Rachel M. Roberts

Mindful pregnancy and childbirth: effects of a mindfulness-based intervention on women's psychological distress and well-being in the perinatal period.

This pilot study explored the effects of an 8-week mindfulness-based cognitive therapy group on pregnant women. Participants reported a decline in measures of depression, stress and anxiety; with these improvements continuing into the postnatal period. Increases in mindfulness and self-compassion scores were also observed over time. Themes identified from interviews describing the experience of participants were: ‘stop and think’, ‘prior experience or expectations’, ‘embracing the present’, ‘acceptance’ and ‘shared experience’. Childbirth preparation classes might benefit from incorporating training in mindfulness.

The independent relationships between insomnia, depression, subtypes of anxiety, and chronotype during adolescence

OBJECTIVES To investigate the independent effects of depression and subtypes of anxiety on insomnia, and vice versa, and the independent effect of chronotype on insomnia, depression, and subtypes of anxiety. METHODS In all, 318 South Australian high school students from grades 7-11 (age range, 12-18years; mean, 14.97±1.34) participated in this cross-sectional study. Validated self-report questionnaires were used to assess insomnia, depression, subtypes of anxiety, and chronotype. RESULTS After confounder variables were controlled, insomnia predicted depression and panic disorder (PD), whereas insomnia was predicted by depression and generalized anxiety disorder (GAD). Obsessive-compulsive disorder (OCD), separation anxiety (SAD), and social phobia (SP) were not significantly related to insomnia. Eveningness predicted the models in which depression and PD predicted insomnia and vice versa. Eveningness also predicted the models in which insomnia was predicted by OCD, SAD, and SP. CONCLUSIONS Insomnia independently predicts depression and is predicted by depression and GAD, but not by other forms of anxiety. The independent prediction of insomnia on PD is unlikely to be clinically significant. Chronotype independently predicts and hence is a risk factor for insomnia and depression, but not subtypes of anxiety. Theoretical and clinical implications are discussed.

Psychosocial functioning in adults with congenital craniofacial conditions.

Objective To examine the psychosocial functioning of adults with congenital craniofacial conditions relative to normative data. Design Single sample cross-sectional design. Setting The Australian Craniofacial Unit, Womens and Childrens Hospital, Adelaide, which is one of the main craniofacial treatment centers in Australia. Participants Adults (N = 93) with congenital craniofacial conditions (excluding cleft lip/palate) who were treated in the Australian Craniofacial Unit. Main Outcome Measures All participants completed self-report scales assessing health-related quality of life (SF-36); life satisfaction, anxiety, and depression (HADS); self-esteem (Rosenberg); appearance-related concerns; perceived social support; and social anxiety. Results Overall, participants were very similar in psychosocial function to the general population. However, adults with craniofacial conditions were less likely to be married and have children (females), were more likely to be receiving a disability pension, and reported more appearance-related concerns and less social support from friends. They also reported more limitations in both their social activities, due to physical or emotional problems, and usual role activities, because of emotional problems, as well as poorer mental health. Conclusions These results give cause to be very positive about the long-term outcomes of children who are undergoing treatment for craniofacial conditions, while also identifying specific areas that interventions could target.

Diffusion Tensor Imaging (DTI) Findings Following Pediatric Non-Penetrating TBI: A Meta-Analysis

This study meta-analyzed research examining Diffusion Tensor Imaging following pediatric non-penetrating traumatic brain injury to identify the location and extent of white matter changes. Fractional anisotropy (FA) and apparent diffusion coefficient (ADC) data from 20 studies were analyzed. FA increased and ADC decreased in most white matter tracts in the short-term (moderate-to-large effects), and FA decreased and ADC increased in the medium- to long-term (moderate-to-very-large effects). Whole brain (short-term), cerebellum and corpus callosum (medium- to long-term) FA values have diagnostic potential, but the impact of age/developmental stage and injury severity on FA/ADC, and the predictive value, is unclear.

The role of skin cancer knowledge in sun-related behaviours: a systematic review

Skin cancer is the most commonly diagnosed cancer in many Western countries. This systematic review provides a comprehensive overview of the relationship between skin cancer knowledge and sun-protective, exposure and tanning behaviours in the general population. A total of 34 studies, published in peer-reviewed journals over three decades, were reviewed and synthesised. Sun-protective behaviour was positively associated with skin cancer knowledge in most cases. Findings were inconsistent regarding other sun-related behaviours. Heterogeneity in measurement compromised the capacity to definitively link knowledge and sun-related behaviours. There is a need for development and utilisation of a standardised skin cancer knowledge scale, and guidelines are suggested.

Snoring and cognitive development in infancy.

OBJECTIVE This study aimed to assess the influence of snoring and sleep duration on developmental outcomes in 6 month old infants. METHODS As part of a longitudinal study of snoring in infancy, we identified 16 children (13 males) who commenced snoring shortly after birth and continued to snore frequently (≥ 3 nights/week) at 6 months of age and 88 healthy infant controls who were reported never to snore in the absence of a cold (36 males). Infants were assessed at 6 months of age with the Bayley Scales of Infant and Toddler Development Edition III, and parents completed demographic, sleep, and developmental surveys. RESULTS Cognitive development was reduced in infants who snored frequently (mean=95.3; SD=4.3) from the first month of life compared to control infants (mean=100.6; SD=3.9) (F [1, 99]=23.8, p<.01; η(p)(2)=.21). CONCLUSION Snoring during the first 6 months of life was associated with lower cognitive development scores. It is unknown whether these infants will continue to snore through childhood and, if so, whether the associated neurocognitive deficits will become worse with time.

Cognitive Functioning in Children and Adults With Nonsyndromal Cleft Lip and/or Palate: A Meta-analysis

OBJECTIVE To provide a meta-analysis of research that has examined the cognitive functioning of children and adults with cleft lip (CL), cleft palate (CP), and cleft lip and palate (CLP). METHODS Data from 29 studies, which compared persons with a cleft to a control group on tests of cognitive functioning, were analyzed. The data were obtained from 1,546 persons with cleft and 279,805 controls. RESULTS Participants with a cleft performed significantly worse on 7 cognitive domains. However, the only moderate and significant deficit, which was based on nonheterogeneous study findings and not subject to publication bias, was in the language domain. CL, CP, and CLP were all associated with cognitive impairments, although the profiles for the groups differed. CONCLUSIONS Cross-sectional studies suggest that persons with clefts experience poorer cognitive functioning across a range of domains, although large-scale longitudinal studies are needed to more definitively differentiate outcomes by cleft type.

General health-related quality of life and oral health impact among Australians with cleft compared with population norms; age and gender differences.

Objective To evaluate general health-related quality of life (HRQoL) and oral health impact among adults treated for cleft to determine age and gender differences, and to compare against population norms. Design Cross-sectional prospective study. Participants/Setting Nonsyndromic cleft patients treated by the Australian Craniofacial Unit from 1975 to 2009 were recruited (n = 112). Response rate was 79% (n = 88). Main outcome measures HRQoL was measured by the Short Form (SF)-36 questionnaire. Oral health impact was measured by the Oral Health Impact Profile (OHIP)-14 questionnaire. State-based and national norms were used for comparative purposes. Results There were no significant age or sex differences in the cleft samples SF-36 and OHIP-14 scores. When compared against South Australian 2002 state-level norms, cleft participants scored higher on physical function and physical role function but lower on vitality and mental health. The prevalence of having experienced one or more of OHIP–14 items “fairly often” or “very often” was 2.7 times higher than national-level estimates, while extent was 2.8 times and severity 1.7 times higher. Conclusions The oral health impact among cleft patients included in our study was poor compared with population-level estimates. The HRQoL showed mixed results, with the vitality and mental health components being poorer in the cleft group compared with population-level estimates. These results indicate that treatment for orofacial clefting does not entirely remove the factors contributing to poor HRQoL and oral health.

Children’s experience of living with a craniofacial condition: Perspectives of children and parents

This is the first study to examine the range of experiences of children living with a wide range of craniofacial anomalies (CFAs), from the perspectives of children and parents. We interviewed 26 young people and 28 parents about both stressors and positive aspects for young people of living with a CFA. Thematic analysis revealed four major stress-related themes (self-acceptance, responses of others, disabilities and impairments, and treatment). Positive themes included personal qualities and support. Psychological theories often applied to those with CFAs relate to attractiveness, stigma and teasing, but the present findings suggest that these are not as useful as the conceptualization of CFAs as chronic conditions which influence adaptive tasks. Implications for clinical practice are discussed.

Facial aesthetics and perceived need for further treatment among adults with repaired cleft as assessed by cleft team professionals and laypersons

The objectives of this study were to compare the ratings of professionals and laypeople with and without a cleft regarding the facial aesthetics of adult patients previously treated for orofacial clefting. The necessity for further treatment, as perceived by the respective groups, is also compared. The design of the study was a cross-sectional study. Professionals (two plastic surgeons, one dentist, one orthodontist, and one psychologist) and laypeople (one male and one female adult without a cleft and one male and one female adult with a cleft) were recruited to rate photographs of 80 non-syndromic cleft patients treated by the Australian Craniofacial Unit from 1975 to 2009. Facial aesthetics were measured by a visual analogue scale (VAS; 0-100 mm). High values indicated good aesthetics. Necessity for further treatment was also measured by a VAS (0-100 mm). High values indicated high perceived need for further treatment. The professionals rated facial aesthetics significantly lower and had a lower perception of need for further treatment than the raters with and without a cleft. The laypeople with a cleft rated facial aesthetics significantly higher and had a lower perceived need for further treatment than laypeople without a cleft. The non-surgical professionals rated facial aesthetics significantly lower and had a lower perceived need for further treatment than the surgical professionals. Differences exist in the facial aesthetics ratings and perceived need for further surgery between professionals and laypeople with and without a cleft. This should be considered when managing cleft treatment expectations.