Centre‐level variation of treatment and outcome in 5‐year‐old children with non‐syndromic unilateral cleft lip and palate: The Cleft Care <scp>UK</scp> study. Part 1: Methodology and results for dento‐facial outcomes

et al. 2017

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Structured AbstractObjectivesThe aims of this study were to describe child behavioural and psychosocial outcomes associated with appearance and speech in the Cleft Care UK (CCUK) study. We also wanted to explore centre‐level variation in child outcomes and investigate individual predictors of such outcomes.Setting and sample populationTwo hundred and sixty‐eight five‐year‐old children with non‐syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK.Materials and methodsParents completed the Strengths and Difficulties questionnaire (SDQ) and reported their own perceptions of the child's self‐confidence. Child facial appearance and symmetry were assessed using photographs, and intelligibility of speech was derived from audio‐visual speech recordings. Centre‐level variation in behavioural and psychosocial outcomes was examined using hierarchical models, and associations with clinical outcomes were examined using logit regression models.ResultsChildren with UCLP had a higher hyperactive difficulty score than the general population. For boys, the average score was 4.5 vs 4.1 (P=.03), and for girls, the average score was 3.8 vs 3.1 (P=.008). There was no evidence of centre‐level variation for behaviour or parental perceptions of the child's self‐confidence. There is no evidence of associations between self‐confidence and SDQ scores and either facial appearance or behaviour.ConclusionsChildren born with UCLP have higher levels of behaviour problems than the general population.

“…All results are adjusted for differences in age and gender. Full details of the method for examining centre‐level variation are described elsewhere in this supplement …”

Section: Participants and Methodsmentioning

confidence: 99%

Centre‐level variation in behaviour and the predictors of behaviour in 5‐year‐old children with non‐syndromic unilateral cleft lip: The Cleft Care UK study. Part 5

Waylen

et al. 2017

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“…All results are adjusted for differences in age and sex. Full details of the method for examining centre‐level variation is described in Wills et al . (within this supplement).…”

Section: Methodsmentioning

confidence: 99%

Centre‐level variation in outcomes and treatment for otitis media with effusion and hearing loss and the association of hearing loss with developmental outcomes at ages 5 and 7 years in children with non‐syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 2

Hall

et al. 2017

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Structured AbstractObjectives: To explore centre-level variation in otitis media with effusion (OME), hearing loss and treatments in children in Cleft Care UK (CCUK) and to examine the association between OME, hearing loss and developmental outcomes at 5 and 7 years.Setting and Sample Population: Two hundred and sixty-eight 5-year-old British children with non-syndromic unilateral cleft lip and palate (UCLP) recruited to CCUK. Materials and Methods:Children had air and bone conduction audiometry at age 5.Information on grommet and hearing aid treatment was obtained from parental questionnaire and medical notes. Hearing loss at age 5 was defined as >20 dB in the better ear and history of OME and hearing loss was determined from past treatment. Children with sensorineural hearing loss were excluded. Associations were examined with speech, behaviour and self-confidence at age 5 and educational attainment at age 7.Centre variation was examined using hierarchical models and associations between hearing variables and developmental outcomes were examined using logistic regression.Results: There was centre-level variation in early grommet placement (variance partition coefficient (VPC) 18%, P=.001) and fitting of hearing aids (VPC 8%, P=.03). A history of OME and hearing loss was associated with poor intelligibility of speech (adjusted odds ratio=2.87, 95% CI 1.42-5.77) and aspects of educational attainment. Conclusions:Hearing loss is an important determinant of poor speech and treatment variation across centres suggest management of OME and hearing loss could be improved. K E Y W O R D Scentralization, developmental outcomes, hearing loss, unilateral cleft lip and palateThis is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

“…Full details of the method for examining centre‐level variation is described in Wills et al. (within this supplement). As noted above, some children in particular centres had their dental assessment performed by uncalibrated assessors, and all children from one particular centre were assessed by an uncalibrated observer.…”

Section: Methodsmentioning

confidence: 99%

Centre‐level variation in dental treatment and oral health and individual‐ and area‐level predictors of oral health in 5‐year‐old children with non‐syndromic unilateral cleft lip and palate: the Cleft Care UK study. Part 3

Smallridge

et al. 2017

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