Closing the Loop on Centralization of Cleft Care in the United Kingdom.

OBJECTIVE: We highlight a major study that investigated the impact of reconfigured cleft care in the United Kingdom some 15 years after centralization. We argue that centralization as an intervention has a major impact on outcomes. SETTING: Audit clinics held in Cleft Centers in the United Kingdom. PATIENTS, PARTICIPANTS: Five-year-olds born between April 1, 2005, and March 31, 2007, with nonsyndromic unilateral cleft lip and palate. INTERVENTIONS: Centralization of cleft care. MAIN OUTCOME MEASURE(S): We collected routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) in a very similar way to a previous survey. RESULTS: We identified 359 eligible children and recruited 268 (74.7%) to the study. Overall, their outcomes were better post-centralization. There have been marked improvements in dentoalveolar arch relationships and in speech whereas the prevalence of dental caries and hearing loss are unchanged. CONCLUSIONS: Centralized cleft care has changed UK outcomes considerably and there is no argument for returning to a dispersed model of treatment.

Comparing safety climate factors as predictors of work-related driving behavior.

INTRODUCTION: Research suggests safety climate (SC) is a strong predictor of safety-related outcomes in organizations. This study explores the relationship between six SC dimensions and four aspects of work-related driving. METHOD: The SC factors measured were "communication and procedures," "work pressures," "relationships," "safety rules," "driver training," and "management commitment." The aspects of self-reported occupational driving measured were traffic violations, driver error, driving while distracted, and pre-trip vehicle maintenance. RESULTS: Hierarchical regression analyses revealed that the SC factors accounted for significant amounts of variance in all four aspects of work-related driving, over and above the control factors of age, sex, and work-related driving exposure. However, further investigation indicated certain SC factors (particularly safety rules, communication, and management commitment) were more strongly related to specific aspects of work-related driving behavior than others. Together, the SC factors were better able to predict self-reported distraction from the road than the other aspects of driving behavior measured. Implications for occupational safety, particularly for the management of work-related drivers are discussed.