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Candido MA, Alonso N. Impact of COVID-19 Pandemic on Cleft Lip/Palate Surgery in Brazil: Assessing the Current Landscape. Cleft Palate Craniofac J 2024:10556656241265926. [PMID: 39043227 DOI: 10.1177/10556656241265926] [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: 07/25/2024] Open
Abstract
OBJECTIVE This study aims to evaluate the impact of COVID-19 and the current situation for cleft lip/palate treatment surgeries within Brazil's public health system. DESIGN Our retrospective study analyzed CL/P corrective surgeries in Brazil's health system using DATASUS TabNet data from March 2020 to December 2022, with historical data from January 2016 to February 2020. We employed ARIMA analysis to estimate pandemic-related surgery cancellations. RESULTS In 2020, 1992 (CI 95%: 989-2995) CL/P surgeries were not conducted due to pandemics, a 44.1% (CI 95%: 28.1-54.2%) decrease compared to expectations for march to December 2020. Between the onset of the pandemic in Brazil and the end of 2022, 10,643 surgeries were performed in the country, representing a 33.8% shortfall compared to the expected number for the period (16,076; 95% CI: 9697-22,456). CONCLUSION The study highlights COVID-19's impact on CL/P surgeries in Brazil. Post-pandemic, surgeries increased but regional disparities remain, urging collaborative efforts to improve services and support affected patients.
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Affiliation(s)
- Marcelo A Candido
- Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Nivaldo Alonso
- Department of Surgery, University of São Paulo Medical School, São Paulo, Brazil
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Hashemi Hosseinabad H, Xing Y, Kemp M. A retrospective analysis of factors affecting speech production in school-aged children with cleft palate (+- cleft lip). Int J Pediatr Otorhinolaryngol 2024; 182:112029. [PMID: 38972249 DOI: 10.1016/j.ijporl.2024.112029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVE The present investigation examined how factors such as cleft type, age of primary palatal surgery, diagnosed syndromes, hearing problems, and malocclusions could predict persistent speech difficulties and the need for speech services in school-aged children with cleft palate. METHODS Participants included 100 school-aged children with cleft palate. Americleft speech protocol was used to assess the perceptual aspects of speech production. The logistic regression was performed to evaluate the impact of independent variables (IV) on the dependent variables (DV): intelligibility, posterior oral CSCs, audible nasal emission, hypernasality, anterior oral CSCs, and speech therapy required. RESULTS Sixty-five percent of the children were enrolled in (or had received) speech therapy. The logistic regression model shows a good fit to the data for the need for speech therapy (Hosmer and Lemeshow's χ2(8)=9.647,p=.291). No IVs were found to have a significant impact on the need for speech therapy. A diagnosed syndrome was associated with poorer intelligibility (Pulkstenis-Robinson's χ2(11)=7.120,p=.789). Children with diagnosed syndromes have about six times the odds of a higher hypernasality rating (Odds Ratio = 5.703) than others. The cleft type was significantly associated with audible nasal emission (Fisher'sexactp=.006). At the same time, malocclusion had a significant association with anterior oral CSCs (Fisher'sexactp=.005). CONCLUSIONS According to the latest data in the Cleft Registry and Audit Network Annual Report for the UK, the majority of children with cleft palate attain typical speech by age five. However, it is crucial to delve into the factors that may influence the continuation of speech disorders beyond this age. This understanding is vital for formulating intervention strategies aimed at mitigating the long-term effects of speech disorders as individuals grow older.
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Affiliation(s)
- Hedieh Hashemi Hosseinabad
- Department of Audiology and Speech-Language Pathology, College of Health and Public Service, University of North Texas, Denton, TX, USA.
| | - Yixun Xing
- Department of Advanced Data Analytics, Toulouse Graduate School, University of North Texas, Denton, TX, USA
| | - Monica Kemp
- Speech Language Pathologist, International Craniofacial Institute, Sage Plastic Surgery, Dallas, TX, USA
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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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Sarilita E, Rafisa A, Desai P, Mossey PA. Age at primary surgery among orofacial cleft individuals in Indonesia. Orthod Craniofac Res 2024; 27 Suppl 1:62-69. [PMID: 38149758 DOI: 10.1111/ocr.12751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVES To observe the age at primary cleft surgery among charity organizations such as Smile Train in helping Indonesia manage patients with OFC. MATERIALS AND METHODS A retrospective analysis of medical records was conducted to identify patients with orofacial clefts who underwent primary surgery between 2001 and 2021. The age at the time of surgery was recorded for each patient. Descriptive statistics were used to analyse the data and determine the average age at primary surgery. RESULTS In the period between 2001 and 2021, a total of 34 239 individuals in Indonesia underwent primary lip surgery, while 16 768 individuals received primary palatal surgery, as recorded in the Smile Train database. Notably, a significant proportion of these surgeries were classified as delayed primary repairs. Approximately 65.3% of primary lip surgeries were performed beyond the recommended timeline of 6 months of age, indicating a delay in the surgical intervention. Similarly, 67% of primary palatal surgeries were also delayed, occurring after the recommended timeline of 18 months of life. CONCLUSIONS This study provides insights into the age at primary surgery among individuals with orofacial clefts in Indonesia. The findings highlight the need for timely intervention and the importance of considering individualized treatment plans based on the specific type of orofacial cleft. Further research is warranted to explore factors influencing the age at primary surgery and their impact on treatment outcomes and long-term functional outcomes in this population.
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Affiliation(s)
- Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Anggun Rafisa
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Priya Desai
- Research and Innovation, Smile Train, New York, New York, USA
| | - Peter A Mossey
- Division of Oral Health Sciences and WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, UK
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Stanton EW, Rochlin D, Lorenz HP, Sheckter CC. Travel Distance and Spanish-Speaking are Associated with Delays in the Treatment of Cleft Palate. Cleft Palate Craniofac J 2024:10556656241256923. [PMID: 38774926 DOI: 10.1177/10556656241256923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVE Delayed repair of cleft palate is associated with worse speech outcomes. Social determinants of health may influence the timing of surgery; however, there are no population health investigations to evaluate factors such as travel distance, language barriers, and payer. This study sought to identify factors that may interfere with timely cleft palate repair. DESIGN Retrospective cohort. SETTING National/multi-center. PATIENTS/PARTICIPANTS All cleft palate repairs within California were extracted from 2000-2021. MAIN OUTCOMES MEASURES The primary outcome was age at surgical repair, which was modeled with linear regression. Covariates included race, primary language, distance from patient home to hospital, socioeconomic status, primary payer, and managed care enrollment status. RESULTS 11 260 patients underwent surgical repair of a cleft palate. Black race was associated with delayed repair (22 additional days, P = .004, 95% CI 67.00-37.7) along with Asian/Pacific-Islander race (11 additional days, P = .006, 95% CI 3.26-18.9) compared to white race. Spanish-speaking patients had significantly later cleft palate repairs by 19 days, (P < .001, 95% CI 10.8-27.7) compared with English-speaking. Further distances from the hospital were significantly associated with later cleft surgeries with out-of-state patients undergoing surgery 52 days later (P < .001, 95% CI 11.3-24.3). Managed care plans and Medi-Cal were significantly associated with earlier surgical repair compared with private insurance. CONCLUSION Black, Asian Pacific Islander, and Spanish-speaking patients and greater distance traveled to hospital were associated with delayed cleft palate repairs. These results underscore the importance of addressing structural and social barriers to care to improve outcomes and reduce health disparities for patients with cleft palate.
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Affiliation(s)
- Eloise W Stanton
- Division of Plastic and Reconstructive Surgery, University of Southern California, Los Angeles, CA, USA
| | - Danielle Rochlin
- Plastic Surgery Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - H Peter Lorenz
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA, USA
| | - Clifford C Sheckter
- Division of Plastic and Reconstructive Surgery, Stanford University, Palo Alto, CA, USA
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Borg TM, Solomon S, Alfarrouh R, Barazi W, Abu Sittah G, Sommerlad B, Ghanem A. Simulation Training Approach for Cleft Lip and Palate Repair in Low-Income Countries. Cleft Palate Craniofac J 2024; 61:706-711. [PMID: 36330704 DOI: 10.1177/10556656221136650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND During periods of civil strife, the need for trauma care and lack of sufficient cleft surgeons causes an increase in children left untreated with cleft lip and palate deformities. During the Syrian war, some cleft care was provided through visiting charities, with surgeries performed both in Syria and neighboring countries. There is a need to increase the number of adequately trained cleft surgeons available in such regions so that care can be achieved beyond mission trips. METHODOLOGY Cleft lip and palate repair workshops were delivered to 50 doctors in Syria. Pre-workshop, trainees received supplementary learning material. During the workshop, attendees received didactic teaching followed by 2 simulation sessions. Pre- and post-workshop, attendees completed questionnaires regarding their confidence and ability to perform cleft lip and palate repair. RESULTS Pre-workshop, 96% of workshop attendees had never independently performed cleft lip repair while 100% of attendees had not previously performed cleft palate repair. The mean pre-workshop confidence score was 2.452. Post-workshop, the mean confidence score was 3.503. Confidence rating scores significantly improved (P < .001). CONCLUSION The workshop delivered in Syria, together with this cleft lip and palate simulator provides an effective training tool that may support surgical training globally, particularly those in low-income countries. Further support is needed by charity organizations to ensure the continued delivery of such training.
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Affiliation(s)
- Tiffanie-Marie Borg
- Department of Plastic and Reconstructive Surgery, James Cook University Hospital, Middlesbrough, UK
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Sara Solomon
- Department of Surgery, Queen's Hospital, Romford, London, UK
| | - Rik Alfarrouh
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Wael Barazi
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | - Ghassan Abu Sittah
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
| | | | - Ali Ghanem
- Academic Plastic Surgery Group, Barts and the London School (QMUL), London, UK
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Khansa I, Pollard SH, Fogolin A, Baylis A, Sitzman TJ, Chapman KL, Kirschner RE. Factors Associated with Delayed Palatoplasty Before, During, and After the COVID-19 Pandemic. J Craniofac Surg 2024:00001665-990000000-01383. [PMID: 38411196 PMCID: PMC11347716 DOI: 10.1097/scs.0000000000010065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Cleft palatoplasty is typically performed around 10 to 12 months of age in the US, and delays can negatively affect speech development. Early during COVID-19, elective surgeries were canceled. The aims of this study were to (1) identify overall risk factors for greater age at palatoplasty and (2) analyze delays in palatoplasty during COVID-19. METHODS This study was part of a larger prospective, multicenter comparative study of speech outcomes in palatoplasty. Participants underwent palatoplasty between March 2019 and September 2022 at 18 pediatric hospitals in the United States. Ages were corrected for prematurity. Dates of palatoplasty were divided into 4 periods corresponding to different phases of the pandemic. Factors analyzed included region, language, adoption status, sex, ethnicity, race, rurality, health insurance type, and cleft type. Analyses were performed using ANOVA, Student's test, and multivariable linear regression, with a P value of ≤0.05 being significant. RESULTS Nine hundred twenty-eight participants were included. Average corrected age at palatoplasty was 374 days. In univariable analysis, palatoplasty was performed later in children who were Hispanic (P=0.003), of a race other than White, Black, or Asian (P<0.001), and without private insurance (P<0.001). On multivariable regression, predictors of delayed palatoplasty were Hispanic ethnicity (P=0.015), from other race (P<0.001), and without private insurance (P<0.001). During COVID-19, disproportionate delays occurred in patients who were female, of other races, from nonrural areas, and on Medicaid. CONCLUSIONS Palatoplasty was performed later in vulnerable populations. Some of these populations were also disproportionately affected by COVID-19 delays. Providers should be aware of these differences as they pertain to equitable access to craniofacial care. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Ibrahim Khansa
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Sarah Hatch Pollard
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT
| | - Alyssa Fogolin
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Adriane Baylis
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
| | - Thomas J Sitzman
- Division of Plastic Surgery, Phoenix Children's Hospital, and University of Arizona College of Medicine-Phoenix, Phoenix, Arizona
| | - Kathy L Chapman
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City, UT
| | - Richard E Kirschner
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH
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Card EB, Morales CE, Kimia R, Ramirez JM, Billingslea M, Marroquín A, Masaya I, Arteaga V, Marazita ML, Friedland LR, Low DW, Schwartz AJ, Scott M, Jackson OA. A Retrospective and Prospective Cohort Study Comparing Pediatric Patients With Cleft Lip and Palate From the United States and Guatemala. J Craniofac Surg 2023; 34:1978-1984. [PMID: 37449578 DOI: 10.1097/scs.0000000000009539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 05/19/2023] [Indexed: 07/18/2023] Open
Abstract
Orofacial clefts (OFC) remain among the most prevalent congenital abnormalities worldwide. In the United States in 2010 to 2014, 16.2 of 10,000 live births are born with OFC compared with 23.6 of 10,000 in Alta Verapaz, Guatemala in 2012. Demographics and cleft severity scores were retrospectively gathered from 514 patients with isolated OFC at the Children's Hospital of Philadelphia scheduled for surgery from 2012 to 2019 and from 115 patients seen during surgical mission trips to Guatemala City from 2017 to 2020. Risk factors were also gathered prospectively from Guatemalan families. The Guatemalan cohort had a significantly lower prevalence of cleft palate only compared with the US cohort, which may be a result of greater cleft severity in the population or poor screening and subsequent increased mortality of untreated cleft palate. Of those with lip involvement, Guatemalan patients were significantly more likely to have complete cleft lip, associated cleft palate, and right-sided and bilateral clefts, demonstrating an increased severity of Guatemalan cleft phenotype. Primary palate and lip repair for the Guatemalan cohort occurred at a significantly older age than that of the US cohort, placing Guatemalan patients at increased risk for long-term complications such as communication difficulties. Potential OFC risk factors identified in the Guatemalan cohort included maternal cooking-fire and agricultural chemical exposure, poor prenatal vitamin intake, poverty, and risk factors related to primarily corn-based diets. OFC patients who primarily rely on surgical missions for cleft care would likely benefit from more comprehensive screening and investigation into risk factors for more severe OFC phenotypes.
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Affiliation(s)
- Elizabeth B Card
- Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Carrie E Morales
- Division of Plastic Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Rotem Kimia
- Division of Plastic and Reconstructive Surgery, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | | | | | | | - Irina Masaya
- Facultad de Ciencias de la Salud, Departamento de Medicina, Universidad Rafael Landívar
| | - Vilma Arteaga
- Guatemalan Functional Occlusion Association, Functional Maxillary Orthopedics and Craniofacial Orthodontics Specialist, Juan Pablo II Children's Hospital, Operation Smile Guatemala, Guatemala
| | - Mary L Marazita
- Center for Craniofacial and Dental Genetics
- Department of Oral and Craniofacial Sciences, School of Dental Medicine
- Department of Human Genetics, Graduate School of Public Health
- Clinical and Translation Sciences
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Leonard R Friedland
- Scientific Affairs and Public Health GSK Vaccines, Research and Development Department, GlaxoSmithKline
| | - David W Low
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania
| | - Alan Jay Schwartz
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia
- Perelman School of Medicine, University of Pennsylvania
| | - Michelle Scott
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia
| | - Oksana A Jackson
- Division of Plastic Surgery, Department of Surgery, University of Pennsylvania Health System
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The effect of short-term preoperative nutritional intervention for cleft surgery eligibility. BMC Nutr 2023; 9:47. [PMID: 36918940 PMCID: PMC10012294 DOI: 10.1186/s40795-023-00704-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 03/06/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Children with orofacial clefts are highly susceptible to malnutrition, with severe malnutrition restricting their eligibility to receive safe surgery. Ready-to-use therapeutic foods (RUTF) are an effective treatment for malnutrition; however, the effectiveness has not been demonstrated in this patient population prior to surgery. We studied the effectiveness of short-term RUTF use in transitioning children with malnutrition, who were initially ineligible for surgery, into surgical candidates. METHODS A cohort of patients from Ghana, Honduras, Malawi, Madagascar, Nicaragua, and Venezuela enrolled in a nutrition program were followed by Operation Smile from June 2017 to January 2020. Age, weight, and length/height were tracked at each visit. Patients were included until they were sufficiently nourished (Z > = -1) with a secondary outcome of receiving surgery. The study was part of a collaborative program between Operation Smile (NGO), Birdsong Peanuts (peanut shellers and distributors), and MANA Nutrition (RUTF producer). RESULTS A total of 556 patients were recruited between June 2017 and January 2020. At baseline 28.2% (n = 157) of patients were diagnosed with severe, 21.0% (n = 117) moderate, and 50.7% (n = 282) mild malnutrition. 324 (58.3%) presented for at least one return visit. Of those, 207 (63.7%) reached optimal nutrition status. By visit two, the mean z-score increased from -2.5 (moderate) to -1.7 (mild) (p < 0·001). The mean time to attain optimal nutrition was 6 weeks. There was a significant difference in the proportion of patients who improved by country(p < 0.001). CONCLUSION Malnutrition prevents many children with orofacial clefts in low- and middle-income countries from receiving surgical care even when provided for free. This creates an even larger disparity in access to surgery. In an average of 6 weeks with an approximate cost of $25 USD per patient, RUTF transitioned over 60% of patients into nutritionally eligible surgical candidates, making it an effective, short-term preoperative nutritional intervention. Through unique partnerships, the expansion of cost-effective, large-scale nutrition programs can play a pivotal role in ensuring those at the highest risk of living with unrepaired orofacial clefts receive timely and safe surgical care.
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Bryski MG, Azad CL, Etchill EW, Rhee DS. Global Disparities in Burn Outcomes: Does Gender Predict Mortality in the Global Burn Registry? J Surg Res 2023; 283:459-468. [PMID: 36434842 DOI: 10.1016/j.jss.2022.10.071] [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: 03/01/2022] [Revised: 10/02/2022] [Accepted: 10/17/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Global burn injury burden disproportionately impacts low- and middle-income countries. Surgery is a mainstay of burn treatment, yet access to surgical care appears to be inequitably distributed for women. This study sought to identify gender disparities in mortality and access to surgery for burn patients in the World Health Organization Global Burn Registry (GBR). METHODS We queried the World Health Organization GBR for a retrospective cohort (2016-2021). Patients were stratified by sex. Outcomes of interest were in-hospital mortality and surgical treatment. Patient demographics, injury characteristics, outcomes, and health facility resources were compared between sexes with Wilcoxon rank sum test for nonparametric medians, and chi-squared or Fisher's exact test for nonparametric proportions. Multivariable logistic regressions were performed to assess the relationships between sex and mortality, and sex and surgery. RESULTS Of 8445 patients in the GBR from 20 countries (10 low resource), 40% of patients were female, with 51% of all patients receiving surgical treatment during their hospitalization. Female patients had a higher incidence of mortality (24% versus 15%, P < 0.001) and a higher median total body surface area (20% versus 15%, P < 0.001), yet a lower incidence of surgery (47% versus 53%, P < 0.001) following burn injury when compared to males. In multivariable analysis, female sex was independently associated with mortality after controlling for age, time to presentation, smoke injury, percent total body surface area, surgery, and country income status. Female sex was independently associated with surgical care (odds ratio 0.86, P = 0.001). CONCLUSIONS Female burn patients suffer higher mortality compared to males and are less likely to receive surgery. Further study into this gender disparity in burns is warranted.
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Affiliation(s)
| | - Chao Long Azad
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric W Etchill
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel S Rhee
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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The Risk of Orofacial Cleft Lip/Palate Due to Maternal Ambient Air Pollution Exposure: A Call for Further Research in South Africa. Ann Glob Health 2023; 89:6. [PMID: 36743286 PMCID: PMC9881443 DOI: 10.5334/aogh.4007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/29/2022] [Indexed: 01/28/2023] Open
Abstract
Background Despite being underreported, orofacial cleft lip/palate (CLP) remains in the top five of South Africa's most common congenital disorders. Maternal air pollution exposure has been associated with CLP in neonates. South Africa has high air pollution levels due to domestic burning practices, coal-fired power plants, mining, industry, and traffic pollution, among other sources. We investigated air pollutant levels in geographic locations of CLP cases. Methods In a retrospective case series study (2006-2020) from a combined dataset by a Gauteng surgeon and South African Operation Smile, the maternal address at pregnancy was obtained for 2,515 CLP cases. Data from the South African Air Quality Information System was used to calculate annual averages of particulate matter (PM) concentrations of particles < 10 µm (PM10) and < 2.5 µm (PM2.5). Correlation analysis determined the relationship between average PM2.5/PM10 concentrations and CLP birth prevalence. Hotspot analysis was done using the Average Nearest Neighbor tool in ArcGIS. Results Correlation analysis showed an increasing trend of CLP birth prevalence to PM10 (CC = 0.61, 95% CI = 0.38-0.77, p < 0.001) and PM2.5 (CC = 0.63, 95% CI = 0.42-0.77, p < 0.001). Hot spot analysis revealed that areas with higher concentrations of PM10 and PM2.5 had a higher proclivity for maternal residence (z-score = -68.2, p < 0.001). CLP birth prevalence hotspot clusters were identified in district municipalities in the provinces of Gauteng, Limpopo, North-West, Mpumalanga, and Free State. KwaZulu-Natal and Eastern Cape had lower PM10 and PM2.5 concentrations and were cold spot clusters. Conclusions Maternal exposure to air pollution is known to impact the fetal environment and increase CLP risk. We discovered enough evidence of an effect to warrant further investigation. We advocate for a concerted effort by the government, physicians, researchers, non-government organizations working with CLP patients, and others to collect quality data on all maternal information and pollutant levels in all provinces of South Africa. Collaboration and data sharing for additional research will help us better understand the impact of air pollution on CLP in South Africa.
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Akmal M, Zahir R, Zahir Z, Ahmed J, Lateef T. SaveSmile: an annual cleft repair mission in Sudan. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.35266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Low- and middle-income countries (LMICs) are often burdened by disease, beyond the scope of their healthcare capabilities. Sudan, in particular, lacks the resources and expertise to surgically repair orofacial clefts. This paper highlights Sudan’s need for medical aid from other countries and outside organizations and the procedures by which they collaborate with local entities to provide relief to those affected by cleft in Sudan. Additionally, this study reports on the prevalence of type of cleft lip and palate as well as rates and explanations of surgical complications over a period of 10 years and the short and long-term benefits to society. Paper copies of patient data was digitalized and run through statistical programs to look for patterns of demographics and diagnoses. Most patients were male, under four years old, and had a cleft lip.
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Affiliation(s)
| | - Rhea Zahir
- George Washington University School of Medicine and Pediatric Specialists of Virginia, USA
| | | | | | - Tarannum Lateef
- George Washington University School of Medicine and Pediatric Specialists of Virginia, USA
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Vu GH, Warden C, Zimmerman CE, Kalmar CL, Humphries LS, McDonald-McGinn DM, Jackson OA, Low DW, Taylor JA, Swanson JW. Poverty and Risk of Cleft Lip and Palate: An Analysis of United States Birth Data. Plast Reconstr Surg 2022; 149:169-182. [PMID: 34936619 PMCID: PMC8691162 DOI: 10.1097/prs.0000000000008636] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The relationship between poverty and incidence of cleft lip and cleft palate remains unclear. The authors investigated the association between socioeconomic status and cleft lip with or without cleft palate and cleft palate only in the United States after controlling for demographic and environmental risk factors. METHODS The U.S. 2016 and 2017 natality data were utilized. Proxies for socioeconomic status included maternal education, use of the Special Supplemental Nutrition Program for Women, Infants, and Children, and payment source for delivery. Multiple logistic regression controlled for household demographics, prenatal care, maternal health, and infant characteristics. RESULTS Of 6,251,308 live births included, 2984 (0.05 percent) had cleft lip with or without cleft palate and 1180 (0.02 percent) had cleft palate only. Maternal education of bachelor's degree or higher was protective against, and delayed prenatal care associated with, cleft lip with or without cleft palate (adjusted ORs = 0.73 and 1.14 to 1.23, respectively; p < 0.02). Receiving assistance under the Special Supplemental Nutrition Program for Women, Infants, and Children was associated with cleft palate only (adjusted OR = 1.25; p = 0.003). Male sex, first-trimester tobacco smoking, and maternal gestational diabetes were also associated with cleft lip with or without cleft palate (adjusted ORs = 1.60, 1.01, and 1.19, respectively; p < 0.05). Female sex, prepregnancy tobacco smoking, and maternal infections during pregnancy were associated with cleft palate only (adjusted ORs = 0.74, 1.02, and 1.60, respectively; p < 0.05). CONCLUSIONS Increased incidence of orofacial clefts was associated with indicators of lower socioeconomic status, with different indicators associated with different cleft phenotypes. Notably, early prenatal care was protective against the development of cleft lip with or without cleft palate. CLIINCAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Giap H Vu
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Clara Warden
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Carrie E Zimmerman
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Christopher L Kalmar
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Laura S Humphries
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Donna M McDonald-McGinn
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Oksana A Jackson
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - David W Low
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Jesse A Taylor
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Jordan W Swanson
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
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14
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Discussion: Global Burden of Orofacial Clefts and the World Surgical Workforce. Plast Reconstr Surg 2021; 148:581e-582e. [PMID: 34550941 DOI: 10.1097/prs.0000000000008335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Sousa GFTD, Roncalli AG. [Factors associated with the delay in primary surgical treatment of cleft lip and palate in Brazil: a multilevel analysis]. CIENCIA & SAUDE COLETIVA 2021; 26:3505-3515. [PMID: 34468646 DOI: 10.1590/1413-81232021269.2.23592019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 10/13/2019] [Indexed: 11/22/2022] Open
Abstract
This study analyzed the delay in the primary surgical treatment of patients with cleft lip and palate in Brazil performed under the Unified Health System (SUS), and the effect of the sociodemographic context and municipal socioeconomic indicators on access to this treatment (2009-2013). Data from the Decentralized Hospital Information System relating to all hospital authorization forms paid for primary cleft lip and/or palate surgeries and socioeconomic data (2010) was used. The ages recommended by the American Cleft Palate-Craniofacial Association (12 months for lip surgeries and 18 months for palate surgeries) were used as parameters. The prevalence of delay observed in primary lip surgeries was 66.4% and in palate surgeries was 71.2%. The North and Northeast regions had the worst percentages of delay. Non-whites had a greater prevalence of delay in cleft lip surgeries with PR = 1.40 (1.30-1.50) and cleft palate surgeries with PR = 1.27 (1.21-1.33). The multilevel analysis identified the influence of self-reported skin color and Human Development Index (HDI) on the delay of primary lip surgery, and of HDI on the delay of palate surgery. The importance of social determination on the access to primary cleft lip and palate surgeries was evident.
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Affiliation(s)
- Giselle Firmino Torres de Sousa
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000. Natal RN Brasil.
| | - Angelo Giuseppe Roncalli
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal do Rio Grande do Norte. Av. Sen. Salgado Filho 1787, Lagoa Nova. 59056-000. Natal RN Brasil.
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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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The Impact of Middle Eastern Crisis on Cleft Care: Evaluation of Demographic and Perioperative Data in Syrian Refugees With Cleft Lip and Palate. J Craniofac Surg 2021; 31:1668-1671. [PMID: 32604304 DOI: 10.1097/scs.0000000000006649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The cleft lip and palate (CL/P) define a heterogeneous group of congenital deformities, which are morphologically highly diverse, with a complex and multifactorial etiology. Affected children may experience social problems due to negative effects on speech, hearing, facial appearance, as well as negative psychological effects on the parents. In 2011, after the civil war began in Syria, a great wave of immigration began to Turkey and other neighboring countries. Refugees may not be able to receive optimal health care because of cultural differences, socioeconomic status, language problems, and psychosocial problems. To increase awareness about this issue, the authors investigated the demographic, perioperative, and post-operative data of Syrian refugee patients with CL/P who were admitted to our cleft center between January 2016 and May 2019. Sixty-eight refugees with CL/P were detected as the result of the screening. Unlike the protocol the authors follow in our center, cleft lip repair was performed at an average of 7.6 months and cleft palate repair was performed at an average of 28.7 months of age. The rate of fistula was found 26.2%.The civil war in Syria has caused the repair of the patients with cleft lip and palate at a later age, hampered the follow-up and treatment, and caused more complications. Considering the demographic, social, economic and cultural characteristics of the patients, it was demonstrated that the necessary health precautions and infrastructure should be provided on the pillar of plastic surgery.
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18
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Sarilita E, Setiawan AS, Mossey PA. Orofacial clefts in low- and middle-income countries: A scoping review of quality and quantity of research based on literature between 2010-2019. Orthod Craniofac Res 2020; 24:421-429. [PMID: 33320981 DOI: 10.1111/ocr.12458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/07/2020] [Accepted: 12/04/2020] [Indexed: 11/30/2022]
Abstract
This paper assesses the research literature on OFC in LMIC over the last decade across various geographical settings and project focus of the indexed literature. A scoping review of the indexed literature was performed using a set of predefined keywords. The articles were filtered by a ten-year time frame (2010-2019) and a strict inclusive-exclusive criterion. Two authors screened the titles/abstracts/full text of the final included papers and input the desired data (year of publication, type of publication, geographical country/region and project focus to a coded spreadsheet). Six hundred and twenty publications were inventoried from the indexed literature on OFC in LMIC settings over the 10-year period. Five hundred and eighty-three derived from single LMIC countries and 37 from multi-settings. More than half of the articles were reported from Asia (57%), then from Americas (22.8%), Africa (15.4%) and the rest from cross-regional, Europe and Oceania (4.9%). The top 3 LMIC contributors towards OFC publications were China (21.5%), Brazil (13.1%) and India (11.6%). The most discussed OFC project themes were prevalence, surgical repair, aetiology and genetics. This study helps OFC researchers, humanitarian missions and research grant funders to identify gaps in the literature on issues impacting on children and adults born with OFC, in which issues were subjected to research and which were less explored in which LMIC regions. In addition, this study offers recommendations for established OFC researchers and international research bodies to identify areas of deficiency in the literature and what information is required to support LMIC governments achieve SDGs by 2030.
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Affiliation(s)
- Erli Sarilita
- Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Asty S Setiawan
- Department of Dental Community Health, Faculty of Dentistry, Universitas Padjadjaran, Bandung, Indonesia
| | - Peter A Mossey
- Division of Oral Health Sciences, WHO Collaborating Centre for Oral Health & Craniofacial Anomalies, University of Dundee, Dundee, Scotland, UK
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Barbero GE, de Miguel M, Sierra P, Merritt G, Bora P, Borah N, Ciarallo C, Ing R, Bosenberg A, de Nadal M. Clonidine as an Adjuvant to Bupivacaine for Suprazygomatic Maxillary Nerve Blocks in Cleft lip and Palate Repair: A Randomized, Prospective, Double-Blind Study. Cleft Palate Craniofac J 2020; 58:755-762. [PMID: 33043691 DOI: 10.1177/1055665620964141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Does clonidine, as adjuvant to bupivacaine for suprazygomatic maxillary nerve blocks, reduce emergence agitation in patients undergoing cleft lip and cleft palate surgery? DESIGN Randomized, controlled, and double-blind study. SETTING Guwahati Comprehensive Cleft Care Center, Guwahati (Assam, India). PARTICIPANTS A total of 124 patients; with a median age of 5 years in the clonidine group (CLG) and 7 years in the control group (CG), who underwent cleft lip or cleft palate surgery were included. Exclusion criteria included lack of consent from patients or their guardians, allergy to local anesthetics, coagulation disorders, local infection at the puncture site before performing the block, and language difficulties or cognitive disorders. INTERVENTIONS Patients were randomized into 2 groups to receive bilateral suprazygomatic maxillary nerve blocks with either a bupivacaine/clonidine mixture for the CLG or bupivacaine alone in the CG. MAIN OUTCOME MEASURE The primary end point was the incidence of emergence agitation. RESULTS There was a statistically significant difference in the incidence of emergence agitation (30.2% in the CG compared to 15.2% in the CLG; difference of incidences: 15%, 95% CI: 0.1-30.1). The percentage of patients requiring intraoperative Fentanyl was lower in the CLG (10.6% compared to 26.4%; difference of incidences: 15.8%, 95% CI: 1.8-29). No other differences were observed. Further research in a more typically aged children population undergoing cleft surgery is needed. CONCLUSIONS The use of clonidine as an adjuvant to bupivacaine in maxillary nerve block reduces the incidence of emergence agitation and intraoperative opioid consumption without hemodynamic or sedative side effects in patients undergoing cleft lip and palate surgery.
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Affiliation(s)
- Gaston Echaniz Barbero
- Department of Anesthesiology, 16810Vall d'Hebron Hospital, Barcelona, Spain.,Department of Surgery, 16810Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marcos de Miguel
- Department of Anesthesiology, 16810Vall d'Hebron Hospital, Barcelona, Spain.,Department of Surgery, 16810Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Plinio Sierra
- Department of Pediatric Anesthesia, 425365King Abdullah Hospital, Riyadh, Saudi Arabia
| | - Glenn Merritt
- Department of Anesthesiology, 2932Children's Hospital Colorado, Denver, Colorado, USA
| | - Pranjal Bora
- Department of Anesthesiology, Guwahati Comprehensive Cleft Care Center, Guwahati, India
| | - Nabamallika Borah
- Department of Anesthesiology, Guwahati Comprehensive Cleft Care Center, Guwahati, India
| | - Christopher Ciarallo
- Department of Anesthesiology, 2932Children's Hospital Colorado, Denver, Colorado, USA
| | - Richard Ing
- Department of Anesthesiology, 2932Children's Hospital Colorado, Denver, Colorado, USA
| | - Adrian Bosenberg
- Department Anesthesiology and Pain Management, Seattle Children's Hospital and 7284University of Washington, Seattle, Washington, USA
| | - Miriam de Nadal
- Department of Anesthesiology, 16810Vall d'Hebron Hospital, Barcelona, Spain.,Department of Surgery, 16810Universitat Autònoma de Barcelona, Barcelona, Spain
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20
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Lindeborg MM, Shakya P, Pradhan B, Rai SK, Gurung KB, Niroula S, Rayamajhi B, Chaudhary H, Gaire B, Mahato N, Rana L, Rokaya P, Shrestha N, Shrestha R, Tamang J, Joshi HD, Gaha P, Khorja DK, Nakarmi KK, Mitnick CD, Rai SM, Shaye DA. A task-shifted speech therapy program for cleft palate patients in rural Nepal: Evaluating impact and associated healthcare barriers. Int J Pediatr Otorhinolaryngol 2020; 134:110026. [PMID: 32272376 DOI: 10.1016/j.ijporl.2020.110026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Though access to surgical care for cleft lip/palate has expanded in low- and middle-income countries (LMICs), post-palatoplasty speech therapy is often lacking due to limited healthcare infrastructure and personnel. This mixed-methods study seeks to: 1) evaluate the impact of task-shifted speech therapy on a standardized speech score; 2) describe the experiences of families with post-operative cleft care and associated barriers; and 3) understand how to optimize cleft care by exploring the experiences of children who had nominal improvements after task-shifted speech therapy. METHODS A convergent parallel mixed-methods study was conducted in Nepal. Standardized speech scores were compared by a blinded speech-language pathologist before and after the speech intervention. Semi-structured interviews (SSIs) and focus groups with families evaluated cleft care experiences and barriers. Qualitative and quantitative data were merged and analyzed. RESULTS Thirty-nine post-palatoplasty children with speech deficits (ages 3-18) underwent task-shifted speech therapy, and demonstrated significant improvements in composite speech scores targeted by exercises (p<0.0001) and weakness (p=0.0002), with improvements in misarticulation (p=0.07) and glottal stop (p=0.05) that trended towards significance. Forty-seven SSIs demonstrated that the greatest barriers to follow-up were family responsibilities (62%), travel/distance (53%), and work (34%). In five focus groups, families expressed a desire to improve their child's speech and seek formal speech therapy. The speech intervention was found to be beneficial because of the compassionate staff, free lodging/food, and ability to socialize with other cleft patients and families. After merging quantitative and qualitative data, we noted that younger children between 3 and 5 years old and families who traveled greater distances for healthcare access benefited less from the speech therapy intervention. CONCLUSIONS Task-shifted speech therapy has the potential to improve cleft lip/palate speech in LMICs. Multiple biosocial issues limit access to appropriate post-operative care.
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Affiliation(s)
- Michael M Lindeborg
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Pramila Shakya
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Bhawani Pradhan
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Shiba Kala Rai
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | | | - Suman Niroula
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Badri Rayamajhi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Hema Chaudhary
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Bhagwati Gaire
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Naina Mahato
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Lila Rana
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Phana Rokaya
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Nilam Shrestha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Renuka Shrestha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Januka Tamang
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Hemanta Dhoj Joshi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Pushpa Gaha
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Dhana Kumari Khorja
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Kiran K Nakarmi
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - Carole D Mitnick
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Shankar Man Rai
- Department of Burns, Plastic and Reconstructive Surgery, Kirtipur Hospital, Nepal
| | - David A Shaye
- Department of Otolaryngology, Massachusetts Eye and Ear, Boston, MA, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, USA.
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Masefield SC, Megaw A, Barlow M, White PCL, Altink H, Grugel J. Repurposing NGO data for better research outcomes: a scoping review of the use and secondary analysis of NGO data in health policy and systems research. Health Res Policy Syst 2020; 18:63. [PMID: 32513183 PMCID: PMC7278191 DOI: 10.1186/s12961-020-00577-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/19/2020] [Indexed: 11/26/2022] Open
Abstract
Background Non-governmental organisations (NGOs) collect and generate vast amounts of potentially rich data, most of which are not used for research purposes. Secondary analysis of NGO data (their use and analysis in a study for which they were not originally collected) presents an important but largely unrealised opportunity to provide new research insights in critical areas, including the evaluation of health policy and programmes. Methods A scoping review of the published literature was performed to identify the extent to which secondary analysis of NGO data has been used in health policy and systems research (HPSR). A tiered analytical approach provided a comprehensive overview and descriptive analyses of the studies that (1) used data produced or collected by or about NGOs; (2) performed secondary analysis of the NGO data (beyond the use of an NGO report as a supporting reference); and (3) analysed NGO-collected clinical data. Results Of the 156 studies that performed secondary analysis of NGO-produced or collected data, 64% (n = 100) used NGO-produced reports (mostly to a limited extent, as a contextual reference or to critique NGO activities) and 8% (n = 13) analysed NGO-collected clinical data. Of these studies, 55% (n = 86) investigated service delivery research topics and 48% (n = 51) were undertaken in developing countries and 17% (n = 27) in both developing and developed countries. NGOs were authors or co-authors of 26% of the studies. NGO-collected clinical data enabled HPSR within marginalised groups (e.g. migrants, people in conflict-affected areas), albeit with some limitations such as inconsistent and missing data. Conclusion We found evidence that NGO-collected and produced data are most commonly perceived as a source of supporting evidence for HPSR and not as primary source data. However, these data can facilitate research in under-researched marginalised groups and in contexts that are hard to reach by academics such as conflict-affected areas. NGO–academic collaboration could help address issues of NGO data quality to facilitate their more widespread use in research. The use of NGO data use could enable relevant and timely research in the areas of programme evaluation and health policy and advocacy to improve health and reduce health inequalities, especially in marginalised groups and developing countries.
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Affiliation(s)
- Sarah C Masefield
- Department of Health Sciences, University of York, York, YO10 5DD, United Kingdom. .,Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.
| | - Alice Megaw
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom
| | - Matt Barlow
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
| | - Piran C L White
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Environment and Geography, University of York, York, YO10 5NG, United Kingdom
| | - Henrice Altink
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of History, University of York, York, YO10 5NH, United Kingdom
| | - Jean Grugel
- Interdisciplinary Global Development Centre, University of York, York, YO10 5DD, United Kingdom.,Department of Politics, University of York, York, YO10 5DD, United Kingdom
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22
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Shaffer AD, Ford MD, Losee JE, Goldstein J, Costello BJ, Grunwaldt LJ, Jabbour N. The Association Between Age at Palatoplasty and Speech and Language Outcomes in Children With Cleft Palate: An Observational Chart Review Study. Cleft Palate Craniofac J 2019; 57:148-160. [DOI: 10.1177/1055665619882566] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective:To determine whether timing of palatoplasty (early, standard, or late) is associated with speech and language outcomes in children with cleft palate.Design:Retrospective case series.Setting:Tertiary care children’s hospital.Participants:Records from 733 children born between 2005 and 2015 and treated at the Cleft Craniofacial Clinic of a tertiary children’s hospital were retrospectively reviewed. Exclusion criteria were cleft repair at an outside hospital, intact secondary palate, absence of postpalatoplasty speech evaluation, syndromes, staged palatoplasty, and introduction to clinic after 12 months of age. Data from 232 children with cleft palate ± cleft lip were analyzed.Interventions:Palatoplasty.Main Outcome Measures:Speech/language delays and disorders at 20 months and 5 years of age based on formal hospital or community-based testing or screening evaluation in the Cleft Craniofacial Clinic; additional speech surgery.Results:Median age at palatoplasty was 12.6 months (range: 8.8-21.9 months). Age at palatoplasty was classified as early (<11 months, n = 28), standard (11-13 months, n = 158), or late (>13 months, n = 46). Late palatoplasty was associated with increased odds of speech/language delays and speech therapy at 20 months, and language delays at 5 years, compared with standard or early palatoplasty ( P < .05 for all comparisons). However, speech sound production disorders, velopharyngeal incompetence, tube replacement, and hearing loss were not significantly associated with age at palatoplasty.Conclusions:Late palatoplasty may be associated with short- and long-term delays in speech/language development. Future studies with standardized surgical technique/timing and outcome measures are required to more definitively describe the impact of age at palatoplasty on speech/language development.
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Affiliation(s)
- Amber D. Shaffer
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Matthew D. Ford
- Cleft Craniofacial Center, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Joseph E. Losee
- Division of Pediatric Plastic Surgery, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Jesse Goldstein
- Division of Pediatric Plastic Surgery, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Bernard J. Costello
- Division of Pediatric Oral and Maxillofacial Surgery, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Lorelei J. Grunwaldt
- Division of Pediatric Plastic Surgery, UPMC Children’s Hospital of Pittsburgh, PA, USA
| | - Noel Jabbour
- Division of Pediatric Otolaryngology, UPMC Children’s Hospital of Pittsburgh, PA, USA
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Introduction of the American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE Database. J Craniofac Surg 2017; 28:1171-1174. [DOI: 10.1097/scs.0000000000003590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abraham MT, Rousso JJ, Hu S, Brown RF, Moscatello AL, Finn JC, Patel NA. Creation of the American Academy of Facial Plastic and Reconstructive Surgery FACE TO FACE Database. JAMA FACIAL PLAST SU 2017; 19:158-160. [DOI: 10.1001/jamafacial.2016.1286] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Manoj T. Abraham
- New York Medical College, Valhalla
- Facial Plastic, Reconstructive, and Laser Surgery, Poughkeepsie, New York
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - Joseph J. Rousso
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - Shirley Hu
- New York Medical College, Valhalla
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - Ryan F. Brown
- Department of Otolaryngology, Kaiser Permanente, Denver, Colorado
| | - Augustine L. Moscatello
- New York Medical College, Valhalla
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - J. Charles Finn
- Department of Otolaryngology, Finn Facial Plastics and Duke University, Durham, North Carolina
| | - Neha A. Patel
- Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York
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