Understanding Performers' Perspectives on Access to Care and Support for Voice Injuries: A Survey Study.

INTRODUCTION: Previous studies show that performers face higher risk of voice injury and experience greater impairment compared to nonperformers. Understanding the factors influencing support for performers is important for improving outcomes. METHODS: An anonymous online survey was distributed to a target audience of performers with past voice injury, inquiring about their understanding of voice injury "red flags," access to voice care support resources, treatment adherence, and comfort discussing injury with others. Responses were analyzed considering various clinicodemographic factors and aspects related to care and treatment. RESULTS: The survey was completed by 151 performers with self-reported history of voice injury, representing multiple performance genres. Participants commonly sought help from a general otolaryngologist (52; 34.44%), laryngologist (41; 27.15%), or voice teacher (40; 26.49%) and treatments included voice therapy, rest, medication, and surgery, with a majority reporting high treatment adherence (129; 87.16%), a statistically significant factor in resolving symptoms. Those with partial or nonadherence cited financial/insurance barriers, scheduling/availability conflicts, or treatment dissatisfaction. Participants reported high awareness of voice injury "red flags" (mean 86.80; SD 18.87%), and moderate access to voice care tools/resources (mean 74.76; SD 29.1) and a voice team (mean 71.23; SD 36.52), but low support from management/production teams (mean 50.69; SD 37.23). Several expressed a desire for better education about preventive care (mean 70.06; SD 37.78). Comfort levels in discussing voice injuries varied across social contexts, but those working with voice teachers were more comfortable discussing their voice problems with colleagues and peers. CONCLUSION: This study explores performers' perspectives on accessing care for voice injuries and emphasizes the importance of increased preventive education to address the ongoing stigma surrounding voice injuries and to foster a supportive environment for performers seeking help. Additionally, the study highlights the role of voice professionals in both providing and advocating for support systems for performers with voice injury.

Performers With History of Voice Injury: A Survey Study of Treatment Outcomes and Vocal Function.

INTRODUCTION: Past studies show that performers are more susceptible to voice injury, have higher incidence of injury, and experience greater vocal impairment than non-performers. Despite literature demonstrating otherwise, there remains fear and stigma that voice injury is a career-ending circumstance. Much of this is due to a lack of information about post-treatment vocal function. METHODS: An anonymous online survey was distributed via email, flyer, and social media to a target audience of performers with a history of voice injury. It inquired about occupation, vocal symptoms, professionals consulted, and treatment adherence. Outcome measures included ability to perform, resolution of symptoms, and attitudes about their voices after voice injury. Findings were analyzed descriptively with statistical analysis to determine factors that may be related to favorable outcomes. RESULTS: The survey was completed by 151 performers representing a range of genres, including musical theatre, classical, and popular genres. The most reported vocal symptoms were decreased range, singing voice quality changes, increased singing effort, and vocal fatigue. Most initially sought care from an otolaryngologist, laryngologist, or voice teacher. Diagnoses and recommendations varied, but those who adhered to treatment were more likely to report resolution of voice symptoms (P = 0.025). Those with symptoms for 2-4 weeks reported greater vocal confidence than those with a longer symptom duration (P = 0.0251). Performers working with a voice teacher were more likely to find treatment helpful (P = 0.0174). Those with neurogenic voice conditions reported less vocal reliability than participants with other pathologies (P = 0.0155). CONCLUSION: The majority of participants continued to perform, reported resolved or improved voice symptoms after treatment, and reported positive attitudes about their voices, regardless of their injury or current presence or absence of pathology on exam. Findings of this study highlight a need for continued outreach to voice teachers, education programs, and production teams about vocal function after voice injury.

Students' Experience with Vocal Injury in Undergraduate Performing Arts Training Programs.

PURPOSE: Voice injuries are well-documented in the literature and can be found in any person regardless of their profession. However, performing artists need a healthy voice in order to do their job properly. In educational environments, students with injuries are presented with the unique challenge of recovery in addition to a heavy course load. This study seeks to understand and question the experience of the undergraduate vocally injured performing arts student. METHOD: An IRB approved, online survey was created to assess vocally injured undergraduate students' experiences and was shared via social media and email outreach. RESULTS: The results of this study show clear ways that undergraduate faculty can support their injured students while they are in training. Additional findings include the importance of the voice teacher/student relationship, timing of diagnoses, and the overall faculty dynamic. Future research may benefit from investigating the voice teacher/student relationship and the mental health repercussions of vocally injured performing arts students. CONCLUSIONS: In conclusion, this study found that vocally injured students have diverse experiences while in undergraduate training programs.

Vocal Health Education in Undergraduate Performing Arts Training Programs.

PURPOSE: Vocal health is taught in multiple formats and to varying degrees across undergraduate training programs. The aim of the study is to identify what methods of instruction lead to a better self-perception of vocal health in order to more adequately prepare graduates for the extreme demands of the performing arts industry. METHOD: A survey investigating how vocal health and vocal injury are being taught was administered to students within 5 years of graduation. This study looked at what type of information is taught, when information is presented, how prepared students feel they are to handle their health and injuries upon graduation, the prevalence of injuries while in school and during the first 5 years of postgraduation, and students' suggestions to improve their overall vocal health education. The survey compares vocal health education between the various disciplines of classical voice, musical theatre, and acting. RESULTS: Students learn more about general vocal hygiene than voice disorders in their undergraduate programs. Classical voice and musical theatre majors learn more about vocal health than acting majors, yet acting majors report a higher incidence of vocal injury within the first 5 years of graduation. Students also retain more vocal health knowledge when presented with information multiple times in their education. CONCLUSIONS: Creating a more specific, consistent vocal health curriculum for all voice-related performing arts programs will improve self-efficacy regarding vocal health upon graduation.

Acoustic Comparison of Lower and Higher Belt Ranges in Professional Broadway Actresses.

PURPOSE: Current research on the female belt voice has generally been limited to the range of C5, which is not representative of the current requirements on Broadway. Additionally, much belt research uses voice teachers or college students. The goal of this study was to acoustically examine both higher and lower belt ranges in 10 women who have performed belt roles on Broadway during the last decade. METHOD: We analyzed the long-term average spectrum of the middle stable portion of three belted pitches, one from a lower, more traditional belt song and two from a higher, more contemporary belt song. The dB levels of the first three peaks in the long-term average spectrum corresponding to the first three harmonics were extracted and compared across tasks. Age, professional roles played on Broadway, and self-perceived belt strategy were obtained via interview to find potential unifying factors in resonance strategies. RESULTS: Overall, the dB level of the peaks closest to the second and third harmonics were higher than the peak close to the fundamental frequency. The difference between peaks was statistically greater in the lower belt compared to both higher belt tasks, indicating these singers relied more on a single harmonic in the lower belt range than the higher belt range. In the higher belt range, there was less variability between peaks. No patterns emerged between resonance strategies and demographic information. CONCLUSIONS: Elite female belters use varying resonance strategies to create commercially viable belt sounds in different belt ranges.

Health Literacy and Perceptions of Stigma.

Calls for progress in health literacy argue that efforts across society are promising for increasing capacities at a broader level. However, it is unknown how the general public perceives people who struggle with health information. While it may be ideal to establish interventions beyond the individual, stigma held by others could limit this work. This study explores whether one's personal health literacy skills are associated with stigma enacted toward others who struggle with health literacy. Adults (N = 5,151) responded to a survey consisting of health literacy assessments and a vignette in which a patient made a health-related mistake. Differences were observed regarding the number of participants who self-reported (n = 251) versus objectively scored as having low health literacy (n = 794). Participants who self-reported (MlowHL = 5.67, MhighHL = 5.99, p < .01) or had low objective health literacy (MlowHL = 5.75, MhighHL = 6.01, p < .001) exhibited less pity for the person in the vignette than health literate participants. Participants were more demanding of a young person featured in the vignette (33-year old), indicating greater personal responsibility (M72 = 5.12, M33 = 5.67), anger (M72 = 4.54, M33 = 5.57), and less pity (M72 = 6.18, M33 = 5.75) compared to an older person (72-year old). Results from the present study suggest contradictory perceptions among patients who are likely to feel stigma themselves.

Bupropion and naltrexone combination alters high fructose corn syrup self-administration and gene expression in rats.

Contrave® is an adjunct pharmacotherapy for obesity that contains bupropion (BUP) and naltrexone (NTX). To further explore the psychopharmacology of this drug combination, male Sprague-Dawley rats were implanted with subcutaneous osmotic mini-pumps releasing: 40 mg/kg/day BUP, 4 mg/kg/day NTX, or 40 + 4 mg/kg/day BUP and NTX (BN). During 12 days of exposure, the animals were tested on operant intraoral self-administration (IOSA) of high fructose corn syrup (HFCS) on continuous (FR1) and progressive ratio (PR) schedules, on home cage drinking of HFCS, and on HFCS taste reactivity. Locomotion activity was also assessed. At the conclusion of the study, mRNA expression of genes involved in reward processing, appetite and mood were quantified. It was found that BN produced effects that could largely be ascribed to either BUP or NTX independently. More specifically, BN-induced reductions of HFCS IOSA on a FR1 schedule and home cage drinking, as well as alterations of MOR and POMC mRNA in the nucleus accumbens core and hypothalamus respectively, were attributable to NTX; while alterations of hippocampal BDNF mRNA was attributable to BUP. But, there was also some evidence of drug synergy: only BN caused persistent reductions of HFCS IOSA and drinking; BN produced the least gain of body weight; and only BN-treated rats displayed altered D2R mRNA in the caudate-putamen. Taken together, these observations support the use of BUP + NTX as a mean to alter consumption of sugars and reducing their impact on brain systems involved in reward, appetite and mood.

Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide.

BACKGROUND: Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing. OBJECTIVE: The purpose of this study was to determine whether health literacy is associated with patients' use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients' perceived ease of use and usefulness of these HIT tools, as well as patients' perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts. METHODS: Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items. RESULTS: Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03). CONCLUSIONS: Patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.