A Systematic Review of the Relationship between Social Isolation and Physical Health in Adults.

Background: According to the World Health Organization, social isolation, particularly of older adults, is a public health issue endangering the well-being of individuals, families, and communities. Social isolation affects health through biological, behavioral, and psychological pathways and is associated with physical and psychological/emotional well-being, increases morbidity and mortality rates, and lowers quality of life. Purpose: This systematic review examined the relationship between social isolation and physical health, including subjective and objective dimensions, and factors that influence this relationship in adults. Methods: This systematic review examined six electronic databases covering the field of health and human services and included results from 1 January 2017 to 10 March 2023 with key terms including adult social connection or social isolation coupled with health, physical, psychological, emotional, mental, or behavioral. The initial search yielded 925 research articles across all databases and was narrowed to 710 when the decision was made to focus on social isolation and physical health. Covidence was used throughout the retrieval and appraisal process, as provided in a PRISMA flow diagram. Twenty-four studies that scored 90 or above in the appraisal process were included in the systematic review. Results: The studies represented included seven studies conducted in the United States and seventeen studies conducted internationally. Regarding study design, twenty-three studies were quantitative, one was qualitative, and one was mixed methods. The majority of quantitative studies were correlational in design with nine being longitudinal. The majority of studies were based on large national data sets representing in total 298,653 participants aged 50 and older. The results indicate that social isolation is related to increases in inflammatory biomarkers associated with diseases, all-cause mortality, lower expectations of longevity, and frailty. In addition, social isolation was associated with cognitive decline and disruptions in sleep. Poor oral health increased social isolation. The results further indicated that decreased physical performance/function and a decline in physical activity were associated with social isolation, as well as decreased overall physical health, poor health behaviors, and self-care, and decreased health-related quality of life. Further research is warranted to examine the possible bidirectionality of these relationships and possible mediating, moderating, or confounding variables. Implications: Future research is needed to explore the biological and behavioral pathways in which social isolation negatively impacts physical health. Going forward, studies are needed that move beyond descriptive, exploratory methods and integrate data from qualitative and mixed-method designs that will inform the development and testing of a conceptual framework related to social isolation and health. By advancing the science behind social isolation, comprehensive interventions can be identified and tested with implications at the individual, family, community, and societal levels to reduce social isolation, particularly among adults, and improve health and quality of life.

Speech and Resonance Disorders in Children With Cleft Palate: Diagnostic Evaluation and Current Speech Therapy Modalities.

This article will provide an overview of how speech and resonance can be impacted in children with cleft palate. The authors will outline evidence-based assessment and treatment approaches commonly used for children with cleft palate and provide information on current initiatives to provide speech therapy. The methods discussed will be the use of telehealth to provide access to speech therapy for patients in areas without speech-language pathologists and the use of speech therapy camps to offer intensive, limited-duration speech therapy for groups of children due to the lack of trained providers in certain geographical regions.

Evaluating the Impact of a Global Cleft Speech Mentorship Program on Expanding Practitioner Competency in Low- and Middle-Income Countries.

A primary challenge in global cleft care lies in the limited opportunities for cleft-specific training and mentorship available to speech practitioners worldwide, particularly in low-income and middle-income countries (LMICs). In addition, the limited number of speech therapists with cleft experience in LMICs creates a significant barrier to access to care for individuals with cleft lip and palate globally. The inaccessibility of cleft-specific clinical instruction and cleft-trained speech therapists impacts the effectiveness of intervention and, subsequently, the speech-language development of cleft-affected individuals worldwide. A structured virtual clinical mentorship program targeting speech practitioners of all skill levels in LMICs was established to address this gap in comprehensive cleft care provision. This article will examine the effectiveness of a structured cleft speech mentorship program in expanding practitioner competency in LMIC communities and, as a result, building capacity for cleft speech care globally. The authors will outline various aspects of the development and implementation of this cleft speech mentorship program, including rationale, participant recruitment, program requirements, and impact assessment tools utilized. An analysis of pre-program and post-program data will be conducted to evaluate the degree to which clinical skills were improved, identify persistent areas of weakness, and examine the effectiveness of the program in expanding speech practitioner competency.

Global partnerships to create communication resources addressing Sustainable Development Goals 3, 4, 8, 10, and 17.

PURPOSE: This commentary describes the development of global partnerships, capacity-building, and the basis for the creation of a website (Leadersproject.org) used throughout the world that contains free educational resources for the assessment and treatment of people with communication disabilities (PWCD). This website contains speech-language assessment and treatment materials, online skill-building courses, over 200 instructional videos, train-the-trainer course materials, and syntheses of important research and trainings in over 30 languages. This commentary relates the work from leadersproject.org to the United Nations Sustainable Development Goals (SDGs). RESULT: Through this website, the authors have established ongoing global partnerships with other health and education professionals. Moreover, PWCD and their families have used the website for information and support throughout the world. Speech-language pathologists (SLPs) and other health and education professionals use these materials to host capacity-building trainings and to support the development of knowledge and skills to local professionals for the benefit of PWCD. The Leadersproject.org resources have been influential and impactful as measured by approximately 24 000 visits from over 130 countries throughout the world. CONCLUSION: The authors of this paper continue to establish partnerships worldwide to spread education and increase the quality of care provided to PWCD. This commentary paper focuses on the United Nations Sustainable Development Goals (SDGs): good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8), reduced inequalities (SDG 10), partnerships for the goals (SDG 17).

Barriers and Resources to Cleft Lip and Palate Speech Services Globally: A Descriptive Study.

BACKGROUND: Although a number of international cleft organizations and cleft professionals in low- and middle-income countries (LMICs) have built and supported comprehensive cleft care and speech therapy models to address the shortage of speech services in LMICs, the specific speech needs of individuals with cleft lip and palate (CLP) in such countries remain unknown. The objective of this study was to evaluate the barriers to accessing speech services for patients with CLP as well as the resources and models of speech services that are currently available for individuals with CLP in LMICs, with the goal of better understanding the needs of this population. METHODS: Qualitative and quantitative methods consisted of Smile Train partner surveys that were distributed June 25th to July 31st, 2018 worldwide. Surveys were distributed through Smile Train's online medical database, Smile Train Express, which every Smile Train partner uses to report their Smile Train sponsored treatment outcomes. A total of 658 Smile Train partners responded to the surveys. Respondents included surgeons, speech therapists, orthodontists, administrators and nurses who represented non-governmental organizations, hospitals (private or public), hospital groups, and private clinics. RESULTS: Results indicated that lack of resources, including access to local speech providers and language materials, as well as financial constraints such as patient travel and speech treatment costs, are the most commonly reported barriers to accessing speech services across all geographic regions surveyed. CONCLUSIONS: Improving access to CLP speech services in LMICs may require strategies that address lack of speech providers, language materials, and financial constraints.

A Qualitative Analysis of Factors Impacting Comprehensive Cleft Lip and Palate Care in Ghana.

OBJECTIVE: The objective of this study was to examine practices regarding cleft lip and palate (CLP) among medical professionals and caregivers of children with CLP and to identify barriers and facilitators to comprehensive CLP care at a hospital in West Africa. DESIGN: Qualitative methods used consisted of individual semistructured interviews with caregivers of children with CLP and one focus group with CLP team members. SETTING: A majority of the interviews took place in the hospital, with some occurring during home visits. The focus group was conducted in the same hospital. PARTICIPANTS: Forty-five caregivers of children with CLP and 1 adult with CLP completed an interview. Additionally, 2 of the caregivers had CLP and completed an interview from their perspective. The focus group consisted of 13 CLP team members from a comprehensive CLP team in Ghana. INTERVENTIONS: Interviews consisted of semistructured, open-ended questions, and the focus group relied on a discussion guide. Line-by-line coding was used to identify common themes regarding barriers and facilitators to CLP care. RESULTS: Barriers to CLP care that were consistent across caregiver interviews and the focus group were lack of knowledge regarding CLP, stigma and cultural beliefs surrounding CLP, transportation, financial, and feeding/nutrition issues. Barriers to care identified in the interviews and focus group were similar; however, facilitators to care varied greatly between the 2. CONCLUSIONS: Two different qualitative methods provided unique perspectives on barriers and facilitators to CLP care. However, patients and caregivers continue to face substantial barriers to obtaining care.