Isolation, Uncertainty and Treatment Delays: Parents' Experiences of Having a Baby with Cleft Lip/Palate During the Covid-19 Pandemic

Presurgical Infant Orthopedic Videos on YouTube™: A Thematic Analysis of Caregiver Narratives

ObjectiveInformation regarding how caregivers cope when using presurgical infant orthopedic (PSIO) appliances is sparse. This study aimed to understand caregivers' perspectives and experiences with contemporary PSIO treatment.DesignPSIO videos shared on the YouTube™ platform were used as the data source. Videos with caregivers were identified (n = 21) and portions with caregiver narratives were transcribed. This was followed by the application of a six-step thematic analysis as conceptualized by Braun and Clarke (2006, 2019).ResultsTwo themes were identified from the caregiver narratives in the PSIO videos. The Family Journey theme included reaction to diagnosis, choice of center, burden of care, care commitment, coping, and testimonials. The Information theme included PSIO techniques and PSIO benefits.ConclusionMultifaceted challenges and coping strategies were described by caregivers during the PSIO phase. Caregivers remained committed to treatment despite the burden of care, were motivated by an understanding of the benefits of PSIO, and customized care based on their individual strengths and needs. Study results can help providers gain an understanding of what caregivers experience outside the clinical environment.

Impact of Pandemic-Related Social Restrictions on Language and Speech Development in Children with Cleft Lip and/or Palate at 18-24 Months

ObjectiveDetermine if early speech and language development in children born with cleft lip and/or palate (CL/P) was impacted by social restrictions during the COVID-19 pandemic.DesignCohort study using data from The Cleft Collective.ParticipantsChildren with CL/P whose first 18-24 months were before the pandemic compared to children whose first 18-24 months were impacted by the pandemic.MeasuresPrimary outcome: parental reported Ages and Stages Questionnaire-Third Edition (ASQ-3). Secondary outcomes: 18- to 24-month speech and language therapy (SLT) assessment location; ability to judge velopharyngeal function for speech; SLT judged-expressive language and consonant inventory size for children with a cleft palate. Analyses adjusted for confounders.ResultsWe found no statistical evidence to suggest a difference in ASQ-3 communication (n = 631; ORadjusted 0.96; 95% CIs 0.533, 1.742; P = 0.902), SLT judgements of expressive language (n = 175; ORadjusted 0.66; 95% CIs 0.224, 1.947; P = 0.452), or consonant inventory size at age 18-24 months (n = 186; IRRadjusted 0.98; 95% CIs 0.775, 1.249; P = 0.896) between pre-pandemic and pandemic impacted groups. There was weak statistical evidence of an association between virtual appointments and SLT being unable to rate features of velopharyngeal function for speech (ORadjusted 3.54; 95%CIs 0.849, 14.755; P = 0.083).ConclusionsNo statistical evidence of an association between exposure to pandemic-related social restrictions and early language development or consonant inventory size at age 18-24 months. Small sample sizes, variation in the pandemic impacted groups, and limitations of the measures should be considered when interpreting the findings. Further work is required to further examine the use of virtual appointments for speech assessment.

Is the Future of Cleft Care Financially Sustainable? An Economic Analysis of Inflation-Adjusted Reimbursements

OBJECTIVE

As Medicaid continues to expand, it remains unclear if reimbursement rates for cleft care are keeping up with the national economy. The purpose of this study is to determine how financial trends in cleft lip and palate repair reimbursements compare to annual changes in the U.S. economy.

DESIGN

Current Procedural Terminology (CPT) codes for cleft lip and palate repair were retrospectively reviewed between 2018 and 2023. Reimbursements were adjusted for inflation to 2023 U.S. dollars using Medicaid physician fee schedules. Annual percentage changes in inflation-adjusted reimbursements, and reimbursement Compounded Annual Growth Rate (CAGR) were compared to the annual change in the U.S. Consumer Price Index (CPI).

SETTING

Multi-state, Medicaid.

PARTICIPANTS

Medicaid reimbursements of 6 U.S. states, 5 with highest birthrates: California, Texas, Florida, New York, and Pennsylvania. Colorado, the study institution, was evaluated.

MAIN OUTCOME(S)

Primary outcomes included annual changes in overall and inflation-adjusted reimbursement rates for cleft lip and palate surgical procedures as compared to annual changes in CPI.

RESULTS

The U.S. CPI increased by 20.9% from 2018 to 2023, while the overall total percentage change in reimbursement rates for all cleft lip and palate procedures increased by 7.23%. The inflation-adjusted overall percent change in reimbursements for all procedures decreased by -12.81%. For all procedures, the average CAGR was -2.66%.

CONCLUSIONS

Inflation-adjusted reimbursement rates for cleft lip and palate repair have significantly decreased in contrast to the annual growth in U.S. CPI. These findings show a potential lack of financial sustainability for surgical cleft care, indicating the need for healthcare policy reform.

Understanding Access to Care: Factors Influencing Patient Attendance at Craniofacial Speech Evaluations

ObjectiveEvaluate predictors for attendance and adherence to speech evaluations and determine factors that influence longitudinal care for patients with cleft palate and craniofacial differences.DesignRetrospective, observational cohort study.SettingTertiary children's hospital.ParticipantsEight hundred and eighty newborns receiving care between 2014 and 2022 were included in the study sample for longitudinal assessment of appointment adherence. Participants were included if they had a cleft-related diagnosis, were scheduled for an initial speech evaluation between 1 and 3 years old, were scheduled for follow-up speech evaluations between 3 and 6 years old, and had demographic, diagnostic, and clinical data in their charts.Main Outcome Measures:Variables of interest included demographic data, diagnostic criteria, insurance data, distance to clinic, speech/resonance characteristics, hard/soft palate integrity, and surgical data. Chi-square analyses, independent sample t-tests, and descriptive statistics were conducted to identify characteristics of those who attended appointments and those who did not. Logistic regression analyses were conducted to examine factors predictive of appointment adherence over time.ResultsA total of 66.9% of patients attended the initial speech evaluation. A total of 50.6% of participants adhered to follow-up appointments. Distance to clinic (P = .018), insurance type (P < .001), and cleft type (P < .001) influenced initial speech evaluation attendance. For follow-up appointment adherence, cleft type (P < .001) was the strongest predictor pre-pandemic, while severity of velopharyngeal function (P = .037) strongly predicted adherence during the pandemic.ConclusionAppointment adherence is multifactorial and driven by geographic, demographic, and clinical variables. Identifying barriers to care may improve appointment adherence for those with speech/resonance needs and prevent patients from being lost to follow-up.

Impact of Geopolitical Unrest on Surgical Delays and Outcomes in Immigrant Populations With Cleft Lip and Palate

BACKGROUND

Geopolitical conflicts in the Middle East have led to mass migrations, with Turkey becoming a major host country. This influx has strained the health care system, particularly regarding specialized care for conditions like cleft lip and palate (CLP). Timely intervention is crucial for optimal outcomes, but cultural, socioeconomic, and logistical barriers often cause delays, impacting physical, functional, and psychosocial development.

METHODS

This retrospective study analyzed 72 immigrant pediatric CLP patients treated in Turkey between 2012 and 2022. Data on demographics, medical history, surgical interventions, complications, and treatment delays were collected. Surgical timing was compared with American Cleft Palate Craniofacial Association guidelines, and the impact of socioeconomic status on delays was assessed.

RESULTS

Seventy-two patients underwent a total of 91 surgical interventions, including 29 cleft lip repairs, 22 cleft palate repairs, 6 pharyngeal flaps, 15 fistula closures, 8 corrections of secondary lip scars and whistling deformities, and 11 alveolar bone graftings. A majority (73.6%) had poor socioeconomic status. The average delays for cleft lip, cleft palate, and alveolar bone grafting surgeries were 5.3±4, 7.3±6.1, and 34.1±23.5 months, respectively, and were significantly longer for patients with poor socioeconomic status ( P =0.00502, 0.030741, and 0.041878). The average delay for pharyngeal flap surgery, performed in patients with poor socioeconomic status (except for one), was 43.7±14.1 months.

CONCLUSIONS

This study highlights the challenges and disparities in CLP care for immigrant children in Turkey due to geopolitical conflict. While surgical complication rates are similar to established data, delays in treatment, especially among those with lower socioeconomic status, are a significant concern. The findings emphasize the need for comprehensive, culturally sensitive care and systemic interventions to improve access and outcomes for this vulnerable population.

Cross-condition risk and protective factors for psychosocial distress in parents and carers of children and young people with appearance-affecting conditions and injuries

Alongside typical parenting challenges, initial condition-specific research suggests thadifferent experiences and support needs.t parents of children with different visible differences may experience similar psychosocial difficulties. Despite this, large-scale cross-condition research to identify risk and protective factors for parental distress and psychosocial adjustment has been lacking. Two hundred and nine parents and carers of children with a range of visible differences completed an online survey comprised of standardised outcome measures, study-specific measures, and open-ended questions. Multiple regression modelling identified possible risk and protective factors, and data collected via open-ended questions were analysed using content analysis. Findings support themes previously identified in small-scale cross-condition qualitative research with parents of children with visible differences. Risk factors for parental negative affect and stress included parental reports of the noticeability of their child's visible difference and teasing. Protective factors included good parent-child communication, self-compassion, knowledge of their child's condition and satisfaction with treatment. The risk and protective factors identified provide important insight into the experiences of this parent population and indicate possible avenues for psychosocial intervention.

The mediating role of life satisfaction in the effect of caregiving burden on mental well-being in parents of children diagnosed with cleft lip/palate

PURPOSE

This study aimed to examine the effect of caregiving burden on the mental well-being of parents of children with cleft lip/palate, with life satisfaction as a mediator.

DESIGN AND METHODS

This descriptive, cross-sectional study was conducted with a sample of 347 parents of children with cleft lip/palate. Data were collected through face-to-face interviews with the parents between March 18 and September 4, 2023. The data collection tools included a sociodemographic data form, the Zarit Burden Interview, the Warwick-Edinburgh Mental Well-Being Scale, and the Satisfaction with Life Scale.

RESULTS

It was found that parents with a higher caregiving burden had lower levels of life satisfaction. Additionally, parents with higher life satisfaction reported better mental well-being. The findings indicated that as the caregiving burden increased, the mental well-being of the parents decreased. The results suggest that life satisfaction mitigates the negative impact of caregiving burden on mental well-being.

CONCLUSION

These findings suggest that life satisfaction plays a significant mediating role in maintaining and supporting parents' mental health. Parents with higher life satisfaction appear to cope better with the challenges posed by caregiving burden, which in turn helps them maintain better mental well-being.

PRACTICE IMPLICATIONS

The findings show that as the caregiving burden increases, both life satisfaction and mental well-being decrease. Therefore, it is crucial to develop practical interventions to support these parents.

The emotional and social concerns of mothers of children with cleft palate: A cross-sectional study

PROBLEM

Among birth defects, a cleft palate is one of the most common defects globally, with a prevalence rate of 1 in 700 live-born children per annum. Caring for a child with cleft palate is considered a challenge for mothers who provide around clock care for these children. Despite this, there is limited knowledge of their experiences and needs particularly in low resource settings.

BACKGROUND

Previous literature emphasized that mothers of children with cleft palate face many challenges involving emotional distress, social isolation, and financial burden.

QUESTION

To investigate the emotional and social concerns of mothers of children with Cleft Palate compared to mothers of children without cleft palate.

METHODS

A comparative study design was conducted at the Jordanian Royal Medical Services using convenience sample of 312 mothers of children with and without cleft palate in Jordan.

FINDINGS

There was a significant difference in the presence of anxious feelings between mothers of children with cleft palate and those mothers without cleft palate children. Within group comparison for mothers of children with cleft palate has shown a significant difference in their social concerns with regards to social support and child's future.

DISCUSSION

Mothers of children with cleft palate reported significantly higher levels of sadness feelings. These emotions could be attributed to several factors, including the financial burden associated with medical treatment and interventions, the burden of caring for a child with special needs, the social stigma related to the child's appearance, the lack of public awareness, and the insufficient social support services.

CONCLUSION

Mothers of children with Cleft Palate experience a considerable amount of emotional and social concerns which require urgent interventions.

Pregnant and postpartum women's experiences of the indirect impacts of the COVID-19 pandemic in high-income countries: a qualitative evidence synthesis

BACKGROUND

Pregnant and postpartum women's experiences of the COVID-19 pandemic, as well as the emotional and psychosocial impact of COVID-19 on perinatal health, has been well-documented across high-income countries. Increased anxiety and fear, isolation, as well as a disrupted pregnancy and postnatal period are widely described in many studies. The aim of this study was to explore, describe and synthesise studies that addressed the experiences of pregnant and postpartum women in high-income countries during the first two years of the pandemic.

METHODS

A qualitative evidence synthesis of studies relating to women's experiences in high-income countries during the pandemic were included. Two reviewers extracted the data using a thematic synthesis approach and NVivo 20 software. The GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) was used to assess confidence in review findings.

RESULTS

Sixty-eight studies were eligible and subjected to a sampling framework to ensure data richness. In total, 36 sampled studies contributed to the development of themes, sub-themes and review findings. There were six over-arching themes: (1) dealing with public health restrictions; (2) navigating changing health policies; (3) adapting to alternative ways of receiving social support; (4) dealing with impacts on their own mental health; (5) managing the new and changing information; and (6) being resilient and optimistic. Seventeen review findings were developed under these themes with high to moderate confidence according to the GRADE-CERQual assessment.

CONCLUSIONS

The findings from this synthesis offer different strategies for practice and policy makers to better support women, babies and their families in future emergency responses. These strategies include optimising care delivery, enhancing communication, and supporting social and mental wellbeing.

The impact of COVID-19 on the well-being of Victorian children born with cleft lip and/or palate

BACKGROUND

A longitudinal cohort study was established to investigate the well-being of children born with cleft lip and/or palate (CL/P) during the COVID-19 pandemic, in Victoria, Australia.

MATERIALS AND METHODS

The Royal Children's Hospital cleft service database was used to identify children aged between 4 and 17 years old born with an isolated CL/P. Families of eligible children who consented to participate were asked to complete the Strengths and Difficulties Questionnaire (SDQ) between October and December 2020 and again 6-month later. SDQ results from typically developing Australian children during the COVID-19 pandemic were utilized from a previously published study.

RESULTS

63 parents completed the baseline questionnaire, with 44 completing the 6-month follow-up. For participants at baseline, the mean age was 8.9 years, with 55% male. All outcome domains of the SDQ improved between baseline and timepoint 2, with the difference in total difficulties scores being statistically significant, indicating a reduction in total difficulties at timepoint 2, associated with the easing of COVID-19 restrictions. When compared with the Australian population during the COVID-19 pandemic, Victorian children born with CL/P had lower SDQ scores for all difficulties outcome domains, with statistically significant results for conduct problems, hyperactivity, peer problems and total difficulties, indicating fewer difficulties for children born with CL/P.

CONCLUSIONS

Children born with CL/P experienced fewer difficulties when compared with the typically developing Australian population during the COVID-19 pandemic. The level of restrictions imposed because of the pandemic also had little influence on the well-being of these children.

Efficacy of telepractice, an alternative therapy tool during the coronavirus disease 2019 pandemic, for speech disorders related to congenital anomalies

Since telepractice regulation does not yet exist in Japan, we assessed telepractice efficacy and the level of satisfaction with telepractice versus that with face-to-face practice (FTFP) in speech therapy to establish effective telepractice in Japan. Changes in the number of therapy sessions and therapy levels were compared between telepractice and FTFP sessions conducted during the study period. Additionally, the patients' parents completed a questionnaire survey regarding telepractice. The mean number of sessions was not significantly different between the two types of therapy; the therapy levels, according to stepwise speech therapy, either increased or remained unchanged. The survey showed satisfaction with telepractice among all parents. Telepractice for cleft palate speech was delivered successfully with complete parental satisfaction.

Disabled people's experiences accessing healthcare services during the COVID-19 pandemic: a scoping review

BACKGROUND

Disruptions to healthcare services during the COVID-19 pandemic are well-recognised problems. However, a dearth of research exists on disabled people's experiences with accessing these services. A scoping review was undertaken to identify and explore research on the experience of disabled people in accessing healthcare services between 2020 and 6 February 2023.

METHODS

PubMed, Web of Science, CINAHL, and OVID were employed to search for research that included the voice of disabled people, or their parents or caregivers. Over two distinct phases, a total of 2,201 articles were reviewed according to article titles, keywords, and abstracts. Eighty-one studies were identified that met the inclusion criteria; these were reviewed in full.

RESULTS

Eighteen studies specifically described the experiences of accessing healthcare or disability services, and sixty-three raised healthcare challenges as a secondary consideration. Many disabled people struggled to access healthcare services and felt they were invisible; as a result, individuals' mental health was negatively affected. Disabled people with compounding vulnerabilities were at the most risk of experiencing a lack of healthcare access.

CONCLUSIONS

There is an urgent need for research and policy that is responsive to disabled people's access to healthcare during the pandemic; currently many health policies are 'disability-blind' and exclude these members of the global community. Furthermore, to assist in creating disability-responsive research, funding needs to prioritise researchers within the disabled community.

Experiences and impact of the UK lockdown amongst adults who have a facial visible difference

Globally, COVID-19 has been shown to have had a wide ranging and significant impact on individuals' daily living, and physical and mental health. However, there are some groups of individuals who may encounter unique challenges with regards to COVID-19 and whose experiences have not been investigated thus far. Therefore, this study aimed to understand the experiences of adults with a facial visible difference in relation to COVID-19 and lockdown. Semi-structured interviews were conducted with 21 adults with a variety of facial visible differences (e.g., cleft lip/palate, facial scars, skin conditions) and analyzed using inductive reflexive thematic analysis. This analysis generated three themes (Escaping the external gaze; Existing feelings manifesting in new challenges; COVID-19 taking priority). The results of this study suggest that the first U.K. lockdown from the COVID-19 pandemic created significant challenges for some individuals with a facial visible difference, and ongoing restrictions and social distancing measures might be particularly challenging for those who experience anxiety around social encounters. These findings highlight the importance of providing appropriate and accessible support for people with facial differences during lockdown and as restrictions ease.

The Impact of the Covid-19 Pandemic on Cleft Lip and Palate Service Delivery for New Families in the United Kingdom: Medical and Community Service Provider Perspectives

OBJECTIVES

Professionals in the United Kingdom providing care to new families affected by cleft lip and/or palate (CL/P) had to adapt to ensure families' needs were met during a time of uncertainty due to Covid-19. The aims of this study were to explore the impacts of the pandemic on CL/P care provision for new families from the perspectives of professionals working in medical and community settings along with any personal impact on professionals and their reflections on the future of CL/P care.

DESIGN

Semistructured interviews (n  =  27) were completed about experiences from March 2020 to October 2020 with consultant cleft surgeons (n  =  15), lead clinical nurse specialists (n  =  8), and staff working at the Cleft Lip and Palate Association (n  =  4). Transcripts were analyzed using inductive thematic analysis.

RESULTS

Three themes were identified: (1) the impact of Covid-19 on the provision of cleft care in the United Kingdom, including working conditions, delays to treatment, and Covid-19 policies; (2) the impact of the pandemic on professionals' mental health, including personal distress and concerns about Covid-19 exposure; and (3) reflections on the future of CL/P care, whereby professionals expressed both hope and concern about the Covid-19 recovery effort.

CONCLUSIONS

The ongoing Covid-19 pandemic has impacted CL/P service delivery for new families significantly, warranting recommendations for cohesive psychological support for families in addition to a safe and resourced recovery effort. Support for professionals is also suggested, following existing evidence-based models for providers' needs that address the difficulties of working throughout challenging times.