Pediatric speech-language pathology in East Africa: educational opportunities and availability of speech-language services.

OBJECTIVE: This paper describes the current situation of the provision of speech-language services in East Africa. An overview of the educational opportunities, workforce density, communication rehabilitation planning, caseload, and ethical and/or cultural challenges is provided. METHOD: A narrative review was performed. All papers referring to communication disorders in East African countries were identified from EMBASE, PubMed, ISI Web of Science: Science Citation Index Expanded, and ISI Web of Science: Conference Proceedings Citation Index-Science using the following search terms: speech therapy, speech pathology, speech-language pathology, speech-language rehabilitation, speech-language therapy, logopedics, East Africa, communication disorders, communication difficulties. Two concepts were combined with a Boolean operator 'AND'. RESULTS: At present, there is an alarming shortage of speech-language pathologists in East Africa. This issue is mainly related to the limited availability of educational programs in speech-language pathology. Although more and more universities are beginning to offer such educational programs, the number of available speech-language pathologists is still too low to meet the needs of all children with communication disorders. In addition, speech-language pathologists are often faced with different cultural and ethical obstacles when they provide intervention to East African children with communication disorders. These speech-language pathologists are therefore challenged to take a broader view of their role as a therapist. These alternative roles often include training of other individuals in the context of community-based rehabilitation. CONCLUSION: In the future, it will be important to carefully consider the development of sustainable learning opportunities in East African contexts. Initiatives, for example, "train-the-trainer" workshops, are needed to support the speechlanguage pathologists. Existing models like the communication disability model can aid to create holistic frameworks for the development of sustainable speech-language services in the East African countries.

Perfil epidemiológico de usuários encaminhados para atendimento fonoaudiológico em um município do Rio Grande do Sul / Epidemiological profile of users referred to speech therapy in a municipality in Rio Grande do Sul

RESUMO Objetivo Caracterizar o perfil epidemiológico de usuários encaminhados para atendimento fonoaudiológico no município de Canoas (RS). Métodos Estudo epidemiológico, transversal e descritivo. A pesquisa foi feita a partir de dados do Sistema Integrado de Gestão de Serviços de Saúde de Canoas (RS), com coleta da lista de espera para atendimento fonoaudiológico, sob controle da Diretoria de Regulação Municipal. Resultados a lista de espera contemplou 850 encaminhamentos para Fonoaudiologia, datando de 18/01/2018 até 27/08/2021. O maior número de encaminhamentos foi de crianças de 4 a 7 anos de idade, com 244 (28%), sendo 484 usuários do gênero masculino (56,9%), 702 brancos (82,6%) e encaminhados pela atenção primária (totalizando 76,2%). O tempo de espera na lista da regulação teve média de um ano e seis meses e variou com 186 usuários aguardando entre 7-12 meses (21,8%), 168 usuários aguardando entre 0,6 meses (19,7%) e 167 usuários aguardando entre 25-30 meses (19,6%). As queixas principais foram de linguagem e fala (60,2%). Conclusão Observou-se um represamento da demanda para atendimento fonoaudiológico pelo Sistema Único de Saúde em Canoas (RS), com baixa rotatividade e tempo de espera longo para reabilitação dos usuários, em sua maioria crianças. A partir deste estudo, espera-se auxiliar na identificação dessa demanda e, assim, possibilitar a criação de políticas públicas de habilitação ou reabilitação no município e melhorar o acesso da população ao atendimento especializado

ABSTRACT Purpose This research aimed to characterize the epidemiological profile of users referred to speech therapy in the city of Canoas/RS. Methods This is an epidemiological, cross-sectional and descriptive study. The research was based on data from the Canoas/RS. Integrated Health Services Management System (SIGSS), with collection of the waiting list for speech therapy, under the control of the Municipal Regulation Board. Results The waiting list included 850 referrals to Speech Therapy, dating from 01/18/2018 to 08/27/2021. The highest number of referrals was from children aged 4 to 7 years, with 244 (28%), 484 male users (56.9%), 702 white (82.6%) and referred by primary care (totaling 76, two%). The waiting time on the regulation list averaged 17.89 months (one year and six months) and varied with 186 users waiting between 7-12 months (21.8%), 168 users waiting between 0.6 months (19.7%) and 167 users waiting between 25-30 months (19.6%). The main complaints were language and speech (60.2%). Conclusion According to the data found, there was a damming of the demand for speech therapy care by the SUS in Canoas/RS., with low turnover and long waiting time for the rehabilitation of users, mostly children. This study is expected to help in the identification of this demand, and thus, enable the creation of public policies of habilitation or rehabilitation in the municipality and improve the population's access to specialized care.

Communication disability in Fiji: Community self-help and help-seeking support.

PURPOSE: To understand how a Fijian community supports people with communication disability (PWCD) and whether their support is associated with participant demographics. METHOD: Thematic analysis of 144 questionnaires that asked about participants' actions to support a fictional child and adult with communication disability. RESULT: Participant responses fell into two categories: what they would do directly (self-help) and people and places where they would seek assistance (help-seeking). Self-help behaviours included: making a change to their own communication style or mode; trying to change their own and others' behaviour; teaching new skills; praying; changing the physical environment; seeking information independently; assessing or observing; and, using traditional medicine, western medicine, or traditional belief practices. Help-seeking behaviours included seeking help from: other community members; education professionals; a professional in another country; spiritual leaders; traditional belief practitioners; traditional medicine practitioners; western health care practitioners; or, an alternative provider (e.g. home, orphanage, nursing home). Younger participants and those of iTaukei Fijian ethnicity were more likely to seek help from other community members. CONCLUSION: This Fijian community actively supports people with communication disability within available networks. Development of speech-language pathology services for people with communication disability living in similar communities should harness the informal knowledge within these networks.

[Nutritional study in geriatric patients (older than 65 years of age) with ambulatory enteral nutrition: correlation between underlying disease, nutritional support, and drug treatment]. / Estudio nutricional en pacientes geriátricos (mayores de 65 años) con nutrición enteral ambulatoria, correlación entre patología de base, aporte nutricional y tratamiento farmacológico.

GOAL: To identify the current status of out-patient enteral nutrition among elderly patients in Galicia: indications, access routes, forms of administration, types of diet, complications, disability status. Assessment of nutritional status and concomitant pharmacological treatment. METHODS: Prospective, observational, multi-centric study lasting for one month. Data capture by means of a questionnaire regarding: age, sex, diagnosed pathology leading to nutritional analysis, disability status, current nutritional status, type of diet, months under treatment with NEA (out-patient enteral nutrition in its Spanish acronym), form of administration, complications, concomitant medication. The statistical methodology included a descriptive analysis and a study of the correlations between the different variables. For the comparison of both groups, Student's t test or Mann-Whitney's U test was used for quantitative variables and chi-squared, Yate's correction or Fisher's exact test was used for qualitative variables. RESULTS: 469 patients were studied, corresponding to 13 publicly-funded centres. Age: 81.15 years (95% CI 80.8-82.3), women (70.6%). DIAGNOSIS: neurological disorders (46.1%), cerebrovascular accidents (27.5%), neoplasia (12.4%) and others (14.1%). 45.2% presented a bedbound disability status and 53.5% presented communication difficulties. Standard diet was the most common (39.4%). DURATION OF THE NUTRITION: > 1 year in 36.7% of cases, between 6 months and 1 year for 21.3%, between 3 and 6 months for 10.9% and < 3 months in 13.7% of cases. Nasogastric tube was the route for administration in 55.2%. Patients with nutrition treatment lasting over 1 year presented a significantly lower rate of malnutrition (p < 0.0001). Neurological patients and those with communication difficulties had a lower prevalence of malnutrition (p < 0.0001), as did those with a greater degree of disability (p < 0.01). Undernourished patients presented a greater prevalence of bedsores (49.1% versus 25.8%, p < 0.0001). The mean number of prescribed medicines was 3.27 +/- 2.41, with 64% of them being administered through the nasogastric tube. The most frequent interaction was digoxin-fibre (29.6%) and incorrect administration was observed with omeprazol and medication to combat Parkinson's disease.