Current knowledge and impressions of speech-language pathologists of the swallow of persons who are obese.

PURPOSE: The overall goal of this study was to provide insight on the topic of dysphagia in the obese population. More specifically, the purpose of this study was to obtain preliminary descriptive data on the knowledge and impressions of speech-language pathologists (SLPs) working in the field of dysphagia on the swallow of persons who are obese. METHODS: One hundred seventy-seven SLPs responded to a web-based survey that was posted on two popular listserves that serve the dysphagia community. RESULTS: Descriptive results showed that nearly all SLPs have assessed and treated patients who are obese for dysphagia, that there is little consensus as to how the obese swallow compares to the normal swallow, and that there is a consensus that dysphagia observed in the obese population is most likely related to other concomitant disorders. CONCLUSIONS: Results provide preliminary insight into the knowledge and impressions of SLPs working with dysphagia and highlight the need for future research to determine (1) if there is an increased incidence of dysphagia in the obese population, and (2) if obesity itself constitutes a risk factor for dysphagia or if any dysphagia observed in this population is related to other comorbidities.

Obstacles to the prescribing of growth hormone in children with chronic kidney disease.

Despite its effectiveness, recombinant human growth hormone (rhGH) is under-utilized in short children with chronic kidney disease (CKD). We conducted a multicenter study to explore the obstacles preventing children with CKD from receiving rhGH. We investigated the use of rhGH in 307 children with CKD from seven pediatric nephrology centers. Among the 110 patients who fell below the 5th percentile, 56 (51%) had not received rhGH. The most common reasons given for these children not receiving rhGH were family refusal, secondary hyperparathyroidism, and non-compliance. However, no explanation was apparent for 25% of the short children with CKD. Boys were more likely than girls to receive rhGH (65% vs 31%; P = 0.002). Use of rhGH was similar in African Americans and non-Hispanic Whites. Children who had received rhGH achieved a 0.5 increase in height z-score in the first year after the initiation of rhGH therapy. Children who had not received rhGH achieved a 0.03 increase in height z-score during the first year after falling below the 5th percentile (P = 0.005 vs the children who had received rhGH). Waiting for insurance company approval led to a significant delay in the initiation of rhGH treatment in 18% of patients. The fact that more than 50% of short children with CKD did not receive rhGH is secondary to multiple factors, many of which may be amenable to intervention efforts.