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Collett BR, Gallagher ER, Johns AL, Trevino CO, Leroux BG, Shic F, Crerand CE, Baylis AL, Cummings CA, Santillan L. Book-Sharing for Toddlers with Clefts (BOOST): Protocol for a randomized controlled trial of a remote intervention to promote language development in children with cleft palate. PLoS One 2024; 19:e0304630. [PMID: 38870107 PMCID: PMC11175488 DOI: 10.1371/journal.pone.0304630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Children with cleft palate, with or without cleft lip (CP±L), exhibit language delays on average compared to children without clefts. Interventions to address these disparities are scarce. In this multi-center study, Book Sharing for Toddlers with Clefts (BOOST), we will test a remote, parent-focused intervention to promote language development in children with CP±L. OBJECTIVES The study will test two primary hypotheses. First, toddlers randomized to BOOST will exhibit better language outcomes than children receiving standard-of-care (SOC). Second, we hypothesize that the BOOST program's effect on language outcomes is mediated by the frequency and quality of parent-child reading interactions. METHODS The study is a randomized-controlled trial comparing the BOOST group to a SOC comparison group. We will enroll N = 320 English and/or Spanish-speaking children ages 24-32 months with isolated CP±L (n = 160 per group). Both groups will receive children's books, and parents will record and upload videos of themselves reading the books with their children using a smartphone app developed for the study. Parents will also complete surveys asking whether they read to their children on five randomly selected days each week. In addition, the BOOST group will participate in 3 remote dialogic book-sharing intervention sessions via Zoom. We will code book-sharing videos to assess parents' target skill usage and children's expressive language. End-of-study assessments will include measures of child language outcomes (e.g., clinician-administered measures, parent reports, and naturalistic child language samples). RESULTS Enrollment began in April 2024 and will continue through approximately April 2028. CONCLUSION The BOOST study will address a critical gap in the literature on interventions to improve language in children with CP±L. The results will inform the care for toddlers with oral clefts and have potential applications for other populations.
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Affiliation(s)
- Brent R Collett
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Emily R Gallagher
- Seattle Children's Craniofacial Center, Seattle Children's Hospital, Seattle, Washington, United States of America
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Alexis L Johns
- Keck School of Medicine, University of Southern California, Los Angeles, California, United States of America
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California, United States of America
| | - Cindy O Trevino
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Brian G Leroux
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
- Department of Oral Health Sciences, University of Washington, Seattle, Washington, United States of America
| | - Frederick Shic
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, United States of America
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Canice E Crerand
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
- Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
- Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Adriane L Baylis
- Department of Plastic and Reconstructive Surgery, The Ohio State University College of Medicine, Columbus, Ohio, United States of America
- Department of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Caitlin A Cummings
- Department of Speech Pathology, Nationwide Children's Hospital, Columbus, Ohio, United States of America
| | - Lupita Santillan
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington, United States of America
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, United States of America
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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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Glinianaia SV, Tan J, Morris JK, Brigden J, Evans HER, Loane M, Neville AJ, Rankin J. Academic achievement at ages 11 and 16 in children born with congenital anomalies in England: A multi-registry linked cohort study. Paediatr Perinat Epidemiol 2024. [PMID: 38318667 DOI: 10.1111/ppe.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Children born with major congenital anomalies (CAs) have lower academic achievement compared with their peers, but the existing evidence is restricted to a number of specific CAs. OBJECTIVES To investigate academic outcomes at ages 11 and 16 in children with major isolated structural CAs and children with Down or Turner syndromes. METHODS This population-based cohort study linked data on approximately 11,000 school-aged children born with major CAs in 1994-2004 registered by four regional CA registries in England with education data from the National Pupil Database (NPD). The comparison group was a random sample of children without major CAs from the background population recorded in the NPD that were frequency matched (5:1) to children with CAs by birth year, sex and geographical area. RESULTS Overall, 71.9%, 73.0% and 80.9% of children with isolated structural CAs achieved the expected attainment level at age 11 compared to 78.3%, 80.6% and 86.7% of the comparison group in English language, Mathematics and Science, respectively. Children with nervous system CAs as a whole had the lowest proportion who achieved the expected attainment at age 11. At age 16, 46.9% of children with CAs achieved the expected level compared to 52.5% of their peers. Major CAs were associated with being up to 9% (95% confidence interval [CI] 8%, 11%) and 12% (95% CI 9%, 14%) less likely to achieve expected levels at ages 11 and 16, respectively, after adjustment for socioeconomic deprivation. CONCLUSIONS Although many children with isolated CAs achieved the expected academic level at ages 11 and 16, they were at higher risk of underachievement compared to their peers. These stark yet cautiously encouraging results are important for counselling parents of children with specific CAs and also highlight the possible need for special education support to reduce potential academic difficulties.
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Affiliation(s)
- Svetlana V Glinianaia
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Joachim Tan
- Population Health Research Institute, St George's, University of London, London, UK
- NIHR GOSH Biomedical Research Centre, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London, London, UK
| | - Jo Brigden
- Population Health Research Institute, St George's, University of London, London, UK
| | - Hannah E R Evans
- Population Health Research Institute, St George's, University of London, London, UK
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Belfast, UK
| | - Amanda J Neville
- 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, UK
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Conrad AL, Bellucci CC, Heppner CE, Albert M, Crerand CE, Woodard S, Sheikh F, Kapp-Simon KA. Screening for Academic Risk Among Students With Cleft Lip and/or Palate: Patterns of Risk and Qualities of Effective Tools. Cleft Palate Craniofac J 2024; 61:68-78. [PMID: 35892129 PMCID: PMC10176211 DOI: 10.1177/10556656221116008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study evaluated the effectiveness of academic screening measures in relation to parent-reported diagnoses. Multicenter, retrospective cohort study including structured interviews, questionnaires, and chart reviews. Six North American cleft centers. Children (n = 391) with cleft lip and/or palate, ages 8 to 10 years of age (192 male) and their guardians were recruited during regular clinic visits. Parent and child ratings on the Pediatric Quality of Life Inventory (PedsQL) School Scale, child report on CleftQ School Scale, parent report on the Adaptive Behavior Assessment System-Third Edition Functional Academics (ABAS-FA) Scale and Child Behavior Checklist (CBCL) School Competency Scale, parent interview, and medical chart review. Risk for concerns ranged from 12% to 41%, with higher risk reflected on the CBCL-SC compared to other measures. Males with cleft palate were consistently at the highest risk. Only 9% of the sample had a parent-reported diagnosis of a learning or language disability. Ratings from the ABAS-FA and CBCL-SC had the highest utility in identifying those with language and/or learning concerns. As cleft teams work to develop standardized batteries for screening and monitoring of patients, it is important to evaluate the effectiveness of measures in identifying those at highest risk. When screening for language and learning disorders, questions related to potential academic struggles, such as increased school effort or increased school distress, are most useful. Referrals for follow-up evaluation are recommended for those identified at high risk.
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Affiliation(s)
- Amy L Conrad
- The Stead Family Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Claudia Crilly Bellucci
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago
| | - Celia E Heppner
- Department of Psychiatry at the University of Texas Southwestern Medical Center and Psychologist, Fogelson Plastic and Craniofacial Surgery Center, Children’s Health/Children’s Medical Center, Dallas, Texas
| | - Meredith Albert
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Illinois, and Clinical Assistant Professor Craniofacial Center, Department of Surgery, University of Illinois at Chicago
| | - Canice E Crerand
- Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine and Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Farah Sheikh
- Division of Plastic and Reconstructive Surgery, the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kathleen A Kapp-Simon
- Craniofacial Center, Department of Surgery, University of Illinois at Chicago and Psychologist & Research Scientist, Cleft-Craniofacial Clinic, Departments of Research, Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, Illinois
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Wehby GL. Association Between Gestational Age and Academic Achievement of Children Born at Term. JAMA Netw Open 2023; 6:e2326451. [PMID: 37523180 PMCID: PMC10391305 DOI: 10.1001/jamanetworkopen.2023.26451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Importance Differences in academic achievement by gestational age of children born at term, especially at 39 to 41 weeks, are not well understood. Objective To examine differences in academic achievement among children born between 37 and 41 weeks' gestational age. Design, Setting, and Participants This retrospective cohort study linked birth certificates of children born in Iowa from 1989 to 2009 with school test scores for grades 2 to 11 from 2017 to 2018. Statistical analysis was performed from January to March 2023. Exposures Gestational age at 37, 38, 39, and 41 weeks vs 40 weeks from clinical or obstetric and calendar measures. Main Outcomes and Measures Outcomes were scores in national percentile rankings (NPRs) on standardized school tests in math and reading. Covariates included demographic and prenatal risk factors. Results The sample included 536 996 children (50.7% male children and 49.3% female children) with math scores (3 576 045 child-grade observations; 6.6%, 15.7%, 28.6%, 35.5%, and 13.7% born at 37, 38, 39, 40, and 41 weeks, respectively) and 537 078 children with reading scores (3 590 408 child-grade observations). Score differences for those born at 39 vs 40 weeks were -0.028 NPRs (95% CI, -0.18 to 0.12 NPRs) for math and 0.085 NPRs (95% CI, -0.067 to 0.24 NPRs) for reading using the clinical or obstetric measure and 0.03 NPRs (95% CI, -0.14 to 0.20 NPRs) for math and 0.13 NPRs (95% CI, -0.042 to 0.31 NPRs) for reading using the calendar measure. With the clinical or obstetric measure, score differences between those born at 41 and 40 weeks were 0.19 NPRs (95% CI, -0.0052 to 0.38 NPRs) for math and 0.098 NPRs (95% CI, -0.096 to 0.29 NPRs) for reading. With the calendar measure, score differences for those born at 41 weeks were -0.22 NPRs (95% CI, -0.43 to -0.013 NPRs) for math and -0.28 NPRs (95% CI, -0.49 to -0.074 NPRs) for reading. With the clinical or obstetric measure, score differences between those born at 37 and 38 weeks vs 40 weeks were -0.59 NPRs (95% CI, -0.84 to -0.33 NPRs) and -0.44 NPRs (95% CI, -0.62 to -0.26 NPRs), respectively, for math, and -0.066 NPRs (95% CI, -0.32 to 0.19 NPRs) and -0.19 NPRs (95% CI, -0.37 to 0.0038 NPRs), respectively, for reading. Conclusions and Relevance This study suggests that there is no evidence of a difference in math and reading scores over grades 2 to 11 among children born between 39 and 40 weeks' gestation, and overall no evidence of better scores among those born at 41 weeks' gestation compared with 40 weeks' gestation. The results can further inform decisions on delivery timing at term birth by offering insights into long-term associations of delivery timing with cognitive development and school achievement.
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Affiliation(s)
- George L Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City
- Department of Economics, University of Iowa, Iowa City
- Department of Preventive and Community Dentistry, University of Iowa, Iowa City
- Public Policy Center, University of Iowa, Iowa City
- National Bureau of Economic Research, Cambridge, Massachusetts
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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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Abstract
Low-income children have higher rates of unmet oral health needs. Prior research suggests that poor oral health is associated with lower academic performance but uses cross-sectional and mostly parent-reported measures. This study examined the association between oral health during the first 5 y of life and subsequent academic achievement for low-income children. Birth certificates of children born in Iowa in 1999-2009 were linked to Medicaid enrollment and dental claims data in 1999-2014 and reading and math standardized school test scores for grades 2 through 11. The following oral health measures were examined: having minor dental treatments (mostly surface fillings), major dental treatments (mostly crowns and pulpotomy) or extractions, and comprehensive dental exams during the first 5 y of life. Regression models were estimated adjusting for sociodemographic factors, early infant health, and school district effects. The sample included 28,859 children and 127,464 child-grade observations. In total, 21%, 12%, and 62% of children had at least 1 minor dental treatment, 1 major treatment or extraction, and 1 comprehensive dental exam in the first 5 y of life, respectively. Children who received a minor dental treatment had higher reading and math scores by 1 percentile (95% CI, 0.09-1.9) and 0.9 percentiles (95% CI, 0.02-1.8), respectively. Children who had a major dental treatment or extraction had lower reading and math scores by 2.4 (95% CI, -3.5 to -1.4) and 1.8 (95% CI, -2.8 to -0.8) percentiles. Children who had a comprehensive oral exam had higher reading and math scores by 0.7 (95% CI, 0.06-1.4) and 1.2 (95% CI, 0.6-1.9) percentiles. The findings suggest that children's oral health before school age is associated with academic achievement later during school years.
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Affiliation(s)
- G.L. Wehby
- Department of Health Management and
Policy, University of Iowa, Iowa City, IA, USA
- Department of Economics, University of
Iowa, Iowa City, IA, USA
- Department of Preventive &
Community Dentistry, University of Iowa, Iowa City, IA, USA
- Public Policy Center, University of
Iowa, Iowa City, IA, USA
- National Bureau of Economic Research,
Cambridge, MA, USA
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Goodwin JW, Conrad AL. A preliminary examination of expressive writing in boys with isolated orofacial clefts. Pediatr Res 2022; 91:1370-1373. [PMID: 34117359 PMCID: PMC8664913 DOI: 10.1038/s41390-021-01619-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/27/2021] [Accepted: 05/26/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with isolated cleft of the lip and/or palate (iCL/P) are at a higher risk for language and reading issues. The current pilot study evaluated concurrent writing skills of children with iCL/P compared to unaffected participants with average (uAR) and impaired (uIR) reading. It was hypothesized that children with iCL/P would perform lower than age-expectations. METHODS Twenty-three males, aged 8-11 years old, were recruited through clinics, local advertisements, and state dyslexia groups (iCL/P = 7, uAR = 8, uIR = 8). Group differences on measures of cognitive processes and writing were evaluated using ANCOVA. Relationships between these measures were compared for each group through Pearson correlations. RESULTS Participants with iCL/P performed within the average range across all measures; group differences were only found for the uIR group. For those with iCL/P, writing was correlated to global cognitive skills rather than more specific skills. CONCLUSIONS While this small sample of children with iCL/P demonstrated average writing skills, patterns suggest performance is related to global cognitive reasoning rather than specific cognitive processes as found in unaffected children with impaired reading. Further research is needed to better understand writing in iCL/P and the relationship to reading and cognitive processes. IMPACT Research in children with isolated cleft of the lip and/or palate (iCL/P) has demonstrated higher rates of language and reading disorders. No work has assessed written expression in children with iCL/P in over 40 years. This study is the first to evaluate elements of written expression and associated cognitive processes among children with iCL/P in comparison to unaffected children with either average or impaired reading skills. Measures of writing were within the average range for children with iCL/P and demonstrated correlation to global cognitive reasoning rather than to specific cognitive processes as found in unaffected children with impaired reading.
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Affiliation(s)
- Jon W Goodwin
- Department of Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, CA, USA.
| | - Amy L Conrad
- The Stead Family Department of Pediatrics, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
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9
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Wehby GL. Gestational Age, Newborn Metabolic Markers and Academic Achievement. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031549. [PMID: 35162571 PMCID: PMC8834716 DOI: 10.3390/ijerph19031549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/19/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gestational age is associated with greater school achievement and variation in newborn metabolic markers. Whether metabolic markers are related to gestational age differences in achievement is unknown. This study examines whether newborn metabolic markers are associated with gestational age differences in performance on standardized school tests. METHODS This retrospective cohort study linked birth certificates of children born in Iowa between 2002 and 2010 to newborn screening records and school tests between 2009 and 2018. The analytical sample includes up to 229,679 children and 973,247 child-grade observations. Regression models estimate the associations between gestational age and 37 newborn metabolic markers with national percentile ranking (NPR) scores on math, reading comprehension, and science tests. RESULTS An additional gestational week is associated with 0.6 (95% CI: 0.6, 0.7), 0.5 (95% CI: 0.4, 0.5), and 0.4 (95% CI: 0.4, 0.5) higher NPRs on math, reading, and science, respectively. Compared to full term children (37-44 weeks), preterm children (32-36 weeks) have 2.2 (95% CI: -2.6, -1.8), 1.5 (95% CI: -1.9, -1.1), and 1.0 (95% CI: -1.4, -0.7) lower NPRs on math, reading comprehension, and science. Very preterm children (20-31 weeks) have 8.3 (95% CI: -9.4, -7.2), 5.2 (95% CI: -6.2, -4.0), and 4.7 (95% CI: -5.6, -3.8) lower NPRs than full term children on math, reading, and science. Metabolic markers are associated with 27%, 36%, and 45% of gestational age differences in math, reading, and science scores, respectively, and over half of the difference in test scores between preterm or very preterm and full term children. CONCLUSIONS Newborn metabolic markers are strongly related to gestational age differences in school test scores, suggesting that early metabolic differences are important markers of long-term child development.
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Affiliation(s)
- George L. Wehby
- Department of Health Management and Policy, University of Iowa, Iowa City, IA 52242, USA;
- Department of Economics, University of Iowa, Iowa City, IA 52242, USA
- Department of Preventive & Community Dentistry, University of Iowa, Iowa City, IA 52242, USA
- Public Policy Center, University of Iowa, Iowa City, IA 52242, USA
- National Bureau of Economic Research, Cambridge, MA 02138, USA
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Wehby GL. The Impact Of Household Health Insurance Coverage Gains On Children's Achievement In Iowa: Evidence From The ACA. Health Aff (Millwood) 2022; 41:35-43. [PMID: 34982630 DOI: 10.1377/hlthaff.2021.01222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Low family income is associated with worse child academic achievement. Little is known about how health insurance expansions affect children's achievement in low-income households. This study examined the effects of the Affordable Care Act's coverage expansions primarily for Medicaid and Marketplace enrollment, beginning in 2014, on children's academic achievement in Iowa. The study employed a unique linkage of birth certificates and data on standardized school tests for children in Iowa and took advantage of differences in uninsurance rates across areas in the state before the ACA insurance expansions. There is evidence that the ACA expansions beginning in 2014 were associated with higher reading scores after three years for children born to mothers with a high school education or less. There is no consistent evidence of an effect on math scores. Overall, these findings suggest broad spillover benefits from health insurance expansions to the well-being and development of children in low-income households that should be part of the continuing policy debate surrounding state and national health insurance reforms.
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Affiliation(s)
- George L Wehby
- George L. Wehby , University of Iowa, Iowa City, Iowa, and National Bureau of Economic Research, Cambridge, Massachusetts
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11
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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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Peck CJ, Pourtaheri N, Parsaei Y, Gowda AU, Yang J, Lopez J, Steinbacher DM. Race-Based Differences in the Utilization and Timing of Secondary Cleft Procedures in the United States. Cleft Palate Craniofac J 2021; 59:1413-1421. [PMID: 34662225 DOI: 10.1177/10556656211047134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Primary CL/P repair, revisions, and secondary procedures-cleft rhinoplasty, speech surgery, and alveolar bone grafting (ABG)-performed from 2014-2018 were identified from the Pediatric National Surgical Quality Improvement Program (NSQIP) database. Utilization estimates were derived via univariable and multivariable logistic regression. A Kruskal-Wallis rank-sum test and multivariable linear regression were used to assess differences in timing for each procedure cohort. The primary outcome measures were the odds of a patient being a certain race/ethnicity, and the age at which patients of different race/ethnicity receive surgery. There were 23 780 procedures analyzed. After controlling for sex, diagnosis, and functional status, there were significant differences in utilization estimates across procedure groups. Primarily, utilization was lowest in patient who were Black for cleft rhinoplasty (OR = 0.70, P = .023), ABG (OR = 0.44, P < .001) and speech surgery (OR = 0.57, P = .012), and highest in patients who were Asian patients in all surgery cohorts (OR 2.05-4.43). Timing of surgery also varied by race, although differences were minimal. CONCLUSIONS Estimates of utilization and timing of secondary cleft procedures varied by race, particularly among patients who were Black (poor utilization) or Asian (high utilization). Further studies should identify the causes and implications of underutilized and/or delayed cleft care.
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Affiliation(s)
- Connor J Peck
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Navid Pourtaheri
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Yassmin Parsaei
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Arvind U Gowda
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Jenny Yang
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Joseph Lopez
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
| | - Derek M Steinbacher
- Section of Plastic and Reconstructive Surgery, 12228Yale University School of Medicine, New Haven, CT, USA
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13
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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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14
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Kuhlmann E, van der Plas E, Axelson E, Conrad AL. Brain Developmental Trajectories in Children and Young Adults with Isolated Cleft Lip and/or Cleft Palate. Dev Neuropsychol 2021; 46:314-326. [PMID: 34348063 DOI: 10.1080/87565641.2021.1946691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The present study evaluated brain development in persons with isolated cleft lip and/or cleft palate (iCL/P) compared to unaffected controls using an accelerated longitudinal design. A sample of 134 males and females, ages 7-27 years, with iCL/P (184 observations, total) was compared to 144 unaffected controls (208 evaluations, total) on Wechsler Index scores and volumetric data from structural MRI scans. Boys with isolated cleft palate had verbal IQ 15.5 points lower than perceptual IQ; a clinically significant difference. Participants with iCL/P had differential growth trajectories of regional cerebrum matter and consistently lower volumes of cerebellar gray matter and subcortical matter.
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Affiliation(s)
- Emily Kuhlmann
- Department of Psychological and Quantitative Foundations, University of Iowa College of Education, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Carver College of Medicine, USA
| | - Eric Axelson
- Department of Psychiatry, University of Iowa Carver College of Medicine, USA
| | - Amy L Conrad
- The Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, USA
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15
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Southby L, Harding S, Phillips V, Wren Y, Joinson C. Speech input processing in children born with cleft palate: A systematic literature review with narrative synthesis. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:668-693. [PMID: 34125466 PMCID: PMC8362211 DOI: 10.1111/1460-6984.12633] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 03/31/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Speech development requires intact and adequately functioning oral anatomy and cognitive 'speech processing' skills. There is evidence that speech input processing skills are associated with speech output problems in children not born with a cleft. Children born with cleft palate ± lip (CP±L) are at high risk of developing disordered speech output. Less is known about their speech input processing skills and whether they are associated with cleft-related speech sound disorder (SSD). AIMS (1) To collate and evaluate studies reporting evidence regarding the speech input processing skills of children born with cleft palate in comparison with data from typically developing children or other comparison groups; and (2) to identify any available evidence regarding relationships between speech input processing skills and speech output in children born with CP±L. METHODS & PROCEDURES Potentially relevant studies published up to November 2019 were identified from the following databases: Medline via Ovid, Embase via Ovid, Cinahl via Ebscohost, PsycInfo via Ebscohost, BNI via ProQuest, AMED via Ovid, Cochrane Library and Scopus. Inclusion criteria were: peer-reviewed articles published in scientific journals, any design, published in English, participants born with a CP±L aged up to age 18 years who completed speech input processing assessments compared with normative data and/or a control or other comparison group. Critical Appraisal Skills Programme (CASP) checklists were used to quality appraise included studies. OUTCOMES & RESULTS Six studies were retained in the final review. There is some evidence that children born with CP±L perform less well than non-cleft controls on some speech input processing tasks and that specific input processing skills may be related to errors in the children's speech. Heterogeneity in relation to study groups and assessments used, as well as small sample sizes, limits generalization of findings. CONCLUSION & IMPLICATIONS There is limited evidence regarding the speech input processing skills of children born with CP±L. There are indications that children born with CP+/L may have difficulty in some aspects of speech input processing in comparison with children not born with a cleft, and that difficulties with some speech input processing tasks may be specific to errors in children's speech output. Further research is required to develop our understanding of these skills in this population and any associations with speech output. WHAT THIS PAPER ADDS What is already known on the subject Few studies have been published that examine aspects of speech input processing in children born with CP±L. Theoretical models of speech processing, and published studies, propose that speech input processing skills are associated with SSD in children who were not born with a cleft. However, it is less clear whether there is any association between speech input processing and cleft-related SSD. What this paper adds to existing knowledge This review systematically collates and evaluates the published, peer-reviewed evidence regarding speech input processing skills in children born with CP±L. The collated evidence indicates that some speech input processing skills differ between children with and without CP±L. There is some evidence, from a single study, that speech input processing of specific cleft speech characteristics (CSCs) may be associated with the presence of these CSCs in the speech output of some children born with CP±L. What are the potential or actual clinical implications of this work? While the evidence is currently limited, increasing our knowledge of speech input processing skills in children born with CP±L contributes to our clinical understanding of the nature of cleft-related SSD. The current evidence suggests that speech and language therapists should consider speech input processing skills when assessing children with cleft-related SSD to support intervention planning. Considering these skills in relation to literacy development in these children may also be important.
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Affiliation(s)
- Lucy Southby
- Cleft.NET.EastCambridge University Hospitals NHS Foundation TrustCambridgeUK
- Centre for Academic Child Health, Bristol Medical SchoolUniversity of BristolBristolUK
- Bristol Speech and Language Therapy Research UnitNorth Bristol NHS TrustBristolUK
| | - Sam Harding
- Bristol Speech and Language Therapy Research UnitNorth Bristol NHS TrustBristolUK
| | | | - Yvonne Wren
- Bristol Speech and Language Therapy Research UnitNorth Bristol NHS TrustBristolUK
- Bristol Dental SchoolUniversity of BristolBristolUK
| | - Carol Joinson
- Centre for Academic Child Health, Bristol Medical SchoolUniversity of BristolBristolUK
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16
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Morris JK, Garne E, Loane M, Barisic I, Densem J, Latos-Bieleńska A, Neville A, Pierini A, Rankin J, Rissmann A, de Walle H, Tan J, Given JE, Claridge H. EUROlinkCAT protocol for a European population-based data linkage study investigating the survival, morbidity and education of children with congenital anomalies. BMJ Open 2021; 11:e047859. [PMID: 34183346 PMCID: PMC8240574 DOI: 10.1136/bmjopen-2020-047859] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Congenital anomalies (CAs) are a major cause of infant mortality, childhood morbidity and long-term disability. Over 130 000 children born in Europe every year will have a CA. This paper describes the EUROlinkCAT study, which is investigating the health and educational outcomes of children with CAs for the first 10 years of their lives. METHODS AND ANALYSIS EUROCAT is a European network of population-based registries for the epidemiological surveillance of CAs. EUROlinkCAT is using the EUROCAT infrastructure to support 22 EUROCAT registries in 14 countries to link their data on births with CAs to mortality, hospital discharge, prescription and educational databases. Once linked, each registry transforms their case data into a common data model (CDM) format and they are then supplied with common STATA syntax scripts to analyse their data. The resulting aggregate tables and analysis results are submitted to a central results repository (CRR) and meta-analyses are performed to summarise the results across all registries. The CRR currently contains data on 155 594 children with a CA followed up to age 10 from a population of 6 million births from 1995 to 2014. ETHICS The CA registries have the required ethics permissions for routine surveillance and transmission of anonymised data to the EUROCAT central database. Each registry is responsible for applying for and obtaining additional ethics and other permissions required for their participation in EUROlinkCAT. DISSEMINATION The CDM and associated documentation, including linkage and standardisation procedures, will be available post-EUROlinkCAT thus facilitating future local, national and European-level analyses to improve healthcare. Recommendations to improve the accuracy of routinely collected data will be made.Findings will provide evidence to inform parents, health professionals, public health authorities and national treatment guidelines to optimise diagnosis, prevention and treatment for these children with a view to reducing health inequalities in Europe.
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Affiliation(s)
- Joan K Morris
- Population Health Research Institute, St George's University of London, London, UK
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Ingeborg Barisic
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | | | - Anna Latos-Bieleńska
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Amanda Neville
- IMER Registry (Emila Romagna Registry of Birth Defects), University Hospital of Ferrara, Emilia-Romagna, Italy
| | - Anna Pierini
- Instituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Hermien de Walle
- Department of Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joachim Tan
- Population Health Research Institute, St George's University of London, London, UK
| | - Joanne Emma Given
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Hugh Claridge
- Population Health Research Institute, St George's University of London, London, UK
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17
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Dardani C, Howe LJ, Mukhopadhyay N, Stergiakouli E, Wren Y, Humphries K, Davies A, Ho K, Weinberg SM, Marazita ML, Mangold E, Ludwig KU, Relton CL, Davey Smith G, Lewis SJ, Sandy J, Davies NM, Sharp GC. Cleft lip/palate and educational attainment: cause, consequence or correlation? A Mendelian randomization study. Int J Epidemiol 2021; 49:1282-1293. [PMID: 32373937 PMCID: PMC7660147 DOI: 10.1093/ije/dyaa047] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/04/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Previous studies have found that children born with a non-syndromic orofacial cleft have lower-than-average educational attainment. Differences could be due to a genetic predisposition to low intelligence and academic performance, factors arising due to the cleft phenotype (such as social stigmatization, impaired speech/language development) or confounding by the prenatal environment. A clearer understanding of this mechanism will inform interventions to improve educational attainment in individuals born with a cleft, which could substantially improve their quality of life. We assessed evidence for the hypothesis that common variant genetic liability to non-syndromic cleft lip with or without cleft palate (nsCL/P) influences educational attainment. METHODS We performed a genome-wide association study (GWAS) meta-analysis of nsCL/P with 1692 nsCL/P cases and 4259 parental and unrelated controls. Using GWAS summary statistics, we performed Linkage Disequilibrium (LD)-score regression to estimate the genetic correlation between nsCL/P, educational attainment (GWAS n = 766 345) and intelligence (GWAS n = 257 828). We used two-sample Mendelian randomization to evaluate the causal effects of genetic liability to nsCL/P on educational attainment and intelligence. RESULTS There was limited evidence for shared genetic aetiology or causal relationships between nsCL/P and educational attainment [genetic correlation (rg) -0.05, 95% confidence interval (CI) -0.12 to 0.01, P 0.13; MR estimate (βMR) -0.002, 95% CI -0.009 to 0.006, P 0.679) or intelligence (rg -0.04, 95% CI -0.13 to 0.04, P 0.34; βMR -0.009, 95% CI -0.02 to 0.002, P 0.11). CONCLUSIONS Common variants are unlikely to predispose individuals born with nsCL/P to low educational attainment or intelligence. This is an important first step towards understanding the aetiology of low educational attainment in this group.
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Affiliation(s)
- Christina Dardani
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Laurence J Howe
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Institute of Cardiovascular Science, University College London, London, UK
| | - Nandita Mukhopadhyay
- Centre for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Evie Stergiakouli
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,The Cleft Collective, University of Bristol, Bristol, UK
| | - Yvonne Wren
- The Cleft Collective, University of Bristol, Bristol, UK.,Bristol Speech and Language Therapy Research Unit, North Bristol NHS Trust, Bristol, UK
| | | | - Amy Davies
- The Cleft Collective, University of Bristol, Bristol, UK
| | - Karen Ho
- The Cleft Collective, University of Bristol, Bristol, UK.,Bristol Bioresource Laboratories, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Seth M Weinberg
- Centre for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary L Marazita
- Centre for Craniofacial and Dental Genetics, Department of Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Kerstin U Ludwig
- Institute of Human Genetics, University of Bonn, Bonn, Germany.,Department of Genomics, Life and Brain Center, University of Bonn, Bonn, Germany
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah J Lewis
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,The Cleft Collective, University of Bristol, Bristol, UK
| | - Jonathan Sandy
- The Cleft Collective, University of Bristol, Bristol, UK.,Dean of the Faculty of Health Sciences, University of Bristol, Bristol, UK
| | - Neil M Davies
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gemma C Sharp
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,The Cleft Collective, University of Bristol, Bristol, UK
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18
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Lyu W, Wanchek T, Wehby GL. The effects of state facial surgery mandates on timeliness of primary cleft repair surgery in the United States. Oral Dis 2021; 28:1620-1627. [PMID: 33586311 DOI: 10.1111/odi.13801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/29/2021] [Accepted: 02/10/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study examines the effects of state facial surgery mandates on the timeliness of primary cleft repair surgery for privately insured children with oral clefts in the United States. MATERIALS AND METHODS Using IBM Health MarketScan® Database from 2001 to 2017, we estimate regression models separately for age at cleft lip repair and cleft palate repair by having a mandate while considering child-level factors and other state differences. The sample includes 1,451 children who had primary cleft lip repair by age 12 months, and 1,402 children who had primary cleft palate repair by age 18 months. RESULTS A mandate was associated with earlier cleft lip repair by 13 days (95% CI, -21.5 to -4.7 days) when controlling for state differences, regardless if the child had other birth defects. For children needing cleft palate repair, a mandate was associated with earlier surgery by 87 days (95% CI, -136.1 to -38.4 days) only when no other birth defects were present. CONCLUSIONS State facial surgery mandates were associated with earlier cleft lip repair for children with or without other birth defects, and earlier cleft palate repair for children without other birth defects (besides oral clefts). Findings suggest benefits to privately insured children with oral clefts from state mandates to cover needed services.
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Affiliation(s)
- Wei Lyu
- Division of Health Systems Management and Policy, School of Public Health, University of Memphis, Memphis, TN, USA.,Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Tanya Wanchek
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - George L Wehby
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA.,Department of Economics, Tippie College of Business, University of Iowa, Iowa City, IA, USA.,Department of Preventive & Community Dentistry, College of Dentistry, University of Iowa, Iowa City, IA, USA.,Public Policy Center, University of Iowa, Iowa City, IA, USA.,National Bureau of Economic Research, Cambridge, MA, USA
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19
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Conrad AL, Kuhlmann E, van der Plas E, Axelson E. Brain structure and neural activity related to reading in boys with isolated oral clefts. Child Neuropsychol 2021; 27:621-640. [PMID: 33557685 DOI: 10.1080/09297049.2021.1879765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: The purpose of this study was to evaluate brain structure and function in participants with iCL/P and unaffected controls. Effects of cleft presence and reading status (average vs impaired) were evaluated.Methods: Males, ages 8-11 years old, including 26 with iCL/P and 57 unaffected peers were recruited and coded for reading status (average vs impaired). All participants underwent a volumetric and task-based functional MRI. Volumes and significant regions of activation during the decoding task were obtained. Main effects of cleft and reading status, and their interaction were evaluated.Results: Participants with iCL/P had significantly increased frontal gray matter volume (associated with average reading) and occipital gray and white matter volume (associated with impaired reading). Impaired readers with iCL/P had a distinctive activation pattern in visual association and motor regions relative to other groups.Conclusions: Findings suggest that increases in frontal gray matter volume may be associated with effective compensation during reading, while posterior increases in occipital volume may be associated with ineffective compensation for participants with iCL/P. These patterns were different from idiopathic dyslexia. Further work in a larger sample is needed to determine if these differences are associated with cleft type and with sex.Abbreviations: iCL/P (isolated cleft lip and/or palate); iCL (isolated cleft lip only); iCLP (isolated cleft lip and palate); iCP (isolated cleft palate only); uAR (unaffected average reader); uIR (unaffected impaired reader); cAR (average reader with iCL/P); cIR (impaired reader with iCL/P).
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Affiliation(s)
- Amy Lynn Conrad
- The Stead Family Department of Pediatrics, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
| | - Emily Kuhlmann
- The Stead Family Department of Pediatrics, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
| | - Ellen van der Plas
- Department of Psychiatry, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
| | - Eric Axelson
- Department of Psychiatry, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, IA, USA
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20
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Yuan L, Gao Y, Pan B, Wang J, Wang Y, Gong C, Wang W, Li X. Resilience and Related Factors: A Comparison of Fathers and Mothers of Patients With Cleft Lip and/or Palate in China. Front Psychiatry 2021; 12:791555. [PMID: 35095604 PMCID: PMC8792896 DOI: 10.3389/fpsyt.2021.791555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Resilience has become a hot spot in the field of positive psychology to study life-change events. However, there were little information on resilience among the fathers and mothers of patients with cleft lip and/or palate respectively. The present study aimed to explore and compare the level and potential influential factors associated with resilience among fathers/mothers of patients with cleft lip and/or palate in China. Method: A cross-sectional study was carried out between April 2019 and July 2020 among fathers/mothers of patients with cleft lip and/or palate in two cleft lip and/or palate treatment centers in China. Sixty Nine fathers and 179 mothers of patients with cleft lip and/or palate were interviewed with a questionnaire on demographic variables and the Resilience Scale-14 (RS-14), Herth Hope Index (HHI), Multidimensional Scale of Perceived Social Support (MSPSS), Revised Life Orientation Test (LOT-R), Parenting Stress Index-Short Form (PSI-SF) and Coping Health Inventory for Parents (CHIP). T-test/univariate one-way ANOVA, Pearson's r, hierarchical linear regression analysis were conducted to explore the influential factors of resilience. Results: Fathers of patients with cleft lip and/or palate had a higher level of resilience (77.77 ± 14.18) than mothers (74.52 ± 14.33) though without significance. Resilience was positively associated with hope, perceived social support, optimism and coping and negatively correlated with parenting stress both in the fathers and the mothers. Hierarchical linear regression analysis showed that hope (β = 0.400, P < 0.01), coping (β = 0.281, P < 0.05), job status, medical payments (β = -0.240, P < 0.05) were found to be associated with resilience among the fathers of patients with CL/P, and all four variables in the model could explain 42.8% of the variance in resilience; Hope (β = 0.225, P < 0.05), perceived social support (β = 0.194, P < 0.05), the age of patients (β = 0.189, P < 0.05) were found to be associated with resilience among the mothers, and all three variables in the model could explain 27.6% of the variance in resilience. Conclusion: Our study showed that, in China, fathers of patients with cleft lip and/or palate had a higher level of resilience than mothers though without significance. Hope was the only communal variable strongly associated with resilience among both the fathers and the mothers; besides, coping, job status and medical payments were found to be associated with resilience among the fathers; while perceived social support and the age of patients were found to be associated with resilience among the mothers. The results suggest that enhance hope in parents of patients with cleft lip and/or palate might greatly help improve their resilience. Besides, fathers and mothers need specific intervention to prompt their resilience.
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Affiliation(s)
- Lulu Yuan
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China.,School of Nursing, China Medical University, Shenyang, China
| | - Yuqin Gao
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Bochen Pan
- Shengjing Hospital, China Medical University, Shenyang, China
| | - Junyan Wang
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Yanjie Wang
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Caixia Gong
- West China School/Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Weiren Wang
- Liaoning Provincial Key Laboratory of Oral Diseases, Department of Nursing, School and Hospital of Stomatology, China Medical University, Shenyang, China
| | - Xiaohan Li
- School of Nursing, China Medical University, Shenyang, China
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Conrad AL, Albert M, Crerand CE, Crilly Bellucci C, Heppner CE, Sheikh F, Woodard S, Kapp-Simon KA. Retrospective Evaluation of Number of Surgeries and Parent Ratings of Academic and Behavioral Functioning Among Children With Isolated Oral Clefts. Cleft Palate Craniofac J 2020; 58:1294-1303. [PMID: 33380226 DOI: 10.1177/1055665620982807] [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: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate possible relationships between number of surgeries and parent ratings of academic functioning among children with isolated oral clefts. DESIGN Multicenter, retrospective cohort study including structured interviews, questionnaires, and chart reviews. SETTING Completion of questionnaires occurred during clinical visits at 6 different cleft centers across North America. PARTICIPANTS Parents of 285 children with isolated clefts of the lip and/or palate, aged 8 to 10 years old, participated in structured interviews and completed questionnaires regarding the academic and behavioral functioning of their children. MAIN OUTCOME MEASURES Parent interview and medical chart review of number of surgeries to date and parent ratings on the Adaptive Behavior Assessment System, Third Edition-Functional Academics Scale (ABAS-FA) and Child Behavior Checklist (CBCL) Total Competency Scale. RESULTS Parent ratings of ABAS-FA were at or above normative expectations, while ratings across CBCL Competency Scales were lower than normative expectations. Socioeconomic status (SES), age, and race were consistent predictors of parent ratings (higher SES, older age, and Caucasian race were associated with better functioning). Number of surgeries did not add significantly to academic ratings but did significantly contribute to ratings of social and activity participation. Patients with more surgeries were rated with lower functioning in these domains. CONCLUSIONS Findings do not support a connection between number of surgeries and later ratings of academic functioning but do support a connection to social and activity involvement. Recommendations for conducting direct studies of the connection between surgeries and academic functioning as well as clinical considerations for surgeries and impact on social and activity involvement are discussed.
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Affiliation(s)
- Amy L Conrad
- Division of Developmental and Behavioral Pediatrics, The Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Meredith Albert
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA.,Craniofacial Center, Department of Surgery, University of Illinois at Chicago, IL,USA
| | - Canice E Crerand
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, OH, USA
| | - Claudia Crilly Bellucci
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA
| | - Celia E Heppner
- Fogelson Plastic and Craniofacial Surgery Center, Children's Health/Children's Medical Center, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Farah Sheikh
- Division of Plastic and Reconstructive Surgery, the Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Kathleen A Kapp-Simon
- Cleft-Craniofacial Clinic, Departments of Psychology and Pediatric Plastic Surgery, Shriners Hospitals for Children-Chicago, IL, USA.,Craniofacial Center, Department of Surgery, University of Illinois at Chicago, IL, USA
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22
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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: 0] [Impact Index Per Article: 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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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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24
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Kuhlmann EH, Conrad AL. Word Reading in Boys With Isolated Oral Clefts: Comparison to Unaffected Average and Dyslexic Readers Using the Dual-Route Model. Cleft Palate Craniofac J 2020; 57:310-320. [PMID: 31370691 PMCID: PMC6994360 DOI: 10.1177/1055665619867015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine word reading performance between boys with isolated cleft lip and/or palate (iCL/P), unaffected average reading (uAR), and unaffected impaired reading (uIR), using the dual-route model. DESIGN Case/control study. SETTING University children's hospital. PARTICIPANTS Males, between the ages of 8 to 11 years, with iCL/P (n = 26), uIR (n = 33), or uAR (n = 28). METHODS Single word reading and achievement were evaluated. Analyses of variance and analyses of covariance evaluated group differences in achievement. Medical records were reviewed for iCL/P participants for audiology and speech history. Spearman ρ correlations were calculated between hearing, speech, and reading achievement for the iCL/P group. MAIN OUTCOME MEASURE(S) Reading performance was evaluated using select subscales from the Woodcock Johnson Reading Mastery Test, 3rd Edition and the Test of Orthographic Competence. RESULTS Participants with iCL/P had higher than expected rates of reading impairment, differing across cleft type (0% iCL, 50% isolated cleft lip and palate [iCLP], 71.4% isolated cleft palate only [iCP]). On measures of word reading accuracy, iCL/P participants outscored uIR participants, with uAR participants scoring the highest. This pattern was specific to nonlexical reading tasks. Participants in the uAR and iCL/P groups outscored uIR participants on lexical tasks, with no significant differences between uAR and iCL/P. Evaluation of speech and hearing revealed no significant relationship to single word reading or achievement measures in the iCL/P group. CONCLUSIONS Boys with iCL/P are at a higher risk of reading impairments, particularly within the iCP subset. Regular screening should be encouraged, with skills from both lexical and nonlexical routes assessed.
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Affiliation(s)
- Emily Hope Kuhlmann
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, IA, USA
| | - Amy Lynn Conrad
- Stead Family Department of Pediatrics, University of Iowa College of Medicine, Iowa City, IA, USA
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Stock NM, Guest E, Stoneman K, Ridley M, Evans C, LeRoy C, Anwar H, McCarthy G, Cunniffe C, Rumsey N. The Contribution of a Charitable Organization to Regional Cleft Lip and Palate Services in England and Scotland. Cleft Palate Craniofac J 2019; 57:14-20. [PMID: 31307213 DOI: 10.1177/1055665619862727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND From diagnosis through to adulthood, a cleft lip and/or palate (CL/P) poses a number of challenges for those affected. Alongside the care provided by clinical teams, complementary information and support is offered by charitable organizations. In 2011, the Cleft Lip and Palate Association received funding to implement a new regional service across England and Scotland, with the aim of increasing support at a local level. The Centre for Appearance Research at the University of the West of England were commissioned to conduct an independent evaluation of the service over 7 years. METHODS A pragmatic, mixed-methods approach was utilized to assess the impact of the service from the perspective of charity volunteers; children, young people, and adults with CL/P; caregivers; and clinicians. Feedback forms were distributed to stakeholders at a variety of events, and qualitative feedback was collected via focus groups and an online survey. RESULTS The majority of participants indicated they had gained access to a local support network, felt more able to cope with CL/P-related challenges, and felt more confident in themselves. Qualitative investigation provided further support for these findings and highlighted additional benefits of the regional service for clinical teams. CONCLUSIONS The evaluation provides encouraging evidence toward the contribution of a relatively small charitable organization in the context of cleft care. The importance of a pragmatic approach to community-based evaluation and the benefits of collaborative working between researchers and the charitable sector were also highlighted.
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Affiliation(s)
- Nicola Marie Stock
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Ella Guest
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Kate Stoneman
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Matthew Ridley
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
| | - Claire Evans
- The Cleft Lip and Palate Association, London, United Kingdom
| | - Cherry LeRoy
- The Cleft Lip and Palate Association, London, United Kingdom
| | - Hamza Anwar
- The Cleft Lip and Palate Association, London, United Kingdom
| | | | - Claire Cunniffe
- The Cleft Lip and Palate Association, London, United Kingdom
| | - Nichola Rumsey
- Centre for Appearance Research, University of the West of England, Bristol, United Kingdom
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26
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Conrad AL. Are predictors of reading impairment in isolated cleft similar to those in idiopathic dyslexia? ANNALS OF DYSLEXIA 2019; 69:153-165. [PMID: 30406510 PMCID: PMC6504631 DOI: 10.1007/s11881-018-00166-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 10/18/2018] [Indexed: 06/05/2023]
Abstract
Children with isolated cleft of the lip and/or palate (iCL/P) are at increased risk for reading impairment. The purpose of this study was to evaluate the impact of early risk factors (hearing, speech, and early literacy) on reading performance compared to unaffected participants with average (uAR) and impaired (uIR) reading. Reading achievement and early literacy skills were evaluated across three groups (27 iCL/P, 32 uAR, and 33 uIR). All participants were males, ages 8-11 years old. Those with history of head trauma/injury or major medical/mental health conditions were excluded. Group differences in achievement and early literacy skills were evaluated with ANCOVAs. Participants with impaired reading achievement (at or below 25th Percentile) were identified. Medical record reviews for participates with iCL/P were conducted and audiology and speech ratings recorded. Correlations were calculated between achievement, early literacy, hearing, and speech. Participants with iCL/P had significantly elevated risk for reading impairment (37%); this risk differed by cleft type (0% iCL, 55% iCLP, and 60% iCP). Achievement for participants with iCP was similar to the uIR group. Early literacy risk resulted in lower achievement scores for both iCL/P and unaffected participants. History of inadequate hearing and speech did not significantly impact early literacy or achievement measures. There is a high risk of reading impairment for children with iCL/P-highest for those with iCLP and iCP. Early literacy predictors of reading outcome are similar for iCL/P and idiopathic dyslexia. Current screening and intervention methods are supported.
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Affiliation(s)
- Amy Lynn Conrad
- University of Iowa Carver College of Medicine, 146-B, CDD. 100 Hawkins Dr., Iowa City, IA, 52242, USA.
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27
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28
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Særvold TK, Hide Ø, Feragen KB, Aukner R. Associations Between Hypernasality, Intelligibility, and Language and Reading Skills in 10-Year-Old Children With a Palatal Cleft. Cleft Palate Craniofac J 2019; 56:1044-1051. [DOI: 10.1177/1055665618824432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: This study investigated the associations between hypernasality and intelligibility, and language and reading skills in 10-year old children with a cleft palate ± lip. Design: Cross-sectional data collected during routine assessments of speech and language in a centralized treatment setting. Participants: Children aged 10, born with cleft palate ± lip from 4 birth cohorts (N = 123). Outcome Measures: Hypernasality and intelligibility: Swedish Articulation and Nasality Test-N; language: Language 6-16 (Sentence recall, Serial recall, Vocabulary); reading: word chain test and reading comprehension test. Results: A total of 71.3% of the children had no occurrence of hypernasality and 82.8% had intelligibility scores within the normal range. For all children with hypernasality and intelligibility within the normal range, reading and language scores were also within normal ranges. Children with presence of hypernasality had significantly lower language skills, with mean scores within the lower normal range. Children with reduced intelligibility had lower scores on reading comprehension. Conclusions: The findings highlight a possible association between hypernasality and language skills, and intelligibility and reading skills. Cleft teams should consider routine assessments of language and reading skills in children with speech impairment, in order to identify potential needs for intervention as early as possible.
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Affiliation(s)
- Tone Kristin Særvold
- Department of Speech and Language Disorders, Statped – National Service for Special Needs Education, Oslo, Norway
| | - Øydis Hide
- Department of Speech and Language Disorders, Statped – National Service for Special Needs Education, Oslo, Norway
| | | | - Ragnhild Aukner
- Department of Speech and Language Disorders, Statped – National Service for Special Needs Education, Oslo, Norway
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29
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Paaske EB, Garne E. Epidemiology of orofacial clefts in a Danish county over 35 years - Before and after implementation of a prenatal screening programme for congenital anomalies. Eur J Med Genet 2018; 61:489-492. [PMID: 29753919 DOI: 10.1016/j.ejmg.2018.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/02/2018] [Accepted: 05/08/2018] [Indexed: 11/16/2022]
Abstract
In 2004 the Danish National Board of Health changed its screening recommendations. Since 2005 a first trimester screening for Down syndrome and a prenatal ultrasound screening for congenital anomalies in the second trimester of pregnancy has been offered to all pregnant women. The aim of this study was to describe the prevalence of cleft lip with or without cleft palate and cleft palate in a Danish area and to describe associated anomalies and the development in prenatal diagnosis over time. The study was based on data from the EUROCAT Registry for Funen County. The registry is based on multiple data sources and includes information about live births, fetal deaths with a gestational age >20 weeks and terminations of pregnancy after prenatal diagnosis of severe fetal anomaly. The study included all fetuses/infants out of a population of 182,907 births diagnosed with orofacial clefts born between 1980 and 2014. There were 271 cases diagnosed with cleft lip with or without cleft palate and 127 cases diagnosed with cleft palate, giving a prevalence of 14.8 per 10,000 births for cleft lip with or without cleft palate and 6.9 per 10,000 births for cleft palate. There were no significant changes in prevalence over time for the two anomalies, calculated with and without inclusion of genetic and chromosomal cases. Overall 66 cases were diagnosed prenatally (17% of total). For isolated cleft lip with or without cleft palate none of the 157 cases born before 2005 were diagnosed prenatally compared to 34 of 58 cases (59%) born in 2005-2014 (p < 0.01). The proportion of liveborn infants with multiple congenital anomalies also changed after 2005 with 15% (39/266) of all liveborn infants with orofacial clefts born 1980-2004 having multiple anomalies compared to 7% (7/96) in 2005-2014 (p < 0.05). The implementation of the new screening programme in 2005 has given a major change in prenatal detection rate and reduced the proportion of liveborn infants with orofacial clefts classified as multiple congenital anomaly cases. The prevalence of cleft lip with or without cleft palate was higher than reported from many other countries.
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Affiliation(s)
- Eva Berenth Paaske
- Department of Anesthesiology and Intensive Care, Odense University Hospital, Denmark
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt - Kolding, Denmark.
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30
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Watkins SE, Allori AC, Meyer RE, Aylsworth AS, Marcus JR, Strauss RP. Special education use in elementary school by children with nonsyndromic orofacial clefts. Birth Defects Res 2018; 111:142-150. [PMID: 30516876 DOI: 10.1002/bdr2.1418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/09/2018] [Accepted: 10/10/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children with nonsyndromic orofacial clefts (NS OFCs) may require exceptional children's (EC) services for academic delays. We examined EC service use of children with and without NS OFCs in NC in elementary school. METHODS We included 559 children with NS OFCs and 6,822 children without birth defects who had NC educational records. We estimated prevalence ratios, trends in enrollment, and characteristics of eligibility classification using descriptive statistics and logistic regression by cleft subtype and race/ethnicity. We estimated the odds of third grade retention by EC enrollment using logistic regression with inverse probability of treatment weights. RESULTS Children with NS OFCs were 3.02 (95% CI: 2.50, 3.64) times as likely to receive third grade special education (SE) services compared to unaffected peers. The prevalence odds was highest among children with CL+P (OR: 4.61, 95% CI: 3.49, 6.09) declining by 54% by fifth grade. The prevalence odds of SE for white children was approximately 1.50 times that for African American children in fourth and fifth grades. Approximately 33% of children with NS OFCs within each racial/ethnic group received SE in third grade. African American children were twice as likely to receive services under specific learning disability. Children with NS OFCs receiving EC services were 44% (OR: 0.56; 95% CI: 0.13, 2.38) less likely to be retained in third grade compared to children with NS OFCs who were not receiving services. CONCLUSIONS Children with NS OFCs are more likely to receive SE services in elementary school compared to their unaffected peers. The eligibility category differed by racial/ethnic group.
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Affiliation(s)
- Stephanie E Watkins
- NC Department of Health and Human Services, Division of Public Health, Women's and Children's Health Section, Raleigh, North Carolina.,Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, North Carolina
| | - Alexander C Allori
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, North Carolina
| | - Robert E Meyer
- NC Department of Health and Human Services, Division of Public Health, Birth Defects Monitoring Program, State Center for Health Statistics, Raleigh, North Carolina.,Department of Maternal and Child Health, University of North Carolina, Chapel Hill, North Carolina
| | - Arthur S Aylsworth
- Departments of Pediatrics and Genetics, University of North Carolina, Chapel Hill, North Carolina
| | - Jeffrey R Marcus
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, North Carolina
| | - Ronald P Strauss
- School of Dentistry and UNC Craniofacial Center, University of North Carolina, Chapel Hill, North Carolina
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Cheong MHY, Young SEL, Young DPCY, Lee MLC, Rickard Liow SJ. Early Reading Abilities of Bilingual Children With Nonsyndromic Orofacial Clefts. Cleft Palate Craniofac J 2018; 55:259-268. [PMID: 29351038 DOI: 10.1177/1055665617723923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the early reading abilities, and related cognitive-linguistic processes, in bilingual children with nonsyndromic cleft lip and/or palate (CL/P), and to identify deficits that might be amenable to intervention. DESIGN AND PARTICIPANTS Bilingual participants with CL/P aged 5 to 6 years who were English-dominant ( n=17) or Mandarin-dominant ( n=18) were recruited using consecutive sampling from a national cleft treatment center and matched pairwise to a sample of typically developing (TD) children on language dominance, age, and socioeconomic status. All participants were assessed in English on single-word reading accuracy using the Wide Range Achievement Test (4th Ed), and key cognitive-linguistic factors associated with reading development: phonological awareness, rapid automatized naming (RAN), receptive and expressive vocabulary, and verbal short-term and working memory. RESULTS CL/P and TD groups were compared within language dominance group (Mandarin or English) for all measures. The Mandarin-dominant CL/P group had significantly poorer reading accuracy and phonological awareness than their TD peers. Additionally, regardless of language dominance, faster RAN correlated significantly with better reading accuracy in both the CL/P groups but not the TD groups. CONCLUSIONS Children with CL/P who are learning English as a second language are at greater risk of reading difficulties. Furthermore, the cognitive-linguistic processes underlying early reading in bilingual children with CL/P differ from those of their TD peers. Routine screening and tailored intervention is advisable.
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Affiliation(s)
- Michelle Heng Yue Cheong
- 1 Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Selena Ee-Li Young
- 1 Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- 2 Department of Plastic, Reconstructive and Aesthetic Surgery, KK Women's and Children's Hospital, Singapore
| | | | - Mary Lay Choo Lee
- 3 Department of Psychology, National University of Singapore, Singapore
| | - Susan Jane Rickard Liow
- 1 Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Common basis for orofacial clefting and cortical interneuronopathy. Transl Psychiatry 2018; 8:8. [PMID: 29317601 PMCID: PMC5802454 DOI: 10.1038/s41398-017-0057-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/11/2017] [Accepted: 10/15/2017] [Indexed: 12/31/2022] Open
Abstract
Orofacial clefts (OFCs) of the lip and/or palate are among the most common human birth defects. Current treatment strategies focus on functional and cosmetic repair but even when this care is available, individuals born with OFCs are at high risk for persistent neurobehavioral problems. In addition to learning disabilities and reduced academic achievement, recent evidence associates OFCs with elevated risk for a constellation of psychiatric outcomes including anxiety disorders, autism spectrum disorder, and schizophrenia. The relationship between these outcomes and OFCs is poorly understood and controversial. Recent neuroimaging studies in humans and mice demonstrate subtle morphological brain abnormalities that co-occur with OFCs but specific molecular and cellular mechanisms have not been investigated. Here, we provide the first evidence directly linking OFC pathogenesis to abnormal development of GABAergic cortical interneurons (cINs). Lineage tracing revealed that the structures that form the upper lip and palate develop in molecular synchrony and spatiotemporal proximity to cINs, suggesting these populations may have shared sensitivity to genetic and/or teratogenic insult. Examination of cIN development in a mouse model of nonsyndromic OFCs revealed significant disruptions in cIN proliferation and migration, culminating in misspecification of the somatostatin-expressing subgroup. These findings reveal a unified developmental basis for orofacial clefting and disrupted cIN development, and may explain the significant overlap in neurobehavioral and psychiatric outcomes associated with OFCs and cIN dysfunction. This emerging mechanistic understanding for increased prevalence of adverse neurobehavioral outcomes in OFC patients is the entry-point for developing evidence-based therapies to improve patient outcomes.
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Watkins SE, Meyer RE, Aylsworth AS, Marcus JR, Allori AC, Pimenta L, Lipinski RJ, Strauss RP. Academic Achievement Among Children With Nonsyndromic Orofacial Clefts : A Population-Based Study. Cleft Palate Craniofac J 2017; 55:12-20. [PMID: 34162061 DOI: 10.1177/1055665617718823] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Children with orofacial clefts (OFCs) may experience poor reading proficiency, learning disabilities, and academic underachievement. We examined the association between nonsyndromic (NS) OFCs and end-of-grade (EOG) performance in reading and math from third through eighth grade in a sample subgroup. PARTICIPANTS We identified a cohort of 559 children with NS-OFCs and 6822 children without birth defects, classifying cleft type by cleft lip alone, with or without cleft alveolar ridge (CL); cleft lip with cleft palate (CL+P); and cleft palate only (CP). MAIN OUTCOME MEASURES Using logistic regression, we estimated the odds of not meeting grade-level standards among children with NS-OFCs compared to unaffected peers. Using longitudinal analyses, we estimated the odds of not meeting grade-level standards and average change in test scores through eighth grade. RESULTS Children with NS-OFCs were 1.22 (95% CI: 0.96, 1.83) times as likely not to meet grade-level standards in reading compared to unaffected peers. The effect was similar for math (OR: 1.17; 95% CI: 0.92, 1.48). Children with CL+P were 1.33 (95% CI: 0.86, 1.83) and 1.74 (95% CI: 1.19, 2.56) times as likely not to meet grade-level standard in reading and in both subjects, respectively, compared to unaffected peers. The average rate of change in both scores was similar for children with and without OFCs. CONCLUSIONS Poor academic performance appears greatest for children with CL+P, a finding compatible with previous observations and hypothesized mechanisms associating orofacial clefts with subtle abnormalities in brain development. Academic performance monitoring and referral for academic assistance is warranted.
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Affiliation(s)
- Stephanie E Watkins
- Women's and Children's Health Section, Division of Public Health, Raleigh, NC, USA
| | - Robert E Meyer
- Birth Defects Monitoring Program, Division of Public Health, State Center for Health Statistics, Raleigh, NC, USA
| | - Arthur S Aylsworth
- Departments of Pediatrics and Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jeffrey R Marcus
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Alexander C Allori
- Division of Plastic, Maxillofacial, and Oral Surgery, Duke University, Durham, NC, USA
| | - Luiz Pimenta
- School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Robert J Lipinski
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Ronald P Strauss
- School of Dentistry and Office of the Provost, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Chacon A, Parkin M, Broome K, Purcell A. Australian children with cleft palate achieve age-appropriate speech by 5 years of age. Int J Pediatr Otorhinolaryngol 2017; 103:93-102. [PMID: 29224774 DOI: 10.1016/j.ijporl.2017.09.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/23/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Children with cleft palate demonstrate atypical speech sound development, which can influence their intelligibility, literacy and learning. There is limited documentation regarding how speech sound errors change over time in cleft palate speech and the effect that these errors have upon mono-versus polysyllabic word production. The objective of this study was to examine the phonetic and phonological speech skills of children with cleft palate at ages 3 and 5. METHODS A cross-sectional observational design was used. Eligible participants were aged 3 or 5 years with a repaired cleft palate. The Diagnostic Evaluation of Articulation and Phonology (DEAP) Articulation subtest and a non-standardised list of mono- and polysyllabic words were administered once for each child. The Profile of Phonology (PROPH) was used to analyse each child's speech. RESULTS N = 51 children with cleft palate participated in the study. Three-year-old children with cleft palate produced significantly more speech errors than their typically-developing peers, but no difference was apparent at 5 years. The 5-year-olds demonstrated greater phonetic and phonological accuracy than the 3-year-old children. Polysyllabic words were more affected by errors than monosyllables in the 3-year-old group only. CONCLUSIONS Children with cleft palate are prone to phonetic and phonological speech errors in their preschool years. Most of these speech errors approximate typically-developing children by 5 years. At 3 years, word shape has an influence upon phonological speech accuracy. Speech pathology intervention is indicated to support the intelligibility of these children from their earliest stages of development.
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Affiliation(s)
- Antonia Chacon
- The University of Sydney, Faculty of Health Sciences, Cumberland Campus C42, PO Box 170, Lidcombe, NSW 1825, Australia.
| | - Melissa Parkin
- Sydney Children's Hospital, Randwick, High Street, Randwick NSW 2031, Australia.
| | - Kate Broome
- Sydney Children's Hospital, Randwick, High Street, Randwick NSW 2031, Australia.
| | - Alison Purcell
- The University of Sydney, Faculty of Health Sciences, Cumberland Campus C42, PO Box 170, Lidcombe, NSW 1825, Australia; Sydney Children's Hospital, Randwick, High Street, Randwick NSW 2031, Australia.
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Pedersen DA, Hageman I, Wehby GL, Christensen K. Use of Psychotropic Medications and Visits to Psychiatrists and Psychologists among Individuals with Nonsyndromic Oral Clefts: A Population-Based Cohort Study. Birth Defects Res 2017; 109:824-835. [PMID: 28402064 DOI: 10.1002/bdr2.1024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/12/2017] [Accepted: 02/04/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Oral clefts (OCs) are among the most common congenital malformations and can have a large impact on the life of the affected individual. Research findings regarding the psychological and psychosocial consequences of OC are inconclusive. METHODS Using Danish nationwide registers, we investigated redeemed prescriptions of psychotropic medication during 1996 to 2012 and visits to psychiatrists and psychologists during 1996 to 2011 among individuals born with nonsyndromic OC in Denmark between 1936 and 2009 and a comparison cohort of individuals without OC. This includes 8244 individuals with OC and 82,665 individuals without OC. RESULTS The Cox regression analysis revealed 12% (95% confidence interval [CI], 7 to 16%) increased risk of using any psychotropic medication for individuals with OC. When examining by cleft type, higher risks for medication use were observed in individuals with cleft lip and palate (CLP) or cleft palate (CP) only. The largest increased relative risk was found for use of antipsychotics and stimulants for individuals with CP followed by use of antipsychotics for individuals with CLP. We found increased risk of visits to psychiatrists for individuals with CP and no increased risk for visits to psychologists for either group. CONCLUSIONS This study indicates that a small group of individuals with nonsyndromic OC, in particular those with palatal involvement, have greater risk of using psychotropic medications. However, elevated use was also observed among younger individuals with cleft lip (CL) only. There seems to be only a modest increase in visits to health professionals for psychological reasons. Undiagnosed syndromes (e.g., 22q11 deletion syndrome), may, however, contribute to an overestimation of the associations. Birth Defects Research 109:824-835, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Dorthe Almind Pedersen
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Ida Hageman
- Psychiatric Department in Copenhagen, University of Copenhagen, Copenhagen University Hospital, Denmark
| | - George L Wehby
- Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
| | - Kaare Christensen
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense C, Denmark.,Department of Clinical Genetics, Department of Biochemistry and Pharmacology, Odense University Hospital, Odense C, Denmark
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Sharp GC, Ho K, Davies A, Stergiakouli E, Humphries K, McArdle W, Sandy J, Davey Smith G, Lewis SJ, Relton CL. Distinct DNA methylation profiles in subtypes of orofacial cleft. Clin Epigenetics 2017; 9:63. [PMID: 28603561 PMCID: PMC5465456 DOI: 10.1186/s13148-017-0362-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/26/2017] [Indexed: 11/13/2022] Open
Abstract
Background Epigenetic data could help identify risk factors for orofacial clefts, either by revealing a causal role for epigenetic mechanisms in causing clefts or by capturing information about causal genetic or environmental factors. Given the evidence that different subtypes of orofacial cleft have distinct aetiologies, we explored whether children with different cleft subtypes showed distinct epigenetic profiles. Methods In whole-blood samples from 150 children from the Cleft Collective cohort study, we measured DNA methylation at over 450,000 sites on the genome. We then carried out epigenome-wide association studies (EWAS) to test the association between methylation at each site and cleft subtype (cleft lip only (CLO) n = 50; cleft palate only (CPO) n = 50; cleft lip and palate (CLP) n = 50). We also compared methylation in the blood to methylation in the lip or palate tissue using genome-wide data from the same 150 children and conducted an EWAS of CLO compared to CLP in lip tissue. Results We found four genomic regions in blood differentially methylated in CLO compared to CLP, 17 in CPO compared to CLP and 294 in CPO compared to CLO. Several regions mapped to genes that have previously been implicated in the development of orofacial clefts (for example, TBX1, COL11A2, HOXA2, PDGFRA), and over 250 associations were novel. Methylation in blood correlated with that in lip/palate at some regions. There were 14 regions differentially methylated in the lip tissue from children with CLO and CLP, with one region (near KIAA0415) showing up in both the blood and lip EWAS. Conclusions Our finding of distinct methylation profiles in different orofacial cleft (OFC) subtypes represents a promising first step in exploring the potential role of epigenetic modifications in the aetiology of OFCs and/or as clinically useful biomarkers of OFC subtypes. Electronic supplementary material The online version of this article (doi:10.1186/s13148-017-0362-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gemma C Sharp
- MRC Integrative Epidemiology Unit, School of Oral and Dental Sciences, University of Bristol, Bristol, England
| | - Karen Ho
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Amy Davies
- School of Oral and Dental Sciences, University of Bristol, Bristol, England
| | - Evie Stergiakouli
- MRC Integrative Epidemiology Unit, School of Oral and Dental Sciences, University of Bristol, Bristol, England
| | - Kerry Humphries
- School of Oral and Dental Sciences, University of Bristol, Bristol, England
| | - Wendy McArdle
- School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Jonathan Sandy
- School of Oral and Dental Sciences, University of Bristol, Bristol, England
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Sarah J Lewis
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, England
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, Bristol, England
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Bell J, Raynes-Greenow C, Turner R, Bower C, Dodson A, Hancock K, Nassar N. School absence and its effect on school performance for children born with orofacial clefts. Birth Defects Res 2017; 109:1048-1056. [DOI: 10.1002/bdr2.1041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/23/2017] [Accepted: 04/06/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Jane Bell
- Menzies Centre for Health Policy, Sydney School of Public Health; University of Sydney; New South Wales Australia
| | | | - Robin Turner
- School of Public Health and Community Medicine; University of New South Wales; New South Wales Australia
| | - Carol Bower
- Telethon Kids Institute, Centre for Child Health Research; University of Western Australia; Australia
| | - Alan Dodson
- WA Education Department, East Perth; Western Australia Australia
| | - Kirsten Hancock
- Telethon Kids Institute, Centre for Child Health Research; University of Western Australia; Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy, Sydney School of Public Health; University of Sydney; New South Wales Australia
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Morgan AR, Bellucci CC, Coppersmith J, Linde SB, Curtis A, Albert M, O'Gara MM, Kapp-Simon K. Language Development in Children With Cleft Palate With or Without Cleft Lip Adopted From Non-English-Speaking Countries. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2017; 26:342-354. [PMID: 28329403 DOI: 10.1044/2016_ajslp-16-0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/07/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE The purpose of this study was to determine whether language skills differed between children with cleft palate or cleft lip and palate (CP±CL) who were adopted into an English-speaking home from a non-English-speaking country (late English exposure [LE]) and children with CP±CL raised from birth in an English-speaking home (early English exposure [EE]). METHOD Children (51 LE, 67 EE), ages 3;0 (years;months) to 9;0, completed the Clinical Evaluation of Language Fundamentals (CELF), Preschool Second Edition or Fourth Edition. Linear regression analysis was used to assess the impact of age of adoption and time in an English-speaking home on language skills, as measured by the CELF-P2 and CELF-4. RESULTS Children with CP±CL who were adopted scored less well on all language indices, with mean adjusted differences between LE and EE children ranging from 0.4 to 0.7 SD on the CELF index scales. Only 53% of the EE children and 57% of the LE children obtained scores above 90 on all indices. For LE children, younger age at adoption was associated with better language skills. CONCLUSION CP±CL increases risk for language delay, with the highest risk for LE children. LE children with CP±CL should receive language services soon after adoption.
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Bell JC, Raynes-Greenow C, Turner R, Bower C, Dodson A, Nicholls W, Nassar N. School performance for children with cleft lip and palate: a population-based study. Child Care Health Dev 2017; 43:222-231. [PMID: 27502161 DOI: 10.1111/cch.12388] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 07/04/2016] [Accepted: 07/04/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Educational attainment is important in shaping young people's life prospects. To investigate whether being born with orofacial cleft (OFC) affects school performance, we compared school test results between children born with and without OFC. METHODS Using record-linked datasets, we conducted a population-based cohort study of children liveborn in Western Australia 1980-2010 with a diagnosis of OFC on the Register of Developmental Anomalies, and a random sample of 6603 children born without OFC. We compared odds ratios for meeting national minimum standards in five domains (reading, numeracy, writing, spelling, grammar and punctuation), and adjusted OR (aOR) for children with cleft lip only (CLO), cleft lip and palate (CL + P) and cleft palate only (CPO) for each domain. RESULTS Results from two testing programs (WALNA and NAPLAN) were available for 3238 (89%) children expected to participate. Most met the national minimum standards. Compared with children without OFC, children with CPO were less likely to meet minimum standards for NAPLAN reading (aOR 0.57 [95%CI 0.34, 0.96]) grammar and punctuation (aOR 0.49 [95%CI 0.32, 0.76]), WALNA writing (aOR 0.66 [95%CI 0.47, 0.92]), and WALNA and NAPLAN numeracy (aOR 0.64 [95%CI 0.43, 0.95] and aOR 0.47 [95%CI 0.28, 0.82]), respectively. Children with CL + P had significantly lower odds for reaching the spelling standard in NAPLAN tests (aOR 0.52 [95%CI 0.29, 0.94]). Children with CLO had similar odds for reaching all minimum standards. CONCLUSION Children born with OFC, particularly children with CPO, should be monitored to identify learning difficulties early, to enable intervention to maximize school attainment.
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Affiliation(s)
- J C Bell
- Research Fellow, Menzies Centre for Health Policy, University of Sydney, New South Wales, Australia
| | - C Raynes-Greenow
- NHMRC Career Development Fellow, Sydney School of Public Health, University of Sydney, New South Wales, Australia
| | - R Turner
- NHMRC Career Development Fellow, School of Public Health and Community Medicine, University of New South Wales, New South Wales, Australia
| | - C Bower
- Western Australian Register of Developmental Anomalies, King Edward Memorial Hospital, Subiaco, Western Australia, Australia.,Senior Principal Research Fellow, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Western Australia, Australia
| | - A Dodson
- Evaluation and Accountability, WA Education Department, East Perth, Western Australia, Australia
| | - W Nicholls
- Clinical Research Associate, Cleft Lip and Palate and Craniomaxillofacial Unit, Princess Margaret Hospital, Subiaco, Western Australia, Australia
| | - N Nassar
- NHMRC Principal Research Fellow, Menzies Centre for Health Policy, University of Sydney, New South Wales, Australia
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Ma X, Li YW, Ma L, McPherson B. Chinese children with nonsyndromic cleft lip/palate: Factors associated with hearing disorder. Int J Pediatr Otorhinolaryngol 2016; 88:117-23. [PMID: 27497398 DOI: 10.1016/j.ijporl.2016.06.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This study examined the auditory status of Chinese children with nonsyndromic cleft lip/palate (NSCL/P), investigated factors associated with peripheral hearing loss and compared results with earlier studies in western countries. METHODS Case history profiles and audiological data from 148 Chinese children with NSCL/P, aged between 6 and 15 years, who attended the Cleft Lip and Palate Clinic Center in a major Chinese urban hospital from July 2012 to September 2013 were acquired. The audiological status of the participants was reviewed, based on the results of their pure tone audiometry, tympanometry and acoustic reflex thresholds assessments. Factors including age, gender, cleft type, residential locality and school achievement were examined in relation to auditory status. RESULTS Findings revealed that 17% of the Chinese children with NSCL/P had hearing impairment at the time of assessment. Unilateral hearing loss was noted in 12% of children and in 5% of cases bilateral hearing loss was noted. In the majority of cases the hearing loss was slight and conductive in nature. Age, gender, residential locality and school achievement were found to have no relationship with severity of hearing loss. Children with cleft lip showed a lower degree of hearing impairment than children with cleft palate or cleft lip and palate. CONCLUSION Similar to studies for western children, Chinese children with CL/P associated with no known syndrome are at risk of peripheral hearing loss, generally of conductive type. However, the prevalence of peripheral hearing loss appears to be less than in western children with NSCL/P. Ethnic/racial factors may be a major contributing factor accounting for the discrepancies between the current results and western studies.
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Affiliation(s)
- Xiaoran Ma
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China.
| | - Yue Wing Li
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China.
| | - Lian Ma
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Peking University, Beijing, China.
| | - Bradley McPherson
- Division of Speech and Hearing Sciences, Faculty of Education, University of Hong Kong, Hong Kong, China.
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Conrad AL, Richman L, Nopoulos P. Reading Achievement in Boys With Non-Syndromic Cleft Palate Only: Relationship to Neuropsychological Skill and Neurocircuitry. Dev Neuropsychol 2016; 40:395-406. [PMID: 26934420 DOI: 10.1080/87565641.2016.1142991] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Reading achievement and neural activation during a reading task were evaluated among boys with isolated cleft palate only (iCP) in comparison to unaffected controls. Ten boys with iCP and 10 unaffected boys between the ages of 8 and 16 years old were assessed. Standardized assessments of intelligence and reading achievement were administered and participants underwent a block-design functional magnetic resonance imaging protocol using non-word rhyming and judgment of line tasks. Among the 10 boys with iCP, reading fluency correlated with phonological awareness and visual memory. Neural activation was increased in regions of the brain associated with a non-fluent/dyslexic reading pattern.
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Affiliation(s)
- Amy L Conrad
- a Stead Family Department of Pediatrics , University of Iowa Children's Hospital , Iowa City , Iowa
| | - Lynn Richman
- a Stead Family Department of Pediatrics , University of Iowa Children's Hospital , Iowa City , Iowa
| | - Peggy Nopoulos
- b Department of Psychiatry , University of Iowa College of Medicine , Iowa City , Iowa
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