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Shelke GS, Marwaha R, Shah P, Challa SN. Impact of Prenatal Health Conditions and Health Behaviors in Pregnant Women on Infant Birth Defects in the United States Using CDC-PRAMS 2018 Survey. Pediatr Rep 2023; 15:197-208. [PMID: 36976722 PMCID: PMC10054588 DOI: 10.3390/pediatric15010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/21/2023] [Accepted: 02/08/2023] [Indexed: 03/05/2023] Open
Abstract
Objective: To assess both individual and interactive effects of prenatal medical conditions depression and diabetes, and health behaviors including smoking during pregnancy on infant birth defects. Methods: The data for this research study were collected by the Pregnancy Risk Assessment Monitoring System (PRAMS) in 2018. Birth certificate records were used in each participating jurisdiction to select a sample representative of all women who delivered a live-born infant. Complex sampling weights were used to analyze the data with a weighted sample size of 4,536,867. Descriptive statistics were performed to explore frequencies of the independent and dependent variables. Bivariate and multivariable analyses were conducted to examine associations among the independent and dependent variables. Results: The results indicate significant interaction between the variables smoking and depression and depression and diabetes (OR = 3.17; p-value < 0.001 and OR = 3.13; p-value < 0.001, respectively). Depression during pregnancy was found to be strongly associated with delivering an infant with a birth defect (OR = 1.31, p-value < 0.001). Conclusion: Depression during pregnancy and its interaction with smoking and diabetes are vital in determining birth defects in infants. The results indicate that birth defects in the United States can be reduced by lowering depression in pregnant women.
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Affiliation(s)
- Girish Suresh Shelke
- Helping Restore Ability, Arlington, TX 76018, USA
- School of Dentistry, University of Texas Health Science Center San Antonio, University of Texas, San Antonio, TX 78229, USA
- Correspondence: ; Tel.: +1-(682)-702-0544
| | - Rochisha Marwaha
- School of Dentistry, University of Texas Health Science Center San Antonio, University of Texas, San Antonio, TX 78229, USA
| | - Pankil Shah
- Department of Urology, University of Texas Health Science Center San Antonio, University of Texas, San Antonio, TX 78229, USA
| | - Suman N. Challa
- School of Dentistry, University of Texas Health Science Center San Antonio, University of Texas, San Antonio, TX 78229, USA
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Pfeifauf KD, Cooper DC, Gibson E, Skolnick GB, Naidoo SD, Snyder-Warwick AK, Patel KB. Factors contributing to delay or absence of alveolar bone grafting. Am J Orthod Dentofacial Orthop 2022; 161:820-828.e1. [DOI: 10.1016/j.ajodo.2021.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 01/01/2021] [Accepted: 01/01/2021] [Indexed: 11/01/2022]
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Delay in Cleft Lip and Palate Surgical Repair: An Institutional Review on Cleft Health Disparities in an Urban Population. J Craniofac Surg 2020; 30:2328-2331. [PMID: 31306388 DOI: 10.1097/scs.0000000000005740] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Access to specialized medical care is critical to decrease complications and minimize long-term morbidity, yet racial disparities in cleft surgery persist as time to initial reconstruction remains delayed among minority patients. Research has demonstrated an average 3-week delay in surgery for minority patients nationally. A retrospective chart review of patient demographics, visit timing, and surgical history was performed for patients who underwent primary cleft lip with or without palate (CL + P) reconstruction between 2002 and 2016 at an urban craniofacial center. Of the 89 children who underwent surgery, 87% were ethnic minorities (58% Hispanic, 25% African-American, 4% Asian/Other). Caucasian children were the earliest to receive CL (3.5 months) and CP (13-months) repair. Minority children trended toward a delay in CL repair, with surgery for African-Americans at 5-months (P = 0.06) and Hispanics at 4.8-months (P = 0.07). Time from first visit to CL surgery showed significant delays for minority, non-English speaking, and public insurance patients; however, for CP repair, male children were delayed from first visit to surgery compared to females (P = 0.03). While there was no statistical difference in age at CL or CP surgical repair among our racial/ethnic cohorts, there were significant racial/ethnic differences in timing spent in the preoperative period for CL. However, racial/ethnic differences decreased as the patients spent more time within the healthcare system. Thus, established, interdisciplinary cleft/craniofacial centers well versed in minority patients can minimize the complex social and cultural factors that contribute to delays in cleft care.
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Li L, Strum D, Larson S, Preciado D. Quality of life outcomes following velopharyngeal insufficiency surgery. Int J Pediatr Otorhinolaryngol 2019; 127:109643. [PMID: 31442731 DOI: 10.1016/j.ijporl.2019.109643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 08/09/2019] [Accepted: 08/10/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Velopharyngeal insufficiency (VPI) may be due to functional or anatomic causes, and can lead to speech deficits, communication difficulty, and emotional strain on patients and their caregivers. The VPI Effects on Life Outcomes (VELO) instrument quantifies quality of life outcomes in VPI patients both before and after VPI surgery. This study aims to identify pre-operative patient characteristics associated with better post-operative quality of life. METHODS This study is a retrospective chart review of 51 patients who underwent VPI surgery between 2009 and 2018 at a tertiary free-standing children's hospital. A 26-item parent-proxy VELO questionnaire was administered by telephone to parents to assess their child's quality of life post-VPI surgery. RESULTS Twenty-seven parents responded to the VELO questionnaire. Average post-operative VELO score was significantly higher in non-syndromic patients as compared with syndromic patients. Average post-operative VELO score was not significantly different between patients with and without submucous cleft (SMC) or those with mild to moderate versus severe pre-operative hypernasality. On multivariate analysis, absence of genetic syndrome, lack of submucous cleft, and presence of severe-pre-operative hypernasality were significantly and positively associated with increased post-operative VELO scores. CONCLUSION Children who undergo VPI surgery are more likely to have better post-operative quality of life outcomes if their VPI was not associated with a genetic syndrome or submucous cleft. Non-syndromic and non-SMC patients with severe pre-operative hypernasality may benefit significantly from VPI surgery and have improved post-operative quality of life.
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Affiliation(s)
- Lilun Li
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA
| | - David Strum
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA
| | - Stephen Larson
- Department of Otolaryngology, University of Tennessee Health Science Center, 910 Madison Avenue, Memphis, TN, 38163, USA
| | - Diego Preciado
- Department of Otolaryngology, Children's National Health System, 111 Michigan, Washington, DC, 20010, USA; Division of Otolaryngology, George Washington University, 2300 M St, Washington, DC, 20037, USA.
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Outcomes of Primary Palatoplasty: An Analysis Using the Pediatric Health Information System Database. Plast Reconstr Surg 2019; 143:533-539. [PMID: 30688897 DOI: 10.1097/prs.0000000000005210] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Previous attempts at reporting oronasal fistula development and secondary speech surgery following cleft palate surgery have been limited to single-center case series. This limitation can be overcome by querying large databases created by health care governing bodies or health care alliances. The authors examined the effect of cleft type and demographic variables on the clinical outcomes. METHODS Data from the Pediatric Health Information System database were queried for patients, aged 6 to 18 months, who had undergone primary palatoplasty between 2004 and 2009. Subsequent repair of an oronasal fistula and/or secondary speech surgery between 2004 and 2015 was identified by procedure codes. Logistic regression models were used to assess the associations between cleft type with oronasal fistula and with secondary speech surgery. RESULTS Seven thousand three hundred twenty-five patients were identified, and 6.4 percent (n = 468) had a subsequent repair of an oronasal fistula and 18.5 percent (n = 1355) had a secondary speech operation. Adjusted for age, sex, and race, patients with cleft lip and palate have increased odds of oronasal fistula (OR, 5.60; 95 percent CI, 4.44 to 7.07) and secondary speech surgery (OR, 2.32; 95 percent CI, 2.05 to 2.63). CONCLUSIONS Using a large, multi-institution billing database, the authors were able to estimate the prevalence of oronasal fistula and surgically treated velopharyngeal insufficiency following primary palatoplasty in the United States. In addition, the authors demonstrated that patients with isolated cleft palate develop fewer oronasal fistulas and require less secondary speech surgery than patients with cleft lip and palate. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Pfeifauf KD, Patel KB, Snyder-Warwick A, Skolnick GB, Scheve S, Naidoo SD. Survey of North American Multidisciplinary Cleft Palate and Craniofacial Team Clinic Administration. Cleft Palate Craniofac J 2018; 56:508-513. [PMID: 29781722 DOI: 10.1177/1055665618776069] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This study aims to provide an understanding of the ways cleft palate (CP) and craniofacial teams address billing, administration, communication of clinical recommendations, appointment scheduling, and diagnosis-specific protocols. DESIGN An online clinic administration survey was developed using data from an open-ended telephone questionnaire. The online survey was distributed by e-mail to the American Cleft Palate-Craniofacial Association (ACPA) nurse coordinator electronic mailing list, used regularly by the ACPA and its members to communicate with teams. The response was 34.1% (42/123). Two incomplete records were excluded, as were any inconsistent responses of 3 teams submitting duplicate records. RESULTS Six (15.8%) of 38 teams do not charge for clinic visits. For all other teams, some or all providers bill individually for services (68.4%) or a single lump sum applies (10.5%). Patients of 34 (89.5%) of 38 teams occasionally or often neglect to schedule or attend follow-up appointments. Twenty-six (66.7%) of 39 team directors were plastic surgeons. Phone is a common method of contacting families for scheduling (60.0%) and appointment reminders (82.5%). Most teams' providers (90.0%) routinely communicate findings to each other during postclinical conference. Most teams saw patients with isolated cleft lip (43.6%), cleft lip and palate (64.1%), or isolated CP (59.0%) annually. CONCLUSIONS The breadth of strategies team clinic administration strategies warrants further exploration of the variations and their effects on patient-centered outcomes including the quality of life, satisfaction, cost, and resource utilization.
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Affiliation(s)
- Kristin D Pfeifauf
- 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Cleft Palate and Craniofacial Institute, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Kamlesh B Patel
- 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Cleft Palate and Craniofacial Institute, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Alison Snyder-Warwick
- 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Cleft Palate and Craniofacial Institute, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Gary B Skolnick
- 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Cleft Palate and Craniofacial Institute, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
| | - Sibyl Scheve
- 2 Cleft Palate and Craniofacial Institute, Saint Louis, MO, USA
| | - Sybill D Naidoo
- 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Cleft Palate and Craniofacial Institute, Washington University in Saint Louis School of Medicine, Saint Louis, MO, USA
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Wheeler KJ, Early JO. Using Photovoice to Explore Quality of Life Factors of Adults With Crouzon Syndrome. QUALITATIVE HEALTH RESEARCH 2018; 28:357-370. [PMID: 29224414 DOI: 10.1177/1049732317742624] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In the United States, one in 60,000 adults live with Crouzon Syndrome (CS) and facial malformations. Phenomenological studies about their lived experiences and quality of life are lacking. The purpose of this participatory action research study was to gain a richer understanding of the perceived biopsychosocial and socioecological factors that impact quality of life for adults living with CS using Photovoice. Another aim was to develop a conceptual framework of quality of life for those experiencing CS to enhance tailored health education and services. A purposeful sample of nine adults with CS were recruited from U.S. national surgery centers and support groups. Participants used photography to represent their experiences and participated in individual interviews and focus groups. Data were analyzed with the participants using thematic analysis, and 44 themes emerged which informed the development of a quality of life conceptual framework and action plan described in this article.
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Affiliation(s)
| | - Jody O Early
- 2 University of Washington Bothell, Bothell, Washington, USA
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Silvestre J, Basta MN, Fischer JP, Lowe KM, Mayro R, Jackson O. Minority and Public Insurance Status: Is there a Delay to Alveolar Bone Grafting Surgery? Cleft Palate Craniofac J 2017; 54:e1-e6. [DOI: 10.1597/15-173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective This study sought to determine the timing of alveolar bone grafting (ABG) surgery among children with cleft lip with or without cleft palate (CL ± P) with regard to race and insurance status. Design A retrospective chart review of consecutive patients receiving ABG surgery was conducted. A multivariate regression model was constructed using predetermined clinical and demographic variables. Setting A large, urban cleft referral center. Patients, Participants Nonsyndromic patients with CL ± P were eligible for study inclusion. Interventions ABG surgery using autogenous bone harvested from the anterior iliac crest. Main Outcome Measure The primary outcome of interest was age at ABG surgery. Results A total of 233 patients underwent ABG surgery at 8.1 ± 2.3 years of age. African American and Hispanic patients received delayed ABG surgery compared with Caucasian patients by approximately 1 year (P < .05). There was no difference in ABG surgery timing by insurance status (P > .05). Conclusions The timing of ABG surgery varied by race but not by insurance status. Greater resources may be needed to ensure timely delivery of cleft care to African American and Hispanic children.
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Affiliation(s)
- Jason Silvestre
- Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marten N. Basta
- Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - John P. Fischer
- Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kristen M. Lowe
- Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rosario Mayro
- School of Dental Medicine, University of Pennsylvania
| | - Oksana Jackson
- Division of Plastic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Trends in medical malpractice claims in patients with cleft or craniofacial abnormalities in the United States. Int J Pediatr Otorhinolaryngol 2016; 90:214-219. [PMID: 27729136 DOI: 10.1016/j.ijporl.2016.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/22/2016] [Accepted: 09/22/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe medical malpractice trends in patients with cleft and/or craniofacial abnormalities. METHODS AND MATERIALS A modified Delphi approach was used to gather search terms. Search settings included "all jury verdicts and settlements", with jurisdiction of "all states" and "all federal courts" (by court and circuit). A retrospective review of WestLawNext legal database was conducted. Cases were excluded if they did not have a direct association from the patient's craniofacial anomaly or if they were not related to malpractice. RESULTS Forty-two cases met inclusion criteria. Cases closed between 1981 and 2014 were included. The mean payment among claims with an indemnity payment was $3.9 million. Of cases brought to trial, 62% were in favor of the plaintiff. Amongst physicians named as co-defendants, pediatricians were most commonly named (24%), followed by plastic surgeons (16%), obstetricians (7.8%), and radiologists (7.8%). "Missed diagnosis" was the most common type of negligent claim (45%), followed by "surgical error" (21%), and "medication error" (17%). "Anoxic brain injury" resulted in the highest median indemnity payment for complication of patient management ($3.5 million), followed by "wrongful birth" ($1.03 million), and "minor physical injury" ($520,000). No specific type of negligent claim (p = 0.764) nor complication of patient management (p = 0.61) was associated with a greater indemnity payment. Mean indemnity payment was $920,000 prior to 2001 and $4.4 million after 2001 (p = 0.058). CONCLUSIONS Mean indemnity payments were fourteen-fold greater in patients as compared to those in the overall population ($3.9 million versus $274,887) and seven-fold greater than those in the average pediatric population ($3.9 million versus $520,923). All healthcare providers should be aware of the associated medical malpractice claims that may be incurred when treating patients at risk for these conditions.
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Conte F, Oti M, Dixon J, Carels CEL, Rubini M, Zhou H. Systematic analysis of copy number variants of a large cohort of orofacial cleft patients identifies candidate genes for orofacial clefts. Hum Genet 2015; 135:41-59. [PMID: 26561393 PMCID: PMC4698300 DOI: 10.1007/s00439-015-1606-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/15/2015] [Indexed: 12/16/2022]
Abstract
Orofacial clefts (OFCs) represent a large fraction of human birth defects and are one of the most common phenotypes affected by large copy number variants (CNVs). Due to the limited number of CNV patients in individual centers, CNV analyses of a large number of OFC patients are challenging. The present study analyzed 249 genomic deletions and 226 duplications from a cohort of 312 OFC patients reported in two publicly accessible databases of chromosome imbalance and phenotype in humans, DECIPHER and ECARUCA. Genomic regions deleted or duplicated in multiple patients were identified, and genes in these overlapping CNVs were prioritized based on the number of genes encompassed by the region and gene expression in embryonic mouse palate. Our analyses of these overlapping CNVs identified two genes known to be causative for human OFCs, SATB2 and MEIS2, and 12 genes (DGCR6, FGF2, FRZB, LETM1, MAPK3, SPRY1, THBS1, TSHZ1, TTC28, TULP4, WHSC1, WHSC2) that are associated with OFC or orofacial development. Additionally, we report 34 deleted and 24 duplicated genes that have not previously been associated with OFCs but are associated with the BMP, MAPK and RAC1 pathways. Statistical analyses show that the high number of overlapping CNVs is not due to random occurrence. The identified genes are not located in highly variable genomic regions in healthy populations and are significantly enriched for genes that are involved in orofacial development. In summary, we report a CNV analysis pipeline of a large cohort of OFC patients and identify novel candidate OFC genes.
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Affiliation(s)
- Federica Conte
- Department of Molecular Developmental Biology, Faculty of Science, Radboud Institute for Molecular Life Sciences, Radboud University, Nijmegen, The Netherlands.,Medical Genetic Unit, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Martin Oti
- Department of Molecular Developmental Biology, Faculty of Science, Radboud Institute for Molecular Life Sciences, Radboud University, Nijmegen, The Netherlands
| | - Jill Dixon
- Faculty of Medical and Human Sciences, University of Manchester, Michael Smith Building, Oxford Road, Manchester, M13 9PT, UK
| | - Carine E L Carels
- Department of Orthodontics and Craniofacial Biology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Michele Rubini
- Medical Genetic Unit, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
| | - Huiqing Zhou
- Department of Molecular Developmental Biology, Faculty of Science, Radboud Institute for Molecular Life Sciences, Radboud University, Nijmegen, The Netherlands. .,Department of Human Genetics, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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Effect of malocclusion among adolescents on family quality of life. Eur Arch Paediatr Dent 2015; 16:357-63. [DOI: 10.1007/s40368-014-0172-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
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Cassell CH, Strassle P, Mendez DD, Lee KA, Krohmer A, Meyer RE, Strauss RP. Barriers to care for children with orofacial clefts in North Carolina. ACTA ACUST UNITED AC 2014; 100:837-47. [PMID: 25200965 DOI: 10.1002/bdra.23303] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/11/2014] [Accepted: 08/12/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about the barriers faced by families of children with birth defects in obtaining healthcare. We examined reported perceived barriers to care and satisfaction with care among mothers of children with orofacial clefts. METHODS In 2006, a validated barriers to care mail/phone survey was administered in North Carolina to all resident mothers of children with orofacial clefts born between 2001 and 2004. Potential participants were identified using the North Carolina Birth Defects Monitoring Program, an active, state-wide, population-based birth defects registry. Five barriers to care subscales were examined: pragmatics, skills, marginalization, expectations, and knowledge/beliefs. Descriptive and bivariate analyses were conducted using chi-square and Fisher's exact tests. Results were stratified by cleft type and presence of other birth defects. RESULTS Of 475 eligible participants, 51.6% (n = 245) responded. The six most commonly reported perceived barriers to care were all part of the pragmatics subscale: having to take time off work (45.3%); long waits in the waiting rooms (37.6%); taking care of household responsibilities (29.7%); meeting other family members' needs (29.5%); waiting too many days for appointments (27.0%); and cost (25.0%). Most respondents (72.3%, 175/242) felt "very satisfied" with their child's cleft care. CONCLUSION Although most participants reported being satisfied with their child's care, many perceived barriers to care were identified. Due to the limited understanding and paucity of research on barriers to care for children with birth defects, including orofacial clefts, additional research on barriers to care and factors associated with them are needed.
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Affiliation(s)
- Cynthia H Cassell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Cassell CH, Krohmer A, Mendez DD, Lee KA, Strauss RP, Meyer RE. Factors associated with distance and time traveled to cleft and craniofacial care. ACTA ACUST UNITED AC 2013; 97:685-95. [PMID: 24039055 DOI: 10.1002/bdra.23173] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 06/28/2013] [Accepted: 07/13/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Information on travel distance and time to care for children with birth defects is lacking. We examined factors associated with travel distance and time to cleft care among children with orofacial clefts. METHODS In 2006, a mail/phone survey was administered in English and Spanish to all resident mothers of children with orofacial clefts born 2001 to 2004 and identified by the North Carolina birth defects registry. We analyzed one-way travel distance and time and the extent to which taking a child to care was a problem. We used multivariable logistic regression to examine the association between selected sociodemographic factors and travel distance (≤60 miles and >60 miles) and time (≤60 min and >60 min) to cleft care. RESULTS Of 475 eligible participants, 51.6% (n = 245) responded. Of the respondents, 97.1% (n = 238) were the child's biological mother. Approximately 83% (n = 204) of respondents were non-Hispanic White; 33.3% (n = 81) were college educated; and 50.0% (n = 115) had private health insurance. One-way mean and median travel distances were 80 and 50 miles, respectively (range, 0-1058 miles). One-way mean and median travel times were 92 and 60 min, respectively (range, 5 min to 8 hr). After adjusting for selected sociodemographics, travel distance varied significantly by maternal education, child's age, and cleft type. Travel time varied significantly by child's age. Approximately 67% (n = 162) reported taking their child to receive care was not a problem. CONCLUSION Approximately 48% of respondents traveled > 1 hr to receive cleft care. Increasing access to care may be important for improving health outcomes among this population.
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Affiliation(s)
- Cynthia H Cassell
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Geirdal AØ, Øverland B, Heimdal K, Storhaug K, Åsten P, Akre H. Association between obstructive sleep apnea and health-related quality of life in individuals affected with Treacher Collins syndrome. Eur Arch Otorhinolaryngol 2013; 270:2879-84. [DOI: 10.1007/s00405-013-2409-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2012] [Accepted: 02/15/2013] [Indexed: 11/29/2022]
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Pausch NC, Herzberg PY, Wirtz C, Hemprich A, Dhanuthai K, Hierl T, Pitak-Arnnop P. German animal terms for oral cleft deformity: A Leipzig survey. J Craniomaxillofac Surg 2012; 40:e236-42. [DOI: 10.1016/j.jcms.2011.10.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2011] [Revised: 10/12/2011] [Accepted: 10/12/2011] [Indexed: 11/28/2022] Open
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Cassell CH, Mendez DD, Strauss RP. Maternal Perspectives: Qualitative Responses about Perceived Barriers to Care among Children with Orofacial Clefts in North Carolina. Cleft Palate Craniofac J 2012; 49:262-9. [DOI: 10.1597/09-235] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To examine maternal perceptions of barriers to care of children with orofacial clefts (OFC) in a population-based survey that solicited open-ended qualitative responses. Design and Setting In 2006, a combination mail/phone survey was sent to all mothers of children with OFC. The questionnaire included 76 items. A final open-ended question was included for additional information about cleft-related care. The analysis included responses to the open-ended question and sociodemographic characteristics of the respondents. Qualitative responses were transcribed and entered into a qualitative software package for analysis, and common themes were elucidated. Participants/Patients The North Carolina Birth Defects Monitoring Program was used to identify all resident infants born with OFC from 2001 to 2004. Of 478 eligible mothers, 52.9% (n = 248) responded to the survey, and 39.5% (n = 98) responded to the final open-ended question. Main Outcome Measures Percentage reporting problems accessing care, frequency of positive and negative comments, and indicators of financial, personal, and structural barriers to care. Results Of the 98 respondents, the majority (n = 95, 96.99%) were the biological mother. Almost 40% of mothers indicated that accessing primary craniofacial care was a problem. Of those citing perceived barriers to care, the major issues cited were financial, structural, and personal barriers. Conclusions Collaborative efforts between craniofacial centers and teams, health care systems, and birth defects registries are warranted to reduce perceived barriers to care among families of children with OFC. Further exploration of the themes and factors associated with barriers to care and services is needed.
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Affiliation(s)
- Cynthia H. Cassell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Dara D. Mendez
- University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Ronald P. Strauss
- Departments of Dental Ecology, Epidemiology, and Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Abbott MM, Kokorowski PJ, Meara JG. Timeliness of surgical care in children with special health care needs: delayed palate repair for publicly insured and minority children with cleft palate. J Pediatr Surg 2011; 46:1319-24. [PMID: 21763828 DOI: 10.1016/j.jpedsurg.2010.10.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 10/03/2010] [Accepted: 10/05/2010] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Disparities in access to health care are known to exist for the most vulnerable pediatric population, children with special health care needs. Timely access to surgical care in this population is critical, yet poorly studied. METHODS A national database of pediatric hospitals in the United States was searched for nonsyndromic, healthy patients younger than 24 months who underwent cleft palate repair from 2003 to 2008. A multivariate, linear regression model was constructed to determine the relationship of public payer status and race with age at palatal repair. RESULTS Age at palate repair was significantly delayed for patients who were publicly insured (1.2 weeks, P = .01), were of nonwhite race/ethnicity (1.5-3.5 weeks, P = .009), and had a diagnosis of cleft lip in addition to cleft palate (3.4 weeks, P = .006) compared to their counterparts in a sample of 2995 patients with cleft palate. CONCLUSION There is a small but significant delay in age at repair for patients who are publicly insured or of nonwhite race/ethnicity. These results may herald broader access disparities that could adversely affect clinical outcomes and should be investigated further.
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Affiliation(s)
- Megan M Abbott
- Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA 02115, USA
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Mouradian WE, Slayton RL, Maas WR, Kleinman DV, Slavkin H, DePaola D, Evans C, Wilentz J. Progress in children's oral health since the Surgeon General's Report on Oral Health. Acad Pediatr 2009; 9:374-9. [PMID: 19945070 DOI: 10.1016/j.acap.2009.09.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Wendy E Mouradian
- Department of Pediatric Dentistry, University of Washington Schools of Dentistry, Medicine, and Public Health, Seattle, Washington, USA.
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