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Stock NM, Crerand CE, Johns AL, McKinney CM, Koudstaal MJ, Drake AF, Heike CL. Establishing an International Interdisciplinary Research Network in Craniofacial Microsomia: The CARE Program. Cleft Palate Craniofac J 2024; 61:1470-1479. [PMID: 37248561 PMCID: PMC10984877 DOI: 10.1177/10556656231176904] [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] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVE Craniofacial microsomia (CFM) is a broad clinical term used to describe a congenital condition most commonly involving the underdevelopment of the external ear, mandible, soft tissues, and facial nerve. Despite medical advances, understanding of the psychological health and healthcare experiences of individuals with CFM and their caregivers remains limited. This article describes a research program designed to address these knowledge gaps, and identify opportunities for psychosocial intervention and improved healthcare provision. DESIGN The Craniofacial microsomia: Accelerating Research and Education (CARE) research program aims to: 1) Conduct up to 160 narrative interviews with individuals and caregivers to validate a conceptual framework; 2) Administer an online international survey of up to 800 individuals with CFM and caregivers to identify predictors of psychological distress; 3) Perform up to 60 semi-structured interviews with healthcare providers and advocacy leaders to examine the extent to which current healthcare provisions address identified patient needs; and 4) Establish a participant registry to build a longitudinal database and develop an international community. RESULTS Teams in the USA and UK have been established, alongside an international, interdisciplinary Advisory Committee. Data analysis for Aim 1 is ongoing and informing the delivery of Aims 2-3. Aim 4 is also in development. A dedicated website serves as a recruitment tool, educational resource, and mechanism for engaging with the CFM community. CONCLUSIONS The CARE program provides a comprehensive approach to understanding the experiences of individuals with CFM and their caregivers. Challenges encountered and lessons learned are shared for the benefit of the community.
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Affiliation(s)
- Nicola M. Stock
- Centre for Appearance Research, University of the West of England, Bristol, BS16 1QY, United Kingdom
| | - Canice E. Crerand
- Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, USA 43205
| | - Alexis L. Johns
- Children’s Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, USA 90027
| | - Christy M. McKinney
- Seattle Children’s Research Institute, 1920 Terry Avenue, Seattle, WA, USA 98101
| | - Maarten J. Koudstaal
- Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Amelia F. Drake
- University of North Carolina at Chapel School of Medicine, 170 Manning Drive, CB 7070, Chapel Hill, NC, USA 27599
| | - Carrie L. Heike
- Seattle Children’s Research Institute, 1920 Terry Avenue, Seattle, WA, USA 98101
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Davies AJV, Humphries K, Lewis SJ, Ho K, Sandy JR, Wren Y. The Cleft Collective: protocol for a longitudinal prospective cohort study. BMJ Open 2024; 14:e084737. [PMID: 38969383 PMCID: PMC11227803 DOI: 10.1136/bmjopen-2024-084737] [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: 01/26/2024] [Accepted: 06/07/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Cleft lip and/or palate (CL/P) affects 1 in 700 live births globally. Children born with CL/P and their families face various challenges throughout the child's development. Extant research is often limited by small numbers and single-centre data. The Cleft Collective, a national cohort study in the UK, aims to build a resource, available to collaborators across the globe, to understand causes, best treatments and long-term outcomes for those born with CL/P, ultimately seeking to enhance their quality of life through improved understanding and care. METHODS AND ANALYSIS A longitudinal prospective cohort study of children born with CL/P and their families. Recruitment occurs across the UK and started in November 2013. Recruitment will continue until September 2027 with an estimated final sample of 4822 children born with CL/P (1157 cleft lip including/excluding the alveolus; 2112 cleft palate only; 1042 unilateral cleft lip and palate and 511 bilateral cleft lip and palate). Biological samples are collected from all recruited members of the family. Parental and child questionnaires are collected at key time points throughout the child's development. Surgical data are collected at the time of surgical repair of the child's cleft. Consent is obtained to link to external data sources. Nested substudies can be hosted within the cohort. Regular engagement with participants takes place through birthday cards for the children, social media posts and newsletters. Patient and Public Involvement is conducted through the Cleft Lip And Palate Association and Cleft Collective Patient Consultation Group who provide insightful and essential guidance to the Cleft Collective throughout planning and conducting research. ETHICS AND DISSEMINATION The Cleft Collective was ethically approved by the National Research Ethics Service committee South West-Central Bristol (REC13/SW/0064). Parental informed consent is required for participation. Findings from the Cleft Collective are disseminated through peer-reviewed publications, conference presentations, newsletters and social media.
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Affiliation(s)
- Amy J V Davies
- Bristol Dental School, The Cleft Collective, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Kerry Humphries
- Bristol Dental School, The Cleft Collective, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Sarah J Lewis
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Karen Ho
- Bristol Bioresource Laboratories, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Jonathan R Sandy
- Bristol Dental School, The Cleft Collective, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Yvonne Wren
- Bristol Dental School, The Cleft Collective, University of Bristol Faculty of Health Sciences, Bristol, UK
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
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Rodgers RF, Gordon AR, Burke NL, Ciao A. Parents and caregivers as key players in the prevention and identification of body image concerns and eating disorders among early adolescents. Eat Disord 2024:1-24. [PMID: 38913912 DOI: 10.1080/10640266.2024.2366546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Early adolescence (ages 11-14 years) is a key period for the emergence of body image and eating concerns, and early identification and access to treatment are imperative for positive outcomes. Despite research identifying this critical developmental period, few prevention resources are available for early adolescents. Parents are key players for this age group and important socializing agents. As such, they are well positioned to help youth access resources or support where needed. However, programs to position and involve parents as interventionists are lacking. Our aims are two-fold. First, we review the evidence for the effectiveness of parents as body image interventionists and the existing data regarding parental needs. Second, we provide directions for future research and outline a framework for empowering parents as interventionists, identifying key domains in which parents may play a role in addressing body image and eating concerns among early adolescents. Based on the extent literature, these domains include facilitating engagement with or co-utilizing intervention content to decrease body image and eating concerns in at-risk children, which may also help to increase parents' effectiveness in their efforts to support youth. In addition, parents may deliver content to decrease or reverse risk-factors and early symptoms, or disrupt the early disorder phase of illness. To date, parents constitute an underutilized resource in eating disorder and disordered eating prevention, and efforts should be made to increase the evidence-based strategies to leverage their relationship with at-risk children.
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Affiliation(s)
- Rachel F Rodgers
- APPEAR, Department of Applied Psychology, Northeastern University, Boston, Massachusetts, USA
- Department of Psychiatric Emergency & Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France
| | - Allegra R Gordon
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Natasha L Burke
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - Anna Ciao
- Department of Psychology, Western Washington University, Bellingham, Washington, USA
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Bennecke E, Strandqvist A, De Vries A, Kreukels BPC. Psychological support for individuals with differences of sex development (DSD). J Psychosom Res 2024; 179:111636. [PMID: 38507969 DOI: 10.1016/j.jpsychores.2024.111636] [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: 09/08/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE Congenital conditions with atypical development of chromosomal, gonadal, or anatomic sex characteristics are referred to as Differences of Sex Development (DSD). Psychosocial care is recommended to be an integral part of clinical management for individuals with DSD. Few studies have examined the perceived need for, utilization of and the opinions of individuals with DSD regarding psychological support. METHODS This cross-sectional study was part of a European multicentre study in 14 different medical centres in six countries. In total, 1040 individuals with DSD participated in a patient-reported outcome questionnaire asking about experiences and opinions regarding psychological support in DSD care. RESULTS A majority of the participants reported that they had not received psychological support, in childhood and/or adolescence (70.6%, n = 692) nor in adulthood (67.9%, n = 661). Need for psychological support in childhood and/or adolescence was reported by 51.3% (n = 503), need for psychological support in adulthood, was reported by 49.5% (n = 482). The majority (80.2%; n = 718) agreed with the statement that people with DSD should always be offered psychological support. According to 78.7% (n = 697) of the participants, parents of children with DSD should always be offered psychological support. CONCLUSION Our findings support the existing consensus that psychological support should be an integral part of DSD care. The discrepancy between received and perceived need for psychological support suggests that individuals with DSD experience barriers to access mental health care services. Psychosocial and psychological services for children, adolescents and adults should therefore be available and offered throughout the lifespan to individuals with DSD.
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Affiliation(s)
- Elena Bennecke
- Sozialpädiatrisches Zentrum (SPZ), Center for Chronically Sick Children, Charité, University Medicine, Berlin, Germany.
| | - Anna Strandqvist
- Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Annelou De Vries
- Department of Child- and Adolescent Psychiatry, Amsterdam University Medical Centers, location VU University, the Netherlands.
| | - Baudewijntje P C Kreukels
- Department of Medical Psychology, Amsterdam University Medical Centers, location VU University, Amsterdam, Netherlands.
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Stock NM, Costa B, Bannister W, Ashby C, Matthews N, Hebden L, Melles L, Hilton-Webb Z, Smith S, Kane K, Carter L, Kearney A, Piggott K, Russell C, Wilkinson-Bell K. "When I was Younger, My Story Belonged to Everyone Else": Co-production of Resources for Adults Living with Craniosynostosis. Cleft Palate Craniofac J 2024:10556656241236580. [PMID: 38500357 DOI: 10.1177/10556656241236580] [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: 03/20/2024] Open
Abstract
OBJECTIVE Despite growing recognition that congenital craniofacial conditions have lifelong implications, psychological support for adults is currently lacking. The aim of this project was to produce a series of short films about living with craniosynostosis in adulthood, alongside a psychoeducational booklet. DESIGN The resources were developed using multiple focus groups and meetings attended by researchers, patient representatives, a leading charitable organisation, an award-winning film production company, clinicians, and other experts in the field. RESULTS An online mixed-methods survey was developed based on prior work to request feedback on the acceptability and utility of the resources from the craniosynostosis community. While data collection to evaluate the resources is ongoing, preliminary results (n = 36) highlight an acceptability rating of 100%. CONCLUSIONS The resources developed represent a step forward in addressing the unmet information and support needs of adults with craniosynostosis and highlight the benefits of co-production in research.
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Affiliation(s)
- Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | - Bruna Costa
- Centre for Appearance Research, University of the West of England, Bristol, UK
| | | | | | | | | | | | | | | | | | | | - Anna Kearney
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Katie Piggott
- Alder Hey Craniofacial Unit, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Charlotte Russell
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Berman S, Sharp GC, Lewis SJ, Blakey R, Davies A, Humphries K, Wren Y, Sandy JR, Stergiakouli E. Prevalence and Factors Associated with Behavioral Problems in 5-Year-Old Children Born with Cleft Lip and/or Palate from the Cleft Collective. Cleft Palate Craniofac J 2024; 61:40-51. [PMID: 36083151 PMCID: PMC10676624 DOI: 10.1177/10556656221119684] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To determine the UK prevalence of behavioral problems in 5-year-old children born with isolated or syndromic cleft lip and/or palate (CL/P) compared to the general population and identify potentially associated factors. DESIGN Observational study using questionnaire data from the Cleft Collective 5-Year-Old Cohort study and three general population samples. MAIN OUTCOME MEASURE The Strengths and Difficulties Questionnaire (SDQ). PARTICIPANTS Mothers of children (age: 4.9-6.8 years) born with CL/P (n = 325). UK general population cohorts for SDQ scores were: Millennium Cohort Study (MCS) (n = 12 511), Office of National Statistics (ONS) normative school-age SDQ data (n = 5855), and Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 9386). RESULTS By maternal report, 14.2% of children born with CL/P were above clinical cut-off for behavioral problems, which was more likely than in general population samples: 7.5% of MCS (OR = 2.05 [1.49-2.82], P < 0.001), 9.8% of ONS (OR = 1.52 [1.10-2.09], P = 0.008), and 6.6% of ALSPAC (OR = 2.34 [1.70-3.24], P < 0.001). Children in the Cleft Collective had higher odds for hyperactivity, emotional and peer problems, and less prosocial behaviors. Maternal stress, lower maternal health-related quality of life and family functioning, receiving government income support, and maternal smoking showed evidence of association (OR range: 4.41-10.13) with behavioral problems, along with maternal relationship status, younger age, and lower education (OR range: 2.34-3.73). CONCLUSIONS Findings suggest elevated levels of behavioral problems in children born with CL/P compared to the general population with several associated maternal factors similar to the general population.
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Affiliation(s)
- Samantha Berman
- Cleft Collective, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Gemma C. Sharp
- Cleft Collective, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Sarah J. Lewis
- Cleft Collective, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Rachel Blakey
- Population Health Sciences, Bristol Medical School, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Amy Davies
- Cleft Collective, University of Bristol, Bristol, UK
| | | | - Yvonne Wren
- Cleft Collective, University of Bristol, Bristol, UK
- Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
| | | | - Evie Stergiakouli
- Cleft Collective, University of Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
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Paganini A, Engström M, Mark H, Persson M. Being Normal yet Different: A Qualitative Study on the Dualistic Experience of Living With Unilateral Cleft Lip and Palate. Cleft Palate Craniofac J 2024; 61:52-60. [PMID: 35979595 PMCID: PMC10676618 DOI: 10.1177/10556656221121037] [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
The aim of the present study was to describe the experiences of young adults living with cleft lip and palate (CLP) and to explore potential gender differences. A descriptive qualitative study was designed involving semi-structured interviews. The interviews were analyzed using qualitative content analysis, as described by Graneheim and Lundman. A total of 9 women and 8 men, aged 22 to 26 years with UCLP. The main theme identified was: the duality of living with a cleft-being normal yet different, and 2 subcategories: "My cleft and me" and "My cleft and the World." The participants described themselves as normal yet different, both in relation to themselves and in relation to others. They also stated that gender norms regarding appearance affected their lives and how they saw the cleft. This study adds to the growing body of qualitative research on CLP. It highlights the dualistic experiences of feeling normal and different at the same time. The interviews indicated that this dualism was based on context and gender, showing the psychological complexity of an individual. The clinical implications of this study emphasizes the need of a person-centered care approach in the cleft care setting where the clinicians are aware of the potential dualistic experience that also may differ over time that individuals with cleft can experience. This can also help clinicians better understand and help patients reduce distress and strengthen positive coping mechanisms.
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Affiliation(s)
- Anna Paganini
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Reconstructive Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - My Engström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hans Mark
- Department of Plastic Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Reconstructive Plastic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin Persson
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
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Van der Straeten C, Verbeke J, Alighieri C, Bettens K, Van Beveren E, Bruneel L, Van Lierde K. Treatment Outcomes of Interdisciplinary Care on Speech and Health-Related Quality of Life Outcomes in Adults With Cleft Palate. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2654-2675. [PMID: 37844623 DOI: 10.1044/2023_ajslp-23-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
PURPOSE Individuals born with a cleft palate with or without a cleft lip (CP ± L) often experience functional, aesthetic, and psychosocial consequences well into adulthood. This study aimed to investigate outcomes of speech and health-related quality of life (HRQoL) in adults with a CP ± L who received interdisciplinary cleft care at the Ghent University Hospital using valid, reliable, and condition-specific instruments. METHOD Thirteen Belgian Dutch-speaking participants with a CP ± L with a mean age of 25.4 years (SD = 5.1, range: 20-33 years) and an age- and gender-matched control group of 13 participants without a CP ± L with a mean age of 25.2 years (SD = 4.8, range: 20-32 years) were included in this study. Speech characteristics were evaluated perceptually and instrumentally. HRQoL was assessed through standardized patient-reported outcome measures. Outcomes were compared with those of the control group and to normative data where available. RESULTS Participants with a CP ± L in this sample demonstrated significantly lower speech acceptability (p < .001) and higher rates of hypernasality (p = .015) and nasal turbulence (p = .005) than the control group. They showed significantly higher satisfaction with appearance of the cleft scar compared with norms of adults with a CP ± L (p = .047). No other differences in speech characteristics, sociodemographics, or HRQoL were found between participants with and without a CP ± L. CONCLUSIONS The reduced speech acceptability and the presence of resonance and nasal airflow disorders may indicate the need for standardized long-term outcome measurement and interdisciplinary follow-up for speech characteristics and velopharyngeal insufficiency in young and middle adulthood in future clinical practice. Additional research is necessary to further substantiate these findings and to determine predictors for these continuing complications in adults with a CP ± L. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24243901.
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Affiliation(s)
- Charis Van der Straeten
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Jolien Verbeke
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Cassandra Alighieri
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Ellen Van Beveren
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Laura Bruneel
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, Centre for Speech and Language Sciences (CESLAS), Ghent University, Belgium
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
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Mcwilliams D, Thornton M, Hotton M, Swan MC, Stock NM. Transitioning from child to adult cleft lip and palate services in the United Kingdom: Are the NICE Guidelines reflected in young adults' experiences? PSYCHOL HEALTH MED 2023; 28:2032-2044. [PMID: 36106353 DOI: 10.1080/13548506.2022.2124291] [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: 11/03/2021] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
Cleft lip and/or palate (CL/P) is one of the most common congenital conditions worldwide. Individuals born with CL/P will embark on a long-term treatment pathway throughout childhood and often into adulthood. As they grow older, young people become more involved in medical decisions. The National Institute for Clinical Excellence (NICE) has published guidance for health professionals on how transitions of responsibility should be managed in health services. The aim of the current study was to examine the extent to which the NICE recommendations are currently being implemented in UK CL/P services according to young adults' first-hand accounts. Semi-structured interviews were carried out with 15 young adults with CL/P aged 16-25 years. Interview questions were designed to map onto the NICE guidance. Data were analysed to assess whether each guideline was met, partially met, or not met for each individual participant. Overall, findings suggest that further consideration is needed as to how best to implement the recommendations effectively. The introduction of assigned transition workers in CL/P services to co-ordinate transition to adult care offers one possible solution. Focusing on the provision of holistic, patient-centred care, this aspect of the CL/P service could include giving patients access to medical history documentation, liaison with key health professionals including GPs and dental practitioners, and the development of age-appropriate resources to facilitate the transition process.
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Affiliation(s)
- Danielle Mcwilliams
- 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
| | - Matthew Hotton
- Spires Cleft Centre, John Radcliffe Hospital, Oxford, UK
| | - Marc C Swan
- Spires Cleft Centre, John Radcliffe Hospital, Oxford, UK
| | - Nicola M Stock
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Popat S, Critchlow S. The restorative dentistry management of adult cleft patients: 'the adult returner'. Br Dent J 2023; 234:906-911. [PMID: 37349439 DOI: 10.1038/s41415-023-5996-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 06/24/2023]
Abstract
This paper will discuss the management of adult patients with cleft lip and palate who return to care, often many decades after their initial course of treatment. This can be a very complex group of patients to treat as they often present with anxiety about dental care and often have other long-standing psychosocial issues. Working very closely with the multi-disciplinary team and the general dental practitioner is crucial to the successful outcome of care. This paper will outline the most common complaints that these patients may present with and the restorative dentistry solutions that are available to address them.
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Affiliation(s)
- Sandip Popat
- Consultant in Restorative Dentistry, Spires Cleft Centre, Headley Way, Oxford, OX3 9DU, United Kingdom.
| | - Simon Critchlow
- Consultant in Restorative Dentistry, Maxillofacial and Dental Department, Great Ormond Street Hospital, London, WC1A 3JH, United Kingdom
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Villafuerte KRV, Obeid AT, de Oliveira NA. Injectable Resin Technique as a Restorative Alternative in a Cleft Lip and Palate Patient: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050849. [PMID: 37241081 DOI: 10.3390/medicina59050849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/14/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Objective: The objective of this study is to present a case report in which the injectable composite resin technique was used as a restorative alternative for dental re-anatomization in a patient with cleft lip and palate and aesthetic complaints. Materials and Methods: The treatment plan included the re-anatomization of the maxillary premolars and canines using a flowable composite resin. This resin was injected and cured through a transparent matrix, which was a copy of the diagnostic wax-up model. Some parameters such as application time and marginal adaptation were also observed when performing the restorations. Additionally, old composite resin restorations on the upper lateral incisors were replaced using the incremental technique with conventional resins, which helped to assess color stability and fracture/wear deterioration for both restorative techniques. Results: The clinical case report shows that the injectable technique was a simple and quick method for restoring the anatomy of teeth (shape and contour) in one session, since the injectable resin can be easily applied in interproximal areas without the need to manually sculpt the resin. In this case, no clinical, visual, or photographic differences were found in marginal discoloration, color stability, and fracture/wear deterioration for the two restorative techniques after one year of follow-up. Conclusions: The professional may have another clinical option for restorative treatment in the case of small re-anatomizations. In addition, the injectable technique seems to require less operator skill and chair time and better marginal adaptation in cases of small anatomical changes.
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Affiliation(s)
- Kelly R V Villafuerte
- South America Center for Education and Research in Public Health, Universidad Privada Norbert Wiener, Lima 15046, Peru
- Dental Division, Restorative Dentistry of the Craniofacial Anomalies Rehabilitation Hospital-HRAC, University of São Paulo, Bauru 17012-230, Brazil
| | - Alyssa Teixeira Obeid
- Department of Dentistry, Endodontics and Dental Materials, University of São Paulo, Bauru 17012-901, Brazil
| | - Naiara Araújo de Oliveira
- Dental Division, Restorative Dentistry of the Craniofacial Anomalies Rehabilitation Hospital-HRAC, University of São Paulo, Bauru 17012-230, Brazil
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Stepp WH, Stein EJ, Canfarotta MW, Wood J, Vandoros E, Stein M, Daniel R, Shockley WW, Clark JM, Drake AF. Body Dysmorphic Disorder in Adult Patients With an Orofacial Cleft: An Unseen Psychological Burden. Laryngoscope 2023; 133:818-821. [PMID: 36054769 DOI: 10.1002/lary.30378] [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: 04/18/2022] [Revised: 07/14/2022] [Accepted: 08/12/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Facial dysmorphic disorder (FDD), a variant of body dysmorphic disorder, occurs when individuals are preoccupied with perceived defects in their facial appearance. Cleft lip and/or palate (CL/P) requires many clinical interventions and has significant psychological impacts on a patient's perception of appearance. This study identified psychological burdens related to living as an adult with CL/P and characterizes the degree of FDD symptoms in an adult craniofacial population. METHODS This was a prospective, single-center, cross-sectional case-control study using semi-structured interviews and symptom assessments at a university-based craniofacial center. Patients without CL/P undergoing non-cosmetic facial surgery were recruited as controls (n = 20). Patients with an orofacial cleft (n = 30) were recruited from medical and dental providers at the University of North Carolina. Body Dysmorphic Disorder-Yale Brown Obsessive Compulsive Scale (BBD-YBOCS) scores were collected from a control population and patients with CL/P to assess FDD severity. RESULTS Demographic factors such age, biological sex, and ethnicity had no significant impact on FDD symptom scores. Patient with CL/P were more likely to have significant FDD symptoms (BDD-YBOCS greater than 16) than patients without CL/P (OR 10.5, CI95 2.7-41.1), and had a mean difference in FDD symptoms scores of 10.04 (p < 0.0001; CI95 5.5-14.6). Patients with CL/P seen by a mental health provider in the past 3 months had 3-fold lower overall FDD symptom scores (OR 0.081; CI95 0.0085-0.77). CONCLUSIONS Adults with CL/P would benefit from treatment for cleft-specific needs and psychological support as they face unique stressors related to their appearance, including an increase in FDD-associated symptoms. This study emphasizes the importance of recognizing psychological symptoms and providing ongoing multidisciplinary care to adults with CL/P. LEVEL OF EVIDENCE 3; Individual case-control study Laryngoscope, 133:818-821, 2023.
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Affiliation(s)
- Wesley H Stepp
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Eva J Stein
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Michael W Canfarotta
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Jeyhan Wood
- University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A.,Department of Surgery, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Eva Vandoros
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Margot Stein
- University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A
| | - Renie Daniel
- University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A.,Department of Oral and Maxillofacial Surgery, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A
| | - William W Shockley
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Joseph Madison Clark
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Amelia F Drake
- Department of Otolaryngology, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, U.S.A.,University of North Carolina Craniofacial Center, University of North Carolina, School of Dentistry, Chapel Hill, North Carolina, U.S.A
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13
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Adult Cleft Patients: An Exploration of Functional Needs and Treatment Barriers. J Craniofac Surg 2023; 34:332-336. [PMID: 35984002 DOI: 10.1097/scs.0000000000008931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/07/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Management of cleft lip and palate has been well characterized in pediatric patients, but limited data exist regarding the long-term functional outcomes of cleft patients once they reach adulthood. MATERIALS AND METHODS An institutional, cross-sectional survey of adult patients with a history of cleft lip and/or palate was performed. The survey recorded patient characteristics, concerns, and barriers to care. Patient-reported outcome measures were assessed using the Nasal Obstruction Symptom Evaluation Scale, Epworth Sleepiness Scale, Mandibular Function Impairment Questionnaire, and the CLEFT-Q Speech Modules. RESULTS A total of 63 patients (18.2%) participated in the survey. The mean patient age was 43.7 years (median: 41 y, range: 19-93 y), and the most common diagnosis was cleft lip and palate (51%) followed by isolated cleft palate (35%) and isolated cleft lip (14%). A subset of patients scored with moderate to severe dysfunction on each outcome measure including the Nasal Obstruction Symptom Evaluation Instrument (59%), Epworth Sleepiness Scale (7%), and Mandibular Function Impairment Questionnaire (13%). Respondent scores on the CLEFT-Q Speech modules demonstrated a bimodal distribution with lower scores in a significant subset of patients with cleft palate and cleft lip and palate. Many respondents (41%) were interested in clinical evaluation but cited barriers to seeking treatment including financial barriers (35%) or lack awareness of clinical options (27%). CONCLUSIONS Many cleft patients have persistent needs or concerns in adulthood, especially regarding speech and nasal breathing. Systemic barriers pose challenges to these patients undergoing clinical evaluation.
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14
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Defabianis P, Cogo C, Massa S, Romano F. Oral-Health-Related Quality of Life among Non-Syndromic School-Age Children with Orofacial Clefts: Results from a Cross-Sectional Study in Northern Italy. CHILDREN 2022; 9:children9071098. [PMID: 35884082 PMCID: PMC9321112 DOI: 10.3390/children9071098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 11/16/2022]
Abstract
The aim of this cross-sectional study was to determine the influence of orofacial clefts on the oral-health-related quality of life (OHRQoL) in a group of Italian children and adolescents and to examine whether gender, age, cleft type, and surgical protocol were associated with patients’ OHRQoL. A total of 71 patients with cleft lip and/or cleft palate (CLP) and 71 age- and gender-matched controls (aged 8 to 18 years) were asked to complete the Child Oral Health Impact Profile (COHIP), a validated and reliable questionnaire to assess self-reported OHRQoL in children and teenagers. Children with orofacial clefts showed statistically significant lower quality of life scores than controls for total OHRQoL and for each of the subscales. Gender, the type of cleft, and the type of surgical protocol had no significant influence on OHRQoL. The negative impact of CLP on the area of self-image was greater in 12–18-year-olds, indicating a higher need for psychosocial counselling. These findings suggest that Italian CLP children and adolescents experience a poorer OHRQoL in comparison to their non-cleft peers.
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15
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Niinomi K, Ueki S, Fujita Y, Kitao M, Matsunaka E, Kumagai Y, Ike M. Differences in specific concerns perceived by parents of children with cleft lip and/or palate based on the types of cleft. Int J Paediatr Dent 2022; 32:304-313. [PMID: 34358380 DOI: 10.1111/ipd.12886] [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: 12/27/2020] [Revised: 07/21/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Parents of children with cleft lip and/or palate (CL/P) have concerns including guilt and worry. Differences in concerns by cleft type is, however, under-researched. AIM To compare differences in perceived concerns among parents of children with CL/P by cleft type, adjusting for children's gender and age. DESIGN Cross-sectional study conducted in an outpatient centre, assessing psychological status of 171 parents of children aged <12 with CL/P using 12 items. RESULTS Across cleft types, 'I am worried about whether the child's teeth will be straight' was the most strongly perceived concern (70.8%). After adjusting for gender and age, logistic regression showed significant differences in type of CL/P for (eg) 'I am worried that the child's appearance will not be beautiful', associated with CL over CP (OR = 0.07, 95% CI: 0.02-0.26) and CLP over CP (8.52, 3.23-22.50);' 'I am concerned about my child being able to speak well', associated with CP (3.12, 1.07-9.11) and CLP (5.69, 2.43-13.33) over CL, and 'I am worried that the child could suffer due to his/her appearance', associated with CL over CP (0.08, 0.02-0.29) and CLP over CP (10.07, 13.78-27.36). CONCLUSIONS Parents' concerns were influenced by cleft type.
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Affiliation(s)
- Kazuteru Niinomi
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shingo Ueki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Fujita
- Department of Nursing, School of Nursing, Mukogawa Women's University, Nishinomiya, Japan
| | - Mika Kitao
- Department of Nursing, School of Nursing, Mukogawa Women's University, Nishinomiya, Japan
| | - Eriko Matsunaka
- Department of Nursing, Japanese Red Cross Kyushu International College of Nursing, Munakata, Japan
| | - Yukari Kumagai
- Department of Nursing, Osaka University Dental Hospital, Suita, Japan
| | - Miho Ike
- Department of Nursing, Osaka University Dental Hospital, Suita, Japan
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16
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Corcoran M, Karki S, Harila V, Luoto A, Ylikontiola L, Sándor GK, Anttonen V. Dental fear among adolescents with cleft. Int J Paediatr Dent 2021; 31:716-723. [PMID: 33730383 DOI: 10.1111/ipd.12782] [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: 09/22/2020] [Revised: 02/07/2021] [Accepted: 03/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dental fear is a prevalent phenomenon among children and adolescents globally. AIM To investigate dental fear among 18-year-olds with cleft lip and/or palate (CLP) at their final follow-up cleft clinic visit, and to evaluate the association between dental fear and OHRQoL. DESIGN This cross-sectional study included the cohort of children with CLP treated at the Oulu University Hospital Cleft Lip and Palate Center, in northern Finland since 1995. A total of 62 of 64 individuals participated in this study. The validated Finnish version of the Oral Health Impact Profile (OHIP-14) was used to assess OHRQoL. Dental fear was studied using the validated Modified Dental Anxiety Scale (MDAS) and cognitive vulnerability model (CVM). RESULTS Almost two fifths of the participants reported moderate dental fear. Participants with cleft including lip and participants reporting impact on OHRQoL reported higher mean MDAS scores. In an unadjusted model, adolescents with cleft including lip had risk for higher dental MDAS scores compared with the ones with cleft including only palate. CONCLUSIONS Dental fear is common among adolescents with CLP, specifically among those with clefts involving the lip. OHRQoL and dental fear seem to be associated.
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Affiliation(s)
- Mirjami Corcoran
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Saujanya Karki
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Virpi Harila
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Anni Luoto
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Leena Ylikontiola
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - George K Sándor
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Vuokko Anttonen
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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17
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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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18
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Ardouin K, Davis N, Stock NM. Expanding Support Services for Adults Born With Cleft Lip and/or Palate in the United Kingdom: An Exploratory Evaluation of the Cleft Lip and Palate Association Adult Services Programme. Cleft Palate Craniofac J 2021; 59:S48-S56. [PMID: 34184577 DOI: 10.1177/10556656211025415] [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: 11/15/2022] Open
Abstract
BACKGROUND The largest group of people living with repaired cleft lip and/or palate (CL/P) are adults. Previous research has identified unmet treatment and psychosocial needs, yet few interventions exist. This article outlines 3 interventions developed by the Cleft Lip and Palate Association as part of its 3-year community-based Adult Services Programme; an Adults Conference, a series of panel discussions ("Cleft Talk") streamed in podcast/video format, and a Leaver's Pack of resources for adults wishing to return to cleft care. METHODS Feedback from attendees of the Adults Conferences (2018-2019) was collected using specifically developed evaluation forms. Streaming metrics and social media interactions were extracted for Cleft Talk panel discussions (2019-2020). The Leaver's Pack was piloted in 2020, using an online evaluation form. Specialist health professionals were invited to provide feedback or participate in a one-to-one interview regarding their perceived impact of the program. RESULTS All 3 interventions across the different modalities received support from participating adults, demonstrating potential to meet adults' needs across the life span. Health professionals also offered support for the program, viewing the interventions as a valuable adjunct to formal medical CL/P services. CONCLUSIONS This exploratory evaluation indicates that peer- and community-led interventions, in combination with ongoing access to specialist medical care, can have a range of positive impacts for adults with CL/P. There is scope for similar initiatives to be developed internationally and for individuals with other craniofacial conditions. Not-for-profit organizations are encouraged to routinely evaluate their interventions to create a stronger evidence base for their valuable work.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, The Green House, London, United Kingdom
| | - Nicky Davis
- Cleft Lip and Palate Association, The Green House, London, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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19
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Alighieri C, D'haeseleer E, Bettens K, Bonte K, Vermeersch H, Vermeire N, Claeys M, Sseremba D, Galiwango G, Van Lierde K. Sociodemographics and Quality of Life in Dutch-Speaking Adolescents and Adults With and Without a Cleft Lip and/or Palate. Cleft Palate Craniofac J 2021; 59:S65-S73. [PMID: 34142586 DOI: 10.1177/10556656211024513] [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: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the impact of living with a cleft lip and/or cleft palate (CL/P) on sociodemographic variables, quality of life, aesthetics, life satisfaction, and social distress in Dutch-speaking adolescents and adults. DESIGN Cross-sectional study. PARTICIPANTS Thirty Dutch-speaking participants with a CL/P with a mean age of 26.93 years (SD = 11.69) and an age- and gender-matched control group of 30 participants (19 men and 11 women) without a CL/P with a mean age of 26.87 years (SD = 11.73). MAIN OUTCOME MEASURES Self-reported outcomes of sociodemographics, quality of life, aesthetics, life satisfaction, social distress, and impact of cleft on well-being and functioning. RESULTS No significant differences in educational level, employment, monthly net income, marital status, and having children were found between participants with and without a CL/P. In addition, quality of life, overall aesthetics, life satisfaction, and social distress did not differ between the 2 groups. Among participants with CL/P, there were no gender differences in the influence of their CL/P on daily functioning, well-being, social contacts, family life, applying for a job, work, education, or leisure time. CONCLUSION The findings revealed no differences between participants with and without a CL/P with regard to sociodemographics, quality of life, aesthetics, life satisfaction, or social distress. There were no gender differences in the influence of cleft on well-being and functioning. Longitudinal research can help determine possible fluctuations in the impact of living with a CL/P across the life span.
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Affiliation(s)
- Cassandra Alighieri
- Department of Rehabilitation Sciences, 26656Ghent University, Corneel Heymanslaan, Ghent, Belgium
| | - Evelien D'haeseleer
- Department of Rehabilitation Sciences, 26656Ghent University, Corneel Heymanslaan, Ghent, Belgium
| | - Kim Bettens
- Department of Rehabilitation Sciences, 26656Ghent University, Corneel Heymanslaan, Ghent, Belgium
| | - Katrien Bonte
- Department of Head and Skin, 26656Ghent University Hospital, Corneel Heymanslaan, Ghent, Belgium
| | - Hubert Vermeersch
- Department of Head and Skin, 26656Ghent University Hospital, Corneel Heymanslaan, Ghent, Belgium
| | - Nele Vermeire
- Department of Rehabilitation Sciences, 26656Ghent University, Corneel Heymanslaan, Ghent, Belgium
| | - Merel Claeys
- Department of Rehabilitation Sciences, 26656Ghent University, Corneel Heymanslaan, Ghent, Belgium
| | - Daniel Sseremba
- Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - George Galiwango
- Comprehensive Rehabilitation Services in Uganda (CoRSU), Kisubi, Uganda
| | - Kristiane Van Lierde
- Department of Rehabilitation Sciences, 26656Ghent University, Corneel Heymanslaan, Ghent, Belgium
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20
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Cronin A, Verdon S, McLeod S. Persistence, strength, isolation, and trauma: An ethnographic exploration of raising children with cleft palate. JOURNAL OF COMMUNICATION DISORDERS 2021; 91:106102. [PMID: 33945933 DOI: 10.1016/j.jcomdis.2021.106102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 02/03/2021] [Accepted: 03/14/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The lives of families of young children with cleft palate (±lip) are complex. Multiple interventions are required as part of the long-term multidisciplinary treatment for children with CP±L, with an impairment-focused approach prevailing. Research with young children with CP±L has focused on treatment and intervention, and previous qualitative research has been collected predominantly via interviews, so little is understood about the day-to-day lives of families of young children with CP±L. AIMS (1) To increase understanding of the lives of children with CP±L and their families by applying an ethnographic lens to improve clinical practice (2) to identify key interactions and encounters that shape the experiences of children with CP±L and their families (3) to examine how family-centered practice can enhance practitioner-family relationships in providing effective and evidence-based care for children with CP±L. METHOD Ethnographic observations of seven families of children with CP±L and their families and educators including parents, siblings, aunts, grandparents, and teachers involved multiple site visits. Rich data were collected to gather information about different aspects of their lives (such as their strengths, routines, preferences, challenges and experiences). There were 84 artefacts collected: 18 interviews, 29 videos, one extended audio recording of a mealtime, seven photos contributed by families, seven case history questionnaires, and 22 field notes. These data were analyzed inductively using thematic analysis. RESULTS Three overarching themes and 11 subthemes were identified: (1) the whole child (persistence, communication, activities, mealtimes), (2) family strength and support (strong families, external support, attitudes, advocacy, positive medical experiences) and (3) family isolation and trauma (negative medical experiences, traumatic and challenging experiences). CONCLUSION This is the first study to use ethnographic methodology to facilitate the collection of unique insights into the lives of young children with CP±L and their families to improve clinical practice for SLPs. The unique application of family-centered practice with these families promoted trust and highlighted their challenges and strengths which could be considered by SLPs to provide holistic intervention.
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Affiliation(s)
- Anna Cronin
- School of Teacher Education, Charles Sturt University, Australia.
| | - Sarah Verdon
- School of Community Health, Charles Sturt University, Australia
| | - Sharynne McLeod
- School of Teacher Education, Charles Sturt University, Australia
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21
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Dardani C, Howe LJ, Mukhopadhyay N, Stergiakouli E, Wren Y, Humphries K, Davies A, Ho K, Weinberg SM, Marazita ML, Mangold E, Ludwig KU, Relton CL, Davey Smith G, Lewis SJ, Sandy J, Davies NM, Sharp GC. Cleft lip/palate and educational attainment: cause, consequence or correlation? A Mendelian randomization study. Int J Epidemiol 2021; 49:1282-1293. [PMID: 32373937 PMCID: PMC7660147 DOI: 10.1093/ije/dyaa047] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies have found that children born with a non-syndromic orofacial cleft have lower-than-average educational attainment. Differences could be due to a genetic predisposition to low intelligence and academic performance, factors arising due to the cleft phenotype (such as social stigmatization, impaired speech/language development) or confounding by the prenatal environment. A clearer understanding of this mechanism will inform interventions to improve educational attainment in individuals born with a cleft, which could substantially improve their quality of life. We assessed evidence for the hypothesis that common variant genetic liability to non-syndromic cleft lip with or without cleft palate (nsCL/P) influences educational attainment. METHODS We performed a genome-wide association study (GWAS) meta-analysis of nsCL/P with 1692 nsCL/P cases and 4259 parental and unrelated controls. Using GWAS summary statistics, we performed Linkage Disequilibrium (LD)-score regression to estimate the genetic correlation between nsCL/P, educational attainment (GWAS n = 766 345) and intelligence (GWAS n = 257 828). We used two-sample Mendelian randomization to evaluate the causal effects of genetic liability to nsCL/P on educational attainment and intelligence. RESULTS There was limited evidence for shared genetic aetiology or causal relationships between nsCL/P and educational attainment [genetic correlation (rg) -0.05, 95% confidence interval (CI) -0.12 to 0.01, P 0.13; MR estimate (βMR) -0.002, 95% CI -0.009 to 0.006, P 0.679) or intelligence (rg -0.04, 95% CI -0.13 to 0.04, P 0.34; βMR -0.009, 95% CI -0.02 to 0.002, P 0.11). CONCLUSIONS Common variants are unlikely to predispose individuals born with nsCL/P to low educational attainment or intelligence. This is an important first step towards understanding the aetiology of low educational attainment in this group.
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Affiliation(s)
- Christina Dardani
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laurence J Howe
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Nandita Mukhopadhyay
- Centre for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Evie Stergiakouli
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,The Cleft Collective, University of Bristol, Bristol, UK
| | - Yvonne Wren
- The Cleft Collective, University of Bristol, Bristol, UK.,Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
| | | | - Amy Davies
- The Cleft Collective, University of Bristol, Bristol, UK
| | - Karen Ho
- The Cleft Collective, University of Bristol, Bristol, UK.,Bristol Bioresource Laboratories, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Seth M Weinberg
- Centre for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary L Marazita
- Centre for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kerstin U Ludwig
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah J Lewis
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,The Cleft Collective, University of Bristol, Bristol, UK
| | - Jonathan Sandy
- The Cleft Collective, University of Bristol, Bristol, UK.,Dean of the Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gemma C Sharp
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,The Cleft Collective, University of Bristol, Bristol, UK
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22
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Ardouin K, Hotton M, Stock NM. Interpersonal Relationship Experiences in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom. Cleft Palate Craniofac J 2021; 58:1412-1421. [PMID: 33535806 DOI: 10.1177/1055665620987109] [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: 11/16/2022] Open
Abstract
OBJECTIVES Previous research has suggested that adults with a cleft lip and/or palate (CL/P) may find their familial, friend, collegial, and/or romantic relationships impacted by their condition. Building on this prior work, this study examined the self-reported interpersonal experiences of a national sample of adults born with CL/P. DESIGN An online survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research. Data from 181 participants were included in the present study, collected between July and October 2018. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics and independent t tests. RESULTS Most participants reported having good relationships with family members and existing friends with similar patterns of marriage as the general population. However, some experienced difficulties initiating new friendships and romantic relationships. Participants described bullying and discrimination in adulthood, most often in public settings and the workplace. Participants reported lower satisfaction with intimate relationships and less secure attachment compared to the general population. Concerns regarding the heritability of CL/P and its impact on the decision to have a family were also reported. CONCLUSIONS Individuals with CL/P are at risk of negative social experiences, which if not appropriately addressed may impact psychological well-being in adulthood. The findings illustrate the importance of routine psychosocial support from childhood onward to help individuals with CL/P build social skills, self-esteem, and social confidence and to develop mutually fulfilling friendships and intimate relationships. Additionally, societal campaigns to raise awareness and target discrimination may be helpful.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, The Green House, London, United Kingdom
| | - Matt Hotton
- The Spires Cleft Centre, 11269John Radcliffe Hospital, Oxford, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, 1981University of the West of England, Bristol, United Kingdom
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Sakran KA, Song S, Li H, Pan P, Chen N, Zeng N, Chi T, Shi B, Huang H, Wang Y, Gong C. Self-Consciousness of Appearance in Chinese Patients With Cleft Lip: Validation of the Chinese Derriford Appearance Scale 59 (DAS 59) Instrument. Front Pediatr 2021; 9:825997. [PMID: 35223716 PMCID: PMC8863654 DOI: 10.3389/fped.2021.825997] [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: 11/30/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To develop a reliable and valid Chinese version of the Derriford Appearance Scale 59 (DAS 59) instrument for assessing the self-consciousness of appearance in Chinese patients with cleft lip. METHODS The original DAS 59 instrument was translated into Mandarin, back-translated, and culturally adapted among the Chinese population, following the protocol of the original DAS 59. The validation of the Chinese DAS 59 instrument was estimated on 443 adult participants including 213 subjects with a history of cleft lip with/without palate (CL/P, study group) and 230 normal subjects without facial appearance concern (control group). The reliability was estimated by Cronbach's α coefficient and Guttman's split-half coefficient. Content validity was tested using the Spearman correlation coefficient, while discriminant validity was tested by the Mann-Whitney U test. RESULTS The overall internal consistency of Chinese DAS 59 was excellent; Cronbach's α was 0.951 (α = 0.965 and 0.959 in the study and control groups, respectively). Further, Guttman's split-half coefficient was excellent in the study group (0.935) and control group (0.901). The validity of content was good with an acceptable correlation between all the items and domains. The construct validity through the discrimination was good with a statistically significant difference in most domains between the two groups. Patients with CL/P had more concern about the general self-consciousness and social self-consciousness of appearance. They also showed a good self-concept score. CONCLUSION The Chinese version of DAS 59 demonstrated acceptable reliability and good construct and discriminant validity. It can be used for the research and assessment of the psychological state and quality of life for Chinese patients with cleft lip as well as other appearance problems and concerns.
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Affiliation(s)
- Karim A Sakran
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Sixing Song
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Huo Li
- Department of Pharmacy, Personalized Drug Therapy Key Laboratory of Sichuan Province Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Peiyue Pan
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Nan Chen
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Ni Zeng
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Ting Chi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Hanyao Huang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan Wang
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Caixia Gong
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Oral Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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24
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Ardouin K, Drake D, Popat S, Stock NM. Treatment Experiences in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom. Cleft Palate Craniofac J 2020; 58:864-871. [PMID: 33138633 DOI: 10.1177/1055665620968342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: Adults with cleft lip and/or palate (CL/P) may report dissatisfaction with aesthetic and/or functional outcomes and express desire for further treatment. Although medical intervention can improve quality of life, surgical procedures require complex decision-making and can invoke psychological distress. The aim of this study was to gain a better understanding of ongoing treatment-related support needs by examining self-reported treatment experiences of a sample of adults born with CL/P. Design: An online, mixed-methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics. Results: Although participants were satisfied with surgical and dental/orthodontic outcomes overall, many reported ongoing difficulties. Some stated they would seek further treatment while others felt conflicted about risks and benefits. Some had refused treatment, citing treatment fatigue, anxiety, and/or concerns that treatment would be unsuccessful. More than 40% of participants were unaware of their entitlement to cleft-related treatment provided by the National Health Service, and many others had experienced difficulties accessing care. Conclusions: Although advances in health care may offer opportunities for adults to improve their quality of life, treatment decisions should be weighed with the support of a clinical psychologist where available. Guidance for young adults considering future treatment is also recommended. Finally, training and resources for local practitioners may improve general awareness of CL/P services and increase access to specialist care for adults with ongoing CL/P-related concerns.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, London, United Kingdom
| | - David Drake
- National Cleft Surgical Service for Scotland, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Sandip Popat
- Restorative Dentistry, Spires Cleft Centre, John Radcliffe Hospital, Headley Way, Oxford, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, United Kingdom
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25
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Ahmed M, Fida M, Jeelani W. Management of an adolescent with complete bilateral cleft lip and palate using fan-shaped expander and secondary alveolar bone graft: A case report. Int Orthod 2020; 18:593-602. [PMID: 32753334 DOI: 10.1016/j.ortho.2020.04.002] [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: 04/10/2020] [Revised: 04/20/2020] [Accepted: 04/22/2020] [Indexed: 11/26/2022]
Abstract
Treatment approach for bilateral cleft lip and palate (BLCLP) patients varies according to their presenting age. This case report describes the successful orthodontic treatment in an adolescent with BLCLP who was classified in Grade 3 according to Bauru BLCLP yardstick. The patient was diagnosed with skeletal Class III malocclusion, severe crowding, anterior and bilateral posterior crossbites and bilateral maxillary anterior alveolar defects. A combined orthodontic and surgical approach comprising of fan-shaped expander, secondary alveolar bone graft followed by comprehensive orthodontic treatment was utilized. The treatment resulted in a greatly improved facial aesthetics and stomatognathic function, which contributed to psychological well being of the patient.
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Affiliation(s)
- Maheen Ahmed
- Bakhtawar Amin Medical and Dental College, Multan, Pakistan
| | - Mubassar Fida
- Section of Dentistry, Department of Surgery, The Aga Khan University Hospital, P.O. Box 3500, Stadium Road, 74800 Karachi, Pakistan
| | - Waqar Jeelani
- Bakhtawar Amin Medical and Dental College, Multan, Pakistan.
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26
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Ardouin K, Davis S, Stock NM. Physical Health in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom. Cleft Palate Craniofac J 2020; 58:153-162. [PMID: 32734770 DOI: 10.1177/1055665620944758] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives: Previous research in the field of cleft lip and/or palate (CL/P) has indicated a high prevalence of common health concerns, functional difficulties, and additional conditions known to affect long-term physical health, cognitive development, and psychological well-being. The aim of the present study was to examine the self-reported physical health of a national sample of adults born with CL/P. Design: Drawing upon previous literature, an online, mixed-methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received between July and October 2018. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics. Results: A considerable proportion of participants reported one or more comorbid conditions, including common health concerns, difficulties related to language and/or learning, unresolved speech and/or hearing issues, problems with vision, breathing difficulties, and concerns related to eating and drinking. Many participants were unaware of their entitlement to specialist treatment, and some had experienced difficulties accessing specialist services through their general practitioner (GP). Conclusions: Individuals with CL/P may be at risk of physical health issues persisting into adulthood. The monitoring of physical symptoms from an early age is recommended, as is a routine physical assessment for adults returning to the CL/P service later in life. Education for both GPs and adults is warranted. Future studies could investigate the wider prevalence of comorbid conditions in CL/P, in order to better understand the longer-term health burden.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, London, United Kingdom
| | - Sinéad Davis
- Welsh Centre for Cleft Lip and Palate, Morriston Hospital, Swansea, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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27
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Matsunaka E, Kumagai Y, Ike M, Takano S, Kogo M. Decision-making process to undergo surgery among adolescent patients with cleft lip and/or palate. Jpn J Nurs Sci 2020; 17:e12342. [PMID: 32390343 DOI: 10.1111/jjns.12342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/19/2020] [Accepted: 03/29/2020] [Indexed: 12/30/2022]
Abstract
AIM As patients with cleft lip and/or palate grow older, the main decision-making process for treatment is likely to shift from a parent-centered to a patient-centered process. However, many adolescent patients have difficulty in treatment decision-making. This study aimed to clarify the decision-making process regarding undergoing surgery among adolescent patients with cleft lip and/or palate. METHODS Participants were adolescent patients with cleft lip and/or palate aged 14-18 years who were admitted to a hospital in Japan for surgery. Fourteen patients (six boys, eight girls) and their parents agreed to participate in this study. Data were collected in face-to-face semi-structured interviews. Data were analyzed qualitatively with inductive content analysis. RESULTS Fifteen categories were classified into three themes for adolescent patients' decision-making processes regarding undergoing surgery. The three themes were: (a) a doctor's recommendation for surgery, (b) psychological conflict about surgery, and (c) a final decision about surgery. CONCLUSION This study's findings suggest that adolescent patients with cleft lip and/or palate were not adequately involved in the decision-making process before undergoing surgery. Medical staff need to explain other treatment options, the risks and benefits of surgery with materials and methods that adolescent patients can understand as part of "a doctor's recommendation for surgery." Medical staff and parents need to encourage adolescent patients to communicate their preferences and values to reduce patients' "psychological conflict about surgery" and adolescent patients' intentions should be considered in "a final decision about surgery."
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Affiliation(s)
- Eriko Matsunaka
- Department of Nursing, Japanese Red Cross Kyushu International College of Nursing, Fukuoka, Japan
| | - Yukari Kumagai
- Nursing Department, Osaka University Dental Hospital, Osaka, Japan
| | - Miho Ike
- Nursing Department, Osaka University Dental Hospital, Osaka, Japan
| | - Sachiko Takano
- Nursing Department, Osaka University Dental Hospital, Osaka, Japan
| | - Mikihiko Kogo
- Department of Oral and Maxillofacial Surgery 1, Graduate School of Dentistry, Osaka University, Osaka, Japan
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28
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Corcoran M, Karki S, Harila V, Kyngäs H, Luoto A, Ylikontiola LP, Sándor GK, Anttonen V. Oral health-related quality of life among young adults with cleft in northern Finland. Clin Exp Dent Res 2020; 6:305-310. [PMID: 32396275 PMCID: PMC7301391 DOI: 10.1002/cre2.284] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 02/01/2023] Open
Abstract
Objectives This study aimed to examine Oral Health‐related Quality of Life (OHRQoL) among patients with cleft lip with or without palate (CLP) at their final scheduled follow‐up visit at the age of 18 years. Another aim was to investigate the motivation to attend multiple follow‐up appointments and the satisfaction with care given by the cleft team using inductive qualitative analysis. Methods This cross‐sectional study was conducted among the cohort of children born with CLP who had undergone treatment at the Oulu University Hospital Cleft Lip and Palate Centre, in northern Finland since 1995. OHRQoL was assessed using the validated Finnish version of the short form of the Oral Health Impact Profile (OHIP‐14). In addition to the OHIP‐14, two open‐ended questions were also included. These questions investigated the experience of each participant concerning their motivation to attend the Oulu University Hospital Cleft Lip and Palate Centre to receive complex treatments, and their satisfaction with care provided by the cleft team. Results were presented as proportions, means, and SD. Inductive content analysis method was performed for analysis of the open‐ended questions. Results A total of 63 patients with CLP participated in this study. More than half of the participants had cleft palate. More than half of the participants reported an impact on OHRQoL (OHIP‐14 score ≥ 3). All the participants with bilateral cleft lip and palate, three fourths of the participants with unilateral cleft lip and palate, and half of the participants with cleft palate reported impact on OHRQoL. Inductive content analysis showed that one fourth of the participants reported a good outcome as a motivation to attend cleft center despite of complex procedures. All the participants reported their appreciation of the cleft team. Conclusions Despite the comprehensive treatment received by the patients born with a CLP, they still experienced lower OHRQoL, especially physical pain and psychological discomfort were more pronounced. However, good outcome, support, and oral health care being a normal routine were the motivating factors to attend a long and demanding oral health care regimen.
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Affiliation(s)
- Mirjami Corcoran
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Saujanya Karki
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Virpi Harila
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu and University Hospital of Oulu, Oulu, Finland
| | - Anni Luoto
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland
| | - Leena P Ylikontiola
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - George K Sándor
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Vuokko Anttonen
- Research Unit of Oral Health Sciences, University of Oulu, Oulu, Finland.,Medical Research Centre Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
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29
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Moi AL, Gjengedal H, Lybak K, Vindenes H. "I smile, but Without Showing My Teeth": The Lived Experience of Cleft, Lip, and Palate in Adults. Cleft Palate Craniofac J 2020; 57:799-807. [PMID: 32351124 PMCID: PMC7297502 DOI: 10.1177/1055665620922096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: To explore and describe the experience of growing up with unilateral cleft lip and palate (CLP) in adults. Design: Face-to-face interviews. Giorgi’s phenomenological method was used for analysis. Participants: Twenty-one (mean age: 40.8 years) adults treated for unilateral CLP during childhood and adolescence participated in the study. Results: Growing up with CLP meant to become aware of bodily otherness. The possible reactions from peers early in life complicated the striving for inclusion outside the close family. Being self-confident, clever in school, physically fit, and having trusted friends represented barriers against teasing and bullying. Nevertheless, the reflected image, in mirrors, windows, and photos, reminded the participants of the objectifying looks from others and often led to bodily adjustments that persisted into adulthood. The trajectory of treatment was not questioned during childhood, and the participants accepted the decisions on care made by experts and parents. Although problems related to the cleft could persist or return after the termination of ordinary treatment, a more hesitant view on the possible benefits of additional surgery was typical in adulthood. Conclusions: In retrospect, growing up with a unilateral CLP was found to have been an unquestioned part of the adult participants’ childhood, a burden that they feared would, to some extent, also be passed to their own children. However, the CLP had not prevented them from achieving goals and satisfaction in life. The occurrence of persisting psychological, functional, and esthetic challenges in adults suggests the need for an individualized, lifelong, and multidisciplinary perspective on CLP follow-up.
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Affiliation(s)
- Asgjerd Litleré Moi
- Department of Plastic, Hand and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Harald Gjengedal
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Kari Lybak
- Department of Plastic, Hand and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway
| | - Hallvard Vindenes
- Department of Plastic, Hand and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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30
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Acum M, Mastroyannopoulou K, O'Curry S, Young J. The Psychosocial Patient-Reported Outcomes of End of Pathway Cleft Surgery: A Systematic Review. Cleft Palate Craniofac J 2020; 57:990-1007. [PMID: 32174163 DOI: 10.1177/1055665620911328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To identify and review the literature on the psychosocial patient-reported outcomes (PROs) of surgery at the end of the cleft treatment pathway. DESIGN A systematic literature search was performed using electronic databases (Medline, PubMed, EMBASE, PsycInfo, Web of Science, and Science Direct) from database inception to September 2017, to identify studies measuring and reporting the psychosocial PROs of end of pathway cleft surgery. RESULTS Of 263 identified papers, 22 studies were eligible for inclusion. Apart from one randomized controlled study, studies were largely observational and adopted a cross-sectional or retrospective design. The majority (n = 16) were small-scale studies. The methodological quality was variable in terms of what, how, and when psychosocial outcomes were measured and reported. None of the studies utilized a psychosocial PRO measure validated in the cleft population, and few studies measured outcomes prospectively. A high proportion of studies utilized bespoke measures of patient satisfaction. Taken together, findings from the included studies are tentative but seem to suggest patients derive some benefit from undergoing end of pathway cleft surgery, in terms of increased satisfaction, quality of life, social interactions, and decreased appearance-related distress. CONCLUSIONS Due to methodological challenges and the heterogeneity of what, how, and when outcomes are measured and currently reported, it is difficult to determine the psychosocial PROs of end of pathway cleft surgeries. Consequently, this review advocates the conduct of well-designed, longitudinal studies using cleft-sensitive tool/s to capture the psychosocial PROs of end of pathway cleft surgery at various time points.
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Affiliation(s)
- Michelle Acum
- Cambridgeshire and Peterborough NHS Foundation Trust, Elizabeth House, Fulbourn Hospital, Cambridge, United Kingdom.,University of East Anglia, Norwich, United Kingdom
| | - Kiki Mastroyannopoulou
- Norfolk and Norwich University Hospital, University of East Anglia, Norwich, United Kingdom
| | - Sara O'Curry
- Psychological Medicine for Children, Young People and their Families, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Judith Young
- University of East Anglia, Addenbrooke's Cambridge University Hospital Trust, Cambridge, United Kingdom
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31
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Ardouin K, Hare J, Stock NM. Emotional Well-Being in Adults Born With Cleft Lip and/or Palate: A Whole of Life Survey in the United Kingdom. Cleft Palate Craniofac J 2020; 57:877-885. [PMID: 31906694 DOI: 10.1177/1055665619896681] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Objectives: Previous research with adults born with cleft lip and/or palate (CL/P) has identified a range of concerns regarding mental health and quality of life, concluding that overall emotional functioning is poorer compared to the general population. The aim of the current study was to build on this previous work by investigating the self-reported emotional well-being of adults born with CL/P in the United Kingdom. Design: An online, mixed methods survey was designed by the Cleft Lip and Palate Association in collaboration with the Centre for Appearance Research at the University of the West of England. A total of 207 eligible responses were received between July and October 2018. Qualitative data were analyzed using inductive content analysis, while quantitative data were analyzed using descriptive statistics and independent t tests. Results: Almost half of the sample reported a diagnosis of a mental health condition. Scores on standardized measures indicated significantly lower global self-worth, higher levels of fear of negative appearance evaluation, and lower self-perceived job competence compared to normative data. Scores of overall body esteem were in line with the general population. Most participants had not received psychological support from their regional CL/P team and 41% were unaware of their entitlement to treatment from the National Health Service. Conclusions: Individuals with CL/P may be at risk of emotional distress persisting into adulthood. The integration of routine psychological support from an early age is highly recommended, as is information for young adults about to complete routine treatment. Comprehensive psychological screening for adults returning to the service later in life is also strongly advised.
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Affiliation(s)
- Kenny Ardouin
- Cleft Lip and Palate Association, London, United Kingdom
| | - Jess Hare
- National Cleft Surgical Service for Scotland, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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32
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Connolly KA, Kurnik NM, Truong TA, Muller C, Beals PH, Singh DJ, Beals SP. Long-Term Outcomes for Adult Patients With Cleft Lip and Palate. J Craniofac Surg 2019; 30:2048-2051. [PMID: 31524752 DOI: 10.1097/scs.0000000000005932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate a single center's experience with adult patients who had cleft lip, cleft palate, or both. The authors aimed to identify common long-term needs in this patient population and evaluated the relationship of team-based care in meeting those needs. To do so, the authors retrospectively reviewed chart records from a single private practice and tertiary referral cleft center for all patients who were ≥15 years of age and who had a history of clefts of the lip or palate, or both, from January 1, 2013, to June 30, 2014. The authors compared the concerns of the patients who received cleft-team-based care by a single, multidisciplinary cleft team; multiple multidisciplinary cleft teams; or no formal cleft team. The authors analyzed data for 142 patients. The most common patient concerns were lip aesthetics (64%), nose aesthetics (61%), septal deviations (47%), nasal obstruction (44%), malocclusion (32%), oronasal fistulas (29%), and speech (21%). Oronasal fistulas were more commonly reported in the group of patients who had care by multiple teams (42.9%; P < .001). Malocclusion was more commonly reported in the group of patients who had care by multiple teams (50%; P = .001). The authors found that adult patients who have undergone rehabilitation for cleft lip and palate appear to have a common set of long-term needs. Multidisciplinary cleft-team-based care appears to be the most effective way to address these needs.
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Affiliation(s)
| | - Nicole M Kurnik
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Hospital
| | - Tuan A Truong
- Division of Plastic and Reconstructive Surgery, Mayo Clinic Hospital
| | | | | | - Davinder J Singh
- Barrow Cleft and Craniofacial Center.,Division of Plastic and Reconstructive Surgery at Phoenix Children's Hospital, Phoenix, AZ
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33
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Bruneel L, Alighieri C, Bettens K, Musasizi D, Ojok I, D'haeseleer E, Van Lierde K. Assessing health-related quality of life in patients with cleft palate in resource-limited countries: A preliminary evaluation of the VELO questionnaire in Uganda. Int J Pediatr Otorhinolaryngol 2019; 124:39-46. [PMID: 31158570 DOI: 10.1016/j.ijporl.2019.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/15/2019] [Accepted: 05/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Studies evaluating health-related quality of life (HRQoL) in patients with cleft palate living in resource-limited countries such as Uganda are scarce. The VELO questionnaire evaluates the impact of speech (and swallowing) difficulties on the patient's HRQoL. The aim was to evaluate an adapted English version of the VELO questionnaire with reduced response options in Ugandan patients with a cleft lip and palate in order to identify influencing factors and future perspectives to implement HRQoL assessement in this population. METHODS Based on the responses of 16 parents of patients with cleft palate, 6 adolescent/adult patients with cleft palate and 12 control participants without cleft palate, observations regarding linguistic and cultural difficulties were noted and the discriminant validity and internal consistency of this adapted version of the questionnaire were evaluated. Additionally, the relationship between these responses and perceptually assessed speech parameters was assessed. RESULTS Half of the participants (11/22) completed the questionnaire independently, frequently resulting in incomplete responses (8/11). Difficulties with wording and cultural aspects influencing the responses were identified. The subscales showed excellent internal consistency, with the exception of the subscale 'swallowing problems'. The score on the subscale 'perception by others' of the parent report showed no significant difference with the score of the control group. The total score on the parent report and the youth report was (borderline) significantly related to the speech variables speech understandability, speech acceptability and the VPC-SUM. DISCUSSION AND CONCLUSION Promising results regarding the validity and internal consistency of the adapted instrument were found, indicating the potential of the VELO questionnaire for HRQoL assessment at the CoRSU hospital in Uganda. However, results should be interpreted cautiously, given that all participants had a primary language other than English, the small sample size with skewed distribution of speech characteristics, and the bias induced by socially desirable responses. In future studies, adaptations based on qualitative research to account for linguistic and cultural aspects, followed by a rigorous forward-backward translation of the questionnaire to English and Luganda are needed.
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Affiliation(s)
- Laura Bruneel
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium.
| | - Cassandra Alighieri
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kim Bettens
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Duncan Musasizi
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Isaac Ojok
- Comprehensive Rehabilitation Services in Uganda (CoRSU), P.O. Box 46, Kisubi, Uganda
| | - Evelien D'haeseleer
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
| | - Kristiane Van Lierde
- Ghent University, Department of Rehabilitation Sciences, Corneel Heymanslaan 10 2P1, 9000, Ghent, Belgium
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Stock NM, Zucchelli F, Hudson N, Kiff JD, Hammond V. Promoting Psychosocial Adjustment in Individuals Born With Cleft Lip and/or Palate and Their Families: Current Clinical Practice in the United Kingdom. Cleft Palate Craniofac J 2019; 57:186-197. [PMID: 31431061 DOI: 10.1177/1055665619868331] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives: The importance of psychosocial aspects of care has received growing recognition in recent years. However, the evidence base for psychosocial intervention remains limited. Specialist clinicians working in cleft lip and/or palate (CL/P) services hold a wealth of knowledge and experience yet to be elicited. The aims of this study were to identify common psychosocial challenges and potential risk and/or protective factors for psychosocial distress from the perspective of specialist clinicians and to establish the types of interventions currently being delivered in practice. Design: Individual interviews with 17 clinical nurse specialists and 19 specialist clinical psychologists, representing all 16 UK CL/P surgical sites. Data were analyzed using inductive content analysis. Results: Numerous psychosocial challenges affecting individuals with CL/P and their families were identified across the life span. Risk factors were predominantly contextual in nature, while protective factors appeared amenable to intervention. Participants drew upon a range of therapeutic models and approaches to guide formulation and intervention, while acknowledging the lack of evidence to support these approaches in CL/P populations specifically. Conclusions: Findings have important implications for the way in which psychosocial support for CL/P and related conditions is delivered and evaluated. A framework for the standardized assessment of holistic individual and familial well-being is proposed. Suggestions for increasing the evidence base for specific psychosocial interventions are made, including enhanced family functioning; social, emotional, and appearance concerns; treatment decision-making; and screening for psychosocial and developmental issues.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, United Kingdom
| | - Fabio Zucchelli
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, United Kingdom
| | | | - James D. Kiff
- Centre for Appearance Research, University of the West of England, Coldharbour Lane, Bristol, United Kingdom
| | - Vanessa Hammond
- Welsh Centre for Cleft Lip and Palate, Swansea, United Kingdom
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Stock NM, Guest E, Stoneman K, Ridley M, Evans C, LeRoy C, Anwar H, McCarthy G, Cunniffe C, Rumsey N. The Contribution of a Charitable Organization to Regional Cleft Lip and Palate Services in England and Scotland. Cleft Palate Craniofac J 2019; 57:14-20. [PMID: 31307213 DOI: 10.1177/1055665619862727] [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: 11/17/2022] Open
Abstract
BACKGROUND From diagnosis through to adulthood, a cleft lip and/or palate (CL/P) poses a number of challenges for those affected. Alongside the care provided by clinical teams, complementary information and support is offered by charitable organizations. In 2011, the Cleft Lip and Palate Association received funding to implement a new regional service across England and Scotland, with the aim of increasing support at a local level. The Centre for Appearance Research at the University of the West of England were commissioned to conduct an independent evaluation of the service over 7 years. METHODS A pragmatic, mixed-methods approach was utilized to assess the impact of the service from the perspective of charity volunteers; children, young people, and adults with CL/P; caregivers; and clinicians. Feedback forms were distributed to stakeholders at a variety of events, and qualitative feedback was collected via focus groups and an online survey. RESULTS The majority of participants indicated they had gained access to a local support network, felt more able to cope with CL/P-related challenges, and felt more confident in themselves. Qualitative investigation provided further support for these findings and highlighted additional benefits of the regional service for clinical teams. CONCLUSIONS The evaluation provides encouraging evidence toward the contribution of a relatively small charitable organization in the context of cleft care. The importance of a pragmatic approach to community-based evaluation and the benefits of collaborative working between researchers and the charitable sector were also highlighted.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Ella Guest
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Kate Stoneman
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Matthew Ridley
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Claire Evans
- The Cleft Lip and Palate Association, London, United Kingdom
| | - Cherry LeRoy
- The Cleft Lip and Palate Association, London, United Kingdom
| | - Hamza Anwar
- The Cleft Lip and Palate Association, London, United Kingdom
| | | | - Claire Cunniffe
- The Cleft Lip and Palate Association, London, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Friedlander L, Berdal A, Boizeau P, Licht BA, Manière MC, Picard A, Azzis O, Vazquez MP, Alberti C, Molla MDLD. Oral health related quality of life of children and adolescents affected by rare orofacial diseases: a questionnaire-based cohort study. Orphanet J Rare Dis 2019; 14:124. [PMID: 31164137 PMCID: PMC6549379 DOI: 10.1186/s13023-019-1109-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 05/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rare diseases affecting the teeth, the oral cavity and the face are numerous, each of them present specific characteristics, and is a life-long condition. The aim of the study was to assess the association between Oral health-related quality of life (OHRQoL), and demographic characteristics, clinical and dental factors, and psycho-social characteristics to investigate that oral symptoms are not the main factors underlying a decrease in OHRQoL. MATERIAL AND METHODS We conducted a national cohort study in French centres for rare diseases (RD) specialized in orofacial diseases. The inclusion criteria were: to have received care in RD centres over the last 5 years (2012-2017) and to have been between 6 and 17 years of age on September 1, 2017. Patients were invited to answer a questionnaire composed of socio-demographic, clinical and dental questions, psychosocial questions and then fill in the Child-OIDP Index. At the end of the questionnaire, a free space was left for the patient to add a verbatim comment to provide qualitative data. Thematic analysis was used to analyze the verbatim answers. RESULTS Complete data were available for 110 patients. The sample included 44.5% boys and 55.5% girls. Ages ranged from 6 to 17 years old and 68.2% were between 6 to 12 years old and 31.8% were between 13 and 17 years old. Factor associated with a lower OHRQoL were: being a girl (p = 0.03), renouncement to dental care for financial reasons (p = 0.01), having syndromic disease (p = 0.01), having a problem with tooth shape and color (p = 0.03), feeling isolated, alone and different from other children (p = 0.003 and p = 0.02). Qualitative analysis highlighted very little recourse to psychological care and patients reported great anxiety and fear about the future. CONCLUSION OHRQoL of children suffering from these diseases is impaired, especially from the psychosocial point of view but also from that of the course of treatment and access to care. There is a need to improve the legibility of care pathways and the financial coverage of treatments.
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Affiliation(s)
- Lisa Friedlander
- Sorbonne Paris Cité, INSERM, Laboratoire ECEVE UMR1123, Université Paris Diderot, Paris, France
- Centre de Reference, Maladies Orales et Dentaires Rares, Hopital Rothschild, APHP, Paris, France
- Filière de Santé Maladies Rares TETECOU, Malformations Rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
| | - Ariane Berdal
- Centre de Reference, Maladies Orales et Dentaires Rares, Hopital Rothschild, APHP, Paris, France
- Filière de Santé Maladies Rares TETECOU, Malformations Rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
- Sorbonne Paris Cité, INSERM, Laboratoire de Physiopathologie Orale et Moléculaire, Université Paris Diderot, UMRS, 1138 Paris, France
| | - Priscilla Boizeau
- AP-HP, Unité d’Epidémiologie Clinique, Hôpital Robert Debré, Paris, France
- Sorbonne Paris-Cité, INSERM U1123 et CIC-EC 1426, Université Paris Diderot, Paris, France
| | - Brigitte Alliot Licht
- Filière de Santé Maladies Rares TETECOU, Malformations Rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
- Centre de Competence, Maladies orales et Dentaires Rares, CHU de Nantes, Nantes, France
| | - Marie-Cécile Manière
- Filière de Santé Maladies Rares TETECOU, Malformations Rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
- Centre de Référence, Maladies orales et dentaires rares, Pôle de Médecine et Chirurgie Bucco-dentaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Arnaud Picard
- Filière de Santé Maladies Rares TETECOU, Malformations Rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
- Centre de Référence des Fentes et Malformations Faciales, Hôpital Necker, AP-HP, Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Olivier Azzis
- Filière de Santé Maladies Rares TETECOU, Malformations Rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
- Centre de Compétence des Fentes et Malformations Faciales, CHU de Rennes, Rennes, France
| | - Marie-Paule Vazquez
- Filière de Santé Maladies Rares TETECOU, Malformations Rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
- Centre de Référence des Fentes et Malformations Faciales, Hôpital Necker, AP-HP, Paris, France
- Université Paris Descartes-Sorbonne Paris Cité, Paris, France
| | - Corinne Alberti
- Sorbonne Paris Cité, INSERM, Laboratoire ECEVE UMR1123, Université Paris Diderot, Paris, France
- AP-HP, Unité d’Epidémiologie Clinique, Hôpital Robert Debré, Paris, France
- Sorbonne Paris-Cité, INSERM U1123 et CIC-EC 1426, Université Paris Diderot, Paris, France
| | - Muriel De La Dure Molla
- Centre de Reference, Maladies Orales et Dentaires Rares, Hopital Rothschild, APHP, Paris, France
- Filière de Santé Maladies Rares TETECOU, Malformations Rares de la tête, du cou et des dents, Hôpital Necker, Paris, France
- INSERM UMRS1163 Bases Moléculaires et Physiopathologiques des Ostéochondrodysplasies, Institut Imagine, Necker, Paris, France
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Menon A, Krishnan S, Shetty V. Development and Application of a Novel Patient-Reported Outcome Measure on QoL and Facial Aesthetics-A Study on South Indian Population. Cleft Palate Craniofac J 2019; 56:1340-1352. [PMID: 31146577 DOI: 10.1177/1055665619852571] [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: 01/11/2023] Open
Abstract
BACKGROUND The goal of cleft therapy has progressed from simply correcting the deformity to uplifting the patient's quality of life (QoL). At the end of comprehensive treatment, a patient with cleft lip and palate (CLP) should report with satisfactory QoL scores in all domains such as aesthetics, speech, function, and psychology. OBJECTIVE To develop and validate a novel, disease-specific questionnaire designed in 2 regional languages to assess the QoL in young adult patients with CLP of South India following comprehensive treatment. METHODS A preliminary questionnaire was created from the literature review and patient interviews, considering regional sociodemographic conditions. The questionnaire was then validated by subject experts and pilot tested. The resultant tool was implemented on patients at treatment completion. Data collected were assimilated for statistical evaluation. RESULTS The questionnaire was deemed reliable (Cronbach α = .854 and test-retest reliability, κ = 0.8) and was administered to 100 young adult patients with CLP (mean age: 22 years). A large majority (83%) of the population felt more confident about themselves, with positive responses to familial relations, social interaction, and self-image. About 25% of the patients faced problems with speech regularly, while a majority of patients did not face problems with chewing and swallowing. Nearly 60% of patients were fully satisfied with their facial appearance, while others had concerns about their lip and nose aesthetics. The results were descriptive of the local population. CONCLUSIONS Most patients achieved satisfactory QoL in all domains following comprehensive multispeciality therapy. The novel tool is simple, reliable, and can be adapted to homogenous population groups.
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Affiliation(s)
- Akash Menon
- Deptartment of Oral and Maxillofacial Surgery, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, India.,Nitte Meenakshi Institute of Craniofacial Surgery, Justice K. S. Hegde Charitable Hospital, Mangalore, India
| | - Shalini Krishnan
- Deptartment of Oral and Maxillofacial Surgery, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, India
| | - Vikram Shetty
- Deptartment of Oral and Maxillofacial Surgery, A. B. Shetty Memorial Institute of Dental Sciences, Mangalore, India.,Nitte Meenakshi Institute of Craniofacial Surgery, Justice K. S. Hegde Charitable Hospital, Mangalore, India
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Kappen IFPM, Bittermann GKP, Stock NM, Mink van der Molen AB, Breugem CC, Swanenburg de Veye HFN. Quality of Life and Patient Satisfaction in Adults Treated for a Cleft Lip and Palate: A Qualitative Analysis. Cleft Palate Craniofac J 2019; 56:1171-1180. [DOI: 10.1177/1055665619843410] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective: Long-term outcomes of patients born with a cleft lip and palate (CLP) are scarcely investigated. Yet, this patient group is of particular interest, as they can provide a valuable retrospective view upon their treatment experiences and psychological adjustment. Qualitative accounts may be especially useful in understanding the patient journey. Design: The present study set out to evaluate quality of life and satisfaction with treatment in adult patients previously treated for CLP at the Wilhelmina Children’s Hospital. Semistructured interviews were performed. Patients: A total of 22 patients aged 17 to 35 years (mean: 25 years) were interviewed about their experiences of growing up with CLP and of the treatment they received. Interviews were audio-recorded and factors thought to influence psychological adjustment were identified. Results: Four main themes were identified: background factors, support systems, treatment factors, and coping/internal factors. Each theme was described with illustrative quotes. Conclusion: This study underlines that psychological adjustment can fluctuate over time and greatly differs between individuals, even during adulthood. Psychological support should therefore be available beyond the finalization of the treatment course. Furthermore, the majority of participants stated they had wanted more psychological support as a child to facilitate resilience and to help them cope with challenges.
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Affiliation(s)
- Isabelle F. P. M. Kappen
- Department of Plastic Surgery, Wilhelmina Children’s Hospital, University of Utrecht, Utrecht, the Netherlands
| | - Gerhard K. P. Bittermann
- Department of Maxillofacial Surgery, Wilhelmina Children’s Hospital, University of Utrecht, Utrecht, the Netherlands
| | - Nicola Marie Stock
- Centre for Academic Child Health, University of Bristol, Bristol, United Kingdom
| | | | - Corstiaan C. Breugem
- Department of Plastic Surgery, Wilhelmina Children’s Hospital, University of Utrecht, Utrecht, the Netherlands
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Ballard LM, Jenkinson E, Byrne CD, Child JC, Davies JH, Inskip H, Lokulo-Sodipe O, Mackay DJG, Wakeling EL, Temple IK, Fenwick A. Lived experience of Silver-Russell syndrome: implications for management during childhood and into adulthood. Arch Dis Child 2019; 104:76-82. [PMID: 29954740 DOI: 10.1136/archdischild-2018-314952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/28/2018] [Accepted: 06/03/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There is limited information on the psychosocial impact of growing up with Silver-Russell syndrome (SRS), characterised by slow growth in utero leading to short stature in adulthood. Such information could aid families in making difficult treatment decisions and guide management strategies for health professionals. We aimed to explore the lived experience of people with SRS across the lifespan. DESIGN/SETTING/PATIENTS In-depth, semi-structured interviews were conducted between January 2015 and October 2016 with a sample of 15 adults (six women) with genetically confirmed SRS from the UK. Qualitative interviews were transcribed and coded to identify similarities and differences: codes were then grouped to form overarching themes. RESULTS Four themes were identified from participant accounts: (1) appearance-related concerns extending beyond height; (2) strategies to deal with real and perceived threats; (3) women's experiences of pain, disability and feeling older than their years; and (4) feeling overlooked in romantic relationships. These themes show that other factors, beyond short stature, affect patient well-being and indicate a mismatch between patient need and healthcare provision. CONCLUSIONS Challenges in SRS during childhood and adolescence were central to the psychosocial impact of SRS, and were not limited to height. These challenges, as well as symptoms such as pain and fatigue for women, have not previously been documented. To help individuals with SRS develop strategies to manage psychosocial issues, we recommend clinicians incorporate psychological services as an integral part of multidisciplinary teams managing individuals with SRS during childhood, adolescence and adulthood.
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Affiliation(s)
- Lisa Marie Ballard
- Faculty of Medicine, Clinical Ethics and Law, University of Southampton, Southampton, UK
| | - Elizabeth Jenkinson
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Christopher D Byrne
- Nutrition and Metabolism Unit, University of Southampton, Southampton, UK.,Southampton National Institute for Health Research, Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Jenny C Child
- Membership and Communications, Child Growth Foundation, Sutton Coldfield, UK
| | - Justin Huw Davies
- Department of Endocrinology, University Hospital Southampton NHS Foundation Trust, Southampton Children's Hospital, Southampton, UK
| | - Hazel Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Oluwakemi Lokulo-Sodipe
- Faculty of Medicine, Human Development and Health, University of Southampton, Southampton, UK.,Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Emma L Wakeling
- North West Thames Regional Genetics Service, London North West Healthcare NHS Trust, London, UK
| | - I Karen Temple
- Wessex Clinical Genetics Service, University Hospital Southampton NHS Foundation Trust, Southampton, UK.,Faculty of Medicine, Human Development and Health, University of Southampton, Southampton, UK
| | - Angela Fenwick
- Faculty of Medicine, Clinical Ethics and Law, University of Southampton, Southampton, UK
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Zhang Q, Yue Y, Shi B, Yuan Z. A Bibliometric Analysis of Cleft Lip and Palate-Related Publication Trends From 2000 to 2017. Cleft Palate Craniofac J 2018; 56:658-669. [PMID: 30376727 DOI: 10.1177/1055665618807822] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Cleft lip and palate (CLP) is the most common human cranial and maxillofacial birth defect. The aim of this bibliometric analysis was to provide an overview of the development of CLP-related research. METHOD Cleft lip and palate-related studies published from 2000 to 2017 were retrieved from the Science Citation Index Expanded core database. Publication date, journal, authors, first authors, keywords, and citations were extracted and quantitatively analyzed using Bibliographic Item Co-Occurrence Matrix Builder software. The word matrix and co-occurrence matrix were established, and the co-citation analysis, keyword clustering, and social network analysis (SNA) of highly cited papers were completed. RESULTS A total of 9040 articles were retrieved from the 18 years of publications that were searched. The number of documents steadily increased over the period of interest, with a slight decrease in 2016 and 2017. This article separately examined the top most cited papers and high-frequency keywords from 3 time periods: 2000 to 2005, 2006 to 2011, and 2011 to 2017. The strategy coordinates of citation reflect TGF-β3, MSX1 gene, technique for cleft lip repair, TTF2, P63, IRF6 gene, FGF signaling, PVRL1, TGFBR2, and BMP4 gene as areas of research interest in the field. Moreover, the SNA of keywords highlighted new research topics: meta-analysis, cone beam computed tomography, tooth agenesis, case-control study, association study, micrognathia, DiGeorge syndrome, NSCL/P, UCLP, GWAS, MTHFR, and CLPTM1L. CONCLUSION We conducted bibliometric research of CLP across an 18-year span. The results help to define an overall command of the latest topics in CLP and provide insight for launching new projects.
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Affiliation(s)
- Qiang Zhang
- 1 Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China.,2 Department of the Second Respiratory, Shengjing Hospital, China Medical University, Shenyang, China
| | - Yuanyi Yue
- 3 Department of the Second Gastroenterology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Bei Shi
- 4 Department of Functional Laboratory, China Medical University, Shenyang, China
| | - Zhengwei Yuan
- 1 Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital, China Medical University, Shenyang, China
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Stock NM, Sharratt ND, Heath J, Nankivell D, Martindale A, Ridley M, Ahmed A, McMullin A, Cunniffe C. Falling through the gap: Dental treatment experiences of patients affected by cleft lip and/or palate. Br Dent J 2018; 225:218-222. [PMID: 30072784 DOI: 10.1038/sj.bdj.2018.542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2018] [Indexed: 11/09/2022]
Abstract
Introduction In the UK, one in 600–700 infants is born with a cleft lip and/or palate (CL/P). Previous research has identified patients with CL/P to be at high risk of long-term oral health issues. Yet, few of these patients are currently accessing community dental care. Aims To assess patients' dental treatment experiences and their suggestions for improving services. Materials and methods Five focus groups were conducted with 24 adults with CL/P. Thematic analysis was performed on the data. Results Participants perceived local dental practitioners to lack knowledge about CL/P and its treatment. Consequently, some participants had stopped visiting a dental practice altogether. Participants were also largely unaware of the specialist CL/P services they are entitled to. Discussion Suggestions are made for the integration of improved training and resources for local dental practitioners. Closer communication between specialist cleft teams and local dental practitioners could also help to bridge the gap in knowledge and improve patients' engagement with dental services. The tertiary sector has a crucial role to play in empowering patients to take more control of their oral health and dental treatment.
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Affiliation(s)
- N M Stock
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - N D Sharratt
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - J Heath
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - D Nankivell
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
| | - A Martindale
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
| | - M Ridley
- University of the West of England, Centre for Appearance Research, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - A Ahmed
- University of Liverpool School of Dentistry, Liverpool, L69 7ZX, United Kingdom
| | - A McMullin
- Cleft Lip & Palate Orthodontics, Royal Manchester Children's Hospital, Oxford Road, Manchester, M13 9WL, United Kingdom
| | - C Cunniffe
- Cleft Lip and Palate Association, London, EC1V 7LQ, United Kingdom
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Nicholls W, Persson M, Robinson S, Selvey L. Adult Narratives of the Psychosocial Impact of Cleft in a Western Australian Cohort. Cleft Palate Craniofac J 2018; 56:373-382. [PMID: 29652531 DOI: 10.1177/1055665618770184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Living with a cleft condition involves many years of multidisciplinary therapy, treatment, and surgical intervention. This complex process may have both physical and psychosocial long-term impacts. There is limited evidence of the psychosocial impact of cleft on individuals in Australia. AIM To obtain an understanding of the adult patient perception of having a cleft and explore the impact of the condition on their lives. DESIGN Qualitative methodologies at one case study site in Western Australia. POPULATION OF INTEREST Adults with a cleft lip and/or palate (CL/P) who had received treatment at Princess Margaret Hospital, the only treatment center for cleft in Western Australia. METHODOLOGY Individual in-depth semi-structured qualitative interviews were conducted and recorded and transcribed for analysis. RESULTS Fifteen adults with a CL/P. Two main themes were identified: lived experience (with 3 subthemes: normality, support networks, and impacts in later life) and advice to others. The majority of participants reported social rejection and isolation, which occurred mostly at school and in some instances at home, but did not often last into adulthood. The greatest protective factor was the support of family and friends, which if missing during their childhood, was desired and appreciated in adulthood. CONCLUSION Adults with CL/P may require psychosocial support from their cleft team including referral to clinicians in adult services. There is also the need for earlier psychological interventions and social programs to support those with appearance-related social difficulties.
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Affiliation(s)
- Wendy Nicholls
- 1 Dental Department/Cleft Lip and Palate Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Martin Persson
- 2 Centre for Appearance Research, University of West England, Bristol, United Kingdom
| | - Suzanne Robinson
- 3 School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Linda Selvey
- 3 School of Public Health, Curtin University, Perth, Western Australia, Australia
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Stock NM, Ridley M, Guest E. Teachers’ Perspectives on the Impact of Cleft Lip and/or Palate During the School Years. Cleft Palate Craniofac J 2018; 56:204-209. [PMID: 29652535 DOI: 10.1177/1055665618770191] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Cleft lip and/or palate (CL/P) poses many challenges for those affected throughout the school years, with recent studies pointing to a trend in poor educational outcomes. Previous research has highlighted the important role that teachers play in supporting young people with chronic health conditions yet studies in the field of CL/P suggest that teachers may lack knowledge of the condition, and underestimate pupils’ academic ability. Qualitative investigation of the impact of CL/P from the teacher’s perspective may provide additional insight as well as potential suggestions for improving the school experience for affected pupils. Methods: Twenty UK preschool, primary, and secondary school teachers with experience of teaching pupils with CL/P completed an open-ended survey, eliciting qualitative data. Results: Qualitative content analysis was performed. Data were presented under 5 key headings: Knowledge of CL/P and its effects, perceived impact of CL/P on education, teachers’ training needs, delivery of training, and impact of CL/P on teachers. Teachers were able to identify a number of potential social, emotional, and treatment-related challenges within the school setting, yet did not believe that CL/P would have a long-term impact on pupils’ educational achievement. Participating teachers reported that cleft-specific training and access to relevant resources would be highly beneficial. Conclusions: Acting as a platform for future research, this exploratory study provides insight into the challenges faced by teachers and offers suggestions for how to improve teachers’ understanding of CL/P, and their confidence in dealing with cleft-related issues.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- The Cleft Collective Bristol, University of Bristol, Bristol, United Kingdom
| | - Matthew Ridley
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
- The Cleft Collective Bristol, University of Bristol, Bristol, United Kingdom
| | - Ella Guest
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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Nicholls W, Selvey LA, Harper C, Persson M, Robinson S. The Psychosocial Impact of Cleft in a Western Australian Cohort Across 3 Age Groups. Cleft Palate Craniofac J 2018; 56:210-221. [PMID: 29649370 DOI: 10.1177/1055665618769660] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Management of a cleft of the lip and/or palate (CL/P) involves a multidisciplinary team approach lasting from birth to potentially postskeletal maturity. This condition is complex, with both medical and psychosocial implications that may place individuals with a cleft at higher risk of developing psychosocial problems. METHODOLOGY A self-administered questionnaire was completed by a sample from the Western Australian cleft population comprising 3 age groups: child (n = 100), adolescent (n = 101), and adult (n = 158). RESULTS Public speaking, being photographed, special relationships, and participation in school were identified as the areas most impacted by having a cleft. Hearing and speech were reported to have a higher importance than facial and dental appearance. Participants rated support given to them by their parents as the most important, with high ratings for treatment providers. For teasing, the impact of cleft was significantly higher among participants with cleft lip and palate for both the adolescent and adult age groups. There was little significant difference by gender across the variables, which suggests that males are just as likely to require support as females. CONCLUSION The impact of a cleft across multiple psychosocial domains needs to be recognized and addressed as part of craniofacial team care across age groups.
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Affiliation(s)
- Wendy Nicholls
- 1 Princess Margaret Hospital Dental/Cleft Lip and Palate Unit, Perth, Western Australia, Australia
| | - Linda A Selvey
- 2 Curtin University, Perth, Western Australia, Australia
| | - Craig Harper
- 3 Private Consultancy, Perth, Western Australia, Australia
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Nicholls W, Harper C, Robinson S, Persson M, Selvey L. Adult-Specific Life Outcomes of Cleft Lip and Palate in a Western Australian Cohort. Cleft Palate Craniofac J 2018; 55:1419-1429. [PMID: 29620916 DOI: 10.1177/1055665618768540] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND People with a cleft of the lip and/or palate (CL/P) differ from their peers due to their facial appearance, hearing and speech difficulties, and the significant time spent attending appointments and recovering from surgical interventions. These differences may impact life outcomes including occupation, income, education, relationships, psychosocial health issues, and lifestyle choices. METHODOLOGY A self-administered questionnaire was posted to 338 former and current patients of the Cleft Lip and Palate Unit of Princess Margaret Hospital (PMH), Perth, Western Australia. RESULTS Completed questionnaires were returned by 158 former and current patients. In comparison to the Australian Bureau of Statistics, study participants attained equivalent highest education levels, full-time annual income levels, occupational categories, employment rates, and home ownership levels. They did not marry later and demonstrated positive health-related lifestyle behaviors. However independent living was significantly delayed, and the number of romantic relationships, marriages, and children was lower, with separation/divorce rates also being lower. A key finding was that 78% of participants self-reported that they experienced at least 1 psychosocial health issue and more than half experienced anxiety and/or depression. CONCLUSION When comparing the sociological outcomes for the study participants, the psychosocial outcomes were the areas of most concern. Further investigation is required to determine the causes for the high self-reported rates of anxiety and/or depression found in this study.
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Affiliation(s)
- Wendy Nicholls
- 1 Dental Department/Cleft Lip and Palate Unit, Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Craig Harper
- 2 School of Computing, Curtin University, Perth, Western Australia, Australia
| | - Suzanne Robinson
- 3 School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Martin Persson
- 4 Centre for Appearance Research, University of West England, Bristol, United Kingdom
| | - Linda Selvey
- 3 School of Public Health, Curtin University, Perth, Western Australia, Australia
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Abstract
Background: More than 2 billion people worldwide now use social networking sites, with an increasing number of users accessing these sites to obtain health information and engage in emotional support. Yet, investigation of social networking sites in the context of cleft lip and/or palate (CL/P) has been scarce. Methods: Real-time data posted during 2 weeks in April 2017 were collected from 2 existing private Facebook groups (hosted by the Cleft Lip and Palate Association United Kingdom) using video screen capture software. The number of posts, comments, unique contributors, and post “likes” was recorded, as well as the type and theme of each post. Data relating to the benefits and challenges of participation in the 2 groups were also collected via an online survey. Results: A content analysis of real-time data identified perioperative care, associated syndromes, and dental health to be particular areas of concern for parents/caregivers. Expectations, experiences, and outcomes of further treatment were key topics of discussion for adults with CL/P. Common benefits of the groups included the ability to connect with others, learn about local events, give and receive emotional support, and obtain quick responses to queries in a semi-anonymous environment. Disadvantages of the groups included a reliance upon opinion rather than medical fact and the frequent use of inappropriate terminology. Conclusions: Social networking sites appear to be a helpful source of health-related information and peer support for the CL/P population, yet closer monitoring of these groups may be required.
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Borghini A, Despars J, Habersaat S, Turpin H, Monnier M, Ansermet F, Hohlfeld J, Muller-Nix C. ATTACHMENT IN INFANTS WITH CLEFT LIP AND/OR PALATE: MARGINAL SECURITY AND ITS CHANGES OVER TIME. Infant Ment Health J 2018; 39:242-253. [PMID: 29489020 DOI: 10.1002/imhj.21696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This study examines the attachment quality and how this changed over time among infants who had cleft lip and palate (CLP), by conducting a prospective longitudinal study addressing the effects of this type of perinatal event on the parent-infant relationship and the emotional development of the infants. At 12 months of age, the Strange Situation Paradigm (SSP; M. Ainsworth, M.C. Blehar, E. Waters, & T. Wall, 1978) was administered to a sample of 38 CLP infants (born between 2003 and 2010) and 17 healthy controls. At 4 years of age, the Attachment Story Completion Task (ASCT; I. Bretherton, D. Ridgeway, & J. Cassidy, 1990) was administered to 32 individuals from the CLP sample and 14 from the control group. As reported in the literature, CLP infants display secure attachment behaviors as frequently as do control infants (55%). However, a more detailed analysis of the attachment scales revealed that CLP infants show more avoidance and less proximity seeking. In addition, a closer examination of the subcategories of attachment styles revealed that most CLP infants (71%) displayed distal attachment strategies such as the B1/B2 or A1/A2 subcategories. At 4 years old, CLP infants clearly displayed more deactivation and less security than did the control sample. Moreover, when detailing the evolution of attachment individually, almost 60% of the CLP children showing distal strategies at 12 months became deactivated or disorganized when they reached 4 years. Indeed, subtle differences in attachment behaviors at 12 months old-which can be considered marginally secure at that age-may reveal attachment vulnerabilities, which seem to be more apparent over the course of development.
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Feragen KB, Stock NM. Factors affecting subjective appearance evaluations among patients with congenital craniofacial conditions: An application of Cash's cognitive-behavioural model of body image development. Body Image 2018; 24:124-136. [PMID: 29414145 DOI: 10.1016/j.bodyim.2017.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 12/11/2022]
Abstract
Satisfaction with appearance is of central importance for psychological well-being and health. For individuals with an unusual appearance, such as congenital craniofacial anomalies (CFA), appearance evaluations could be especially important. However, few, if any papers have presented a comprehensive synthesis of the factors found to affect subjective satisfaction with appearance among children, adolescents, and adults born with a CFA. Further, only a handful of craniofacial studies have applied psychological theories or models to their findings, resulting in an overall lack of guidance for researchers in the field. This paper summarises the literature pertaining to satisfaction with appearance among those affected by CFAs, and examines the extent to which Cash's cognitive-behavioural model of body image development (2012) fits with this literature. Given the overlap between factors of interest in the field of CFAs, and in the area of body image more broadly, a closer collaboration between the two research fields is suggested.
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Affiliation(s)
| | - Nicola Marie Stock
- 'Scar Free Foundation Research Fellow' at the 'Centre for Appearance Research and The Cleft Collective', University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom.
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Stock NM, Anwar H, Sandy JR, Rumsey N. Centralization of Cleft Lip and Palate Services in the United Kingdom. Cleft Palate Craniofac J 2018; 55:676-681. [DOI: 10.1177/1055665617744064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Since the implementation of centralized services in the United Kingdom for those affected by cleft lip and/or palate (CL/P), several studies have investigated the impact of service rationalization on the delivery of care. While large-scale quantitative studies have demonstrated improvements in a range of patient outcomes, and smaller studies have reported on the benefits and challenges of centralization from the views of health professionals, little research has attempted to capture the patient perspective. Furthermore, few studies have investigated the views of adult “returners” who have undergone treatment both pre- and postcentralization. Methods: Qualitative data relevant to the subject of this article were extracted from 2 previous larger studies carried out between January 2013 and March 2014. A total of 16 adults born with CL/P contributed data to the current study. These data were subjected to inductive thematic analysis. Results: The findings suggest that centralization of CL/P services has considerably enhanced the patient experience. Specifically, the overall standard and coordination of care has improved, service delivery has become more patient centered, and access to professional psychological support and peer support has greatly improved patients’ capacity to cope with the associated emotional challenges. Conclusions: The data collected provide additional insight into the impact of centralization from the perspective of a largely unexplored patient population. In combination with other literature, these findings are also relevant to future efforts to centralize other specialist services around the world.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research and The Cleft Collective, University of the West of England, Bristol, UK
| | - Hamza Anwar
- Regional Coordinator for the East of England, Cleft Lip and Palate Association, London, UK
| | - Jonathan R. Sandy
- Dean of the Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, UK
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Stock NM, Feragen KB, Rumsey N. Adults’ Narratives of Growing up with a Cleft Lip and/or Palate: Factors Associated with Psychological Adjustment. Cleft Palate Craniofac J 2018; 53:222-39. [DOI: 10.1597/14-269] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Growing up with a cleft lip and/or palate presents a number of challenges for those affected and their families. Understanding why some individuals cope well while others struggle is key to psychological research in this field. A better appreciation of the factors and processes that contribute to psychological adjustment to cleft lip and/or palate (CL/P) from the patient perspective would be of value to both researchers and clinicians. Design Qualitative data elicited from individual interviews with 52 adults born with CL/P. Result Inductive thematic analysis identified three main themes: “background” factors (age, gender, sexual orientation, culture, additional conditions, socioeconomic status, and adoption), “external” factors (treatment autonomy, familial coping and support, salience, public understanding, psychological input, and peer support), and “internal” psychological factors (perceptions of difference, noticeability and teasing, social confidence, internalization of beauty ideals, valence, expectations of treatment, responding to challenges, social comparisons, acceptance, faith, dispositional style, and recognition of strengths and positive growth). Conclusions The number and breadth of factors identified in this study are testament to the importance of psychology in the field of CL/P and may offer guidance in relation to developing and assessing the value of psychological interventions. There is a clear role for psychologists in tackling appearance-related concerns, designing materials, supporting patient decision making, and improving social interaction, as well as providing specialist psychological support. The findings illustrate the potential degree of individual variation in perspectives and offer insight into the conflicting results found within current literature.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | | | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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