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Loomis-Goltl E, Briley P, Kotlarek KJ. Impact of Prenatal Care on Newborn Complications for Infants with Cleft Lip with or Without Cleft Palate. Cleft Palate Craniofac J 2024; 61:1041-1051. [PMID: 36718491 PMCID: PMC10387128 DOI: 10.1177/10556656231153453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To determine the association between prenatal care and cleft lip with or without cleft palate (CL ± P) and examine differences in newborn complications among infants diagnosed with CL ± P as a function of prenatal care. DESIGN Population-based retrospective cohort study. SETTING 2018 United States National Vital Statistics System-Natality component (NVSS-N) was used to examine nationwide birth certificate data. PARTICIPANTS 3,414,338 infants from the 2018 National Vital Statistics System, of which 1,699 had CL ± P. MAIN OUTCOME MEASURE Diagnosis of CL ± P and presence of newborn complications as a function of prenatal care. RESULTS Significant differences were found among various infant- and mother-specific variables when baseline comparisons were made between infants with and without CL ± P. After controlling for baseline differences, results indicated decreased odds of a diagnosis of CL ± P in cases where overall adequate prenatal care was obtained (OR = .841; 95% CI .757, .934), including prenatal care beginning in the 1st trimester (OR = .839; 95% CI .750, .939) and an adequate number of prenatal visits received (OR = .864; 95% CI .764, .976). Of infants with CL ± P, reduced odds of the infant admitted to the neonatal intensive care unit (OR = .777; 95% CI .613, .985) or transferred (OR = .601; 95% CI .407, .888) were apparent when adequate prenatal care was received. CONCLUSION Results suggest adequate prenatal care not only reduces the likelihood of CL ± P in infants but may also decrease the severity of negative outcomes in infants diagnosed with CL ± P. These findings emphasize necessity for adequate prenatal care.
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Affiliation(s)
- Evy Loomis-Goltl
- Department of Zoology and Physiology, University of
Wyoming, Laramie, WY, USA
| | - Patrick Briley
- Department of Communication Sciences and Disorders, East
Carolina University, Greenville, NC, USA
| | - Katelyn J. Kotlarek
- Division of Communication Disorders, University of Wyoming,
Laramie, WY, USA
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2
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Zanin EM, Arpini NE, Roth JC, Avalos GV, Duarte DW, Martins Collares MV. Dermal Matrix Graft Effects on Facial Growth in a Veau-Wardill-Kilner Palatoplasty Model: An Experimental Study in Rats. Cleft Palate Craniofac J 2024; 61:733-739. [PMID: 36373603 DOI: 10.1177/10556656221139674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
The primary goal of palatoplasty is the restoration of normal speech, that can be aimed by, among many procedures, lengthening the palate through the pushback technique; one of its complications is abnormal maxillary growth. The main factor affecting facial growth in CLP patients is believed by many to be the palatoplasty-due to the large scar retraction resulting from some surgical techniques. The non-crosslinked two-layer bioabsorbable collagen matrix Mucograft™ (Geistlich Pharma AG, Wolhusen, Switzerland) is a potential tool to aid in wound closure in a second-intention healing situation. The objective of this work was to test the use of an acellular dermal matrix (Mucograft®) in an experimental model of Veau-Wardill-Kilner palatoplasty, as a tool to reduce scar retraction of the denuded palatine mucosa. Twenty-four 3-week-old male Wistar rats were used. The animals were randomly divided into two groups. In the control group, an excision was made with bone exposure in the palate, simulating the defect left in the Veau-Wardill-Kilner palatoplasty. In the intervention group, the same procedure was performed, and the area of denuded palatine bone was treated with a bioabsorbable collagen matrix (Mucograft®). For data collection, 9 weeks after surgery (12 weeks of life), the animals were euthanized by excessive anesthetic dosage. Maxillary growth, macroscopic appearance of the scar, pain, and bleeding were evaluated. There were significant statistical differences between the groups for palate length growth (7.6 mm + -0.38 mm vs 5.5 mm + -0.36 mm, P = .009) and for palate width growth (1.47 mm + -0.8 mm vs -0.09 mm + -0.55 mm, P = .001), favoring dermal matrix group compared to controls. Whereas for pain and bleeding, there were no differences between the groups. The use of dermal matrix in rats with an area of bone denudation on the palate increases maxillary length and width growth patterns. Besides, it does not increase pain, bleeding, or post-operative complications.
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Affiliation(s)
| | - Nícolas Endrigo Arpini
- Student at Universidade Federal do Rio Grande do Sul Medical School, Porto Alegre, RS, Brazil
| | - Julia Caletti Roth
- Student at Universidade Federal do Rio Grande do Sul Medical School, Porto Alegre, RS, Brazil
| | - Galo Verdugo Avalos
- Division of Plastic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
| | - Daniele Walter Duarte
- Division of Plastic Surgery, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
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3
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Pisek A, McKinney CM, Muktabhant B, Pitiphat W. Maternal Metabolic Status and Orofacial Cleft Risk: A Case-Control Study in Thailand. Int Dent J 2024:S0020-6539(24)00061-3. [PMID: 38614877 DOI: 10.1016/j.identj.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/31/2024] [Accepted: 02/13/2024] [Indexed: 04/15/2024] Open
Abstract
OBJECTIVES Metabolic syndrome (MetS) has been suggested to play a role in congenital defects. This study investigated the association of MetS and its components with orofacial clefts (OFCs). METHODS We conducted a case-control study in Northeast Thailand. Ninety-four cases with cleft lip, with or without cleft palate, were frequency matched with 94 controls on the infant's age and mother's education. We administered a mother's health questionnaire and collected anthropometric measurements and blood samples. Multiple logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Subgroup analyses were performed among infants without a family history of OFCs, mothers who were not currently breastfeeding, and mothers who were >6 months postpartum. RESULTS When compared to mothers of normal weight, the OR associated with OFCs were 2.44 (95% CI, 1.04-5.76, P = .04) in overweight mothers, and 3.30 (95% CI, 1.14-9.57, P = .03) in obese mothers. Low HDL-C raised the risk of OFCs 2.95 times (95% CI, 1.41-6.14, P = .004) compared to normal HDL-C levels. Mothers with 4 or 5 features of MetS were 2.77 times as likely to have the affected child than those who did not (95% CI, 0.43-17.76), but this difference was not statistically significant (P = .28). Subgroup analyses showed similar results, uncovering an additional significant association between underweight mothers and OFCs. CONCLUSIONS The results indicate a robust association between underweight and overweight/obese maternal body mass index and increased OFC risk. Additionally, low HDL-C in mothers is linked to an elevated risk of OFCs. Further research is needed to evaluate if promoting strategies to maintain optimal body weight and enhance HDL-C levels in reproductive-age and pregnant women icould contribute to a reduction of the risk of OFCs in their progeny.
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Affiliation(s)
- Araya Pisek
- Division of Dental Public Health, Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Christy M McKinney
- Division of Craniofacial Medicine, Department of Pediatrics, University of Washington, and Seattle Children's Research Institute, Seattle, Washington, USA
| | - Benja Muktabhant
- Department of Public Health Administration, Health Promotion and Nutrition, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand
| | - Waranuch Pitiphat
- Division of Dental Public Health, Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand.
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Bedard T, Lowry RB, Crawford S, Wang TG, Bakal J, Metcalfe A, Harrop AR, Grevers X, Thomas MA. Publicly funded healthcare costs associated with orofacial clefts for children born in Alberta, Canada between 2002 and 2018. Birth Defects Res 2024; 116:e2295. [PMID: 38179866 DOI: 10.1002/bdr2.2295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/04/2023] [Accepted: 12/13/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Orofacial clefts (OFCs) include cleft palate (CP), cleft lip (CL), and cleft lip with cleft palate (CLP) and require multidisciplinary healthcare services. Alberta, Canada has a publicly funded, universal access healthcare system. This study determined publicly funded healthcare costs for children with an OFC and compared these costs to children without congenital anomalies. METHODS This retrospective population-based cohort analysis used the Alberta Congenital Anomalies Surveillance System to identify children born between 2002 and 2018 with an isolated OFC. They were matched 1:1 to a reference cohort based on sex and year of birth. The study population included 1614 children, from birth to 17 years of age linked to administrative databases to estimate annual inpatient and outpatient costs. Average annual all-cause costs were compared using two-sample independent t tests. RESULTS The mean total cleft-related costs per patient were highest for children with CLP ($74,138 CAD, standard deviation (SD) $43,447 CAD), followed by CP ($53,062 CAD, SD $74,366 CAD), and CL ($35,288 CAD, SD $49,720 CAD). The mean total all-cause costs per child were statistically significantly higher (p < .001) in children with an OFC ($56,305 CAD, SD $57,744 CAD) compared to children without a congenital anomaly ($18,600 CAD, SD $61,300 CAD). CONCLUSIONS Despite public health strategies to mitigate risk factors, the trend for OFCs has remained stable in Alberta, Canada for over 20 years. The costs reported are useful to other jurisdictions for comparison, and to families, healthcare professionals, service planners, and policy makers.
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Affiliation(s)
- Tanya Bedard
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
| | - R Brian Lowry
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Pediatrics and Medical Genetics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Susan Crawford
- Alberta Perinatal Health Program, Alberta Health Services, Calgary, Alberta, Canada
| | - Ting Grace Wang
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jeffrey Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Amy Metcalfe
- Department of Obstetrics and Gynecology, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - A Robertson Harrop
- Departments of Pediatrics and Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Plastic Surgery, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Xin Grevers
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
| | - Mary Ann Thomas
- Alberta Congenital Anomalies Surveillance System, Alberta Health Services, Calgary, Alberta, Canada
- Departments of Pediatrics and Medical Genetics, University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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5
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Taritsa IC, Ledwon JK, Bajaj A, Gosain AK. 12-Year Trends of Orofacial Clefts in the United States: Highlighting Racial/Ethnic Differences in Prevalence of Cleft Lip and Cleft Palate. Cleft Palate Craniofac J 2024:10556656241227033. [PMID: 38291621 DOI: 10.1177/10556656241227033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE Discrepancies in prevalence among infants with orofacial clefts are public health research priorities. Our objective was to calculate updated estimated prevalence of orofacial clefts in the United States, with sub-analyses by racial/ethnic group. DESIGN The National Birth Defect Prevention Network database was used to evaluate trends in cases with orofacial cleft in the United States from 2006 to 2018. Cases with cleft lip with and without cleft palate (CL ± P) and cleft palate (CP) alone were sub-stratified by racial/ethnic category. Estimated prevalence was calculated using the total live births reported in each maternal racial/ethnic group. The odds ratio (OR) was calculated to measure the strength of association between racial/ethnic group and risk of orofacial clefts. RESULTS Estimated prevalence rates show that maternally-reported Native American/Alaskan Native individuals were 43.8% (p < 0.0001) and 36.0% (p < 0.0001) more likely to have CL ± P and CP alone, respectively, compared to maternally-reported non-Hispanic White individuals. Estimated prevalence of CL ± P in maternally-reported non-Hispanic Black individuals (OR = 0.64) and maternally-reported Asians/Pacific Islander individuals were significantly lower than in maternally-reported non-Hispanic White individuals (OR = 0.63, p < 0.0001). Estimated prevalence of CP alone was significantly lower in maternally-reported non-Hispanic Black individuals (OR = 0.64, p < 0.0001), maternally-reported Asians/Pacific Islander individuals (OR = 0.69, p < 0.0001), and maternally-reported Hispanic individuals (OR = 0.81, p < 0.0001). CONCLUSIONS Across the total population, there was no significant change in estimated orofacial cleft prevalence. However, there were significant disproportions in estimated orofacial cleft prevalence across racial/ethnic groups, which may guide further discussion among craniofacial health care providers and centers and their patients regarding differences in cleft risk factors.
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Affiliation(s)
- Iulianna C Taritsa
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joanna K Ledwon
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Anitesh Bajaj
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arun K Gosain
- Division of Plastic Surgery, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Heydari MH, Sadeghian A, Khadivi G, Mustafa HJ, Javinani A, Nadjmi N, Khojasteh A. Prevalence, trend, and associated risk factors for cleft lip with/without cleft palate: a national study on live births from 2016 to 2021. BMC Oral Health 2024; 24:36. [PMID: 38185687 PMCID: PMC10771673 DOI: 10.1186/s12903-023-03797-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 12/18/2023] [Indexed: 01/09/2024] Open
Abstract
BACKGROUNDS Cleft lip with or without cleft palate (CL/P) is the most common congenital craniofacial anomaly, including non-syndromic cleft lip with or without cleft palate and cleft palate only. Failure in the fusion of median and lateral nasal processes, the maxillary prominence, and soft tissues around the oral cavity can cause CL/P. Previously, the prevalence has been estimated to be 1 among every 1000 births in 2014 among American neonates and no other reports have been available since. Thus, this study aimed to calculate the prevalence and trend of isolated CL/P among American live births from 2016 to 2021 with its associated risk factors. METHODS AND MATERIALS In this cross-sectional population-based retrospective study, we used live birth data provided by the National Center for Health Statistics (NCHS) from the Center for Disease Control and Prevention (CDC). We calculated the prevalence per 10,000 live births of isolated (non-syndromic) CL/P from 2016 to 2021. To examine risk factors for developing isolated CL/P, we used logistic regression modelling. RESULTS The total prevalence per 10,000 births from 2016 to 2021 was 4.88 (4.79-4.97), for both sexes, and 5.96 (5.82-6.10) for males, and 3.75 (3.64-3.87) for females. The prevalence did not show any consistent linear decreasing or increasing pattern. We found significant association between increased odds of developing isolated CL/P among cases with 20 to 24 year-old mothers (OR = 1.07, 1.01-1.13, p = 0.013), mothers who smoked 11 to 20 cigarettes per day (OR = 1.46, 1.33-1.60, p < 0.001), mothers with extreme obesity (OR = 1.32, 1.21-1.43, p < 0.001), mothers with grade II obesity (OR = 1.32, 1.23-1.42, p < 0.001), mothers with pre-pregnancy hypertension (OR = 1.17, 1.04-1.31, p = 0.009), mothers with pre-pregnancy diabetes mellitus (OR = 1.96, 1.71-2.25, p < 0.001), and mothers who used assisted reproductive technology (OR = 1.40, 1.18-1.66, p < 0.001). CONCLUSIONS Our findings suggest a minuscule increase, albeit insignificant, in the trend of CL/P prevalence from 2016 to 2021. Developing CL/P had greater odds among mothers with pre-pregnancy diabetes, smoking, obesity, and pre-pregnancy hypertension mothers along with mothers who used assisted reproductive technology. Isolated CL/P had the highest prevalence in non-Hispanic Whites, American Indian or Alaskan Native and Native Hawaiian and Other Pacific Islanders.
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Affiliation(s)
- Mohammad-Hossein Heydari
- Department of Oral and Maxillofacial Surgery, Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak St, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Sadeghian
- Department of Oral and Maxillofacial Surgery, Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak St, Tehran, Iran
| | - Gita Khadivi
- Department of Oral and Maxillofacial Surgery, Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak St, Tehran, Iran
| | - Hiba J Mustafa
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Riley Children's and Indiana University Health Fetal Center, Indianapolis, IN, USA
| | - Ali Javinani
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nasser Nadjmi
- Department of Cranio-Maxillofacial Surgery/University Hospital, Faculty of Medicine & Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Arash Khojasteh
- Department of Oral and Maxillofacial Surgery, Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Chamran Highway, Velenjak St, Tehran, Iran.
- Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Bascom JT, Stephens SB, Lupo PJ, Canfield MA, Kirby RS, Nestoridi E, Salemi JL, Mai CT, Nembhard WN, Forestieri NE, Romitti PA, St. Louis AM, Agopian AJ. Scientific impact of the National Birth Defects Prevention Network multistate collaborative publications. Birth Defects Res 2024; 116:e2225. [PMID: 37492989 PMCID: PMC10910332 DOI: 10.1002/bdr2.2225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/16/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Given the lack of a national, population-based birth defects surveillance program in the United States, the National Birth Defects Prevention Network (NBDPN) has facilitated important studies on surveillance, research, and prevention of major birth defects. We sought to summarize NBDPN peer-reviewed publications and their impact. METHODS We obtained and reviewed a curated list of 49 NBDPN multistate collaborative publications during 2000-2022, as of December 31, 2022. Each publication was reviewed and classified by type (e.g., risk factor association analysis). Key characteristics of study populations and analytic approaches used, along with publication impact (e.g., number of citations), were tabulated. RESULTS NBDPN publications focused on prevalence estimates (N = 17), surveillance methods (N = 11), risk factor associations (N = 10), mortality and other outcomes among affected individuals (N = 6), and descriptive epidemiology of various birth defects (N = 5). The most cited publications were those that reported on prevalence estimates for a spectrum of defects and those that assessed changes in neural tube defects (NTD) prevalence following mandatory folic acid fortification in the United States. CONCLUSIONS Results from multistate NBDPN publications have provided critical information not available through other sources, including US prevalence estimates of major birth defects, folic acid fortification and NTD prevention, and improved understanding of defect trends and surveillance efforts. Until a national birth defects surveillance program is established in the United States, NBDPN collaborative publications remain an important resource for investigating birth defects and informing decisions related to health services planning of secondary disabilities prevention and care.
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Affiliation(s)
- Jacqueline T. Bascom
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Sara B. Stephens
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
| | - Philip J. Lupo
- Department of Pediatrics, Section of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Russell S. Kirby
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Eirini Nestoridi
- Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Jason L. Salemi
- Chiles Center, College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Cara T. Mai
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wendy N. Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nina E. Forestieri
- Birth Defects Monitoring Program, State Center for Health Statistics, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina, USA
| | - Paul A. Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa, USA
| | - Amanda M. St. Louis
- Birth Defects Registry, Center for Environmental Health, New York State Department of Health, New York, USA
| | - A. J. Agopian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, Texas, USA
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Arslan C, Aksahin EC, Nur Yılmaz RB, Germec Cakan D. Does YouTube TM Offer High-Quality Information About Nasoalveolar Molding? Cleft Palate Craniofac J 2024; 61:5-11. [PMID: 35861787 DOI: 10.1177/10556656221115025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the content and quality of YouTubeTM videos concerning nasoalveolar molding (NAM). DESIGN YouTubeTM was searched for videos containing information relevant to NAM with the 2 keywords "nasoalveolar molding," and "presurgical infant orthopedics." A total of 24 out of 51 videos were found to be applicable to this study and rated for quality using the Global Quality Scale (GQS). To determine whether the contents of the selected 24 videos were useful or not, a content usefulness index consisting of 8 parameters was created. The videos were classified according to the usefulness index as low or high content videos. Spearman rank correlation analysis, Kolmogorov-Smirnov, Shapiro-Wilk, and Mann-Whitney U-tests were used for statistical analysis. RESULTS The mean GQS score of the 24 YouTubeTM videos on NAM was 2.3 ± 0.8, indicating overall poor quality. In terms of information, videos with high content (29.2%) were less in number than low content videos (70.8%). GQS values were found to be significantly higher in the high content group (P < .01). Regarding the source, video, and audio quality values were significantly higher in the expert group compared to the caregiver group (P < .01), whereas the usefulness index did not differ between groups (P > .05). A significant relationship was found between GQS and usefulness index, audio quality, and video quality (P < .001). CONCLUSIONS YouTube™ videos on NAM were generally inadequate in their content information and poor in quality. Expert videos, showing better audiovisual quality and flow compared to non-expert videos, did not offer higher quality information about NAM considering the usefulness index.
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Affiliation(s)
- Can Arslan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | - Elif Ceren Aksahin
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
| | | | - Derya Germec Cakan
- Department of Orthodontics, Faculty of Dentistry, Yeditepe University, Istanbul, Turkey
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Huang Z, Wu J, Qiu Y, Lin J, Huang W, Ma X, Zhang H, Yang X. Association between gestational exposure and risk of orofacial clefts: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:829. [PMID: 38041018 PMCID: PMC10691060 DOI: 10.1186/s12884-023-06104-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 11/02/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND The occurrence of orofacial Clefts (OFCs) is a congenital disease caused by many factors. According to recent studies, air pollution has a strong correlation with the occurrence of OFCs. However, there are still some controversies about the current research results, and there is no relevant research to review the latest results in recent years. OBJECTIVE In this paper, the authors conducted a systematic review and meta-analysis to explore the correlation between ambient air pollution and the occurrence of neonatal OFCs deformity. METHODS We searched Pubmed, Web of science, and Embase databases from the establishment of the database to May 2023. We included observational studies on the relationship between prenatal exposure to fine particulate matter 2.5 (PM2.5), fine particulate matter 10 (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), carbon monoxide (CO) and the risk of cleft lip (CL), cleft palate (CP), cleft lip with or without palate (CL/P). the Newcastle-Ottawa quality assessment scale (NOS) was used to evaluate the quality of the literature. Funnel plot and Egger's regression were used to verify the publication bias. Random effect model or fixed effect model was used to estimate the combined relative risk (RR) and 95% confidence interval (95%CI). RESULTS A total of eleven studies were included in this study, including four cohort studies and seven case-control studies, including 22,453 cases of OFCs. Ten studies had low risk of bias and only one study had high risk of bias. Three studies reported that PM2.5 was positively correlated with CL and CP, with a combined RR and 95%CI of 1.287(1.174,1.411) and 1.267 (1.105,1.454). Two studies reported a positive correlation between O3 and CL, with a combined RR and 95%CI of 1.132(1.047,1.225). Two studies reported a positive correlation between PM10 and CL, with a combined RR and 95%CI of 1.108 (1.017,1.206). No association was found between SO2, CO, NO2 exposure during pregnancy and the risk of OFCs. CONCLUSION The results of this study showed that there was a significant statistical correlation between exposure to PM10, PM2.5, O3 and the risk of OFCs in the second month of pregnancy. Exposure assessment, research methods and mechanisms need to be further explored.
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Affiliation(s)
- ZhiMeng Huang
- Department Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University, Fujian Province, 361000, China
| | - JinZhun Wu
- Department Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University, Fujian Province, 361000, China
| | - Yue Qiu
- Key Laboratory of Urban Environment and Health, Institute of Urban Environment, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Fujian Province, 361000, China
| | - Jiayan Lin
- Department Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University, Fujian Province, 361000, China
| | - Wanting Huang
- Department Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University, Fujian Province, 361000, China
| | - Xiaohui Ma
- Department Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University, Fujian Province, 361000, China
| | - Huifen Zhang
- Department Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University, Fujian Province, 361000, China
| | - Xiaoqing Yang
- Department Pediatrics, Women and Children's Hospital, School of Medicine, Xiamen University, Fujian Province, 361000, China.
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10
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Moreira T, Dias M, Von Hafe M, Curval AR, Ramalho C, Maia AM, Moura CP. Orofacial clefts: Reflections on prenatal diagnosis and family history based on a series of cases of a tertiary children hospital. Congenit Anom (Kyoto) 2023; 63:195-199. [PMID: 37653578 DOI: 10.1111/cga.12538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023]
Abstract
Prenatal diagnosis of orofacial clefts allows adequate counseling and planning for prenatal care and delivery. In 2001, two-dimensional ultrasound screening became universally used in Portugal by government guidelines, and after 2007 more advanced ultrasound became available. This study aimed to describe the prevalence of family history in patients with orofacial clefts and analyze prenatal diagnosis in patients born before 2001, between 2001 and 2007 and after 2007. Retrospective analysis of a cohort of patients with orofacial clefts followed by the trans-disciplinary team of a tertiary hospital. A total of 672 OFCs were identified: 40.9% isolated cleft palate, 38.1% cleft lip and palate, 19.7% cleft lip and 1.3% atypical cleft; 57.1% were male. The prevalence of family history was 26.0% of which 30.9% had a recognizable syndrome. Of those born before 2001, 13.7% had prenatal diagnosis; of those born between 2001 and 2007, 32.6% orofacial clefts were diagnosed in utero; and in children born after 2007, prenatal diagnosis increased to 47.1%. In our study, about one-fourth of children had a positive family history. Since the implementation of universal ultrasound screening in Portugal, more orofacial clefts were identified in utero (42.5% vs. 13.7%; p < 0.05) and after the availability of advanced ultrasound, prenatal diagnosis increased to 47.1% (vs. 20.4% before 2007; p < 0.05). Of all orofacial clefts diagnosed prenatally, ultrasound revealed more accuracy for the diagnosis of cleft lip and palate (65.4%) and cleft lip (24.8%). Cleft palate is the most difficult to detect in utero (9.3%). Prenatal ultrasound screening in Portugal has technically evolved with consequent better diagnostic accuracy for the identification of orofacial clefts, allowing better parenteral counseling.
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Affiliation(s)
- Tatiana Moreira
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Margarida Dias
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Madalena Von Hafe
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ana Rita Curval
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carla Ramalho
- Transdisciplinary Team of Cleft Lip and Palate, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Obstetrics, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Gynaecology-Obstetrics and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Human Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Maria Maia
- Department of Paediatrics, Centro Hospitalar Universitário de São João, Porto, Portugal
- Transdisciplinary Team of Cleft Lip and Palate, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Gynaecology-Obstetrics and Paediatrics, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carla Pinto Moura
- Transdisciplinary Team of Cleft Lip and Palate, Centro Hospitalar Universitário de São João, Porto, Portugal
- Department of Human Genetics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Otorhinolaryngology, Centro Hospitalar Universitário de São João, Porto, Portugal
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
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11
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Ha J, Gu GY, Yeou SH, Kim H, Choo OS, Jang JH, Park HY, Choung YH. Determination of Tympanostomy Tube Types for Otitis Media with Effusion in Patients with Cleft Palate: Comparison between Paparella Type 1 and Type 2 Tubes. J Clin Med 2023; 12:6651. [PMID: 37892790 PMCID: PMC10607012 DOI: 10.3390/jcm12206651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 09/30/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
This study examined the effects of different types of tympanostomy tubes in pediatric patients undergoing cleft palate (CP) surgery in order to provide guidance for the proper insertion of tympanostomy tubes in the management of otitis media with effusion (OME). A total of 101 ears with middle ear effusion in 51 patients with CP were included in this study. Patients underwent palatoplasty and tympanostomy tube surgery at the same time. The type of tube inserted (Paparella type 1 or 2), the severity of CP, and types of palatoplasty surgeries were investigated. All patients were followed up for at least 6 months, and recurrence rates, complications, and reinsertion surgery were evaluated. The rate of OME recurrence after spontaneous tube extrusion was significantly higher in the type 1 group than in the type 2 group (44.3% vs. 19.4%, respectively, p = 0.016). Persistent eardrum perforation was more common in the type 2 group than in the type 1 group (41.9% vs. 12.9%, respectively, p = 0.001). The tube reinsertion rate was higher in the type 1 group than in the type 2 group (22.9% vs. 3.2%, respectively, p = 0.015). The tube reinsertion rate decreased to 8.6% in cases of palatoplasty with Sommerlad's technique, even with type 1 tube insertion, which was not significantly different from the reinsertion rate in the type 2 group (3.7%, p = 0.439). The Paparella type 1 tube would be a better choice in cases of palatoplasty performed using Sommerlad's technique, particularly considering the higher rate of persistent eardrum perforation after extrusion associated with the Paparella type 2 tube. Alternatively, a larger size type 2 tube may be considered in other surgeries to decrease the frequency of recurrence and tube reinsertion.
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Affiliation(s)
- Jungho Ha
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
| | - Ga Young Gu
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
| | - Se Hyun Yeou
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
| | - Hantai Kim
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
- Department of Otorhinolaryngology, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Oak-Sung Choo
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
- Department of Otorhinolaryngology-Head and Neck Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Jeong Hun Jang
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
| | - Hun Yi Park
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
| | - Yun-Hoon Choung
- Department of Otolaryngology, Ajou University School of Medicine, Suwon 16499, Republic of Korea; (J.H.); (G.Y.G.); (S.H.Y.); (J.H.J.); (H.Y.P.)
- Department of Medical Sciences, Ajou University Graduate School of Medicine, Suwon 16499, Republic of Korea; (H.K.); (O.-S.C.)
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12
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Baek SH, Hong H, Yang IH, Chung JH, Choi JY, An JS. Classification of Skeletal Phenotypes of Preadolescent Patients With Isolated Cleft Palate Using Principal Component Analysis and Cluster Analysis. J Craniofac Surg 2023; 34:2051-2055. [PMID: 37643113 DOI: 10.1097/scs.0000000000009692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 07/29/2023] [Indexed: 08/31/2023] Open
Abstract
This study aimed to classify the skeletal phenotypes of preadolescent patients with isolated cleft palate using principal component analysis and cluster analysis. Sixty-four preadolescent female patients with isolated cleft palate (incomplete hard palate and complete soft palate cleft group, n=51; complete cleft of the hard and soft palate group, n=13; the mean age when lateral cephalograms were taken, 7.08±0.76 y) were included. Ten angular and 2 ratio cephalometric variables were measured on a lateral cephalogram. Cluster analysis was performed using 3 representative variables obtained from principal component analysis (SN-GoMe, SNA, and SNB). The differences in the variables among the clusters were characterized using the Kruskal-Wallis test. As a result of the analysis, 6 clusters were obtained from 3 groups: the retrusive maxilla and mandible group: cluster 3 (14.1%, moderately hyperdivergent pattern), cluster 5 (17.2%, severely hyperdivergent pattern); the normal maxilla and mandible group: cluster 1 (23.4%, normodivergent pattern), cluster 4 (12.5%, moderately hyperdivergent pattern), cluster 6 (20.3%, severely hyperdivergent pattern); the normal maxilla and protrusive mandible group: cluster 2 (12.5%, normodivergent pattern). The distribution of isolated cleft palate types did not differ among the 6 clusters ( P >0.05). Two thirds of the patients (68.7%, clusters 1, 2, 4, and 6) had a normal anteroposterior position of the maxilla, while one third of the patients (31.3%, clusters 3 and 5) showed a retrusive mandible. These results indicate that isolated cleft palate patients have diverse maxillo-mandibular growth patterns compared with patients with cleft lip and palate.
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Affiliation(s)
- Seung-Hak Baek
- Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Hyunseung Hong
- Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Ii-Hyung Yang
- Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Jee Hyeok Chung
- Department of Plastic and Reconstructive Surgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Jung-Sub An
- Department of Orthodontics, School of Dentistry, Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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13
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Henkle G, Ustrell S, Simmons JK, Petersson RS. A Unique Apparatus to Treat Dehiscence Following Bilateral Cleft Lip Repair: A Case Report. EAR, NOSE & THROAT JOURNAL 2023; 102:5S-7S. [PMID: 37147769 DOI: 10.1177/01455613231173457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
We report a case of a 6-month-old male that presented with wound dehiscence, in part due to mechanical tongue trauma, following bilateral cleft lip repair. A silastic sheeting dressing with retention sutures was uniquely fashioned to decrease wound tension and protect the surgical site from patient interference. This solution may potentially be used in similar circumstances.
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Affiliation(s)
- Garrett Henkle
- California Northstate University School of Medicine, Elk Grove, CA, USA
| | - Sarah Ustrell
- Cedars Sinai Sinus Center of Excellence, Los Angeles, CA, USA
- St. George's University School of Medicine, West Indies, Grenada
| | - Jordan K Simmons
- Division of Otolaryngology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Rajanya S Petersson
- Department of Otolaryngology/Head and Neck Surgery, Children's Hospital of Richmond at VCU, Richmond, VA, USA
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14
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Goodman DC, Romano CJ, Hall C, Bukowinski AT, Mu TS, Gumbs GR, Conlin AMS, Vereen RJ, Leyenaar JK. The association of regional perinatal risk factors and neonatal intensive care capacity for Military Health System-insured newborns. J Perinatol 2023; 43:787-795. [PMID: 36792685 DOI: 10.1038/s41372-023-01633-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To characterize hospitals where military-insured newborns received care and test the association of regional perinatal risk with neonatal intensive care unit (NICU) capacity. STUDY DESIGN We identified birth hospitals for live newborns October 2015-December 2018 (n = 296,568) and assigned newborns to health service areas (HSAs). Perinatal risk factors and the number of neonatal special care beds and neonatologists were calculated at HSA levels. Cross-sectional correlation analyses assessed perinatal risk factors and capacity across HSAs. RESULTS 27.0% (n = 10) of military birth hospitals had special care beds (intermediate and intensive) compared with 44.3% of civilian hospitals (n = 1224; p < 0.05). The number of special care beds and neonatologists per newborn varied more than twofold across regions and were only weakly associated with the proportion of higher risk newborns (R2 < 0.05). CONCLUSIONS The lack of meaningful association of regional perinatal risk with NICU capacity poses challenges for effective specialized care among military-associated newborns.
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Affiliation(s)
| | - Celeste J Romano
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Clinton Hall
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Anna T Bukowinski
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Thornton S Mu
- Uniformed Services University of the Health Services, Bethesda, MD, USA
- Brooke Army Medical Center, San Antonio, TX, USA
| | - Gia R Gumbs
- Leidos, Inc., San Diego, CA, USA
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | - Ava Marie S Conlin
- Deployment Health Research Department, Naval Health Research Center, San Diego, CA, USA
| | | | - JoAnna K Leyenaar
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
- Children's Hospital at Dartmouth, Lebanon, NH, USA
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15
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Mullen MC, Yan F, Ford ME, Patel KG, Pecha PP. Racial and Ethnic Disparities in Primary Cleft Lip and Cleft Palate Repair. Cleft Palate Craniofac J 2023; 60:482-488. [PMID: 34967229 PMCID: PMC9793871 DOI: 10.1177/10556656211069828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To examine the impact of race/ethnicity on timing and postoperative outcomes of primary cleft lip (CL) and cleft palate (CP) repair. DESIGN Cross-sectional analysis of the National Surgical Quality Improvement Program Pediatric (NSQIP-P) database from 2013 to 2018. PATIENTS AND MAIN OUTCOME MEASURES Patients under 2 years of age who underwent primary CL or CP repair were identified in the NSQIP-P. Outcomes were the timing of surgery and 30-day readmission and reoperation rates stratified by race and ethnicity. RESULTS In total, 6021 children underwent CL and 6938 underwent CP repair. Adjusted rates of CL repair over time were 10% lower in Hispanic children (95%CI: 0.84-0.96) and 38% lower for Asian children (95%CI: 0.55-0.70) compared with White infants. CP repair rates over time were 13% lower in Black (95%CI: 0.79-0.95), 17% lower in Hispanic (95%CI: 0.77-0.89), and 53% lower in Asian children (95%CI: 0.43-0.53) than in White infants. Asian patients had the highest rates of delayed surgical repair, with 19.3% not meeting American Cleft Palate-Craniofacial Association (ACPA) guidelines for CL (P < .001) and 28.2% for CP repair (P< .001). Black and Hispanic children had 80% higher odds of readmission following primary CL repair (95%CI: 1.16-2.83 and 95%CI: 1.27-2.61, respectively). CONCLUSIONS This study of a national database identified several racial/ethnic disparities in primary CL and CP, with reduced receipt of cleft repair over time for non-White children. Asian patients were significantly more likely to have delayed cleft repair per ACPA guidelines. These findings underscore the need to better understand disparities in cleft repair timing and postoperative outcomes.
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Affiliation(s)
| | - Flora Yan
- Medical University of South Carolina, Charleston, SC, USA
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16
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Huybrechts KF, Straub L, Karlsson P, Pazzagli L, Furu K, Gissler M, Hernandez-Diaz S, Nørgaard M, Zoega H, Bateman BT, Cesta CE, Cohen JM, Leinonen MK, Reutfors J, Selmer RM, Suarez EA, Ulrichsen SP, Kieler H. Association of In Utero Antipsychotic Medication Exposure With Risk of Congenital Malformations in Nordic Countries and the US. JAMA Psychiatry 2023; 80:156-166. [PMID: 36477338 PMCID: PMC9856848 DOI: 10.1001/jamapsychiatry.2022.4109] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance Psychiatric disorders are common among female individuals of reproductive age. While antipsychotic medication use is increasing, the safety of such medications in pregnancy is an area with large evidence gaps. Objective To evaluate the risk of first-trimester antipsychotic exposure with respect to congenital malformations, focusing on individual drugs and specific malformation subtypes. Design, Setting, and Participants This cohort study used data from nationwide health registers from the 5 Nordic countries and the US and spanned 1996 to 2018. The Nordic cohort included all pregnancies resulting in singleton live-born infants, and the US cohort consisted of publicly insured mothers linked to their live-born infants nested in the nationwide Medicaid Analytic eXtract. Data were analyzed from November 2020 to April 2022. Exposures One or more first-trimester dispensing of any atypical, any typical, and individual antipsychotic drugs. Main Outcomes and Measures Any major congenital malformation and specific malformation subtypes previously suggested to be associated with antipsychotic exposure in utero: cardiovascular malformations, oral clefts, neural tube defects, hip dysplasia, limb reduction defects, anorectal atresia/stenosis, gastroschisis, hydrocephalus, other specific brain anomalies, and esophageal disorders. Propensity score stratification was used to control for potential confounders. Pooled adjusted estimates were calculated using indirect standardization. Results A total of 6 455 324 unexposed mothers (mean maternal age range across countries: 24-31 years), 21 751 mothers exposed to atypical antipsychotic drugs (mean age range, 26-31 years), and 6371 mothers exposed to typical antipsychotic drugs (mean age range, 27-32 years) were included in the study cohort. Prevalence of any major malformation was 2.7% (95% CI, 2.7%-2.8%) in unexposed infants, 4.3% (95% CI, 4.1%-4.6%) in infants with atypical antipsychotic drug exposure, and 3.1% (95% CI, 2.7%-3.5%) in infants with typical antipsychotic drug exposure in utero. Among the most prevalent exposure-outcome combinations, adjusted relative risks (aRR) were generally close to the null. One exception was olanzapine exposure and oral cleft (aRR, 2.1 [95% CI, 1.1-4.3]); however, estimates varied across sensitivity analyses. Among moderately prevalent combinations, increased risks were observed for gastroschisis and other specific brain anomalies after atypical antipsychotic exposure (aRR, 1.5 [95% CI, 0.8-2.6] and 1.9 [95% CI, 1.1-3.0]) and for cardiac malformations after chlorprothixene exposure (aRR, 1.6 [95% CI, 1.0-2.7]). While the association direction was consistent across sensitivity analyses, confidence intervals were wide, prohibiting firm conclusions. Conclusions and Relevance In this study, considering the evidence from primary and sensitivity analyses and inevitable statistical noise for very rare exposure-outcome combinations, in utero antipsychotic exposure generally was not meaningfully associated with an increased risk of malformations. The observed increased risks of oral clefts associated with olanzapine, gastroschisis, and other specific brain anomalies with atypical antipsychotics and cardiac malformations with chlorprothixene requires confirmation as evidence continues to accumulate.
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Affiliation(s)
- Krista F. Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Pär Karlsson
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Laura Pazzagli
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kari Furu
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway,Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Mika Gissler
- Research Centre for Child Psychiatry, University of Turku, Turku, Finland,Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Helga Zoega
- School of Population Health, Faculty of Medicine & Health, UNSW Sydney, Sydney, New South Wales, Australia,Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Brian T. Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carolyn E. Cesta
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jacqueline M. Cohen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway,Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Maarit K. Leinonen
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Randi M. Selmer
- Department of Chronic Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Elizabeth A. Suarez
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sinna Pilgaard Ulrichsen
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden,Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
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17
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Van Swol J, Wolf BJ, Toumey J, Pecha P, Patel KG. Follow-Up Care Barriers for Patients with Orofacial Clefts. Cleft Palate Craniofac J 2022; 59:1213-1221. [PMID: 34678105 PMCID: PMC10731588 DOI: 10.1177/10556656211042162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate whether a patient with a cleft's age, associated syndrome, cleft phenotype or travel distance affects their follow-up rate. DESIGN This study is a retrospective review of patients with CL/P treated by a craniofacial clinic. SETTING The setting was a craniofacial clinic at a tertiary care university hospital. PATIENTS, PARTICIPANTS Candidates were patients seen by the craniofacial clinic between January 2007 and December 2019. An initial pool of 589 patients was then reduced to 440 due to exclusion criteria. INTERVENTIONS None. MAIN OUTCOME MEASURE(S) The outcome measure was actual patient attendance to the craniofacial team compared to the team goal expectation of annual return visits. RESULTS The mean age of participants at the end of the study was 9.0 ± 5.4 years with a mean follow-up period (total possible follow-up period length based on patient age at presentation and study window) of 5.5 ± 3.6 years. There was no association between cleft phenotype, type of syndrome, or distance to the clinic with attendance. Children with syndromes had an 11% decrease in the odds of attending follow-up visits with each 1-year increase in age compared to a 4% decrease in children without syndromes. CONCLUSIONS The only significant factors determining patient attendance were the presence of a syndrome and increasing age.
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Affiliation(s)
- Joshua Van Swol
- College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Bethany J. Wolf
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Julia Toumey
- Craniofacial Anomalies and Cleft Palate Team, Medical University of South Carolina, Charleston, SC, USA
| | - Phayvanh Pecha
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Krishna G. Patel
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
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18
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Willie D, Holmes G, Jabs EW, Wu M. Cleft Palate in Apert Syndrome. J Dev Biol 2022; 10:jdb10030033. [PMID: 35997397 PMCID: PMC9397066 DOI: 10.3390/jdb10030033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/06/2022] [Accepted: 08/07/2022] [Indexed: 11/17/2022] Open
Abstract
Apert syndrome is a rare genetic disorder characterized by craniosynostosis, midface retrusion, and limb anomalies. Cleft palate occurs in a subset of Apert syndrome patients. Although the genetic causes underlying Apert syndrome have been identified, the downstream signaling pathways and cellular mechanisms responsible for cleft palate are still elusive. To find clues for the pathogenic mechanisms of palatal defects in Apert syndrome, we review the clinical characteristics of the palate in cases of Apert syndrome, the palatal phenotypes in mouse models, and the potential signaling mechanisms involved in palatal defects. In Apert syndrome patients, cleft of the soft palate is more frequent than of the hard palate. The length of the hard palate is decreased. Cleft palate is associated most commonly with the S252W variant of FGFR2. In addition to cleft palate, high-arched palate, lateral palatal swelling, or bifid uvula are common in Apert syndrome patients. Mouse models of Apert syndrome display palatal defects, providing valuable tools to understand the underlying mechanisms. The mutations in FGFR2 causing Apert syndrome may change a signaling network in epithelial–mesenchymal interactions during palatogenesis. Understanding the pathogenic mechanisms of palatal defects in Apert syndrome may shed light on potential novel therapeutic solutions.
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19
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Alade A, Ismail W, Nair R, Schweizer M, Awotoye W, Oladayo A, Ryckman K, Butali A. Periconceptional use of vitamin A and the risk of giving birth to a child with nonsyndromic orofacial clefts-A meta-analysis. Birth Defects Res 2022; 114:467-477. [PMID: 35357092 PMCID: PMC9321711 DOI: 10.1002/bdr2.2005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/03/2022] [Accepted: 03/16/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND We conducted a meta-analysis of observational epidemiological studies to evaluate the association between periconceptional use of vitamin A and the risk of giving birth to a child with nonsyndromic orofacial clefts (NSOFCs). METHODS We carried out a systematic literature search of Embase, PubMed, Web of Science, Google Scholar, and OpenGrey from inception to June 30, 2021. Two reviewers independently evaluated the studies that met the inclusion criteria and filled out an abstraction form for each study. Study quality was assessed using the Newcastle-Ottawa Assessment Scale (NOS). Adjusted estimates were pooled with an inverse variance weighting using a random-effects model. Heterogeneity and publication bias were assessed using the Cochran's Q test and funnel plot, respectively. RESULTS A total of six case-control studies with moderate risk of bias were included. The pooled OR showed a 20% reduction in the risk of NSOFCs for periconceptional use of vitamin A which was not statistically significant (OR = .80; 95% CI .54-1.17, p = .25). For nonsyndromic cleft lip with or without cleft palate (NSCL/P), the studies were homogenous, and the pooled estimate showed a 13% risk reduction, which was significant (OR = .87; 95% CI .77-.99, p = .03). For nonsyndromic cleft palate only (NSCPO), the pooled estimate showed a 33% lower likelihood, which was not statistically significant (OR = .67; 95% CI .42-1.08, p = .10). CONCLUSION Our results suggest a possible protective effect for the periconceptional use of vitamin A on the risk of NSCL/P. This finding should be investigated further in prospective studies across multiple populations.
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Affiliation(s)
- Azeez Alade
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIowaUSA
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIowaUSA
| | - Wesam Ismail
- College of PharmacyUniversity of IowaIowa CityIowaUSA
| | - Rajeshwari Nair
- University of Iowa Hospitals and ClinicsUniversity of IowaIowa CityIowaUSA
- Center for Access and Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
| | - Marin Schweizer
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIowaUSA
- University of Iowa Hospitals and ClinicsUniversity of IowaIowa CityIowaUSA
- Center for Access and Delivery Research and EvaluationIowa City VA Health Care SystemIowa CityIowaUSA
| | - Waheed Awotoye
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIowaUSA
| | - Abimbola Oladayo
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIowaUSA
| | - Kelli Ryckman
- Department of Epidemiology, College of Public HealthUniversity of IowaIowa CityIowaUSA
| | - Azeez Butali
- Iowa Institute of Oral Health ResearchUniversity of IowaIowa CityIowaUSA
- Department of Oral Pathology, Radiology and Medicine, College of DentistryUniversity of IowaIowa CityIowaUSA
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Uncovering the Pathogenesis of Orofacial Clefts Using Bioinformatics Analysis. J Craniofac Surg 2022; 33:1971-1975. [PMID: 35142735 DOI: 10.1097/scs.0000000000008560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Many genes have been found to be associated with the occurrence of the orofacial clefts (OFC). The links between these pathogenic genes are rarely studied. In this study, bioinformatics analysis were performed in order to find associations between OFC-related genes and provide new ideas for etiology study of OFCs. METHODS Orofacial clefts-related genes were searched and identified from the Online Mendelian Inheritance of Man (OMIM.org). These genes were then analyzed by bioinformatics methods, including protein-protein interaction network, functional enrichment analysis, module analysis, and hub genes analysis. RESULTS After searching the database of OMIM.org and removing duplicate results, 279 genes were finally obtained. These genes were involved to 369 pathways in biological process, 56 in cell component, 64 in molecular function, and 45 in the Kyoto Encyclopedia of Genes and Genomes. Most identified genes were significantly enriched in embryonic appendage morphogenesis (29.17%), embryonic limb morphogenesis (6.06%), and limb development (4.33%) for biological process (Fig. 5A); ciliary tip (42.86%), MKS complex (28.57%), ciliary basal body (14.29%), and ciliary membrane (14.29%) for cell component. The top 10 hub genes were identified, including SHH, GLI2, PTCH1, SMAD4, FGFR1, BMP4, SOX9, SOX2, RUNX2, and CDH1. CONCLUSIONS Bioinformatics methods were used to analyze OFC-related genes in this study, including hub gene identifying and analysis, protein-protein interaction network construction, and functional enrichment analysis. Several potential mechanisms related to occurrence of OFCs were also discussed. These results may be helpful for further studies of the etiology of OFC.
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Constantin J, Wehby GL. Academic Outcomes of Children with Orofacial clefts: A Review of the Literature and Recommendations for Future Research. Oral Dis 2022; 28:1387-1399. [DOI: 10.1111/odi.14137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/11/2022] [Accepted: 01/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Joanne Constantin
- Department of Health Management and Policy University of Iowa Iowa City IA USA
| | - George L. Wehby
- Department of Health Management and Policy University of Iowa Iowa City IA USA
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22
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Vu GH, Warden C, Zimmerman CE, Kalmar CL, Humphries LS, McDonald-McGinn DM, Jackson OA, Low DW, Taylor JA, Swanson JW. Poverty and Risk of Cleft Lip and Palate: An Analysis of United States Birth Data. Plast Reconstr Surg 2022; 149:169-182. [PMID: 34936619 PMCID: PMC8691162 DOI: 10.1097/prs.0000000000008636] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The relationship between poverty and incidence of cleft lip and cleft palate remains unclear. The authors investigated the association between socioeconomic status and cleft lip with or without cleft palate and cleft palate only in the United States after controlling for demographic and environmental risk factors. METHODS The U.S. 2016 and 2017 natality data were utilized. Proxies for socioeconomic status included maternal education, use of the Special Supplemental Nutrition Program for Women, Infants, and Children, and payment source for delivery. Multiple logistic regression controlled for household demographics, prenatal care, maternal health, and infant characteristics. RESULTS Of 6,251,308 live births included, 2984 (0.05 percent) had cleft lip with or without cleft palate and 1180 (0.02 percent) had cleft palate only. Maternal education of bachelor's degree or higher was protective against, and delayed prenatal care associated with, cleft lip with or without cleft palate (adjusted ORs = 0.73 and 1.14 to 1.23, respectively; p < 0.02). Receiving assistance under the Special Supplemental Nutrition Program for Women, Infants, and Children was associated with cleft palate only (adjusted OR = 1.25; p = 0.003). Male sex, first-trimester tobacco smoking, and maternal gestational diabetes were also associated with cleft lip with or without cleft palate (adjusted ORs = 1.60, 1.01, and 1.19, respectively; p < 0.05). Female sex, prepregnancy tobacco smoking, and maternal infections during pregnancy were associated with cleft palate only (adjusted ORs = 0.74, 1.02, and 1.60, respectively; p < 0.05). CONCLUSIONS Increased incidence of orofacial clefts was associated with indicators of lower socioeconomic status, with different indicators associated with different cleft phenotypes. Notably, early prenatal care was protective against the development of cleft lip with or without cleft palate. CLIINCAL QUESTION/LEVEL OF EVIDENCE Risk, III.
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Affiliation(s)
- Giap H Vu
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Clara Warden
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Carrie E Zimmerman
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Christopher L Kalmar
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Laura S Humphries
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Donna M McDonald-McGinn
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Oksana A Jackson
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - David W Low
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Jesse A Taylor
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
| | - Jordan W Swanson
- From the Divisions of Plastic and Reconstructive Surgery and Human Genetics, Children's Hospital of Philadelphia; and the University of Pennsylvania Perelman School of Medicine
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Melo DG, Sanseverino MTV, Schmalfuss TDO, Larrandaburu M. Why are Birth Defects Surveillance Programs Important? Front Public Health 2021; 9:753342. [PMID: 34796160 PMCID: PMC8592920 DOI: 10.3389/fpubh.2021.753342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 10/08/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Débora Gusmão Melo
- Department of Medicine, Federal University of São Carlos (UFSCar), São Carlos, Brazil
| | - Maria Teresa Vieira Sanseverino
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil.,Medical Genetics Service, Clinical Hospital of Porto Alegre, Porto Alegre, Brazil
| | | | - Mariela Larrandaburu
- Disability and Rehabilitation Program, Ministry of Public Health of Uruguay, Montevideo, Uruguay
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24
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Oral wound healing models and emerging regenerative therapies. Transl Res 2021; 236:17-34. [PMID: 34161876 PMCID: PMC8380729 DOI: 10.1016/j.trsl.2021.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 06/07/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022]
Abstract
Following injury, the oral mucosa undergoes complex sequences of biological healing processes to restore homeostasis. While general similarities exist, there are marked differences in the genomics and kinetics of wound healing between the oral cavity and cutaneous epithelium. The lack of successful therapy for oral mucosal wounds has influenced clinicians to explore alternative treatments and potential autotherapies to enhance intraoral healing. The present in-depth review discusses current gold standards for oral mucosal wound healing and compares endogenous factors that dictate the quality of tissue remodeling. We conducted a review of the literature on in vivo oral wound healing models and emerging regenerative therapies published during the past twenty years. Studies were evaluated by injury models, therapy interventions, and outcome measures. The success of therapeutic approaches was assessed, and research outcomes were compared based on current hallmarks of oral wound healing. By leveraging therapeutic advancements, particularly within in cell-based biomaterials and immunoregulation, there is great potential for translational therapy in oral tissue regeneration.
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25
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Comprehensive Cleft Care Delivery in Developing Countries: Impact of Geographic and Demographic Factors. J Craniofac Surg 2021; 32:2041-2044. [PMID: 33710048 DOI: 10.1097/scs.0000000000007624] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The authors analyzed the insights of participants and faculty members of Global Smile Foundation's Comprehensive Cleft Care Workshops concerning the barriers and interventions to multidisciplinary cleft care delivery, after stratification based on demographic and geographic factors. METHODS During 2 simulation-based Comprehensive Cleft Care Workshops organized by Global Smile Foundation, participants and faculty members filled a survey. Surveys included demographic and geographic data and investigated the most relevant barrier to multidisciplinary cleft care and the most significant intervention to deliver comprehensive cleft care in outreach settings, as perceived by participants. RESULTS The total response rate was 57.8%. Respondents reported that the greatest barrier to comprehensive cleft care was financial, and the most relevant intervention to deliver multidisciplinary cleft care was building multidisciplinary teams. Stratification by age, gender, and geographical area showed no statistical difference in reporting that the greatest barrier to cleft care was financial. However, lack of multidisciplinary teams was the most important barrier according to respondents with less than 5 years of experience (P = 0.03). Stratification by gender, years in practice, specialty, and geographical area showed no statistical difference, with building multidisciplinary teams reported as the most significant intervention. However, increased training was reported as the main intervention to cleft care for those aged less than 30 years old (P = 0.04). CONCLUSIONS Our study delivers an assessment for barriers facing multidisciplinary cleft care delivery and interventions required to improve cleft care delivery. The authors are hoping that stratification by demographic and geographic factors will help them delineate community-specific road maps to refine cleft care delivery.
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Auslander A, McKean-Cowdin R, Brindopke F, Sylvester B, DiBona M, Magee K, Kapoor R, Conti DV, Rakotoarison S, Magee W. The role of smoke from cooking indoors over an open flame and parental smoking on the risk of cleft lip and palate: A case- control study in 7 low-resource countries. J Glob Health 2021; 10:020410. [PMID: 33110573 PMCID: PMC7568926 DOI: 10.7189/jogh.10.020410] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Cleft is one of the most common birth defects globally and the lack of access to surgery means millions are living untreated. Smoke exposure from cooking occurs infrequently in developed countries but represents a high-proportion of smoke exposure in less-developed regions. We aimed to study if smoke exposure from cooking is associated with an increased risk in cleft, while accounting for other smoke sources. Methods We conducted a population-sampled case-control study of children with cleft lip and/or palate and healthy newborns from Vietnam, Philippines, Honduras, Nicaragua, Morocco, Congo, and Madagascar. Multivariable regression models were used to assess associations between maternal cooking during pregnancy, parental smoking, and household tobacco smoke with cleft. Results 2137 cases and 2014 controls recruited between 2012-2017 were included. While maternal smoking was uncommon (<1%), 58.3% case and 36.1% control mothers cooked over an open fire inside. Children whose mothers reported cook smoke exposure were 49% (95% confidence interval (CI) = 1.2-1.8) more likely to have a child with a cleft. This was consistent in five of seven countries. No significant associations were found for any other smoke exposure. Conclusions Our finding of maternal cook smoke and cleft in low-resource countries, similar to maternal tobacco smoke in high-resource countries, may reflect a common etiology. This relationship was present across geographically diverse countries with variable socioeconomic statuses and access to care. Exposures specific to low-resource settings must be considered to develop public health strategies that address the populations at increased risk of living with cleft and inform the mechanisms leading to cleft development.
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Affiliation(s)
- Allyn Auslander
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, California, USA.,Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, California, USA.,USC Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, California, USA
| | - Frederick Brindopke
- Children's Hospital Los Angeles, Los Angeles, California, USA.,Operation Smile, Inc.; Virginia Beach, Virginia, USA
| | - Beau Sylvester
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Kathy Magee
- Operation Smile, Inc.; Virginia Beach, Virginia, USA
| | - Rijuta Kapoor
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, California, USA
| | - David V Conti
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, California, USA
| | | | - William Magee
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, California, USA.,Children's Hospital Los Angeles, Los Angeles, California, USA
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van Dalen M, Hermans MM, Leemreis WH, Kraaij V, De Laat PCJ, Pasmans SGMA, Versnel SL, Koudstaal MJ, Hillegers MHJ, Utens EMWJ, Okkerse JME. Emotional and Behavioral Problems in Children With a Cleft Lip With or Without Palate or an Infantile Hemangioma. Cleft Palate Craniofac J 2021; 59:S74-S83. [PMID: 34293942 DOI: 10.1177/10556656211031411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Life can be challenging for children with a visible difference due to a medical condition, and they might be at risk for emotional and behavioral problems. This study examines emotional and behavioral problems in children with a cleft lip with or without palate (CL ± P) or an infantile hemangioma (IH) in relation to the visibility of the condition, the presence of additional condition-related problems, and parental affect. SETTING This cross-sectional study took place in an academic medical hospital in the Erasmus MC Sophia Children's Hospital, the Netherlands. PARTICIPANTS A total of 309 parents (mean age = 40.34, 44.00% male) of 182 children with CL ± P and 48 parents (mean age = 39.21, 37.50% male) of 33 children with an IH completed questionnaires. Children were 1.5 to 12 years old. RESULTS Parents reported fewer child emotional and behavioral problems compared to normative data. Problems reported were mainly related to learning difficulties and parent gender, while visibility of the condition had no significant influence. Parental negative affect was related to child internalizing problems. Parental positive affect was not related to any of the outcome measures. CONCLUSIONS Parents reported fewer problems for their children compared to normative data. This is inconsistent with previous research, showing similar or worse scores for these children compared to peers. Our findings may be explained by a protective parenting style, a response shift in parents, or problems developing at a later point in life.
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Affiliation(s)
- Marije van Dalen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Mireille M Hermans
- Department of Dermatology, Centre of Pediatric Dermatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Willem H Leemreis
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Vivian Kraaij
- Clinical Psychology, Leiden University, the Netherlands
| | - Peter C J De Laat
- Department of Pediatrics, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Suzanne G M A Pasmans
- Department of Dermatology, Centre of Pediatric Dermatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Sarah L Versnel
- Department of Plastic and Reconstructive Surgery and Hand Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Maarten J Koudstaal
- Department of Oral and Maxillofacial Surgery, The Dutch Craniofacial Centre, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, the Netherlands.,Academic Center for Child Psychiatry Levvel/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Jolanda M E Okkerse
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, the Netherlands
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Sun JL, Shi JY, Yin B, Lin YS, Shi B, Jia ZL. Association analysis of SNPs in GRHL3, FAF1, and KCNJ2 with NSCPO sub-phenotypes in Han Chinese. Oral Dis 2021; 28:2204-2214. [PMID: 34255421 DOI: 10.1111/odi.13961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Non-syndromic cleft palate only (NSCPO) is a common congenital deformity with complex etiologies. GRHL3, FAF1, and KCNJ2 have been reported to be involved in the pathogenesis of NSCPO. Up till now, there have been no replication studies based on large Han Chinese. Therefore, this study aimed to investigate associations between GRHL3, FAF1, KCNJ2, and NSCPO sub-phenotypes patients in Han Chinese. MATERIALS AND METHODS Firstly, we selected 2 SNPs based on previous literatures: FAF1 (rs3827730) and GRHL3 (rs41268753). Also, we selected 8 tagSNPs in GRHL3 (rs557811, rs609352, rs10903078, rs6659209, rs12401714, rs12568599, rs3887581, rs12024148) and 2 tagSNPs in KCNJ2 (rs75855040 and rs236514). Afterward, we evaluated these SNPs among 1668 NSCPO patients and 1811 normal controls from Han Chinese. Following data were analyzed by PLINK and Haploview program. RESULTS Association analysis under additive model showed that allele A at rs12568599 in GRHL3 gene is significantly associated with NSCPO (p = 0.0034, OR = 1.38 and 95%CI: 1.11-1.72) and its sub-phenotype incomplete cleft palate (ICP) (p = 0.0039, OR = 1.4 and 95%CI: 1.11-1.75), and it could increase the risk of both NSCPO and ICP. CONCLUSIONS This study firstly found that rs12568599 in GRHL3 is associated with NSCPO and ICP in Han Chinese, indicating that sub-phenotypes of NSCPO have different etiologies.
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Affiliation(s)
- Jia-Lin Sun
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Jia-Yu Shi
- Division of Growth and Development and Section of Orthodontics, School of Dentistry, University of California, Los Angeles, California, USA
| | - Bin Yin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yan-Song Lin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Bing Shi
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhong-Lin Jia
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Department of Cleft Lip and Palate, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Decreasing Incidence of Palatoplasty in the United States. J Craniofac Surg 2021; 32:2710-2712. [PMID: 34231517 DOI: 10.1097/scs.0000000000007799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cleft palate is amongst the most common birth defect across the world. Although its etiology is multifactorial, including genetic and environmental contributors, the investigators were interested in exploring whether its incidence was changing over time. METHODS The Nationwide Inpatient Sample database, the largest publically available healthcare database in the United States, was used to identify all primary palatoplasties performed under 2 years of age and births which occurred over a 17-year period from 1999 to 2015. The change in rate of palatoplasties and overall maternal demographics were assessed longitudinally using the chi-squared test. Significance level was set at P < 0.001. RESULTS A total of 13,808,795 pregnancies were reviewed during the time period, from 1999 to 2015, inclusively. A total of 10,567 primary palatoplasties were performed in that period of time reflecting an overall rate of 7.7 palatoplasties per 10,000 deliveries. Palatoplasty rates decreased across the study period from 9.5 per 10,000 in 1999 to 7.1 per 10,000 died/delivered pregnancies in 2015 which corresponds to an average compounded year-to-year decrease of 1.76%, P < 0.001. CONCLUSIONS The rate of primary palatoplasties, as a proxy for the rate of cleft palate prevalence, has been significantly decreasing over the last 2 decades and may represent improvements in early diagnosis in pregnancy, changing genetic or racial demographics, and/or environmental factors such as decreased maternal smoking in the US population. Future research may be directed at better understanding the definitive etiology of this decreasing prevalence of children undergoing primary cleft palate repairs in the United States.
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Barriers to Accessing Medical Care for Hispanic Individuals With Craniofacial Conditions. Plast Surg Nurs 2021; 40:236-243. [PMID: 33259425 DOI: 10.1097/psn.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the United States, having limited access to health care has been an ongoing concern that could cause detrimental effects for minority populations, specifically the Hispanic population. Numerous barriers to accessing health care were identified for both pediatric and adult Hispanic patients who were born with craniofacial conditions. Barriers that were determined to impact Hispanic patients with craniofacial conditions from receiving medical and health services included language and communication, patient-health care provider relationships, socioeconomic status and finances, insurance status, timely access to appointments, citizenship and immigration status, and lack of family and social support. Interventions for these barriers were also proposed to increase support for Hispanic patients. Lamentably, there is scant research that investigates how these barriers affect this special population, despite the limitations that they have in their ability to access health care. In addition, these barriers to treatment have dire consequences for individuals with craniofacial conditions. The findings and proposed interventions discussed in this review article provide measures to minimize these barriers and define ways to benefit Hispanic patients with craniofacial conditions.
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Effect of Cleft Palate Repair Timing on Inpatient Complication Rate: Review of a National Database. J Craniofac Surg 2021; 32:466-468. [PMID: 33704961 DOI: 10.1097/scs.0000000000007069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Timing of cleft palate repair is controversial. We aim to assess whether timing of cleft palate repair affects rates of inpatient complications, length of stay (LOS), and cost of stay. METHODS The Healthcare Cost and Utilization Project Kids' Inpatient Database 2009 was queried for all admissions with a primary diagnosis of cleft palate during which cleft palate repair was performed as a primary procedure. Age 6 months or less was termed "early" repair, while age >6 months was termed "standard" repair. Patients age >3 years old, inpatient stays >30 days, and those stays in which a cleft lip repair was performed were excluded. Logistic regressions were used to model the probability of complications. Generalized linear models and a natural log link function were used for LOS and hospital charges, using SAS 9.4. RESULTS We included 223 early and 1482 standard repair patients. Early repairs were exclusively performed in urban hospitals (P < 0.001). Eighty-nine patients experienced a total of 100 complications, including respiratory failure (N = 53), airway obstruction (N = 18), and oropharyngeal hemorrhage (N = 13). We found no significant difference in complication rate or total hospital charges in the 2 groups. The earlier repair group had a slightly longer LOS (P = 0.048). CONCLUSION Over 85% of United States cleft palate repairs are performed after 6 months of age. All early repairs were performed at urban hospitals, and had slightly longer LOS. There was a 5.1% overall complication rate. Available data revealed no significant difference in complication rates between early repair and standard repair groups. LEVEL OF EVIDENCE 3b.
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Auslander A, McKean-Cowdin R, Feigelson D, Brindopke F, DiBona M, Magee K, Arakaki L, Kapoor R, Ly S, Conti DV, Rakotoarison S, Mahmoudi F, McGregor A, Giron M, Hernandez AR, Nguyen THD, Mwepu A, Sanchez-Lara PA, Magee W. The International Family Study of Nonsyndromic Orofacial Clefts: Design and Methods. Cleft Palate Craniofac J 2021; 59:S37-S47. [PMID: 34056937 DOI: 10.1177/10556656211018956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The majority of research to understand the risk factors of nonsyndromic orofacial clefts (NSOFCs) has been conducted in high-income populations. Although patients with NSOFCs in low- and middle-income countries (LMICs) are at the highest risk of not receiving care, global health infrastructure allows innovative partnerships to explore the etiologic mechanisms of cleft and targets for prevention unique to these populations. METHODS The International Family Study (IFS) is an ongoing case-control study with supplemental parental trio data designed to examine genetic, environmental, lifestyle, and sociodemographic risk factors for NSOFCs in 8 LMICs (through August 2020). Interview and biological samples are collected for each family. The interview includes demographics, family history of cleft, diet and water sources, maternal pregnancy history, and other lifestyle and environmental factors. RESULTS Seven of 8 countries are currently summarized (2012-2017) for a total of 2955 case and 2774 control families with 11 946 unique biological samples from Vietnam, Philippines, Honduras, Madagascar, Morocco, Democratic Republic of the Congo, and Nicaragua. The phenotype distribution was 1641 (55.5%) cases with cleft lip and palate, 782 (26.5%) with cleft lip (CL), and 432 (14.6%) with cleft palate (CP). DISCUSSION The International Family Study is the largest case set of NSOFCs with an associated biobank in LMICs currently assembled. The biobank, family, and case-control study now include samples from 8 LMICs where local health care infrastructure cannot address the surgical burden of cleft or investigate causal mechanisms. The International Family Study can be a source of information and may collaborate with local public health institutions regarding education and interventions to potentially prevent NSOFCs.
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Affiliation(s)
- Allyn Auslander
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, CA, USA.,Children's Hospital Los Angeles, CA, USA.,Operation Smile, Inc, Virginia Beach, VA, USA
| | - Roberta McKean-Cowdin
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, CA, USA.,Department of Ophthalmology, Keck School of Medicine of the University of Southern California, USC Eye Institute, CA, USA
| | - Devin Feigelson
- Children's Hospital Los Angeles, CA, USA.,Operation Smile, Inc, Virginia Beach, VA, USA
| | | | | | - Kathy Magee
- Operation Smile, Inc, Virginia Beach, VA, USA
| | | | - Rijuta Kapoor
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, CA, USA
| | - Stephanie Ly
- Department of Public Health, College of Education, Health, and Human Services, California State University, San Marcos, CA, USA
| | - David V Conti
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, CA, USA
| | | | | | | | | | | | | | - Anselme Mwepu
- University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Pedro A Sanchez-Lara
- Operation Smile, Inc, Virginia Beach, VA, USA.,Department of Pediatrics, Cedars-Sinai Medical Center & David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - William Magee
- Children's Hospital Los Angeles, CA, USA.,Operation Smile, Inc, Virginia Beach, VA, USA
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Applied Online Crowdsourcing in Plastic and Reconstructive Surgery: A Comparison of Aesthetic Outcomes in Unilateral Cleft Lip Repair Techniques. Ann Plast Surg 2021; 84:S307-S310. [PMID: 32282397 DOI: 10.1097/sap.0000000000002389] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Aesthetic outcomes of unilateral cleft lip repairs have important psychosocial implications for patients who are heavily influenced by social perceptions. Online crowdsourcing offers the unique potential to efficiently recruit large numbers of laypeople to assess public perception. The aim of this study was to use the online crowdsourcing platform Mechanical Turk to compare the postoperative outcomes of Fisher, Millard, and Mohler cleft lip repair techniques. METHODS Two hundred fifty-four participants were recruited through Mechanical Turk to evaluate 29 cropped and deidentified photographs of children, 8 photographs were controls without cleft lips and 21 were children with unilateral cleft lips who had undergone Fisher, Millard, or Mohler repairs (7 in each group). Respondents were asked whether a scar was present, whether they would be personally satisfied with the surgical result and used a Likert scale from 1 to 5 to rate overall appearance, scar severity, and nasal symmetry. RESULTS Fewer respondents reported that a scar was present when assessing postoperative photographs of Fisher repairs (70.3 ± 8.6%) compared with Millard (92.0 ± 1.5%) or Mohler (88.8 ± 3.1%) repairs. Average rating of scar severity was also lower for Fisher (1.9) compared with Millard (2.6) or Mohler (2.6) repairs. Average ratings of nose symmetry, general appearance, and satisfaction with operative result were not statistically significantly different between the repair groups. CONCLUSIONS This study demonstrates the potential of online crowdsourcing to assess public perception of plastic surgery outcomes. The Mechanical Turk platform offers a reduction in selection bias, ease of study design, and enhanced efficiency of large-scale participant recruitment. Results indicate that the Fisher repair led to the most favored aesthetic outcomes compared with the Millard and Mohler techniques, particularly with regard to scar severity. Crowdsourcing is a powerful tool to assess layperson perception of plastic surgery outcomes and can be used to better guide surgical decision-making.
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Kapos FP, White LA, Schmidt KA, Hawes SE, Starr JR. Risk of non-syndromic orofacial clefts by maternal rural-urban residence and race/ethnicity: A population-based case-control study in Washington State 1989-2014. Paediatr Perinat Epidemiol 2021; 35:292-301. [PMID: 33258502 PMCID: PMC8687885 DOI: 10.1111/ppe.12727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 08/12/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Orofacial clefts (OFC) have multifactorial aetiology. Established risk factors explain a small proportion of cases. OBJECTIVES To evaluate OFC risk by maternal rural residence and race/ethnicity, and test whether these associations changed after US-mandated folic acid fortification. METHODS This population-based case-control study included all non-syndromic OFC cases among Washington State singleton livebirths between 1989-2014 and birth year-matched controls. Data sources included birth certificates and hospital records. Logistic regression estimated odds ratios (OR) and 95% confidence intervals (CI) for OFC by maternal rural-urban residence (adjusted for maternal race/ethnicity) and by maternal race/ethnicity. We evaluated additive and multiplicative effect measure modification by time of folic acid fortification (before vs. after). Probabilistic quantitative bias analysis accounted for potential differential case ascertainment for infants born to Black mothers. RESULTS The overall non-syndromic OFC birth prevalence was 1.0 per 1000 livebirths (n = 2136 cases). Among controls (n = 25 826), 76% of mothers were urban residents and 72% were of White race/ethnicity. OFC risk was slightly higher for infants born to rural than to urban mothers, adjusting for race/ethnicity (OR 1.12, 95% CI 1.01, 1.25). The association was similar before and after US-mandated folic acid fortification. Compared with infants born to White mothers, OFC risk was higher for American Indian mothers (OR 1.73, 95% CI 1.35, 2.23) and lower for Black (OR 0.62, 95% CI 0.48, 0.81), Hispanic (OR 0.75, 95% CI 0.64, 0.87), and Asian/Pacific Islander (API) mothers (OR 0.87, 95% CI 0.74, 1.02). Bias analysis suggests the observed difference for Black mothers may be explained by selection bias. Post-fortification, the association of OFC with maternal API race/ethnicity decreased and with maternal Black race/ethnicity increased relative to maternal White race/ethnicity. CONCLUSIONS Infants born to rural mothers and to American Indian mothers in Washington State during 1989-2014 were at higher OFC risk before and after US-mandated folic acid fortification.
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Affiliation(s)
- Flavia P. Kapos
- Department of Epidemiology, University of Washington, School of Public Health
- Department of Oral Health Sciences, University of Washington, School of Dentistry
| | - Lauren A. White
- Department of Epidemiology, University of Washington, School of Public Health
- School of Social Work, University of Michigan
| | - Kelsey A. Schmidt
- Nutritional Sciences Program, University of Washington, School of Public Health
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center
| | - Stephen E. Hawes
- Department of Epidemiology, University of Washington, School of Public Health
| | - Jacqueline R. Starr
- The Forsyth Institute
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine
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Barriers to Accessing Medical Care for Hispanic Individuals With Craniofacial Conditions. Plast Surg Nurs 2021; 40:73-80. [PMID: 32459754 DOI: 10.1097/psn.0000000000000302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the United States, having limited access to health care has been an ongoing concern that could cause detrimental effects for minority populations, specifically the Hispanic population. Numerous barriers to accessing health care were identified for both pediatric and adult Hispanic patients who were born with craniofacial conditions. Barriers that were determined to impact Hispanic patients with craniofacial conditions from receiving medical and health services included language and communication, patient-health care provider relationships, socioeconomic status and finances, insurance status, timely access to appointments, citizenship and immigration status, and lack of family and social support. Interventions for these barriers were also proposed to increase support for Hispanic patients. Lamentably, there is scant research that investigates how these barriers affect this special population, despite the limitations that they have in their ability to access health care. In addition, these barriers to treatment have dire consequences for individuals with craniofacial conditions. The findings and proposed interventions discussed in this review article provide measures to minimize these barriers and define ways to benefit Hispanic patients with craniofacial conditions.
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Zhang W, Venkataraghavan S, Hetmanski JB, Leslie EJ, Marazita ML, Feingold E, Weinberg SM, Ruczinski I, Taub MA, Scott AF, Ray D, Beaty TH. Detecting Gene-Environment Interaction for Maternal Exposures Using Case-Parent Trios Ascertained Through a Case With Non-Syndromic Orofacial Cleft. Front Cell Dev Biol 2021; 9:621018. [PMID: 33937227 PMCID: PMC8085423 DOI: 10.3389/fcell.2021.621018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Two large studies of case-parent trios ascertained through a proband with a non-syndromic orofacial cleft (OFC, which includes cleft lip and palate, cleft lip alone, or cleft palate alone) were used to test for possible gene-environment (G × E) interaction between genome-wide markers (both observed and imputed) and self-reported maternal exposure to smoking, alcohol consumption, and multivitamin supplementation during pregnancy. The parent studies were as follows: GENEVA, which included 1,939 case-parent trios recruited largely through treatment centers in Europe, the United States, and Asia, and 1,443 case-parent trios from the Pittsburgh Orofacial Cleft Study (POFC) also ascertained through a proband with an OFC including three major racial/ethnic groups (European, Asian, and Latin American). Exposure rates to these environmental risk factors (maternal smoking, alcohol consumption, and multivitamin supplementation) varied across studies and among racial/ethnic groups, creating substantial differences in power to detect G × E interaction, but the trio design should minimize spurious results due to population stratification. The GENEVA and POFC studies were analyzed separately, and a meta-analysis was conducted across both studies to test for G × E interaction using the 2 df test of gene and G × E interaction and the 1 df test for G × E interaction alone. The 2 df test confirmed effects for several recognized risk genes, suggesting modest G × E effects. This analysis did reveal suggestive evidence for G × Vitamin interaction for CASP9 on 1p36 located about 3 Mb from PAX7, a recognized risk gene. Several regions gave suggestive evidence of G × E interaction in the 1 df test. For example, for G × Smoking interaction, the 1 df test suggested markers in MUSK on 9q31.3 from meta-analysis. Markers near SLCO3A1 also showed suggestive evidence in the 1 df test for G × Alcohol interaction, and rs41117 near RETREG1 (a.k.a. FAM134B) also gave suggestive significance in the meta-analysis of the 1 df test for G × Vitamin interaction. While it remains quite difficult to obtain definitive evidence for G × E interaction in genome-wide studies, perhaps due to small effect sizes of individual genes combined with low exposure rates, this analysis of two large case-parent trio studies argues for considering possible G × E interaction in any comprehensive study of complex and heterogeneous disorders such as OFC.
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Affiliation(s)
- Wanying Zhang
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sowmya Venkataraghavan
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Jacqueline B. Hetmanski
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Elizabeth J. Leslie
- Department of Human Genetics, School of Medicine, Emory University, Atlanta, GA, United States
| | - Mary L. Marazita
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine and Clinical and Translational Science, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Eleanor Feingold
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Seth M. Weinberg
- Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, School of Dental Medicine and Clinical and Translational Science, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Human Genetics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ingo Ruczinski
- Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Margaret A. Taub
- Department of Biostatistics, School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Alan F. Scott
- Department of Genetic Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Debashree Ray
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Terri H. Beaty
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Shehan JN, Danis DO, Bains A, Basa K, Marston AP, Levi JR. Cleft Palate in Newborns Diagnosed With Prematurity. Otolaryngol Head Neck Surg 2021; 165:887-894. [PMID: 33752517 DOI: 10.1177/01945998211002148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Cleft lip and/or palate (CLP) is the most common major congenital malformation of the head and neck. Although numerous genetic features, syndromes, nutritional deficiencies, and maternal exposures have been implicated in the etiology of CLP, the impact of prematurity on the pathogenesis remains incompletely understood. This study seeks to evaluate the associations between prematurity and the development of CLP in the United States. STUDY DESIGN Cross-sectional. SETTING Academic medical center. METHODS The Kids' Inpatient Database (2016) was used to identify weighted in-hospital births with diagnoses of prematurity or CLP. Demographic information was obtained. Odds ratios were used to determine associations between prematurity and CLP. RESULTS Among patients included in our data set, 8.653% (n = 326,147) were preterm; 0.136% (n = 5115) had CLP; and 0.021% (n = 808) were preterm and had CLP. Preterm infants had 1.90 times the odds (95% CI, 1.74-2.07) of developing CLP when compared with the nonpreterm population. The binary logistic regression model accounting for possible confounding variables produced an odds ratio of 1.83 (95% CI, 1.66-2.01) for the association between prematurity and CLP. CONCLUSION Infants who are born preterm are more likely to have CLP than full-term infants. The current results will allow for improved risk stratification, maternal counseling, and interventions in the case of prematurity. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Jennifer N Shehan
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | | | - Ashank Bains
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Krystyne Basa
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Alexander P Marston
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jessica R Levi
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA.,School of Medicine, Boston University, Boston, Massachusetts, USA
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Cleft Care Packages and the Impact on Postoperative Care Following a Primary Cleft Lip Repair. J Craniofac Surg 2021; 32:2282-2284. [PMID: 33606437 DOI: 10.1097/scs.0000000000007561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To provide caregivers with all the resources needed to care for a surgical site following a primary cleft lip repair and evaluate its efficacy on postoperative care. SETTING/PARTICIPANTS Caregivers of infants ages 3 to 6 months with a cleft lip and/or palate undergoing a primary repair at the Texas Children's Hospital. METHODS Packages were given to caregivers at discharge following repair. Packages included instructions and supplies needed for surgical site care. At discharge an advanced practice provider obtained informed consent and a questionnaire that established baseline knowledge of surgical site care. Following the questionnaire, the advanced practice provider demonstrated how to care for the site using the package provided. Assessment of scar healing, nasal stent compliance, and ease of care was evaluated at postoperative follow up. RESULTS Thirty-two families were enrolled in this study. Our data supports that caregivers who are provided resources to care for the site had increased comfort level, preparedness, and compliance rates following a primary cleft lip repair. Eighty-four percent of respondents strongly agreed that the package provided aided in preparedness for site care with 100% of respondents recommending the resources to future families undergoing a cleft lip repair. CONCLUSIONS Caregivers feel comfortable and equipped with their ability to care for their child's repaired cleft lip when given the appropriate instructions and supplies. In addition, they would recommend the packages to future families following a repair. Empowering families to be proactive in postoperative care will potentially lead to better outcomes in cleft care.
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Mamidi IS, Mantilla-Rivas E, Ichiuji BA, Rana MS, Ramirez KI, Stein JR, Aivaz M, Manrique M, McGrath J, Rogers GF, Oh AK. Administration of Single-Dose Antibiotic Does Not Decrease Oronasal Fistula Rates After Primary Palatoplasty. Cleft Palate Craniofac J 2021; 59:14-21. [PMID: 33583204 DOI: 10.1177/1055665621992653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Oronasal fistula (ONF) is a known complication after primary palatoplasty (PP). Studies investigating the effect of perioperative antibiotics on fistula rates after PP are limited by inadequate sample size or reliance on self-reporting through national databases. In this study, the authors evaluated the association between single-dose perioperative antibiotics and postoperative fistula rates after PP at a single institution. DESIGN A retrospective study. PARTICIPANTS Children younger than 2 years who underwent PP from April 2009 to September 2019 were included. INTERVENTIONS Patients were divided into 2 categories: Group 1 received a single intraoperative dose of IV antibiotic, while group 2 did not. MAIN OUTCOME MEASURE(S) Outcome measures included ONF formation, length of stay (LOS), and 30-day readmission rates. Multivariable firth logistic regression, quantile regression, and χ2 tests were performed. RESULTS Of the 424 patients, 215 and 209 patients were in groups 1 and 2, respectively. The overall ONF rate was 1.9% among all patients. Patients in group 1 experienced an ONF rate of 3.3%, while patients in group 2 had an ONF rate of 0.5%. After correcting for confounding variables, the difference in ONF rates was not statistically different (P = .68). Median LOS was 35.7 hours and 35.5 hours (P = .17), while the rate of readmission within 30 days was 4.7% and 2.4% for group 1 and 2, respectively (P = .96). CONCLUSIONS Administration of a single-dose perioperative antibiotic did not decrease fistula formation after PP, nor did it affect the patient's LOS or 30-day readmission rate.
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Affiliation(s)
- Ishwarya Shradha Mamidi
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Brynne A Ichiuji
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Karen I Ramirez
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Jason R Stein
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Marudeen Aivaz
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Monica Manrique
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Jennifer McGrath
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Gary F Rogers
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Albert K Oh
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
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Lyu W, Wanchek T, Wehby GL. The effects of state facial surgery mandates on timeliness of primary cleft repair surgery in the United States. Oral Dis 2021; 28:1620-1627. [PMID: 33586311 DOI: 10.1111/odi.13801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/29/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examines the effects of state facial surgery mandates on the timeliness of primary cleft repair surgery for privately insured children with oral clefts in the United States. MATERIALS AND METHODS Using IBM Health MarketScan® Database from 2001 to 2017, we estimate regression models separately for age at cleft lip repair and cleft palate repair by having a mandate while considering child-level factors and other state differences. The sample includes 1,451 children who had primary cleft lip repair by age 12 months, and 1,402 children who had primary cleft palate repair by age 18 months. RESULTS A mandate was associated with earlier cleft lip repair by 13 days (95% CI, -21.5 to -4.7 days) when controlling for state differences, regardless if the child had other birth defects. For children needing cleft palate repair, a mandate was associated with earlier surgery by 87 days (95% CI, -136.1 to -38.4 days) only when no other birth defects were present. CONCLUSIONS State facial surgery mandates were associated with earlier cleft lip repair for children with or without other birth defects, and earlier cleft palate repair for children without other birth defects (besides oral clefts). Findings suggest benefits to privately insured children with oral clefts from state mandates to cover needed services.
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Affiliation(s)
- Wei Lyu
- Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN, USA.,Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Tanya Wanchek
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - George L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA.,Department of Economics, Tippie College of Business, University of Iowa, Iowa City, IA, USA.,Department of Preventive & Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA.,Public Policy Center, University of Iowa, Iowa City, IA, USA.,National Bureau of Economic Research, Cambridge, MA, USA
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Fuangtharnthip P, Chonnapasatid W, Thiradilok S, Manopatanakul S, Jaruratanasirikul S. Registry-Based Study of Prevalence of Cleft Lip/Palate in Thailand from 2012 to 2015. Cleft Palate Craniofac J 2021; 58:1430-1437. [PMID: 33486980 DOI: 10.1177/1055665620987677] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Two main objectives were established. First objective was to determine the prevalence of the cleft lip and/or cleft palate (CL/P) in Thailand from 2012 to 2015 using the orofacial clefts (OFCs) registry and civil registration. Second objective was to conduct a quality control of this OFC registry especially for the Birth Defects Registration (BDR). DESIGN Registry-based survey. SETTING Analyzing data from the Thailand National Health Security Office. PARTICIPANTS Registered patients with CL/P in Thailand from 2012 to 2015. INTERVENTION None. MAIN OUTCOME MEASURE Duplicated records were verified using National Identity Number (Thai ID#) and date of birth. The prevalence of CL/P and specific phenotypes was then calculated. From this prevalence estimate method, quality assurance of the OFCs registry was possible. RESULTS For the main outcome, the population-weighted pool prevalence of CL/P was 2.14 per 1000 live births (95% confidence interval of 2.08-2.20). Thai ID# and expense reimbursement systems were the main factors driving this cases capturing. However, this OFCs registration still requires active case finding with clinical verification, improvement of staff training and databases networking. CONCLUSIONS This study reported a very high CL/P prevalence of Thailand. Strengths and limitations of these OFCs registry and BDR were described.
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Affiliation(s)
- Pornpoj Fuangtharnthip
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Wannapong Chonnapasatid
- Master of Science in Advanced General Dentistry, Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Thailand
| | - Sasipa Thiradilok
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Somchai Manopatanakul
- Department of Advanced General Dentistry, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
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Kariyawasam D, Jahanfar S. The Prevalence of Nonsyndromic Oral Clefts in Twins Compared to Singletons: The Association With Birth Weight. Cleft Palate Craniofac J 2020; 58:718-727. [PMID: 34047210 DOI: 10.1177/1055665620974566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To examine the prevalence of nonsyndromic oral clefts in twins compared to singletons in the United States and to evaluate the association between birth weight and nonsyndromic oral clefts. DESIGN A large population-based cross-sectional study was performed using the data from the US National Center for Health Statistics database in 2017. PARTICIPANTS Our sample consisted of 128 310 twins and 3 723 273 singletons. METHODS The variables collected were sociodemographic variables, environmental predictors, and clinical measures. Descriptive analysis, bivariate, and multivariate logistic regression were performed. MAIN OUTCOME MEASURE The main outcome variable in our study is nonsyndromic oral clefts. RESULTS The prevalence of nonsyndromic oral clefts was 5.22 per 10 000 in twins and 5.12 per 10 000 in singletons. Results show no significant risk of nonsyndromic oral clefts in twins compared to singletons (P = .92). There was a significant relationship between birth weight and infant diagnosed with nonsyndromic oral clefts (P = .01). Unadjusted odds ratio for birth weight was 2.52 (95% CI: 2.25-2.82). Adjusted odds for potential confounders such as mother's age, race, mother's education, gender of the infant, APGAR 5-minute score, gestational age, prenatal smoking, number of prenatal care visits, and mother's body mass index were resulted in similar but with a slightly lower odds of 2.11 (95% CI: 1.78-2.50). CONCLUSION Compared to singletons, twins did not have higher risk of nonsyndromic oral clefts. Infants with low birth weight were more prone to have nonsyndromic oral clefts.
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Messinger CJ, Lipsitch M, Bateman BT, He M, Huybrechts KF, MacDonald S, Mogun H, Mott K, Hernández-Díaz S. Association Between Congenital Cytomegalovirus and the Prevalence at Birth of Microcephaly in the United States. JAMA Pediatr 2020; 174:1159-1167. [PMID: 32926077 PMCID: PMC7490747 DOI: 10.1001/jamapediatrics.2020.3009] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 06/11/2020] [Indexed: 11/14/2022]
Abstract
Importance Congenital cytomegalovirus (cCMV) has received far less clinical and public health attention as a teratogenic infection than the Zika virus epidemic. However, cCMV may be responsible for a large fraction of microcephaly cases in the United States. Objective To evaluate the association between cCMV and the prevalence at birth of microcephaly in the United States. Design, Setting, and Participants This population-based cohort study included pregnant women and their newborns identified in 2 insurance claims databases from the United States: Medicaid Analytic eXtract (January 1, 2000, to December 31, 2013) and IBM Research MarketScan, a database for employer-sponsored private health insurance (January 1, 2011, to September 30, 2015). All pregnancies that resulted in live births in women with full health benefits were included. Analysis began June 2016 and ended May 2020. Exposures Congenital cytomegalovirus infection documented in inpatient or outpatient newborn claims records. Main Outcomes and Measures The primary outcome was microcephaly at birth documented in inpatient or outpatient newborn and/or maternal claims records. Cases with chromosomal abnormalities or neural tube defects were excluded. The association between cCMV and microcephaly was estimated in the pooled cohort using prevalence ratios (PRs) and 95% CIs. Results In the pooled cohort of 2 338 580 pregnancies (2 075 410 pregnancies [88.7%] were among women younger than 35 years), 336 infants (0.014%) had a cCMV diagnosis. The prevalence of microcephaly among newborns with and without a cCMV diagnosis was 655 and 2.8 per 10 000 live births, respectively (PR, 232; 95% CI, 154-350). After restricting to CMV-tested newborns (572 [0.024%]) to correct for preferential testing of infants with microcephaly, the PR was 15 (95% CI, 5.2-41). However, this PR is biased if other cCMV-related outcomes (eg, hearing loss) trigger testing because cCMV prevalence in tested infants, with ([46%]) or without microcephaly (22 of 559 [3.9%]), would overestimate that in the source population. Therefore, the prevalence of cCMV in overall infants with microcephaly (22 of 669 [3.2%]) was compared with that from an external unbiased sample of US infants screened at birth (449 of 100 332 [0.45%]) to estimate a PR of 7.4 (95% CI, 4.8-11.5) as a conservative lower bound. Conclusions and Relevance Congenital cytomegalovirus infection increases the prevalence of microcephaly at birth by at least 7-fold. Prevention of CMV infection during pregnancy might substantially reduce the number of newborns with microcephaly and other cCMV-related outcomes in the United States.
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Affiliation(s)
- Chelsea J. Messinger
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Marc Lipsitch
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Center for Communicable Disease Dynamics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Brian T. Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Mengdong He
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Krista F. Huybrechts
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sarah MacDonald
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Katrina Mott
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
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Madhoun LL, Crerand CE, O'Brien M, Baylis AL. Feeding and Growth in Infants With Cleft Lip and/or Palate: Relationships With Maternal Distress. Cleft Palate Craniofac J 2020; 58:470-478. [PMID: 32924577 DOI: 10.1177/1055665620956873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine relationships between early feeding and growth and maternal distress in infants with and without cleft lip and/or palate (CL/P). DESIGN Cross-sectional. SETTING Pediatric academic medical center in the Midwestern United States. PARTICIPANTS Mothers of infants 1 to 12 weeks old with CL/P (n = 30) and without CL/P (control group, n = 30) were recruited at craniofacial clinic or pediatrician appointments. MAIN OUTCOME MEASURE(S) Maternal responses on the Feeding/Swallowing Impact Survey (FS-IS), Parenting Stress Index, Fourth Edition, Short Form (PSI-4-SF), and Edinburgh Postnatal Depression Scale. Infant feeding history and growth measurements were obtained. RESULTS Having an infant with CL/P revealed greater impact on maternal health-related quality of life due to feeding problems (F = 4.83, P = .03). Mothers of infants with CL/P reported average range Total Stress scores on the PSI-4-SF, which were higher than controls (F = 4.12, P = .05). Edinburgh Postnatal Depression Scale scores did not differ between groups. Compared to controls, infants with cleft palate had lower percentiles for weight (t = 4.13, P = .04) and length (t = 2.93, P = .01). Higher FS-IS scores were associated with longer feeding duration (r = 0.32, P = .01) and lower weight (r = -0.31, P = .02) and length (r = -0.32, P = .02). CONCLUSIONS Despite receiving early team care and feeding interventions, mothers of infants with CL/P reported higher stress and more challenges with feeding and growth. Future studies should examine targeted psychosocial interventions to improve feeding and growth outcomes in infants with CL/P.
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Affiliation(s)
- Lauren L Madhoun
- Department of Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Canice E Crerand
- Department of Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Center for Biobehavioral Health, The Abigail Wexner Research Institute at 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Meghan O'Brien
- Department of Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA
| | - Adriane L Baylis
- Department of Plastic and Reconstructive Surgery, 2650Nationwide Children's Hospital, Columbus, OH, USA.,Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Speech and Hearing Science, The Ohio State University, Columbus, OH, USA
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45
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Assessing the Fisher, Mohler, and Millard Techniques of Cleft Lip Repair Surgery With Eye-Tracking Technology. Ann Plast Surg 2020; 82:S313-S319. [PMID: 30882421 DOI: 10.1097/sap.0000000000001911] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cleft lip repair is essential to restoring physiologic function and ensuring social and psychological well-being in children with orofacial clefts. It is important to critically study various techniques to understand the elements of the lip and nasal repair that contribute to favorable results. Here, we use eye-tracking technology to evaluate how viewers analyze images of cleft lips repaired by the Fisher, Millard, or Mohler techniques. METHODS Thirty viewers were shown 5 images without deformity and 5 images each of unilateral cleft lips repaired by the Fisher, Millard, or Mohler techniques. Viewers assessed the esthetic quality of images on a Likert scale while eye-tracking technology analyzed their gaze patterns. RESULTS Of the 3 repair techniques, viewers found Fisher repairs most esthetically pleasing (mean ± standard error, 6.91 ± 0.13). Mohler repairs were next most attractive at (6.47 ± 0.13), followed by Millard repairs at (5.60 ± 0.14). The proportion of time spent in fixed gaze on the nose and upper lip was greatest for Millard repairs (58.3% ± 0.4%) and least for Fisher repairs (51.9% ± 0.5%). Viewers fixated most frequently on the nose and upper lip in Millard repairs (83.2% ± 0.5%) and least frequently in Fisher repairs (75.3% ± 0.5%). When examining the Millard compared with Fisher and Mohler repairs, viewers spent more time and fixations on the ipsilateral lip, nose, and repair scar than on the contralateral lip. CONCLUSIONS The esthetics of the Fisher repair appear to be favored as measured by Likert scores and gaze data. Eye-tracking technology may be a useful tool to assess outcomes in plastic surgery.
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Danis DO, Bachrach K, Piraquive J, Marston AP, Levi JR. Cleft Lip and Palate in Newborns Diagnosed With Neonatal Abstinence Syndrome. Otolaryngol Head Neck Surg 2020; 164:199-205. [PMID: 32689883 DOI: 10.1177/0194599820944899] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Cleft lip and/or cleft palate (CLP) is the most common major congenital malformation of the head and neck. Previous studies suggested an association between fetal opioid exposure and CLP. This study seeks to evaluate the associations between CLP and neonatal abstinence syndrome (NAS) in the United States. STUDY DESIGN Population-based inpatient registry analysis. SETTING Academic medical center. SUBJECTS AND METHODS Kids' Inpatient Database (2016) was used to identify weighted in-hospital births with diagnoses of CLP or NAS. Demographic information was obtained. RESULTS Among 3.8 million weighted in-hospital births, prevalence rates of CLP in the NAS and non-NAS populations were 3.13 and 1.35 per 1000, respectively. The odds ratios for patients with NAS developing CLP, isolated cleft palate, isolated cleft lip, and cleft lip and palate when compared with the reference population were 2.33 (95% CI, 1.87-2.91; P < .001), 4.97 (95% CI, 3.84-6.43; P < .001), 1.01 (P = .98), and 0.80 (P = .46). Independent predictors of CLP within the NAS population included median household income for patients' zip code, race, hospital region, payment method, and maternal use of tobacco or other drugs of addiction. The binary logistic regression model accounting for possible confounding variables produced an odds ratio of 1.74 (95% CI, 1.36-2.23; P < .001) for the association between NAS and CLP. CONCLUSION Our study found an association between NAS and CLP, specifically isolated cleft palate, suggesting that prenatal exposure to opioids may be an environmental risk factor in the development of CLP.
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Affiliation(s)
| | - Kevin Bachrach
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Jacquelyn Piraquive
- Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Alexander P Marston
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jessica R Levi
- School of Medicine, Boston University, Boston, Massachusetts, USA.,Department of Otolaryngology-Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts, USA
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Long-term results of unilateral cleft lip repair with multiple infantile hemangiomas including one involving the cleft side of the upper lip. Arch Plast Surg 2020; 47:263-266. [PMID: 32252209 PMCID: PMC7264915 DOI: 10.5999/aps.2019.00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 03/02/2020] [Indexed: 11/10/2022] Open
Abstract
Infantile hemangiomas have a growth phase and an involution phase. For this reason, serial observation has generally been recommended as the treatment for uncomplicated infantile hemangiomas. Recently, however, individualized approaches have been emphasized. Although cleft lip and infantile hemangioma are common congenital diseases, infantile hemangiomas on the cleft side (i.e., in the operative field of the cleft lip) are extremely rare, and no clear guidelines have been established for their treatment. We experienced a case in which a patient with a cleft lip had an infantile hemangioma on the cleft side. In accordance with general treatment guidelines, cleft repair was performed 3 months after birth. The Millard rotation- advancement technique, which involves the use of a lower small triangular flap, was used for the repair. No intraoperative complications, such as massive bleeding, or postoperative complications were noted. The patient has received regular follow-up for the past 18 years, and other than a reddish scar on the lower lip, he currently has no related issues. Therefore, this case demonstrates that cleft lip repair performed according to cleft lip treatment guidelines produces good outcomes, even in cases involving a hemangioma on the cleft side.
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Yoshida S, Takeuchi M, Kawakami C, Kawakami K, Ito S. Maternal multivitamin intake and orofacial clefts in offspring: Japan Environment and Children's Study (JECS) cohort study. BMJ Open 2020; 10:e035817. [PMID: 32234746 PMCID: PMC7170615 DOI: 10.1136/bmjopen-2019-035817] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Orofacial clefts are common birth defects with a lack of strong evidence regarding their association with maternal nutrition. We aimed to determine whether a relationship exists between maternal nutrient or multivitamin intake and orofacial clefts. DESIGN This is a prospective, population-based nationwide cohort study. SETTING The study was conducted in 15 regional centres, consisting of local administrative units and study areas. PARTICIPANTS A total of 98 787 eligible mother-child pairs of the Japan Environment and Children's Study were included. INTERVENTION Exposures were maternal nutrition and the use of supplemental multivitamins in mothers. PRIMARY AND SECONDARY OUTCOME MEASURES Outcomes were the occurrence of any orofacial cleft at birth. Multinomial logistic regression analyses were used to evaluate the association between maternal multivitamin intake and the incidence of orofacial clefts. RESULTS Of the 98 787 children, 69 (0.07%) were diagnosed with cleft lip alone, 113 (0.11%) were diagnosed with cleft lip and palate, and 52 (0.05%) were diagnosed with cleft palate within 1 month after birth. Regarding the total orofacial cleft outcome, statistically significant point estimates of relative risk ratios (RR) were determined for multivitamin intake before pregnancy (RR=1.71; 95% CI 1.06 to 2.77) and during the first trimester (RR=2.00; 95% CI 1.18 to 3.37), but the association was not significant for multivitamin intake after the first trimester (RR=1.34; 95% CI 0.59 to 3.01). Maternal micronutrient intake via food was not associated with the incidence of orofacial clefts in offspring. CONCLUSIONS Intake of multivitamin supplements shortly before conception or during the first trimester of pregnancy was found to be associated with an increased incidence of orofacial clefts at birth. Pregnant women and those intending to become pregnant should be advised of the potential risks of multivitamin supplementation.
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Affiliation(s)
- Satomi Yoshida
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Masato Takeuchi
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Chihiro Kawakami
- Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Koji Kawakami
- Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
| | - Shuichi Ito
- Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
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Min JG, Khosla RK, Curtin C. Descriptive Overview of Primary Cleft Palate Surgeries in the Low- and Middle-Income Countries. Cleft Palate Craniofac J 2020; 57:984-989. [PMID: 32207319 DOI: 10.1177/1055665620911556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To increase access to high-quality and multiregional databases in global epidemiology of cleft surgeries through partnership with an NGO. DESIGN The study retrospectively analyzes 34 801 primary palate surgeries in 70+ countries from the 2016 electronic health records of an non-governmental organization (NGO). The study also utilizes the Kids' Inpatient Database to compare the epidemiology of primary cleft palate surgeries in the United States. PARTICIPANTS Patient records of those undergoing primary cleft palate surgeries only. MAIN OUTCOME MEASURES Region, age, sex, type of cleft, laterality of cleft. RESULTS Key findings show that average age of those receiving primary cleft palate surgery in the low- and middle-income countries (LMICs) was 1.95 years. The distribution of males and females receiving surgery corresponds to the US national data. More hard cleft palates were on the left side (66.18%) than the right side (33.82%), independent of gender and region. CONCLUSIONS Databases from an established NGO can be used to enhance our understanding of the disease characteristics in these regions. By increasing the information available regarding cleft surgeries in the LMIC, we hope to increase awareness of the similarities and differences in surgeries across various regions, as part of an effort to inform the goals set by Global Surgery 2030 initiative by the Lancet Commission.
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Affiliation(s)
- Jung Gi Min
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Rohit K Khosla
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Catherine Curtin
- Division of Plastic Surgery, Stanford University School of Medicine, Stanford, CA, USA
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Wanchek T, Wehby G. State-Mandated Coverage of Cleft Lip and Cleft Palate Treatment. Cleft Palate Craniofac J 2020; 57:773-777. [PMID: 32174157 DOI: 10.1177/1055665620910529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We conducted a comprehensive review of state laws and regulations that require private health insurance plans to cover the services needed by children born with cleft lip and/or cleft palate (CL/P). The goal is to better understand how states are reducing the barriers children with CL/P face when seeking recommended health care services. DESIGN We identified all state laws and regulations mandating insurance coverage of services for children with CL/P by private insurance carriers from 1999 through 2017 using Westlaw legal database. We categorized laws and regulations into ten services: facial surgery (facial, corrective, reconstructive), oral surgery, orthodontics, dental care, habilitation/rehabilitation/speech therapy, prosthetic treatment, audiology, nutrition counseling, genetic testing, and psychological counseling. We also captured broad mandates indicating coverage for all necessary treatments. RESULTS There was a trend toward increased coverage of services for CL/P over time. In 1999, 27 states and Washington, DC did not have relevant laws or regulations. By 2017, there were 19 states without laws or regulations mandating services. The most common mandated service was facial surgery followed by habilitation/rehabilitation/speech therapy, orthodontics, dental care, and oral surgery. Nutrition, audiology, genetic testing and psychological counseling were rarely included in mandated services. CONCLUSIONS States vary widely in their requirements for coverage of services needed by children with CL/P in private health insurance plans. There has been an increase in mandates over the past two decades to cover services, although significant variation continues to exist across states.
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Affiliation(s)
- Tanya Wanchek
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - George Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, IA, USA
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