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Vyas H, Mohi A, Boyce M, Durham EL, Cray JJ. In utero nicotine exposure affects murine palate development. Orthod Craniofac Res 2024. [PMID: 39092604 DOI: 10.1111/ocr.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/29/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES Despite data linking smoking to increased risk of fetal morbidity and mortality, 11% of pregnant women continue to smoke or use alternative nicotine products. Studies confirm that nicotine exposure during pregnancy increases the incidence of birth defects; however, little research has focused on specific anatomic areas based on timing of exposure. We aim to determine critical in utero and postnatal periods of nicotine exposure that affect craniofacial development, specifically palate growth. Malformation of the palatal structures can result in numerous complications including facial growth disturbance, or impeding airway function. We hypothesized that both in utero and postnatal nicotine exposure will alter palate development. MATERIALS AND METHODS We administered pregnant C57BL6 mice water supplemented with 100 μg/mL nicotine during early pregnancy, throughout pregnancy, during pregnancy and lactation, or lactation only. Postnatal day 15 pups underwent micro-computed tomography (μCT) analyses specific to the palate. RESULTS Resultant pups revealed significant differences in body weight from lactation-only nicotine exposure, and μCT investigation revealed several dimensions affected by lactation-only nicotine exposure, including palate width, palate and cranial base lengths, and mid-palatal suture width. CONCLUSIONS These results demonstrate the direct effects of nicotine on the developing palate beyond simple tobacco use. Nicotine exposure through tobacco alternatives, cessation methods, and electronic nicotine delivery systems (ENDS) may disrupt normal growth and development of the palate during development and the postnatal periods of breastfeeding. Due to the recent dramatic increase in the use of ENDS, future research will focus specifically on this nicotine delivery method.
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Affiliation(s)
- Heema Vyas
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Amr Mohi
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Mark Boyce
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio, USA
- The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Emily L Durham
- Division of Human Genetics, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - James J Cray
- Department of Biomedical Education and Anatomy, The Ohio State University College of Medicine, Columbus, Ohio, USA
- The Ohio State University College of Dentistry, Columbus, Ohio, USA
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2
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Alamoudi RA, Sabbagh HJ, Zeinalddin M, Al-Batayneh OB, Al Bulushi T, AboulHassan MA, Koraitim M, Alkharafi L, Almuqbali B, Alghamdi SM, Bahdila D, Refahee SM, Quritum M, Taqi FF, Albassam B, Ayed M, Embaireeg A, Alnahdi R, AlSharif MT, Aljohar AJ, Abdulhameed FD, Alrejaye NS, Viswapurna PS, Al Halasa T, Basri OA, Bataineh MA, Tantawi ME. COVID-19 vaccine and non-syndromic orofacial clefts in five arab countries. A case-control study. Clin Oral Investig 2024; 28:357. [PMID: 38839609 DOI: 10.1007/s00784-024-05744-w] [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: 11/13/2023] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES Risk factors for non-syndromic orofacial cleft (NSOFCs) include genetic profile and environmental exposure to medication and illnesses during pregnancy. We assessed the association between the COVID-19 vaccination and the incidence of NSOFC across five Middle Eastern countries. MATERIALS AND METHODS This multi-country, hospital-based, case-control study included infants with NSOFCs whose first 3 intrauterine months coincided with the time when pregnant women were allowed to receive COVID-19 vaccination in the countries participating in the study. Newborns with NSOFCs were examined for cleft type and their parents were interviewed for maternal exposures and COVID-19 vaccination. Controls were newborns matched to cases in gender and setting. RESULTS The study recruited 977 (348 children with NSOFCs and 629 controls). Maternal use of nicotine (Adjusted Odds Ratio (AOR): 2.437; P = 0.044) and family history of NSOFC (AOR: 11.059; P < 0.001) increased significantly the AOR of having a child with NSOFC. On the other hand, COVID-19 vaccine administration to pregnant mothers have significantly decreased the AOR of having a child with NSOFC (AOR: 0.337; P = 0.006). CONCLUSION This study suggests that COVID-19 vaccination is not related to NSOFC and might protect against having a child affected with such a congenital anomaly. CLINICAL RELEVANCE The finding of this study is important for healthcare providers for considering COVID-19 vaccination for pregnant woman. Clear communication and education about the potential risks and benefits would be crucial for informed decision-making. The study's results would directly impact pregnant individuals, as they would need accurate information to make informed decisions about their health and the health of their infants.
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Affiliation(s)
- Rana A Alamoudi
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, PO Box 80200, Jeddah, 21589, Saudi Arabia
| | - Heba Jafar Sabbagh
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, PO Box 80200, Jeddah, 21589, Saudi Arabia.
| | | | - Ola B Al-Batayneh
- Department of Orthodontics, Pediatric and Community Dentistry, College of Dental Medicine, University of Sharjah, PO Box 27272, Sharjah, United Arab Emirates
- Preventive Dentistry Department, Faculty of Dentistry, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | | | | | - Mohamed Koraitim
- Maxillofacial and Plastic Surgery Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Lateefa Alkharafi
- Cleft and Craniofacial Unit, Ministry of Health, Kuwait City, Kuwait
| | | | - Sultan Musaad Alghamdi
- Ministry of Health, Bisha, 67711, Saudi Arabia
- Pediatric Dentistry Department, Bisha Dental Centre, Ministry of Health, Bisha, Saudi Arabia
| | - Dania Bahdila
- Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, PO Box 80200, Jeddah, 21589, Saudi Arabia
| | | | - Maryam Quritum
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Fatemah Fahad Taqi
- Department of General Dentistry, Ministry of Health, Kuwait City, Kuwait
| | - Bader Albassam
- Department of General Dentistry, Ministry of Health, Kuwait City, Kuwait
| | - Mariam Ayed
- Neonatal Department, Maternity Hospital-Kuwait, Kuwait City, Kuwait
| | - Alia Embaireeg
- Neonatal Department, Maternity Hospital-Kuwait, Kuwait City, Kuwait
| | | | - Mona Talal AlSharif
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Aziza Johar Aljohar
- Department of Dentistry, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fatma Dawood Abdulhameed
- Pediatric Surgery Department, King Salman Medical City, Maternity and Children's Hospital, Madinah, Saudi Arabia
| | - Najla Sulaiman Alrejaye
- Department of Dentistry, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | | | - Tamara Al Halasa
- Preventive Dentistry Department, Faculty of Dentistry, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Osama Adel Basri
- King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed A Bataineh
- Faculty of Medicine, Jordan University of Science & Technology, Irbid, 22110, Jordan
| | - Maha El Tantawi
- Department of Pediatric Dentistry and Dental Public Health, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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Brown MI, McCandless MG, Hopper SJ, Lucas ED, Corder BN, Galarza LI, Hoppe IC, Humphries LS. Epidemiologic Trends of Cleft Lip and Palate in a Southern State: A 30-Year Follow-Up. South Med J 2024; 117:316-322. [PMID: 38830585 DOI: 10.14423/smj.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVES Children's of Mississippi at the University of Mississippi Medical Center serves as the state's only American Cleft Palate-Craniofacial Association-approved cleft team at the only pediatric hospital in the state. The goal of this study is to report geographic and demographic patterns of patients with orofacial cleft (OFC) treated at Children's of Mississippi, which are lacking. METHODS Patients with OFC treated at Children's of Mississippi from 2015 to 2020 were included. Demographic data were collected, including birth county and total live births from state data. Significant differences between incidence of OFC among public health regions of Mississippi were examined using analysis of variance (P < 0.05). Cases were compared with historical data from 1980 to 1989. RESULTS There were 184 patients who presented with OFC, with a statewide incidence of 0.83 per 1000 live births among 222,819 live births in the state across 6 years. The incidence of OFC was 0.83/1000 for Whites and 0.82/1000 for non-Whites versus a historical rate of 1.36 and 0.54, respectively. Significantly fewer children in the northern region (0.25/1000) were born with OFC than in central (1.21; P < 0.001) and southern (0.86; P < 0.001) regions. CONCLUSIONS Results from this study suggest changing regional patterns of OFC in Mississippi. Although rates increased among non-White infants, the overall incidence of OFC has decreased compared with historical data. The findings may reflect actual incidence patterns in the state or the proximity of certain regions to Children's of Mississippi. Further study may reveal regional differences in risk factors underlying OFC incidence, and/or issues with access to cleft care for different regions in the state.
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Affiliation(s)
- Madyson I Brown
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson
| | - Martin G McCandless
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson
| | - Samuel J Hopper
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson
| | - Eric D Lucas
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson
| | - Brittany N Corder
- From the Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Mississippi Medical Center, Jackson
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Wands ZE, Cave DGW, Cromie K, Hough A, Johnson K, Mon-Williams M, Feltbower RG, Glaser AW. Early educational attainment in children with major congenital anomaly in the UK. Arch Dis Child 2024; 109:326-333. [PMID: 38262694 DOI: 10.1136/archdischild-2023-326471] [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: 10/14/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVE To describe early educational attainment and special educational needs (SEN) provision in children with major congenital anomaly (CA) compared with peers. DESIGN Analysis of educational data linked to the ongoing Born in Bradford cohort study. Confounders were identified via causal inference methods and multivariable logistic regression performed. SETTING Children born in Bradford Royal Infirmary (BRI), West Yorkshire. PATIENTS All women planning to give birth at BRI and attending antenatal clinic from March 2007 to December 2010 were eligible. 12 453 women with 13 776 pregnancies (>80% of those attending) were recruited. Records of 555 children with major CA and 11 188 without were linked to primary education records. OUTCOMES Key Stage 1 (KS1) attainment at age 6-7 years in Maths, Reading, Writing and Science. SEN provision from age 4 to 7 years. RESULTS 41% of children with major CA received SEN provision (compared with 14% without), and 48% performed below expected standards in at least one KS1 domain (compared with 29% without). The adjusted odds of children with CA receiving SEN provision and failing to achieve the expected standard at KS1 were, respectively, 4.30 (95% CI 3.49 to 5.31) and 3.06 (95% CI 2.47 to 3.79) times greater than their peers. Those with genetic, heart, neurological, urinary, gastrointestinal and limb anomalies had significantly poorer academic achievement. CONCLUSIONS These novel results demonstrate that poor educational attainment extends to children with urinary, limb and gastrointestinal CAs. We demonstrate the need for collaboration between health and education services to assess and support children with major CA, so every CA survivor can maximise their potential.
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Affiliation(s)
- Zoë E Wands
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Daniel G W Cave
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kirsten Cromie
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
| | - Amy Hough
- Born in Bradford, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | - Kathryn Johnson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
- National Congenital Anomaly and Rare Disease Registration Service, London, UK
| | - Mark Mon-Williams
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Born in Bradford, Wolfson Centre for Applied Health Research, Bradford Royal Infirmary, Bradford, UK
| | | | - Adam W Glaser
- Leeds Institute for Data Analytics (LIDA), University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Davies A, Davies A, Main B, Wren Y, Deacon S, Cobb A, McLean N, David D, Chummun S. Association of Perioperative Antibiotics with the Prevention of Postoperative Fistula after Cleft Palate Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5589. [PMID: 38322814 PMCID: PMC10846777 DOI: 10.1097/gox.0000000000005589] [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: 07/04/2023] [Accepted: 11/27/2023] [Indexed: 02/08/2024]
Abstract
Background There is debate amongst surgeons regarding the use of antibiotics to prevent fistulae after palatoplasty. Prescribing should be evidence based, as antibiotic stewardship is integral to reducing antibiotic resistance. Our aim was to determine whether differing perioperative regimens affect the prevalence of postoperative fistulae. Methods The sample comprised participants from the Cleft Collective who had undergone palatoplasty. Participants were recruited across all 16 UK cleft centers between 2013 and 2021. The exposure was perioperative antibiotic regimen prescribed at the time of palatoplasty. The primary outcome was the presence of palatal fistula. Results Fistula data were available for 167 participants when exploring antibiotic regimen and for 159 when exploring antibiotic agent. There was no evidence to suggest a difference in fistula rate between those receiving antibiotics on induction only versus as an inpatient or up to 7 days postoperatively (χ2 = 4.57; P = 0.10). There was no evidence to suggest a difference in fistula rate between those who received co-amoxiclav and those who had an alternative antibiotic (χ2 = 0.16; P = 0.69). Postoperative fistulae increased with the extent of the cleft (χ2 = 20.39; P < 0.001). When adjusting for cleft type, no evidence of an association between antibiotic regimen and fistulae was found (inpatient antibiotics: OR 1.36; 95% confidence interval, 0.53-3.51; antibiotics up to 7 days postoperatively: OR 0.68; 95% confidence interval, 0.26-1.80). Conclusions The choice of antibiotic and dosing regimen does not influence the formation of postoperative fistulae. These results should be supported by interventional trials.
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Affiliation(s)
- Alex Davies
- From the South West Cleft Service, Bristol Dental Hospital, Bristol, United Kingdom
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Amy Davies
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Barry Main
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
- Oral and Maxillofacial Surgery, Bristol Dental Hospital, Bristol, United Kingdom
| | - Yvonne Wren
- The Cleft Collective, Bristol Dental School, University of Bristol, Bristol, United Kingdom
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Scott Deacon
- From the South West Cleft Service, Bristol Dental Hospital, Bristol, United Kingdom
| | - Alistair Cobb
- From the South West Cleft Service, Bristol Dental Hospital, Bristol, United Kingdom
| | - Neil McLean
- Craniofacial Australia, North Adelaide, Australia
| | - David David
- Craniofacial Australia, North Adelaide, Australia
| | - Shaheel Chummun
- From the South West Cleft Service, Bristol Dental Hospital, Bristol, United Kingdom
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de Oliveira Júnior AG, Montagna E, Zaia V, Barbosa CP, Bianco B. Oral health-related quality of life in patients aged 8 to 19 years with cleft lip and palate: a systematic review and meta-analysis. BMC Oral Health 2023; 23:670. [PMID: 37716942 PMCID: PMC10505326 DOI: 10.1186/s12903-023-03382-4] [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: 02/28/2023] [Accepted: 09/01/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Cleft lip and palate (CLP) is the most common facial birth defect worldwide and causes morphological, aesthetic, and functional problems with psychosocial implications for an individual's life and well-being. The present systematic review and meta-analysis assessed whether the treatment of CLP impacts the oral health-related quality of life (OHRQoL) in children and adolescents in comparison to healthy controls. METHODS We searched MEDLINE/PubMed, EMBASE, and PsycINFO databases using terms related to CLP, and included articles until August 2023. Observational comparison studies that assessed OHRQoL in non-syndromic CLP patients aged 8-19 years with validated scales designed to such aim or scales capable to identify aspects related to oral health compared to healthy controls were included. We used the ROBINS-I tool for risk of bias assessment. A meta-analysis of continuous variables was performed using inverse variance for pooling estimates, Standardized Mean Difference (SMD) as a summary measure, with random effects model. Heterogeneity was estimated by the I2 statistics. Sensitivity analyses included subgrouping based on the scale, risk of bias and scale domains. Meta-regression was performed under a mixed-effects model considering the variables type of scale, scale domains and risk of bias. RESULTS Fourteen studies were included comprising 1,185 patients with CLP and 1,558 healthy controls. The direction of the effect of OHRQoL favoured the healthy group (-0.92; 95% CI:-1,55;-0,10) and I2 = 95%. After removing three studies, I2 dropped to 80%. Meta-regression showed no influence on risk of bias (p = 0.2240) but influence of scale type (p = 0.0375) and scale domains (p < 0.001). The subgroup analysis indicated that the CPQ and COHIP scales presented very discrepant SMD values, despite pointing to the same effect direction. In contrast, the OHIP scale showed a non-significant difference between cases and controls, with estimates much lower than the other two scales. Results also suggest that OHRQoL associated with oral functionality and social well-being is more influential on outcomes than emotional well-being. CONCLUSION The global OHRQoL is slightly worst in the CLP patients than control group. The difference between OHRQoL was mainly detected through OHIP. The most affected domains are functional, emotional and social. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022336956.
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Affiliation(s)
| | - Erik Montagna
- Postgraduation Program in Health Sciences, Faculdade de Medicina do ABC/Centro Universitário FMABC, Santo André, Brazil
| | - Victor Zaia
- Postgraduation Program in Health Sciences, Faculdade de Medicina do ABC/Centro Universitário FMABC, Santo André, Brazil
| | - Caio Parente Barbosa
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário FMABC, Av. Lauro Gomes, 2000, Santo André, CEP 09060-870, SP, Brazil
| | - Bianca Bianco
- Discipline of Sexual and Reproductive Health, and Populational Genetics, Department of Collective Health, Faculdade de Medicina do ABC/Centro Universitário FMABC, Av. Lauro Gomes, 2000, Santo André, CEP 09060-870, SP, Brazil.
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Park MH, Fitzsimons KJ, Deacon S, Medina J, Wahedally MAH, Butterworth S, Russell C, van der Meulen JH. Longitudinal educational attainment among children with isolated oral cleft: a cohort study. Arch Dis Child 2023:archdischild-2023-325310. [PMID: 37068923 DOI: 10.1136/archdischild-2023-325310] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 03/27/2023] [Indexed: 04/19/2023]
Abstract
OBJECTIVES (1) To explore differences in educational attainment between children born with isolated clefts and the general population at ages 5, 7 and 11 years; (2) to describe longitudinal changes in attainment among children with cleft through primary education. DESIGN Analysis of Cleft Registry and Audit Network data linked to national educational outcomes. SETTING English state schools. PATIENTS 832 children born with isolated cleft, aged 5 years in 2006-2008. MAIN OUTCOME MEASURES Difference in teacher-assessed attainment between children with a cleft and general population at each age, for all children and by cleft type. Percentage of children with low attainment at age 5 years who had low attainment at age 11 years, for all children and by cleft type. RESULTS Children with a cleft had lower attainment than the general population in all subject areas (Z-score range: -0.29 (95% CI -0.36 to -0.22) to -0.22 (95% CI -0.29 to -0.14)). This difference remained consistent in size at all ages, and was larger among children with a cleft affecting the palate (cleft palate/cleft lip and palate (CP/CLP)) than those with a cleft lip (CL). Of 216 children with low attainment in any subject at age 5 years, 54.2% had low attainment in at least one subject at age 11 years. Compared with children with CL, those with CP/CLP were more likely to have persistent low attainment. CONCLUSIONS An educational attainment gap for children born with isolated clefts is evident throughout primary education. Almost half of children with low attainment at age 5 years achieve normal attainment at age 11 years.
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Affiliation(s)
- Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Kate J Fitzsimons
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Scott Deacon
- South West Cleft Service, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | | | - Sophie Butterworth
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Craig Russell
- Royal Hospital for Children, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - Jan H van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
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Walker VM, Zheng J, Gaunt TR, Smith GD. Phenotypic Causal Inference Using Genome-Wide Association Study Data: Mendelian Randomization and Beyond. Annu Rev Biomed Data Sci 2022; 5:1-17. [PMID: 35363507 PMCID: PMC7614231 DOI: 10.1146/annurev-biodatasci-122120-024910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
statistics for genome-wide association studies (GWAS) are increasingly available for downstream analyses. Meanwhile, the popularity of causal inference methods has grown as we look to gather robust evidence for novel medical and public health interventions. This has led to the development of methods that use GWAS summary statistics for causal inference. Here, we describe these methods in order of their escalating complexity, from genetic associations to extensions of Mendelian randomization that consider thousands of phenotypes simultaneously. We also cover the assumptions and limitations of these approaches before considering the challenges faced by researchers performing causal inference using GWAS data. GWAS summary statistics constitute an important data source for causal inference research that offers a counterpoint to nongenetic methods when triangulating evidence. Continued efforts to address the challenges in using GWAS data for causal inference will allow the full impact of these approaches to be realized.
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Affiliation(s)
- Venexia M. Walker
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Jie Zheng
- MRC (Medical Research Council) Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom;
| | - Tom R. Gaunt
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC (Medical Research Council) Integrative Epidemiology Unit, University of Bristol, Bristol, United Kingdom;
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Naqvi S, Hoskens H, Wilke F, Weinberg SM, Shaffer JR, Walsh S, Shriver MD, Wysocka J, Claes P. Decoding the Human Face: Challenges and Progress in Understanding the Genetics of Craniofacial Morphology. Annu Rev Genomics Hum Genet 2022; 23:383-412. [PMID: 35483406 PMCID: PMC9482780 DOI: 10.1146/annurev-genom-120121-102607] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Variations in the form of the human face, which plays a role in our individual identities and societal interactions, have fascinated scientists and artists alike. Here, we review our current understanding of the genetics underlying variation in craniofacial morphology and disease-associated dysmorphology, synthesizing decades of progress on Mendelian syndromes in addition to more recent results from genome-wide association studies of human facial shape and disease risk. We also discuss the various approaches used to phenotype and quantify facial shape, which are of particular importance due to the complex, multipartite nature of the craniofacial form. We close by discussing how experimental studies have contributed and will further contribute to our understanding of human genetic variation and then proposing future directions and applications for the field.
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Affiliation(s)
- Sahin Naqvi
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, California, USA; , .,Department of Genetics, Stanford University School of Medicine, Stanford, California, USA
| | - Hanne Hoskens
- Center for Processing Speech and Images, Department of Electrical Engineering, KU Leuven, Leuven, Belgium; , .,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium
| | - Franziska Wilke
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA; ,
| | - Seth M Weinberg
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; , .,Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Anthropology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - John R Shaffer
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; , .,Center for Craniofacial and Dental Genetics, Department of Oral and Craniofacial Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Susan Walsh
- Department of Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA; ,
| | - Mark D Shriver
- Department of Anthropology, The Pennsylvania State University, University Park, Pennsylvania, USA;
| | - Joanna Wysocka
- Department of Chemical and Systems Biology, Stanford University School of Medicine, Stanford, California, USA; , .,Department of Developmental Biology, Stanford University School of Medicine, Stanford, California, USA.,Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, California, USA
| | - Peter Claes
- Center for Processing Speech and Images, Department of Electrical Engineering, KU Leuven, Leuven, Belgium; , .,Medical Imaging Research Center, University Hospitals Leuven, Leuven, Belgium.,Department of Human Genetics, KU Leuven, Leuven, Belgium.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
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Leslie EJ. Genetic models and approaches to study orofacial clefts. Oral Dis 2021; 28:1327-1338. [PMID: 34923716 DOI: 10.1111/odi.14109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/08/2021] [Accepted: 12/16/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Orofacial clefts (OFCs) are common craniofacial birth defects with heterogeneous phenotype and etiology. Geneticists have applied nearly every available method and technology to further our understanding of the genetic architectures of OFCs. OBJECTIVE This review describes the evidence for a genetic etiology in OFCs, statistical genetic approaches employed to identify genetic causes, and how the results have shaped our current understanding of the genetic architectures of syndromic and nonsyndromic OFCs. CONCLUSION There has been rapid progress towards elucidating the genetic architectures of OFCs due to the availability of large collections of DNA samples from cases, controls, and families with OFCs and the consistent adoption of new methodologies and novel statistical approaches as they are developed. Genetic studies have identified rare and common variants influencing risk of OFCs in both Mendelian and complex forms of OFCs, blurring the distinctions traditional categories used in genetic studies and clinical medicine.
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Glinianaia SV, McLean A, Moffat M, Shenfine R, Armaroli A, Rankin J. Academic achievement and needs of school-aged children born with selected congenital anomalies: A systematic review and meta-analysis. Birth Defects Res 2021; 113:1431-1462. [PMID: 34672115 PMCID: PMC9298217 DOI: 10.1002/bdr2.1961] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/21/2021] [Indexed: 11/09/2022]
Abstract
Children with congenital anomalies have poorer intellectual and cognitive development compared to their peers, but evidence for academic achievement using objective measures is lacking. We aimed to summarize and synthesize evidence on academic outcomes and special education needs (SEN) of school‐aged children born with selected major structural congenital anomalies. Electronic databases (MEDLINE, EMBASE, Scopus, PsycINFO, CINAHL, ProQuest Natural Science and Education Collections), reference lists and citations for 1990–2020 were systematically searched. We included original‐research articles on academic achievement in children with non‐syndromic congenital anomalies that involved school test results, standardized tests and/or SEN data. Random‐effects meta‐analyses were performed to estimate pooled mean test scores in mathematics and/or reading where possible and pooled odds ratios (ORs) for SEN in children with severe congenital heart defects (CHDs) and children with orofacial clefts (OFCs). Thirty‐nine eligible studies (n = 21,066 children) were synthesized narratively. Sixteen studies were included in meta‐analyses. Children with non‐syndromic congenital anomalies were at a higher risk of academic underachievement than controls across school levels. Children with severe CHD (pooled OR = 2.32, 95% CI: 1.90, 2.82), and children with OFC (OR = 1.38 (95% CI: 1.20, 1.57), OR = 3.07 (95% CI: 2.65, 3.56), and OR = 3.96 (95% CI: 3.31, 4.72) for children with cleft lip, cleft palate and cleft lip/palate, respectively) had significantly higher ORs for SEN than controls. Children with non‐syndromic congenital anomalies underperform academically and have higher SEN rates compared to their peers. Early monitoring and development of differential SEN are important to promote academic progress in these children.
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Affiliation(s)
- Svetlana V Glinianaia
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ashleigh McLean
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Rebekka Shenfine
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Annarita Armaroli
- Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
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12
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Gjerdevik M, Lie RT, Haaland ØA, Berg E, Feragen KB, Sivertsen Å. Isolated oral clefts and school grades: population-based cohort study from Norway. BMJ Open 2021; 11:e046944. [PMID: 34610928 PMCID: PMC8493916 DOI: 10.1136/bmjopen-2020-046944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To compare school grades of adolescents in Norway born with isolated cleft with those of their unaffected peers. DESIGN Population-based cohort study. SETTING Norway. PATIENTS A total of 347 419 individuals born in Norway between 1986 and 1992, including 523 isolated cleft cases which were identified using data from Norway's two treatment centres. Individuals were followed from birth through compulsory school. MAIN OUTCOME MEASURES Grade point average (GPA) from middle school graduation (around the age of 16). Specific subject grades were also investigated. RESULTS Using a grade scale from 1-6, the observed mean GPA for the reference group was 3.99. Both cleft lip only (CLO) and cleft lip with cleft palate (CLP) had a mean GPA similar to the reference group (adjusted GPA differences from the reference with 95% CIs of 0.06 (-0.04 to 0.16) and -0.08 (-0.19 to 0.03), respectively). Cleft palate only (CPO) had a marginally lower GPA (adjusted GPA difference: -0.18 (-0.28 to -0.08)). These comparisons were consistent across specific subjects. Overall, the evidence suggests a larger difference in GPA between cases and controls in males compared with females. Females with CLO even had a higher estimated GPA than females in the reference group (adjusted GPA difference: 0.19 (0.013 to 0.36)). Grades were similar regardless of laterality of cleft lip (CLO or CLP). CONCLUSION In Norway, individuals born with isolated CLO or CLP did not have lower average school grades when graduating from middle school. Individuals born with isolated CPO had marginally lower grades.
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Affiliation(s)
- Miriam Gjerdevik
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Rolv Terje Lie
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Øystein Ariansen Haaland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Erik Berg
- Department of Plastic and Reconstructive Surgery, Southern Norway Hospital, Arendal, Norway
| | | | - Åse Sivertsen
- Department of Plastic Surgery and Norwegian Quality Registry of Cleft Lip and Palate, Haukeland University Hospital, Bergen, Norway
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13
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Howe LJ, Tudball M, Davey Smith G, Davies NM. Interpreting Mendelian-randomization estimates of the effects of categorical exposures such as disease status and educational attainment. Int J Epidemiol 2021; 51:948-957. [PMID: 34570226 PMCID: PMC9189950 DOI: 10.1093/ije/dyab208] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background Mendelian randomization has been previously used to estimate the effects of binary and ordinal categorical exposures—e.g. Type 2 diabetes or educational attainment defined by qualification—on outcomes. Binary and categorical phenotypes can be modelled in terms of liability—an underlying latent continuous variable with liability thresholds separating individuals into categories. Genetic variants influence an individual’s categorical exposure via their effects on liability, thus Mendelian-randomization analyses with categorical exposures will capture effects of liability that act independently of exposure category. Methods and results We discuss how groups in which the categorical exposure is invariant can be used to detect liability effects acting independently of exposure category. For example, associations between an adult educational-attainment polygenic score (PGS) and body mass index measured before the minimum school leaving age (e.g. age 10 years), cannot indicate the effects of years in full-time education on this outcome. Using UK Biobank data, we show that a higher educational-attainment PGS is strongly associated with lower smoking initiation and higher odds of glasses use at age 15 years. These associations were replicated in sibling models. An orthogonal approach using the raising of the school leaving age (ROSLA) policy change found that individuals who chose to remain in education to age 16 years before the reform likely had higher liability to educational attainment than those who were compelled to remain in education to age 16 years after the reform, and had higher income, lower pack-years of smoking, higher odds of glasses use and lower deprivation in adulthood. These results suggest that liability to educational attainment is associated with health and social outcomes independently of years in full-time education. Conclusions Mendelian-randomization studies with non-continuous exposures should be interpreted in terms of liability, which may affect the outcome via changes in exposure category and/or independently.
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Affiliation(s)
- Laurence J Howe
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Matthew Tudball
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK
| | - Neil M Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, University of Bristol, Bristol, UK.,K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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14
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Yoshikawa M, Asaba K. Educational Attainment Decreases the Risk of COVID-19 Severity in the European Population: A Two-Sample Mendelian Randomization Study. Front Public Health 2021; 9:673451. [PMID: 34150709 PMCID: PMC8212884 DOI: 10.3389/fpubh.2021.673451] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/12/2021] [Indexed: 01/19/2023] Open
Abstract
Observational studies have reported that the severity of COVID-19 depends not only on physical conditions but also on socioeconomic status, including educational level. Because educational attainment (EA), which measures the number of years of schooling, is moderately heritable, we investigated the causal association of EA on the risk of COVID-19 severity using the Mendelian randomization (MR) approach. A two-sample MR analysis was performed using publicly available summary-level data sets of genome-wide association studies (GWASs). A total of 235 single-nucleotide polymorphisms (SNPs) were extracted as instrumental variables for the exposure of EA from the Social Science Genetic Association Consortium GWAS summary data of 766,345 participants of European ancestry. The effect of each SNP on the outcome of COVID-19 severity risk was obtained from the GWAS summary data of 1,059,456 participants of European ancestry gathered from the COVID-19 Host Genetics Initiative. Using inverse variance weighted method, our MR study shows that EA was significantly associated with a lower risk of COVID-19 severity (odds ratio per one standard deviation increase in years of schooling, 0.540; 95% confidence interval, 0.376–0.777, P = 0.0009). A series of sensitivity analyses showed little evidence of bias. In conclusion, we show for the first time using a two-sample MR approach the associations between higher EA and the lower risk of COVID-19 severity in the European population. However, the genetic or epidemiological mechanisms underlying the association between EA and the risk of COVID-19 severity remain unknown, and further studies are warranted to validate the MR findings and investigate underlying mechanisms.
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Affiliation(s)
- Masahiro Yoshikawa
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Kensuke Asaba
- Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
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15
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Fitzsimons KJ, Deacon SA, Copley LP, Park MH, Medina J, van der Meulen JH. School absence and achievement in children with isolated orofacial clefts. Arch Dis Child 2021; 106:154-159. [PMID: 32816695 DOI: 10.1136/archdischild-2020-319123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To examine school absence and academic achievement among 7-year-old children with isolated orofacial clefts in England. DESIGN Analysis of educational data linked to national cleft registry and administrative hospital data. SETTING English state schools. PATIENTS 3523 children with isolated clefts aged 7 years between 2006 and 2014. MAIN OUTCOME MEASURES Annual school absence and reaching the national 'expected level' according to teacher-assessed academic achievement. RESULTS Children with isolated clefts had higher mean annual school absence (10.5 days) than their peers in the national population (8.9 days). Total absence was higher in children with a cleft lip and palate (CLP; 11.3 days) or with a cleft palate only (CPO; 10.5 days) than in children with a cleft lip only (CLO; 9.5 days). The percentage reaching the expected academic level decreased with increasing school absence (from 77.4% (923/1192) with annual school absence ≤5 days to 43.4% (193/445) with annual school absence >20 days). However, differences in school absence did not explain that children with CPO (65.9% reaching expected level) or CLP (66.1% reaching expected level) had poorer levels of academic achievement than children with CLO (73.5% reaching expected level). Children with a cleft were twice as often recognised as having special education needs (40.5%) than their peers (21.6%). CONCLUSIONS School absence and cleft type are both independently associated with school attainment at 7 years. Children with an isolated cleft, especially when the palate is involved, and those with high levels of school absence may benefit from increased support addressing their educational needs.
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Affiliation(s)
- Kate J Fitzsimons
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Scott A Deacon
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Bristol Dental Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Lynn P Copley
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Min Hae Park
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Jibby Medina
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - Jan H van der Meulen
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.,Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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16
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Howe LJ, Hemani G, Lesseur C, Gaborieau V, Ludwig KU, Mangold E, Brennan P, Ness AR, St Pourcain B, Davey Smith G, Lewis SJ. Evaluating shared genetic influences on nonsyndromic cleft lip/palate and oropharyngeal neoplasms. Genet Epidemiol 2020; 44:924-933. [PMID: 32710482 PMCID: PMC8240308 DOI: 10.1002/gepi.22343] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/12/2020] [Accepted: 07/15/2020] [Indexed: 12/23/2022]
Abstract
It has been hypothesised that nonsyndromic cleft lip/palate (nsCL/P) and cancer may share aetiological risk factors. Population studies have found inconsistent evidence for increased incidence of cancer in nsCL/P cases, but several genes (e.g., CDH1, AXIN2) have been implicated in the aetiologies of both phenotypes. We aimed to evaluate shared genetic aetiology between nsCL/P and oral cavity/oropharyngeal cancers (OC/OPC), which affect similar anatomical regions. Using a primary sample of 5,048 OC/OPC cases and 5,450 controls of European ancestry and a replication sample of 750 cases and 336,319 controls from UK Biobank, we estimate genetic overlap using nsCL/P polygenic risk scores (PRS) with Mendelian randomization analyses performed to evaluate potential causal mechanisms. In the primary sample, we found strong evidence for an association between a nsCL/P PRS and increased odds of OC/OPC (per standard deviation increase in score, odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.04, 1.13; p = .000053). Although confidence intervals overlapped with the primary estimate, we did not find confirmatory evidence of an association between the PRS and OC/OPC in UK Biobank (OR 1.02; 95% CI: 0.95, 1.10; p = .55). Mendelian randomization analyses provided evidence that major nsCL/P risk variants are unlikely to influence OC/OPC. Our findings suggest possible shared genetic influences on nsCL/P and OC/OPC.
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Affiliation(s)
- Laurence J. Howe
- Medical Research Council Integrative Epidemiology Unit, Population Health SciencesUniversity of BristolBristolUK
- Institute of Cardiovascular ScienceUniversity College LondonLondonUK
- Max Planck Institute for PsycholinguisticsNijmegenThe Netherlands
| | - Gibran Hemani
- Medical Research Council Integrative Epidemiology Unit, Population Health SciencesUniversity of BristolBristolUK
| | - Corina Lesseur
- Section of GeneticsInternational Agency for Research on CancerLyonFrance
| | - Valérie Gaborieau
- Section of GeneticsInternational Agency for Research on CancerLyonFrance
| | | | | | - Paul Brennan
- Section of GeneticsInternational Agency for Research on CancerLyonFrance
| | - Andy R. Ness
- NIHR Bristol Biomedical Research CentreUniversity Hospitals BristolBristolUK
- Weston NHS Foundation TrustUniversity of BristolBristolUK
| | - Beate St Pourcain
- Medical Research Council Integrative Epidemiology Unit, Population Health SciencesUniversity of BristolBristolUK
- Max Planck Institute for PsycholinguisticsNijmegenThe Netherlands
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, Population Health SciencesUniversity of BristolBristolUK
| | - Sarah J. Lewis
- Medical Research Council Integrative Epidemiology Unit, Population Health SciencesUniversity of BristolBristolUK
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17
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Sandy J, Davies A, Humphries K, Ireland T, Wren Y. Cleft lip and palate: Care configuration, national registration, and research strategies. J World Fed Orthod 2020; 9:S40-S44. [PMID: 33023731 PMCID: PMC7532935 DOI: 10.1016/j.ejwf.2020.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/24/2022]
Abstract
A child born with a cleft lip and palate will face 20 years or more of hospital care and surgery. This is a global problem with approximately 10 million people affected worldwide. Various models of care exist around the condition, and the best configurations of services within an economy need to be optimized. We provide examples of how centralized care can improve outcomes and provide an opportunity to establish national registries, and then emphasize the opportunities for building research platforms of relevance. The default of any cleft service should be to centralize care and enable cleft teams with a sufficient volume of patients to develop proficiency and measure the quality of outcomes. The latter needs to be benchmarked against the better centers in Europe. Two areas of concern for those with cleft are morbidity/mortality and educational attainment. These two issues are placed in context within the literature and wider approaches using population genetics. Orthodontists have always played a key role in developing these initiatives and are core members of cleft teams with major responsibilities for these children and their families. Cleft lip and palate affects about 10 million people worldwide. Centralised care can improve outcome and establish national registries. Orthodontists have played a key role in developing these initiatives. No strong evidence of an association between clefting and cancer. Proper care can positively influence lives of children born with a cleft.
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Affiliation(s)
- Jonathan Sandy
- The Cleft Collective, University of Bristol, Bristol, United Kingdom.
| | - Amy Davies
- The Cleft Collective, University of Bristol, Bristol, United Kingdom
| | - Kerry Humphries
- The Cleft Collective, University of Bristol, Bristol, United Kingdom
| | - Tony Ireland
- The Cleft Collective, University of Bristol, Bristol, United Kingdom
| | - Yvonne Wren
- The Cleft Collective, University of Bristol, Bristol, United Kingdom
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18
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Grewal SS, Ponduri S, Leary SD, Wren Y, Thompson JMD, Ireland AJ, Ness AR, Sandy JR. Educational Attainment of Children Born with Unilateral Cleft Lip and Palate in the United Kingdom. Cleft Palate Craniofac J 2020; 58:587-596. [PMID: 32990032 PMCID: PMC8044616 DOI: 10.1177/1055665620959989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: This study evaluated association between functional outcomes in children born with unilateral cleft lip and palate (UCLP) and educational attainment. Design: Cleft Care UK (CCUK) was a United Kingdom (UK) wide cross-sectional study. Setting: UK Cleft Teams (data collected from all UK sites providing centralized cleft services). Patients, Participants: Five-year olds born with nonsyndromic UCLP (n = 268). Main Outcome Measure(s): National tests for educational attainment Key Stage 1 (KS1) undertaken by children at age 7 were linked to CCUK data to describe differences in educational attainment. Associations between functional outcomes and KS1 results were evaluated using regression analysis. We adjusted for birth month, gender, and an area-based measure of socioeconomic status. Results: Data were available for 205 children with UCLP. These children scored lower than national average (NA) scores across all subject areas, with a 0.62 lower score observed in the Average Point Score (APS; P = .01). There was association between being in a lower category for a cleft related outcomes and poorer KS1 results, with a trend for poorer attainment with higher numbers of poor functional outcomes. Those with 3 or more poor outcomes had a −2.26 (−3.55 to −0.97) lower APS compared to those with 0 to 1 poor outcomes. Conclusions: Children born with UCLP have poorer educational attainment at age 7 across all subject areas though differences were modest. Children with poor functional outcomes at age 5 had worse educational outcomes age 7. Improvements in functional outcomes could enhance educational outcomes.
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Affiliation(s)
- Sukhraj S Grewal
- 61139King's College London Dental Institute, London, United Kingdom
| | - Sirisha Ponduri
- Queen Alexandra Hospital, Cosham, Portsmouth, Hampshire, United Kingdom
| | - Sam D Leary
- NIHR Bristol Biomedical Research Centre Nutrition Theme, Level 3, 1980University Hospitals Bristol Education Centre, Bristol, United Kingdom
| | - Yvonne Wren
- Speech and Language, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
| | - John M D Thompson
- Department of Obstetrics & Gynaecology, Faculty of Health Science and Medicine, 1415University of Auckland, Auckland, New Zealand
| | - Anthony J Ireland
- Orthodontics, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
| | - Andy R Ness
- Epidemiology, NIHR Bristol Biomedical Research Centre Nutrition Theme, Level 3, 1980University Hospitals Bristol Education Centre, Bristol, United Kingdom
| | - Jonathan R Sandy
- Orthodontics, Bristol Dental School, 1980University of Bristol, Bristol, United Kingdom
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19
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van Eeden S, Stringer H. Linguistic and auditory processing skills in non-syndromic children with cleft palate: A scoping review. JOURNAL OF COMMUNICATION DISORDERS 2020; 87:106029. [PMID: 32712335 DOI: 10.1016/j.jcomdis.2020.106029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Cleft lip and/or palate (CL/P) is the most common congenital craniofacial condition. Children born with CL/P are at increased risk of persistent speech difficulties related to velopharyngeal incompetence (VPI) and compensatory articulation problems. It has also been reported that they achieve poorer results academically than their peers. There is a further body of evidence to suggest delayed language skills. These potentially related outcomes are often reported separately. AIM To review published and unpublished research into the nature of difficulties related to spoken and written language across all non-syndromic cleft diagnoses. To review any evidence of associations between comorbidities. METHOD A scoping review was carried out in October 2016 and updated in June 2019 following published methodology (Arksey & O'Malley, 2005; Levac et al. 2010). RESULTS A search of the literature over the two time points found 38 papers in total. Three main themes were found: oral language skills, reading and auditory processing difficulties. CONCLUSIONS There is evidence of early language delay in children born with CL/P. Evidence of persistent oral language problems is less conclusive. Many studies have reported scores within the average range for language, auditory processing and reading but poorer outcomes when compared to non-cleft control groups. However, studies have used a range of outcome measures, making comparisons difficult. Moreover there is no clear evidence how these difficulties might relate to speech outcomes or educational achievement and no comparison to other populations with speech, language and communication needs (SLCN).
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Affiliation(s)
- Stephanie van Eeden
- School of Education, Communication and Language Sciences, Newcastle University, King George VIth Building, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU, United Kingdom; Regional Cleft Lip and Palate Service, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP, United Kingdom.
| | - Helen Stringer
- School of Education, Communication and Language Sciences, Newcastle University, King George VIth Building, Queen Victoria Road, Newcastle upon Tyne, NE1 7RU, United Kingdom.
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