{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:32:16Z","timestamp":1792549936505,"version":"4.5.0"},"reference-count":24,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2018,8,28]],"date-time":"2018-08-28T00:00:00Z","timestamp":1535414400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The Cleft Palate Craniofacial Journal"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In low- and middle-income countries, poor access to care can result in delayed surgical repair of orofacial clefts leading to poor functional outcomes. Even in Brazil, an upper middle-income country with free comprehensive cleft care, delayed repair of orofacial clefts commonly occurs. This study aims to assess patient-perceived barriers to cleft care at a referral center in S\u00e3o Paulo.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A 29-item questionnaire assessing the barriers to care was administered to 101 consecutive patients (or their guardians) undergoing orofacial cleft surgery in the Plastic Surgery Department in Hospital das Cl\u00ednicas, in S\u00e3o Paulo, Brazil, between February 2016 and January 2017.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 54.4% of patients had their first surgery beyond the recommended time frame of 6 months for a cleft lip or cleft lip and palate and 18 months for a cleft palate. There was a greater proportion of isolated cleft palates in the delayed group (66.7% vs 33.3%). Almost all patients had a timely diagnosis, but delays occurred from diagnosis to repair. The mean number of barriers reported for each patient was 3.8. The most frequently cited barriers related to lack of access to care include (1) lack of hospitals available to perform the surgery (54%) and (2) lack of availability of doctors (51%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Delays from diagnosis to treatment result in patients receiving delayed primary repairs. The commonest patient-perceived barriers are related to a lack of access to cleft care, which may represent a lack of awareness of available services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1055665618796018","type":"journal-article","created":{"date-parts":[[2018,8,29]],"date-time":"2018-08-29T07:26:17Z","timestamp":1535527577000},"page":"639-645","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":26,"title":["Patient-Perceived Barriers to Accessing Cleft Care at a Tertiary Referral Center in S\u00e3o Paulo, Brazil"],"prefix":"10.1177","volume":"56","author":[{"given":"Ananda","family":"Ise","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camila","family":"Menezes","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joao","family":"Batista Neto","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saurab","family":"Saluja","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia R.","family":"Amundson","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hillary","family":"Jenny","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Massenburg","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Citron","sequence":"additional","affiliation":[{"name":"Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nivaldo","family":"Alonso","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, University of Sao Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,8,28]]},"reference":[{"key":"bibr1-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23528"},{"key":"bibr2-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1590\/S0102-311X2006000100003"},{"key":"bibr3-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2015.06.010"},{"key":"bibr4-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1016\/S0266-4356(96)90242-9"},{"key":"bibr5-1055665618796018","unstructured":"Instituto Brasileiro de Geografia e Estat\u00edstica. 2016. Available at: https:\/\/ww2.ibge.gov.br\/english\/. Accessed December 27, 2017. Updated August, 14, 2018."},{"key":"bibr6-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e3181b03824"},{"key":"bibr7-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-009-0333-7"},{"key":"bibr8-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000003038"},{"issue":"1","key":"bibr9-1055665618796018","first-page":"137","volume":"12","author":"McQueen KAK","year":"2010","journal-title":"Heal Hum Rights"},{"key":"bibr10-1055665618796018","unstructured":"Minist\u00e9rio da Sa\u00fade-Sistema de Informa\u00e7\u00f5es Hospitalares do SUS (SIH\/SUS). 2016. Available at: http:\/\/tabnet.datasus.gov.br\/cgi\/tabcgi.exe?sih\/cnv\/qiuf.def. Accessed June 9, 2016."},{"key":"bibr11-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-009-0263-4"},{"key":"bibr12-1055665618796018","unstructured":"MS\/SVS\/DASIS\u2014Sistema de Informa\u00e7\u00f5es sobre Nascidos Vivos (SINASC). 2016. Available at: http:\/\/tabnet.datasus.gov.br\/cgi\/tabcgi.exe?sinasc\/cnv\/nvuf.def. Accessed June 9, 2016."},{"issue":"7","key":"bibr13-1055665618796018","first-page":"S11","volume":"98","author":"Panamonta V","year":"2015","journal-title":"J Med Assoc Thai"},{"key":"bibr14-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-015-3367-z"},{"key":"bibr15-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1097\/00006534-200008000-00026"},{"key":"bibr16-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1097\/01.PRS.0000037680.39989.74"},{"key":"bibr17-1055665618796018","volume":"2","author":"Scheffer M.","year":"2013","journal-title":"Demografia m\u00e9dica no Brasil"},{"key":"bibr18-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1054\/jcms.2001.0217"},{"key":"bibr19-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1016\/j.fsc.2015.04.008"},{"key":"bibr20-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000000415"},{"key":"bibr21-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1590\/1807-3107bor-2017.vol31.0023"},{"key":"bibr22-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-017-3896-8"},{"key":"bibr23-1055665618796018","unstructured":"World Health Organization. Global Strategies to Reduce the Health-Care Burden of Craniofacial Anomalies: Report of WHO Meetings on International Collaborative Research on Craniofacial Anomalies: Geneva, Switzerland, November 5-8, 2000; Park City, UT, May 24-26, 2001. Human Genetics Programme, Management of Noncommunicable Diseases, World Health Organization; 2002."},{"key":"bibr24-1055665618796018","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000002656"}],"container-title":["The Cleft Palate Craniofacial Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1055665618796018","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1055665618796018","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1055665618796018","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T16:19:39Z","timestamp":1777393179000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1055665618796018"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,28]]},"references-count":24,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2019,5]]}},"alternative-id":["10.1177\/1055665618796018"],"URL":"https:\/\/doi.org\/10.1177\/1055665618796018","relation":{},"ISSN":["1055-6656","1545-1569"],"issn-type":[{"value":"1055-6656","type":"print"},{"value":"1545-1569","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,28]]}}}