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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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Zhou X, Cai S, Wang H, Fang J, Gao J, Kuang H, Xie D, He J, Wang A. Update from a cohort study for birth defects in Hunan Province, China, 2010-2020. Sci Rep 2023; 13:20257. [PMID: 37985789 PMCID: PMC10662386 DOI: 10.1038/s41598-023-47741-1] [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: 05/06/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023] Open
Abstract
To define the relationship between sex, residence, maternal age, and a broad range of birth defects by conducting a comprehensive cross-analysis based on up-to-date data. Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2010-2020. Prevalences of birth defects (number of cases per 10,000 fetuses (births and deaths at 28 weeks of gestation and beyond)) with 95% confidence intervals (CI) were calculated by sex, residence, maternal age, year, and 23 specific defects. Cross-analysis of sex, residence, and maternal age was conducted, and crude odds ratios (ORs) were calculated to examine the association of each maternal characteristic with birth defects. A total of 1,619,376 fetuses and 30,596 birth defects were identified. The prevalence of birth defects was 188.94/10,000 (95% CI 186.82-191.05). Birth defects were more frequent in males than females (210.46 vs. 163.03/10,000, OR = 1.30, 95% CI 1.27-1.33), in urban areas than in rural areas (223.61 vs. 162.90/10,000, OR = 1.38, 95% CI 1.35-1.41), and in mothers ≥ 35 than mothers 25-29 (206.35 vs. 187.79/10,000, OR = 1.10, 95% CI 1.06-1.14). Cross-analysis showed that the prevalence of birth defects was higher in urban females than in rural males (194.53 vs. 182.25/10,000), the difference in prevalence between males and females was more significant for maternal age < 20 compared to other age groups (OR = 1.64, 95% CI 1.37-1.95), and the prevalence difference between urban and rural areas is more significant for maternal age 25-34 compared to other age groups (OR = 1.49, 95% CI 1.43-1.57). Cleft palates were more frequent in males, and nine specific defects were more frequent in females. Five specific defects were more frequent in rural areas, and eight were more frequent in urban areas. Compared to mothers 25-29, five specific defects were more frequent in mothers < 20, seven specific defects were more frequent in mothers 20-24, two specific defects were more frequent in mothers 30-34, and ten specific defects were more frequent in mothers ≥ 35. Our data indicate that sex, residence, and maternal age differences in the prevalences of birth defects and most specific defects are common. We have found some new epidemiological characteristics of birth defects using cross-analysis, such as residence is the determining factor for the prevalence of birth defects, the difference in prevalence between males and females was more significant for maternal age < 20 compared to other age groups, the prevalence difference between urban and rural areas is more significant for maternal age 25-34 compared to other age groups. And differences in the epidemiological characteristics of some specific defects from previous studies. Future studies should examine mechanisms. Our findings contributed to clinical counseling and advancing research on the risk factors for birth defects.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Shenglan Cai
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Hua Wang
- The Hunan Children's Hospital, Changsha, Hunan, China.
- National Health Commission Key Laboratory of Birth Defects Research, Prevention and Treatment, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Jie Gao
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China.
| | - Haiyan Kuang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Donghua Xie
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Jian He
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Aihua Wang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
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Silvestre CMR, Silva AMC, Ferreira da Silva RCG, Bittencourt WS, Borba AM, Fernandes V, da Silva CAL. Environmental Factors at the Periconceptional Period and the Occurrence of Cleft Lip and Palate in a Midwest Brazil Population: A Case-Control Study. J Occup Environ Med 2022; 64:e751-e756. [PMID: 36069817 DOI: 10.1097/jom.0000000000002689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate the association between periconceptional environmental exposures and the occurrence of cleft lips and palates. METHODS This case-control study analyzed 150 mothers of children with cleft lips and palates living in the same city as 250 mothers whose children did not present with this malformation (controls). Environmental exposure data were gathered through a questionnaire (Latin American Collaborative Study of Congenital Malformations methodology). RESULTS Multivariate analysis revealed that monthly income below minimum wage, having another malformed child, other diseases in the first gestational trimester (urinary infection), use of pesticides in home gardens, and pesticide use in farms close to the home were risk factors associated with the malformation, whereas taking vitamins was a protective factor. CONCLUSION Maternal and paternal exposure to pesticides is associated with cleft lip and palate in Mato Grosso State, Brazil.
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Affiliation(s)
- Carla Meliso R Silvestre
- From the University of Cuiabá, Cuiabá, Mato Grosso, Brazil (Ms Silvestre, Dr Silva, Dr R.C.G. da Silva, Dr Bittencourt, Dr Borba, Dr Fernandes, Dr C.A.L. da Silva); General Hospital of Cuiabá, Cuiabá, Mato Grosso, Brazil (Ms Silvestre, Dr R.C.G. da Silva, Dr Borba, Dr Fernandes, Dr C.A.L. da Silva)
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Goida J, Pilmane M. The Evaluation of FGFR1, FGFR2 and FOXO1 in Orofacial Cleft Tissue. CHILDREN 2022; 9:children9040516. [PMID: 35455561 PMCID: PMC9032315 DOI: 10.3390/children9040516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/21/2022]
Abstract
Although cleft lip with or without cleft palate (CL/P) is one of the most common congenital anomalies worldwide, the morphopathogenesis of non-syndromic orofacial clefts is still unclear. Many candidate genes have been proposed to play a causal role; however, only a few have been confirmed, leaving many still to be assessed. Taking into account the significance of FGFR1, FGFR2 and FOXO1 in embryogenesis, the aim of this work was to detect and compare the three candidate genes in cleft-affected lip and palatine tissue. Ten soft tissue samples were taken during cheiloplasty and veloplasty. The signals of the candidate genes were visualized using chromogenic in situ hybridization and analyzed using a semi-quantitative method. No statistically important difference in the distribution of FGFR1, FGFR2 and FOXO1 between neither the patients’ lip and vomer mucosa nor the control group was observed. Statistically significant very strong and strong correlations were found between genes in the lip and palatine tissue. The expression of FGFR1, FGFR2 and FOXO1 in cleft-affected lip and palatine tissue seems to be highly individual. Numerous intercorrelations between the genes do not exclude their role in the possible complex morphopathogenesis of orofacial clefts.
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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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6
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Sullivan ZC, Van Eeden S, May J, Flannigan N, Seshu M, Dominguez-Gonzalez S. Identifying associations between dental arch relationship scores, relative deprivation and other cleft audit outcomes. Part 2. Orthod Craniofac Res 2021; 25:103-111. [PMID: 34056824 DOI: 10.1111/ocr.12504] [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: 11/28/2020] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
Identify associations between dental arch relationship scores, oral health status and deprivation index in patients with complete unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP). Ninety-two 5-year-old children with non-syndromic complete UCLP and thirty-nine 5-year-old children with non-syndromic complete BCLP from the United Kingdom. Data were collected from the 5-year audit outcomes submitted to the Cleft Registry and Audit Network (CRANE). The index of multiple deprivation (IMD) and Welsh index of deprivation were used to assess a relative measure of deprivation. Comparisons of 5-year-old index/BCLP Deciduous Dentition Yardstick outcome against IMD and dmft are performed using multivariable linear regression models. Both UCLP and BCLP had a high percentage of children with dmft >0 (47% and 49%, respectively). The mean dmft for the UCLP cohort was 2.8 and 2.6 for the BCLP cohort. In the UCLP group, a poorer 5-year-old index was associated with an increased dmft score (P = .023) and higher level of deprivation (P = .010). In the BCLP group, there was no significant associations between BCLP Deciduous Dentition Yardstick, dmft and IMD. A poorer dental arch relationship outcome may be associated with higher level of area deprivation and oral health status, in children with UCLP. Those with a poor outcome for the 5-year-old Index are more likely to have increased caries experience.
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Affiliation(s)
| | | | - Joanna May
- Alder Hey Hospital Children's Hospital, Liverpool, UK
| | - Norah Flannigan
- Orthodontic department, Liverpool University Dental Hospital, Liverpool, UK
| | - Madhavi Seshu
- Alder Hey Hospital Children's Hospital, Liverpool, UK
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7
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van Woerden H, Bucholc M, Clubbs Coldron B, Coates V, Heaton J, McCann M, Perrin N, Waterson R, Watson A, MacRury S. Factors influencing hospital conveyance following ambulance attendance for people with diabetes: A retrospective observational study. Diabet Med 2021; 38:e14384. [PMID: 33464629 DOI: 10.1111/dme.14384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 11/29/2022]
Abstract
AIM To assess variables contributing to hospital conveyance for people with diabetes and the interactions between them. A secondary aim was to generate hypotheses for further research into interventions that might reduce avoidable hospital admissions. METHODS A national retrospective data set including 30 999 diabetes-related callouts from the Scottish Ambulance Service was utilized covering a 5-year period between 2013 and 2017. The relationship between diabetes-related hospital conveyance and seven potential risk factors was analysed. Independent variables included: age, gender, deprivation, paramedic attendance, treatment at the scene, first blood glucose measurement and day of the week. RESULTS In Scotland, hyperglycaemia was associated with a higher number of people being conveyed to hospital than hypoglycaemia (49.8% with high blood glucose vs. 39.3% with low glucose, P ≤ 0.0001). Treatment provided in pre-hospital care was associated with reduced conveyance rates (47.3% vs. 58.2% where treatment was not administered, P ≤ 0.0001). Paramedic attendance was also associated with reduced conveyance to hospital (51.4% vs. 59.5% where paramedic was not present, P ≤ 0.0001). Paramedic attendance in hyperglycaemic cases was associated with significantly reduced odds of conveyance (odds ratio 0.52, P ≤ 0.001). CONCLUSIONS A higher rate of conveyance associated with hyperglycaemic cases indicates a need for more resources, education and training in this area. Higher conveyance rates were also associated with no paramedic being present and no treatment being administered. This suggests that paramedic attendance may be crucial in reducing avoidable admissions. Developing and validating protocols for pre-hospital services and treatment may help to reduce hospital conveyance rates.
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Affiliation(s)
- H van Woerden
- Department of Public Health, NHS Highlands, Assynt House, Inverness
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, Co. Antrim, BT37 0QB
| | - M Bucholc
- Intelligent Systems Research Centre, School of Computing, Engineering & Intelligent Systems, Ulster University
| | - B Clubbs Coldron
- Division of Rural Health and Wellbeing, Centre for Health Science, Inverness
| | - V Coates
- School of Nursing, Ulster University, Derry
- Western Health and Social Care Trust, Altnagelvin Area Hospital, Londonderry
| | - J Heaton
- Division of Rural Health and Wellbeing, Centre for Health Science, Inverness
| | - M McCann
- Letterkenny Institute of Technology, Port Road, Letterkenny, Ireland
| | - N Perrin
- Psychology Department, University of the Highlands and Islands, Inverness
| | - R Waterson
- Scottish Ambulance Service, National Headquarters, Edinburgh, UK
| | - A Watson
- School of Nursing, Ulster University, Derry
| | - S MacRury
- Department of Public Health, NHS Highlands, Assynt House, Inverness
- Division of Rural Health and Wellbeing, Centre for Health Science, Inverness
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Ali MA, Nasir AF, Abass SK. Oral Health-Related Quality of Life Among Sudanese Children Treated for Cleft Lip and Palate. Cleft Palate Craniofac J 2021; 58:1405-1411. [PMID: 33467903 DOI: 10.1177/1055665620987694] [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: 11/17/2022] Open
Abstract
OBJECTIVE This study compared the oral health-related quality of life (OHRQoL) among children with a cleft lip with or without a cleft palate (CL±P) and a group of their peers. The reliability of the Arabic version of the Child Oral Health Impact Profile Questionnaire (COHIP) was also assessed. DESIGN A cross-sectional study. SETTINGS Cleft clinic in a private dental college in Omdurman City, Sudan. PATIENTS In all, 75 children (mean age 11.3 ± 2.5 years) with a history of CL±P and a group of 150 school children without CL±P (mean age 11.4 ± 2.6 years). MAIN OUTCOME MEASURES Overall and subscale scores on the Arabic version of the COHIP. RESULTS Test-retest reliability of COHIP in Arabic was high with an interclass correlation coefficient >0.8. Cronbach α value internal consistency was 0.8 for the total scale and between 0.7 and 0.8 for the subscales. The COHIP score was 89.41 ± 19.97 in children with CL±P and 122.82 ± 9.45 for the control group. Children with CL±P had significantly lower scores on the overall and all subscales when compared to children without CL±P (P ≤ .001). Among the children with CL±P, there were no statistically significant differences on the COHIP based on age and/or gender (P ≥ .05). CONCLUSIONS Children with CL±P had a relatively high OHRQoL, which was lower than that of their peers without CL±P in both the overall scale and all subscales. Gender and age differences had no significant impact on the OHRQoL. The COHIP Arabic version showed appropriate reliability.
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Affiliation(s)
- Mecheala Abbas Ali
- Department of Orthodontics, 245677University of Science and technology, Omdurman, Sudan
| | - Alwaleed Fadul Nasir
- Department of Orthodontics, 245677University of Science and technology, Omdurman, Sudan.,Department of Preventative Dentistry, 48023King Faisal University, Saudi Arabia
| | - Shaza K Abass
- Department of Orthodontics, 89235University of Khartoum, Sudan
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Jovic TH, Gibson JAG, Griffiths R, Dobbs TD, Akbari A, Wilson-Jones N, Costello R, Evans P, Cooper M, Key S, Lyons R, Whitaker IS. Microtia: A Data Linkage Study of Epidemiology and Implications for Service Delivery. Front Pediatr 2021; 9:630036. [PMID: 33842409 PMCID: PMC8033003 DOI: 10.3389/fped.2021.630036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 03/02/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Previous studies of microtia epidemiology globally have demonstrated significant geographical and ethnic variation, cited broadly as affecting 3-5 in 10,000 live births. The aim of this study was to determine the incidence of microtia in a largely homogeneous ethnic population in the United Kingdom (Wales) and to identify factors, such as distance and socioeconomic status, which may influence the access to surgical intervention. Materials and Methods: A retrospective cohort study was conducted using data linkage to identify patients born between 2000 and 2018 with a diagnosis of microtia. Microtia incidence was calculated using annual and geographic birth rates. Surgical operation codes were used to classify patients into those that had no surgery, autologous reconstruction or prosthetic reconstruction. Sociodemographic attributes were compared using descriptive statistics to determine differences in access to each type of surgical intervention. Results: A total of 101 patients were identified, 64.4% were male and the median age was 12 (8-16). The mean annual incidence was 2.13 microtia cases per 10,000 births over the 19-year study period. Both temporal and geographic variation was noted. The majority of patients undergoing surgery opted for autologous reconstruction (72.9%) at a median age of 9 (7-10) compared to 7 (5-8) for prosthetic reconstruction. Autologous reconstruction had a higher median number of surgeries (2, 1-3) than prosthetic (1.5, 1-2) and a higher median socioeconomic status of 3 (2-4) compared to 2 (1-4) for the prosthetic cohort. There were no statistically significant differences in the distance traveled for surgery. Discussion: This study highlights a role for data linkage in epidemiological analyses and provides a revised incidence of microtia in Wales. Although the majority of patients opted for autologous reconstruction, demographic disparities in socioeconomic status warrant further investigation, emphasizing the importance of striving for equity in accessibility to surgical intervention.
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Affiliation(s)
- Thomas H Jovic
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom.,Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, United Kingdom
| | - John A G Gibson
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom.,Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, United Kingdom
| | - Rowena Griffiths
- Health Data Research UK, Swansea University, Swansea, United Kingdom
| | - Thomas D Dobbs
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom.,Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, United Kingdom
| | - Ashley Akbari
- Health Data Research UK, Swansea University, Swansea, United Kingdom.,Administrative Data Research Wales, Swansea University, Swansea, United Kingdom
| | - Nicholas Wilson-Jones
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Rhodri Costello
- Department of Otolaryngology, Morriston Hospital, Swansea, United Kingdom
| | - Peter Evans
- Department of Maxillofacial Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Mark Cooper
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Steve Key
- Department of Maxillofacial Surgery, Morriston Hospital, Swansea, United Kingdom
| | - Ronan Lyons
- Health Data Research UK, Swansea University, Swansea, United Kingdom.,Administrative Data Research Wales, Swansea University, Swansea, United Kingdom
| | - Iain S Whitaker
- The Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, United Kingdom.,Reconstructive Surgery and Regenerative Medicine Research Group (ReconRegen), Swansea University Medical School, Institute of Life Sciences, Swansea, United Kingdom
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10
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Shin H, Ahn E, Choi EJ. Access to antenatal healthcare and the prevalence of oral clefts: a spatial analysis. Eur J Oral Sci 2020; 128:145-152. [PMID: 32171043 DOI: 10.1111/eos.12688] [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: 09/05/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/30/2022]
Abstract
Congenital anomalies are caused by a variety of risk factors, including individual and environmental ones. This study estimated the prevalence of oral clefts and examined their area-level risk indicators using data from The National Congenital Anomaly Survey in South Korea. Disease mapping and ecological regression were used to assess the geographical variation and potential risk indicators for oral clefts, such as living in a rural area, material deprivation, and limited access to antenatal healthcare. In South Korea, 1.15 (95% CI, 1.08-1.23) children out of every 1,000 births were born with oral clefts during 2005 and 2006. The most common oral cleft type was cleft palate, followed by cleft lip, then cleft lip and palate. Disease mapping showed that the proportion of areas with a higher risk than the national average was relatively higher for oral clefts than for all congenital abnormalities among rural and healthcare underserved areas. The relative risk of oral cleft prevalence was higher in rural areas and healthcare underserved areas than in urban areas and areas with better access to healthcare. The findings suggest that access to antenatal healthcare as well as area-level risk indicators should be considered a priority when developing measures to decrease the occurrence of oral clefts.
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Affiliation(s)
- Hosung Shin
- Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, Iksan, Korea
| | - Eunsuk Ahn
- Department of Dental Hygiene, Daejeon Institute of Science and Technology, Daejeon, Korea
| | - Eun Joo Choi
- Department of Oral and Maxillofacial Surgery, Wonkwang University School of Dentistry, Iksan, Korea
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11
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Malic CC, Lam M, Donelle J, Richard L, Vigod SN, Benchimol EI. Incidence, Risk Factors, and Mortality Associated With Orofacial Cleft Among Children in Ontario, Canada. JAMA Netw Open 2020; 3:e1921036. [PMID: 32049294 DOI: 10.1001/jamanetworkopen.2019.21036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Orofacial cleft (OFC) is one of the most common congenital malformations, with a wide variation in incidence worldwide. However, population-based studies on the incidence of OFC in North America are lacking. OBJECTIVES To examine the incidence of OFC in Ontario, Canada, and to compare risk factors and mortality associated with children with OFC vs children without OFC. DESIGN, SETTING, AND PARTICIPANTS This population-based retrospective cohort study used health administrative data from the province of Ontario, Canada. Children with OFC who were born from April 1, 1994, to March 31, 2017, in Ontario were each matched to 5 children without OFC based on sex, date of birth (±30 days), and mother's age (±5 years). Analyses were conducted from September 2018 to January 2019. EXPOSURES Children born with OFC. MAIN OUTCOMES AND MEASURES Incidence of OFC over time and regional variation. Risk factors for OFC were assessed using 1-way analysis of variance for means, Kruskal-Wallis for medians, and χ2 tests for categorical variables. Adjusted Cox regression models were used to assess mortality. RESULTS From 1994 to 2017, 3262 children were born with OFC in Ontario, Canada, and they were matched to 15 222 children born without OFC. Incidence of OFC in Ontario was 1.12 cases per 1000 live births, with wide geographic variation and a lower incidence from 2004 to 2017 compared with 1994 to 2003 (1.02 vs 1.13 cases per 1000 live births; P = .002), especially for the subgroup with cleft palate (0.52 vs 0.44 cases per 1000 live births; P = .006). Children with OFC, compared with children without OFC, were more likely to be born prematurely (406 children [13.3%] vs 1086 children [7.1%]; P < .001; standardized difference, 0.21) and had lower mean (SD) birth weight (3215.3 [687.6] g vs 3382.6 [580.0] g; P < .001; standardized difference, 0.26). The mortality rate among children with OFC was higher than among matched children without OFC (hazard ratio, 10.60; 95% CI, 7.79-14.44; P < .001). When mortality was adjusted for the presence of congenital or chromosomal anomalies, the risk of death was not significantly different between children with OFC and those without OFC (hazard ratio, 1.35; 95% CI, 0.73-2.72). CONCLUSIONS AND RELEVANCE These findings suggest that incidence of OFC In Ontario, Canada, decreased from 1994 to 2017. Mortality in children with OFC was high, especially in the first 2 years of life, and was predominantly associated with the presence of other congenital or chromosomal anomalies. Further research is required to better understand the causes of wide geographical variations of OFC incidence and improve the survival of these patients.
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Affiliation(s)
- Claudia C Malic
- Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Jessy Donelle
- ICES uOttawa, Ottawa, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Simone N Vigod
- Division of Equity, Gender and Population, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's Mental Health Research, Women's College Hospital and Research Institute, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Eric I Benchimol
- ICES uOttawa, Ottawa, Ontario, Canada
- Department of Pediatrics, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Health Information Technology Program, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
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Abebe ME, Deressa W, Oladugba V, Owais A, Hailu T, Abate F, Hailu A, Demissie Y, Degu S, Alemayehu B, Gessesse M, Deribew M, Gravem PE, Mossey P, Butali A. Oral Health-Related Quality of Life of Children Born With Orofacial Clefts in Ethiopia and Their Parents. Cleft Palate Craniofac J 2018; 55:1055665618760619. [PMID: 29561719 DOI: 10.1177/1055665618760619] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the oral health-related quality of life (OH-RQoL) using a translated standardized measure in an understudied population of Ethiopian children born with orofacial clefts (OFCs) and their parents. METHODS Using a descriptive study design, we assessed the OH-RQoL of 41 patients with OFCs between the ages of 8 and 17 years and their parents. Participants received multidisciplinary cleft care from 2008 to 2016. They completed an Amharic translation of the Child Oral Health Impact Profile (COHIP). RESULTS There was strong internal reliability with the translated COHIP for parents and patients. Parents' COHIP scores ranged from 67 to 186, and patients' scores were 78 to 190. The mean for patients and parents was 155, indicating good OH-RQoL. CONCLUSION The Amharic translation of the COHIP appears appropriate for use with families in Ethiopia. Both parents and patients reported OH-RQoL at similar levels as other international populations.
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Affiliation(s)
- Mekonen Eshete Abebe
- 1 Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- 2 Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Wakgari Deressa
- 2 Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Victoria Oladugba
- 3 Department of Pediatric Dentistry, College of Dentistry, University of Lagos, Nigeria
| | - Arwa Owais
- 4 Department of Pediatric Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA
| | - Taye Hailu
- 5 Plastic and Reconstructive Surgery Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Fikre Abate
- 5 Plastic and Reconstructive Surgery Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Abiye Hailu
- 1 Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- 5 Plastic and Reconstructive Surgery Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Yohannes Demissie
- 1 Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- 5 Plastic and Reconstructive Surgery Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Shiferaw Degu
- 6 Dental Department, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bezuwork Alemayehu
- 5 Plastic and Reconstructive Surgery Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Mulualem Gessesse
- 5 Plastic and Reconstructive Surgery Unit, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Milliard Deribew
- 1 Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Paul Egl Gravem
- 7 Department of Plastic and Reconstructive Surgery, Haukeland University Hospital, Bergen, Norway
| | - Peter Mossey
- 8 Department of Orthodontics, University of Dundee, Scotland, United Kingdom
| | - Azeez Butali
- 9 Department of Oral Pathology, Radiology and Medicine, College of Dentistry, University of Iowa, Iowa City, IA, USA
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Pawluk MS, Campaña H, Rittler M, Poletta FA, Cosentino VR, Gili JA, Gimenez LG, López Camelo JS. Individual deprivation, regional deprivation, and risk for oral clefts in Argentina. Rev Panam Salud Publica 2017. [PMID: 29466515 PMCID: PMC6645331 DOI: 10.26633/rpsp.2017.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective. The aim of this study was to analyze the effects of individual low socioeconomic status (SES) and deprived geographical area (GA) on the occurrence of isolated cleft lip with or without cleft palate (CL±P) in Argentina.
Methods. This case-control study included 577 newborns with isolated CL±P and 13 344 healthy controls, born between 1992 and 2001, from a total population of 546 129 births in 39 hospitals in Argentina. Census data on unsatisfied basic needs were used to establish the degree of geographical area deprivation. An SES index for each individual was established, using maternal age, gravidity, low paternal and maternal education, and low-level paternal occupation. Logistic regression was used to assess the effects of low SES and of deprived GA on CL±P.
Results. A slightly increased risk of CL±P was observed in mothers with a low SES, while a deprived GA showed no effect. Native ancestry, acute maternal illnesses, and poor prenatal care were significant risk factors for CL±P for the mothers with low SES, after using propensity scores to adjust for the demographic characteristics in cases and controls.
Conclusions. Low individual SES slightly increased the risk for CL±P, but a deprived GA did not have that effect. There was no interaction between individual SES and deprived GA. Factors related to low individual SES—including poor prenatal care, low parental education, lack of information, and lifestyle factors—should be primarily targeted as risk factors for CL±P rather than factors related to a deprived place of residence.
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Affiliation(s)
- Mariela Soledad Pawluk
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina
| | | | - Monica Rittler
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Hospital Materno Infantil Ramón Sarda, Buenos Aires, Argentina
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Chidzonga MM, Carneiro LC, Kalyanyama BM, Kwamin F, Oginni FO. Determinants of Oral Diseases in the African and Middle East Region. Adv Dent Res 2017; 27:26-31. [PMID: 26101337 DOI: 10.1177/0022034515581645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oral health policies must be developed that emphasize the role of social determinants in health and oral diseases. The aim of this report is to review literature on determinants of oral diseases and apply the concepts to promoting oral health in the African countries in the African and Middle East region (AMER). Structural and proximal determinants of oral diseases are common to those affected by other noncommunicable diseases (NCDs). Oral diseases are also heavily affected by issues of politics, poor health behaviors, underdeveloped health systems, and low oral health literacy. Wide-scale poverty exists in populations in the AMER. Oral health promotion and preventive oral health programs should therefore be integrated with those for general health and use the common risk factor approach (CRFA). Attempts should be made to improve the daily living conditions and reduce the incline of the social gradient. Oral health practitioners should use the CRFA when dealing with determinants of oral diseases and in the design of preventive oral health programs. The detrimental effects of the social determinants of health may be ameliorated by involving both the individual and community. Interventions in health promotion programs in the AMER need more research on the epidemiology of oral diseases and the role played by the social determinants of oral diseases, especially with regard to poverty. The high levels of poverty and low gross domestic product in most countries in the African region make it difficult to fund high-quality, affordable, accessible oral health services.
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Affiliation(s)
- M M Chidzonga
- Department of Dentistry, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - L C Carneiro
- School of Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - B M Kalyanyama
- School of Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - F Kwamin
- Deparment of Oral Medicine and Oral Pathology, University of Ghana, Dental School, Korle-Bu, Accra, Ghana
| | - F O Oginni
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Deguen S, Kihal W, Jeanjean M, Padilla C, Zmirou-Navier D. Neighborhood Deprivation and Risk of Congenital Heart Defects, Neural Tube Defects and Orofacial Clefts: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0159039. [PMID: 27783616 PMCID: PMC5082651 DOI: 10.1371/journal.pone.0159039] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/27/2016] [Indexed: 11/22/2022] Open
Abstract
Background We conducted this systematic review and meta-analysis to address the open question of a possible association between the socioeconomic level of the neighborhoods in which pregnant women live and the risk of Congenital Heart Defects (CHDs), Neural Tube Defects (NTDs) and OroFacial Clefts (OFCs). Methods We searched MEDLINE from its inception to December 20th, 2015 for case-control, cohort and ecological studies assessing the association between neighborhood socioeconomic level and the risk of CHDs, NTDs and the specific phenotypes Cleft Lip with or without Cleft Palate (CLP) and Cleft Palate (CP). Study-specific risk estimates were pooled according to random-effect and fixed-effect models. Results Out of 245 references, a total of seven case-control studies, two cohort studies and two ecological studies were assessed in the systematic review; all studies were enrolled in the meta-analysis with the exception of the two cohort studies. No significant association has been revealed between CHDs or NTDs and neighborhood deprivation index. For CLP phenotype subgroups, we found a significantly higher rate in deprived neighborhoods (Odds Ratios (OR) = 1.22, 95% CI: 1.10, 1.36) whereas this was not significant for CP phenotype subgroups (OR = 1.20, 95%CI: 0.89, 1.61). Conclusion In spite of the small number of epidemiological studies included in the present literature review, our findings suggest that neighborhood socioeconomic level where mothers live is associated only with an increased risk of CLP phenotype subgroups. This finding has methodological limitations that impede the formulation of firm conclusions, and further investigations should confirm this association.
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Affiliation(s)
- Séverine Deguen
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- INSERM U1085 (IRSET), Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- * E-mail:
| | - Wahida Kihal
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
| | - Maxime Jeanjean
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- INSERM U1085 (IRSET), Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
| | - Cindy Padilla
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
| | - Denis Zmirou-Navier
- EHESP School of Public Health, Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- INSERM U1085 (IRSET), Department of Environmental and Occupational Health, Rennes, Cedex 35043, France
- Lorraine University Medical School, Nancy, Cedex 54052, France
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Kadir A, Mossey PA, Blencowe H, Moorthie S, Lawn JE, Mastroiacovo P, Modell B. Systematic Review and Meta-Analysis of the Birth Prevalence of Orofacial Clefts in Low- and Middle-Income Countries. Cleft Palate Craniofac J 2016; 54:571-581. [PMID: 27440051 DOI: 10.1597/15-221] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the last comprehensive review of the literature published in 2002, little information on the prevalence of orofacial clefts was available from low- and middle-income countries (LMICs). OBJECTIVE To analyze published data on the birth prevalence of cleft lip and/or palate (CL/P) from LMIC. DESIGN Systematic review of the literature and meta-analysis of data from original papers on the birth prevalence of cleft lip and/or cleft palate (CL/P) in LMICs between 1990 and 2014. Secondary inclusion criteria were developed to analyze lower-quality studies from countries with scarce data. MAIN OUTCOME MEASURE Birth prevalence of undifferentiated CL/P (with or without associated syndrome or other anomaly). RESULTS Twenty-eight studies met strict inclusion criteria. Among 31,475,278 total births, the pooled birth prevalence of undifferentiated CL/P was 1.38 per 1000 births (95% confidence interval [CI]: 1.20 to 1.56). Four studies met criteria for secondary analysis, providing data on 75,627 births, with a pooled prevalence of 0.75 CL/P cases per 1000 births (95% CI: 0.56 to 0.95). Comparison of studies was limited by variable definitions of cases and of the reference population and by inconsistent reporting of outcomes. There is significant heterogeneity in the findings. CONCLUSIONS In LMICs, approximately 1 in every 730 children is born with CL/P. To optimize comparability across settings, future research should use a standard classification system and standard criteria for data collection and presentation. As clefting is associated with deprivation, understanding the true scale, risks, and preventive measures for orofacial clefts in LMIC is a matter of both scientific and humanitarian importance.
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Kawalec A. Risk factors involved in orofacial cleft predisposition - review. Open Med (Wars) 2015; 10:163-175. [PMID: 28352691 PMCID: PMC5152966 DOI: 10.1515/med-2015-0027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 12/11/2014] [Indexed: 11/20/2022] Open
Abstract
Clefts that occur in children are a special topic. Avoiding risk factors, and also an early diagnosis of cleft possibility can result in minimizing or avoiding them. If on the other hand when clefts occur they require a long-term, multistage specialized treatment. Etiology of clefts seems to be related to many factors. Factors such as genetic, environmental, geographic and even race factors are important. Identification of risk factors can lead to prevention and prophylactic behaviors in order to minimize its occurrence. Exposure to environmental factors at home and work that lead to cleft predisposition should not be disregarded. It seems that before planning a family it would be wise to consult with doctors of different specializations, especially in high-risk families with cleft history in order to analyze previous lifestyle. Clefts are very common in hereditary facial malformations and are causing a lot of other irregularities in the head and neck region. In this paper after a brief papers review authors present socio-geographic, environmental and also work place related factors that are influencing pregnant women condition and should be taken under serious consideration.
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Affiliation(s)
- Agata Kawalec
- Wroclaw Medical University, Wrocław, Poland, Department of Hygiene, Silesian Piast’s Medical University, Poland
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18
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Orofacial cleft outreach in rural Ghana: any positive impact on the community? EUROPEAN JOURNAL OF PLASTIC SURGERY 2015. [DOI: 10.1007/s00238-014-1025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Choa RM, Slator R, Jeremy A, Robinson S, Franklin D, Roberts A, Winter R, Extence H, Collard M, Clark V. Identifying the effect of cleft type, deprivation and ethnicity on speech and dental outcomes in UK cleft patients: A multi-centred study. J Plast Reconstr Aesthet Surg 2014; 67:1637-43. [DOI: 10.1016/j.bjps.2014.07.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 04/01/2014] [Accepted: 07/22/2014] [Indexed: 11/25/2022]
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20
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Lowry RB, Sibbald B, Bedard T. Stability of Orofacial Clefting Rate in Alberta, 1980–2011. Cleft Palate Craniofac J 2014; 51:e113-21. [DOI: 10.1597/13-340] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To determine the prevalence and trends of orofacial clefts in Alberta (Canada) over a 33-year period (1980 through 2011) and to determine whether the trends differ for subcategories of orofacial clefts for the period from 1997 through 2011. Design A prevalence study based on the Alberta Congenital Anomalies Surveillance System, which has multiple sources of ascertainment, capability of verification, and an upper age limit of 1 year. Inclusion All live born and stillborn babies and fetal deaths less than 20 weeks' gestation (including terminations of pregnancy) born in Alberta of mothers who reside in Alberta. Results and Conclusions Rates for cleft lip with or without cleft palate and cleft palate only have been very stable over the 33-year period (1980 through 2011). These rates include all clefts (isolated, syndromes, recognizable conditions, chromosomal and multiple congenital anomalies). Ascertainment of fetal deaths less than 20 weeks' gestation began in 1997. There are trends for the 1997 through 2011 cohort with a marginally significant increase for cleft lip with or without cleft palate in the isolated category and a significant decrease for cleft palate, mainly in the associated groups. The impact of folic acid fortification and/or multivitamins/folic acid supplementation reports in the literature have shown no consensus with respect to a change in the prevalence of orofacial clefts. It is unclear whether folic acid fortification has had any impact in Alberta.
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Affiliation(s)
- R. Brian Lowry
- Departments of Pediatrics and Medical Genetics, University of Calgary, Alberta Children's Hospital; Alberta Children's Hospital Research Institute, Calgary, Canada
| | - Barbara Sibbald
- Alberta Congenital Anomalies Surveillance System, Alberta Health and Wellness, Calgary, Canada
| | - Tanya Bedard
- Alberta Congenital Anomalies Surveillance System, Alberta Health and Wellness, Calgary, Canada
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Materna-Kiryluk A, Więckowska B, Wiśniewska K, Czyżewska M, Godula-Stuglik U, Jaworska-Bobkier R, Walencka Z, Kucharska Z, Latos-Bieleńska A. Spatial and temporal clustering of isolated cleft lip with or without cleft palate in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2014; 24:567-579. [PMID: 24559046 DOI: 10.1080/09603123.2014.883593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Geographic variation in the prevalence of isolated cleft lip with or without cleft palate may be due to exogenous environmental factors or genetic variation. In this study, we aim to evaluate the prevalence of isolated cleft lip with or without cleft palate in Polish urban and rural environments in order to identify geographic areas with high prevalence (defect clusters). METHODS We use all cases of congenital malformations reported to the Polish Registry of Congenital Malformations in the years 1998-2008 from the total population of 2,362,502 births. RESULTS We detect a strong signal of increased prevalence of isolated cleft lip with or without cleft palate in a single region of Poland, the Dolnośląskie voivodeship. Furthermore, we demonstrate a statistically significant prevalence differences between the urban and rural areas within this region. Through our comprehensive spatiotemporal analysis, we precisely define the cluster of the highest risk that comprises the eastern part of this voivodeship.
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Affiliation(s)
- Anna Materna-Kiryluk
- a Department of Medical Genetics , Karol Marcinkowski University of Medical Sciences in Poznan , Poznan , Poland
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Wehby GL, Nyarko KA, Lopez-Camelo JS. Fetal health shocks and early inequalities in health capital accumulation. HEALTH ECONOMICS 2014; 23:69-92. [PMID: 23339079 PMCID: PMC3865137 DOI: 10.1002/hec.2901] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 11/16/2012] [Accepted: 12/05/2012] [Indexed: 06/01/2023]
Abstract
Several studies report socioeconomic inequalities in child health and consequences of early disease. However, not much is known about inequalities in health capital accumulation in the womb in response to fetal health shocks, which is essential for finding the earliest sensitive periods for interventions to reduce inequalities. We identify inequalities in birth weight accumulation as a result of fetal health shocks from the occurrence of one of the most common birth defects, oral clefts, within the first 9 weeks of pregnancy, using quantile regression and two datasets from South America and the USA. Infants born at lower birth weight quantiles are significantly more adversely affected by the health shock compared with those born at higher birth weight quantiles, with overall comparable results between the South American and US samples. These results suggest that fetal health shocks increase child health disparities by widening the spread of the birth weight distribution and that health inequalities begin in the womb, requiring interventions before pregnancy.
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Affiliation(s)
- George L Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA
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The financial impact of unrepaired cleft lip and palate in the Philippines. Int J Pediatr Otorhinolaryngol 2013; 77:1925-8. [PMID: 24139590 DOI: 10.1016/j.ijporl.2013.08.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 08/20/2013] [Accepted: 08/22/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVES There are over 96 million people in the Philippines. Close to 77 thousand persons in this country have orofacial clefting. We estimate nearly 64 thousand are unrepaired. Unemployment and underemployment because of the communication disorders associated with unrepaired clefts will affect family income and hence tax revenues. The purpose of this study is to understand the financial impact of unrepaired cleft lip and/or palate on families and identify how that would translate to the Philippine government in tax revenues. METHODS The incidence of orofacial cleft in the Philippines was estimated to be at least 1 in 750 people, with only 16% anticipated to be repaired under current conditions. Assuming a 21% unemployment rate in subjects with untreated clefts, and a tax rate of 6-12.4%, projected lost personal income and federal tax revenue was calculated. RESULTS In 2012 alone the financial impact on the families may be as much as $US 73-88 million in lost revenue from unemployment and underemployment. This would cost the government between $8.0 and $9.8 million dollars in lost tax revenue. Over a 20 year period at least $US 1.7 billion dollars in family income would be affected costing the government at least $US 194 million in taxes. CONCLUSION By appropriately caring for the cleft population tax revenues should increase substantially. The development of the infrastructure for surgical care of this problem would be costly but could be more than offset by revenues. Inattention to surgically correctable causes of communication disorders is not affordable.
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Roberts RM, Mathias JL, Wheaton P. Cognitive Functioning in Children and Adults With Nonsyndromal Cleft Lip and/or Palate: A Meta-analysis. J Pediatr Psychol 2012; 37:786-97. [DOI: 10.1093/jpepsy/jss052] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wehby GL, Tyler MC, Lindgren S, Romitti P, Robbins J, Damiano P. Oral clefts and behavioral health of young children. Oral Dis 2011; 18:74-84. [PMID: 21883709 DOI: 10.1111/j.1601-0825.2011.01847.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study examined the behavioral health of young children with oral clefts, and effects of satisfaction with facial appearance, cleft team care, number of cleft-related surgeries, and socioeconomic status (SES). SUBJECTS AND METHODS The study included a population-based sample of 104 children aged 2-12 years with isolated oral clefts from the state of Iowa. Behavior was evaluated with the Child Behavior Checklist or the Pediatric Behavior Scale 30, depending on age, compared with normative samples. RESULTS Risks of behavioral problems were not significantly different from normative samples except for higher inattention/hyperactivity risks at age 6-12 years. Low satisfaction with facial appearance was associated with behavioral problems in all domains, except aggression. Team-care effects were not associated with behavioral problems. Number of cleft-related surgeries was associated with increased anxiety/depression and somatic symptom risks. Higher SES was associated with reduced inattention/hyperactivity, aggressive/oppositional behavior, and somatic symptoms. CONCLUSIONS Most children with oral clefts may have similar behavioral health outcomes to unaffected children, except for increased inattention/hyperactivity risks at older ages. However, low satisfaction with facial appearance, increased exposure to surgeries, and lower SES may significantly increase behavioral problems. Also, the findings emphasize the need to study the representation of behavioral health professionals on cleft teams and access to behavioral health care.
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Affiliation(s)
- G L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA 52242, USA.
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Wehby G, Jugessur A, Murray JC, Moreno L, Wilcox A, Lie RT. GENES AS INSTRUMENTS FOR STUDYING RISK BEHAVIOR EFFECTS: AN APPLICATION TO MATERNAL SMOKING AND OROFACIAL CLEFTS. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2011; 11:54-78. [PMID: 22102793 DOI: 10.1007/s10742-011-0071-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study uses instrumental variable (IV) models with genetic instruments to assess the effects of maternal smoking on the child's risk of orofacial clefts (OFC), a common birth defect. The study uses genotypic variants in neurotransmitter and detoxification genes relateded to smoking as instruments for cigarette smoking before and during pregnancy. Conditional maximum likelihood and two-stage IV probit models are used to estimate the IV model. The data are from a population-level sample of affected and unaffected children in Norway. The selected genetic instruments generally fit the IV assumptions but may be considered "weak" in predicting cigarette smoking. We find that smoking before and during pregnancy increases OFC risk substantially under the IV model (by about 4-5 times at the sample average smoking rate). This effect is greater than that found with classical analytic models. This may be because the usual models are not able to consider self-selection into smoking based on unobserved confounders, or it may to some degree reflect limitations of the instruments. Inference based on weak-instrument robust confidence bounds is consistent with standard inference. Genetic instruments may provide a valuable approach to estimate the "causal" effects of risk behaviors with genetic-predisposing factors (such as smoking) on health and socioeconomic outcomes.
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Affiliation(s)
- George Wehby
- Assistant Professor, Dept. of Health Management and Policy, College of Public Health, University of Iowa, 200 Hawkins Drive, E205 GH, Iowa City, IA 52242 USA,
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Mossey PA, Shaw WC, Munger RG, Murray JC, Murthy J, Little J. Global oral health inequalities: challenges in the prevention and management of orofacial clefts and potential solutions. Adv Dent Res 2011; 23:247-58. [PMID: 21490237 PMCID: PMC6699117 DOI: 10.1177/0022034511402083] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The birth prevalence of orofacial clefts, one of the most common congenital anomalies, is approximately one in 700 live births, but varies with geography, ethnicity, and socio-economic status. There is a variation in infant mortality and access to care both between and within countries, so some clefts remain unrepaired into adulthood. Quality of care also varies, and even among repaired clefts there is residual deformity and morbidity that significantly affects some children. The two major issues in attempts to address these inequalities are (a) etiology/possibilities for prevention and (b) management and quality of care. For prevention, collaborative research efforts are required in developing countries, in line with the WHO approach to implement the recommendations of the 2008 Millennium Development Goals (www.un.org/millenniumgoals). This includes the "common risk factor" approach, which analyzes biological and social determinants of health alongside other chronic health problems such as diabetes and obesity, as outlined in the Marmot Health inequalities review (2008) (www.ucl.ac.uk/gheg/marmotreview). Simultaneously, orofacial cleft research should involve clinical researchers to identify inequalities in access to treatment and identify the best interventions for minimizing mortality and residual deformity. The future research agenda also requires engagement with implementation science to get research findings into practice.
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Affiliation(s)
- P A Mossey
- University of Dundee Dental Hospital & School, Scotland, UK.
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González-Osorio CA, Medina-Solís CE, Pontigo-Loyola AP, Casanova-Rosado JF, Escoffié-Ramírez M, Corona-Tabares MG, Maupomé G. [Ecologic study in Mexico (2003-2009) on cleft lip and/or palate and associated sociodemographic, socioeconomic and pollution factors]. An Pediatr (Barc) 2011; 74:377-87. [PMID: 21382756 DOI: 10.1016/j.anpedi.2011.01.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 09/21/2010] [Accepted: 01/17/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyze the rates of cleft lip and/or cleft palate (CLP) in Mexico between 2003 and 2009 and assess their association with variables at ecological level, sociodemographic, socioeconomic, and pollution. MATERIAL AND METHODS An ecological study was conducted with data from the 32 states of Mexico for incidence of CLP, obtained from the Ministry of Health. We included sociodemographic, socioeconomic, and pollution information, obtained from governmental agencies. CLP incidence rates were used as dependent variable; independent variables were socioeconomic, demographic and pollution indicators. Statistical analysis was performed using Spearman correlation and chi(2) tests. RESULTS During the study period 10573 new cases presented (mean 1510.43 per year). The States with the highest rate (per 1000 births) were: in 2003 the Federal District (Mexico City) (1.76), in 2004 Jalisco (2.62), in 2005 Oaxaca (1.66), in 2006 the State of Mexico (1.29), in 2007, 2008 and 2009 Jalisco (2.17, 2.92, and 1.99). For all the years men were more likely affected than women (P<.05). Variables found positively correlated to LPH rates were total population, solid waste, life expectancy, urban solid waste. The variables negatively correlated were population percentages of high alcohol users, and of alcohol abuse or addiction. CONCLUSIONS The State of Jalisco was one of the most affected locations over the years. Ecologic positive correlations existed between cleft lip and/or palate and sociodemographic, socioeconomic, and pollution factors. Incidence rate was negatively correlated with alcohol use and abuse. More detailed epidemiological studies are needed to fully characterize risk factors in Mexican populations.
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Affiliation(s)
- C A González-Osorio
- Unidad Académica de Odontología, Universidad Autónoma de Nayarit, Tepic, Nayarit, México
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Prevalence at Birth of Cleft Lip with or without Cleft Palate: Data from the International Perinatal Database of Typical Oral Clefts (IPDTOC). Cleft Palate Craniofac J 2011; 48:66-81. [DOI: 10.1597/09-217] [Citation(s) in RCA: 271] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As part of a collaborative project on the epidemiology of craniofacial anomalies, funded by the National Institutes for Dental and Craniofacial Research and channeled through the Human Genetics Programme of the World Health Organization, the International Perinatal Database of Typical Orofacial Clefts (IPDTOC) was established in 2003. IPDTOC is collecting case-by-case information on cleft lip with or without cleft palate and on cleft palate alone from birth defects registries contributing to at least one of three collaborative organizations: European Surveillance Systems of Congenital Anomalies (EUROCAT) in Europe, National Birth Defects Prevention Network (NBDPN) in the United States, and International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) worldwide. Analysis of the collected information is performed centrally at the ICBDSR Centre in Rome, Italy, to maximize the comparability of results. The present paper, the first of a series, reports data on the prevalence of cleft lip with or without cleft palate from 54 registries in 30 countries over at least 1 complete year during the period 2000 to 2005. Thus, the denominator comprises more than 7.5 million births. A total of 7704 cases of cleft lip with or without cleft palate (7141 livebirths, 237 stillbirths, 301 terminations of pregnancy, and 25 with pregnancy outcome unknown) were available. The overall prevalence of cleft lip with or without cleft palate was 9.92 per 10,000. The prevalence of cleft lip was 3.28 per 10,000, and that of cleft lip and palate was 6.64 per 10,000. There were 5918 cases (76.8%) that were isolated, 1224 (15.9%) had malformations in other systems, and 562 (7.3%) occurred as part of recognized syndromes. Cases with greater dysmorphological severity of cleft lip with or without cleft palate were more likely to include malformations of other systems.
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Abstract
Orofacial clefts are common and burdensome birth defects with a complex genetic and environmental etiology. The contribution of nutritional factors and supplements to the etiology of orofacial clefts has long been theorized and studied. Multiple studies have evaluated the role of folic acid in the occurrence and recurrence of orofacial clefts, using observational and non-randomized interventional designs. While preventive effects of folic acid on orofacial clefts are commonly reported, the evidence remains generally inconsistent. This paper reviews the findings of the main studies of the effects of folic acid on orofacial clefts, summarizes study limitations, and discusses research needs with a focus on studying the effects of high dosage folic acid on the recurrence of oral clefts using a randomized clinical trial design. The role of folic acid in the prevention of neural tube defects is also briefly summarized and discussed as a reference model for orofacial clefts.
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Affiliation(s)
- G L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA 52242, USA
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Messer LC, Luben TJ, Mendola P, Carozza SE, Horel SA, Langlois PH. Urban-rural residence and the occurrence of cleft lip and cleft palate in Texas, 1999-2003. Ann Epidemiol 2010; 20:32-9. [PMID: 20006274 DOI: 10.1016/j.annepidem.2009.09.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Revised: 09/12/2009] [Accepted: 09/19/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE The etiology of orofacial clefts is complex and relatively unknown. Variation in cleft lip with or without palate (CLP) and cleft palate alone (CP) was examined in Texas across urban-rural residence (1999 to 2003). METHODS Cases came from the Texas Birth Defects Registry (1,949 CLP and 1,054 CP) and denominator data came from vital records (254 counties; 1,827,317 live births). Variation in maternal residence was measured using four classification schemes: Rural Urban Continuum Codes, Urban Influence Codes, percentage of county in cropland, and Rural Urban Commuting Areas. Poisson regression was used to calculate rate ratios, adjusted for infant sex, plurality, gestational age, maternal parity, age, race/ethnicity, and education. RESULTS Compared to the most urban referent category, living in more rural areas was associated with an increased adjusted risk of CLP. For example, the Rural-Urban Continuum Codes demonstrated elevated risks for CLP in "thinly populated areas" compared to "metropolitan-urban areas" (adjusted prevalence ratio = 1.9; 95% confidence intervals (CI) 1.2-2.8); CP was not similarly associated. Percentage of county cropland was not consistently associated with any outcome. CONCLUSION The association patterns between non-urban residence and risk of CLP, except for percentage of cropland, suggests a constellation of exposures that may differ across urban-rural residence.
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Affiliation(s)
- Lynne C Messer
- Center for Health Policy, Duke Global Health Institute, Durham, NC 27705, USA.
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Abstract
Orofacial clefts are common birth defects that may impose a large burden on the health, quality of life, and socioeconomic well-being of affected individuals and families. They also result in significant healthcare use and costs. Understanding the impact of orofacial clefts on these outcomes is important for identifying unmet needs and developing public policies to reduce the burden of orofacial clefts at the individual, family and societal levels. This paper reviews and summarizes the main findings of recent studies that have evaluated the impact of orofacial clefts on these outcomes, with a focus on quality of life, socioeconomic outcomes, long-term health, and healthcare use and costs. Several studies identify an increased burden of orofacial clefts on these outcomes, but some of the findings are inconsistent. A summary of the primary limitations of the studies in this area is presented, along with recommendations and directions for future research.
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Affiliation(s)
- G L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA.
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da Silva Dalben G. Termination of pregnancy after prenatal diagnosis of cleft lip and palate—possible influence on reports of prevalence. ACTA ACUST UNITED AC 2009; 107:759-62. [DOI: 10.1016/j.tripleo.2009.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2008] [Revised: 12/24/2008] [Accepted: 02/03/2009] [Indexed: 11/17/2022]
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