The Global Otolaryngology-Head and Neck Surgery Workforce.

Importance: A core component of delivering care of head and neck diseases is an adequate workforce. The World Health Organization report, Multi-Country Assessment of National Capacity to Provide Hearing Care, captured primary workforce estimates from 68 member states in 2012, noting that response rates were a limitation and that updated more comprehensive data are needed. Objective: To establish comprehensive workforce metrics for global otolaryngology-head and neck surgery (OHNS) with updated data from more countries/territories. Design, Setting, and Participants: A cross-sectional electronic survey characterizing the OHNS workforce was disseminated from February 10 to June 22, 2022, to professional society leaders, medical licensing boards, public health officials, and practicing OHNS clinicians. Main Outcome: The OHNS workforce per capita, stratified by income and region. Results: Responses were collected from 121 of 195 countries/territories (62%). Survey responses specifically reported on OHNS workforce from 114 countries/territories representing 84% of the world's population. The global OHNS clinician density was 2.19 (range, 0-61.7) OHNS clinicians per 100 000 population. The OHNS clinician density varied by World Bank income group with higher-income countries associated with a higher density of clinicians. Regionally, Europe had the highest clinician density (5.70 clinicians per 100 000 population) whereas Africa (0.18 clinicians per 100 000 population) and Southeast Asia (1.12 clinicians per 100 000 population) had the lowest. The OHNS clinicians deliver most of the surgical management of ear diseases and hearing care, rhinologic and sinus diseases, laryngeal disorders, and upper aerodigestive mucosal cancer globally. Conclusion and Relevance: This cross-sectional survey study provides a comprehensive assessment of the global OHNS workforce. These results can guide focused investment in training and policy development to address disparities in the availability of OHNS clinicians.

Ear and hearing health in Niue: a qualitative study on the worldviews, knowledge, beliefs and use of health care.

Introduction Hearing is a primary sense that facilitates the development of spoken language, social connection and an appreciation of sounds within the natural world. Hearing loss has multiple adverse effects across the life course. Understanding the worldviews of ear and hearing health in Pacific peoples is crucial to inform responsive and appropriate hearing health and primary healthcare services. Aim To understand the worldviews, knowledge and beliefs held by the Niuean community in Niue towards ear and hearing health, and the use of healthcare methods to contribute to service development. Methods Twenty semi-structured interviews were conducted with Niuean community members. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis methods. Results Niuean people value hearing health as an important way to communicate and connect with each other. They are proactive health seekers, have good knowledge about ear disease and hearing health and use mainstream medicines alongside spiritual practices and traditional remedies to maintain good ear and hearing health. The hospital system is responsive and accessible to the community's needs, contrasting with Pacific people's access to hearing health services in New Zealand. Discussion There is a high level of awareness of the importance of hearing health amongst the Niuean community and good accessibility and utilisation of healthcare services. There is potential to implement locally focused ear and hearing health strategies in Niue and conduct hearing health research among the New Zealand-based Niuean community to improve primary healthcare services delivery.

Telephone triage does not improve attendance rates in a paediatric audiology outpatient service.

AIMS: To investigate the impact of clinician-led telephone consultation during the New Zealand COVID-19 lockdown on subsequent appointment attendance in a paediatric audiology service, particularly for Maori and Pacific families. METHODS: A retrospective clinical audit at Counties Manukau Health of all children (>3 years old) on the audiology waiting list. Binary logistic regression analysis tested for association of appointment attendance following attempted audiologist-led telephone consultation, with ethnicity, waiting times, socio-economic deprivation levels and telephone consultation contact. RESULTS: Of 349 eligible children, 208 families participated in telephone consultations (59%). Ten percent of those contacted were able to be discharged as no longer requiring care. There were no differences in attendance rates between those who had participated in telephone consultation and those who had not (77.5% versus 77.8%). Pacific and Maori children were 68% and 64% less likely to attend appointments after adjusting for socio-economic deprivation level, waiting time and telephone consultation compared to NZ European children. Longer waiting times were significantly associated with decreased attendance rates. CONCLUSIONS: Attendance was found to be associated with ethnicity and waiting times. Telephone consultation did not improve attendance rates overall nor for ethnicity subgroups. It is therefore concluded that telephone consultation was found to be of only limited benefit in paediatric audiology services.

New Zealand resident Tongan peoples' health and illness beliefs and utilisation of the health care system.

This study investigated the perceptions of health and illness, and the utilisation of the health care system, over the last five years, of Tongan people who reside in New Zealand. A descriptive qualitative approach was used, with the study being implemented by networking with representatives of the Tongan community and health care workers. Twenty adult Tongan people volunteered and were given the interview questions in advance. The individual face to face semi-structured interviews took approximately 30 to 45 minutes. Participants verified the transcription of their interviews. Answers were analysed by identifying themes in response to each interview question. Most participants considered health to be a state of physical, mental, social and spiritual well being. Illness beliefs were predominantly either a biological malfunction of the body, or a breakdown of the holistic state of well being. All participants had used the western orthodox medical system, with the general practitioner being consulted more than other services. A high level of satisfaction was expressed with this service. Traditional Tongan healing was utilised by about half the participants, and most were happy with its outcomes. A lesser number of participants had used alternative health care, but the levels of satisfaction with it were mixed.