{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:18:41Z","timestamp":1787015921965,"version":"build-2736575974"},"reference-count":17,"publisher":"Wiley","issue":"S2","license":[{"start":{"date-parts":[[2017,6,29]],"date-time":"2017-06-29T00:00:00Z","timestamp":1498694400000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Orthod Craniofacial Res"],"published-print":{"date-parts":[[2017,6]]},"abstract":"<jats:title>Structured Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      To summarize and discuss centre\u2010level variation across a range of treatment and outcome measures and examine individual and ecological determinants of outcome in children in Cleft Care\n                      <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>\n                      (\n                      <jats:styled-content style=\"fixed-case\">CCUK<\/jats:styled-content>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and sample population<\/jats:title>\n                    <jats:p>\n                      Two hundred and sixty\u2010eight 5\u2010year\u2010old British children with non\u2010syndromic unilateral cleft lip and palate (\n                      <jats:styled-content style=\"fixed-case\">UCLP<\/jats:styled-content>\n                      ) recruited to\n                      <jats:styled-content style=\"fixed-case\">CCUK<\/jats:styled-content>\n                      and treated within a centralized service.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Children had a range of treatment and outcome measures collected at a 5\u2010year audit clinic. These outcomes included dento\u2010alveolar arch relationships from study models, measures of facial appearance from cropped photographs, hearing loss from audiological assessment, speech from speech recordings, self\u2010confidence and strengths and difficulties from parental self\u2010report. Data were collected on educational attainment at age 7 using record linkage. Centre variation was examined using hierarchical regression and associations between variables were examined using logistic or poisson regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was centre\u2010level variation for some treatments (early grommet placement, fitting of hearing aids, fluoride treatment, secondary speech surgery and treatment for cleft speech characteristics) and for some outcomes (intelligibility of speech). Hearing loss was associated with a higher risk of poor speech while speech therapy was associated with a lower risk of poor speech. Children had high levels of caries but levels of preventative treatment (fluoride varnish and tablets) were low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Further improvements to and monitoring of the current centralized model of care are required to ensure the best outcomes for all children with cleft lip and palate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ocr.12188","type":"journal-article","created":{"date-parts":[[2017,6,29]],"date-time":"2017-06-29T05:15:12Z","timestamp":1498713312000},"page":"48-51","source":"Crossref","is-referenced-by-count":10,"title":["Centre\u2010level variation in treatment and outcomes and predictors of outcomes in 5\u2010year\u2010old children with non\u2010syndromic unilateral cleft lip treated within a centralized service: the Cleft Care\n                    <scp>UK<\/scp>\n                    study. Part 6: summary and implications"],"prefix":"10.1111","volume":"20","author":[{"given":"A. R.","family":"Ness","sequence":"first","affiliation":[{"name":"National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle The University Hospitals Bristol NHS Foundation Trust and the University of Bristol  Bristol UK"},{"name":"Bristol Dental School University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. K.","family":"Wills","sequence":"additional","affiliation":[{"name":"National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle The University Hospitals Bristol NHS Foundation Trust and the University of Bristol  Bristol UK"},{"name":"Bristol Dental School University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"School of Social and Community Medicine University of Bristol  Bristol UK"},{"name":"Department of Applied Statistics Helwan University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Hall","sequence":"additional","affiliation":[{"name":"Life and Health Sciences Aston University  Birmingham UK"},{"name":"Children's Hearing Centre St Michael's Hospital  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Sell","sequence":"additional","affiliation":[{"name":"North Thames Regional Cleft Service, Speech and Language Therapy Department Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID) Great Ormond Street Hospital NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Smallridge","sequence":"additional","affiliation":[{"name":"Cleft.NET. East Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Southby","sequence":"additional","affiliation":[{"name":"School of Social and Community Medicine University of Bristol  Bristol UK"},{"name":"Cleft.NET. East Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital  Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D.","family":"Stokes","sequence":"additional","affiliation":[{"name":"Cleft Lip and Palate Association  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Toms","sequence":"additional","affiliation":[{"name":"National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle The University Hospitals Bristol NHS Foundation Trust and the University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Waylen","sequence":"additional","affiliation":[{"name":"Bristol Dental School University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y.","family":"Wren","sequence":"additional","affiliation":[{"name":"Bristol Dental School University of Bristol  Bristol UK"},{"name":"Bristol Speech &amp; Language Therapy Research Unit North Bristol NHS Trust, Southmead Hospital  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. R.","family":"Sandy","sequence":"additional","affiliation":[{"name":"Bristol Dental School University of Bristol  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,6,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/ocr.12183"},{"key":"e_1_2_9_3_1","first-page":"1","article-title":"Centre\u2010level variation in outcomes and treatment for otitis media with effusion and hearing loss and the association of hearing loss with developmental outcomes at ages 5 and 7 years in children with non\u2010syndromic unilateral cleft lip and palate: The Cleft Care UK study. Part 2","author":"Hall A","year":"2017","journal-title":"Orthod Craniofac Res"},{"key":"e_1_2_9_4_1","first-page":"1","article-title":"Centre\u2010level variation in dental treatment and oral health and individual\u2010and area\u2010level predictors of oral health in 5\u2010year\u2010old children with non\u2010syndromicunilateral cleft lip and palate: the Cleft Care UK study. Part 3","author":"Smallridge J","year":"2017","journal-title":"Orthod Craniofac Res"},{"key":"e_1_2_9_5_1","first-page":"1","article-title":"Centre\u2010level variation in speech outcome and interventions, and factors associated with poor speech outcomes in 5\u2010year\u2010old children with non\u2010syndromic unilateral cleft lip and palate: The Cleft Care UK study. 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