Family Impact of Child Oro-Facial Cleft.

OBJECTIVE: To describe the association between children's orofacial cleft (OFC) and families' quality of life (QoL), using the short-form Family Impact Scale questionnaire (FIS-SF). Also assessed were the psychometric properties of the FIS-SF, as well as whether certain demographic and clinical variables impacted the family. DESIGN: Observational cross-sectional study. SETTING: Tertiary care public children's hospital in New South Wales, Australia. PARTICIPANTS: Parents/caregivers of children with OFC. MAIN OUTCOME MEASURE(S): The short-form Family Impact Scale questionnaire. RESULTS: Two hundred and fourteen parents completed the FIS-SF. Excellent convergent validity was evident, but discriminant validity was weaker. Those children with velopharyngeal insufficiency/submucous cleft reported lower scores on the family/parental activity, and lower overall family impact scores than those with cleft lip (CL) or cleft palate (CP). Those with cleft lip and palate (CL/P) had poorer family/parental activity scores than those with CP. There were no systematic differences in FIS-SF scores by the child's age, gender, private health insurance, living location, the number of cleft-related operations, or whether a child had commenced orthodontic treatment. CONCLUSIONS: The FIS-SF is a valid and reliable measure for determining the impact that OFC has on family QoL. The impact of OFC on children's families differs according to cleft type.

Validity and reliability of the COHIP-SF in Australian children with orofacial cleft.

AIM: To measure the validity and reliability of the Child Oral Health Impact Profile-Short Form (COHIP-SF) in Australian children with orofacial cleft (OFC) and to evaluate the need for a proxy report. DESIGN: Children with OFC and their proxy completed a COHIP-SF questionnaire. Items were divided into oral health, functional and socio-emotional subscales, and scores on all subscales were compared between and within groups. RESULTS: A total of 222 children (average age 11.3, SD = 3.5, range 8.0-14.0) and 215 proxies completed the COHIP-SF, with similar mean scores of 50.8 (SD = 13.7) and 48.1 (SD = 14.0). Excellent internal consistency reliability (Cronbach's alpha 0.9) and convergent validity was evident (P < 0.001); however, discriminant validity was weaker. There was strong correlation between child and proxy reports (Pearson's r = 0.7), and intraclass correlation coefficients were high indicating good child/proxy agreement. Older children had poor socio-emotional well-being (P < 0.004), and children with bilateral cleft lip and palate (CL/P) and velopharyngeal insufficiency/submucous cleft (VPI/SMC) had poor functional well-being. Those with private health insurance reported better oral health-related quality of life (OHRQoL) (P < 0.05). CONCLUSION: The COHIP-SF is a valid and reliable measure for measuring OHRQoL in Australian children with OFC. Proxy reports did not add further information regarding a child's OHRQoL.

Morphoscopic analysis of experimentally produced bony wounds from low-velocity ballistic impact.

Understanding how bone behaves when subjected to ballistic impact is of critical importance for forensic questions, such as the reconstruction of shooting events. Yet the literature addressing microscopic anatomical features of gunshot wounds to different types of bone is sparse. Moreover, a biomechanical framework for describing how the complex architecture of bone affects its failure during such impact is lacking. The aim of this study was to examine the morphological features associated with experimental gunshot wounds in slaughtered pig ribs. We shot the 4th rib of 12 adult pigs with .22 mm subsonic bullets at close range (5 cm) and examined resultant wounds under the light microscope, scanning electron microscope SEM and micro tomograph µCT. In all cases there was a narrow shot channel followed by spall region, with evidence of plastic deformation with burnishing of the surface bone in the former, and brittle fracture around and through individual Haversian systems in the latter. In all but one case, the entrance wounds were characterized by superficially fractured cortical bone in the form of a well-defined collar, while the exit wounds showed delamination of the periosteum. Inorganic residue was evident in all cases, with electron energy dispersive spectroscopy EDS confirming the presence of carbon, phosphate, lead and calcium. This material appeared to be especially concentrated within the fractured bony collar at the entrance. We conclude that gunshot wounds in flat bones may be morphologically divided into a thin burnished zone at the entry site, and a fracture zone at the exit.

Health promotion interventions to improve oral health of adolescents: A systematic review and meta-analysis.

OBJECTIVES: To evaluate the effectiveness of health promotion interventions on oral health knowledge, behaviour and status of healthy adolescents. METHODS: This review included randomized controlled trials (RCTs) of oral health promotion interventions targeting adolescents. Primary clinical outcomes (gingival health, plaque scores, caries) and secondary proxy outcomes were evaluated. Meta-analysis of primary outcomes was conducted where possible, with subgroup analysis based on intervention (comprehensive health promotion and education-only). RESULTS: Thirty-seven eligible publications reporting on 28 unique RCTs of oral health promotion interventions were included. Quality appraisal of studies ranged from 48% to 96%. Interventions reported ranged from single-session interventions to community-wide programmes, including clinical preventive procedures and take-home products. Half used a health behaviour change theory to inform their intervention. The meta-analysis pooling of results favoured the intervention over control for all clinical outcomes, except DMFS in the education-only subgroup. Stronger intervention effects were seen in the comprehensive intervention subgroup than the education-only subgroup for DMFS (P = .02). This effect was slight, but not as clear in all other clinical categories. The majority of studies reported improvements in oral health knowledge, attitudes and behaviours. More positive outcomes were found with longer programmes, especially for dental caries outcomes. CONCLUSIONS: Oral health promotion programmes targeting adolescents have the ability to improve clinical oral health outcomes in the short and long term. Programmes should use more behavioural theory-based interactive and strategic methods, including self-awareness and the use of the wider community and peers for oral health promotion activities over a longer intervention duration.

Multifocal Epithelial Hyperplasia.

Multifocal epithelial hyperplasia is a rare disease associated with human papilloma virus types 13 and 32. Diagnosis is based on clinical and histopathological findings, and most lesions are asymptomatic and regress spontaneously with time. The purpose of this paper is to describe a five-year-old girl who presented with multiple intraoral lesions on the buccal mucosa and tongue, which regressed spontaneously in 15 months.