Characteristics and outcomes of youth with functional seizures attending intensive interdisciplinary pain treatment.

Functional seizures (FS) can be debilitating and negatively impact quality of life. Yet intervention research for FS is limited, especially for youth. This study examined clinical characteristics and outcomes of youth with FS (13-23 years) presenting to a pediatric intensive interdisciplinary pain treatment (IIPT) program in the midwestern United States. Sixty youth (mean age = 16.5 years; 83.3 % female) met inclusion criteria. At intake, comorbid chronic pain, somatic symptoms, autonomic dysfunction, eating and weight disturbances, and mental health concerns were common. Despite this high symptom burden, youth with FS reported significant improvements in functioning measured with the Functional Disability Inventory, t(53) = 9.80, p <.001, d = 1.32; depression measured with the Center for Epidemiological Studies - Depression Scale for Children, t(53) = 6.76, p <.001, d = 0.91; anxiety measured with the Spence Children's Anxiety Scale, t(53) = 3.97, p < .001, d = 0.53; and catastrophizing measured with the Pain Catastrophizing Scale for Children, t(53) = 6.44, p <.001, d = 0.86, following completion of the program, suggesting that IIPT may be an effective treatment option for highly disabled and emotionally distressed youth with FS. Future research is needed to continue to refine best practices for youth with FS to reduce suffering and improve outcomes.

Gender Disparities in Academic Otolaryngology.

OBJECTIVE: The aim was to evaluate representation of women in otolaryngology by examining authorship of research publications and presentations, awards, research grants, leadership, and membership in related organizations. METHODS: Authorship was reviewed from articles published in three otolaryngology journals from 2000 through 2021 to assess the frequency and percentages of female and combination of male and female gender authorship. Gender was evaluated for poster and scientific abstract presentations from 2007 to 2021. Gender representation was reviewed for institutional and society leadership positions, award, and grant recipients in the American Laryngological Society (ALA). Changes in the frequency of female and combination of male and female gender authorship over time were examined with Cochran-Armitage test for trend. RESULTS: A total of 16,921 articles, 1,017 presentations, 480 leadership positions, 129 president positions, and 1,137 awards and grants were studied. Women were first authors in 4,153 (24.9%) and last authors in 2,935 (17.8%) published articles for which gender could be determined. Women were first authors in 372 (37.4%) presentations and last authors in 199 (20.2%). Most presentations had a combination of male and female presentation authorship (630, 68%). Women held 69 (14.4%) leadership positions. Of the award and grant recipients, 327 (28.8%) were female. Significant trends were observed for increasing female representation (first authorship publications increased 69.9% from 2000 to 2020, first authorship presentations increased 73.9% from 2007 to 2013, p < 0.001; leadership and awards from 3% to 18% representation, p = 0.02). CONCLUSION: The proportion of women receiving awards and holding leadership positions is increasing. Efforts that promote gender diversity may further increase representation of women in otolaryngology literature and among the grant and award winners. LEVEL OF EVIDENCE: NA Laryngoscope, 134:2144-2152, 2024.

Geographic Distribution of Otolaryngology Training Programs and Potential Opportunities for Strategic Program Growth.

OBJECTIVE: To characterize the geographic distribution of US otolaryngology residents based on geographical population density to determine current status and identify potential opportunities for otolaryngology residency program expansion. METHODS: The locoregional population of otolaryngology residency programs was analyzed (as defined by the US Census) and the number of resident trainees per 100,000 people in each region was calculated. Otolaryngology residency program location was determined by mailing address, and program size was determined by AAMC public data. RESULTS: The average metropolitan city in the United States contained 2.07 otolaryngology trainees per 100,000 people. Cities with low trainee numbers per population included Phoenix, AZ (0.20 trainees per 100,000 people); Las Vegas, NV (0.26 per 100,000); Dallas, TX (0.26 per 100,000), Atlanta, GA (0.33 per 100,000); and Miami, FL (0.34 per 100,000). Comparing otolaryngology to other surgical subspecialties demonstrated similar distributions. Metropolitan centers with a population over 1 million without full academic representation in otolaryngology were also identified and included Charlotte, NC; Orlando, FL; Austin, TX; Providence, RI; Jacksonville, FL; Raleigh, NC; and Grand Rapids, MI. CONCLUSION: Strategic residency training program expansion should be considered in cities that exhibit a low trainee to population ratio. Although many factors ultimately determine program expansion or development of new training programs, this study provides substantiated population data describing where expansion could be prioritized. LEVEL OF EVIDENCE: NA Laryngoscope, 133:1600-1605, 2023.

Anxiety and Depression in Patients With Idiopathic Subglottic Stenosis.

OBJECTIVES: To characterize the presence and severity of anxiety and depression in patients with symptomatic idiopathic subglottic stenosis (ISGS). To determine the relationship between dyspnea severity and anxiety and depression symptom severity. METHODS: Patients diagnosed with idiopathic subglottic stenosis and treated at Mayo Clinic Florida or Mayo Clinic Arizona retrospectively completed the PROMIS Depression, PROMIS Anxiety, PROMIS Dyspnea Functional Limitations, and Dyspnea Index questionnaires. Patients with dyspnea and without idiopathic subglottic stenosis were also asked to complete the questionnaires as a control group. RESULTS: This explorative retrospective study includes 44 control patients and 46 ISGS patients. Unadjusted and adjusted group comparisons found no statistically significant difference in dyspnea index, depression, anxiety, nor dyspnea functional limitation scores. Relationships between dyspnea severity and anxiety and depression severity were significant and persistent in both groups. Anxiety and depression were positively correlated (r = 0.66). Dyspnea severity positively correlate with both anxiety and depression (anxiety r = 0.49, depression r = 0.32). CONCLUSIONS: Patients with symptomatic idiopathic subglottic stenosis are not at an increased risk of having anxiety and depression when compared to other dyspneic patients. As dyspnea severity worsens, patients are more likely to experience anxiety and depression. These findings support the prior literature and suggest the presence of dyspnea may warrant appropriate psychological screening and treatment to optimize dyspneic patients' quality of life and symptom improvement.

Inpatient pediatric chaplain service utilization among children with chronic, non-cancer diseases.

Despite the broad importance of pediatric spiritual care, most research focuses on oncologic and palliative care contexts. We aim to describe the utilization of pediatric chaplain services by children hospitalized for non-cancer chronic illnesses and to identify factors that predict utilization of chaplain services. Among 629 patients with 915 admissions, we found chaplain services were utilized in 5.0% of admissions. Utilization was similar between religiously affiliated patients (7.5%, 95%CI [5.3-10.6%]) and un-affiliated patients (6.4%, [3.6-11.0%]). Christian patients (7.3% [5.1-10.5%]) demonstrated similar utilization as non-Christian patients (7.0% [4.3-11.2%]). Utilization was significantly higher among patients with LOS >2 days (10.8% [7.9-14.6%]), compared to LOS ≤2 (1.7% [0.9-3.1%]). These results may represent an addressable gap in spiritual care, and they highlight an opportunity for pediatric chaplains to play a larger role in the holistic care of hospitalized children with chronic diseases, regardless of religious affiliation.

Longitudinal associations between family conflict, parent engagement, and metabolic control in children with recent-onset type 1 diabetes.

INTRODUCTION: We prospectively investigated the associations between diabetes-related family conflict, parent engagement in child type 1 diabetes (T1D) care, and child glycated hemoglobin (HbA1c) in 127 families of school-age children who we recruited within the first year of their T1D diagnosis. RESEARCH DESIGN AND METHODS: Parents completed the Diabetes Family Conflict Scale-Revised (DFCS-R) to assess for diabetes-related family conflict and the Diabetes Self-Management Questionnaire-Brief (DSMQ-Brief) to assess parent engagement in child T1D care at the initial study visit (T1) and at 12 (T2) and 27 (T3) months later. We also collected child HbA1c at these time points. Our analyses included Pearson correlations and repeated measures linear mixed models controlling for child age, sex, and T1D duration at T1. RESULTS: Parents' DFCS-R scores negatively correlated with DSMQ-Brief scores (r=-0.13, p<0.05) and positively correlated with children's HbA1c (r=0.26, p<0.001). In our linear mixed models, parents' DSMQ-Brief scores were unchanged at T2 (ß=-0.71, 95% CI -1.59 to 0.16) and higher at T3 (ß=8.01, 95% CI 6.89 to 9.13) compared with T1, and there was an association between increasing DFCS-R and decreasing DSMQ-Brief scores (ß=-0.14, 95% CI -0.21 to -0.06). Child HbA1c values were significantly higher at T2 (ß=0.66, 95% CI 0.38 to 0.94) and T3 (ß=0.95, 95% CI 0.63 to 1.27) compared with T1, and there was an association between increasing DFCS-R scores and increasing child HbA1c (ß=0.04, 95% CI 0.02 to 0.06). CONCLUSIONS: Increasing diabetes-specific family conflict early in T1D may associate with decreasing parent engagement in child T1D care and increasing child HbA1c, suggesting a need to assess and intervene on diabetes-specific family conflict. Trial registration number NCT03698708.