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Baghaki S, Karacetin G, Yerlikaya Oral E, Guzel Tuncer AB, Demir T, Bingol Caglayan H, Uysal O, Ozdamar Mandi O. Psychopathology in Infants, Toddlers, and Preschool Children with Nonsyndromic Clefts of the Lip and/or Palate: A Case-Control Study. J Craniofac Surg 2024:00001665-990000000-01881. [PMID: 39226428 DOI: 10.1097/scs.0000000000010559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 07/22/2024] [Indexed: 09/05/2024] Open
Abstract
OBJECTIVE The aim of this study is to assess psychopathology and maternal interactions in infants, toddlers, and preschool children with nonsyndromic clefts of the lip and/or palate (NSCLP) and association of psychopathology with cleft-related factors and maternal interactions. DESIGN Twenty-six children from 4 to 72 months of age with NSCLP, who were attending the Plastic, Reconstructive and Aesthetic Surgery Department were included as the case group. Fifty-two healthy children who were matched on age and sex with the case group were taken as controls. Children were assessed in aspects of psychiatric diagnosis, articulation, and development. RESULTS Speech and language disorders (SLD) ( P <0.001), disorders of affect (DA) ( P =0.005), feeding behavior disorder ( P =0.002), sleep-behavior disorder (SBD) ( P =0.038), and disordered mother-child relationship ( P <0.001) were more prevalent in children with NSCLP. Dental alignment ( P =0.024), number of operations ( P =0.006), and type of operations ( P =0.012) were associated with DA. The children in the case group, who had disordered relationship with their mothers had significantly more SLD ( P =0.036) and SBD ( P =0.039). CONCLUSIONS Children with NSCLP are at risk of developing psychopathology, especially SLD and DA. Maternal interactions and the above cleft-related factors and may be the target of interventions to prevent and treat psychiatric disorders in these children.
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Affiliation(s)
- Semih Baghaki
- Department of Plastic, Reconstructive and Aesthetic Surgery, Koc University Hospital, Istanbul, Turkey
| | - Gul Karacetin
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Elif Yerlikaya Oral
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Ayse Beste Guzel Tuncer
- Department of Child and Adolescent Psychiatry, Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, University of Health Sciences, Istanbul, Turkey
| | - Turkay Demir
- Department of Child and Adolescent Psychiatry, Private Practice, Istanbul, Turkey
| | | | - Omer Uysal
- Department of Child and Adolescent Psychiatry, Private Practice, Istanbul, Turkey
| | - Ozlem Ozdamar Mandi
- Department of Biostatistics and Medical Informatics, Bezmialem Vakif University Medical School, Istanbul, Turkey
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Arora JS, Khoshab N, Donnelly M, Vargas S, Zadeh T, Vyas RM. Interactive iPad-Based Education for Parents of Patients with Cleft Lip and Palate. Cleft Palate Craniofac J 2024:10556656241275534. [PMID: 39155533 DOI: 10.1177/10556656241275534] [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: 08/20/2024] Open
Abstract
OBJECTIVE To assess the effectiveness of an interactive iPad-based educational module (cleft iBook) in enhancing parent/caregiver education related to cleft lip and/or cleft palate (CL/P) care. DESIGN A prospective study involving pre- and post-intervention surveys. SETTING The study was conducted at a craniofacial clinic in a dedicated children's hospital specifically during initial consultations for CL/P care. PARTICIPANTS Thirty-two participants (parents/legal guardians/caregivers) ≥18 years of age, English and/or Spanish-speaking, and attending with a child with CL/P. INTERVENTIONS Participants were provided with iPads and engaged with the interactive iPad-based educational module. Pre- and post-intervention surveys were administered. MAIN OUTCOME MEASURE(S) The survey assessed the understanding of a CL/P diagnosis and management and usability of the iBook. Survey responses were graded on a 5-point Likert scale. Total scores for pre- and post-intervention surveys were compared. RESULTS Utilizing the cleft iBook module before consultation significantly enhanced comprehension in multiple domains: prenatal development of CL/P, dento-facial molding, surgical techniques, steps after the initial consultation, postoperative care, and the necessity of long-term care for affected children (P < .01). Cumulative survey scores increased by 10.2 points, reflecting significantly improved responses regarding overall comprehension (P < .001). CONCLUSIONS The interactive, iPad-based cleft educational module emerges as a viable, digital strategy for providing education and empowerment to parents and caregivers navigating the challenges of caring for a child with CL/P. The cleft iBook serves as a readily accessible resource, fostering connections among the child, caregivers, and care team.
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Affiliation(s)
- Jagmeet S Arora
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Nima Khoshab
- Department of Plastic Surgery, University of California, Irvine, Orange, CA, USA
| | - Megan Donnelly
- School of Medicine, University of California Irvine, Irvine, CA, USA
| | - Sharon Vargas
- Division of Plastic Surgery, CHOC Children's Hospital, Orange, CA, USA
| | - Touran Zadeh
- Department of Plastic Surgery, University of California, Irvine, Orange, CA, USA
- Division of Plastic Surgery, CHOC Children's Hospital, Orange, CA, USA
| | - Raj M Vyas
- Department of Plastic Surgery, University of California, Irvine, Orange, CA, USA
- Division of Plastic Surgery, CHOC Children's Hospital, Orange, CA, USA
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Parikh N, Hu KG, Allam O, Ihnat JM, Rancu AL, Boroumand S, Persing JA, Alperovich M. Sports participation after craniosynostosis repair: the critical role of post-operative guidance in parental decision-making. Childs Nerv Syst 2024; 40:2551-2556. [PMID: 38578479 DOI: 10.1007/s00381-024-06381-0] [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: 03/09/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
PURPOSE Despite previous research supporting patient safety in sports after craniosynostosis surgery, parental anxiety remains high. This study sought to evaluate the role of healthcare providers in guiding patients and families through the decision-making process. METHODS Parents of children with repaired craniosynostosis were asked to assess sports involvement and parental decision-making in children ages 6 and older. Questions were framed primarily on 5-point Likert scales. Sport categorizations were made in accordance with the American Academy of Pediatrics. Chi-squared, linear regression, and Pearson correlation tests were used to analyze associations between the questions. RESULTS Forty-three complete parental responses were recorded. Mean ages at surgery and time of sports entry were 7.93 ± 4.73 months and 4.76 ± 2.14 years, respectively. Eighty-two percent of patients participated in a contact sport. Discussions with the primary surgeon were more impactful on parental decisions about sports participation than those with other healthcare providers (4.04 ± 1.20 vs. 2.69 ± 1.32). Furthermore, children whose parents consulted with the primary surgeon began participating in sports at a younger age (4.0 ± 1.0 vs. 5.8 ± 2.7 years, p = 0.034). The mean comfort level with contact sports (2.8 ± 1.4) was lower than that with limited-contact (3.8 ± 1.1, p = 0.0001) or non-contact (4.4 ± 1.3, p < 0.0001) sports. CONCLUSION This study underscores the critical role that healthcare professionals, primarily surgeons, have in guiding families through the decision-making process regarding their children's participation in contact sports.
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Affiliation(s)
- Neil Parikh
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Kevin G Hu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Omar Allam
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Jacqueline M Ihnat
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Albert L Rancu
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Sam Boroumand
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - John A Persing
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA
| | - Michael Alperovich
- Division of Plastic & Reconstructive Surgery, Department of Surgery, Yale School of Medicine, 330 Cedar Street, Boardman Building, New Haven, CT, 06510, USA.
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Lindberg NE, Kynø NM, Billaud Feragen K, Pripp AH, Tønseth KA. Early Follow-up of Parents by a Specialized Cleft Nurse After the Birth of an Infant with Cleft lip and/or Palate. Cleft Palate Craniofac J 2024; 61:1369-1382. [PMID: 37151047 PMCID: PMC11308288 DOI: 10.1177/10556656231171750] [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: 05/09/2023] Open
Abstract
OBJECTIVE To document the impact of early follow-up by specialized cleft nurses (SCNs) to families of infants with cleft lip and/or cleft palate (CL/P). DESIGN Prospective inclusion of a control group, which received standard care alone, followed by an intervention group, which in addition received early SCN follow-up. SETTING The cleft lip and palate team at a University hospital. PARTICIPANTS 70 families (69 mothers and 57 fathers); control group (n = 38); intervention group (n = 32). INTERVENTION SCNs offered a consultation at the maternity ward and follow-ups by phone or face-to-face at one, three, eight weeks and six months after birth. OUTCOME MEASURES Use of Internet-Questionnaire, Quality of discharge teaching scale (QDTS), Post discharge coping difficulty scale (PDCDS), Response on follow-up by health professionals. RESULTS Infants in the intervention group were admitted less frequently to a Neonatal Intensive Care unit (NICU); 21.9% vs 51.4%, P = .012. Parents in the intervention group used internet for cleft-related reasons less frequently (74.6% vs 85.9%), P = .112 and the mothers benefitted less from cleft-related activity on the internet (P = .013). The intervention group reported higher mean score for satisfaction with total cleft care (P = .001). There were no significant group differences regarding mean total score for discharge teaching (P = .315) and coping difficulties (P = .919). CONCLUSION Early follow-up by a SCN with expertise in cleft care is highly valued by parents. Closer cooperation between the cleft team and health professionals at birth hospitals and Child health centers is necessary for optimal follow-up.
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Affiliation(s)
- Nina Ellefsen Lindberg
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nina Margrete Kynø
- Department of Nursing and Health Promotion, Acute and Critical illness, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Thornton M, Harcourt D, Deave T, Kiff J, White P, Williamson H. Cross-condition risk and protective factors for psychosocial distress in parents and carers of children and young people with appearance-affecting conditions and injuries. Body Image 2024; 51:101768. [PMID: 38996660 DOI: 10.1016/j.bodyim.2024.101768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024]
Abstract
Alongside typical parenting challenges, initial condition-specific research suggests thadifferent experiences and support needs.t parents of children with different visible differences may experience similar psychosocial difficulties. Despite this, large-scale cross-condition research to identify risk and protective factors for parental distress and psychosocial adjustment has been lacking. Two hundred and nine parents and carers of children with a range of visible differences completed an online survey comprised of standardised outcome measures, study-specific measures, and open-ended questions. Multiple regression modelling identified possible risk and protective factors, and data collected via open-ended questions were analysed using content analysis. Findings support themes previously identified in small-scale cross-condition qualitative research with parents of children with visible differences. Risk factors for parental negative affect and stress included parental reports of the noticeability of their child's visible difference and teasing. Protective factors included good parent-child communication, self-compassion, knowledge of their child's condition and satisfaction with treatment. The risk and protective factors identified provide important insight into the experiences of this parent population and indicate possible avenues for psychosocial intervention.
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Affiliation(s)
- Maia Thornton
- Centre for Appearance Research, University of the West of England, Bristol, UK.
| | - Diana Harcourt
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Toity Deave
- School of Health and Social Wellbeing, University of the West of England, Bristol, UK
| | - James Kiff
- Outlook Service, Southmead Hospital, Bristol, UK
| | - Paul White
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Fladeboe KM, Stock NM, Heike CL, Evans KN, Junkins C, Stueckle L, O'Daffer A, Rosenberg AR, Yi-Frazier JP. Feasibility and Acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) Intervention for Caregivers of Children with Craniofacial Conditions. Cleft Palate Craniofac J 2024; 61:1125-1133. [PMID: 36802967 DOI: 10.1177/10556656231157449] [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] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVES Few evidence-based psychosocial programs exist within craniofacial care. This study (a) assessed feasibility and acceptability of the Promoting Resilience in Stress Management-Parent (PRISM-P) intervention among caregivers of children with craniofacial conditions and (b) described barriers and facilitators of caregiver resilience to inform program adaptation. DESIGN In this single-arm cohort study, participants completed a baseline demographic questionnaire, the PRISM-P program, and an exit interview. PARTICIPANTS Eligible individuals were English-speaking legal guardians of a child <12-years-old with a craniofacial condition. INTERVENTION PRISM-P included 4 modules (stress-management, goal-setting, cognitive-restructuring, meaning-making) delivered in 2 one-on-one phone or videoconference sessions 1-2 weeks apart. MAIN OUTCOME MEASURES Feasibility was defined as >70% program completion among enrolled participants; acceptability was defined as >70% willingness to recommend PRISM-P. Intervention feedback and caregiver-perceived barriers and facilitators of resilience were summarized qualitatively. RESULTS Twenty caregivers were approached and 12 (60%) enrolled. The majority were mothers (67%) of a child <1-year-old diagnosed with a cleft lip and/or palate (83%) or craniofacial microsomia (17%). Of these, 8 (67%) completed PRISM-P and 7 (58%) completed interviews; 4 (33%) were lost-to-follow-up before PRISM-P and 1 (8%) before the interview. Feedback was highly positive, with 100% willing to recommend PRISM-P. Perceived barriers to resilience included uncertainty about their child's health; facilitators included social support, parental identity, knowledge, and control. CONCLUSIONS PRISM-P was acceptable among caregivers of children with craniofacial conditions but not feasible based on program completion rates. Barriers and facilitators of resilience support the appropriateness of PRISM-P for this population and inform adaptation.
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Affiliation(s)
- Kaitlyn M Fladeboe
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Carrie L Heike
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Kelly N Evans
- Department of Pediatrics. University of Washington School of Medicine, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Courtney Junkins
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Laura Stueckle
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Alison O'Daffer
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
| | - Abby R Rosenberg
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Palliative Care, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Joyce P Yi-Frazier
- Seattle Children's Research Institute, Center for Clinical & Translational Research, Seattle, WA, USA
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Miller R, Mackenzie A, Welman T, Bodger S, Horwitz MD. Establishing the psychological impact of congenital upper limb differences on parents and families. J Hand Surg Eur Vol 2024:17531934241256793. [PMID: 38833552 DOI: 10.1177/17531934241256793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
The aim of this prospective study was to report the psychological experiences of parents caring for children with a congenital upper limb difference and to compare these to population norms. Contributing factors were explored, including access to support and coping strategies. Finally, parents with a congenital upper limb difference themselves were compared to those without. Data recorded included demographics, a validated wellbeing and family impact measure, a unique measure of emotions experienced and exploratory questions. Wellbeing and family impact scores were significantly lower than populations norms. Mothers experienced significantly more negative emotions than fathers. There was no significant different between parents with and without a congenital upper limb difference. Of the parents, 68% felt there should be improved access to psychological support. This demonstrates that parents of children with congenital upper limb differences have unique psychological experiences and needs. They may benefit from specialist psychological support and further research is needed.Level of evidence: III.
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Affiliation(s)
- Robert Miller
- Department of Hand and Plastic Surgery, Chelsea and Westminster Hospital, London, UK
- Surgical Psychology and Performance Group, UK
| | - Alexandra Mackenzie
- Department of Hand and Plastic Surgery, Chelsea and Westminster Hospital, London, UK
| | - Ted Welman
- Department of Hand and Plastic Surgery, Chelsea and Westminster Hospital, London, UK
| | - Sue Bodger
- Paediatric Psychology Team, Department of Psychology, Chelsea and Westminster Hospital, London, UK
| | - Maxim D Horwitz
- Department of Hand and Plastic Surgery, Chelsea and Westminster Hospital, London, UK
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Sunal Akturk E, Seker ED, Capkın D, Kutuk MS. Evaluation of Anxiety in Turkish Parents of Newborns with Cleft Palate with or Without Cleft Lip. Cleft Palate Craniofac J 2024; 61:492-497. [PMID: 36594490 DOI: 10.1177/10556656221148903] [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] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE (1) To compare anxiety between parents of newborns with cleft lip and palate (CLP), isolated cleft palate (CP), and healthy newborns and (2) to evaluate anxiety between parental dyads within these groups. DESIGN A cross-sectional study. SETTING University Hospital. PARTICIPANTS Surveys were completed by 20 mothers and 20 fathers of newborns with CLP, 21 mothers and 21 fathers of newborns with CP, and 23 mothers and 23 fathers of healthy newborns (controls). MAIN OUTCOME MEASURE The State-Trait Anxiety Inventory (STAI) assessed parental anxiety. Mothers of newborns with a cleft reported on concerns regarding cleft-related issues and facial appearance. RESULTS State and trait anxiety were generally in the moderate range for parents of newborns with a cleft, while control parents had low state anxiety and moderate trait anxiety. Mothers of newborns with CP and CLP had significantly higher state and trait anxiety levels than control mothers (p < .05). Fathers of newborns with CLP had a higher state anxiety level than control fathers. When maternal and paternal anxiety was compared within the groups, only trait anxiety scores were significantly higher in mothers of newborns with CLP than that of fathers (p < .05). More than half of mothers of newborns with a cleft were concerned about their newborn's feeding, speech, and palate. CONCLUSIONS Parents of children with a cleft may need psychological support in the early postnatal period. It is important for neonatal cleft team providers to help reduce parental anxiety and educate families about cleft care, with a focus on feeding.
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Affiliation(s)
- Ezgi Sunal Akturk
- Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Elif Dilara Seker
- Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Duygu Capkın
- Faculty of Dentistry, Department of Orthodontics, Bezmialem Vakif University, Istanbul, 34093, Turkey
| | - Mehmet Serdar Kutuk
- Faculty of Medicine, Department of Obstetrics and Gynecology, Bezmialem Vakif University, Istanbul, 34093, Turkey
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Payer D, Krimmel M, Reinert S, Koos B, Weise H, Weise C. Oral health-related quality of life in patients with cleft lip and/or palate or Robin sequence. J Orofac Orthop 2024; 85:98-109. [PMID: 35852562 PMCID: PMC10879386 DOI: 10.1007/s00056-022-00414-6] [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] [Received: 01/15/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE To compare the oral health-related quality of life (OHRQoL) in patients with cleft lip and/or palate or Robin sequence versus a healthy control group using the Child Oral Health Impact Profile (COHIP-G19). Factors such as age, gender, and cleft type were considered. METHODS Over an 8-month period, the OHRQoL was surveyed by using the COHIP-G19 questionnaire. Included were patients with a craniofacial disorder (n = 61; average age 11.24 years) and a healthy control group (n = 70, average age 12.63 years) for a total of 131 patients (average age 11.99 years) from the Department of Orthodontics University Hospital Tübingen, Germany. These were divided into two age groups (6-11 years; 12-18 years). RESULTS Statistically, patients with a craniofacial disorder presented a significantly lower OHRQoL than the control group (p = 0.0055). In the craniofacial disorder group, older patients revealed a significantly (p = 0.005) lower OHRQoL than the younger patients. Female patients showed in nearly all groups a better OHRQoL than male patients, but this difference was not statistically significant (p > 0.05). Males with a craniofacial disorder scored significantly lower than males without (p = 0.016); females showed no differences between the groups. Visibility, location, and severity of the craniofacial malformation did not have a significant influence on the OHRQoL. CONCLUSION The occurrence of a craniofacial malformation impacted the OHRQoL especially in older and male affected patients, unrelated to the expression level or localization. An early instruction about oral health, rehabilitation and functional training should be considered in therapy.
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Affiliation(s)
- D Payer
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - M Krimmel
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - S Reinert
- Department of Oral and Maxillofacial Surgery, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - B Koos
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - H Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany
| | - C Weise
- Department of Orthodontics, University Hospital Tuebingen, Osianderstr. 2-8, 72076, Tuebingen, Germany.
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10
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Lindberg NE, Kynø NM, Feragen KB, Pripp AH, Tønseth KA. Parental Stress, Infant Feeding and Well-being in Families Affected by Cleft Lip and/or Cleft Palate: The Impact of Early Follow-up. Cleft Palate Craniofac J 2024:10556656241231524. [PMID: 38384126 DOI: 10.1177/10556656241231524] [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: 02/23/2024] Open
Abstract
OBJECTIVE To document the impact of early follow-up by specialized cleft nurses (SCNs) provided to families affected by cleft lip and/or palate (CL/P) and the status of parental stress, infant feeding and well-being. DESIGN Prospective inclusion of a control group, which only received standard care, followed by an intervention group that also received early SCN follow-up. SETTING The cleft lip and palate team at Oslo University Hospital, Norway. PARTICIPANTS Seventy families (69 mothers and 57 fathers) distributed into an intervention group (n = 32) and a control group (n = 38). INTERVENTION SCNs provided a consultation at the maternity ward and a follow-up conversation by phone or face-to-face at scheduled times for six months. OUTCOME MEASURES Parental Stress Index (PSI), Perceived Stress Scale (PSS-14), feeding questionnaire, survey of infant diets, weight percentiles. RESULTS The mothers reported higher stress scores than the fathers, but in the control group only in the PSI parent domain at T2 and T3 (P = .007, P = .018). Infants in the intervention group used pacifiers less frequently than in the control group (55.2% vs. 81.1%, P = .023). Otherwise, no significant differences were found between the groups. Overall, the infants received less breast milk than norms. CONCLUSION Contextual strategies for early follow-up of families affected by clefts need to be developed, with an emphasis on involving fathers and those parents reporting elevated stress and/or feeding difficulties. There is a need for diagnosis-specific guidelines about the use of pacifiers as well as collaboration between the health professionals involved to increase breastmilk feeding.
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Affiliation(s)
- Nina Ellefsen Lindberg
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Margrethe Kynø
- Department of Nursing and Health Promotion, Acute and Critical illness, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
- Department of Neonatal Intensive Care, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | | | - Are Hugo Pripp
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Kim Alexander Tønseth
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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11
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Gavelle P, Dissaux C, Dupont M, Khonsari RH, Picard A. Parental and Child Diagnosis Storytelling and Self-Image in French Children With Cleft lip With or Without Cleft Palate. Cleft Palate Craniofac J 2024; 61:200-208. [PMID: 36112838 DOI: 10.1177/10556656221126268] [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] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE Psychosocial adjustment can be challenging for children with cleft lip with or without a cleft palate (CL ± P). Previous studies have linked social integration with self-acceptance and highlighted the impact of the parents' stress on self-acceptance. Teasing can be linked to children having difficulties explaining their diagnosis to others. This prospective research aimed to gain a better understanding of family communication about cleft, children's oral storytelling about their cleft, and explore their self-image and perceived familial acceptance. PARTICIPANTS Parents and their children with CL ± P (N = 54; average age: 5.6 years). DESIGN Semistructured interviews with parents and structured interviews with children were conducted regarding their oral storytelling focusing on scars from cleft lip surgery. Children completed a projective test to explore their self-image and perceptions of familial acceptance. Language screening was completed with the French Wechsler Preschool Primary Scale of Intelligence-Fourth Edition. RESULTS Only 30% of children explained their cleft in a way appropriate for peers, including presence at birth, having had surgery, and scar location. Children's ability to explain their cleft was not related to language performance, which was in the average range of 84%. Children's cleft explanations were dependent on parents' narratives and education methods, including the use of verbal explanations and preoperative photographs. Children's storytelling was related to their self-image and perceived parental acceptance. CONCLUSION Cleft teams should assist families in building their cleft story based on a complete explanation with photographs and a positive and accepting approach.
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Affiliation(s)
- Pascale Gavelle
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Centre de Référence Fente et Malformations Faciales MAFACE, Filière Maladies Rares Tête Cou, Université de Paris, Paris, France
| | - Caroline Dissaux
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique des Hôpitaux Universitaires de Strasbourg, Centre de Compétence des Fentes labio-palatines, Strasbourg, France
| | - Mathilde Dupont
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Centre de Référence Fente et Malformations Faciales MAFACE, Filière Maladies Rares Tête Cou, Université de Paris, Paris, France
| | - Roman Hossein Khonsari
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Centre de Référence Fente et Malformations Faciales MAFACE, Filière Maladies Rares Tête Cou, Université de Paris, Paris, France
| | - Arnaud Picard
- Service de Chirurgie Maxillo-Faciale et Chirurgie Plastique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Centre de Référence Fente et Malformations Faciales MAFACE, Filière Maladies Rares Tête Cou, Université de Paris, Paris, France
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12
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Morsi AO, Yehia AM, Badran AS, Khattab NMA. "Challenges and concerns faced by parents of a group of Egyptian children with cleft lip/palate: a qualitative study". BMC Oral Health 2023; 23:1011. [PMID: 38104058 PMCID: PMC10725599 DOI: 10.1186/s12903-023-03747-9] [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] [Received: 10/25/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Cleft lip and palate are the most common developmental anomalies that affect the mouth and related structures. They can both affect children physiologically, socially, and functionally and lead to psychological distress in their parents. The present study aims to understand the challenges parents of cleft lip and palate patients face in Egypt, elucidate how they cope with these challenges, and assess their concerns for the future. METHODS For the present phenomenological qualitative exploration, the parents of cleft lip and palate patients attending the cleft care clinic were invited to participate in the study through face-to-face recruitment at the clinic. An interview guide about the research question was developed to include standardized open-ended questions providing a framework for structured discussions. The interviews were audio-recorded after obtaining written informed consent from participants then collected data were transcribed for data analysis. RESULTS Of the 12 participants, there were nine mothers and three fathers. Their children's ages ranged from 1.5 years to 19 years and had different presentations of cleft lip and palate from unilateral cleft lip to complete bilateral cleft lip and palate. Feeding difficulty was one of the main challenges encountered by the parents. At the same time, fear of being subjected to bullying was the main concern for the future of their children. Six themes were noted that were continually reported: Health & Wellbeing; Parental emotions; Parental attitudes & behaviors; Financial aspects; Relationship aspects; and Career/Education. CONCLUSIONS There were 4 factors that directly impacted the themes, namely: the type of cleft, gender of the child, gender role of the parent, and the age of the child impacted the parental concerns and the challenges faced under the influence of sociocultural beliefs and existing support systems.
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13
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Washington GN, Cepeda A, Moffitt J, Groff CK, Greives MR, Nguyen PD. Is the Message Clear? Evaluation of Readability Levels for Cleft Lip, Cleft Palate, and Craniofacial Websites. Cleft Palate Craniofac J 2023; 60:1619-1624. [PMID: 35788157 DOI: 10.1177/10556656221112672] [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: 11/15/2022] Open
Abstract
Web-based health information is the leading source of medical knowledge for patients and families. The American Medical Association (AMA) and US Department of Health and Human Services recommend reading material be at or below a sixth-grade reading level. This study aimed to evaluate and compare the readability of the most popularly searched cleft lip and/or palate (CL/P) and other craniofacial syndrome (CFS) websites. Google searches for "cleft lip," "cleft palate," and "craniofacial syndromes" were performed to identify the top 40 websites in an incognito window with the location set to the United States. Flesch Reading Ease Score (FRES) was used to determine ease of reading from 0 (most difficult) to 100 (greatest ease of reading) and Flesch-Kincaid Reading Grade (FKGL) for website content and compared between websites using an FRES of 80 to 90 and FKGL of 6.0 to 6.9 for a sixth-grade reading level. Readability was low for all sites with 6 CL/P websites and no CFS websites at or below a sixth-grade reading level. CL/P websites had FRES readability scores of 58.5 ± 12.3 and were at a 9.4 ± 2.3 grade level. CFS websites had readability scores on the FRES of 39.8 ± 13.1 and were at a 10.8 ± 1.8 grade level. Web-based information related to CL/P and CFS is on average several grade levels above the recommended sixth-grade reading level. Online information for CL/P and CFS may need to be revised to improve understanding for the public and families.
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Affiliation(s)
- George N Washington
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Alfredo Cepeda
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Joseph Moffitt
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Connor K Groff
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Matthew R Greives
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Phuong D Nguyen
- The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, TX, USA
- Division of Pediatric Plastic Surgery, Children's Memorial Hermann Hospital, Houston, TX, USA
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14
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Costa B, Edwards W, Wilkinson-Bell K, Stock NM. Raising a Child with Craniosynostosis: Psychosocial Adjustment in Caregivers. Cleft Palate Craniofac J 2023; 60:1284-1297. [PMID: 35786018 DOI: 10.1177/10556656221102043] [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] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE While knowledge of the psychosocial impact of craniofacial conditions is growing, literature regarding the impact on parents remains limited. Parents of children born with a health condition may be at risk of experiencing a range of psychosocial challenges. This study conducted an initial investigation of psychosocial adjustment of parents of individuals with craniosynostosis to inform support provision for families. SETTING An online UK-wide mixed-methods survey was distributed to members of Headlines Craniofacial Support. DESIGN Quantitative data including standardized measures were analysed using descriptive statistics and independent samples t-tests, and inductive content analysis was used for open-ended questions. PARTICIPANTS Mothers (n = 109) and fathers (n = 9) of individuals ages 3 months to 49 years with single suture (63%) or syndromic (33%) craniosynostosis participated. RESULTS Compared to the general population, parents of individuals with craniosynostosis reported higher levels of stress, anxiety, and depression; lower levels of resilience and optimism. Qualitative responses provided insight into parents' experiences of birth, diagnosis, healthcare provision, familial wellbeing, and relationships. Parents reported several unmet information and support needs, alongside a range of positive outcomes. CONCLUSIONS This study illustrates the potential long-term psychosocial implications for parents raising children with craniosynostosis. There is a need for routine psychological screening for family members and provision of appropriate psychological support for those at risk for distress. Non-specialist health professionals may benefit from additional training about craniofacial conditions so they are better equipped to support and refer families.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
| | - Wendy Edwards
- Headlines Craniofacial Support, St Albans, Hertfordshire, UK
| | | | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, BS16 1QY, UK
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15
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Costa B, McWilliams D, Blighe S, Hudson N, Hotton M, Swan MC, Stock NM. Isolation, Uncertainty and Treatment Delays: Parents' Experiences of Having a Baby with Cleft Lip/Palate During the Covid-19 Pandemic. Cleft Palate Craniofac J 2023; 60:82-92. [PMID: 34841909 PMCID: PMC9218610 DOI: 10.1177/10556656211055006] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Previous literature finds that having a child with a cleft lip and/or palate (CL/P) may pose social and emotional challenges for parents. For parents of children born during the Covid-19 pandemic, such challenges may be heightened. Further, novel demands brought about by the pandemic could have caused additional hardships. The aim of this study was to describe the impact of the pandemic on new parents through qualitative exploration of their experiences. DESIGN Semi-structured interviews were conducted with 14 parents of children born in the United Kingdom with CL/P between January and June 2020, around the start of the pandemic. Data were analysed using inductive thematic analysis. RESULTS Three themes, with sub-themes, were identified. The first theme, "Changes to Healthcare: The Impact of Restrictions and Reduced Contact", discussed the impact of the pandemic on perinatal care, the care received from the specialist CL/P teams, and parents' experiences of virtual consultations. The second theme, "Family Functioning During the Pandemic", covered parental anxiety, fathers' experiences, and social support. The third theme, "Surgical Prioritisation: Delays and Uncertainty", addressed changes to surgical protocols, coping with uncertainty, complications associated with delayed surgery, and how parents created positive meaning from this period. CONCLUSIONS A range of increased and additional psychosocial impacts for parents were identified, along with several coping strategies, utilization of social support, and the positive aspects of their experiences. As the pandemic continues, close monitoring of families affected by CL/P remains imperative, particularly for those at risk of emotional distress.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of
England, Bristol, UK,Nicola Marie Stock, Associate Professor in
Psychology, Centre for Appearance Research, University of the West of England,
Bristol, United Kingdom.
| | - Danielle McWilliams
- Centre for Appearance Research, University of the West of
England, Bristol, UK
| | - Sabrina Blighe
- Spires Cleft Centre, Level 2 Children's
Hospital, John Radcliffe Hospital, Oxford, UK
| | - Nichola Hudson
- Spires Cleft Centre, Salisbury District
Hospital, Salisbury, UK
| | - Matthew Hotton
- Spires Cleft Centre, Level 2 Children's
Hospital, John Radcliffe Hospital, Oxford, UK
| | - Marc C Swan
- Spires Cleft Centre, Children's
Hospital, John Radcliffe Hospital, Oxford, UK
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16
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María CZA, María MDC, Emilia CHG. Maternal perception of breastfeeding in children with unilateral cleft lip and palate: A qualitative interpretative analysis. Int Breastfeed J 2022; 17:88. [PMID: 36536368 PMCID: PMC9762076 DOI: 10.1186/s13006-022-00528-y] [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: 11/03/2021] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Unilateral cleft lip and / or palate (UCL/P) is one of the most common congenital craniofacial differences. The objective of this study was to describe the maternal perception of breastfeeding in children with unilateral cleft lip and palate and to assess the role of breastfeeding counseling. METHODS This study was conducted using an interpretive phenomenological approach to explore the experience from the perspectives of mothers breastfeeding her UCL/P child. Twenty-eight mothers of patients with nonsyndromic UCL/P treated with nasoalveolar molding (NAM) therapy between April 2015 and April 2018 were selected during consultations at the Fundación Clínica Noel in Medellín, Colombia. Thematic analysis was conducted for qualitative data. RESULTS The findings resulted in six main categories: First contact with the CL/P team, access to early diagnosis and timely treatment, perceptions of parents about health personnel on breastfeeding of CL/P patients, perceptions of mothers toward breastfeeding, perception of advantages and disadvantages of the NAM technique regarding breastfeeding and assessment of the CL/P team. The interviewed mothers, both prenatally and postnatally, stated the benefits of initiating the process prenatally. There are still difficulties in reaching a timely diagnosis. Several mothers noted that health professionals and assistants determined the hospitalization, installation of a nasogastric tube or feeding through a baby bottle or syringe, which prevented the first contact between mother and child. Even though the exclusive breastfeeding process is difficult for these mothers, they acknowledge its immense advantages. Interviewed mothers considered using the NAM therapy advantageous as the obturator allowed a better bottle-feeding process. The interdisciplinary team generates satisfaction, motivation, expectations and happiness in the mothers who initiated this therapy with their children. CONCLUSION The participants related difficulties with exclusive breastfeeding. Mothers acknowledged the clinical results when using the NAM therapy and the support provided by the IBCLC. We encourage health providers in Medellín, Colombia, to seek education to enhance their clinical skills and promote and protect breastfeeding. Also, health professionals in other cities or countries could consider search more breastfeeding education as well.
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Rasset P, Mange J, Montalan B, Stutterheim SE. Towards a better understanding of the social stigma of facial difference. Body Image 2022; 43:450-462. [PMID: 36345083 DOI: 10.1016/j.bodyim.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
Facial difference (FD) is not only an individual experience; it is inherently social, reflecting interactions between social norms and individual attitudes. Often FD is stigmatized. In this paper, we employ a widely used stigma framework, namely the social stigma framework put forth by Pryor and Reeder (2011), to unpack the stigma of FD. This framework posits that there are four forms of stigma: public stigma, self-stigma, stigma by association, and structural stigma. We first discuss the social and psychological literature on FD as it pertains to these various forms of stigma. We then describe coping approaches for FD stigma. Lastly, we delineate evidence-based methods for addressing the various forms of FD stigma, such that future efforts can more effectively tackle the stigma of facial difference.
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Affiliation(s)
- Pauline Rasset
- Laboratoire de Psychologie de Caen Normandie (LPCN EA 7452), Université de Caen Normandie, France.
| | - Jessica Mange
- Laboratoire de Psychologie de Caen Normandie (LPCN EA 7452), Université de Caen Normandie, France
| | - Benoît Montalan
- Centre de Recherche sur les Fonctionnements et Dysfonctionnements Psychologiques (CRFDP EA 7475), Université de Rouen Normandie, France
| | - Sarah E Stutterheim
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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18
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Marcus E, Latos-Bielenska A, Jamry-Dziurla A, Barišić I, Cavero-Carbonell C, Den Hond E, Garne E, Genard L, Santos AJ, Lutke LR, Matias Dias C, Neergaard Pedersen C, Neville AJ, Niemann A, Odak L, Pierini A, Rico J, Rissmann A, Rankin J, Morris JK. Information needs of parents of children with congenital anomalies across Europe: a EUROlinkCAT survey. BMC Pediatr 2022; 22:657. [PMID: 36368959 PMCID: PMC9652126 DOI: 10.1186/s12887-022-03734-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Parents of children who have a congenital anomaly can experience significant worry about their child's health. Access to clear, helpful, and trustworthy information can provide a valuable source of support. In this study the aim was to explore the information needs of parents/carers of children with congenital anomalies across Europe. METHOD A cross-sectional online survey was developed in nine languages to measure parents' information needs, including: (1) the 'helpfulness'/'trustworthiness' of information received from eight relevant sources, and (2) overall satisfaction with information received. Parents/carers of children (0-10 years) with cleft lip, spina bifida, congenital heart defect [CHD] requiring surgery, and/or Down syndrome were recruited online via relevant organisations in 10 European countries from March-July 2021. Quantitative analyses using multivariable logistic regressions were performed. RESULTS One thousand seventy parents/carers of children with a cleft lip (n = 247), spina bifida (n = 118), CHD (n = 366), Down syndrome (n = 281), and Down syndrome with CHD (n = 58) were recruited in Poland (n = 476), the UK (n = 120), Germany (n = 97), the Netherlands/Belgium (n = 74), Croatia (n = 68), Italy (n = 59), other European countries (n = 92), and not specified/non-European countries (n = 84). Most participants were mothers (92%) and aged 31-40 years (71%). Participants were most likely to rate support groups (63%), patient organisations (60%), specialist doctors/nurses (58%), and social media (57%) as 'very helpful' information sources. 'Very trustworthy' ratings remained high for specialist doctors/nurses (61%), however, they declined for support groups (47%), patient organisations (48%), and social media (35%). Germany had the highest proportion of participants who were 'very satisfied' (44%, 95% CI = 34%-54%) with information, whereas this percentage was lowest in Croatia (11%, 95% CI = 3%-19%) and Poland (15%, 95% CI = 11%-18%). Parents of children with Down syndrome had significantly lower satisfaction ratings than parents of children with CHD; 13% (95% CI = 8%-18%) reported being 'very satisfied' compared to 28% (95% CI = 23%-33%) in the CHD group. CONCLUSIONS Findings suggest that informal sources of information (e.g. support groups) are of value to parents, however, they are not deemed as trustworthy as specialist medical sources. Satisfaction ratings differed across countries and by anomaly, and were particularly low in Croatia and Poland, as well as for parents of children with Down syndrome, which warrants further investigation.
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Affiliation(s)
- Elena Marcus
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
| | - Anna Latos-Bielenska
- Chair and Department of Medical Genetics, Poznan University of Medical Sciences, Collegium Maius, Fredry 10, 61-701, Poznań, Poland
| | - Anna Jamry-Dziurla
- Chair and Department of Medical Genetics, Poznan University of Medical Sciences, Collegium Maius, Fredry 10, 61-701, Poznań, Poland
| | - Ingeborg Barišić
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Ul. Vjekoslava Klaića 16, 10000, Zagreb, Croatia
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Fundacio per al Foment de la Investigacio Sanitaria i Biomedica, Av. de Catalunya, 21, 46020, València, Spain
| | - Elly Den Hond
- Provincial Institute for Hygiene (PIH), Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Lucas Genard
- Provincial Institute for Hygiene (PIH), Kronenburgstraat 45, 2000, Antwerp, Belgium
| | - Ana João Santos
- Department of Epidemiology, National Institute of Health Doctor Ricardo Jorge, Av. Padre Cruz, 1600-609, Lisbon, Portugal
| | - LRenée Lutke
- Department of Genetics, University Medical Center, University of Groningen, 9712 CP, Groningen, Netherlands
| | - Carlos Matias Dias
- Department of Epidemiology, National Institute of Health Doctor Ricardo Jorge, Av. Padre Cruz, 1600-609, Lisbon, Portugal
| | - Christina Neergaard Pedersen
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Amanda J Neville
- IMER Registry (Emilia Romagna Registry of Birth Defects), University of Ferrara and Azienda Ospedaliero Universitaria Di Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Italy
| | - Annika Niemann
- Medical Faculty, Malformation Monitoring Centre Saxony-Anhalt, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Ljubica Odak
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Ul. Vjekoslava Klaića 16, 10000, Zagreb, Croatia
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi, 1, 56124, Pisa, Italy
| | - Juan Rico
- Rare Diseases Research Unit, Fundacio per al Foment de la Investigacio Sanitaria i Biomedica, Av. de Catalunya, 21, 46020, València, Spain
| | - Anke Rissmann
- Medical Faculty, Malformation Monitoring Centre Saxony-Anhalt, Otto-Von-Guericke-University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, NE1 7RU, UK
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
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Tang AR, Chen JW, Sellyn GE, Chen H, Zhao S, Gannon SR, Shannon CN, Bonfield CM. Evaluating caregiver stress in craniosynostosis patients. J Neurosurg Pediatr 2022; 30:224-231. [PMID: 35561696 DOI: 10.3171/2022.4.peds21596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/06/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Caregiver stress from a child's diagnosis can impact a caregiver's ability to participate in treatment decisions, comply, and manage long-term illness. The aim of this study was to compare caregiver stress in children with craniosynostosis at diagnosis and postoperatively. METHODS This prospective study included caregivers of pediatric patients with craniosynostosis receiving operative intervention. Demographics and Parenting Stress Index, Short Form (PSI-SF) and Pediatric Inventory for Parents (PIP) surveys at baseline (preoperatively) and 3 and 6 months postoperatively were completed. PSI-SF scores between 15 and 80 are considered normal, with > 85 being clinically significant and requiring follow-up. Higher PIP scores represent increased frequency and difficulty of stressful events due to the child's illness. Pairwise comparisons were performed using the Wilcoxon signed-rank test. Multivariate analysis was performed to assess for PSI-SF and PIP predictors. RESULTS Of 106 caregivers (84% Caucasian), there were 62 mothers and 40 fathers. There were 68 and 45 responses at 3 and 6 months postoperatively, respectively. Regarding the baseline group, more than 80% were between 20 and 40 years of age and 58% had less than 2 years of college education. The median household income fell in the $45,001-$60,000 bracket. There was no significant difference between median baseline PSI-SF score (65, IQR 51-80) and those at 3 months (p = 0.45) and 6 months (p = 0.82) postoperatively. Both median PIP frequency (89 vs 74, p < 0.01) and difficulty (79 vs 71, p < 0.01) scores were lower at 3 months, although no significant difference was observed at 6 months (frequency: 95 vs 91, p = 0.67; difficulty: 82 vs 80, p = 0.34). Female sex, uninsured status, and open surgery type were all risk factors for higher parental stress. CONCLUSIONS Stress levels ranged from normal to clinically significant in the caregivers, with sex, uninsured status, and open repair predicting higher stress. Stress decreased at 3 months postoperatively before increasing at 6 months. Intervention targeting caregiver stress should be explored to maintain lower stress observed at 3 months after surgery.
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Affiliation(s)
- Alan R Tang
- 1Vanderbilt University School of Medicine, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Jeffrey W Chen
- 1Vanderbilt University School of Medicine, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Georgina E Sellyn
- 1Vanderbilt University School of Medicine, Nashville
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Heidi Chen
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
- 3Department of Biostatistics, Vanderbilt University, Nashville; and
| | - Shilin Zhao
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
- 3Department of Biostatistics, Vanderbilt University, Nashville; and
| | - Stephen R Gannon
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
| | - Chevis N Shannon
- 2Surgical Outcomes Center for Kids, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 4Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Daae E, Feragen KB, Sitek JC, von der Lippe C. It's more than just lubrication of the skin: parents' experiences of caring for a child with ichthyosis. Health Psychol Behav Med 2022; 10:335-356. [PMID: 35402085 PMCID: PMC8986293 DOI: 10.1080/21642850.2022.2053685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The ichthyoses are a group of genetic skin disorders, characterized by excessive amounts of dry, thickened skin, which may be fragile, inelastic and prone to fissures and infection. Skin care is time consuming and demanding, and, usually performed by the parents. Methods: We aimed to explore parental experience of caring for a child with ichthyosis, and collected data using semistructured interview, and thematic analysis. Results: Our analysis revealed four main themes: Parents' and others' reactions to the child's difference, Experiences with healthcare services, It's all skin care, and Impact on relationships. Conclusion: After birth of a child with severe ichthyosis, the parents experienced emotional distress and stigmatization due to the different appearance of the skin and healthcare professionals' lack of knowledge. Skin care caused pain in the child, was time consuming, and caused financial burdens. This study can guide healthcare professionals on where to focus future efforts in meeting the clinical and psychological needs of parents caring for a child with ichthyosis.
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Affiliation(s)
- Elisabeth Daae
- Center for Rare Disorders, Oslo University Hospital HF, Oslo, Norway
| | | | - Jan C Sitek
- Department of Dermatology, Oslo University Hospital HF, Oslo, Norway
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Boztepe H, Çınar S, Kanbay Y, Acımış B, Özgür F, Terzioglu F. Validity and reliability of the Family Empowerment Scale for parents of children with cleft lip and/or palate. Child Care Health Dev 2022; 48:277-285. [PMID: 34786745 DOI: 10.1111/cch.12928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/11/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Empowerment is recognized as a crucial concept in strengthening the position of parents in healthcare services. This study aimed to evaluate the validity and reliability of the Turkish Family Empowerment Scale (FES). METHODS This methodological study was conducted between January and March 2021, with 348 family members actively caring for their children in the age group of 0-18 years with cleft lip and/or palate (CL/P). The English FES was translated into Turkish using back translation and modified so that it is generic and convenient for all families. The construct validity, internal validity, internal consistency, and split-half test reliability and responsiveness of the Turkish FES were examined. RESULTS The original FES structure with three factors (family, health services provided to the child and community participation) and 34 items was verified in Turkish culture. This obtained structure can explain 66% of the variance of the relevant concept. Scores of parents ranged between 34 and 170 points. Increasing scores indicated a positive significance regarding family empowerment. The Cronbach's α reliability coefficient of the scale was calculated as 0.976. CONCLUSION The study findings and the goodness-of-fit values indicated that the FES and its Turkish version are a valid and reliable measurement instrument to be used in Turkish culture.
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Affiliation(s)
- Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atılım University, Ankara, Turkey
| | - Sevil Çınar
- Faculty of Health Sciences, Artvin Çoruh University, Artvin, Turkey
| | - Yalçın Kanbay
- Department of Nursing, Faculty of Health Sciences, Artvin Coruh University, Artvin, Turkey
| | - Burcu Acımış
- Plastic, Reconstructive and Esthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Figen Özgür
- Department of Plastic, Reconstructive and Esthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Füsun Terzioglu
- Faculty of Health Sciences, Kocaeli Health and Technology University, Kocaeli, Turkey
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22
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McWilliams D, Costa B, Blighe S, Swan MC, Hotton M, Hudson N, Stock NM. The Impact of the Covid-19 Pandemic on Cleft Lip and Palate Service Delivery for New Families in the United Kingdom: Medical and Community Service Provider Perspectives. Cleft Palate Craniofac J 2022; 60:551-561. [PMID: 35195455 PMCID: PMC9218609 DOI: 10.1177/10556656221074870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Professionals in the United Kingdom providing care to new families affected by cleft lip and/or palate (CL/P) had to adapt to ensure families' needs were met during a time of uncertainty due to Covid-19. The aims of this study were to explore the impacts of the pandemic on CL/P care provision for new families from the perspectives of professionals working in medical and community settings along with any personal impact on professionals and their reflections on the future of CL/P care. DESIGN Semistructured interviews (n = 27) were completed about experiences from March 2020 to October 2020 with consultant cleft surgeons (n = 15), lead clinical nurse specialists (n = 8), and staff working at the Cleft Lip and Palate Association (n = 4). Transcripts were analyzed using inductive thematic analysis. RESULTS Three themes were identified: (1) the impact of Covid-19 on the provision of cleft care in the United Kingdom, including working conditions, delays to treatment, and Covid-19 policies; (2) the impact of the pandemic on professionals' mental health, including personal distress and concerns about Covid-19 exposure; and (3) reflections on the future of CL/P care, whereby professionals expressed both hope and concern about the Covid-19 recovery effort. CONCLUSIONS The ongoing Covid-19 pandemic has impacted CL/P service delivery for new families significantly, warranting recommendations for cohesive psychological support for families in addition to a safe and resourced recovery effort. Support for professionals is also suggested, following existing evidence-based models for providers' needs that address the difficulties of working throughout challenging times.
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Affiliation(s)
- Danielle McWilliams
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
| | - Sabrina Blighe
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Marc C Swan
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Matthew Hotton
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Nichola Hudson
- Spires Cleft Centre, 11269John Radcliffe Hospital, Headley Way, Headington, Oxford, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
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23
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Alighieri C, Bettens K, Verhaeghe S, Van Lierde K. Speech diagnosis and intervention in children with a repaired cleft palate: A qualitative study of Flemish private community speech-language pathologists' practices. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 24:53-66. [PMID: 34229538 DOI: 10.1080/17549507.2021.1946153] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose: This study investigated the practice patterns of private community speech-language pathologists (SLPs) when treating children with a repaired cleft of the palate with or without a cleft of the lip (CP ± L). Practices were explored in terms of diagnostics and treatment focus, treatment dosage and experienced difficulties when treating children with a CP ± L.Method: Eleven female private community SLPs, who lived in Flanders (i.e. the northern part of Belgium) and were aged between 23 and 62 years participated in this study. Data were collected from semi-structured face-to-face interviews. The qualitative software program NVivo 12 was used for data analysis. The interviews were analysed using an inductive thematic approach.Result: SLPs reported a lack of available information on speech-related cleft care. SLPs expressed the need to receive a referral letter from the hospital in order to make an adequate speech diagnosis. Most therapists reported that they performed an articulatory assessment combined with a language assessment. Most SLPs used a hybrid treatment model including a variety of intervention techniques. These techniques were not always in line with available scientific evidence. SLPs reported the desire to receive practical step-by-step guidelines on how to provide speech intervention to children with a CP ± L. In contrast, there was a strong consensus among the therapists that an individualised treatment plan is necessary.Conclusion: The results of this study have revealed gaps in the dissemination and implementation of scientific evidence relevant to speech services for children with a CP ± L (i.e. a research-practice gap) in Flanders. Research evidence needs to be adequately translated into clinical practice by providing concrete and practical guidelines.
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Affiliation(s)
| | - Kim Bettens
- Department of Rehabilitation Sciences, Ghent University, Gent, Belgium
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, Ghent University, Gent, Belgium
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24
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Batra P, Sybil D, Izhar A, Batra P, Thiruvenkatachari B. Standard of Care for Patients With Cleft Lip and Palate in India-A Questionnaire-Based Study. Cleft Palate Craniofac J 2022; 60:536-543. [PMID: 35099313 DOI: 10.1177/10556656221074212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A national survey of cleft teams was undertaken to evaluate the current standard of care for patients with cleft lip and palate (CLP) in India as a part of Cleft Care India study. This was a cross-sectional questionnaire-based study. Cleft teams across India attending the 19th Annual Conference of the Indian Society of Cleft Lip and Palate were invited to complete the questionnaire. The questionnaire consisted of 18 questions that included demographics, institutional details, patient protocols, surgical technique, rehabilitation facilities, and accessibility. The data are descriptively reported. A total of 112 centers completed the survey. Nongovernment organizations funded 87% of the cleft centers and 8% did not receive any funding. Only 39% of the centers had centralized cleft services providing multidisciplinary care. Speech therapy was provided either onsite or through referral at 90% of the centers, whereas audiology was provided only at 4% of centers. Feeding advice was routinely provided in 52% of centers. Millard technique was the most preferred technique for unilateral cleft lip repair (66%). The 2-flap technique (37%) and pharyngeal flap (48%) were the most common surgeries for cleft palate and pharyngoplasty, respectively. Although 54% of centers reported their patients to be interested in comprehensive care, 43% reported that their patients only wanted surgical correction. There is wide diversity in access to cleft care and clinical practices across centers in India. Further work is needed to evaluate the quality of care by assessing outcomes of centers treating patients with CLP.
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Affiliation(s)
- Panchali Batra
- Faculty of Dentistry, 28849Jamia Millia Islamia University, New Delhi, India
| | - Deborah Sybil
- Faculty of Dentistry, 28849Jamia Millia Islamia University, New Delhi, India
| | - Arisha Izhar
- Faculty of Dentistry, 28849Jamia Millia Islamia University, New Delhi, India
| | - Puneet Batra
- 29873Manav Rachna Dental College (Faculty of Dental Sciences), Manav Rachna International Institute of Research and Studies (MRIIRS), Faridabad, India
| | - Badri Thiruvenkatachari
- School of Dentistry, 5292University of Manchester, Manchester, UK.,Sree Balaji Dental College and Hospital, Bharath Institute of Higher Education and Research, Pallikaranai, Chennai, India
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25
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Feragen KJB, Myhre A, Stock NM. "Will You Still Feel Beautiful When You Find Out You Are Different?": Parents' Experiences, Reflections, and Appearance-Focused Conversations About Their Child's Visible Difference. QUALITATIVE HEALTH RESEARCH 2022; 32:3-15. [PMID: 34596475 PMCID: PMC8739583 DOI: 10.1177/10497323211039205] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
To investigate parents' reflections and experiences of having a child born with an appearance-altering condition, interviews with 33 parents of children born with rare craniofacial conditions were analyzed using inductive thematic analysis. Three themes emerged: "Managing emotions: A dynamic process," "Through another lens: External reminders of difference," and "Awareness of difference: Approaching the child." Findings suggest that although parents learned to accept and love their child's visible difference, external factors such as appearance-altering surgery and other people's reactions activated difficult emotions in parents. Parents struggled to decipher whether and when to raise appearance-related issues with their child, and how this could be done without distressing the child. Anticipatory guidance that facilitates positive appearance-focused conversations both within and outside the home seems to be needed. Parenting skills could also be strengthened by preparing parents for social reactions to the child's visible difference, and their child's changed appearance following surgery.
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26
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A Booklet to Promote Psychological Health in New Families Affected by Craniosynostosis. J Craniofac Surg 2021; 33:1670-1673. [PMID: 34974462 DOI: 10.1097/scs.0000000000008454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Recent research indicates that parents of children with craniosynostosis may be at risk of emotional distress. Yet, parents may not be accessing the support they need to cope with common challenges. The aim of this project was to develop a research-informed booklet to promote psychological health in new families, and to assess acceptability of the booklet within the craniosynostosis community. The first draft was designed in close collaboration with leading UK charity Headlines Craniofacial Support 5 parent representatives, and 3 specialist clinical psychologists via online focus groups. The draft booklet, attached to an online acceptability survey, was distributed to a broader group of parents and multidisciplinary specialists working in craniofacial teams in England for feedback. A total of 44 complete responses to the online acceptability survey were received. Acceptability (measured by the number of respondents who would recommend the booklet) was 100%. All respondents reported they "agreed" or "strongly agreed" with the UK-wide distribution of the booklet. Evidence for psychological intervention in the craniofacial field remains scarce, and specialist teams may be under-resourced to effectively screen and support parents. It is hoped this booklet will begin to address the gap in psychological support for new families affected by craniosynostosis.
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27
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Everhart SA, Cochran KM, Lambrou NH, Davies WH, Marik PK. Psychosocial Experiences That Support Positive Self-Concept in Children with Cleft Lip and Palate Adopted From China. Cleft Palate Craniofac J 2021; 59:1509-1519. [PMID: 34860609 PMCID: PMC9676477 DOI: 10.1177/10556656211051222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective Existing psychosocial research offers little information on the unique challenges and strengths of children adopted from China with cleft lip and/or palate (CL/P). The present study aimed to understand biopsychosocial factors that support positive self-concept in this population. Design Qualitative, semistructured interviews were conducted with children and their parents. Interpretive phenomenological analysis of transcribed interviews was utilized for data analysis. Setting Participants were recruited in an outpatient, pediatric multidisciplinary cleft clinic during a standard team visit. Patients, Participants Participants were ages 8 to 12 years with a diagnosis of isolated cleft lip-palate who were internationally adopted from China before the age of 2 years and English-speaking. Participants also included English-speaking parents. Results Themes reflecting data from the child and parent subsamples include: (1) child's characteristics, (2) family strengths, (3) adoption identity, (4) cultural identity, (5) coping with a cleft, and (6) social factors. Additional 2 to 3 subthemes were identified for the parent and child subsamples within each broader theme. Conclusions Findings from this sample suggested factors supporting positive self-concept included pride and self-efficacy in activities, family support, instilment of family values, strategies for coping with a cleft, family belonging, cultural exposure, and normalization of differences. Medical providers can support patients and families by providing education on surgeries, CL/P sequelae and outcomes, and pediatric medical stress. Mental health providers can screen for social and emotional challenges and provide psychoeducation on racial/ethnic socialization, identity development, and coping.
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Affiliation(s)
- S A Everhart
- 20209Children's Hospital of Orange County, Orange, CA, USA.,14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - K M Cochran
- 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA.,Lighthouse Clinic, LLC, Milwaukee, WI, USA
| | - N H Lambrou
- Geriatric Research Education and Clinical Center, 20132Wm S Middleton Memorial Veterans Hospital, Madison, WI, USA.,School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - W H Davies
- 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - P K Marik
- 5497Children's Wisconsin, Milwaukee, WI, USA.,5506Medical College of Wisconsin, Milwaukee, WI, USA
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28
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Lecourtois-Amézquita MG, Cuevas-Córdoba B, Santiago-García J. Homozygous deletion of glutathione S-transferase theta 1 and mu 1 increase the risk of non-syndromic oral clefts in a Mexican population. Arch Oral Biol 2021; 130:105246. [PMID: 34454376 DOI: 10.1016/j.archoralbio.2021.105246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate whether null variants of Glutathione S-transferase Mu 1 (GSTM1) and GST Theta 1 (GSTT1) in infants and mothers, as well as maternal exposures to environmental factors, contribute to the risk of non-syndromic cleft lip with or without palate (NSCL/P) in a Mexican population. DESIGN We performed a matched pair case-control study, including 98 cases and 98 controls and their mothers. Sociodemographic information and environmental exposures were collected by a questionnaire. Null variants of GSTM1 and GSTT1 were assessed by multiplex Polymerase Chain Reaction (PCR). Odds ratios (OR) and their 95 % confidence intervals (CI) were calculated to estimate risks. The interaction of genetic variables with smoking and adjusted ORs were evaluated by binary logistic regression. RESULTS Homozygous null GSTM1 was associated with the risk of NSCL/P when present in mothers (OR = 2.45, 95 % CI 1.23-4.86) or infants (OR = 2.98, 95 % CI 1.45-6.14). A higher risk was also found when children carried the homozygous null GSTT1 (OR = 4.89, 95 % CI 2.42-9.87). In mothers, this variant showed a crude risk of 9.17 (95 % CI 3.95-21.29), which increased to OR = 13.81 (95 % CI 1.63-117.09) upon interaction with frequent passive smoking (5-7 days/week). Sociodemographic and other environmental exposures were not significantly associated with the risk of NSCL/P. CONCLUSIONS Maternal and infant GSTT1 and GSTM1 homozygous null genotypes were associated with a higher risk of NSCL/P, and the results suggest an interaction of the maternal GSTT1-null/null genotype with frequent passive smoking.
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Affiliation(s)
- Mariana G Lecourtois-Amézquita
- Programa de Doctorado en Ciencias de la Salud, Universidad Veracruzana, Luis Castelazo S/N. Xalapa, Veracruz, 91190, Mexico; Instituto de Investigaciones Biológicas, Universidad Veracruzana, Luis Castelazo S/N. Xalapa, Veracruz, 91190, Mexico
| | - Betzaida Cuevas-Córdoba
- Instituto de Investigaciones Biológicas, Universidad Veracruzana, Luis Castelazo S/N. Xalapa, Veracruz, 91190, Mexico
| | - Juan Santiago-García
- Instituto de Investigaciones Biológicas, Universidad Veracruzana, Luis Castelazo S/N. Xalapa, Veracruz, 91190, Mexico.
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29
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Thornton M, Harcourt D, Deave T, Kiff J, Williamson H. "Have We Done Enough?" A Cross-condition Exploration of the Experiences of Parents Caring for A Child with an Appearance-affecting Condition or Injury. Dev Neurorehabil 2021; 24:418-428. [PMID: 33852812 DOI: 10.1080/17518423.2021.1901150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Children and young people (CYP) with appearance-affecting conditions/injuries report common pervasive psychosocial difficulties, regardless of cause, nature or extent of their visible differences. Parents or carers can also experience psychosocial difficulties and challenges specific to having CYP with a visible difference. Current literature is confined to exploring condition-specific concerns of parents, typically in more prevalent appearance-affecting conditions/injuries, whilst the experiences of parents of CYP with other visible differences are unknown. Thirty-one interviews (parents n = 20, health and support professionals n = 11) and 4 parent focus groups (n = 25) were conducted. Three overarching themes were constructed: "Appearance does(n't) matter" describes the impact of having a child with a socially undesirable appearance; "Being 'battle' ready" reflects parents' desire to arm their child with resources to manage challenges, whilst "Walking the tightrope" reflects parents' lack of clarity about how best to approach this. Findings highlight shared and common cross-condition psychosocial difficulties among parents and carers.
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Affiliation(s)
- Maia Thornton
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Diana Harcourt
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Toity Deave
- Nursing and Midwifery, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - James Kiff
- Outlook Service, Southmead Hospital, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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30
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Costa B, Ardouin K, Stock NM. Factors Associated With Psychological Adjustment in Adults With Cleft Lip and/or Palate: Findings From a National Survey in the United Kingdom. Cleft Palate Craniofac J 2021; 59:S7-S17. [PMID: 34235990 DOI: 10.1177/10556656211028494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Research has identified adults born with cleft lip and/or palate (CL/P) to be at risk of poorer psychological outcomes compared to the general population. This study investigated factors that may contribute to positive and negative adjustment in adults born with CL/P. DESIGN A survey was designed and distributed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research CAR at the University of the West of England (UWE). There were 207 eligible responses (95% completed online) received between July and October 2018. Dependent variables included the Body Esteem Scale for Adolescents and Adults, Harter's Self Perception Profile for Adults (Global Self-Worth, Social Competence, and Intimacy subscales), the Fear of Negative Appearance Evaluation Scale, and the Revised Adult Attachment Scale. Independent variables were the Revised Life Orientation Test, biodemographic data, and self-reported single-item questions. RESULTS Factors associated with positive adjustment included reports of a happy childhood, talking about CL/P with family, close friendships, comfort in public spaces, satisfaction with appearance, and a positive life orientation. Psychological distress was associated with a desire for further surgery to improve appearance and/or function. CONCLUSIONS Several factors were identified that may influence psychological adjustment in adults with CL/P. Throughout childhood, family-centered practice to support family cohesion and an open dialogue about CL/P is indicated, as is support for young people to develop social confidence. For adults returning to the cleft service, treatment options for appearance and/or functional concerns should be explored, with access to psychological support when indicated. Interventions to increase optimism, resilience, and self-acceptance may also be warranted throughout the life span.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Kenny Ardouin
- Cleft Lip and Palate Association, London, United Kingdom
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31
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Lopez-Bassols I. Assisted Nursing: A Case Study of an Infant With a Complete Unilateral Cleft Lip and Palate. J Hum Lact 2021; 37:419-424. [PMID: 33201761 DOI: 10.1177/0890334420964159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This case presents a mother's feeding experience of an infant born with a complete unilateral cleft lip and palate from birth until both were repaired. She fed him directly at the breast with assistance, controlling the delivery of the mother's own milk. The infant received only his mother's own milk, no bottles, and the excess expressed milk was donated to a milk bank. MAIN ISSUE The Cleft Team supported the mother's wish to breastfeed but expressed realism that cleft lip and palate infants could not create suction. Success had never been observed in the unit. Instead, the team suggested expressing to deliver as much of the mother's own milk. The mother had previously breastfed her three children and was keen on finding innovative ways to breastfeed. MANAGEMENT Several techniques were trialed with the help of an International Board Certified Lactation Consultant. The most sustainable and successful was the use of a nipple shield applied to the maternal nipple areola complex to cover the lip palate. Underneath, a nasogastric tube connected to a syringe delivered the mother's own milk. Exclusive expressing protected maternal supply, the infant's nutrition and growth were monitored carefully and this technique reinforced mother-infant bonding. CONCLUSION Feeding with the modifications was challenging at times. However, maternal satisfaction was high because the mother had achieved her goal of breastfeeding without assistance post cheiloplasty and palatoplasty. This case adds to the limited body of research about feeding infants with cleft lips and palates directly at the breast.
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32
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Çınar S, Ay A, Boztepe H, Gürlen E. "Unexpected event": Having an infants with cleft lip and/or palate. Congenit Anom (Kyoto) 2021; 61:38-45. [PMID: 33103293 DOI: 10.1111/cga.12398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 10/16/2020] [Indexed: 11/26/2022]
Abstract
This study aimed to determine the difficulties that the mothers of infants with a cleft lip and/or palate (CL/P) go through, the problems they encounter in this process, and how they perceive the support of healthcare professionals, families, and friends. The study used a phenomenological approach from qualitative research methods. The study sample included 18 mothers of 0 to 3-month-old infants with CL/P. The data were collected using socio-demographic information form and semi-structured interview form. The data obtained from the interviews were evaluated using content and thematic analysis approaches. On the basis of the interviews conducted with mothers of infants with CL/P, the following themes emerged: (a) "unexpected event: having an infant with CL/P," (b) "using social media," (c) "stigma," and (d) "uncertainty of long-term treatment." In this study, it was determined that mothers experienced shock, confusion, sadness, and disappointment in this process; therefore, they used social media to seek support from the families as well as conducted research on the disease that involved a lot of uncertainty due to long-term treatments. The present study can help healthcare professionals, who play a role in the care and treatment of infants with CL/P, to understand and know what mothers need in the preoperative period.
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Affiliation(s)
- Sevil Çınar
- Pediatric Nursing Department, Faculty of Health Sciences, Artvin Çoruh University, Artvin, Turkey
| | - Ayşe Ay
- Department of Nursing, Faculty of Health Sciences, Başkent University, Ankara, Turkey
| | - Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atılım University, Ankara, Turkey
| | - Eda Gürlen
- Faculty of Education, Department of Educational Sciences, Curriculum and Instruction, Hacettepe University Ankara, Turkey
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33
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van Dalen M, Leemreis WH, Kraaij V, De Laat PCJ, Pasmans SGMA, Versnel SL, Koudstaal MJ, Hillegers MHJ, Utens EMWJ, Okkerse JME. Parenting Children With a Cleft Lip With or Without Palate or a Visible Infantile Hemangioma: A Cross-Sectional Study of Distress and Parenting Stress. Cleft Palate Craniofac J 2021; 58:1536-1546. [PMID: 33583213 PMCID: PMC8586175 DOI: 10.1177/1055665621993298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: Parents of children with a medical condition and a visible difference can experience challenging situations. We evaluated distress and parenting stress in parents of children with a cleft lip with or without cleft palate (CL±P) or a visible infantile hemangioma (IH). Setting: This cross-sectional study took place in an academic medical hospital in Rotterdam, the Netherlands. Participants: Three-hundred nine parents (mean age = 40.30, 56.00% mothers) of children with CL±P and 91 parents (mean age = 36.40, 58.24% mothers) of children with IH. Main Outcome Measures: The Dutch version of the Parenting Stress Index – Short Form and the subscales Anxiety, Depression, and Hostility of the Symptom Checklist – 90. Results: One sample t tests and mixed linear modeling were used. On average, parents of children with CL±P and of children with IH showed significantly lower parenting stress compared to normative data. Anxiety was significantly lower in parents of children with CL±P than that in the norm group. Visibility of the condition was not related to distress or parenting stress. Child behavioral problems were positively related to parenting stress, depression, and hostility. Conclusions: Parents of children with CL±P and IH report less distress and parenting stress compared to the norm. On average, these parents seem well adjusted. A practical implication is to monitor parents of children with behavioral problems.
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Affiliation(s)
- M van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - W H Leemreis
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - V Kraaij
- Department of Clinical Psychology, 4496Leiden University, the Netherlands
| | - P C J De Laat
- Department of Pediatrics, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - S G M A Pasmans
- Department of Dermatology, Centre of Pediatric Dermatology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - S L Versnel
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
| | - E M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Academic Center for Child Psychiatry Levvel, Amsterdam, the Netherlands
| | - J M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, 97759Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands
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Nabatanzi M, Seruwagi GK, Tushemerirwe FB, Atuyambe L, Lubogo D. "Mine did not breastfeed", mothers' experiences in breastfeeding children aged 0 to 24 months with oral clefts in Uganda. BMC Pregnancy Childbirth 2021; 21:100. [PMID: 33516176 PMCID: PMC7847043 DOI: 10.1186/s12884-021-03581-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Appropriate breastfeeding is vital for infant and young child nutrition. Annually, oral clefts affect 0.73 per 1000 children in Uganda. Despite this low incidence, children with a cleft face breastfeeding difficulty which affect their nutrition status. In addition, knowledge on maternal experiences with breastfeeding and support is limited. We explored maternal perceptions, experiences with breastfeeding and support received for their children 0 to 24 months with a cleft attending Comprehensive Rehabilitative Services of Uganda (CoRSU) Hospital. METHODS This cross-sectional study combined quantitative and qualitative methods. We consecutively recruited 32 mothers of children with a cleft aged 0 to 24 months attending CoRSU hospital between April and May 2018. A structured questionnaire collected data on breastfeeding practices and device use (n = 32). To gain a broad understanding of mothers' perceptions and experiences with breastfeeding and support received, we conducted two Focus Group Discussions (in each, n = 5), and 15 In Depth Interviews. Descriptive statistics were analyzed using SPSS software. Qualitative data were analyzed thematically. RESULTS Of the 32 children with a cleft, 23(72%) had ever breastfed, 14(44%) were currently breastfeeding, and among those under 6 months, 7(35%) exclusively breastfed. Of 25 mothers interviewed in IDIs and FGDs, 17(68%; IDIs = 8/15, FGD1 = 5/5 and FGD2 = 4/5) reported the child's failure to latch and suckle as barriers to breastfeeding. All ten mothers who used the soft squeezable bottle reported improved feeding. Nineteen (76%) mothers experienced anxiety and 14(56%), social stigma. Family members, communities and hospitals supported mothers with feeding guidance, money, child's feeds and psycho-social counselling. Appropriate feeding and psycho-social support were only available at a specialized hospital which delayed access. CONCLUSIONS Breastfeeding practices were sub-optimal. Mothers experienced breastfeeding difficulties, anxiety and social stigma. Although delayed, feeding, social and psycho-social support helped mothers cope. Routine health care for mothers and their children with a cleft should include timely support.
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Affiliation(s)
- Maureen Nabatanzi
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
| | - Gloria Kimuli Seruwagi
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
| | - Florence Basiimwa Tushemerirwe
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
| | - Lynn Atuyambe
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
| | - David Lubogo
- Makerere University College of Health Sciences, School of Public Health, New Mulago Hospital Complex, P.O. Box 22864, Kampala, Uganda
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Costa B, Thornton M, Guest E, Meyrick J, Williamson H. The effectiveness of interventions to improve psychosocial outcomes in parents of children with appearance-affecting health conditions: A systematic review. Child Care Health Dev 2021; 47:15-30. [PMID: 32876343 DOI: 10.1111/cch.12805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 08/23/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although many cope well, the impact of supporting a child with an Appearance-Affecting Health Condition (AAHC) can place a significant demand on parents. As such, it is vital that families have access to appropriate psychosocial support to reduce any potential difficulties. Although previous reviews have explored the effectiveness of psychosocial interventions for parents of Children and Young People (CYP) with general health conditions, the evidence of effectiveness remains limited. Further, little is known about the effectiveness of such interventions specifically among parents of CYP with AAHCs. This review aimed to identify and assess the evidence of effectiveness of psychosocial interventions among parents of CYP with AAHCs. METHODS Database searches were conducted using MEDLINE, PsychARTICLES, PsychINFO, CINAHL Plus, the British Nursing Database and the Cochrane Library. Results were reviewed against the inclusion criteria and data were extracted. Methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment Tool, and a narrative synthesis was conducted. RESULTS Fifteen studies, evaluating 10 interventions, were included and overall seven interventions were found to be effective (effect sizes and methodological quality varied). CONCLUSIONS This review finds moderate to strong evidence of effectiveness of the Triple P Positive Parenting Program, the Early Family Intervention Program and general parent education/training interventions. These findings offer useful insights relating to the delivery of current support, as well as for the development of future parent and family interventions. Finally, recommendations for future intervention evaluation studies in this area are made.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Maia Thornton
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Ella Guest
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Jane Meyrick
- Department of Health and Social Science, University of the West of England, Bristol, UK
| | - Heidi Williamson
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Carvalho NO, Matos MFS, Belchior IFC, Araújo MB, Rocha CT, Neves BG. Parents' Emotional and Social Experiences of Caring a Child with Cleft Lip and/or Palate. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2021. [DOI: 10.1590/pboci.2021.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Yuan L, Gao Y, Pan B, Wang J, Wang Y, Gong C, Wang W, Li X. Resilience and Related Factors: A Comparison of Fathers and Mothers of Patients With Cleft Lip and/or Palate in China. Front Psychiatry 2021; 12:791555. [PMID: 35095604 PMCID: PMC8792896 DOI: 10.3389/fpsyt.2021.791555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Resilience has become a hot spot in the field of positive psychology to study life-change events. However, there were little information on resilience among the fathers and mothers of patients with cleft lip and/or palate respectively. The present study aimed to explore and compare the level and potential influential factors associated with resilience among fathers/mothers of patients with cleft lip and/or palate in China. Method: A cross-sectional study was carried out between April 2019 and July 2020 among fathers/mothers of patients with cleft lip and/or palate in two cleft lip and/or palate treatment centers in China. Sixty Nine fathers and 179 mothers of patients with cleft lip and/or palate were interviewed with a questionnaire on demographic variables and the Resilience Scale-14 (RS-14), Herth Hope Index (HHI), Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Parenting Stress Index-Short Form (PSI-SF) and Coping Health Inventory for Parents (CHIP). T-test/univariate one-way ANOVA, Pearson's r, hierarchical linear regression analysis were conducted to explore the influential factors of resilience. Results: Fathers of patients with cleft lip and/or palate had a higher level of resilience (77.77 ± 14.18) than mothers (74.52 ± 14.33) though without significance. Resilience was positively associated with hope, perceived social support, optimism and coping and negatively correlated with parenting stress both in the fathers and the mothers. Hierarchical linear regression analysis showed that hope (β = 0.400, P < 0.01), coping (β = 0.281, P < 0.05), job status, medical payments (β = -0.240, P < 0.05) were found to be associated with resilience among the fathers of patients with CL/P, and all four variables in the model could explain 42.8% of the variance in resilience; Hope (β = 0.225, P < 0.05), perceived social support (β = 0.194, P < 0.05), the age of patients (β = 0.189, P < 0.05) were found to be associated with resilience among the mothers, and all three variables in the model could explain 27.6% of the variance in resilience. Conclusion: Our study showed that, in China, fathers of patients with cleft lip and/or palate had a higher level of resilience than mothers though without significance. Hope was the only communal variable strongly associated with resilience among both the fathers and the mothers; besides, coping, job status and medical payments were found to be associated with resilience among the fathers; while perceived social support and the age of patients were found to be associated with resilience among the mothers. The results suggest that enhance hope in parents of patients with cleft lip and/or palate might greatly help improve their resilience. Besides, fathers and mothers need specific intervention to prompt their resilience.
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Affiliation(s)
- Lulu Yuan
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China.,School of Nursing, China Medical University, Shenyang, China
| | - Yuqin Gao
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Bochen Pan
- Shengjing Hospital, China Medical University, Shenyang, China
| | - Junyan Wang
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Yanjie Wang
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Caixia Gong
- West China School/Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weiren Wang
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, China
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Ma SW, Lai S, Yang YY, Zhou Z, Yang BT, Zheng GZY, Gao J, Lu L. Relationships Between Anxiety Symptoms, Hopelessness and Suicidal Ideation Among Parental Caregivers of Mandarin-Speaking Children With Speech Impairment: The Mediating Effect of Depressive Symptoms. Front Psychiatry 2021; 12:648885. [PMID: 33986701 PMCID: PMC8110902 DOI: 10.3389/fpsyt.2021.648885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/22/2021] [Indexed: 12/05/2022] Open
Abstract
Background: Determining the mental health status of parents who chronically care for a child with speech impairment is important for developing appropriate interventions to improve both parents' and children's health and achieve a win-win situation. Unfortunately, no study in China has explored this issue. This study investigated the differences in four aspects of mental health between maternal and paternal caregivers for the Mandarin-speaking children with speech impairment and determine whether depressive symptoms mediate the relationships between anxiety symptoms and suicidal ideation, hopelessness and suicidal ideation. Methods: This cross-sectional questionnaire survey was conducted in February 2020 by sending a link to the predesigned electronic questionnaire in WeChat. Standardized assessment tools were employed. Hierarchical multiple logistic regression was conducted to examine the associations between various factors and suicidal ideation, and two separate structural equation models were performed to evaluate the mediating effects of depressive symptoms in the relationship between anxiety symptoms and suicidal ideation as well as between hopelessness and suicidal ideation. Results: This study included 446 parental caregivers of Mandarin-speaking children with speech impairment. Paternal caregivers had greater score than maternal caregivers on loss of motivation (one of the subdomains of hopelessness). Somatic complications of the child (OR = 2.73, 95% CI: 1.09-6.67) and depressive symptoms (OR = 3.38, 95% CI: 1.83-6.30) were positively associated with caregivers' suicidal ideation. Having speech therapy of child (OR = 0.54, 95% CI: 0.29-0.98) was negatively correlated with caregivers' suicidal ideation. There was direct effect of depressive symptoms on suicidal ideation. Depressive symptoms play mediating roles on the relationships between anxiety symptoms (β = 0.171, p < 0.001) as well as between hopelessness and suicidal ideation (β = 0.187, p < 0.001). Conclusions: Paternal and maternal caregivers of Mandarin-speaking children with speech impairment suffered from mental health problems. Preventive strategies and interventions to ameliorate parental psychological well-being, and health care policies to increase the accessibility to speech therapy care of children with speech impairment are imperative.
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Affiliation(s)
- Si-Wei Ma
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China.,School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, China.,Research Center of Stomatology, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Yan-Yan Yang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Bin-Ting Yang
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi'an Jiaotong University, Xi'an, China
| | | | - Jianmin Gao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, China
| | - Li Lu
- Team IETO, Bordeaux Population Health Research Center, INSERM, Université de Bordeaux, Bordeaux, France
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Costa B, White P, Kiff JD, Davies A, Stock NM. Parent-reported socioemotional and cognitive development in children with a cleft lip and/or palate at 18 months: Findings from a UK birth cohort. Child Care Health Dev 2021; 47:31-39. [PMID: 32990944 DOI: 10.1111/cch.12813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND One of the most common congenital conditions in the world, cleft lip and/or palate (CL/P) has been shown to potentially impact long-term physical and developmental outcomes in affected children. However, little is known about the factors that contribute to such outcomes, and there is a lack of consensus about which screening tools may be most effective. The aims of the current study were (a) to assess parent-reported socioemotional and cognitive development in children born with CL/P at 18 months of age; (b) to identify factors associated with the incidence of developmental concerns; and (c) to assess the utility of the widely recommended Ages and Stages Questionnaires (ASQs) in identifying developmental concerns from an early age in the CL/P population. METHODS Parent-reported questionnaire data were extracted from The Cleft Collective Cohort Study for 322 mothers of children with CL/P aged 18 months. RESULTS Mean scores across both ASQ measures indicated typical development in the study sample overall. However, 31.1% of children met a referral criterion on at least one domain. Child-related risk factors included problems with physical development and feeding method. Parent-related risk factors included the mother's levels of anxiety and depression and mother's marital status. Additional developmental concerns extracted from mothers' qualitative data included feeding difficulties, speech development, sleep patterns, aggressive behaviours, vision, oral health, hearing, breathing and motor skills. CONCLUSIONS The majority of children in this study were developing as expected at 18 months of age. However, parent-reported developmental concerns were identified in a minority of children, suggesting a need to screen for potential risk factors in routine practice. Further, the ASQ appears to offer a viable option in the early identification of developmental concerns in children with CL/P. A combined medical and systemic approach to healthcare is recommended to support the prevention of long-term developmental concerns in the child and poor psychological adjustment in parents.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, UK
| | - James D Kiff
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Amy Davies
- The Cleft Collective, The University of Bristol, Bristol, UK
| | - Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Breuning EE, Courtemanche RJ, Courtemanche DJ. Experiences of Canadian Parents of Young Children With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2020; 58:577-586. [PMID: 33267616 DOI: 10.1177/1055665620977271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Prior literature has described the perspectives of parents of young children with clip lip and/or palate; however, few studies have described parents' experiences within a Canadian health care system. This study aims to better understand the experiences of parents of young children with cleft lip and/or palate seen at a Canadian tertiary care center and identify their care needs. DESIGN In-depth semistructured interviews. SETTING Pediatric tertiary care center. PARTICIPANTS Parents of children younger than 7 years of age with cleft lip and/or palate. RESULTS From 14 interviews, 4 themes were identified. The diagnosis theme was associated with reactions, timing, and search for information. Key concerns within the theme of physiology and function were around feeding and speech. The health care experience theme included burden of care, peripheral hospitals and services, the cleft lip and palate clinic, and clinicians. The psychosocial theme included parents' reactions to their child's pain, coping strategies, family interactions, and school/day care experiences. Parents felt care could be improved by having: access to good information and community speech therapists, shorter appointment wait times, a peer support network, and increased cleft knowledge within their child's school and peer groups. CONCLUSIONS The experience of parents of children with cleft lip and/or palate is complex but can be organized into 4 themes. Clinics may consider suggestions offered by parents to improve care. Future work should address parents' needs and aim to create a parent-reported quality-of-life measure specific to parents of young children with cleft lip and/or palate.
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Affiliation(s)
- Eleonore E Breuning
- Division of Plastic Surgery, Department of Surgery, 8166University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Rebecca J Courtemanche
- Division of Plastic Surgery, Department of Surgery, 8166University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Douglas J Courtemanche
- Division of Plastic Surgery, Department of Surgery, 8166University of British Columbia, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
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Experiences of Parents of Infants Diagnosed With Mild or Severe Grades of Congenital Muscular Torticollis. Pediatr Phys Ther 2020; 32:322-329. [PMID: 32991556 DOI: 10.1097/pep.0000000000000738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The primary purpose of this study was to describe the experiences of parents of infants diagnosed with congenital muscular torticollis (CMT). A secondary purpose was to compare the experiences of parents of infants with mild grades versus severe grades of involvement based on the CMT severity classification system. METHODS Through semistructured interviews, a qualitative phenomenological approach of inquiry was used to investigate the lived experiences of 12 parents. RESULTS Eight themes common to both groups of parents were identified. Findings indicated having an infant with CMT has a significant effect on the parents and other caregivers. Two themes were unique to parents of the infants with severe CMT. CONCLUSIONS Parents are faced with a diagnosis that requires regular therapy visits and a challenging home program. A multimodal approach by clinicians for teaching and supporting parents during the episode of care may best address their unique challenges and stresses.
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Scheller K, Urich J, Scheller C, Watzke S. Psychosocial and socioeconomically aspects of mothers having a child with cleft lip and/or palate (CL/P): a pilot-study during the first year of life. J Clin Exp Dent 2020; 12:e864-e869. [PMID: 32994876 PMCID: PMC7511053 DOI: 10.4317/jced.56288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/07/2019] [Indexed: 12/02/2022] Open
Abstract
Background The emotional impact on parents at the birth of their new-born with cleft lip and/or palate (CL/P) can be traumatic for parents, especially mothers, and affect the sensitive early parent-child relationship. Unlike many other congenital malformations facial deformities are visible to all. The uncommon facial appearance creates feelings and reactions in the mother, families and other people. Only few studies deal with this psychosocial burden of these mothers.
Material and Methods This pilot-study deals with mothers’ early experiences (n=84) having a child with CL/P. Mothers were asked to complete a questionnaire at diagnosis, birth and after lip surgery. The questions were focused on the social background of the mother (educational degree, marital status, lifestyle and prenatal care), the medical information at diagnosis and the following reaction. The surveys were administrated from 01/2014 – 12/2016.
Results 84 mothers of affected children (CL/P) replied the completed questionnaire (84/103, 81.5%). At diagnosis 65 mothers (77%) lived in a solid partnership and 44% worked full-time (40h). The diagnosis caused fear among the mothers (60.7%, p≤0.01), despair (27.4%, p≤0.01), grief (17.9%, p≤0.01) and guilt (16.7%, p≤0.01). Despite the emotional stress after the diagnosis only 5 mothers asked for psychological support (6.0%). The medical information by the gynecologist (41.6%) or maxillofacial surgeon (32.2%) was rated as “good” (n=26) or “very good” (n=26) in 60.2%. A lack of medical information and care was rated with “insufficient” (11.9%) or “poor” (14.3%).
Conclusions There are only few studies about mothers’ early feelings and emotions having a child with a CL/P. We found high parental stress, physical and emotional strain among the mothers after diagnosis, mostly caused due to insufficient information’s. This stress was not correlated with the educational level and CLP appearance showed no relation about the socioeconomic status. Key words:Cleft lip/palate, mother’s emotional experience, psychosocial aspects
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Affiliation(s)
- Konstanze Scheller
- Department of Oral and Maxillofacial and Facial Plastic Surgery, Martin-Luther-University Halle-Wittenberg (Head: apl. Prof. Dr. Dr. A.W. Eckert), Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Jasmin Urich
- Department of Oral and Maxillofacial and Facial Plastic Surgery, Martin-Luther-University Halle-Wittenberg (Head: apl. Prof. Dr. Dr. A.W. Eckert), Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Christian Scheller
- Department of Neurosurgery, Martin-Luther-University Halle-Wittenberg (Head: Prof. Dr. C. Strauss), Ernst-Grube-Straße 40, 06120 Halle, Germany
| | - Stephan Watzke
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg (Head: Prof. Dr. D. Rujescu), Julius-Kühn-Str.7, 06112 Halle/Saale
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Kuta V, Curry L, McNeely D, Walling S, Chorney J, Bezuhly M. Understanding families' experiences following a diagnosis of non-syndromic craniosynostosis: a qualitative study. BMJ Open 2020; 10:e033403. [PMID: 32973048 PMCID: PMC7517552 DOI: 10.1136/bmjopen-2019-033403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 07/08/2020] [Accepted: 08/04/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Craniosynostosis is typically diagnosed and surgically corrected within the first year of life. The diagnosis and surgical correction of the condition can be a very stressful experience for families. Despite this, there is little research exploring the impact that craniosynostosis has on families, especially in the period immediately following diagnosis and correction. In this study, the authors aimed to qualitatively examine the psychosocial experience of families with a child diagnosed with craniosynostosis. DESIGN Qualitative study. SETTING Tertiary care paediatric health centre. PARTICIPANTS Mothers of children newly diagnosed with single-suture, non-syndromic craniosynostosis. INTERVENTION Semistructured interviews regarding parental experience with the initial diagnosis, their decision on corrective surgery for their child, the operative experience, the impact of craniosynostosis on the family and the challenges they encountered throughout their journey. PRIMARY AND SECONDARY OUTCOME MEASURES Thematic analysis, a type of qualitative analysis that provides an in-depth account of participant's experiences, was used to analyse the interview data. RESULTS Over a 4-year period, 12 families meeting eligibility criteria completed the study. Three main themes (six subthemes) emerged from the preoperative interviews: frustration with diagnostic delays (parental intuition and advocacy, hope for improved awareness), understanding what to expect (healthcare supports, interest in connecting with other families) and justifying the need for corrective surgery (influence of the surgeon, struggle with cosmetic indications). Two main themes (four subthemes) were drawn from the postoperative interviews: overcoming fear (the role of healthcare professionals, transition home) and relief (reduction in parental anxiety, cosmetic improvements). CONCLUSIONS Overall, the diagnosis of craniosynostosis has a profound impact on families, leading them to face many struggles throughout their journey. A better understanding of these experiences will help to inform future practice, with a hope to improve this experience for other families moving forward.
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Affiliation(s)
- Victoria Kuta
- Division of Otolaryngology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lauren Curry
- Division of General Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel McNeely
- Division of Neurosurgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Simon Walling
- Division of Neurosurgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill Chorney
- Department of Anaesthesia, Pain Management and Perioperative Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Division of Plastic Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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Sato Y, Yoshioka E, Saijo Y, Miyamoto T, Sengoku K, Azuma H, Tanahashi Y, Ito Y, Kobayashi S, Minatoya M, Bamai YA, Yamazaki K, Ito S, Miyashita C, Araki A, Kishi R. Trajectories of the Psychological Status of Mothers of Infants With Nonsyndromic Orofacial Clefts: A Prospective Cohort Study From the Japan Environment and Children's Study. Cleft Palate Craniofac J 2020; 58:369-377. [PMID: 32844663 DOI: 10.1177/1055665620951399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study examined psychological status trajectories of mothers of infants with nonsyndromic orofacial clefts in Japan. DESIGN Prospective cohort study. SETTING Data from the Japan Environment and Children's Study. PARTICIPANTS Infants with a nonsyndromic cleft (N = 148) including cleft lip and palate (CLP; n = 72), cleft lip (CL; n = 46), and cleft palate (CP; n = 30). The control group included unaffected infants (N = 84 454). MAIN OUTCOME MEASURES At 15 weeks and 27 weeks of pregnancy and 12 months after birth, the Kessler Psychological Distress Scale (clinical cutoff ≥5) was used. At 1 month and 6 months after birth, the Edinburgh Postnatal Depression Scale (clinical cutoff ≥9) was used. RESULTS Prenatal diagnosis rates were unavailable. Mothers of infants with CLP had higher psychological distress than controls at 27 weeks of pregnancy (prevalence ratio [PR] = 1.36, 95% CI: 1.06-1.74) and postnatal depression at 1 month after birth (PR = 2.21, 95% CI: 1.53-3.19). Mothers of infants with CP showed heightened psychological distress at 27 weeks of pregnancy (PR = 1.62, 95% CI: 1.21-2.17) and postnatal depression 6 months after birth (PR = 1.86, 95% CI: 1.01-3.43). There was no significant association between CL and maternal psychological status. At 12 months after birth, no differences in distress were found between mothers of infants with a cleft and controls. CONCLUSIONS Mothers of infants with orofacial clefts may need psychosocial support, particularly during pregnancy and the first year after birth.
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Affiliation(s)
- Yukihiro Sato
- Division of Public Health and Epidemiology, Department of Social Medicine, 38051Asahikawa Medical University, Asahikawa, Japan
| | - Eiji Yoshioka
- Division of Public Health and Epidemiology, Department of Social Medicine, 38051Asahikawa Medical University, Asahikawa, Japan
| | - Yasuaki Saijo
- Division of Public Health and Epidemiology, Department of Social Medicine, 38051Asahikawa Medical University, Asahikawa, Japan
| | - Toshinobu Miyamoto
- Department of Obstetrics and Gynecology, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Kazuo Sengoku
- Department of Obstetrics and Gynecology, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Hiroshi Azuma
- Department of Pediatrics, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Tanahashi
- Department of Pediatrics, 543377Asahikawa Medical University, Asahikawa, Japan
| | - Yoshiya Ito
- Faculty of Nursing, 38325Japanese Red Cross Hokkaido College of Nursing, Hokkaido, Japan
| | - Sumitaka Kobayashi
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Machiko Minatoya
- Faculty of Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Yu Ait Bamai
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Keiko Yamazaki
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Sachiko Ito
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Chihiro Miyashita
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Atsuko Araki
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
| | - Reiko Kishi
- Center for Environmental and Health Sciences, 12810Hokkaido University, Sapporo, Japan
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Yilmaz HN, Abuhan E. Maternal and paternal anxiety levels through primary lip surgery. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:478-483. [PMID: 32828994 DOI: 10.1016/j.jormas.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/13/2020] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to evaluate the anxiety levels of the parents of infants with cleft lip and palate (CLP) before and after primary lip surgery. MATERIALS AND METHOD Forty mothers (mean ages: 31.9 ± 6.16 years) and 40 fathers (mean ages: 34.6 ± 5.91 years) of infants with CLP were included in this study. They were asked to answer the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and Spielberger's State-Trait Anxiety Inventory (STAI) just 1 h before the primary lip surgery (T0) and 1 month after (T1) surgery. Student t-test and Mann-Whitney U test were used for inter-group comparison, the paired-sample t was used for the intra-group comparisons (p < 0.05). RESULTS There were no statistically significant differences for the comparisons of state (STAI-S) and trait (STAI-T) anxiety or APAIS scores between the parents. While state anxiety scores of the mothers increased significantly post-surgically, APAIS scores showed significant decreases in both parents (p < 0.05). APAIS scores of the fathers with bilateral CLP infants were significantly higher (p < 0.05) than the fathers of unilateral ones. The parents with local anesthesia experience showed significantly lower APAIS scores (p < 0.05). A negative correlation was present between maternal age and STAI-T, whereas a positive correlation was present between paternal age and the anxiety. CONCLUSIONS The anxiety levels of the parents were similar. Parents asked for more information about the anesthesia than the surgery, therefore communication with the anesthesiologist in the preoperative period is important. Routine assessment of parents' stress and psychosocial support should be provided by the cleft team.
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Affiliation(s)
- Hanife Nuray Yilmaz
- Department of Orthodontics, Faculty of Dentistry, Marmara University, Başıbüyük Street 9/3, 34854, Başıbüyük, Maltepe, Istanbul, Turkey.
| | - Ece Abuhan
- Dentistry Specialty Student, Department of Orthodontics, Faculty of Dentistry, Marmara University, Başıbüyük Street 9/3, 34854, Başıbüyük, Maltepe, Istanbul, Turkey.
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Kerr AM, Thompson CM, Rubinsky V. Memorable Messages Parents of Children with Vascular Birthmarks Receive from Others: Implications for Stigma and Identity. HEALTH COMMUNICATION 2020; 35:685-695. [PMID: 30793957 DOI: 10.1080/10410236.2019.1582314] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Parents of children with visible illnesses and physical differences, such as vascular birthmarks (VBs), often fear that their child will be stigmatized by others. Despite their use of various strategies to minimize this stigma, parents still frequently receive comments and questions from others about their child's condition. In the current study, we explore the source, content, and valence of these messages using a memorable messages framework. We also examine how parents react to messages from others and why those messages are considered memorable. To collect data, we administered a cross-sectional online survey through the website and social media pages of a national support group for parents of children with vascular birthmarks. A total of 70 parents completed the survey and, altogether, recalled 92 memorable messages. Our analyses revealed that the significance of the memorable messages coalesced around identity. Specifically, the messages described carried implications for a) participants in terms of their identities as parents, and b) participants' children in terms of their identities as stigmatized individuals. When messages were directed at parents, parents appraised them negatively or positively to the extent that they made parents feel judged or validated as parents of children with VBs. When messages were directed at children, parents appraised them negatively or positively to the extent that they labeled children and their VB as abnormal, unattractive, and undesirable, or accepted and complimented children as unique, special, and beautiful. The current research extends previous research exploring the role of memorable messages in negotiating identity.
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Affiliation(s)
- Anna M Kerr
- Department of Family Medicine, Heritage College of Osteopathic Medicine, Ohio University
| | - Charee M Thompson
- Department of Communication, College of Liberal Arts and Sciences, University of Illinois Urbana Champaign
| | - Valerie Rubinsky
- School of Communication Studies, Scripps College of Communication, Ohio University
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Boztepe H, Çınar S, Özgür, MD FF. Parenting Stress in Turkish Mothers of Infants With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2020; 57:753-761. [DOI: 10.1177/1055665619898592] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To explore parenting stress and factors affecting the mothers of infants with cleft lip and/or palate (CL/P) in Turkey. Design and Participants: The study compared mothers of infants born with CL/P (n = 90) with mothers of healthy infants (n = 90). Mothers completed the data collection form, the Parenting Stress Index-Short Form, and the Multidimensional Scale of Perceived Social Support. Results: Mothers of infants born with CL/P had higher mean parenting stress scores than the control mothers. A significant negative relationship was found between social support and parenting stress for mothers of infants born with CL/P but was not related for control mothers. Among mothers with an infant with CL/P, the mean parenting stress scores were higher for mothers preoperatively than mothers responding postoperatively. Among mothers with an infant with a cleft, higher stress was found for diagnosis after birth, not breastfeeding, feeding difficulties, lack of fathers’ support, perceived difficult infant temperament, blame, anger, and concern for the future. Conclusion: Parenting stress was higher and social support was lower for mothers of infants with a cleft. Treatment teams can design interventions aimed at factors related to stress, such as addressing feeding issues, teaching coping skills, and linking to social support.
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Affiliation(s)
- Handan Boztepe
- Department of Nursing, Faculty of Health Sciences, Atılım University, Ankara, Turkey
| | - Sevil Çınar
- Pediatric Nursing Department, Faculty of Health Sciences, Artvin Çoruh University, Artvin, Turkey
| | - Fatma Figen Özgür, MD
- Department of Plastic, Reconstructive and Esthetic Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Costa B, White P, Stock NM. Satisfaction With Health Care in Families Following a Diagnosis of Cleft Lip and/or Palate in the United Kingdom. Cleft Palate Craniofac J 2019; 57:599-605. [PMID: 31813267 DOI: 10.1177/1055665619888318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Having a child born with a cleft lip and/or palate (CL/P) poses several challenges for new parents and can have a significant psychological impact on the family as a whole. Previous research has indicated that dissatisfaction with health care is a risk factor for poor parental adjustment and family functioning. Yet, knowledge is lacking in regard to which aspects of care parents may be dissatisfied with. The current study aimed to comprehensively evaluate health-care satisfaction in families following a diagnosis of CL/P by utilizing data collected from a UK-wide birth cohort. METHODS Self-reported questionnaire data were obtained from 517 parent dyads enrolled in The Cleft Collective Birth Cohort Study. The "Pediatric Quality of Life Inventory-Healthcare Satisfaction Generic Module" was used as the primary outcome measure. RESULTS Overall, parents were satisfied with the care they had received. However, less favorable scores were identified in relation to the information parents had been given. A good degree of agreement between mothers and fathers was observed. However, marginal evidence suggested that fathers were significantly more dissatisfied than mothers regarding the "Communication" and "Inclusion of Family" subscales. CONCLUSIONS Although the findings of this large-scale study reflect overall health-care satisfaction, issues are raised in relation to the quality of information families received, particularly for fathers. In addition, fathers may feel less included in their child's treatment pathway. These findings offer practical suggestions as to which areas of care could be targeted by all health professionals to improve parents' health-care experiences and promote overall familial adjustment.
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Affiliation(s)
- Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Paul White
- Applied Statistics Group, University of the West of England, Bristol, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Maternal and Paternal Well-Being During Nasoalveolar Molding and Primary Surgery Periods. J Craniofac Surg 2019; 30:2227-2232. [PMID: 31574786 DOI: 10.1097/scs.0000000000006028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
AIM The aim was to evaluate the anxiety and depression of both the father and mother of an infant with cleft lip and palate (CLP) before, during and after nasoalveolar molding (NAM) therapy and before and after the lip surgery. SUBJECTS AND METHOD Forty mothers (age range: 18-36; mean ± SD: 23.6 ± 4.51) and 40 fathers (age range: 19-40; mean ± SD: 26.9 ± 4.69) of infants with CLP were asked to answer the 21-item Beck Depression as well as Anxiety Inventory (BDI and BAI) at 1 week after birth and before any intervention (T1), after impression taking (T2), after 2 months of NAM (T3), immediate before primary surgery (T4) and approximately 1 month of recovery after surgery (T5). RESULTS Maternal and paternal depression levels between T1, T2, T3, T4, and T5 showed significant differences (P < 0.05). The BDI scores decrease from T2 to T3 and T4 to T5. The increases of scores from T3 to T4 were significant (P < 0.05). The maternal depression and anxiety levels were higher than the paternal ones in all time periods. The BDI and BAI levels were lesser in mothers and fathers of babies with unilateral than bilateral CLP (P < 0.05). CONCLUSION Hence realizing of recovery, being in contact with the cleft team and other families, and having an active role in the therapy, the maternal and parental well-being increase with NAM therapy. However, depression and anxiety levels significantly increase before the lip surgery. It may be recommended that the cleft team deliver information and psychological support especially at birth and before the surgical approaches.
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Stock NM, Costa B. Provision of Care for Families Affected by Craniofacial Conditions: The Views of Nonspecialist Health Professionals. Cleft Palate Craniofac J 2019; 57:470-476. [PMID: 31665891 DOI: 10.1177/1055665619883151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE A diagnosis of a congenital craniofacial condition can have a significant impact on the psychological well-being of the affected family. As the first health professionals likely to come into contact with families, nonspecialists, such as diagnostic sonographers, midwives, and health visitors play a crucial role in facilitating familial adjustment. Yet, previous research has demonstrated parental dissatisfaction with the care delivered by nonspecialists. The aim of this study was to investigate the provision of care for families affected by craniofacial conditions from the perspective of nonspecialist health professionals, with a view to informing the development of educational materials. DESIGN Individual semistructured telephone interviews (n = 14) were conducted with 3 diagnostic sonographers, 2 fetal medicine consultants, 3 midwives, 4 health visitors, and 2 children's nurses. RESULTS Participants identified a range of barriers to the delivery of optimal care, including dealing with parental reactions, time pressure, hospital protocols and resources, a lack of contact with specialist craniofacial teams, and the emotional impact of delivering a diagnosis. Most participants had received no prior training in the area of congenital craniofacial conditions, while those who had felt current training materials were insufficient. All participants expressed a desire for further training and provided guidance regarding preferred content and format. CONCLUSIONS This study provides insight into the challenges faced by nonspecialists, as well as a range of information and training needs that could improve their knowledge and confidence. Suggestions for the development of educational materials for nonspecialist health professionals are made.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
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- Centre for Appearance Research, University of the West of England, Bristol, England, United Kingdom
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