UK adult ADHD services in crisis.

The UK's services for adult attention-deficit hyperactivity disorder (ADHD) are in crisis, with demand outstripping capacity and waiting times reaching unprecedented lengths. Recognition of and treatments for ADHD have expanded over the past two decades, increasing clinical demand. This issue has been exacerbated by the COVID-19 pandemic. Despite an increase in specialist services, resource allocation has not kept pace, leading to extended waiting times. Underfunding has encouraged growth in independent providers, leading to fragmentation of service provision. Treatment delays carry a human and financial cost, imposing a burden on health, social care and the criminal justice system. A rethink of service procurement and delivery is needed, with multiple solutions on the table, including increasing funding, improving system efficiency, altering the service provision model and clinical prioritisation. However, the success of these solutions hinges on fiscal capacity and workforce issues.

A narrative review of the logistic and economic feasibility of cochlear implants in lower-income countries.

Objectives: Globally, less than 1% of people who could benefit from a cochlear implant have one and the problem is particularly acute in lower-income countries. Here we give a narrative review of the economic and logistic feasibility of cochlear implant programmes in lower-income countries and discuss future developments that would enable better healthcare. We review the incidence and aetiology of hearing loss in low- and middle-income countries, screening for hearing loss, implantation criteria, issues concerning imaging and surgery, and the professional expertise required. We also review the cost of cochlear implantation and ongoing costs. Findings: The cost effectiveness of cochlear implants in lower-income countries is more limited by the cost of the device than the cost of surgery, but there are also large ongoing costs that will deter many potential users. Conclusions: We conclude that the main barriers to the future uptake of cochlear implants are likely to be logistical rather than technical and cochlear implant provision should be considered as part of a wider programme to improve the health of those with hearing loss.

The impact of ear disease and hearing impairment on the lives of Nepali patients in Pokhara: a qualitative study.

BACKGROUND: Ear disease in Nepal is a common problem which, left untreated, can cause serious complications such as hearing impairment (HI). Evidence shows that HI is associated with educational difficulties, employment problems and social isolation. Currently, there is little qualitative literature investigating the long-term impact of ear disease, and none specifically reporting on Nepali populations. This qualitative study explored the experiences of individuals affected by ear disease, with a view to informing hospital services and educational programmes. METHODS: A quota sampling technique was used, with 21 face-to-face semi-structured interviews conducted in Pokhara, Nepal during February-March 2014. Interviews were audiotaped, and verbatim transcripts were analysed using a conventional content analysis approach. RESULTS: Three overarching themes were identified: stigma, non-disclosure and barriers as a result of HI, stigma and non-disclosure. Stigma was both experienced and feared by participants throughout their lives, and as a result, they would not disclose their problem to friends, teachers and employers. Participants faced barriers in their education and work but did not receive the support they required because people were unaware of their condition. CONCLUSIONS: This research suggests that a 'stigma cycle' has developed and that participants are being trapped within it. This impacts adversely upon individuals' personal, social and economic development, limiting the human capital available to Nepal.

Hearing impairment in otitis media with effusion: a cross-sectional study based in Pokhara, Nepal.

OBJECTIVE: Otitis media with effusion (OME) is a major cause of childhood hearing impairment (HI) in the developing world, but its prevalence has never been quantified in Nepal. This study therefore set out to determine the proportion of cases of OME complicated by HI and to identify associated factors. METHODS: This was a cross-sectional prevalence survey carried out in rural, urban and Tibetan schools in and around Pokhara, Nepal. HI was the primary outcome, and was defined as a middle-frequency pure tone average >25 dB on audiological testing. The study population was defined as children aged four years and older, attending primary school and with a diagnosis of OME. RESULTS: One hundred and eleven schoolchildren with a combined total of 172 ears affected by OME underwent audiometric assessment. HI was most prevalent in the rural Nepali population; 27% (95%CIs 18-38%) had HI, with a mean hearing loss of 22 dB (15-25 dB). In the Tibetan population, 16% (8-29%) had HI, with a mean loss of 17 dB (12-22 dB). The urban Nepali population had the least HI; 4% (1-13%) were affected, with a mean loss of 16 dB (15-19 dB). The difference in prevalence between the urban and rural Nepali populations was statistically significant (p>0.05). Logistic regression analysis did not identify any associated factors. CONCLUSIONS: HI is a common complication of OME in Nepal. There is hitherto-unreported variation between populations in the number of cases of OME complicated by HI. This study identified higher rates of morbidity amongst rural populations but was unable to identify associated factors.