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Cerón-Zapata AM, Manrique-Hernández RD, Mejía-Ortega LM. A systematic review of barriers to accessing cleft care worldwide. Birth Defects Res 2024; 116:e2364. [PMID: 38847124 DOI: 10.1002/bdr2.2364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/14/2024] [Accepted: 05/09/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE Patients with cleft lip/palate need an interdisciplinary approach. Delays in the care of these patients and difficulties in accessing health services have been reported in different low-, middle-, and high-income countries. This study aimed to characterize worldwide publications on access to cleft lip and palate health treatment. METHODS Databases were selected systematically and searched until July 2021. The review process followed standard methods for systematic reviews. The study quality was evaluated using the Strengthening the Reporting of Observational studies in Epidemiology guidelines for observational studies. RESULTS A total of 289 publications were identified using our search strategy. After reviewing the titles and reading the abstracts and full text, 16 studies met the inclusion criteria in the review. In one study, financial difficulties obtained the attention of the professionals who attended to cleft lip/palate patients. Ethnic disparities, problems in transportation, and long distances between users and health centers were found. Additionally, there was misinformation about treatment and follow-up among the caregivers of patients with cleft lip/palate. CONCLUSION When reviewing the literature on access to health services for patients with cleft lip/palate, barriers were reported in access to information, physical access to care centers, financial resources to cover expenses for treatment, and opportunities in care.
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Affiliation(s)
| | - Ruben Darío Manrique-Hernández
- Dental School, Universidad CES, Medellín, Antioquia, Colombia
- Graduate School, Universidad CES, Medellín, Antioquia, Colombia
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2
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Barr J, Mackie A, Gorelik D, Buckingham H, Clark D, Brissett AE. Health Disparities Research in Facial Plastic and Reconstructive Surgery: A Scoping Review. Otolaryngol Head Neck Surg 2024. [PMID: 38796736 DOI: 10.1002/ohn.825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/09/2024] [Accepted: 05/04/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVE Health disparities contribute significantly to disease, health outcomes, and access to care. Little is known about the state of health disparities in facial plastic and reconstructive surgery (FPRS). This scoping review aims to synthesize the existing disparities research in FPRS and guide future disparities-related efforts. DATA SOURCES PubMed, Embase, Web of Science. REVIEW METHODS We conducted a scoping review in adherence with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews checklist. Our search included all years through March 03, 2023. All peer-reviewed primary literature of any design related to disparities in FPRS was eligible for inclusion. RESULTS Of the 12283 unique abstracts identified, 215 studies underwent full-text review, and 108 remained for final review. The most frequently examined topics were cleft lip and palate (40.7%), facial trauma (29.6%), and gender affirmation (9.3%). There was limited coverage of other areas. Consideration of race/ethnicity (68.5%), socioeconomic status (65.7%), and gender/sex (40.7%) were most common. Social capital (0%), religion, occupation, and features of relationships were least discussed (0.01% each). The majority of studies were published after 2018 (59.2%) and were of nonprospective designs (95.4%). Most studies focused on disparity detection (80.6%) and few focused on understanding (13.9%) or reducing disparities (0.06%). CONCLUSION This study captures the existing literature on health disparities in FPRS. Studies are concentrated in a few areas of FPRS and are primarily in the detecting phase of public health research. Our review highlights several gaps and opportunities for future disparities-related focus.
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Affiliation(s)
- Jeremy Barr
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, Texas, USA
| | - Aaron Mackie
- School of Medicine, Texas A&M University, Bryan, Texas, USA
| | - Daniel Gorelik
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
| | - Hannah Buckingham
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Delaney Clark
- School of Medicine, University of Texas Medical Branch, Galveston, Texas, USA
| | - Anthony E Brissett
- Department of Otolaryngology, Houston Methodist Hospital, Houston, Texas, USA
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Taiwo AO, Lehmann U, Scott V, Shafi'u I, Lawal SG, Abdulmajid U, Braimah RO, Ibikunle AA, Abubakar AB, Mujtaba B, Ogbeide ME, Labbo-Jadadi S, Adigun OI, Ile-Ogedengbe BO. Barriers in Cleft Service Access in Sub-Saharan Africa: A Thematic Analysis of Practical Needs of Rural Families. Cleft Palate Craniofac J 2024:10556656241244976. [PMID: 38557293 DOI: 10.1177/10556656241244976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE To explore the experiences and perceptions of barriers of parents and family members of patients with cleft lip and palate in accessing cleft services in remote northwest Nigeria. DESIGN Face-to-face semi-structured audio recorded interviews were used to obtained qualitative textual data. Thematic analysis using interpretative descriptive techniques was employed to understand the participants' lived experiences with barriers and accessibility to cleft services. SETTING Participants were from Sokoto, Kebbi and Zamfara states in remote northwest, Nigeria. PARTICIPANTS Consisted of 22 caregivers (17 parents and 5 extended family members) were purposively sampled between 2017 and 2020. MAIN OUTCOME MEASURES Barriers experienced while accessing cleft services were identified during thematic analysis. RESULT Over three quarter of the respondents had patients with both cleft lip and palate and without any previous family history (n = 20). About two-thirds of the participants (n = 15) were females. Most of the interviews were conducted before the surgeries (n = 15). FIVE THEMES EMERGED lack of information, financial difficulty, misrepresentation from health workers, multiple transportation and previous disappointment. CONCLUSIONS Areas of poor awareness, misinformation from primary health care workers, financial hurdles, multiple transportation logistics and others were identified. Aggressive broadcasting of information through radio, timely treatment and collaboration with influential religious leaders were emphasized. Support, grants and subsidies from government and voluntary agencies are encouraged to mitigate the huge out of pocket cost of cleft care in the region.
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Affiliation(s)
- Abdurrazaq Olanrewaju Taiwo
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
- Resmile Craniofacial Anomaly Foundation Zamfara, Gusau, Zamfara, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Health Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Uta Lehmann
- School of Public Health, University of Western Cape, Cape town, South Africa
| | - Vera Scott
- School of Public Health, University of Western Cape, Cape town, South Africa
| | | | - Suleman Gusau Lawal
- Department of Family Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Usamatu Abdulmajid
- Department of Otolaryngology/ENT, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Ramat Oyebummi Braimah
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Health Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Adebayo Aremu Ibikunle
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | | | - Bala Mujtaba
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Sciences, College of Health Science, Usmanu Danfodiyo University, Sokoto, Nigeria
| | - Mike Eghosa Ogbeide
- Department of Dental and Maxillofacial Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Suwaiba Labbo-Jadadi
- Department of Dental and Maxillofacial Surgery, Sir Yahyah Memorial Hospital, Birnin-Kebbi, Kebbi, Nigeria
| | - Olufemi Ibrahim Adigun
- Resmile Craniofacial Anomaly Foundation Zamfara, Gusau, Zamfara, Nigeria
- Department of Dental and Maxillofacial Surgery, Federal Medical Centre, Gusau, Zamfara, Nigeria
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4
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Netson RA, Miller S, Nuzzi LC, Parry GJ, Bridges SK, Taghinia AH. Trends in Outcomes and Variation by Race and Ethnicity in Pediatric Plastic Surgery in the United States. Plast Reconstr Surg Glob Open 2023; 11:e4813. [PMID: 36761013 PMCID: PMC9901994 DOI: 10.1097/gox.0000000000004813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/20/2022] [Indexed: 02/08/2023]
Abstract
The American College of Surgeons' National Surgical Quality Improvement Project-Pediatric Data manages a multicenter dataset for monitoring outcomes in pediatric surgical care. We explored trends in outcomes in the most frequently sampled current procedural terminology codes related to craniofacial and cleft lip and palate (CLP) surgical procedures over a 7-year period. Methods We used National Surgical Quality Improvement Project-Pediatric Data on 28,147 pediatric patients who underwent plastic surgical procedures between January 1, 2012, and December 31, 2018. Eighteen relevant current procedural terminology codes were selected and sorted into two procedure groups: CLP and craniofacial. For each group, we explored trends in readmission, reoperation, extended length of stay, morbidity, and racial and ethnic variation. Results The proportion of readmissions following CLP repair saw a significant reduction per year (from 3.6% to 1.7%). African American or Black CLP patients had significantly higher rates of readmission and extended length of stay when compared to the overall cohort. Asian and White CLP patients had significantly lower rates of experiencing an extended length of stay. For craniofacial cases, extended length of stay decreased significantly per year (from 7.7% to 2.8%). One possible driver of this change was a decrease in transfusion rates during the study period from 59% to 47%. Conclusions Pediatric CLP and craniofacial cases saw significant improvements in safety, as indicated by reductions in readmission and extended length of stay. Given the racial differences observed, especially among CLP patients, continued research to identify and address systems of racism in health care remains a priority.
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Affiliation(s)
- Rebecca A. Netson
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | - Stephanie Miller
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | - Laura C. Nuzzi
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | - Gareth J. Parry
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | - Samantha K. Bridges
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
| | - Amir H. Taghinia
- From the Department of Plastic and Oral Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, Mass
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Citron I, Batista J, Costa E, Lima C, Ise A, Menezes C, Roa L, Saluja S, Staffa SJ, da Silva Freitas R, de Andrade Sá ÁJ, Rocha F, Collares MV, Alonso N. Patient-perceived barriers to surgical treatment of cleft lip and palate in Brazil- A multi-region study. J Plast Reconstr Aesthet Surg 2022; 75:2375-2386. [DOI: 10.1016/j.bjps.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/04/2021] [Accepted: 02/12/2022] [Indexed: 11/25/2022]
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Kantar RS, Breugem CC, Alfonso AR, Keith K, Kassam S, Annan B, Chahine EM, Wasicek PJ, Patel KG, Flores RL, Hamdan US. Perceived Barriers to Comprehensive Cleft Care Delivery: Results From A Capacity-Building Educational Initiative and Implications. Ann Plast Surg 2021; 87:194-198. [PMID: 34253700 DOI: 10.1097/sap.0000000000002604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We analyzed the perceptions of participants and faculty members in simulation-based comprehensive cleft care workshops regarding comprehensive cleft care delivery in developing countries. METHODS Data were collected from participants and faculty members in 2 simulation-based comprehensive cleft care workshops organized by Global Smile Foundation. We collected demographic data and surveyed what they believed was the most significant barrier to comprehensive cleft care delivery and the most important intervention to deliver comprehensive cleft care in developing countries. We also compared participant and faculty responses. RESULTS The total number of participants and faculty members was 313 from 44 countries. The response rate was 57.8%. The majority reported that the most significant barrier facing the delivery of comprehensive cleft care in developing countries was financial (35.0%), followed by the absence of multidisciplinary cleft teams (30.8%). The majority reported that the most important intervention to deliver comprehensive cleft care was creating multidisciplinary cleft teams (32.2%), followed by providing cleft training (22.6%). We found no significant differences in what participants and faculty perceived as the greatest barrier to comprehensive cleft care delivery (P = 0.46), or most important intervention to deliver comprehensive cleft care in developing countries (P = 0.38). CONCLUSIONS Our study provides an appraisal of barriers facing comprehensive cleft care delivery and interventions required to overcome these barriers in developing countries. Future studies will be critical to validate or refute our findings, as well as determine country-specific roadmaps for delivering comprehensive cleft care to those who need it the most.
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Affiliation(s)
| | - Corstiaan C Breugem
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | | | | | | | | | - Philip J Wasicek
- Department of Surgery, The University of Maryland Medical System, Baltimore, MD
| | | | - Roberto L Flores
- The Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health, New York City, NY
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Stoneburner J, Munabi NCO, Nagengast ES, Williams MS, Goel P, Auslander A, Howell LK, Hammoudeh JA, Urata MM, Magee WP. Factors Associated With Delay in Cleft Surgery at a Tertiary Children's Hospital in a Major US Metropolitan City. Cleft Palate Craniofac J 2021; 58:1508-1516. [PMID: 33648362 DOI: 10.1177/1055665621989508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify factors associated with late cleft repair at a US tertiary children's hospital. DESIGN Retrospective study of children with CL/P using Children's Hospital Los Angeles (CHLA) records. SETTING US tertiary children's hospital. PATIENTS/PARTICIPANTS Patients undergoing primary CL or CP repair at CHLA from 2009 to 2018. MAIN OUTCOME MEASURES Proportion of children who had delayed primary CL repair or CP repair using CHLA and American Cleft Palate-Craniofacial Association (ACPA) guidelines and factors associated with late surgery. RESULTS In total, 805 patients-503 (62.5%) who had CL repair, 302 (37.5%) CP repair-were included. Using CHLA protocol, 14.3% of patients seeking CL repair had delayed surgery. Delay was significantly associated with female gender, non-Hispanic ethnicity, Spanish primary language, government insurance, bilateral cleft, cleft lip and palate (CLP), and syndromic diagnosis. Using ACPA guidelines, 5.4% had delayed surgery. Female gender and syndromic diagnosis were significantly associated with delay and remained significant after adjustment for confounders in multivariate models. For CP repair, 60.3% of patients had delayed surgery using CHLA protocol. Cleft lip and palate diagnosis, complete cleft, syndromic diagnosis, and longer travel distance were significantly associated with delay. Using ACPA guidelines, 28.5% had delayed surgery; however, significant association with patient variables was not consistently observed. CONCLUSIONS Delay in cleft surgery occurs most often for patients seeking CP repair and is associated with female gender, non-Hispanic ethnicity, Spanish language, government insurance, and bilateral CL, CLP, or syndromic diagnoses. Initiatives should aim to optimize cleft surgery delivery for these subpopulations.
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Affiliation(s)
| | - Naikhoba C O Munabi
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Eric S Nagengast
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Madeleine S Williams
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Pedram Goel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Allyn Auslander
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Lori K Howell
- Division of Plastic and Reconstructive Surgery, Oregon Health & Science University, School of Medicine, Portland, OR, USA
| | - Jeffrey A Hammoudeh
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Mark M Urata
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - William P Magee
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.,Division of Plastic and Reconstructive Surgery, Shriner's Hospital for Children, Pasadena, CA, USA
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8
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Care of the Asian American Child With Cleft Lip or Palate. Plast Surg Nurs 2020; 39:142-147. [PMID: 31790043 DOI: 10.1097/psn.0000000000000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Orofacial clefts are one of the most common global birth defects. Orofacial clefts may be part of a syndrome or an isolated birth defect, and affect approximately 1-1.5 per 1,000 live births worldwide with noted inequalities across geographical areas and cultures. In the United States, Asian American populations have a substantially higher incidence of cleft lip with or without cleft palate (2/1,000 live births). Orofacial clefts are a key health issue with substantial health care costs, and associated medical, psychological, and social ramifications. It has been estimated that the health care costs within the United States are approximately $697 million over a child's lifetime. In disorders like orofacial clefts, because of the complexity of the condition and subsequent medical interventions, as well as the cultural intricacies of the Asian culture, it requires significant knowledge and understanding by the health care providers. In order to provide optimal and safe cleft care, reduce health care costs, and improve the outcomes for the Asian American population, a culturally sensitive, multidisciplinary, and coordinated approach is needed. Increased culturally specific education, early access to prenatal care, and ongoing infant and pediatric health care are essential.
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9
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Surgical Approach and Periprocedural Outcomes by Race and Ethnicity of Children Undergoing Craniosynostosis Surgery. Plast Reconstr Surg 2019; 144:1384-1391. [DOI: 10.1097/prs.0000000000006254] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Crerand CE, Da Silveira AC, Kapa H, Litteral J, Markey MK, Mercado A, Scott M. Adherence to Orthodontic Treatment in Youth With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2019; 57:218-227. [PMID: 31394915 DOI: 10.1177/1055665619867556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify rates of nonadherence to orthodontic treatment among youth with cleft lip and/or palate (CL/P) and to compare demographic and clinical characteristics of patients categorized as adherent or nonadherent. DESIGN Retrospective chart review. SETTING Orthodontic treatment program affiliated with a US pediatric hospital-based craniofacial team. PARTICIPANTS Medical charts of 54 patients with CL/P beginning phase I or phase II orthodontics between 2011 and 2014 (54% male; mean age: 11.7 ± 3.2 years) were reviewed. MAIN OUTCOME MEASURE(S) Data abstracted included demographic and clinical characteristics. Patients were classified as nonadherent based upon treatment termination due to nonadherence, treatment courses extending beyond 3 years, and information about missed appointments, poor oral hygiene, and broken appliances. RESULTS In all, 24% had treatment terminated due to nonadherence and were significantly more likely to have behavioral health diagnoses (P = .01) or visits (P = .02) and social work consults (P = .01) than patients without termination. Thirty-seven percent had treatment courses beyond 3 years; youth with longer courses were significantly more likely to have cleft lip and palate versus cleft palate only or cleft lip (P = .03). Patients who missed more than 4 appointments were less likely to have behavioral health diagnoses (P < .01) compared to those with fewer missed appointments. Poor hygiene and broken appliance notations were common. Youth with poor hygiene notations were significantly older (P < .01) at treatment initiation than those without notations. CONCLUSIONS Nonadherence was associated with diagnosis, age, and history of behavioral health or social work involvement. An understanding of adherence and relationships with clinical and demographic factors can inform clinical care and support intervention development to improve outcomes.
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Affiliation(s)
- Canice E Crerand
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Hillary Kapa
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Litteral
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Mia K Markey
- The University of Texas at Austin, Austin, TX, USA.,The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ana Mercado
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Division of Orthodontics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Michelle Scott
- Division of Plastic and Reconstructive Surgery, Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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11
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Abstract
Orofacial clefts are one of the most common global birth defects. Orofacial clefts may be part of a syndrome or an isolated birth defect, and affect approximately 1-1.5 per 1,000 live births worldwide with noted inequalities across geographical areas and cultures. In the United States, Asian American populations have a substantially higher incidence of cleft lip with or without cleft palate (2/1,000 live births). Orofacial clefts are a key health issue with substantial health care costs, and associated medical, psychological, and social ramifications. It has been estimated that the health care costs within the United States are approximately $697 million over a child's lifetime. In disorders like orofacial clefts, because of the complexity of the condition and subsequent medical interventions, as well as the cultural intricacies of the Asian culture, it requires significant knowledge and understanding by the health care providers. In order to provide optimal and safe cleft care, reduce health care costs, and improve the outcomes for the Asian American population, a culturally sensitive, multidisciplinary, and coordinated approach is needed. Increased culturally specific education, early access to prenatal care, and ongoing infant and pediatric health care are essential.
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12
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Crerand CE, Kapa HM, Litteral J, Da Silveira AC, Markey MK. Adherence to Orthodontic Treatment in Youth With Craniofacial Conditions: A Survey of US Orthodontists. Cleft Palate Craniofac J 2019; 56:1322-1332. [PMID: 31159560 DOI: 10.1177/1055665619853132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE (1) To explore orthodontists' perceptions of nonadherence and related factors in their patients with craniofacial conditions; (2) to examine differences in adherence perceptions by provider characteristics; (3) to evaluate current adherence interventions. DESIGN Cross-sectional. SETTING United States-based orthodontists affiliated with a nonprofit association for providers treating oral cleft and craniofacial conditions received survey invitations via list-serv, e-mail, and social media. PARTICIPANTS Thirty-eight orthodontists participated (mean age = 50.5 ± 10.7 years; 76% Caucasian; 55% male; 54% private practice). MAIN OUTCOME MEASURE An 80-item survey assessed demographic characteristics; frequencies of various adherence problems and adherence-related prolonged or terminated treatment; importance of adherence to treatment outcomes; factors that may impact adherence; interest in improving adherence; and use of adherence-enhancing interventions. RESULTS Adherence problems were common, yet 80.6% of participants rated adherence as "very important" to cleft treatment outcomes. Child behavior and motivation, caregiver reinforcement of behavior, and provider communication with the family were identified as factors that greatly impact adherence. Orthodontists in university-affiliated programs were more likely to rate individual, family, health-care system, and community factors as impacting adherence compared to private practice orthodontists; 80.6% used adherence interventions; these strategies were all rated as "sometimes successful." CONCLUSIONS Nonadherence to cleft lip/palate-related orthodontic care is common and potentially detrimental to care. Current interventions are not uniformly successful and could be better tailored. Understanding provider, patient, and family factors that affect adherence can inform individualized treatment planning to improve adherence and ultimately, treatment outcomes.
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Affiliation(s)
- Canice E Crerand
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hillary M Kapa
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Litteral
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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13
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Efficacy of Facilitated Capacity Building in Providing Cleft Lip and Palate Care in Low- and Middle-Income Countries. J Craniofac Surg 2018; 28:1737-1741. [PMID: 28872505 DOI: 10.1097/scs.0000000000003884] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Providing surgical repair for congenital anomalies such as cleft lip and palate (CLP) can be challenging in low- and middle-income countries. One nonprofit organization seeks to address this need through a partnership model. This model provides long-term aid on multiple levels: surgeon and healthcare provider education, community outreach, and funding. The authors examined the effectiveness of this partnership model in providing CLP care and increasing cleft care capacity over time. This organization maintains data on each partner and procedure and collected data on hospital and patient characteristics through voluntary partner surveys from 2010 to 2014. Effectiveness of care provision outcomes included number of surgeries/partner hospital and patient demographics. Cleft surgical system strengthening was measured by the complexity of repair, waitlist length, and patient follow-up. From 2001 to 2014, the number of procedures/hospital/year grew from 15 to 109, and frequency of alveolar bone grafts increased from 1% to 3.4%. In addition, 97.9% of partners reported that half to most patients come from rural areas. Waitlists decreased, with 9.2% of partners reporting a waitlist of ≥50 in 2011 versus 2.7% in 2014 (P < 0.001). Patient follow-up also improved: 35% of partners in 2011 estimated a follow-up rate of ≥75%, compared with 51% of partners in 2014 (P < 0.001). The increased number of procedures/hospital/year supports the partnership model's effectiveness in providing CLP care. In addition, data supports cleft surgical system strengthening-more repairs use alveolar bone grafts, waitlists decreased, and follow-up improved. These findings demonstrate that the partnership model may be effective in providing cleft care and increasing cleft surgical capacity.
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14
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Crerand CE, Kapa HM, Litteral J, Pearson GD, Eastman K, Kirschner RE. Identifying Psychosocial Risk Factors Among Families of Children With Craniofacial Conditions: Validation of the Psychosocial Assessment Tool-Craniofacial Version. Cleft Palate Craniofac J 2018; 55:536-545. [PMID: 29315004 DOI: 10.1177/1055665617748010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the psychometric properties of the Psychosocial Assessment Tool-Craniofacial Version (PAT-CV), a screening instrument for psychosocial risk in families of children with craniofacial conditions, and to examine risk classification of patients in a craniofacial population. DESIGN Prospective, cross-sectional, single-center study. SETTING Interdisciplinary cleft lip and palate/craniofacial center at a US children's hospital. PARTICIPANTS Parents/caregivers (n = 242) of 217 children ages 1 month to 17 years being treated for a congenital syndromic or nonsyndromic craniofacial condition completed the PAT-CV and validating measures from July 2015 to July 2016. The PAT-CV was completed by 121 caregivers a second time to assess test-retest reliability. MAIN OUTCOME MEASURES PAT-CV, Child Behavior Checklist, Adult Self-Report, Pediatric Quality of Life Inventory, Craniofacial Experiences Questionnaire, and Family Environment Scale. RESULTS Construct validity of the PAT-CV was supported by significant correlations ( P < .001) between PAT-CV total and subscale scores and the validated measures. PAT-CV total scores categorized 59.9% of families within the universal risk group, 32.3% within the targeted risk group, and 7.8% within the clinical range. Good criterion validity was indicated by significantly higher scores ( P < .0001) obtained on the validated measures for those in the targeted and clinical risk groups. Internal consistency (Cronbach's α = 0.86) and test-retest reliability for the PAT-CV total score ( r = 0.77, P < .0001) were acceptable. CONCLUSIONS The PAT-CV appears to be a reliable and valid screening instrument for psychosocial risk. Accurate identification of risk and implementation of appropriate interventions may contribute to improvements in medical and psychosocial outcomes.
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Affiliation(s)
- Canice E Crerand
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
- 2 Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hillary M Kapa
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Litteral
- 1 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Gregory D Pearson
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Katherine Eastman
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Richard E Kirschner
- 3 Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
- 4 Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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Factors associated with the timeliness of postnatal surgical repair of spina bifida. Childs Nerv Syst 2016; 32:1479-87. [PMID: 27179533 PMCID: PMC5007061 DOI: 10.1007/s00381-016-3105-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/02/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE Clinical guidelines recommend repair of open spina bifida (SB) prenatally or within the first days of an infant's life. We examined maternal, infant, and health care system factors associated with time-to-repair among infants with postnatal repair. METHODS This retrospective, statewide, population-based study examined infants with SB born in Florida 1998-2007, ascertained by the Florida Birth Defects Registry. We used procedure codes from hospital discharge records to identify the first recorded myelomeningocele repair (ICD-9 CM procedure code 03.52) among infants with birth hospitalizations. Using Poisson multivariable regression, we examined time-to-repair by hydrocephalus, SB type (isolated [no other coded major birth defect] versus non-isolated), and other selected factors. RESULTS Of 199 infants with a recorded birth hospitalization and coded myelomeningocele repair, 87.9 % had hydrocephalus and 19.6 % had non-isolated SB. About 76.4 % of infants had repair by day 2 of life. In adjusted analyses, infants with hydrocephalus were more likely to have timely repair (adjusted prevalence ratio (aPR) = 1.48, 95 % confidence interval (CI) 1.02-2.14) than infants without hydrocephalus. SB type was not associated with repair timing. Infants born in lower level nursery care hospitals with were less likely to have timely repairs (aPR = 0.71, 95 % CI 0.52-0.98) than those born in higher level nursery care hospitals. CONCLUSIONS Most infants with SB had surgical repair in the first 2 days of life. Lower level birth hospital nursery care was associated with later repairs. Prenatal diagnosis can facilitate planning for a birth hospital with higher level of nursery care, thus improving opportunities for timely repair.
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Moore CA, McCabe ERB. Editorial utility of population-based birth defects surveillance for monitoring the health of infants and as a foundation for etiologic research. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2015; 103:895-8. [PMID: 26458078 PMCID: PMC4682153 DOI: 10.1002/bdra.23421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/22/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Strassle PD, Cassell CH, Shapira SK, Tinker SC, Meyer RE, Grosse SD. What we don't know can hurt us: Nonresponse bias assessment in birth defects research. ACTA ACUST UNITED AC 2015; 103:603-9. [PMID: 26173046 DOI: 10.1002/bdra.23408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/03/2015] [Accepted: 06/08/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nonresponse bias assessment is an important and underutilized tool in survey research to assess potential bias due to incomplete participation. This study illustrates a nonresponse bias sensitivity assessment using a survey on perceived barriers to care for children with orofacial clefts in North Carolina. METHODS Children born in North Carolina between 2001 and 2004 with an orofacial cleft were eligible for inclusion. Vital statistics data, including maternal and child characteristics, were available on all eligible subjects. Missing 'responses' from nonparticipants were imputed using assumptions based on the distribution of responses, survey method (mail or phone), and participant maternal demographics. RESULTS Overall, 245 of 475 subjects (51.6%) responded to either a mail or phone survey. Cost as a barrier to care was reported by 25.0% of participants. When stratified by survey type, 28.3% of mail respondents and 17.2% of phone respondents reported cost as a barrier. Under various assumptions, the bias-adjusted estimated prevalence of cost as barrier to care ranged from 16.1% to 30.0%. Maternal age, education, race, and marital status at time of birth were not associated with subjects reporting cost as a barrier. CONCLUSION As survey response rates continue to decline, the importance of assessing the potential impact of nonresponse bias has become more critical. Birth defects research is particularly conducive to nonresponse bias analysis, especially when birth defect registries and birth certificate records are used. Future birth defect studies which use population-based surveillance data and have incomplete participation could benefit from this type of nonresponse bias assessment. Birth Defects Research (Part A) 103:603-609, 2015. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Paula D Strassle
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cynthia H Cassell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Stuart K Shapira
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert E Meyer
- North Carolina Birth Defects Monitoring Program, State Center for Health Statistics, North Carolina Division of Public Health, Raleigh, North Carolina.,Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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