Gender Views and Relationships in Families of Children With Craniofacial Differences

2017 ◽  
Vol 55 (2) ◽  
pp. 189-195
Author(s):  
Danielle N. Shapiro ◽  
Jennifer Waljee ◽  
Steven Buchman ◽  
Kavitha Ranganathan ◽  
Seth Warshcausky
Keyword(s):  
Family Functioning ◽  
Parenting Stress ◽  
Relationship Quality ◽  
Cleft Lip ◽  
Short Form ◽  
Medical Center ◽  
Academic Medical Center ◽  
Positive Association ◽  
Gender Attitudes ◽  
Linear Modeling

Objective: Gender values and beliefs are known to influence family functioning. The aim of the current study was to describe the association between views about gender and family functioning within families with a child with a craniofacial difference (CFD). Design: Participants included 74 dyads composed of children (8-18 years old) with CFD (n = 36 female), including cleft lip/palate, and a parent (n = 56 female). Children and caregivers both completed the activities subscale of the Occupations, Activities, and Traits–Attitudes Measure (C/OAT-AM). Children completed selected items from the Parent Perception Inventory (PPI). Caregivers completed the nurturance subscale of the Parenting Dimensions Inventory–Short Form (PDI-S) and the Parenting Stress Scale (PSS). Setting: Participants were recruited from an outpatient program at an academic medical center. Results: There were no significant relationships among the participant demographics and the study variables, with the exception that more complex CFD diagnoses were correlated with increased parenting stress. General linear modeling showed that parents with more flexible gender attitudes reported more nurturing parenting behaviors. There was also a positive association between parental flexibility in gender views and child-reported parent-child relationship quality. An interaction showed that the relationship between parental flexibility in gender views and child-reported relationship quality was stronger for females and nonsignificant for males. Conclusions: Caregivers with more flexible gender attitudes perceived themselves as more nurturing and were seen more positively by their daughters with a CFD. This pattern may inform parenting interventions for CFD populations.

Feeding and Growth in Infants With Cleft Lip and/or Palate: Relationships With Maternal Distress

2020 ◽  
pp. 105566562095687
Author(s):  
Lauren L. Madhoun ◽  
Canice E. Crerand ◽  
Meghan O’Brien ◽  
Adriane L. Baylis
Keyword(s):  
Postnatal Depression ◽  
Cleft Lip ◽  
Edinburgh Postnatal Depression Scale ◽  
Short Form ◽  
Medical Center ◽  
Academic Medical Center ◽  
Depression Scale ◽  
Maternal Distress ◽  
Stress Index ◽  
Control Group

Objective: To examine relationships between early feeding and growth and maternal distress in infants with and without cleft lip and/or palate (CL/P). Design: Cross-sectional. Setting: Pediatric academic medical center in the Midwestern United States. Participants: Mothers of infants 1 to 12 weeks old with CL/P (n = 30) and without CL/P (control group, n = 30) were recruited at craniofacial clinic or pediatrician appointments. Main Outcome Measure(s): Maternal responses on the Feeding/Swallowing Impact Survey (FS-IS), Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF), and Edinburgh Postnatal Depression Scale. Infant feeding history and growth measurements were obtained. Results: Having an infant with CL/P revealed greater impact on maternal health-related quality of life due to feeding problems ( F = 4.83, P = .03). Mothers of infants with CL/P reported average range Total Stress scores on the PSI-4-SF, which were higher than controls ( F = 4.12, P = .05). Edinburgh Postnatal Depression Scale scores did not differ between groups. Compared to controls, infants with cleft palate had lower percentiles for weight ( t = 4.13, P = .04) and length ( t = 2.93, P = .01). Higher FS-IS scores were associated with longer feeding duration ( r = 0.32, P = .01) and lower weight ( r = −0.31, P = .02) and length ( r = −0.32, P = .02). Conclusions: Despite receiving early team care and feeding interventions, mothers of infants with CL/P reported higher stress and more challenges with feeding and growth. Future studies should examine targeted psychosocial interventions to improve feeding and growth outcomes in infants with CL/P.

Psychometric and Clinimetric Validity of the Modified 25-Item Sino-Nasal Outcome Test

2019 ◽  
Vol 33 (5) ◽  
pp. 577-585 ◽  
Author(s):  
Sarah D. Tait ◽  
Dorina Kallogjeri ◽  
Smrithi Chidambaram ◽  
John Schneider ◽  
Jay F. Piccirillo
Keyword(s):  
Disease Burden ◽  
Short Form ◽  
Medical Center ◽  
Academic Medical Center ◽  
Evaluation Instrument ◽  
Productivity Losses ◽  
Valid Instrument ◽  
Test Retest Reliability ◽  
The Impact ◽  
Snot 22

Background Productivity losses are a significant part of the disease burden associated with rhinosinusitis, but existing measures of disease-specific quality of life exclude explicit assessment of the impact of the disease on productivity. Objective The objective of this study was to evaluate the clinimetric and psychometric validity of the 25-item Sino-Nasal Outcome Test (SNOT-25), a modified version of the SNOT-22. Methods This was a prospective cohort study conducted at an academic medical center. Participants included adult patients with rhinosinusitis who presented for routine visits to the Washington University in St. Louis School of Medicine otolaryngology clinic between August 2016 and March 2017. Results The SNOT-25 was created with the addition of three productivity-specific items to the SNOT-22 instrument. A total of 120 rhinosinusitis patients completed all baseline measurements and 94 (78.3%) completed 3-month follow-up. The Cronbach’s α was 0.83, indicating high internal consistency. Rhinosinusitis patients had on average a 24-point higher baseline SNOT-25 score (95% confidence interval [CI]: 13–35) as compared to healthy controls indicating good discriminative validity. There was high correlation between SNOT-25 scores at 3 months and 3.5 months ( r = .81; 95% CI, 0.73–0.87) confirming strong test–retest reliability. SNOT-25 had a strong correlation with the overall score of the Nasal Obstruction Symptom Evaluation instrument ( r = .55; 95% CI, 0.42–0.65), and among Short Form-36 subscales, the strongest correlations existed between SNOT-25 and the fatigue scale ( r = −.522; 95% CI, −0.63 to −0.39). Exploratory factor analysis revealed that the 3 new questions of SNOT-25 loaded together with reduction in productivity and concentration items on a new “productivity” factor. Conclusion The SNOT-25 is a valid instrument that can be used to assess rhinosinusitis disease burden including the impact on productivity and may be a better predictor of treatment decisions and outcomes.

Long-Term Otologic and Audiometric Outcomes in Patients with Cleft Palate

2017 ◽  
Vol 157 (4) ◽  
pp. 676-682 ◽  
Author(s):  
Terence E. Imbery ◽  
Lindsay B. Sobin ◽  
Emily Commesso ◽  
Lindsey Koester ◽  
Sherard A. Tatum ◽  
...  
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Cleft Lip And Palate ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Closure Rate ◽  
Pressure Equalization

Objective Describe longitudinal audiometric and otologic outcomes in patients with cleft palates. Study Design Case series with chart review. Setting Single academic medical center. Methods Charts of 564 patients with a diagnosis of cleft palate (59% syndromic etiology, 41% nonsyndromic) from 1998 to 2014 were reviewed. Patients without at least 1 audiometric follow-up were excluded from analysis. Patient demographics, surgeries, audiometric tests, and otologic data were recorded for 352 patients. Results Forty-five percent had isolated cleft palates, 34% had unilateral cleft lip and palate, and 21% had bilateral cleft lip and palate. Patients were followed for a mean of 50.3 months with a mean of 3.2 separate audiograms performed. Patients received a mean of 2.93 pressure equalization tubes. Increased number of pressure equalization tubes was not associated with incidence of cholesteatoma, which was identified in only 4 patients. Nine patients underwent eventual tympanoplasty with an 89% closure rate. Analysis of mean air-bone gap by cleft type did not reveal significant differences ( P = .08), but conductive losses and abnormal tympanometry persisted into teenage years. Conclusions Patients with cleft palates have eustachian tube dysfunction, which, in our cohort, resulted in persistent conductive hearing loss, highlighting the importance of long-term follow-up. Cholesteatoma incidence was low and not associated with number of tubes, which at our institution were placed prophylactically. Tympanoplasty was successful in those with persistent perforations.

Parenting Stress in Infancy and Psychosocial Adjustment in Toddlerhood: A Longitudinal Study of Children with Craniofacial Anomalies

2005 ◽  
Vol 42 (5) ◽  
pp. 556-559 ◽  
Author(s):  
Alice W. Pope ◽  
Karen Tillman ◽  
Heather T. Snyder
Keyword(s):  
Parenting Stress ◽  
Psychosocial Adjustment ◽  
Child Behavior Checklist ◽  
Short Form ◽  
Medical Center ◽  
Retrospective Chart Review ◽  
Multiple Informants ◽  
Stress Index ◽  
Craniofacial Anomalies ◽  
Reconstructive Plastic Surgery

Objective To evaluate the association between parenting stress during infancy and child psychosocial adjustment during toddlerhood, within a sample of children with craniofacial anomalies (CFAs). Design Retrospective chart review. Setting Urban medical center department of reconstructive plastic surgery. Participants Parents of 47 children aged birth to 24 months at time 1 and 24 to 46 months at time 2. Main Outcome Measures Parenting Stress Index/Short Form completed at times 1 and 2; Child Behavior Checklist completed at time 2. Results Relative to norms, more parents of children with CFAs experienced serious levels of parenting stress at times 1 and 2; however, fewer children with CFAs experienced serious levels of adjustment problems. Parenting stress during infancy predicted psychosocial adjustment in toddlerhood but was mediated by parenting stress in toddlerhood. Parents high on stress at both assessments showed clinical levels of total parenting stress and parent-child dysfunctional interaction when their children were infants; their toddlers showed higher levels of maladjustment than those with parents elevated on parenting stress during only infancy. Conclusions Elevated levels of parenting stress during infancy may be stable through toddlerhood for families having a child with a CFA. The relation between parenting stress and child adjustment is likely to be reciprocal. These findings should be replicated with a larger sample and multiple informants.

scholarly journals Elevated FGF23 Levels Are Associated with Impaired Calcium-Mediated Suppression of PTH in ESRD

2010 ◽  
Vol 24 (12) ◽  
pp. 2406-2407
Author(s):  
James B. Wetmore ◽  
Peter Santos ◽  
Jonathan D. Mahnken ◽  
Ron Krebill ◽  
Rochelle Menard ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Medical Center ◽  
Fibroblast Growth Factor 23 ◽  
Academic Medical Center ◽  
Positive Association ◽  
Calcium Sensing ◽  
Academic Medical ◽  
High Calcium ◽  
Gland Function ◽  
The Relationship

Abstract Context: The positive association of elevated fibroblast growth factor-23 (FGF23) with PTH levels in the setting of secondary hyperparathyroidism is paradoxical to the purported effects of FGF23 to suppress PTH secretion. Objective: We used dynamic calcium-mediated suppression of PTH levels in hemodialysis (HD) patients to determine the relationship between FGF23 levels and parathyroid gland function. Design: HD patients with elevated PTH were washed out of vitamin D analogs and/or calcimimetics and then exposed them to a high-calcium dialysate bath designed to suppress PTH. Setting: The study was conducted at an outpatient HD unit of an academic medical center. Participants: Eighteen maintenance HD patients with elevated PTH levels participated in the study. Main Outcome Measures: Ionized calcium (iCa), PTH, and FGF23 levels were measured during HD. The slope of the relationship between iCa and PTH (a marker of parathyroid gland mass) and the iCa level required for a 50% reduction in PTH were determined, and the association of these with FGF23 levels was determined. Results: Increased baseline log FGF23 levels were associated with putative alterations in gland mass as estimated by significantly shallower slopes of the iCa/PTH suppression curves (P = 0.0004), but there was no association between FGF23 and calcium sensing as measured by ionized Ca associated with a 50% suppression of PTH (P = 0.38). FGF23 levels decreased significantly during HD, but this change was not correlated with decrements in either renal phosphate or PTH. Conclusions: High FGF23 levels may be a marker for parathyroid gland hyperplasia in HD patients. Acute reductions in neither PTH nor renal phosphate during dialysis correlated with PTH suppression.

Delirium etiology subtypes and their effect on six-month function and cognition in older emergency department patients

2018 ◽  
Vol 31 (2) ◽  
pp. 267-276 ◽  
Author(s):  
Jamie Cirbus ◽  
Alasdair M. J. MacLullich ◽  
Christopher Noel ◽  
E. Wesley Ely ◽  
Rameela Chandrasekhar ◽  
...  
Keyword(s):  
Emergency Department ◽  
Short Form ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
The Elderly ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Emergency Department Patients ◽  
Factor Interactions

ABSTRACTBackground:Delirium is heterogeneous and can vary by etiology.Objectives:We sought to determine how delirium subtyped by etiology affected six-month function and cognition.Design:Prospective cohort study.Setting:Tertiary care, academic medical center.Participants:A total of 228 hospitalized patients > 65 years old were admitted from the emergency department (ED).Measurements:The modified Brief Confusion Assessment Method was used to determine delirium in the ED. Delirium etiology was determined by three trained physician reviewers using a Delirium Etiology checklist. Pre-illness and six-month function and cognition were determined using the Older American Resources and Services Activities of Daily Living (OARS ADL) questionnaire and the short-form Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Multiple linear regression was performed to determine if delirium etiology subtypes were associated with six-month function and cognition adjusted for baseline OARS ADL and IQCODE. Two-factor interactions were incorporated to determine pre-illness function or cognition-modified relationships between delirium subtypes and six-month function and cognition.Results:In patients with poorer pre-illness function only, delirium secondary to metabolic disturbance (β coefficient = −2.9 points, 95%CI: −0.3 to −5.6) and organ dysfunction (β coefficient = −4.3 points, 95%CI: −7.2 to −1.4) was significantly associated with poorer six-month function. In patients with intact cognition only, delirium secondary to central nervous system insults was significantly associated with poorer cognition (β coefficient = 0.69, 95%CI: 0.19 to 1.20).Conclusions:Delirium is heterogeneous and different etiologies may have different prognostic implications. Furthermore, the effect of these delirium etiologies on outcome may be dependent on the patient's pre-illness functional status and cognition.

Parenting Stress in Turkish Mothers of Infants With Cleft Lip and/or Palate

2020 ◽  
Vol 57 (6) ◽  
pp. 753-761 ◽  
Author(s):  
Handan Boztepe ◽  
Sevil Çınar ◽  
Fatma Figen Özgür, MD
Keyword(s):  
Social Support ◽  
Parenting Stress ◽  
Cleft Lip ◽  
Short Form ◽  
Negative Relationship ◽  
Stress Index ◽  
Factors Affecting ◽  
Feeding Difficulties ◽  
Healthy Infants ◽  
Collection Form

Objective: To explore parenting stress and factors affecting the mothers of infants with cleft lip and/or palate (CL/P) in Turkey. Design and Participants: The study compared mothers of infants born with CL/P (n = 90) with mothers of healthy infants (n = 90). Mothers completed the data collection form, the Parenting Stress Index-Short Form, and the Multidimensional Scale of Perceived Social Support. Results: Mothers of infants born with CL/P had higher mean parenting stress scores than the control mothers. A significant negative relationship was found between social support and parenting stress for mothers of infants born with CL/P but was not related for control mothers. Among mothers with an infant with CL/P, the mean parenting stress scores were higher for mothers preoperatively than mothers responding postoperatively. Among mothers with an infant with a cleft, higher stress was found for diagnosis after birth, not breastfeeding, feeding difficulties, lack of fathers’ support, perceived difficult infant temperament, blame, anger, and concern for the future. Conclusion: Parenting stress was higher and social support was lower for mothers of infants with a cleft. Treatment teams can design interventions aimed at factors related to stress, such as addressing feeding issues, teaching coping skills, and linking to social support.

Cleft Palate in Newborns Diagnosed With Prematurity

2021 ◽  
pp. 019459982110021
Author(s):  
Jennifer N. Shehan ◽  
David O’Neil Danis ◽  
Ashank Bains ◽  
Krystyne Basa ◽  
Alexander P. Marston ◽  
...  
Keyword(s):  
Cleft Lip ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Nutritional Deficiencies ◽  
Binary Logistic Regression Model ◽  
Level Of Evidence ◽  
Term Infants ◽  
Data Set ◽  
The Impact

Objective Cleft lip and/or palate (CLP) is the most common major congenital malformation of the head and neck. Although numerous genetic features, syndromes, nutritional deficiencies, and maternal exposures have been implicated in the etiology of CLP, the impact of prematurity on the pathogenesis remains incompletely understood. This study seeks to evaluate the associations between prematurity and the development of CLP in the United States. Study Design Cross-sectional. Setting Academic medical center. Methods The Kids’ Inpatient Database (2016) was used to identify weighted in-hospital births with diagnoses of prematurity or CLP. Demographic information was obtained. Odds ratios were used to determine associations between prematurity and CLP. Results Among patients included in our data set, 8.653% (n = 326,147) were preterm; 0.136% (n = 5115) had CLP; and 0.021% (n = 808) were preterm and had CLP. Preterm infants had 1.90 times the odds (95% CI, 1.74-2.07) of developing CLP when compared with the nonpreterm population. The binary logistic regression model accounting for possible confounding variables produced an odds ratio of 1.83 (95% CI, 1.66-2.01) for the association between prematurity and CLP. Conclusion Infants who are born preterm are more likely to have CLP than full-term infants. The current results will allow for improved risk stratification, maternal counseling, and interventions in the case of prematurity. Level of Evidence: 4.

Infant-Driven Feeding Systems: Do They “Normalize” the Feeding Experience of Infants With Cleft Palate?

2021 ◽  
pp. 105566562098435
Author(s):  
Lauren L. Madhoun ◽  
Meghan O’Brien ◽  
Adriane L. Baylis
Keyword(s):  
Cleft Palate ◽  
Cleft Lip ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bottle Feeding ◽  
Control Group ◽  
Cross Sectional ◽  
Level 1 ◽  
Level 2 ◽  
Feeding Systems

Objective: To examine feeding skills of infants with cleft palate with or without cleft lip (CP±L) using infant-driven feeding systems compared to healthy controls on standard bottles. Design: Cross-sectional cohort. Setting: Large pediatric academic medical center in the Midwestern United States. Participants: Infants with CP±L (n = 15) using the Dr. Brown’s Specialty Feeding System and typically developing infants without CP±L (n = 15) using the Dr. Brown’s Natural Flow Original or Options bottles. Main Outcome Measure(s): Bottle-feeding proficiency, duration, milk transfer, and signs of feeding difficulty. Results: Five-minute feeding proficiency differed significantly between groups with the control group taking 45% of the feed compared to 16% for the CP±L group on level 1 ( P < .001) and 30% on level 2 ( P < .001) nipples. Proportion of milk transfer was 96% ± 7% for controls and 75% ± 24% for the CP±L group ( P = .013). Feeding duration (minutes) differed between the control group (13 ± 3) and the CP±L groups on each nipple level (level 1: 29 ± 16; P = .003; level 2: 32 ± 11; P = .001). Milk transfer rate (mL/min) was 9 ± 3 for control infants compared to 3 ± 1 for infants with CP±L on level 1 ( P < .001) and 5 ± 1 on level 2 ( P = .007). Coughing occurred in 40% of infants with CP±L and 27% of controls. Conclusions: Even when using specialty bottles, infants with CP±L differ from noncleft infants in feeding proficiency, duration, and overall intake.

scholarly journals Management of delirium at an academic medical center: Plans for antipsychotic prescribing upon discharge

2020 ◽  
Vol 10 (1) ◽  
pp. 25-29
Author(s):  
Lauren Halavonich ◽  
Sophie Robert ◽  
Dan McGraw ◽  
Erin Weeda ◽  
Kristen Mullinax ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Positive Association ◽  
International Classification Of Diseases ◽  
Discharge Instructions ◽  
Academic Medical ◽  
Classification Of Diseases ◽  
Antipsychotic Prescribing

Abstract Introduction Delirium is an acute, fluctuating change in mental status, often associated with behavioral manifestations such as agitation. Literature suggests that many patients who continue on antipsychotics for extended management of delirium are not provided instructions for discontinuation. However, there is a positive correlation between consult services and instructions for discontinuation. The objective of this study was to determine the frequency at which patients with delirium were prescribed an antipsychotic at hospital discharge and to characterize discharge antipsychotic prescribing for psychiatric consult and nonconsult cohorts. Methods This study was a retrospective chart review of adult patients with an International Classification of Diseases 10th revision code of delirium who received at least 1 dose of antipsychotic during their admission. Inclusion criteria were all patients aged 18 years or older with a diagnosis of or relating to delirium who were administered antipsychotics during their admission. Results A total of 152 patients were included, of which 43 received a psychiatric consult. Antipsychotics were prescribed at discharge for management of delirium for 52 (34.2%) of 152 total patients. More patients in the psychiatric consult cohort were discharged with an antipsychotic as compared to those in the nonconsult cohort (53.3% vs 26.6%, P =  .02). Discussion Compared to previous studies, patients in this retrospective review were more likely to be discharged on an antipsychotic that was initiated during admission for management of delirium. Findings from this study also align with prior research demonstrating a positive association between antipsychotic discharge instructions and specialty consult recommendations.

Sign in / Sign up

Export Citation Format

Share Document