68, p = 0.016), and persistent postoperative hypothyroidism (∆BMIz = 0.41 ± 0.41, p = 0.012). These changes remained significant after the second year. Age at thyroidectomy correlated negatively with ∆BMIz only after the first year (r = -0.40, p = 0.002). Regression analysis, controlling for Graves' status, persistent postoperative hypothyroidism, and insurance coverage, identified age at thyroidectomy as a significant predictor of ∆BMIz after the first year (b = -0.06, p = 0.004) and Hispanic ethnicity as a significant predictor after the second year (b = 0.60, p = 0.003). CONCLUSION: A small increase in BMIz post-thyroidectomy was observed across several patient subgroups. Younger age at thyroidectomy and Hispanic ethnicity were associated with increased BMIz in the first 2 years post-thyroidectomy. LEVEL OF EVIDENCE: Level 4 - Historically controlled cohort Laryngoscope, 133:1518-1523, 2023.

Soothe the savage beast: Patient perceptions of the benefits of music therapy in an inpatient rehabilitation facility.

INTRODUCTION: Despite the known benefits of music therapy (MT) and its potential applications in an inpatient rehabilitation facility (IRF), there remains a lack of access to MT in a significant number of hospitals in the United States. Exploration of stakeholder (e.g., physician, therapist, and patient) perceptions as a potential barrier to uptake has been limited. OBJECTIVE: To assess the favorability of patients admitted to an IRF toward MT through the domains of knowledge, attitudes, and beliefs. We hypothesized that patient domain scores would reflect a favorable perception of MT across rehabilitation diagnoses. DESIGN: Descriptive and cross-sectional survey. SETTING: Free-standing, acute IRF. PATIENTS: A total of 119 English-speaking, adult patients across three impairment categories (general rehabilitation, spinal cord injury, and brain injury) were recruited over a 3-month period and during each patient's hospital stay. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: A modified version of the Global Complementary/Alternative and Music Therapy Assessment (GCAMTA) measured the domains of knowledge, attitudes, and beliefs. RESULTS: An overall response rate of 79.3% was achieved. Most patients (n = 95; 79.8%) scored in either the favorable or neutral ranges of the instrument. Age correlated negatively (r = -0.193, p < .05) with total score, whereas highest level of education correlated positively (rs  = 0.222, p < .05). There were no significant differences in scores across impairment categories (V = 0.068, p = .232). Knowledge scores, controlling for education and age, predicted 30.4% of the variance in attitudes and beliefs scores (R2  = 0.304, p < .001). CONCLUSIONS: It is unlikely that patient perceptions are a barrier to MT uptake. Younger, more educated patients have higher knowledge, attitudes, and beliefs about MT. Increasing patient knowledge about MT may improve their attitudes and beliefs, thereby further optimizing this therapy for widespread use.

Perspectives and Experiences of College-Aged Singers Regarding Voice Injury and Visiting the ENT: A Phenomenological Approach.

Among singers, stigma surrounding voice injury can affect self-esteem, self-efficacy, and self-worth and can lead to hesitancy to disclose vocal injuries for fear of damaging their career. In addition, stressors in the singer-physician relationship can work against positive interactions with physicians. To date, no study has documented the perspectives of singers about voice injury and their interactions with physicians through a qualitative approach. The purpose of this study was to a) examine the perspectives and experiences of college-aged singers regarding voice injury and visiting an ear, nose, and throat physician (ENT), and b) identify behaviors of singers and ENT physicians that establish a functional and healthy relationship with the other. Following an interpretive phenomenological design, 6 collegiate singers were interviewed using a semi-structured guide, and from the results of these interviews three emergent themes were generated: a) the emotional connection of a singer and their voice, b) the presence of stigma surrounding voice injury, and c) the barriers to effective relationships between a singer and an ENT physician.

All Tied Up: The Effect of Wearing a Necktie on Acoustic and Perceptual Measures of Male Solo Singing.

The purpose of this study was to assess acoustically (long-term average spectra and multidimensional voice profile) and perceptually (participant perceived phonatory ease and expert listening panel) the effect of wearing a necktie on male singing in a solo setting. No study to date has assessed the potential effects of wearing neckties in a solo vocal setting. Among primary results: (a) statistically significant differences in spectral energy (0-10 kHz) between performances with and without a necktie, (b) increases in mean jitter and shimmer percentage measurements of singers with a necktie, (c) significant reduction in perceived phonatory ease when singing while wearing a necktie, and (d) listener preferences for singing without a necktie. Results were discussed in terms of limitations of the study, suggestions for future research, and implications for voice pedagogy.