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Objective: Identification of patient factors influencing velopharyngeal function for speech following initial cleft palate repair. Design: A literature search of relevant databases from inception until 2018 was performed using medical subject headings and keywords related to cleft palate, palatoplasty and speech assessment. Following three stage screening data extraction was performed. Setting: Systematic review and meta-analysis of relevant literature. Patients/Participants: Three hundred and eighty-three studies met the inclusion criteria, comprising data on 47 658 participants. Interventions: Individuals undergoing initial palatoplasty. Main Outcome Measures: Studies including participants undergoing initial cleft palate repair where the frequency of secondary speech surgery and/or velopharyngeal function for speech was recorded. Results: Patient factors reported included cleft phenotype (95% studies), biological sex (64%), syndrome diagnosis (44%), hearing loss (28%), developmental delay (16%), Robin Sequence (16%) and 22q11.2 microdeletion syndrome (11%). Meta-analysis provided strong evidence that rates of secondary surgery and velopharyngeal dysfunction varied according to cleft phenotype (Veau I best outcomes, Veau IV worst outcomes), Robin Sequence and syndrome diagnosis. There was no evidence that biological sex was associated with worse outcomes. Many studies were poor quality with minimal follow-up. Conclusions: Meta-analysis demonstrated the association of certain patient factors with speech outcome, however the quality of the evidence was low. Uniform, prospective, multi-centre documentation of preoperative characteristics and speech outcomes is required to characterise risk factors for post-palatoplasty velopharyngeal insufficiency for speech. Systematic Review Registration: Registered with PROSPERO CRD42017051624. [ABSTRACT FROM AUTHOR]

Describes research on the prevalence of alcohol, drug, and mental (ADM) disorders and the characteristics of homeless substance abusers and persons with mental illnesses. Reviews methodological problems. Finds prevalence rates of ADM disorders, extreme poverty, isolation from support network, and contact with correctional agencies higher in homeless groups. (JB)

Surveys the many categories of people comprising the homeless population and describes the methods that have been used to estimate their numbers. Concludes that the vast effort required to enumerate homeless people would be better directed toward focused research on the needs of identifiable subgroups. (DM)

Studies of the homeless have estimated the prevalence of serious mental disorder to be in the range of 20 to 50 percent. Although research has tended to emphasize the mental health problems of the homeless, this population also suffers from substantial rates of substance abuse (e.g., alcoholism) and other health problems. The Baltimore Homeless Study which examined 528 homeless people in shelters, missions, and jail, was conducted to provide data on the health and service needs of homeless people. The most frequently cited general health problems were found to be mouth and dental, gynecologic, dermatologic, cardiovascular, musculoskeletal, respiratory, neurological, anemia, and sexually transmitted disease. Current or prior substance abuse, primarily involving alcohol, was noted in the medical histories of 85 percent of the men and 67 percent of the women. There were notable differences between the groups of homeless individuals sampled from shelters, missions, and jail. The most important finding uncovered by this study was the widespread range of health problems. Research also found that the most frequent disorders among the homeless are those connected with substance abuse. Additionally, findings suggest that despite common beliefs, the majority of homeless people do not suffer from major medical problems such as schizophrenia. Instead, phobias, depression, and anxiety are much more common., ABSTRACT: A study of homeless people in Baltimore, Md, focused on their health and other characteristics, with special emphasis on their needs for services. In the first stage, 298 men and 230 women were randomly selected from the missions, shelters, and jail in Baltimore to respond to a baseline interview that provided extensive sociodemographic and health-related data. In the second stage, a subsample of 203 subjects was randomly selected from the baseline survey respondents to have systematic psychiatric and physical examinations. Data are presented from both stages. Data from the first stage demonstrate, among other things, the high levels of disaffiliation of this population and their heavy involvement in substance abuse. Data from the clinical examinations demonstrate the high prevalence of mental illnesses and other psychiatric disorders and of a wide range of physical disorders and confirm the high prevalence of alcohol abuse disorders. The high rates of comorbidity of these conditions is demonstrated and data are provided on the subjects' needs for mental health and substance abuse services.

Individuals with schizophrenia are at risk of developing HIV and are known to experience barriers to optimal medical care. Our goal was to determine, among a cohort of HIV clinicians, whether or not the diagnosis of schizophrenia affected the clinical decision to offer highly active antiretroviral therapy (HAART) to AIDS patients. This is a cross-sectional study of a random, national sample of HIV experts drawn from the membership of the American Academy of HIV Medicine. Participants were mailed a self-administered questionnaire with a case vignette of a new onset AIDS patient and were specifically asked whether or not they would recommend HAART treatment. Vignettes were randomly assigned to include a diagnosis of schizophrenia or not. We located 649 clinicians (93%); 347 responded (53.4%). Responders and non-responders did not differ in demographics or work characteristics. Recommendation of antiretroviral treatment did not differ between those who received a case vignette with schizophrenia versus those who did not (95.8% vs. 96.6%, p = 0.69). Compared to those Who received a case vignette without schizophrenia, those who received vignettes with schizophrenia were more likely to avoid prescribing efavirenz, a medication with known neuropsychiatric side effects (17.7% vs. 45.5%, p < 0.01), more likely to agree to be helped by a specialist (34.5% vs. 12.9%, p < 0.01), and more likely to recommend directly observed therapy (20% vs. 10%, p = 0.01). HIV clinicians recognize the importance of recommending HAART treatment to individuals with schizophrenia and AIDS and avoid using antiretroviral medication with known neuropsychiatric side effects. [ABSTRACT FROM AUTHOR]

Health care reform has posed special challenges for departments of psychiatry in academic medical centers. This report describes one department's strategic responses to a marketplace with high penetration by managed care and provides examples of the kinds of faculty concerns that can arise when major departmental reorganizations are attempted. The department's successful adaptation to a radically altered professional environment is attributed to the following five initiatives: vertical integration and diversification of clinical programs, service line management, outcomes measurement, regional network development, and institutional managed care partnerships Although the authors did not design their adaptive efforts as a research study, they offer objective data to support their conclusion that the viability of their overall clinical enterprise has been sustained despite an external environment inhospitable to academic psychiatry. [ABSTRACT FROM AUTHOR]