Evaluation of nasolabial esthetics in 8- to 12-year-old patients with cleft lip and palate by healthcare professionals in Northeast Thailand.

Objective: To assess the aesthetics of the nasolabial appearance of patients with cleft lip and palate aged 8-12 years by experienced and inexperienced professionals. Methods: A cross-sectional study was conducted on 32 patients with cleft lip and palate, who underwent surgery and follow-up treatment at the Cleft Center. The research tools included a parent-completed survey providing GO graphic data and two-dimensional frontal view photographs of patients from both left and right sides. The aesthetic of the lip, nose, and nasolabial region was evaluated by an experienced and inexperienced medical professional team in groups of four individuals. In addition, data analysis was performed using descriptive statistics, mean values, standard deviations, Cronbach's alpha reliability coefficient, and the Wilcoxon signed-rank test. Results: The average age of patients was 10.32 years, mainly male (65.63%), had unilateral cleft lip and palate (62.50%), and underwent bone grafting (96.88%). Regarding the assessment in three aspects, the aesthetic score assessed by experienced evaluators is fair level (2.64 ± 1.09) with an acceptable value of 0.73. In contrast, the inexperienced evaluator showed a high level (2.43 ± 0.83) with a high inter-rater reliability acceptable value of 0.60. Inexperienced evaluators showed higher scores for the lip and nasolabial region than experienced evaluators, which was statistically significant (p-values < 0.01). Conclusions: The inexperienced evaluators showed significantly higher scores for appearance than experienced evaluators. This result can improve surgical techniques in future procedures to meet the needs of patients seeking lip and nasolabial appearance corrections across different age groups.

Birth Prevalence and Risk Factors Associated With CL/P in Thailand.

INTRODUCTION: The objectives of this study were to obtain the birth prevalence of cleft lips and/or cleft palates (CL±P) and to identify potential associated risk factors in the population of the Northeast (NE) region of Thailand. METHODS: The data were collected from October 1, 2012, to September 30, 2013, for infant deliveries with nonsyndromic CL±P in all hospitals of 4 provinces in the region. Workshops were conducted to establish diagnostic criteria, treatment guidelines, referral systems, data collection, and data reporting. All patients included in this study, including a case (the child born with cleft lip and palate [CLP]) and 2 control cases (2 following children born without CLP in the same hospital), completed a questionnaire regarding demographics, cleft characteristics, and factors of interest such as alcohol intake, smoking, vitamin use, and medication. Unadjusted and adjusted odds ratio were presented for the magnitude of associations between proposed risk factors and CL±P along with 95% CIs. RESULTS: The overall birth prevalence of CL±P was 1.93 per 1000 live births. There was a significant difference in percentages of infants with low birth weights (P = .03), family history of CL±P (P = .01) in cases than controls. Mothers who took self-medication or a menstrual regulation supplement were more likely to have the child with CL±P (P = .01 adjusted). CONCLUSIONS: The prevalence of CL±P in the NE Thailand was high. Low infant birth weight, family history of CL±P, and the use of self-medication or menstrual regulation herbal supplement was significant factors.

Case-control study of nutritional and environmental factors and the risk of oral clefts in Thailand.

BACKGROUND: One infant in 700 is born with an oral cleft. Prior studies suggest low micronutrient status is associated with an increased risk of oral clefts. Environmental factors such as passive smoke exposure or supplement use may also affect oral cleft risk. We examined nutrition and environmental related risk factors for oral clefts. METHODS: We conducted a case-control study in Northeast Thailand in 2012 to 2013. We enrolled 95 cases and 95 controls. We recruited cases with a nonsyndromic cleft lip with or without a cleft palate (CL±P) less than 24 months old. Cases were matched to controls on age and place of conception. We collected survey data, a food frequency questionnaire, and measured zinc concentrations in toenail trimmings. We calculated descriptive statistics by case and control status. We used conditional logistic regression to estimate unadjusted and adjusted associations, 95% confidence intervals (CIs), and p-values. RESULTS: Any liver intake (adjusted OR [aOR] for ≥1/week versus none), 10.58; 95%CI, 1.74-64.37, overall p = 0.02) and the presence of food insecurity (aOR, 9.62; 95% CI, 1.52-61.05; p = 0.02) in the periconceptional period increased CL±P risk. Passive smoke exposure increased the risk of CL±P (aOR, 6.52; 95% CI, 1.98-21.44; p < 0.01). Toenail zinc concentrations were not associated with CL±P risk. CONCLUSION: Our findings add to a growing body of knowledge of environmental risk factors for oral clefts from low- and middle-income countries. Our findings on liver are contradictory to prior results. Large multisite studies are needed to identify environmental and genetic risk factors for oral clefts. Birth Defects Research (Part A) 106:624-632, 2016. © 2016 Wiley Periodicals, Inc.

Effectiveness of Networking of Khon Kaen University Community-Based Speech Model: Quality of Life.

Background: After surgically correcting deformities in children with cleft lip/palate (CLP), 88% still had speech disorders, resonance disorders, voice abnormalities, and unintelligibility that affected daily life. Accessibility to speech therapy in developing countries is limited. The community-Based Speech Therapy Model is one means of improving communication and quality of life. Objective: To evaluate quality of life and reflections from children, families, and speech assistants (SAs) who participated in Networking of Khon Kaen University Community-Based, Speech Therapy Model (KKUCBSM) in Mahasarakham province. Material and Method: The model was piloted from March 2014 to February 2015. The Tawanchai Quality of Life questionnaire, General Health Questionnaire (Thai GHQ-12), and open-ended question feedback were used for collecting data June to August 2015. Demographic data were reported as percentages, means, standard deviations, and content analysis of openended questions. Results: Fourteen children with cleft lip and palate (mean age 5.5 years: 7 boys, 7 girls), 14 caregivers and 6 SAs were recruited for this study. Most caregivers were parents (9 families). Their needs were dental care followed by skills to support child development and skills to improve the children's speech (score 4.64+0.497, 4.57+0.646, 4.50+0.519, respectively). The score for psychosocial satisfaction vis-a-vis facial appearance was good (3.50+0.760), but for negative result scores, they felt significantly less happy, tired, and hopeless (4.79+0.579). The anxiety score was in the normal range. As a result of interviewing about problems and obstacles before joining, caregivers reported their greatest problems arose from difficulties traveling to join the project (costs were greater than reimbursements and time was insufficient). SAs reported being overworked. Benefits from participation in the project included: children with clefts consistently accessed speech services by SAs in community, caregivers gained good experiences for daily living support and speech correction. SAs gained experiences in speech correction under supervision of Speech and language pathologists (SLPs) that could be used to help other children with speech defects and other patients besides children with clefts. Conclusion: KKUCBSM for children with CLP was not only the effective way for solving articulation defects, but also improved quality of life in children with CLP.

Evidence-Triggers for Care of Patients with Cleft Lip and Palate in Srinagarind Hospital: The Tawanchai Center and Out-Patients Surgical Room.

Background: Cleft lip and palate (CLP) is a congenital anomaly of the lip and palate that is caused by several factors. It was found in approximately one per 500 to 550 live births depending on nationality and socioeconomic status. The Tawanchai Center and out-patients surgical room of Srinagarind Hospital are responsible for providing care to patients with CLP (starting from birth to adolescent) and their caregivers. From the observations and interviews with nurses working in these units, they reported that both patients and their caregivers confronted many problems which affected their physical and mental health. Based on the Soukup's model (2000), the researchers used evidence triggers from clinical practice (practice triggers) and related literature (knowledge triggers) to investigate the problems. Objective: The purpose of this study was to investigate the problems of care for patients with CLP in the Tawanchai Center and out-patient surgical room of Srinagarind Hospital. Material and Method: The descriptive method was used in this study. For practice triggers, the researchers obtained the data from medical records of ten patients with CLP and from interviewing two patients with CLP, eight caregivers, two nurses, and two assistant workers. Instruments for the interview consisted of a demographic data form and a semi-structured questionnaire. For knowledge triggers, the researchers used a literature search. The data from both practice and knowledge triggers were collected between February and May 2016. The quantitative data were analyzed through frequency and percentage distributions and the qualitative data were analyzed through a content analysis. Results: The problems of care gained from practice and knowledge triggers were consistent and were identified as holistic issues, including 1) insufficient feeding, 2) risks of respiratory tract infections and physical disorders, 3) psychological problems, such as anxiety, stress, and distress, 4) socioeconomic problems, such as stigmatization, isolation, and loss of income, 5)spiritual problems, such as low self-esteem and low quality of life, 6) school absence and learning limitation, 7) lack of knowledge about CLP and its treatments, 8) misunderstanding towards roles among the multidisciplinary team, 9) no available services, and 10) shortage of healthcare professionals, especially speech language pathologists (SLPs). Conclusion: From evidence-triggers, the problems of care affect the patients and their caregivers holistically. Integrated long-term care by the multidisciplinary team is needed for children with CLP starting from birth to adolescent. Nurses should provide effective care to these patients and their caregivers by using a holistic approach and working collaboratively with other healthcare providers in the multidisciplinary team.

Evidence-Triggers for Care of Patient with Cleft Lip and Palate at Srinagarind Hospital: Antenatal Care Unit.

Background: The abnormalities of cleft lip and palate (CLP) condition are the serious problems which always found in the northeastern region of Thailand. The treatment must be sustainably and continuously integrated by the interdisciplinary team, including registered nurses who take care of all nine organizations under the corporation among nurses who work at Tawanchai Cleft Center. Starting from the diagnosis of the fetus by the new technology along with medical knowledge which can diagnose the abnormalities since birth. The diagnosis of the fetus with CLP affects mental and health of mother, so the nurse who takes extended care of them needs to have the data in order to plan the integration treatment and prepare them to be ready of confronting to the crisis. Also, this is for the adaption of fetal abnormalities and the encouragement for their new baby. Hence, clinical evidence triggered for care of pregnant women with fetal CLP is really important. Objective: To trigger the clinical evidence of pregnant women whom found the fetal CLP at antenatal care unit, Srinagarind Hospital. Material and Method: This descriptive study of clinical evidence-triggers for care of pregnant women with fetal CLP is the part of the study in antenatal care clinic which was applied to use the clinical evidence-triggers of The Center for Advance Nursing Practice Model. After the considerations of human ethics, the four stimulators were examined as the followings: 1) the simulation of practice triggers which was studied by reviewing five patient medical records in order to know the general data and health condition; 2) reviewed related literature, 3) interviewed five pregnant women whom diagnosed with fetal CLP, 4) interviewed one responsible nurse with 15-20 minutes, and using open-ended questions to ask about the health problems of pregnant woman, also giving an advice. The data were collected during January-December 2015. The descriptive data were analyzed using percentage and the qualitative data were analyzed by content analyses. Results: A total of five pregnant women with fetal CLP were included in the study with the mean age of 32 years, and the second pregnancy was 80%. The clinical problems of pregnancy with fetal CLP included: 1) mental and health of pregnant women and families; 2) discouragement of being pregnant and taking care of their pregnancy; 3) fetal facial image; and 4) nurture of such fetus after birth. The results after the diagnosis of pregnancy with fetal CLP and receiving advice from physicians and nurses were found regarding medical records that they were advised from the physician and nurse towards the abnormalities and chromosome inspection, and given treatment after birth. According to the interviewing of the nurse, it was found that the pregnancy felt regret and denied the diagnostic results, and needed treatment information. Besides, according to the interviewing of the pregnancy, it was found that they wanted to discontinue the pregnancy, needed information, wanted to know about any abnormality. The literature review revealed that nurses were those who providing care, knowledge, and advice. Conclusion: The clinical problems of pregnant women detected with fetal CLP included feelings of disappointment, sadness, and regret whether or not found other abnormalities and being stress in caring for pregnant and postpartum care. The best handling and treatment was to obtain care from the interdisciplinary team in order to help them and their families to face with the crisis, accept to the abnormality of the fetus and having alternatives, and select such the appropriate alternatives, including antepartum and postpartum care.

Study of Treatment Expense of Patients with Congenital Malformations of Craniofacial in Srinagarind Hospital between 2010 and 2014.

Objectives: To report the treatment expenses of the congenital malformations of craniofacial of in-patients of Srinagarind Hospital between 2010 and 2014 Material and Method: The expenses of congenital malformations of craniofacial in-patients of Srinagarind Hospital were studied by analyzing the actual amount charged and the reimbursement of treatment expenses. Results: One thousand eight hundred forty five in-patients were treated 2,144 times. The average treatment was about once or twice per person. Male patients were 54.1% and female were 45.9%. About 84% of the patients were under the universal coverage, with an average Relative Weight (RW) between 2010 and 2014 of 1.6988, 1.7059, 1.4847, 1.4165, and 1.5096, respectively. The average of the RW and the treatment expenses differentiated by the patients' eligible medical expenses for self-paid, Government or State Enterprise Officer (OFC), Social Security Scheme (SSS), and universal coverage (UC) were 1.0398, 1.1596, 1.2759, 1.3477, respectively. The average RW calculated under diagnosis-related group (DRG) for each patient was 1.3148. The estimated RW of OFC at 13,378 and UC at 9,600 baht per RW were 18,081, 14,535, 14,259, and 17,118 baht, for an average of 16,842 baht. The average of the treatment expenses charged by the hospital to the OFC was 14,535 baht and to the UC was 17,118 baht for each treatment. The treatment expense under DRG was lower than the cost under the hospital charge by 2,051,072 baht. Conclusion: The present study analyzed the treatment expense by patients' eligible medical expenses between 2010 and 2014. The universal coverage and government or state enterprise officer's charges were reimbursed to the hospital under DRG system for 32,257,000 baht while the hospitals actual charges were 34,308,072 baht. This indicated that Srinagarind Hospital must set up the fund to support congenital malformations of craniofacial patients for a minimum sum of 410,214 baht per year. This is likely to increase in the future.

Assessment of Chromosome 22q11.2 Deletion in Patients with Isolated Cleft Palate: A Systematic Review of Prospective Studies.

Background: The prevalence of 22q11.2 deletion in patients presenting with isolated cleft palate has not been systematically assessed. Objective: To assess the evidence in the literature for the prevalence of 22q11.2 deletion in patients who were presenting with isolated cleft palate. Material and Method: A systematic literature search was conducted through PubMed between 1992 and June 2016 using search terms of 22q11.2 deletion OR 22q11 deletion AND cleft palate. Results: Of the six prospective studies reported, 328 patients with isolated cleft palate had been screened with FISH (Fluorescence In Situ Hybridization) test for 22q11.2 deletion. Among the 328 patients, there was one (0.3%) patient with positive FISH test for 22q11.2 deletion. This patient was clinically assessed and did not have an associated malformation or clinically recognized syndrome. Conclusion: The prevalence of 22q11.2 deletion among patients with isolated cleft palate is rather low. Of more than 400 genetic disorders involving occurrences of isolated cleft palate, FISH testing for 22q11.2 deletion in a patient with isolated cleft palate is recommended on clinical suspicion of additional clinical presentations of 22q11.2 deletion syndrome such as conotruncal congenital heart diseases, dysmorphic facies, velopharyngeal insufficiencies, immune deficiencies, hypoparathyroidisms, and neuropsychiatric disorders.

Birth Prevalence of Chromosome 22q11.2 Deletion Syndrome: A Systematic Review of Population-Based Studies.

Background: A birth prevalence of chromosome 22q11.2 deletion syndrome among population-based reports has been documented to vary, however, a systematic assessment is lacking. Objective: To assess the evidence in the literature for the birth prevalence of chromosome 22q11.2 deletion syndrome. Material and Method: A systematic literature search was conducted through PubMed between 1992 and June 2016 using search terms of 22q11.2 deletion OR 22q11 deletion and prevalence. Results: Of the six studies reported, there were 156 patients with 22q11.2 deletion syndrome found in total study populations of 1,111,336 live births. According to countries, the birth prevalence of this deletion syndrome (95% confidence interval) from United States, Belgium, Sweden, United Kingdom, France, and Singapore were 1.68 (1.22-2.26), 1.56 (1.33-1.72), 1.36 (0.91-2.08), 1.30 (0.45-2.15), 1.03 (0.53-2.23), and 1.02 per 10,000 live births, respectively. Estimates of minimum prevalence rates on the basis of the presence of this syndrome in cohorts of patients with cardiovascular malformations were from one in 4,000 to one in 7,092 live births. Conclusion: This systematic review indicates that the 22q11.2 deletion syndrome is rather common. The findings can help physicians, health care planners and other health professionals to plan and manage better care of these patients.

Prevalence of Congenital Heart Diseases in Patients with Orofacial Clefts: A Systematic Review.

BACKGROUND: The reports on prevalence rates of congenital heart diseases (CHDs) in patients with orofacial clefts (OFCs) have varied widely. OBJECTIVE: To systematically review the prevalence rates of CHDs in patients with OFCs. MATERIAL AND METHOD: A computer search was conducted through the PubMed from 1950 to June 2015 using key words or search terms of congenital heart diseases, orofacial clefts, cleft lip/palate and prevalence. RESULTS: The search resulted in nine studies with 598 CHDs cases identified in 5,707 patients with OFCs. The prevalence of CHDs in patients with OFCs ranged from 3.9% to 23.9%. The five prospective studies had prevalence rates of 12.0% (95% confidence interval [CI]: 10.9 to 13.2) whilst the four retrospective studies had prevalence rates of 8.6% (95% CI: 7.5 to 9.8). Concerning the prospective studies, the newborn study had a higher prevalence than those of other childhood studies [23.9% vs. 11.5% (95% CI: 10.4 to 12.7)]. The newborn study with the use of echocardiography had a higher prevalence than those without using echocardiography (23.9% vs. 12.8%). Atrial septal defect was the most frequent CHD found. CONCLUSION: CHD is commonly found in a patient with OFC. Echocardiography should be used to assess CHD in patients with OFCs.

Global Birth Prevalence of Orofacial Clefts: A Systematic Review.

BACKGROUND: A birth prevalence of orofacial clefts (OFCs) worldwide has been documented to vary. However a systematic assessment is lacking. OBJECTIVE: To assess the evidence in the literature for the birth prevalence of OFCs. MATERIAL AND METHOD: A systematic literature search was conducted using electronic databases through PubMed between 1950 and June 2015 using key words and search terms of cleft lip palate OR orofacial cleft AND prevalence. RESULTS: There were 45,193 patients with OFCs found in a study population of 30,665,615 live births. According to continents, the OFC birth prevalence (95% confidence interval)from Asia, North America, Europe, Oceania, South America, and Africa were 1.57 (1.54-1.60), 1.56 (1.53-1.59), 1.55 (1.52-1.58), 1.33 (1.30-1.36), 0.99 (0.96-1.02), and 0.57 (0.54-0.60) per 1,000 live births, respectively. The American Indians had the highest prevalence rates of 2.62 per 1,000 live births, followed by the Japanese, the Chinese, and the Whites of 1.73, 1.56, and 1.55 per 1,000 live births, respectively. The Blacks had the lowest rate of 0.58 per 1,000 live births. CONCLUSION: Observed differences may also be of ethnic origin, genetic, environmental factors, and methods of ascertainment. Further investigations are needed to manage this global health problem.

Roles of Medical Record and Statistic Staff on Research at the Tawanchai Center.

The medical record and statistic staffs play a crucial role behind the achievements of treatment and research of physicians, nurses and other health care professionals. The medical record and statistic staff are in charge of keeping patient medical records; creating databases; presenting information; sorting patient's information; providing patient medical records and related information for various medical teams and researchers; Besides, the medical record and statistic staff have collaboration with the Center of Cleft Lip-Palate, Khon Kaen University in association with the Tawanchai Project. The Tawanchai Center is an organization, involving multidisciplinary team which aims to continuing provide care for patients with cleft lip and palate and craniofacial deformities who need a long term of treatment since newborns until the age of 19 years. With support and encouragement from the Tawanchai team, the medical record and statistic staff have involved in research under the Tawanchai Centre since then and produced a number of publications locally and internationally.

Empowering Volunteers at Tawanchai Centre for Patients with Cleft Lip and Palate.

BACKGROUND: Cleft lip and palate (CLP) congenital anomalies have a high prevalence in the Northeast of Thailand. A care team's understand of treatment plan would help to guide the family of patients with CLP to achieve the treatment. OBJECTIVE: To examine the impact of the empowering volunteer project, established in the northeast Thailand. MATERIAL AND METHOD: The Empowering Volunteer project was conducted in 2008 under the Tawanchai Royal Granted project. The patients and family's general information, treatment, the group brainstorming, and satisfaction with the project were analysed. RESULTS: Participants were 12 children with CLP their families and five volunteers with CLP; the participating patients were predominantly females and the mean age was 12.2 years. The treatment comprised of speech training, dental hygiene care, bone graft and orthodontic treatment. Four issues were addressed including: problems in taking care of breast feeding, instructions' needs for care at birth, difficulty in access information and society impact, and needs in having a network of volunteers. CONCLUSIONS: Empowering volunteer is important for holistic care of patients with CLP which provides easy access and multiple channels for patients and their families. It should be developed as part of the self-help and family support group, the development of community based team and comprehensive CLP care program.

Development and Monitoring the Key Performent Index of The Quality of Care for Patients with Cleft/Palate in Tawanchai Center and Out-Patient Surgical Room Srinagarind Hospital Thailand.

BACKGROUND: Cleft lips and cleft palates have the most incidences in the Northeast of Thailand (2.49/1,000 newborns). Cleft lips and cleft palates (CLP) can affect patients and families both physically and mentally. It takes critical long-term medical treatment starting when prenatal, newborn, and fully grown until 19 years old by a multidisciplinary team; therefore, it was effective to have collaboration with patients, families, and a multidisciplinary team in order to build up the same objective and create key performance index to monitor the treatment outcome also to develop the quality of care. OBJECTIVE: 1) to create the key performance index and 2) to develop the index system by using information technology. MATERIAL AND METHOD: After the research received ethics approval from Khon Kaen University, qualitative and quantitative data were collected. There were two periods in this study. The 1st period as following list below: 1) Field research was performed by conference meetings and problem-learning process, which participants participated in each step. There were two example groups: (1) Patients and families cooperated 2 times and (2) Nursing care cooperated 4 times in October-December 2013 (3) Combining the conclusions to set the key performance index and develop the index system in January-February 2014 (4) Recording the system in March-June 2014. Content analysis and percentage were used in this study. RESULTS: Nine organizations were engaged in this study; eight key performance indexes were established and the research recorded continuously for 4 months. There were three key performance indexes, which performed successfully: 1) Patients/caregivers received follow-up treatment continuously, 92.06%, 2) Patients/caregivers reported 89.69% satisfaction after asking the information, 3) Patients/families reported overall satisfaction of 92.11%. CONCLUSION: It is shown that recording the key performance index for the 1st period covered every quality of care. The Tawanchai Center and Out-patient Surgical Room under Srinagarind Hospital applied eight key performance indexes and found that three key performance indexes were feasibly implemented. For the 2nd period, the 1st outcome of key performance indices will be analyzed and developed including improving the software in order to record data and analyze the percentages automatically.

Development and Monitoring the Key Performance Indicators of the Quality of Care for Patients with Cleft Lips/Palates at Srinagarind Hospital.

BACKGROUND: Congenital deformities, such as cleft lips and/or cleft palates (CLP), have high incidences in the Northeast of Thailand. These birth defects can affect patient's quality of life. CLP patients need crucial and long-term treatments by a multidisciplinary team starting from prenatal stage to late adulthood. Patients and their families should involve in their own care, and their care objectives should correspond with healthcare providers. Besides the clinical outcome of interdisciplinary team, key performance indicators (KPIs) need to be developed in the hospital service unit in order to improve quality of care and treatment outcomes. OBJECTIVE: 1) to establish KPIs in hospital service units, and 2) to develop the information system to collect, analysis and improve the quality of CLP care. MATERIAL AND METHOD: A nurse coordinator was appointed in the Tawanchai Center to coordinate care. The three periods were conducted for the nurse coordinator to work with nine service units in Srinagarind Hospital for consensus on both qualitative and quantitative data to be used as service unit quality measurement. RESULTS: Thirty one KPIs from nine service units were established, collected and analyzed during a four-month period in 2014. The 20 KPIs achieved the unit targets. Two PKIs of the rates of complication with anesthesia during/after surgery in the first 24 hours and the rates of patient/caregiver's satisfaction in acquiring information from the officer were improving. There were 11 KPIs that did not achieve the targets. The coordinator nurse of the Tawanchai Center discussed with the service unit for the cause and how to improve the outcome. CONCLUSION: The monitoring KPIs will lead to improvement of outcome for better patient quality as well as benchmarking with other hospitals of Cleft Center. The KPIs from hospital service units with the monitoring and analysis of information by the nurse coordinator will enhance and lead to improvement of the quality of the patients and family centered care process.

Speech Correction for Children with Cleft Lip and Palate by Networking of Community-Based Care.

BACKGROUND: Prevalence of cleft lip and palate (CLP) is high in Northeast Thailand. Most children with CLP face many problems, particularly compensatory articulation disorders (CAD) beyond surgery while speech services and the number of speech and language pathologists (SLPs) are limited. OBJECTIVE: To determine the effectiveness of networking of Khon Kaen University (KKU) Community-Based Speech Therapy Model: Kosumphisai Hospital, Kosumphisai District and Maha Sarakham Hospital, Mueang District, Maha Sarakham Province for reduction of the number of articulations errors for children with CLP. MATERIAL AND METHOD: Eleven children with CLP were recruited in 3 1-year projects of KKU Community-Based Speech Therapy Model. Articulation tests were formally assessed by qualified language pathologists (SLPs) for baseline and post treatment outcomes. Teachings on services for speech assistants (SAs) were conducted by SLPs. Assigned speech correction (SC) was performed by SAs at home and at local hospitals. Caregivers also gave SC at home 3-4 days a week. RESULTS: Networking of Community-Based Speech Therapy Model signficantly reduced the number of articulation errors for children with CLP in both word and sentence levels (mean difference = 6.91, 95% confidence interval = 4.15-9.67; mean difference = 5.36, 95% confidence interval = 2.99-7.73, respectively). CONCLUSION: Networking by Kosumphisai and Maha Sarakham of KKU Community-Based Speech Therapy Model was a valid and efficient method for providing speech services for children with cleft palate and could be extended to any area in Thailand and other developing countries, where have similar contexts.

Khon Kaen: a community-based speech therapy model for an area lacking in speech services for clefts.

Absence of speech rehabilitation services is one of the critical difficulties in care for clefts in Thailand and some other developing countries. The objective of this study was to determine the effectiveness of the "Khon Kaen Community-Based Speech Therapy Model" in decreasing the number of articulation defects in children with cleft palate and/or lip. Sixteen children with cleft palate and/or lip in 6 districts of Maha Sarakham Province were enrolled for study. A three-day intensive speech camp was held in Srinagarind Hospital and followed by an outreach program of six one-day follow-up speech camps in Maha Sarakham Hospital. Six paraprofessionals, speech assistants, provided home- or community- based speech correction every week for one year. Numbers of various articulation errors were compared pre- and post-treatment using the Wilcoxon signed-rank test. The number of articulation defects showed a statistically significant reduction (mean difference = 10; Z = -3.52; p < 0.001; 95% CI: 8-13). The "Khon Kaen Community-Based Speech Therapy Model" is one of the best models for solving speech therapy problems in areas of Thailand lacking speech services and can be applied to other developing countries.

Treatment of 4-5 year old patients with cleft lip and cleft palate in Tawanchai Center: prevalence and type of associated malformations.

BACKGROUND: Patients with cleft lip/palate may have other associated malformations but the reported prevalence and type of associated malformations varied between different studies. OBJECTIVE: To report the prevalence and the type of associated malformations in Northeastern Thai patients with cleft lip/palate. MATERIAL AND METHOD: A retrospective study of 123 cleft lip/palate patients aged 4-5 years was carried out at the Tawanchai Cleft Center, Khon Kaen University during the periodfrom October to December 2011. Data were collected by reviewing the patients medical records. RESULTS: Seventeen (14%) of the 123patients had associated malformations. Four (21%) of the 19patients with cleft palate, eleven (15%) of the 74 patients with clefts lip and palate, and two (7%) of the 30 patients with cleft lip had associated malformations. The organ systems affected by associated malformations were cardiovascular system (41%), craniofacial anomaly (23%), skeletal system (12%), urogenital system (12%) and central nervous systemn (12%). Atrial septal defect and tetralogy ofFallot were most common associated cardiovascular malformation found. CONCLUSION: The high prevalence of associated malformationsfound in patients with cleft lip/palate emphasizes the needfor a thorough screening of associated malformations and congenital heart disease ofall cleft lip/palatepatients.

Oral health status and oral impacts on quality of life in early adolescent cleft patients.

OBJECTIVE: To determine the levels of dental caries, periodontal disease and oral health-related quality of life in children with cleft lip and/or cleft palate compared to non-cleft controls. MATERIAL AND METHOD: This cross-sectional study was conducted in Khon Kaen, Thailand. Subjects included 68 oral cleft and 118 non-cleft individuals aged 10-14 years, who were interviewed using the Child-Oral Impacts on Daily Pemformance (Child-OIDP) index and received oral examinations. RESULTS: Decayed, missing and filled teeth (DMFT) index in permanent teeth, plaque index (PI), and gingival index (GI) scores were significantly higher in the children with cleft than in the controls. However, there was no significant difference in caries prevalence and decayed, missing and filled teeth (dmnft) index inprimaly teeth between comparison groups. The prevalence of oral impacts on Speaking and Smiling was significantly higher in the cleft children than non-cleft controls. The mean impact score between both groups were not significantly different, but the cleft children with impacts had a significantly higher mean impact score (11.9) than did the controls (8.6). The impact score in the cleft children was high for speaking (4.5), emotion control (4.2), eating (3.4) and relaxing (3.4) activities. The main causes of these impacts included having oro-nasalftstula, having orthodontics appliance, position of teeth and deformity of mouth or face. CONCLUSION: The cleft children had higher levels ofdental caries and gingivitis, and poorer oral hygiene than the controls. They also had lower quality of life than the controls in most pelformances with different perceived causes.

Clinical outcomes of primary palatoplasty in pre-school-aged cleft palate children in Srinagarind hospital: quality of life.

BACKGROUND: Cleft lips and cleft palates are common congenital anomalies, which affects facial appearance, speech, hearing, teeth alignment and other structures. Craniofacial anomalies and speech disorders are crucial problems in the preschool-aged children (5-6 years old), when they start attending school and become more engaged in the community. This condition, which differentiates them from other students, can lead to teasing or mocking which can cause low-self esteem, an inferiority complex, andfoster bad relationships with friends. Missing class in order to receive treatment and other additional care can affect a student's learning, development and overall-quality of life. OBJECTIVE: The purpose of this research was to study the quality of life in preschool-aged cleftpalate children and satisfaction with their level of speech. MATERIAL AND METHOD: This was a retrospective, descriptive study. The data were collected by reviewing medical records of patients with cleft lip and cleft palate aged 5-6 years old who underwent operation and treatment with the Tawanchai Center at Srinagarind Hospital. There were 39patients in this study. Data collection was conducted for 5 months (June to October 2013). The research instruments were: (1) General Demographic Questionnaire, (2) Quality of Life Questionnaire with 5 Domains, and (3) the Satisfaction of Speech Questionnaire. The descriptive statistics, percentages and the standard deviation were analyzed in the present study. RESULTS: The findings revealedfamily information pertaining to CLP treatment and the impact it has on consumption, speech training, hearing test, development, dental treatment, communication skills, participation, referral treatment as well as the quality ofcoordinationfor advanced treatment. The present study revealed that all ofthe aforementioned criteria were met at a high level. Moreover the child's sickness had only a moderate impact on family life. In conclusion, the overall satisfaction was at a very high level. CONCLUSION: It was concluded that the collaboration of the Tawanchai Cleft Center and the government, as well as with private and non-governmental organizations was exceptional, particularly in regard to providing proper and continuous treatment for patients with cleft lips and/or cleft palate. The findings reflect a good quality of life in the pre-schooled children with cleft lip and cleft palate that received treatment from the Tawanchai Cleft Center at Srinagarind Hospital. Furthermore, the study showed that the problems associated with the condition, only affected the family's lives at a minimal level.