Christopher Johnston

Self-reports of psychosocial functioning among children and young adults with cleft lip and palate.

Objective: A cross-sectional study was employed to determine the psychosocial effects of cleft lip and/or palate among children and young adults, compared with a control group of children and young adults without cleft lip and palate. Participants: The study comprised 160 children and young adults with cleft lip and/or palate and 113 children and young adults without cleft lip and/or palate. All participants were between 8 and 21 years of age. Outcome measures: Psychological functioning (anxiety, self-esteem, depression, and behavioral problems) was assessed using validated psychological questionnaires. Happiness with facial appearance was rated using a visual analog scale. Social functioning, including experience of teasing/bullying and satisfaction with speech, was assessed using a semistructured interview. Results: Participants with cleft lip and/or palate reported greater behavioral problems (p < .001) and more symptoms of depression (p < .01); they were teased more often (p < .001) and were less happy with their facial appearance (p < .01) and speech (p < .001), compared with controls. There were no significant difference between subjects with cleft lip and/or palate and subjects without cleft lip and/or palate in terms of anxiety (p > .05) or self-esteem (p > .05). Having been teased was a significant predictor of poor psychological functioning, more so than having a cleft lip and/or palate per se (p < .001). Conclusions: Teasing was greater among participants who had cleft lip and/ or palate and it was a significant predictor of poorer psychosocial functioning. Children and young adults with cleft lip and/or palate require psychological assessment, specifically focusing on their experience of teasing, as part of their routine cleft care.

Parent reports of the psychosocial functioning of children with cleft lip and/or palate.

Objectives: (1) to determine the opinion of parents regarding the psychosocial functioning of their child with cleft lip and/or palate (CLP); (2) to identify predictors of psychosocial functioning; and (3) to determine the level of agreement between children with CLP and their parents. Participants: One hundred twenty-nine parents of children with CLP and 96 parents of children without CLP participated in this cross-sectional study. Outcome measures: Parental opinion of the childs self-esteem, anxiety, happiness, and problems caused by facial appearance were assessed using visual analogue scales. Parents completed the Child Behavior Checklist and were interviewed. Results: Children with CLP were more anxious (p < 0.05), less happy with their appearance (p < 0.001), and in general (p < 0.05) had lower self-esteem (p < 0.05) and greater behavioral problems (p < 0.001) compared with non-CLP children. Parents reported that their child with CLP was teased more often (p < 0.001) and was less satisfied with his/her speech (p < 0.01) compared with reports of parents in the control group. A number of factors affected parents’ ratings of their childs psychosocial functioning (presence of CLP, appearance happiness, previous history of CLP, and visibility of scar). Children who had been teased were more anxious (p ≤ 0.01), less happy with their appearance (p < 0.001) and had greater behavioral problems (p < 0.001). Conclusions: Parents of children with CLP reported various psychosocial problems among their children. Parents considered children who had been teased to have greater psychosocial problems.

The effect of etch duration on the microstructure of molar enamel: An in vitro study

This in vitro study evaluated the influence of varying etch time on the microstructure of molar buccal enamel. The buccal surfaces of four groups of extracted first molar teeth were etched for 15, 30, 45, and 60 seconds. The etch patterns obtained were photographed with a scanning electron microscope and rated with a 3-grade scale. The 15-second etch time failed to produce any optimal etch patterns. The best etch patterns were found in molars etched for 60 seconds.

A Comparison of Craniofacial Form in Northern Irish Children With Unilateral Cleft Lip and Palate Treated With Different Primary Surgical Techniques

Objective The quality of outcomes in patients with unilateral cleft lip and palate (UCLP) was compared between two senior plastic surgeons. One surgeon carried out a one-stage Wardill-Kilner palate repair. The other surgeon employed a vomer flap hard palate repair followed by a von Langenbeck soft palate closure (Oslo protocol). Design Retrospective analysis. Patients Thirty-four children (mean age 9.7 years) born with complete skeletal UCLP in Northern Ireland from 1983 to 1991 who received primary repair surgery from one of the two surgeons. Main Outcome Measures Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. Results Twenty-nine of the 34 subjects had good or satisfactory arch relationships. Comparison between the surgeons revealed that the Wardill-Kilner group had a greater proportion of Goslon grades of greater than 3, indicating poor arch relationships. However, this difference failed to reach statistical significance. There were no significant cephalometric differences between patients treated by the two surgeons. Conclusions Although the difference was not statistically significant, the highest proportion of patients likely to require orthognathic surgery was found in those treated using the Wardill-Kilner technique.

Psychological Status of Patients Referred for Orthognathic Correction of Skeletal II and III Discrepancies

OBJECTIVE To establish the extent of psychological problems among patients who require orthognathic treatment. MATERIALS AND METHODS Five aspects of psychological functioning were assessed for 162 patients who required orthognathic treatment and compared with 157 control subjects. RESULTS Analysis of variance did not detect any significant difference in the five psychological scores recorded for the skeletal II, skeletal III, and control groups. The proportion of subjects with one or more psychological measure beyond the normal range was 27% for skeletal II subjects, 25% for skeletal III subjects, and 26% for control subjects. One skeletal II subject (1.5%), three skeletal III subjects (3%), and five control subjects (3%) required referral for psychological counseling. CONCLUSIONS The orthognathic patients did not differ significantly from the control subjects in their psychological status.

A Retrospective Comparison of Craniofacial Form in Northern Irish Children with Unilateral Cleft Lip and Palate

OBJECTIVE This study evaluated the craniofacial form of a sample of Northern Irish children with unilateral cleft lip and palate (UCLP). The quality of the outcomes achieved was compared with the outcomes reported for the six centers involved in the European multicenter study (Mars et al., 1992; Mølsted et al, 1992). DESIGN Retrospective analysis. PATIENTS All children born with complete skeletal UCLP in Northern Ireland during the years 1983 to 1987. MAIN OUTCOME MEASURES Cephalometric analysis was used to determine the craniofacial form and soft tissue profile. The quality of the dental arch relationships was independently assessed using the Goslon ranking system. RESULTS The sample comprised 25 children with complete skeletal UCLP who had cephalometric radiographs and study casts recorded at a mean age of 9.4 years (range, 8 to 11 years). Cephalometric analysis revealed no important skeletal differences between the Northern Irish UCLP children and the published results from the six Eurocleft centers. The soft tissue profile of the Northern Irish UCLP children was significantly more convex than the soft tissue profile recorded for center D in the Eurocleft study. The Goslon ranking system revealed that 18 (72%) of the Northern Irish UCLP children had good or satisfactory dental arch relationships. CONCLUSIONS No clinically important differences were detected between the mean cephalometric skeletal parameters of the Northern Irish UCLP children and those published for the six cleft centers involved in the Eurocleft study. On average, the Northern Irish UCLP children were found to differ significantly from Euroclefts center D in their soft tissue facial contour and sagittal lip profile. The quality of the dental arch relationships of the Northern Irish sample was between the best and the less good Eurocleft centers.

Distribution of glucagon-like peptide-2 in normal colonic tissue

Glucagon-like peptide-2 (GLP-2) is a regulatory peptide with trophic effects on the intestine achieved through intestinal epithelial proliferation, crypt cell hyperplasia and inhibition of apoptosis (1). GLP-2 is released from the enteroglucagon cells (L-cells) and is derived from the breakdown of proglucagon that undergoes tissue-specific processing. Several authors have suggested that the terminal ileum and proximal colon are important regions in the colon for the production of GLP-2 (2, 3). The density of L cells in human colonic mucosa increases distally in the intestine and is maximal in the rectum (4). It is surprising that GLP-2 production should be maximal in the proximal colon and therefore the aim was to establish the distribution of GLP-2 cells in the human colon.