An Evaluation of Health-Related Quality of Life (HRQoL) in a group of 4-7 year-old children with cleft lip and palate

Assessing the Psychosocial Impacts of Whole-Genome Sequencing Outcomes on Orofacial Cleft Caregivers in Nigeria: A Mixed-Methods Study

ObjectiveTo investigate the behavioral outcomes of children with clefts and the psychosocial impact and mental health experiences of their caregivers regarding unintended outcomes of genomic sequencing, that is, secondary genetic findings (SFs).DesignConvergent parallel mixed methods.SettingThe cleft and immunization clinics at the Lagos University Teaching, Hospital, Nigeria.ParticipantsIn total, 127 cases and 158 control caregiver child dyads (quantitative) and 22 caregivers of children with clefts (qualitative).Main Outcome MeasuresStandardized questionnaires were used to assess caregiver-reported mental health, quality of life (QoL), and their children's behavioral difficulties. In 2 focus groups, participants shared their perspectives on genomic testing outcomes, including SFs, mental health, and expectations in the context of clefts.ResultsCompared to the control group, caregivers of children with clefts reported poorer mental health, lower QoL and more behavioral difficulties in their children. Also, they believed that introducing genomic testing outcomes, including SFs, may exacerbate existing burdens. Following qualitative data analyses, 5 themes emerged-genetics knowledge/awareness, stressors, cognitive appraisals, coping/support strategies, and negative impact/positive gains. Both qualitative and quantitative results showed that caring for children with clefts required significant financial resources placing substantial stress on caregivers.ConclusionsThese findings highlight the importance of addressing caregivers' psychosocial needs and the need for proactive measures to prepare for the return of genomic sequencing outcomes to patients and research participants, particularly in resource-limited settings like Africa, where such support may be lacking.

Is There a Role for Comfort Care in Neonates With Severe Craniofacial Anomalies? Case Report and Review of Quality-of-Life Literature

This article aims to determine how quality of life (QoL) is defined and assessed in cases of severe craniofacial anomalies, as well as the impact such considerations may have on the treatment of a neonate with these conditions with respect to palliative neonatal care. Our literature review found insufficient evidence to suggest that craniofacial anomalies result in consistently poor QoL. Based on these findings and in line with the current acceptable standards for the ethical care of neonates, with the exception of rare cases, resuscitative efforts should always be performed on patients with isolated craniofacial anomalies, as demonstrated in the management of this reported patient.

Psychological and Peer Difficulties of Children with Cleft Lip and/or Palate: A Systematic Review and Meta-Analysis

OBJECTIVES

A systematic review and meta-analysis were conducted to determine if children born with cleft lip and/or palate are at increased risk of psychological and peer difficulties, and if so, which difficulties they develop.

METHODS

EMBASE, MEDLINE, and PsycINFO were searched for English language studies published between January 2005 and January 2022 which investigated the psychological outcomes and peer function of children with nonsyndromic cleft lip and palate. Outcomes included internalizing problems, such as anxiety and depression, externalizing problems, such as hyperactivity, conduct disorders, self-concept including self-image and self-esteem, peer problems, resilience, coping, and overall psychological function. A risk of bias assessment was performed using the Newcastle-Ottawa Scale. Random effects models were used in the meta-analysis to compare the outcomes for children born with a cleft and those without.

RESULTS

In total 41 studies met inclusion criteria, with 9 included in the meta-analysis. Children born with a cleft appear to have similar psychological outcomes compared to normative controls when using the strengths and difficulties questionnaire. There are some minor differences between self-report and parent report, with parents generally reporting that their child with a cleft has increased emotional, conduct, and hyperactivity problems. The small differences between the study cohort and control cohorts are unlikely to imply any differences on a clinical level.

CONCLUSIONS

Overall psychological outcomes appear to be similar between children born with a cleft and the nonaffected population, however, some symptoms such as anxiety and depression appear higher in children with cleft lip and/or palate.

Assessment of Self-Esteem and Quality of Life in Patients with Complete Unilateral Cleft Lip and Palate Undergoing Orthodontic Treatment

Objective

To assess the self-esteem and quality of life (QOL) in patients with complete unilateral cleft lip and palate (UCLP) who were undergoing orthodontic treatment.

Materials and Methods

This cross-sectional study was conducted on a total sample of 300 individuals consisted of 150 patients with UCLP (Group I) and 150 normal controls (Group II) with an age range of 10-25 years, who were undergoing comprehensive orthodontic treatment from December 2016 to December 2018. The Self Esteem and QOL were assessed using the Rosenberg Self Esteem scale (RSE) and Modified Paediatric QOL Inventory Scale (M-PQOL), respectively, in Group I and II.

Results

The comparison of overall mean scores of responses to RSE questionnaires showed nonsignificant differences for all the responses and was significant only for RSE 6 and RSE 8 in the age group of 10-15 years and 21-25 years, respectively, and nonsignificant for all other questions in all the age groups. The comparison of overall mean scores of M-PQOL for the total sample showed nonsignificant differences in Group I and II for physical functioning, emotional functioning, and school functioning domain, and were highly significant differences (P ≤ 0.001) in the social functioning domain and M-PQOL 12 and M-PQOL 21.

Conclusions

This study demands a definite need of a psychologist/psychiatrist among the cleft care team to counsel the patients with cleft during orthodontic treatment for motivating them to gain self-respect and acceptance in the society as certain aspects, particularly social functioning domain made them feel different from normal children because of the functional and aesthetic problems.

Quality of life in early age Spanish children treated for cleft lip and/or palate: a case-control study approach

OBJECTIVE

The objectives of this study were to evaluate health-related quality of life (HRQoL) in 4-7-year-old children treated for cleft lip and/or palate (CL/P) compared to healthy controls and to estimate a possible association with cleft type, gender, age, and surgical re-interventions.

MATERIALS AND METHODS

A total of 171 children with CL/P (mean age 5.7 years) and 186 healthy controls (mean age 5.5 years) were included in the study. Sixty-four (37.4%) children experienced both cleft lip and palate, 56 (32.8%) cleft lip only, and 51 (29.8%) cleft palate only. HRQoL in children was assessed by Kiddy-KINDL and COHIP-14 questionnaires and in parents by KINDL-p. Total score and dimensions of each questionnaire were compared between cleft children, their parents, and controls.

RESULTS

The total scores and dimension scores of Kiddy-KINDL showed similar values between CL/P and control groups, except for "self-esteem" dimension (p = 0.036). The comparison of Kiddy-KINDL and KINDL-p showed a statistically significant total score (82.11 vs. 80.44, p = 0.047). The CL/P group presented significantly worse values with respect to controls in total score of COHIP-14 (10.53 vs 5.01, p < 0.001) and in all its dimensions.

CONCLUSIONS

Children treated for CL/P had a negative impact on HRQoL at early age compared to controls. Significant differences were found in the psychological and functional dimensions related to lip and palatal affectation, respectively. Parents reported significantly worse scores than their children. HRQoL measurement provided valuable complementary information to better inform to parents and make clinical decisions in children with CL/P at early age.

CLINICAL RELEVANCE

Our findings suggested that Spanish children between 4 and 7 years of age with a history of surgically treated CL/P experienced a poorer HRQoL when compared with their non-cleft peers.

Psychological Variables in Children and Adolescents with Cleft Lip and/or Palate

Objective: This review analyzes the psychological variables most frequently studied over the last 10 years in children and adolescents with cleft lip/palate (CL/P). Such variables are assumed to be the keys to these patients' psychosocial adjustment. Study design: Articles published from January 2007 to February 2017 were retrieved from PubMed to identify the psychological variables most commonly studied in children and adolescents with CL/P, irrespective of gender or type of cleft. The search terms were "cleft palate" and "psychology", with the operator AND. Results: Of the 324 articles retrieved, 26 met the criteria for inclusion in the review. The psychological variables most extensively studied over the years were children's social functioning, quality of life and ability to cope. Conclusion: While CL/P patients' quality of life was unanimously agreed to be affected, no consensus was found in the literature on social functioning or coping. In addition to the cleft, patient adjustment was reported to be governed by individual variables and mediators. The range of ages most frequently studied was 7 to 16.

Interdisciplinary approach for a patient with unilateral cleft lip and palate

The oral rehabilitation of patients with cleft lip and palate is a challenge. The aim of this case report was to underline the importance of a sequential interdisciplinary approach to correct functional problems and improve facial esthetics for a patient with unilateral cleft lip and palate. Few clinical reports have described this treatment in a teenager. The patient, a girl, age 12.6 years, had a complete right cleft lip and palate with a Class II molar tendency and a full Class II canine relationship on the right side, and a full Class II molar relationship with a canine Class I on the left side. Transposed, impacted, and anomalously shaped teeth and crowding added to the patient's problems. Treatment included maxillary expansion and maxillary and mandibular extractions. An interdisciplinary approach was necessary to achieve proper occlusion and better esthetics.

Salivary Cortisol Rhythms in Children With Cleft Lip and/or Palate: A Case-Control Study

OBJECTIVE

Knowledge about the stress response in children with cleft lip and/or palate (CL/P) is sparse and the association between the stress response and health-related quality of life (HRQoL) is unknown. Consequently, investigations on the influence of CL/P on the stress response alone and its association with HRQoL are of importance. The purpose was to determine whether salivary cortisol concentration in children with CL/P differs from that in children without clefts (controls) and whether there are any differences in salivary cortisol concentrations between ages, gender, and type of cleft. Furthermore, the final aim was to determine the correlation between salivary cortisol concentration and HRQoL.

DESIGN

The study used a cross-sectional case-control design.

PARTICIPANTS

Ninety-one 5- and 10-year-old children with CL/P and 180 age-matched controls.

MAIN OUTCOME MEASURES

Salivary samples were collected on 2 mornings and 1 evening for each child. Samples were analyzed using a commercial competitive radioimmunoassay and HRQoL was assessed using the KIDSCREEN-52.

RESULTS

Salivary cortisol concentrations were similar in children with CL/P and controls. There was no difference in salivary cortisol concentrations between children with different types of cleft. There was no correlation between cortisol concentration and HRQoL.

CONCLUSION

Five- and 10-year-old children with corrected CL/P seemed not to be more stressed than controls, and there were no correlation to HRQoL. The HRQoL levels - were comparable to that of a European norm population.

Oral health-related quality of life of children with oral clefts and their families

Oral health problems can influence people's Quality of Life (QoL) because of pain, discomfort, limitations, and other esthetics problems, affecting their social life, feeding, daily activities, and the individual's well-being. To compare oral health-related quality of life (OHRQoL) of children with and without oral clefts and their families. 121 children aged from 2 to 6 years, from both sexes, enrolled in the treatment routine of the Pediatric Dentistry Clinics of a Dental School and a Hospital for Cleft Treatment were divided into two groups: Group 1 - children with cleft lip and palate; Group 2 - children without cleft lip and palate. The OHRQoL was assessed using the validated Portuguese version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). The questionnaire was answered individually, only once, at a private place. Mann-Whitney U test was used to verify differences between groups. Spearman's Rho test was used to associate sex and age with quality of life. The level of significance was set at 5% (p<0.05). According to the parents' perception on the OHRQoL of children with and without cleft lip and palate, oral health of children with oral clefts (Group 1) had a statistically significant impact on OHRQoL. The correlation of sex with impact on OHRQoL did not show statistically significant differences. On the other hand, the higher the age the higher the impact on QoL. The group comparison revealed that the cleft lip and palate negatively impacted on OHRQoL of 2 to 6-year-old children and their parents.

A comparison of health-related quality of life in 5- and 10-year-old Swedish children with and without cleft lip and/or palate

BACKGROUND

The current understanding on health-related quality of life (HRQoL) in young Swedish children with cleft lip and/or palate (CL/P) is sparse, and therefore, research on impact of CL/P on HRQoL in children is needed.

AIMS

To investigate HRQoL in 5- and 10-year-old Swedish children with CL/P in comparison with non-cleft controls. Also to analyse whether there were any differences in HRQoL between children with cleft lip (with or without cleft palate, CL ± P) and cleft palate only (CP) and/or gender differences.

DESIGN

A total of 137 children with CL/P and 305 non-cleft controls participated. HRQoL was measured with KIDSCREEN-52.

RESULTS

All children in the study exhibited HRQoL within or above the age-matched reference interval of the method with similar results in both groups; however, in the dimension 'social support and peers', the 10-year-old children with CL/P perceived lower HRQoL than the non-cleft controls, but it did not reach statistical significance. Type of cleft or gender did not influence HRQoL.

CONCLUSIONS

Both 5- and 10-year-old Swedish children with CL/P had HRQoL in the normal reference interval. Their general life situations were well adjusted to their clefts, but the older children with CL/P felt more excluded and less supported by peers.

A Population-Based Exploration of the Social Implications Associated with Cleft Lip and/or Palate

Background:

Clefts of the lip and/or palate (CL/P) carry a social stigma that often causes psychosocial stress. The purpose of this study was to consider the association of cleft phenotype and age with self-reported aspects of psychosocial stress.

Methods:

Children with nonsyndromic CL/P and unaffected children born between 1997 and 2003 were identified through the North Carolina Birth Defects Monitoring Program and North Carolina birth records, respectively. The psychosocial concerns of children with CL/P were assessed via a 29-question subset of a larger survey. Responses were analyzed according to school age and cleft phenotype (cleft lip with/without cleft alveolus, CL ± A; cleft palate only, CP; or cleft lip with cleft palate, CL + P).

Results:

Surveys were returned for 176 children with CL/P and 333 unaffected children. When compared with unaffected children, responses differed for CL ± A in 4/29 questions, for CP in 7/29 questions, and for CL + P in 8/29 questions (P < 0.05). When stratified by school age, children with CL/P in elementary, middle, and high school differed from unaffected children by 1/29, 7/29, and 2/29 questions, respectively. Middle school–aged children with CL/P were more affected by aesthetic concerns, bullying, and difficulties with friendship, and social interaction. Children with CL + P reported more severe aesthetic-related concerns than children with CL ± A or CP but experienced similar speech-related distress as children with CP only.

Conclusion:

Social implications associated with CL/P are most pronounced during middle school, and less so during elementary and high school. This information identifies areas of social improvement aimed at reducing the stigma of CL/P.

Health-Related Quality of Life Patients With a Cleft Lip and/or Palate

BACKGROUND

The authors evaluated health-related quality of life (HRQoL) in patients with cleft lip and/or palate (CLP).

METHODS

A descriptive, observational, cross-sectional study was conducted in the largest referral facility for treating individuals with CLP in Sergipe state. The authors created 3 groups with 97 subjects each: CLP, family, and control. An initial cognitive evaluation was performed with the Mini-Mental State Examination, and the Medical Outcomes Study 36 item Short-Form Health Survey (SF-36) was applied to evaluate HRQoL in individuals with sufficient cognitive capacity.

RESULTS

Individuals with CLP usually had a primary education, were single, and had incomes between 1 and 2 minimum wages, and slightly more than half presented with a transforamen cleft (59.8%). No significant difference was observed in the overall HRQoL score among the 3 groups (cleft: 72.2; family: 70.6; control: 72.5). Individuals with CLP had a lower average on the Emotional Aspects domain of the SF-36 than that in the control group, whereas the CLP group had higher averages in the Vitality domain when compared with their relatives. Men had higher averages on the Physical Function (PF) and Mental Health (MH) domains. Patients operated on at the optimal time (≤12 months of age) had higher mean PF domain scores.

CONCLUSIONS

Patients with CLP and their families often represent people with low purchasing power, strengthening the socioeconomic inequality. Although the global HRQoL was similar among all groups surveyed, the cleft influenced both the patients and their relatives.

A descriptive epidemiology study of oral cleft in sergipe, Brazil

Introduction The nonsyndromic orofacial cleft is the fourth most common birth defect, but in Brazil, data about the cleft epidemiology are not accurate.

Objective This study aimed to describe the epidemiologic characteristics of oral cleft cases at Specialized Society Attending Cleft Patient in Sergipe State.

Methods Data were obtained from patients' medical records in relation to the following characteristics: age; gender; race; origin; cleft type; additional malformations and/or complications; prenatal accomplishment; treatment applied. For diagnosis analysis, it was noted if mothers had received prenatal care and if they had ultrasonography performed and if the cleft was viewed in it.

Results We observed a prevalence of male gender (54%). Age between 0 and 4 years old was most prevalent (53%), and pheoderma race was observed in 47%. Transincisive foramen cleft was found in 52.3% of the individuals. The prevalence of pre- and transincisive foramen cleft was higher in men (66.3 and 55.7%), women accounted for 65.0% of postincisive foramen, and atypical facial cleft (0.3%) occurred in one case. Associated malformations and complications were present in 12% of patients. Prenatal care was reported by 48% of the mothers.

Conclusion In this study male gender was the most affected, and 0 to 4 years was the most frequent age group. Transincisive foramen cleft type was most frequently encountered. Prenatal care was reported by most mothers. So, this study found that early treatment is a reality in SEAFESE (Service Specializing in Cleft Care of Sergipe), and consequently the chances of successful integration of the child to society will be better.

Measurement of Health-Related and Oral Health–Related Quality of Life among Individuals with Nonsyndromic Orofacial Clefts: A Systematic Review and Meta-Analysis

Objective

To compare health-related quality of life and oral health–related quality of life between nonsyndromic individuals with and without cleft lip and/or cleft palate and to identify the most affected quality of life dimensions in individuals with cleft lip and/or palate.

Design

Systematic review and meta-analysis were conducted. Of the 314 identified citations, 23 articles were submitted to quality assessment. Data from nine studies on health-related quality of life and six on oral health–related quality of life were extracted for meta-analysis.

Main Outcome Measures

Pooled mean differences of health-related quality of life between adults with and without cleft lip and/or palate, pooled means of health-related quality of life dimensions of children and adults with cleft lip and/or palate and oral health–related quality of life dimensions of children and adolescents with cleft lip and/or palate with a 95% confidence interval were calculated.

Results

Quality assessment revealed methodological differences between studies. Lack of subgroup stratification and absence of control for confounders were the main limitations. Heterogeneity was detected on the comparison of oral health–related quality of life and health-related quality of life between children with and without cleft lip and/or palate, and oral health–related quality of life between adolescents with and without cleft lip and/or palate. A random-effect model showed a significant difference on health-related quality of life between adults with and without cleft lip and/or palate (mean difference = 0.10; 95% confidence interval, 0.16 to 0.05). Psychological health (mean, 78.9; 95% confidence interval, 70.1 to 87.7) and vitality (mean, 68.1; 95% confidence interval, 48.0 to 88.1) were the most affected health-related quality of life dimensions in children and adults with cleft lip and/or palate, respectively. Means of health-related quality of life dimensions in children and adults with cleft lip and/or palate and oral health–related quality of life in children and adolescents with cleft lip and/or palate varied yet did not differ in indirect comparisons.

Conclusion

The presence of cleft lip and/or palate negatively affected the health-related quality of life of adults, mainly on psychosocial dimensions.

Self-Esteem, Coping Styles, and Quality of Life in Polish Adolescents and Young Adults with Unilateral Cleft Lip and Palate

Objectives

To evaluate self-esteem, coping styles, and health-related quality of life and their relationships in Polish adolescents and young adults with unilateral complete cleft lip and palate and related sex differences.

Design and Participants

Self-report questionnaires measuring self-esteem (Multidimensional Self-Esteem Inventory), coping styles (Coping Inventory for Stressful Situations), and health-related quality of life (WHOQOL-BREF) were completed by 48 participants with cleft lip and palate (age, 16 to 23 years; 31 males, 17 females) and 48 controls without cleft lip and palate (age, 16 to 23 years; 28 males, 20 females) matched for age, place of residence, and socioeconomic status.

Results

Regarding self-esteem, individuals with cleft lip and palate scored higher on body functioning ( P < .01) and defensive self-enhancement ( P < .05). Self-control showed an interaction effect: Females with cleft lip and palate scored higher than controls, but males did not differ between groups ( P < .05). Males with cleft lip and palate scored lower than controls in personal power but higher in body functioning ( P < .05); females showed no differences between groups. The groups did not differ with regard to coping styles or quality of life, but several correlations were found between self-esteem and coping styles, and quality of life ( P < .01).

Conclusions

Late adolescents and young adults with and without cleft lip and palate differed little in terms of psychological adjustment measures. The higher scores in defensive self-enhancement of individuals with cleft lip and palate suggest the need for instruments measuring social approval in psychosocial adjustment research involving this group.

Health-related quality of life in children with hemifacial microsomia: parent and child perspectives

PURPOSE

To compare health-related quality of life (HRQOL) among children with and without hemifacial microsomia (HFM) as assessed by parents and the children themselves during the elementary school years.

METHODS

One hundred thirty-six children with HFM (49 females, mean age = 6 years, 11.9 months, SD = 1.004) were compared with 568 matched controls (285 females, mean age = 6 years, 10.2 months, SD = 0.998) for parent and child responses on the PedsQL Version 4.0.

RESULTS

After adjustment for sociodemographic factors, parent-reported summary scores were worse for affected children than control group children for physical (effect sizes [ES] = 0.26, p = .004), social (ES = 0.34, p = .001), and school (ES = 0.32, p = .001) functioning. There were no significant mean differences in summary scores based on children's self-reported functioning.

CONCLUSIONS

Case-control mean differences in HRQOL were more apparent based on parent report, but not child self-report. Summary score findings suggest that case parents have concerns about their child's HRQOL, particularly with respect to their child's physical, social, and school functioning. Additionally, our findings highlight the potential differences between child and parent perspectives and the importance of collecting data from multiple reporters.