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Sun B, Wallace ER, Ni Y, Loftus CT, Szpiro A, Day D, Barrett ES, Nguyen RHN, Kannan K, Robinson M, Bush NR, Sathyanarayana S, Mason A, Swan SH, Trasande L, Karr CJ, LeWinn KZ. Prenatal exposure to polycyclic aromatic hydrocarbons and cognition in early childhood. Environ Int 2023; 178:108009. [PMID: 37331181 PMCID: PMC10519343 DOI: 10.1016/j.envint.2023.108009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Epidemiological evidence for gestational polycyclic aromatic hydrocarbon (PAH) exposure and adverse child cognitive outcomes is mixed; little is known about critical windows of exposure. OBJECTIVE We investigated associations between prenatal PAH exposure and child cognition in a large, multi-site study. METHODS We included mother-child dyads from two pooled prospective pregnancy cohorts (CANDLE and TIDES, N = 1,223) in the ECHO-PATHWAYS Consortium. Seven urinary mono-hydroxylated PAH metabolites were measured in mid-pregnancy in both cohorts as well as early and late pregnancy in TIDES. Child intelligence quotient (IQ) was assessed between ages 4-6. Associations between individual PAH metabolites and IQ were estimated with multivariable linear regression. Interaction terms were used to examine effect modification by child sex and maternal obesity. We explored associations of PAH metabolite mixtures with IQ using weighted quantile sum regression. In TIDES, we averaged PAH metabolites over three periods of pregnancy and by pregnancy period to investigate associations between PAH metabolites and IQ. RESULTS In the combined sample, PAH metabolites were not associated with IQ after full adjustment, nor did we observe associations with PAH mixtures. Tests of effect modification were null except for the association between 2-hydroxynaphthalene and IQ, which was negative in males (βmales = -0.67 [95%CI:-1.47,0.13]) and positive in females (βfemales = 0.31 [95%CI:-0.52,1.13])(pinteraction = 0.04). In analyses across pregnancy (TIDES-only), inverse associations with IQ were observed for 2-hydroxyphenanthrene averaged across pregnancy (β = -1.28 [95%CI:-2.53,-0.03]) and in early pregnancy (β = -1.14 [95%CI:-2.00,-0.28]). SIGNIFICANCE In this multi-cohort analysis, we observed limited evidence of adverse associations of early pregnancy PAHs with child IQ. Analyses in the pooled cohorts were null. However, results also indicated that utilizing more than one exposure measures across pregnancy could improve the ability to detect associations by identifying sensitive windows and improving the reliability of exposure measurement. More research with multiple timepoints of PAH assessment is warranted.
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Affiliation(s)
- Bob Sun
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Erin R Wallace
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Yu Ni
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Adam Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Drew Day
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Emily S Barrett
- Department of Biostatistics and Epidemiology, Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ruby H N Nguyen
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Morgan Robinson
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Shanna H Swan
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Leonardo Trasande
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Wallace ER, Buth E, Szpiro AA, Ni Y, Loftus CT, Masterson E, Day DB, Sun BZ, Sullivan A, Barrett E, Nguyen RH, Robinson M, Kannan K, Mason A, Sathyanarayana S, LeWinn KZ, Bush NR, Karr CJ. Prenatal exposure to polycyclic aromatic hydrocarbons is not associated with behavior problems in preschool and early school-aged children: A prospective multi-cohort study. Environ Res 2023; 216:114759. [PMID: 36370819 PMCID: PMC9817935 DOI: 10.1016/j.envres.2022.114759] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Epidemiological study findings are inconsistent regarding associations between prenatal polycyclic aromatic hydrocarbon (PAH) exposures and childhood behavior. This study examined associations of prenatal PAH exposure with behavior at age 4-6 years in a large, diverse, multi-region prospective cohort. Secondary aims included examination of PAH mixtures and effect modification by child sex, breastfeeding, and child neighborhood opportunity. METHODS The ECHO PATHWAYS Consortium pooled 1118 mother-child dyads from three prospective pregnancy cohorts in six U.S. cities. Seven PAH metabolites were measured in prenatal urine. Child behavior was assessed at age 4-6 using the Total Problems score from the Child Behavior Checklist (CBCL). Neighborhood opportunity was assessed using the socioeconomic and educational scales of the Child Opportunity Index. Multivariable linear regression was used to estimate associations per 2-fold increase in each PAH metabolite, adjusted for demographic, prenatal, and maternal factors and using interaction terms for effect modifiers. Associations with PAH mixtures were estimated using Weighted Quantile Sum Regression (WQSR). RESULTS The sample was racially and sociodemographically diverse (38% Black, 49% White, 7% Other; household-adjusted income range $2651-$221,102). In fully adjusted models, each 2-fold increase in 2-hydroxynaphthalene was associated with a lower Total Problems score, contrary to hypotheses (b = -0.80, 95% CI = -1.51, -0.08). Associations were notable in boys (b = -1.10, 95% CI = -2.11, -0.08) and among children breastfed 6+ months (b = -1.31, 95% CI = -2.25, -0.37), although there was no statistically significant evidence for interaction by child sex, breastfeeding, or neighborhood child opportunity. Associations were null for other PAH metabolites; there was no evidence of associations with PAH mixtures from WQSR. CONCLUSION In this large, well-characterized, prospective study of mother-child pairs, prenatal PAH exposure was not associated with child behavior problems. Future studies characterizing the magnitude of prenatal PAH exposure and studies in older childhood are needed.
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Affiliation(s)
- Erin R Wallace
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Erin Buth
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Yu Ni
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Erin Masterson
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Drew B Day
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Bob Z Sun
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Alexis Sullivan
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Emily Barrett
- Department of Biostatistics and Epidemiology, Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Ruby Hn Nguyen
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA
| | - Morgan Robinson
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY, 10016, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY, 10016, USA
| | - Alex Mason
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Nicole R Bush
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA; Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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Loftus CT, Szpiro AA, Workman T, Wallace ER, Hazlehurst MF, Day DB, Ni Y, Carroll KN, Adgent MA, Moore PE, Barrett ES, Nguyen RHN, Kannan K, Robinson M, Masterson EE, Tylavsky FA, Bush NR, LeWinn KZ, Sathyanarayana S, Karr CJ. Maternal exposure to urinary polycyclic aromatic hydrocarbons (PAH) in pregnancy and childhood asthma in a pooled multi-cohort study. Environ Int 2022; 170:107494. [PMID: 36279735 PMCID: PMC9810359 DOI: 10.1016/j.envint.2022.107494] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND Prenatal exposure to polycyclic aromatic hydrocarbons (PAH) may increase risk of pediatric asthma, but existing human studies are limited. OBJECTIVES We estimated associations between gestational PAHs and pediatric asthma in a diverse US sample and evaluated effect modification by child sex, maternal asthma, and prenatal vitamin D status. METHODS We pooled two prospective pregnancy cohorts in the ECHO PATHWAYS Consortium, CANDLE and TIDES, for an analytic sample of N = 1296 mother-child dyads. Mono-hydroxylated PAH metabolites (OH-PAHs) were measured in mid-pregnancy urine. Mothers completed the International Study on Allergies and Asthma in Childhood survey at child age 4-6 years. Poisson regression with robust standard errors was used to estimate relative risk of current wheeze, current asthma, ever asthma, and strict asthma associated with each metabolite, adjusted for potential confounders. We used interaction models to assess effect modification. We explored associations between OH-PAH mixtures and outcomes using logistic weighted quantile sum regression augmented by a permutation test to control Type 1 errors. RESULTS The sociodemographically diverse sample spanned five cities. Mean (SD) child age at assessment was 4.4 (0.4) years. While there was little evidence that either individual OH-PAHs or mixtures were associated with outcomes, we observed effect modification by child sex for most pairs of OH-PAHs and outcomes, with adverse associations specific to females. For example, a 2-fold increase in 2-hydroxy-phenanthrene was associated with current asthma in females but not males (RRfemale = 1.29 [95 % CI: 1.09, 1.52], RRmale = 0.95 [95 % CI: 0.79, 1.13]; pinteraction = 0.004). There was no consistent evidence of modification by vitamin D status or maternal asthma. DISCUSSION This analysis, the largest cohort study of gestational PAH exposure and childhood asthma to date, suggests adverse associations for females only. These preliminary findings are consistent with hypothesized endocrine disruption properties of PAHs, which may lead to sexually dimorphic effects.
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Affiliation(s)
- Christine T Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Adam A Szpiro
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Tomomi Workman
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Erin R Wallace
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Marnie F Hazlehurst
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Drew B Day
- Department of Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Yu Ni
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Kecia N Carroll
- Department of Pediatrics, Department of Environmental Medicine & Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret A Adgent
- Department of Pediatrics, College of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Paul E Moore
- Division of Allergy, Immunology, and Pulmonology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily S Barrett
- Department of Epidemiology, Environmental and Occupational Health Sciences Institute, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Ruby H N Nguyen
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics, Department of Environmental Medicine, New York University School of Medicine, New York City, NY, USA
| | - Morgan Robinson
- Department of Pediatrics, Department of Environmental Medicine, New York University School of Medicine, New York City, NY, USA
| | - Erin E Masterson
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Frances A Tylavsky
- Department of Preventive Medicine, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nicole R Bush
- Department of Psychiatry and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry and Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Sheela Sathyanarayana
- Department of Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, School of Medicine, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Catherine J Karr
- Department of Pediatrics, School of Medicine, Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
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Wallace ER, Ni Y, Loftus CT, Sullivan A, Masterson E, Szpiro AA, Day DB, Robinson M, Kannan K, Tylavsky FA, Sathyanarayana S, Bush NR, LeWinn KZ, Karr CJ. Prenatal urinary metabolites of polycyclic aromatic hydrocarbons and toddler cognition, language, and behavior. Environ Int 2022; 159:107039. [PMID: 34902794 PMCID: PMC8748410 DOI: 10.1016/j.envint.2021.107039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 05/06/2023]
Abstract
BACKGROUND Animal and epidemiological studies suggest that prenatal exposure to polycyclic aromatic hydrocarbons (PAHs) may negatively impact toddler neurodevelopment. METHODS We investigated this association in 835 mother-child pairs from CANDLE, a diverse pregnancy cohort in the mid-South region of the U.S. PAH metabolite concentrations were measured in mid-pregnancy maternal urine. Cognitive and Language composite scores at ages 2 and 3 years were derived from the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3). Behavior Problem and Competence scores at age 2 were derived from the Brief Infant and Toddler Social Emotional Assessment (BITSEA). We used multivariate linear or Poisson regression to estimate associations with continuous scores and relative risks (RR) of neurodevelopment delay or behavior problems per 2-fold increase in PAH, adjusted for maternal health, nutrition, and socioeconomic status. Secondary analyses investigated associations with PAH mixture using Weighted Quantile Sum Regression (WQS) with a permutation test extension. RESULTS 1- hydroxypyrene was associated with elevated relative risk for Neurodevelopmental Delay at age 2 (RR = 1.20, 95% CI: 1.03,1.39). Contrary to hypotheses, 1-hydroxynaphthalene was associated with lower risk for Behavior Problems at age 2 (RR = 0.90, 95% CI: 0.83,0.98), and combined 1- and 9-hydroxyphenanthrene was associated with 0.52-point higher (95% CI: 0.11,0.93) Cognitive score at age 3. For PAH mixtures, a quintile increase in hydroxy-PAH mixture was associated with lower Language score at age 2 (βwqs = -1.59; 95% CI: -2.84, -0.34; ppermutation = 0.07) and higher Cognitive score at age 3 (βwqs = 0.96; 95% CI: 0.11, 1.82; ppermutation = 0.05). All other estimates were consistent with null associations. CONCLUSION In this large southern U.S. population we observed some support for adverse associations between PAHs and neurodevelopment.
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Affiliation(s)
- Erin R Wallace
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA.
| | - Yu Ni
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Christine T Loftus
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Alexis Sullivan
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Erin Masterson
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA
| | - Adam A Szpiro
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Drew B Day
- Seattle Children's Research Institute, Seattle, WA, USA
| | - Morgan Robinson
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Kurunthachalam Kannan
- Department of Pediatrics and Department of Environmental Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - Fran A Tylavsky
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sheela Sathyanarayana
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Nicole R Bush
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, USA; Department of Pediatrics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Kaja Z LeWinn
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Catherine J Karr
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, WA, USA; Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
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Abstract
PURPOSE To examine differences in community participation and environmental support for youth with and without craniofacial microsomia. METHODS This study involved secondary analyses of a subset of data (n = 396) from a longitudinal cohort study. Multiple linear and Poisson regression analyses and Wilcoxon Mann-Whitney tests were used to estimate differences in community participation and environmental support between youth with craniofacial microsomia and youth without craniofacial microsomia, stratified based on their history of education and health-related service use. Chi-square analyses were used to explore item-level group differences in change desired across community activities. RESULTS Statistically significant differences were found in community participation frequency (ES = -0.52; p < 0.001), level of involvement (r = -0.16; p = 0.010), and desire for change in participation when comparing youth with craniofacial microsomia and non-affected peers not receiving services (p < 0.001). There were no statistically significant differences between youth with craniofacial microsomia and non-affected peers receiving services. CONCLUSIONS Results suggest lower community participation in youth with craniofacial microsomia as compared to non-affected peers not receiving services. This may suggest opportunities for designing and testing interventions to promote community participation among youth with craniofacial microsomia, so as to support their transition to adulthood.Implications for rehabilitationYouth with craniofacial microsomia may have unmet rehabilitation needs related to their community participation.Rehabilitation professionals should pay attention to participation of youth with craniofacial microsomia in activities that place a higher demand on involvement with others.Rehabilitation professionals should appraise participation frequency and involvement of youths with craniofacial microsomia to gain accurate insight into their current community participation.
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Affiliation(s)
- Vera C. Kaelin
- Rehabilitation Sciences, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA
| | - Erin R. Wallace
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, USA
| | - Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Brent R. Collett
- Child Psychiatry at Seattle Children’s Hospital and Departments of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
| | - Mary A. Khetani
- Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, USA.,CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Canada.,Corresponding Author: Mary A. Khetani, ScD, OTR/L, Department of Occupational Therapy, University of Illinois at Chicago, 1919 West Taylor Street, Room 316A, Chicago, IL 60612-7250 Telephone: +1 312-996-0942, Fax: +1 312-413-0256,
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Kaelin VC, Wallace ER, Werler MM, Collett BR, Rosenberg J, Khetani MA. Caregiver Perspectives on School Participation Among Students With Craniofacial Microsomia. Am J Occup Ther 2021; 75:7502205100p1-7502205100p10. [PMID: 33657352 PMCID: PMC7929606 DOI: 10.5014/ajot.2021.041277] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Importance: Knowledge of unmet school participation needs for students with craniofacial microsomia (CFM) can inform decisions regarding intervention support. Objective: To compare students with and without CFM on school participation (i.e., frequency, involvement, desire for participation to change) and caregivers’ perceptions of environmental support for participation in occupations. Design: Cross-sectional design using secondary analyses of a subset of data. Setting: Multisite cohort study. Participants: Caregivers of students with CFM (n = 120) and of students without CFM (n = 315), stratified by history of education- and health-related service use. Outcomes and Measures: School participation and environmental support, obtained with the Participation and Environment Measure–Children and Youth. Results: Significant group differences were found in frequency of school participation (effect size [ES] = −0.38, 95% confidence interval [−0.64, −0.12], p = .005), level of involvement (ES = −0.14, p = .029), and desired change (p = .001), with students with CFM exhibiting greater participation restriction than students without CFM and no history of service use. No statistically significant group differences were found in environmental support for participation in the school setting. Item-level findings showed statistically significant higher desire for participation to change in three of five school occupations (odds ratio = 1.77–2.39, p = .003–.045) for students with CFM compared with students without CFM and no history of service use. Conclusions and Relevance: The results suggest that students with CFM experience restriction in participation at school. What This Article Adds: Students with CFM may benefit from targeted school-based interventions to optimize their inclusion.
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Affiliation(s)
- Vera C Kaelin
- Vera C. Kaelin, MScOT, is PhD Student and Graduate Research Assistant, Program in Rehabilitation Sciences, University of Illinois at Chicago
| | - Erin R Wallace
- Erin R. Wallace, PhD, is Research Consultant, Department of Occupational and Environmental Health Sciences, University of Washington, Seattle. At the time this research was conducted, Wallace was Clinical Research Scientist, Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA
| | - Martha M Werler
- Martha M. Werler, DSc, is Professor, Department of Epidemiology, School of Public Health, Boston University, Boston, MA
| | - Brent R Collett
- Brent R. Collett, PhD, is Associate Professor, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle
| | - Janine Rosenberg
- Janine Rosenberg, PhD, is Pediatric Psychologist, Department of Psychiatry and Surgery, University of Illinois Hospital and Health Science System, Chicago, IL
| | - Mary A Khetani
- Mary A. Khetani, ScD, is Associate Professor, Department of Occupational Therapy, College of Applied Health Sciences and Program in Rehabilitation Sciences, University of Illinois at Chicago, and Research Scientist, CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada;
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Collett BR, Wallace ER, Ola C, Kartin D, Cunningham ML, Speltz ML. Do Infant Motor Skills Mediate the Association Between Positional Plagiocephaly/Brachycephaly and Cognition in School-Aged Children? Phys Ther 2020; 101:6041454. [PMID: 33340327 PMCID: PMC8525193 DOI: 10.1093/ptj/pzaa214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/26/2020] [Accepted: 11/02/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Positional plagiocephaly/brachycephaly (PPB) is associated with lower cognitive scores in school-aged children. This study tested the hypothesis that infant motor skills mediate this association. METHODS Children with a history of PPB (cases, n = 187) and without PPB (controls, n = 149) were followed from infancy through approximately 9 years of age. Infant motor skills were assessed using the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-3), and cognition was assessed using the Differential Ability Scales, 2nd edition (DAS-2). The Bayley-3 motor composite was examined as a mediator of the association between PPB and DAS-2 general cognitive ability (GCA) scores. In secondary analyses, mediation models were examined for the DAS-2 verbal ability, nonverbal ability, and working memory scores; models using the Bayley-3 fine versus gross motor scores also were examined. RESULTS Cases scored lower than controls on the DAS-GCA (β = -4.6; 95% CI = -7.2 to -2.0), with an indirect (mediated) effect of β = -1.5 (95% CI = -2.6 to -0.4) and direct effect of β = -3.1 (95% CI = -5.7 to -0.5). Infant motor skills accounted for approximately 33% of the case-control difference in DAS-2 GCA scores. Results were similar for other DAS-2 outcomes. Evidence of mediation was greater for Bayley-3 gross motor versus fine motor scores. CONCLUSION Infant motor skills partially mediate the association between PPB and cognition in school-aged children. Monitoring motor development and providing intervention as needed may help offset associated developmental concerns for children with PPB. IMPACT To our knowledge, this study is the first longitudinal investigation of the development of children with and without PPB from infancy through the early school years and the first to examine motor skills as a mediator of cognitive outcomes in this population. The findings highlight the importance of early motor skills for other developmental outcomes. LAY SUMMARY Infants' motor skills are related to the development of PPB and its association with later cognition. If your child has PPB, physical therapists may have an important role in assessing and providing treatment to promote motor development.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA,Address all correspondence to Dr Collett at:
| | - Erin R Wallace
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA
| | - Cindy Ola
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA 98101, USA
| | - Deborah Kartin
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Michael L Cunningham
- Department of Pediatrics, University of Washington, Seattle Children’s Craniofacial Center, Seattle, Washington, USA
| | - Matthew L Speltz
- Department of Pediatrics, University of Washington, Seattle Children’s Craniofacial Center, Seattle, Washington, USA
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Collett BR, Wallace ER, Kapp-Simon KA, Johns AL, Drake AF, Heike CL, Kinter S, Luquetti DV, Magee L, Norton S, Sie K, Speltz ML. Cognitive, Motor, and Language Development of Preschool Children With Craniofacial Microsomia. Cleft Palate Craniofac J 2020; 58:1169-1177. [PMID: 33322943 DOI: 10.1177/1055665620980223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To examine neurodevelopment in preschool-aged children with craniofacial microsomia (CFM) relative to unaffected peers. DESIGN Multisite, longitudinal cohort study. SETTING Tertiary care centers in the United States. PARTICIPANTS We included 92 children with CFM ("cases") through craniofacial centers and clinics. Seventy-six children without CFM (controls) were included from pediatric practices and community advertisements. This study reports on outcomes assessed when participants were an average age of 38.4 months (SD = 1.9). MAIN OUTCOME MEASURES We assessed cognitive and motor skills using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III), and language function using subtests from the Clinical Evaluation of Language Fundamentals-Preschool, second edition (CELF-P2). RESULTS Case-control differences were negligible for Bayley-III cognitive (effect sizes [ES] = -0.06, P = .72) and motor outcomes (ES = -0.19, P = .25). Cases scored lower than controls on most scales of the CELF-P2 (ES = -0.58 to -0.20, P = .01 to .26). Frequency counts for "developmental delay" (ie, one or more scores > 1 SD below the normative mean) were higher for cases (39%) than controls (15%); however, the adjusted odds ratio = 1.73 (P = 0.21) was not significant. Case-control differences were most evident in children with microtia or other combinations of CFM-related facial features. CONCLUSIONS Cognitive and motor scores were similar for preschool-aged children with and without CFM. However, children with CFM scored lower than controls on language measures. We recommend early monitoring of language to identify preschoolers with CFM who could benefit from intervention.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, 7284University of Washington, Seattle, WA, USA
| | - Erin R Wallace
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Kathleen A Kapp-Simon
- Department of Surgery, University of Illinois at Chicago and 24183Shriners Hospitals for Children, Chicago, IL, USA
| | - Alexis L Johns
- Clinical Pediatrics, 5150Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Amelia F Drake
- Department of Otolaryngology/Head and Neck Surgery, 2331University of North Carolina, Chapel Hill, NC, USA
| | - Carrie L Heike
- Division of Craniofacial Medicine, Department of Pediatrics, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Sara Kinter
- Seattle Children's Craniofacial Center, Seattle, WA, USA
| | - Daniela V Luquetti
- Division of Craniofacial Medicine, Department of Pediatrics, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- Department of Otolaryngology, 7284University of Washington, Seattle, WA, USA
| | - Kathleen Sie
- Department of Otolaryngology, 7284University of Washington, Seattle, WA, USA
| | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, 7284University of Washington, Seattle, WA, USA
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Johns AL, Wallace ER, Collett BR, Kapp-Simon KA, Drake AF, Heike CL, Kinter SL, Luquetti DV, Magee L, Norton S, Sie K, Speltz ML. Behavioral Adjustment of Preschool Children With and Without Craniofacial Microsomia. Cleft Palate Craniofac J 2020; 58:42-53. [PMID: 32783465 DOI: 10.1177/1055665620947987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The study aim was to assess behavioral adjustment in preschool children with and without craniofacial microsomia (CFM). DESIGN Multisite cohort study of preschoolers with CFM ("cases") or without CFM ("controls"). PARTICIPANTS Mothers (89%), fathers (9%), and other caregivers (2%) of 161 preschoolers. OUTCOME MEASURE Child Behavior Check List (CBCL 1.5-5); linear regressions with standardized effect sizes (ES) adjusted for sociodemographic confounds. RESULTS Child Behavior Check Lists for 89 cases and 72 controls (average age 38.3 ± 1.9 months). Children were male (54%), white (69%), and of Latino ethnicity (47%). Cases had microtia with mandibular hypoplasia (52%), microtia only (30%), or other CFM-associated features (18%). Nearly 20% of cases had extracranial anomalies. Composite CBCL scores were in the average range compared to test norms and similar for cases and controls. On the subscales, cases' parents reported higher Anxious/Depressed scores (ES = 0.35, P = .04), Stress Problems (ES = 0.40, P = .04), Anxiety Problems (ES = 0.34, P = .04), and Autism Spectrum Problems (ES = 0.41, P = .02); however, the autism subscale primarily reflected speech concerns. Among cases, more problems were reported for children with extracranial anomalies and certain phenotypic categories with small ES. CONCLUSIONS Behavioral adjustment of preschoolers with CFM was comparable to peers. However, parental reports reflected greater concern for internalizing behaviors; thus, anxiety screening and interventions may benefit children with CFM. Among cases, more problems were reported for those with more complex presentations of CFM. Craniofacial microsomia-related speech problems should be distinguished from associated psychosocial symptoms during developmental evaluations.
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Affiliation(s)
- Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, 5150Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Erin R Wallace
- Center for Child Health, Behavior, and Development, 145793Seattle Children's Research Institute, Seattle, WA, USA
| | - Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kathleen A Kapp-Simon
- Department of Surgery, University of Illinois at Chicago, Chicago, IL, USA.,24183Shriners Hospitals for Children, Chicago, IL, USA
| | - Amelia F Drake
- Otolaryngology, 2331University of North Carolina, Chapel Hill, NC, USA
| | - Carrie L Heike
- Craniofacial Center, 7274Seattle Children's Hospital, Seattle, WA, USA
| | - Sara L Kinter
- Pediatrics, University of Washington, Seattle, WA, USA
| | | | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- Department of Otolaryngology, University of Washington, Seattle, WA, USA
| | - Kathleen Sie
- Department of Otolaryngology, University of Washington, Seattle, WA, USA
| | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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10
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Wallace ER, Ola C, Leroux BG, Speltz ML, Collett BR. Prediction of school-age IQ, academic achievement, and motor skills in children with positional plagiocephaly. Paediatr Child Health 2020; 26:e132-e137. [PMID: 33936342 DOI: 10.1093/pch/pxaa012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/20/2019] [Indexed: 11/14/2022] Open
Abstract
Introduction Children with positional plagiocephaly and/or brachycephaly (PPB) are at risk of early developmental delay, but little is known about early life factors associated with school-age neurodevelopment. This study examined associations of demographic characteristics, prenatal risk factors and early neurodevelopment assessment with school-age IQ, academic performance, and motor development in children with PPB. Methods The study sample consisted of 235 school-age children with PPB followed since infancy. Outcome measures included IQ using the Differential Ability Scales-Second Edition, academic achievement as measured by the Wechsler Individualized Achievement Tests-Third Edition), and motor function using the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition. Linear regression was used to examine the incremental improvement of model fit of demographics, prenatal and early life characteristics, severity of PPB, and neurodevelopment at ages 7, 18, and 36 months as measured by the Bayley-3 on school-age scores. Results Mean age at school-age assessment was 9.0 years. Adjusted r2 for demographic, prenatal, and early life risk factors ranged from 0.10 to 0.22. Addition of PPB severity and Bayley-3 measures at ages 7 and 18 months did not meaningfully change model fit. Adjusted r2 after inclusion of Bayley-3 at 36 months ranged from 0.35 to 0.41. Conclusion This study suggests that PPB severity and very early life neurodevelopment have little association with school-age neurodevelopment above and beyond demographic and early life risk factors. However, preschool-age neurodevelopmental assessment may still be useful in identifying children with PPB at risk for delay and who may benefit from early intervention.
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Affiliation(s)
- Erin R Wallace
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Cindy Ola
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Brian G Leroux
- Department of Biostatistics, University of Washington School of Dentistry, Seattle, Washington, USA
| | - Matthew L Speltz
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Brent R Collett
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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Abstract
OBJECTIVE To determine whether children with a history of positional plagiocephaly/brachycephaly (PPB) show persistent deficits in motor development. METHODS In a longitudinal cohort study, we completed follow-up assessments with 187 school-aged children with PPB and 149 participants without PPB who were originally enrolled in infancy. Primary outcomes were the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2) composite scores. RESULTS Children with PPB scored lower than controls on the BOT-2. Stratified analyses indicated that differences were restricted to children who had moderate-severe PPB. No consistent differences were observed in children who had mild PPB. CONCLUSION Children who had moderate-severe PPB in infancy show persistent differences in motor function. We suggest close developmental monitoring and early intervention to address motor deficits.
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Affiliation(s)
- Brent R Collett
- Center for Child Health, Behavior, and Development (Drs Collett, Wallace, and Speltz), Seattle Children's Research Institute, Seattle, Washington; Departments of Psychiatry and Behavioral Sciences (Drs Collett and Speltz), Rehabilitation Medicine (Dr Kartin), and Pediatrics (Dr Cunningham), University of Washington, Seattle, Washington; Seattle Children's Craniofacial Center (Dr Cunningham), Seattle, Washington
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12
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Collett BR, Chapman K, Wallace ER, Kinter SL, Heike CL, Speltz ML, Werler M. Speech, Language, and Communication Skills of Adolescents With Craniofacial Microsomia. Am J Speech Lang Pathol 2019; 28:1571-1581. [PMID: 31580699 PMCID: PMC7251598 DOI: 10.1044/2019_ajslp-19-0089] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 06/10/2023]
Abstract
Purpose Youth with craniofacial microsomia (CFM) have anomalies and comorbidities that increase their risk for speech, language, and communication deficits. We examined these outcomes in youth with and without CFM and explored differences as a function of CFM phenotype and hearing status. Method Participants included youth ages 11-17 years with CFM (n = 107) and demographically similar controls (n = 306). We assessed speech intelligibility, articulation, receptive and expressive language, and parent and teacher report measures of communication. Hearing status was also screened at the study visit. Group differences were estimated using linear regression analyses with standardized effect sizes (ES) adjusted for demographic characteristics (adjusted ES) or negative binomial regression. Results Youth with CFM scored lower than unaffected peers on most measures of intelligibility, articulation, expressive language, and parent- and-teacher-rated communication. Differences were most pronounced among participants with CFM who had mandibular hypoplasia plus microtia (adjusted ES = -1.15 to -0.18). Group differences were larger in youth with CFM who failed the hearing screen (adjusted ES = -0.73 to 0.07) than in those who passed the hearing screen (adjusted ES = -0.34 to 0.27). Conclusions Youth with CFM, particularly those with mandibular hypoplasia plus microtia and/or hearing loss, should be closely monitored for speech and language concerns. Further research is needed to identify the specific needs of youth with CFM as well as to document the course of speech and language development in children with CFM.
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Affiliation(s)
- Brent R Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
| | - Kathy Chapman
- Department of Communication Sciences and Disorders, University of Utah, Salt Lake City
| | - Erin R Wallace
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
| | | | | | - Matthew L Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, WA
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13
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Abstract
UNLABELLED : media-1vid110.1542/5972296741001PEDS-VA_2018-2373Video Abstract BACKGROUND: Studies have revealed an association between positional plagiocephaly and/or brachycephaly (PPB) and development, although little is known about long-term outcomes. We examined cognition and academic achievement in children with and without PPB, testing the hypothesis that children who had PPB as infants would score lower than controls. METHODS We enrolled 187 school-aged children with a history of PPB and 149 controls. Exposures were the presence or absence and severity of infancy PPB (mild, moderate to severe). Cognitive and academic outcomes were assessed by using the Differential Ability Scales, Second Edition and Wechsler Individual Achievement Test, Third Edition, respectively. RESULTS Children with PPB scored lower than controls on most scales of the Differential Ability Scales, Second Edition (standardized effect sizes [ESs] = -0.38 to -0.20) and the Wechsler Individual Achievement Test, Third Edition (ESs = -0.22 to -0.17). Analyses by PPB severity revealed meaningful differences among children with moderate to severe PPB (ESs = -0.47 to -0.23 for 8 of 9 outcomes), but few differences in children with mild PPB (ESs = -0.28 to 0.14). CONCLUSIONS School-aged children with moderate to severe PPB scored lower than controls on cognitive and academic measures; associations were negligible among children with mild PPB. The findings do not necessarily imply that these associations are causal; rather, PPB may serve as a marker of developmental risk. Our findings suggest a role for assessing PPB severity in clinical practice: providing developmental assessment and intervention for infants with more severe deformation and reassurance and anticipatory guidance for patients with mild deformation.
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Affiliation(s)
- Brent R. Collett
- Center for Child Health, Behavior, and Development and,Departments of Psychiatry and Behavioral Sciences
| | | | | | - Michael L. Cunningham
- Center for Developmental Biology and Regenerative Medicine, Seattle Children’s Research Institute, Seattle, Washington;,Pediatrics, School of Medicine, University of Washington, Seattle, Washington; and,Seattle Children’s Craniofacial Center, Seattle, Washington
| | - Matthew L. Speltz
- Center for Child Health, Behavior, and Development and,Departments of Psychiatry and Behavioral Sciences
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Luquetti DV, Speltz ML, Wallace ER, Siebold B, Collett BR, Drake AF, Johns AL, Kapp-Simon KA, Kinter SL, Leroux BG, Magee L, Norton S, Sie K, Heike CL. Methods and Challenges in a Cohort Study of Infants and Toddlers With Craniofacial Microsomia: The Clock Study. Cleft Palate Craniofac J 2019; 56:877-889. [PMID: 30621445 DOI: 10.1177/1055665618821014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The Craniofacial microsomia: Longitudinal Outcomes in Children pre-Kindergarten (CLOCK) study is a longitudinal cohort study of neurobehavioral outcomes in infants and toddlers with craniofacial microsomia (CFM). In this article, we review the data collection and methods used to characterize this complex condition and describe the demographic and clinical characteristics of the cohort. SETTING Craniofacial and otolaryngology clinics at 5 study sites. PARTICIPANTS Infants with CFM and unaffected infants (controls) ages 12 to 24 months were recruited from the same geographical regions and followed to age 36 to 48 months. METHODS Phenotypic, neurodevelopmental, and facial expression assessments were completed during the first and third waves of data collection (time 1 and time 3, respectively). Medical history data were taken at both of these time points and during an intermediate parent phone interview (time 2). RESULTS Our cohort includes 108 cases and 84 controls. Most cases and controls identified as white and 55% of cases and 37% of controls identified as Hispanic. Nearly all cases had microtia (95%) and 59% had mandibular hypoplasia. Cases received extensive clinical care in infancy, with 59% receiving care in a craniofacial clinic and 28% experiencing at least one surgery. Study visits were completed at a study site (92%) or at the participant's home (8%). CONCLUSIONS The CLOCK study represents an effort to overcome the challenges of characterizing the phenotypic and neurodevelopmental outcomes of CFM in a large, demographically and geographically diverse cohort.
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Affiliation(s)
- Daniela V Luquetti
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Matthew L Speltz
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Erin R Wallace
- 1 Seattle Children's Research Institute, Seattle, WA, USA
| | - Babette Siebold
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA
| | - Brent R Collett
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | | | - Kathleen A Kapp-Simon
- 6 Shriners Hospitals for Children, Chicago, IL, USA.,7 University of Illinois, Chicago, IL, USA
| | - Sara L Kinter
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA
| | - Brian G Leroux
- 8 University of Washington School of Dentistry, Seattle, WA, USA
| | - Leanne Magee
- 9 Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Susan Norton
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Kathleen Sie
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | - Carrie L Heike
- 1 Seattle Children's Research Institute, Seattle, WA, USA.,2 Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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15
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Collett BR, Wallace ER, Kartin D, Speltz ML. Infant/toddler motor skills as predictors of cognition and language in children with and without positional skull deformation. Childs Nerv Syst 2019; 35:157-163. [PMID: 30377774 PMCID: PMC6447299 DOI: 10.1007/s00381-018-3986-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To estimate associations between early motor abilities (at two age points, 7 and 18 months on average) and cognitive/language outcomes at age 3. To determine whether these associations are similar for children with and without positional plagiocephaly and/or brachycephaly (PPB). METHODS The Bayley Scales of Infant/Toddler Development 3 were given at all age points to 235 children with PPB and 167 without PPB. Linear regressions assessed longitudinal associations between fine and gross motor scales and cognition/language. Item analyses examined the contributions of specific motor skills. RESULTS Associations between 7-month motor skills and cognition/language were modest overall (effect sizes [ES] = - 0.08 to 0.10, p = .13 to .95). At 18 months, both fine and gross motor skills were associated with outcomes for children with PPB (ES = 0.21 to 0.41, p < .001 to .01), but among those without PPB, only fine motor skills were associated with outcomes (ES = 0.21 to 0.27, p < .001 to .001). CONCLUSIONS Toddlers' motor skills were associated with cognition and language at 3 years, particularly among children with PPB. Interventions targeting early motor development in infants and toddlers with PPB may have downstream benefits for other outcomes.
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Affiliation(s)
- Brent R. Collett
- Corresponding Author: Brent R. Collett, Ph.D., Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, 2001 8th Ave, CW8-6, Seattle, WA 98102,
| | - Erin R. Wallace
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
| | | | - Matthew L. Speltz
- Psychiatry and Behavioral Sciences, University of Washington, Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute
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16
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Speltz ML, Kapp-Simon KA, Johns AL, Wallace ER, Collett BR, Magee L, Leroux BG, Luquetti DV, Heike CL. Neurodevelopment of Infants with and without Craniofacial Microsomia. J Pediatr 2018; 198:226-233.e3. [PMID: 29685618 PMCID: PMC6019149 DOI: 10.1016/j.jpeds.2018.02.076] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 02/15/2018] [Accepted: 02/27/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To determine whether infant cases with craniofacial microsomia (CFM) evidence poorer neurodevelopmental status than demographically similar infants without craniofacial diagnoses ("controls"), and to examine cases' neurodevelopmental outcomes by facial phenotype and hearing status. STUDY DESIGN Multicenter, observational study of 108 cases and 84 controls aged 12-24 months. Participants were assessed by the Bayley Scales of Infant and Toddler Development-Third Edition and the Preschool Language Scales-Fifth Edition (PLS-5). Facial features were classified with the Phenotypic Assessment Tool for Craniofacial Microsomia. RESULTS After adjustment for demographic variables, there was little difference in Bayley Scales of Infant and Toddler Development-Third Edition or Preschool Language Scales-Fifth Edition outcomes between cases and controls. Estimates of mean differences ranged from -0.23 to 1.79 corresponding to standardized effect sizes of -.02 to 0.12 (P values from .30 to .88). Outcomes were better among females and those with higher socioeconomic status. Among cases, facial phenotype and hearing status showed little to no association with outcomes. Analysis of individual test scores indicated that 21% of cases and 16% of controls were developmentally delayed (OR 0.68, 95% CI 0.29-1.61). CONCLUSIONS Although learning problems have been observed in older children with CFM, we found no evidence of developmental or language delay among infants. Variation in outcomes across prior studies may reflect differences in ascertainment methods and CFM diagnostic criteria.
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Affiliation(s)
- Matthew L Speltz
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Kathleen A Kapp-Simon
- Cleft-Craniofacial Center, Shriners Hospital for Children, Chicago, IL; Craniofacial Center, Department of Surgery, University of Illinois, Chicago, IL
| | - Alexis L Johns
- Division of Plastic and Maxillofacial Surgery, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Erin R Wallace
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Brent R Collett
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA
| | - Leanne Magee
- Division of Plastic and Reconstructive Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Brian G Leroux
- University of Washington School of Dentistry, Seattle, WA
| | - Daniela V Luquetti
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA
| | - Carrie L Heike
- Centers for Child Health, Behavior and Development, Developmental Biology & Regenerative Medicine, and Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA; Craniofacial Center, Seattle Children's Hospital, Seattle, WA; Departments of Pediatrics and Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA
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17
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Hammal Z, Cohn JF, Wallace ER, Heike CL, Birgfeld CB, Oster H, Speltz ML. Facial Expressiveness in Infants With and Without Craniofacial Microsomia: Preliminary Findings. Cleft Palate Craniofac J 2018; 55:711-720. [PMID: 29377723 PMCID: PMC5936082 DOI: 10.1177/1055665617753481] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare facial expressiveness (FE) of infants with and without craniofacial macrosomia (cases and controls, respectively) and to compare phenotypic variation among cases in relation to FE. DESIGN Positive and negative affect was elicited in response to standardized emotion inductions, video recorded, and manually coded from video using the Facial Action Coding System for Infants and Young Children. SETTING Five craniofacial centers: Children's Hospital of Los Angeles, Children's Hospital of Philadelphia, Seattle Children's Hospital, University of Illinois-Chicago, and University of North Carolina-Chapel Hill. PARTICIPANTS Eighty ethnically diverse 12- to 14-month-old infants. MAIN OUTCOME MEASURES FE was measured on a frame-by-frame basis as the sum of 9 observed facial action units (AUs) representative of positive and negative affect. RESULTS FE differed between conditions intended to elicit positive and negative affect (95% confidence interval = 0.09-0.66, P = .01). FE failed to differ between cases and controls (ES = -0.16 to -0.02, P = .47 to .92). Among cases, those with and without mandibular hypoplasia showed similar levels of FE (ES = -0.38 to 0.54, P = .10 to .66). CONCLUSIONS FE varied between positive and negative affect, and cases and controls responded similarly. Null findings for case/control differences may be attributable to a lower than anticipated prevalence of nerve palsy among cases, the selection of AUs, or the use of manual coding. In future research, we will reexamine group differences using an automated, computer vision approach that can cover a broader range of facial movements and their dynamics.
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Affiliation(s)
- Zakia Hammal
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Jeffrey F. Cohn
- Robotics Institute, Carnegie Mellon University, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Carrie L. Heike
- Seattle Children’s Research Institute, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Craig B. Birgfeld
- Seattle Children’s Research Institute, Seattle, WA, USA
- Seattle Children’s Hospital, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
| | - Harriet Oster
- NYU School of Professional Studies, New York, NY, USA
| | - Matthew L. Speltz
- Seattle Children’s Research Institute, Seattle, WA, USA
- University of Washington School of Medicine, Seattle, WA, USA
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Collett BR, Leroux BG, Wallace ER, Gallagher E, Shao J, Speltz ML. Head shape at age 36 months among children with and without a history of positional skull deformation. J Neurosurg Pediatr 2018; 21:204-213. [PMID: 29303454 PMCID: PMC5832631 DOI: 10.3171/2017.7.peds16693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE In this study, the authors examined head shape through age 36 months for children with and without a history of positional plagiocephaly and/or brachycephaly (PPB). METHODS Infants with PPB (cases) were identified through a craniofacial clinic at the time of diagnosis. Infants without diagnosed PPB were identified through a participant registry. Clinician ratings of 3D cranial images were used to confirm the presence or absence of PPB. The cohort included 235 case infants (diagnosed PPB, confirmed with 3D imaging), 167 unaffected controls (no diagnosed PPB, no deformation detected), and 70 affected controls (no diagnosed PPB, discernible skull deformation). Participants were seen in infancy (age 7 months, on average) and again at ages 18 and 36 months. At each visit, automated 3D measures of skull deformation quantified posterior flattening and generated an absolute asymmetry score. The authors also used automated 2D measures to approximate overall asymmetry (approximate oblique cranial length ratio) and calculate the cephalic index. They used linear regression to compare cases to unaffected controls and to compare affected versus unaffected controls on all measures. They also calculated the proportion of children in each group with "persistent PPB," defined as one or more head shape measures above the 95th percentile relative to unaffected controls at 36 months. RESULTS Head shape became more rounded and symmetric for children with and without PPB, particularly between infancy and age 18 months. However, children with PPB continued to show greater skull deformation and asymmetry than unaffected controls at age 36 months. These differences were large in magnitude, ranging from 1 to 2 standard deviations (SDs), and in most (85.6%) of the cases, there was evidence of persistent PPB at 36 months. Similarly, although differences were more modest (i.e., 0.26-0.94 SD), affected controls continued to exhibit skull deformation on most measures relative to unaffected controls and approximately 30% had persistent PPB. Within the case group, head shape at 36 months was similar for untreated patients with PPB and for those who received helmet treatment and for patients with and without a history of torticollis. CONCLUSIONS Although head shape continues to improve, children with a history of skull deformation in infancy continue to exhibit measureable cranial flattening and asymmetry through age 36 months.
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Affiliation(s)
- Brent R. Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Brian G. Leroux
- Department of Oral Health Sciences, University of Washington, Seattle, Washington,Department of Biostatistics, University of Washington, Seattle, Washington
| | - Erin R. Wallace
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Emily Gallagher
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Jason Shao
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Matthew L. Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
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19
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Delaney JA, Yin X, Fontes JD, Wallace ER, Skinner A, Wang N, Hammill BG, Benjamin EJ, Curtis LH, Heckbert SR. Hospital and clinical care costs associated with atrial fibrillation for Medicare beneficiaries in the Cardiovascular Health Study and the Framingham Heart Study. SAGE Open Med 2018; 6:2050312118759444. [PMID: 29511541 PMCID: PMC5826000 DOI: 10.1177/2050312118759444] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/22/2018] [Indexed: 01/19/2023] Open
Abstract
Background Atrial fibrillation is increasingly prevalent as the US population ages and is associated with significant morbidity and mortality. Care for patients with atrial fibrillation can be costly, US health care costs are comparatively high, and there are few cost estimates available that incorporate detailed measurement of comorbidities and their effects on costs. Methods and Results In the Cardiovascular Health Study and the Framingham Heart Study, participants aged 65 years or older with newly diagnosed atrial fibrillation were matched on age and follow-up time to referents free of atrial fibrillation. The total clinical and hospital medical costs paid by Medicare Parts A and B (drug costs from Medicare Part D costs were not included) in the year prior to diagnosis (or matching) were compared with costs in the following year. Estimates were adjusted for other medical conditions and adjusted to 2009 dollars. In the Cardiovascular Health Study, 513 participants were diagnosed with new-onset atrial fibrillation and survived 30 days post-atrial fibrillation diagnosis, and 513 referents (as a control cohort) were identified, with a mean age of 77 years. In the Framingham Heart Study, we identified 336 participants diagnosed with atrial fibrillation, who survived 30 days post-atrial fibrillation diagnosis and matched these participants to 336 referents. We compared these new-onset atrial fibrillation participants with referents, using a difference in difference design to account for both time trends and differences between the two groups. The adjusted incremental cost for participants with atrial fibrillation, compared with referents, was US$18,060 (95% confidence interval: US$14,965-US$21,155) in the Cardiovascular Health Study and US$20,012 (95% confidence interval: US$15,057-US$24,966) in the Framingham Heart Study. The pooled estimate was US$18,601 (95% confidence interval: US$15,981-US$21,234). Conclusion Atrial fibrillation was associated with increased costs in the year after diagnosis in two community-based cohorts, even after careful accounting for age, time period, and systematically measured comorbidities.
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Affiliation(s)
- Joseph Ac Delaney
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Xiaoyan Yin
- Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, NHLBI and Boston University, Boston, MA, USA
| | | | - Erin R Wallace
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | - Na Wang
- Boston University School of Medicine, Boston, MA, USA
| | | | - Emelia J Benjamin
- Boston University School of Medicine, Boston, MA, USA.,Framingham Heart Study, NHLBI and Boston University, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | | | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington, Seattle, WA, USA
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20
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Wallace ER, Collett BR, Heike CL, Werler MM, Speltz ML. Behavioral-Social Adjustment of Adolescents with Craniofacial Microsomia. Cleft Palate Craniofac J 2018; 55:664-675. [PMID: 29356621 DOI: 10.1177/1055665617750488] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective was to assess differences in psychosocial adjustment between adolescents with and without craniofacial microsomia (CFM). DESIGN This is a case-control follow-up study in adolescents with and without CFM. SETTING Participants were originally recruited as infants from 26 cities across the United States and Canada. PARTICIPANTS Participants included 142 adolescents with CFM (cases) and 316 peers without CFM (controls), their caregivers, and their teachers. MAIN OUTCOME MEASURES Social and behavior measures from the Achenbach System of Empirically Based Assessments (ASEBA), the PedsQL: Core Version, and the Children's Communication Checklist-2nd edition (CCC-2) were used. Linear regression was used to estimate case-control differences and corresponding standardized effect sizes (ES) and 95% confidence intervals after adjustment for sociodemographic confounds. We also examined case-control differences by facial phenotype and hearing status. RESULTS The magnitude and direction of case-control differences varied across assessment and respondent, but were generally modest (ES = -0.4 to 0.02, P values ranged from .003 to .85). There was little evidence for variation in case-control differences across different facial phenotypes or as a function of hearing status. CONCLUSIONS Our results suggest that in spite of multiple risk factors, adolescents with CFM exhibit behavior problems no more frequently than their peers without CFM. Future studies of individuals with CFM should focus on resilience and social coping mechanisms, in addition to maladjustment.
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Affiliation(s)
- Erin R Wallace
- 1 Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Brent R Collett
- 1 Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA.,2 Child and Adolescent Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Carrie L Heike
- 4 Craniofacial Center, Seattle Children's Hospital, Seattle, WA, USA.,5 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Matthew L Speltz
- 1 Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, USA.,2 Child and Adolescent Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA.,3 Department of Psychiatry and Behavioral Medicine, University of Washington School of Medicine, Seattle, WA, USA
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21
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Aldridge K, Collett BR, Wallace ER, Birgfeld C, Austin JR, Yeh R, Feil M, Kapp-Simon KA, Aylward EH, Cunningham ML, Speltz ML. Structural brain differences in school-age children with and without single-suture craniosynostosis. J Neurosurg Pediatr 2017; 19:479-489. [PMID: 28156213 PMCID: PMC5642047 DOI: 10.3171/2016.9.peds16107] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Single-suture craniosynostosis (SSC), the premature fusion of a cranial suture, is characterized by dysmorphology of the craniofacial skeleton. Evidence to suggest that children with SSC are at an elevated risk of mild to moderate developmental delays and neurocognitive deficits is mounting, but the associations among premature suture fusion, neuroanatomy, and neurocognition are unexplained. The goals of this study were to determine 1) whether differences in the brain are present in young children with the 2 most common forms of SSC (sagittal and metopic) several years following surgical correction, and 2) whether the pattern of differences varies by affected suture (sagittal or metopic). Examination of differences in the brains of children with SSC several years after surgery may illuminate the growth trajectory of the brain after the potential constraint of the dysmorphic cranium has been relieved. METHODS The authors compared quantitative measures of the brain acquired from MR images obtained from children with sagittal or metopic craniosynostosis (n = 36) at 7 years of age to those obtained from a group of unaffected controls (n = 27) at the same age. The authors measured the volumes of the whole brain, cerebral cortex, cerebral white matter, cerebral cortex by lobe, and ventricles. Additionally, they measured the midsagittal area of the corpus callosum and its segments and of the cerebellar vermis and its component lobules. Measurements obtained from children with SSC and controls were compared using linear regression models. RESULTS No volume measures of the cerebrum or of the whole brain differed significantly between patients with SSC and controls (p > 0.05). However, ventricle volume was significantly increased in patients with SSC (p = 0.001), particularly in those with sagittal craniosynostosis (p < 0.001). In contrast, the area of the corpus callosum was significantly reduced in patients with metopic synostosis (p = 0.04), particularly in the posterior segments (p = 0.004). Similarly, the area of lobules VI-VII of the cerebellar vermis was reduced in patients with SSC (p = 0.03), with those with metopic craniosynostosis showing the greatest reduction (p = 0.01). CONCLUSIONS The lack of differences in overall brain size or regional differences in the size of the lobes of the cerebrum in children with metopic and sagittal synostosis suggests that the elevated risk of neurodevelopmental deficits is not likely to be associated with differences in the cerebral cortex. Instead, this study showed localized differences between sagittal and metopic craniosynostosis cases as compared with controls in the ventricles and in the midsagittal structures of the corpus callosum and the cerebellum. It remains to be tested whether these structural differences are associated with the increased risk for developmental delay and neurocognitive deficits in children with SSC.
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Affiliation(s)
- Kristina Aldridge
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri
| | - Brent R. Collett
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington,Seattle Children’s Craniofacial Center, Seattle Children’s Hospital, Seattle, Washington
| | - Erin R. Wallace
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | - Craig Birgfeld
- Seattle Children’s Craniofacial Center, Seattle Children’s Hospital, Seattle, Washington
| | - Jordan R. Austin
- Department of Pathology & Anatomical Sciences, University of Missouri School of Medicine, Columbia, Missouri
| | - Regina Yeh
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Madison Feil
- Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Kathleen A. Kapp-Simon
- Department of Surgery, Northwestern University, Chicago, Illinois,Shriner’s Hospital for Children, Chicago, Illinois
| | - Elizabeth H. Aylward
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington,Center for Integrative Brain Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Michael L. Cunningham
- Seattle Children’s Craniofacial Center, Seattle Children’s Hospital, Seattle, Washington
| | - Matthew L. Speltz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington,Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington,Seattle Children’s Craniofacial Center, Seattle Children’s Hospital, Seattle, Washington
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22
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Wallace ER, Siscovick DS, Sitlani CM, Dublin S, Mitchell P, Robbins JA, Fink HA, Cauley JA, Bůžková P, Carbone L, Chen Z, Heckbert SR. Incident atrial fibrillation and the risk of fracture in the cardiovascular health study. Osteoporos Int 2017; 28:719-725. [PMID: 27714443 PMCID: PMC5782802 DOI: 10.1007/s00198-016-3778-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/13/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED In this prospective cohort of 4462 older adults, incident atrial fibrillation (AF) was not statistically significantly associated with subsequent risk of incident fracture. INTRODUCTION AF is associated with stroke, heart failure, dementia, and death, but its association with fracture is unknown. Therefore, we examined the association of incident AF with the risk of subsequent fracture in the Cardiovascular Health Study (CHS) cohort. METHODS Of the CHS participants aged ≥65 years, 4462 were followed between 1991 and 2009, mean follow-up 8.8 years. Incident AF was identified by annual study electrocardiogram (ECG), hospital discharge diagnosis codes, or Medicare claims. Fractures of the hip, distal forearm, humerus, or pelvis were identified using hospital discharge diagnosis codes or Medicare claims. We used Cox proportional hazard models to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the association between incident AF (time-varying) and the risk of subsequent fracture. We also evaluated whether AF was associated with risk of sustaining a fall. RESULTS Crude incident fracture rate was 22.9 per 1000 person-years in participants with AF and 17.7 per 1000 person-years in participants without AF. Individuals with incident AF were not at significantly higher risk of hip fracture (adjusted HR = 1.09, 95 % CI 0.83-1.42) or fracture at any selected site (adjusted HR = 0.97, 95 % CI 0.77-1.22) or risk of sustaining a fall (adjusted HR = 1.00, 95 % CI = 0.87-1.16) compared with those without AF. CONCLUSION In this cohort of older, community-dwelling adults, incident AF was not shown to be associated with falls or hip or other fractures.
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Affiliation(s)
- E R Wallace
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, 2001 Eighth Ave, Suite 400, Seattle, WA, 98121, USA.
| | - D S Siscovick
- New York Academy of Medicine, New York, NY, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - C M Sitlani
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - S Dublin
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Group Health Cooperative, Group Health Research Institute, Seattle, WA, USA
| | - P Mitchell
- School of Nursing, University of Washington, Seattle, WA, USA
| | - J A Robbins
- University of California, Davis, Davis, CA, USA
| | - H A Fink
- Geriatric Research Education and Clinical Center, VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - J A Cauley
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - P Bůžková
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - L Carbone
- Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Z Chen
- University of Arizona, Tucson, AZ, USA
| | - S R Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Group Health Cooperative, Group Health Research Institute, Seattle, WA, USA
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Speltz ML, Collett BR, Wallace ER, Kapp-Simon K. Behavioral Adjustment of School-Age Children with and without Single-Suture Craniosynostosis. Plast Reconstr Surg 2016; 138:435-445. [DOI: 10.1097/prs.0000000000002383] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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24
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Wallace ER, Siscovick DS, Sitlani CM, Dublin S, Mitchell PH, Odden MC, Hirsch CH, Thielke S, Heckbert SR. Incident Atrial Fibrillation and Disability-Free Survival in the Cardiovascular Health Study. J Am Geriatr Soc 2016; 64:838-43. [PMID: 26926559 DOI: 10.1111/jgs.14037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess the associations between incident atrial fibrillation (AF) and disability-free survival and risk of disability. DESIGN Prospective cohort study. SETTING Cardiovascular Health Study. PARTICIPANTS Individuals aged 65 and older and enrolled in fee-for-service Medicare followed between 1991 and 2009 (MN = 4,046). Individuals with prevalent AF, activity of daily living (ADL) disability, or a history of stroke or heart failure at baseline were excluded. MEASUREMENTS Incident AF was identified according to annual study electrocardiogram, hospital discharge diagnosis, or Medicare claims. Disability-free survival was defined as survival free of ADL disability (any difficulty or inability in bathing, dressing, eating, using the toilet, walking around the home, or getting out of a bed or chair). ADLs were assessed at annual study visits or in a telephone interview. Association between incident AF and disability-free survival or risk of disability was estimated using Cox proportional hazards models. RESULTS Over an average of 7.0 years of follow-up, 660 individuals (16.3%) developed incident AF, and 3,112 (77%) became disabled or died. Incident AF was associated with shorter disability-free survival (hazard ratio (HR) for death or ADL disability = 1.71, 95% confidence interval (CI) = 1.55-1.90) and a higher risk of ADL disability (HR = 1.36, 95% CI = 1.18-1.58) than in individuals with no history of AF. This association persisted after adjustment for interim stroke and heart failure. CONCLUSION These results suggest that AF is a risk factor for shorter functional longevity in older adults, independent of other risk factors and comorbid conditions.
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Affiliation(s)
- Erin R Wallace
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Washington
| | | | - Colleen M Sitlani
- Department of Medicine, University of Washington, Seattle, Washington
| | - Sascha Dublin
- Department of Epidemiology, University of Washington, Seattle, Washington.,Group Health Research Institute, Group Health Cooperative, Seattle, Washington
| | | | - Michelle C Odden
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Calvin H Hirsch
- University of California at Davis Health System, Davis, California
| | - Stephen Thielke
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington, Seattle, Washington.,Group Health Research Institute, Group Health Cooperative, Seattle, Washington
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25
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Sinner MF, Piccini JP, Greiner MA, Walkey AJ, Wallace ER, Heckbert SR, Benjamin EJ, Curtis LH. Geographic variation in the use of catheter ablation for atrial fibrillation among Medicare beneficiaries. Am Heart J 2015; 169:775-782.e2. [PMID: 26027614 DOI: 10.1016/j.ahj.2015.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Accepted: 03/04/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Catheter ablation for atrial fibrillation is used increasingly in older patients, yet the risks and benefits are not completely understood. With such uncertainty, local medical opinion may influence catheter ablation use. METHODS In a 100% sample of Medicare beneficiaries ≥65 years who underwent catheter ablation for atrial fibrillation between January 1, 2007, and December 31, 2009, we investigated variation in use by hospital referral region (HRR) for 20,176 catheter ablation procedures. RESULTS Across 274 HRRs, median age was 71.2 years (interquartile range 70.5-71.8), a median of 98% of patients were white, and a median of 39% of patients were women. The median age-standardized prevalence of atrial fibrillation was 77.1 (69.4-84.2) per 1,000 beneficiaries; the median rate of catheter ablation was 3.5 (2.4-4.9) per 1,000 beneficiaries. We found no significant associations between the rate of catheter ablation and prevalence of atrial fibrillation (P = .99), end-of-life Medicare expenditures per capita (P = .09), or concentration of cardiologists (P = .45) but a slight association with Medicare expenditures per capita (linear regression estimate 0.016; 95% CI 0.001-0.031; P = .04). Examined HRR characteristics explained only 2% of the variation in HRR-level rates of catheter ablation (model R(2) = 0.016). CONCLUSION The rate of catheter ablation for atrial fibrillation in older patients was low, varied substantially by region, and was not associated with the prevalence of atrial fibrillation, the availability of cardiologists, or end-of-life resource use and was only slightly associated with overall Medicare expenditures per capita.
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Affiliation(s)
- Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Campus Grosshadern, Ludwig Maximilians University, Munich, Germany
| | - Jonathan P Piccini
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Melissa A Greiner
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Allan J Walkey
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Erin R Wallace
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Susan R Heckbert
- Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Emelia J Benjamin
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Lesley H Curtis
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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26
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Blum MR, Bauer DC, Collet TH, Fink HA, Cappola AR, da Costa BR, Wirth CD, Peeters RP, Åsvold BO, den Elzen WPJ, Luben RN, Imaizumi M, Bremner AP, Gogakos A, Eastell R, Kearney PM, Strotmeyer ES, Wallace ER, Hoff M, Ceresini G, Rivadeneira F, Uitterlinden AG, Stott DJ, Westendorp RGJ, Khaw KT, Langhammer A, Ferrucci L, Gussekloo J, Williams GR, Walsh JP, Jüni P, Aujesky D, Rodondi N. Subclinical thyroid dysfunction and fracture risk: a meta-analysis. JAMA 2015; 313:2055-65. [PMID: 26010634 PMCID: PMC4729304 DOI: 10.1001/jama.2015.5161] [Citation(s) in RCA: 203] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
IMPORTANCE Associations between subclinical thyroid dysfunction and fractures are unclear and clinical trials are lacking. OBJECTIVE To assess the association of subclinical thyroid dysfunction with hip, nonspine, spine, or any fractures. DATA SOURCES AND STUDY SELECTION The databases of MEDLINE and EMBASE (inception to March 26, 2015) were searched without language restrictions for prospective cohort studies with thyroid function data and subsequent fractures. DATA EXTRACTION Individual participant data were obtained from 13 prospective cohorts in the United States, Europe, Australia, and Japan. Levels of thyroid function were defined as euthyroidism (thyroid-stimulating hormone [TSH], 0.45-4.49 mIU/L), subclinical hyperthyroidism (TSH <0.45 mIU/L), and subclinical hypothyroidism (TSH ≥4.50-19.99 mIU/L) with normal thyroxine concentrations. MAIN OUTCOME AND MEASURES The primary outcome was hip fracture. Any fractures, nonspine fractures, and clinical spine fractures were secondary outcomes. RESULTS Among 70,298 participants, 4092 (5.8%) had subclinical hypothyroidism and 2219 (3.2%) had subclinical hyperthyroidism. During 762,401 person-years of follow-up, hip fracture occurred in 2975 participants (4.6%; 12 studies), any fracture in 2528 participants (9.0%; 8 studies), nonspine fracture in 2018 participants (8.4%; 8 studies), and spine fracture in 296 participants (1.3%; 6 studies). In age- and sex-adjusted analyses, the hazard ratio (HR) for subclinical hyperthyroidism vs euthyroidism was 1.36 for hip fracture (95% CI, 1.13-1.64; 146 events in 2082 participants vs 2534 in 56,471); for any fracture, HR was 1.28 (95% CI, 1.06-1.53; 121 events in 888 participants vs 2203 in 25,901); for nonspine fracture, HR was 1.16 (95% CI, 0.95-1.41; 107 events in 946 participants vs 1745 in 21,722); and for spine fracture, HR was 1.51 (95% CI, 0.93-2.45; 17 events in 732 participants vs 255 in 20,328). Lower TSH was associated with higher fracture rates: for TSH of less than 0.10 mIU/L, HR was 1.61 for hip fracture (95% CI, 1.21-2.15; 47 events in 510 participants); for any fracture, HR was 1.98 (95% CI, 1.41-2.78; 44 events in 212 participants); for nonspine fracture, HR was 1.61 (95% CI, 0.96-2.71; 32 events in 185 participants); and for spine fracture, HR was 3.57 (95% CI, 1.88-6.78; 8 events in 162 participants). Risks were similar after adjustment for other fracture risk factors. Endogenous subclinical hyperthyroidism (excluding thyroid medication users) was associated with HRs of 1.52 (95% CI, 1.19-1.93) for hip fracture, 1.42 (95% CI, 1.16-1.74) for any fracture, and 1.74 (95% CI, 1.01-2.99) for spine fracture. No association was found between subclinical hypothyroidism and fracture risk. CONCLUSIONS AND RELEVANCE Subclinical hyperthyroidism was associated with an increased risk of hip and other fractures, particularly among those with TSH levels of less than 0.10 mIU/L and those with endogenous subclinical hyperthyroidism. Further study is needed to determine whether treating subclinical hyperthyroidism can prevent fractures.
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Affiliation(s)
- Manuel R Blum
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Douglas C Bauer
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
| | - Tinh-Hai Collet
- Service of Endocrinology, Diabetes and Metabolism, University Hospital of Lausanne, Lausanne, Switzerland
| | - Howard A Fink
- Department of Medicine, University of Minnesota School of Medicine, Minneapolis5Geriatric Research Education and Clinical Center, VA Medical Center, Minneapolis, Minnesota
| | - Anne R Cappola
- University of Pennsylvania School of Medicine, Philadelphia7Associate Editor, JAMA
| | - Bruno R da Costa
- Department of Physical Therapy, Nicole Wertheim College of Nursing and Health Science, Florida International University, Miami
| | - Christina D Wirth
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands10Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bjørn O Åsvold
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway12Department of Endocrinology, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Wendy P J den Elzen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Robert N Luben
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Misa Imaizumi
- Radiation Effects Research Foundation, Nagasaki, Japan
| | - Alexandra P Bremner
- School of Population Health, University of Western Australia, Crawley, WA, Australia
| | - Apostolos Gogakos
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Richard Eastell
- Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Elsa S Strotmeyer
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Erin R Wallace
- Cardiovascular Health Research Unit, University of Washington, Seattle
| | - Mari Hoff
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway22Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Graziano Ceresini
- Department of Clinical and Experimental Medicine, Geriatric Endocrine Unit, University Hospital of Parma, Parma, Italy
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands10Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands10Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | | | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Arnuf Langhammer
- Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of Health, Baltimore, Maryland
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Graham R Williams
- Department of Medicine, Imperial College London, London, United Kingdom
| | - John P Walsh
- School of Medicine and Pharmacology, University of Western Australia, Crawley, WA, Australia28Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Peter Jüni
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
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Speltz ML, Collett BR, Wallace ER, Starr JR, Cradock MM, Buono L, Cunningham M, Kapp-Simon K. Intellectual and academic functioning of school-age children with single-suture craniosynostosis. Pediatrics 2015; 135:e615-23. [PMID: 25713274 PMCID: PMC4338322 DOI: 10.1542/peds.2014-1634] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We compared the developmental status of school-age children with single-suture craniosynostosis (case group) and unaffected children (control group). Within the case group we compared the performance of children distinguished by location of suture fusion (sagittal, metopic, unicoronal, lambdoid). METHODS We administered standardized tests of intelligence, reading, spelling, and math to 182 case participants and 183 control participants. This sample represented 70% of those tested during infancy before case participants had corrective surgery. RESULTS After adjustment for demographics, case participants' average scores were lower than those of control participants on all measures. The largest observed differences were in Full-Scale IQ and math computation, where case participants' adjusted mean scores were 2.5 to 4 points lower than those of control participants (Ps ranged from .002 to .09). Adjusted mean case-control differences on other measures of achievement were modest, although case deficits became more pronounced after adjustment for participation in developmental interventions. Among case participants, 58% had no discernible learning problem (score <25th percentile on a standardized achievement test). Children with metopic, unicoronal, and lambdoid synostosis tended to score lower on most measures than did children with sagittal fusions (Ps ranged from <.001 to .82). CONCLUSIONS The developmental delays observed among infants with single-suture craniosynostosis are partially evident at school age, as manifested by lower average scores than those of control participants on measures of IQ and math. However, case participants' average scores were only slightly lower than those of control participants on reading and spelling measures, and the frequency of specific learning problems was comparable. Among case participants, those with unicoronal and lambdoid fusions appear to be the most neurodevelopmentally vulnerable.
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Affiliation(s)
- Matthew L Speltz
- Departments of Psychiatry and Behavioral Sciences and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington;
| | - Brent R Collett
- Departments of Psychiatry and Behavioral Sciences and Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Erin R Wallace
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Jacqueline R Starr
- Department of Clinical and Translational Research, The Forsyth Institute, Cambridge, Massachusetts; Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts
| | - Mary Michaeleen Cradock
- Department of Psychology, St Louis Children's Hospital, St Louis, Missouri; Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Lauren Buono
- Center for Craniofacial Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Michael Cunningham
- Pediatrics, University of Washington, Seattle, Washington; Craniofacial Center, Seattle Children's Hospital, Seattle, Washington
| | - Kathleen Kapp-Simon
- Department of Surgery, Northwestern University, Chicago, Illinois; and Shriners Hospital for Children, Chicago, Illinois
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Fretts AM, Mozaffarian D, Siscovick DS, Djousse L, Heckbert SR, King IB, McKnight B, Sitlani C, Sacks FM, Song X, Sotoodehnia N, Spiegelman D, Wallace ER, Lemaitre RN. Plasma phospholipid saturated fatty acids and incident atrial fibrillation: the Cardiovascular Health Study. J Am Heart Assoc 2014; 3:e000889. [PMID: 24970268 PMCID: PMC4309088 DOI: 10.1161/jaha.114.000889] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 06/05/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND Prior studies suggest that circulating fatty acids may influence the risk of atrial fibrillation (AF), but little is known about the associations of circulating saturated fatty acids with risk of AF. METHODS AND RESULTS The study population included 2899 participants from the Cardiovascular Health Study, a community-based longitudinal cohort of adults aged 65 years or older in the United States who were free of prevalent coronary heart disease and AF in 1992. Cox regression was used to assess the association of all the long-chain saturated fatty acids-palmitic acid (16:0), stearic acid (18:0), arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0)-with incident AF. During a median of 11.2 years of follow-up, 707 cases of incident AF occurred. After adjustment for other AF risk factors, higher levels of circulating 16:0 were associated with a higher risk of AF (hazard ratio comparing highest and lowest quartiles: 1.48; 95% CI: 1.18, 1.86). In contrast, higher levels of circulating 18:0, 20:0, 22:0, and 24:0 were each associated with a lower risk of AF. The hazard ratios (95% CI) for AF in the top and bottom quartiles were 0.76 (95% CI: 0.61, 0.95) for 18:0; 0.78 (95% CI: 0.63, 0.97) for 20:0; 0.62 (95% CI: 0.50, 0.78) for 22:0; and 0.68 (95% CI: 0.55, 0.85) for 24:0. CONCLUSIONS Results from this prospective cohort study of older adults demonstrate divergent associations of circulating 16:0 versus longer-chain saturated fatty acids with incident AF, highlighting the need to investigate both determinants of these levels and potential pathways of the observed differential risk.
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Affiliation(s)
- Amanda M. Fretts
- Department of Epidemiology, University of Washington, Seattle, WA (A.M.F., D.S.S., S.R.H., E.R.W.)
| | - Dariush Mozaffarian
- Department of Epidemiology, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.M., D.S.)
- Department of Nutrition, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.M., F.M.S.)
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.M., F.M.S.)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.M., F.M.S.)
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA (D.M.)
| | - David S. Siscovick
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (D.S.S., C.S., N.S., R.N.L.)
- Department of Epidemiology, University of Washington, Seattle, WA (A.M.F., D.S.S., S.R.H., E.R.W.)
| | - Luc Djousse
- Division of Aging, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (L.D.)
| | - Susan R. Heckbert
- Department of Epidemiology, University of Washington, Seattle, WA (A.M.F., D.S.S., S.R.H., E.R.W.)
| | - Irena B. King
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM (I.B.K.)
| | - Barbara McKnight
- Department of Biostatistics, University of Washington, Seattle, WA (B.M.K.)
| | - Colleen Sitlani
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (D.S.S., C.S., N.S., R.N.L.)
| | - Frank M. Sacks
- Department of Nutrition, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.M., F.M.S.)
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.M., F.M.S.)
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.M., F.M.S.)
| | - Xiaoling Song
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA (X.S.)
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (D.S.S., C.S., N.S., R.N.L.)
| | - Donna Spiegelman
- Department of Epidemiology, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.M., D.S.)
- Department of Biostatistics, Harvard School of Public Health, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (D.S.)
| | - Erin R. Wallace
- Department of Epidemiology, University of Washington, Seattle, WA (A.M.F., D.S.S., S.R.H., E.R.W.)
| | - Rozenn N. Lemaitre
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle, WA (D.S.S., C.S., N.S., R.N.L.)
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Suchy-Dicey AM, Wallace ER, Mitchell SVE, Aguilar M, Gottesman RF, Rice K, Kronmal R, Psaty BM, Longstreth WT. Blood pressure variability and the risk of all-cause mortality, incident myocardial infarction, and incident stroke in the cardiovascular health study. Am J Hypertens 2013; 26:1210-7. [PMID: 23744496 DOI: 10.1093/ajh/hpt092] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recent reports have linked variability in visit-to-visit systolic blood pressure (SBP) to risk of mortality and stroke, independent of the effect of mean SBP level. This study aimed to evaluate whether variability in SBP is associated with all-cause mortality, incident myocardial infarction (MI), and incident stroke, independent of mean SBP or trends in SBP levels over time. METHODS The Cardiovascular Health Study is a longitudinal cohort study of vascular risk factors and disease in the elderly. Participants who attended their first 5 annual clinic visits and experienced no event before the 5th visit were eligible (n = 3,852). Primary analyses were restricted to participants not using antihypertensive medications throughout the first 5 clinic visits (n = 1,642). Intraindividual SBP variables were defined using each participant's 5-visit blood pressure measures. Cox proportional hazards models estimated adjusted hazard ratios (HRs) per SD increase in intraindividual SBP variability, adjusted for intraindividual SBP mean and change over time. RESULTS Over a mean follow-up of 9.9 years, there were 844 deaths, 203 MIs, and 195 strokes. Intraindividual SBP variability was significantly associated with increased risk of mortality (HR = 1.13; 95% confidence interval (CI) = 1.05-1.21) and of incident MI (HR = 1.20; 95%CI = 1.06-1.36), independent of the effect from adjustment factors. Intraindividual SBP variability was not associated with risk of stroke (HR = 1.03; 95% CI = 0.89-1.21). CONCLUSIONS Long-term visit-to-visit SBP variability was independently associated with a higher risk of subsequent mortality and MI but not stroke. More research is needed to determine the relationship of BP variability with cardiovascular risk and the clinical implications.
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Abstract
BACKGROUND Severe maternal morbidity (SMM) is a serious health condition potentially resulting in death without immediate medical attention, including organ failure, obstetric shock and eclampsia. SMM affects 20000 US women every year; however, few population-based studies have examined SMM risk factors. METHODS We conducted a population-based case-control study linking birth certificate and hospital discharge data from Washington State (1987-2008), identifying 9485 women with an antepartum, intrapartum or postpartum SMM with ≥3-day hospitalisation or transfer from another facility and 41 112 random controls. Maternal age, race, smoking during pregnancy, parity, pre-existing medical condition, multiple birth, prior caesarean delivery, and body mass index were assessed as risk factors with logistic regression to estimate odds ratios (OR) and 95% confidence intervals [CI], adjusted for education and delivery payer source. RESULTS Older women (35-39: OR 1.65 [CI 1.52, 1.79]; 40+: OR 2.48 [CI 2.16, 2.81]), non-White women (Black: OR 1.82 [CI 1.64, 2.01]; American Indian: OR 1.52 [CI 1.32, 1.73]; Asian/Pacific Islander: OR 1.30 [CI 1.19, 1.41]; Hispanic: OR 1.17 [CI 1.07, 1.27]) and women at parity extremes (nulliparous: OR 1.83 [CI 1.72, 1.95]; parity 3+: OR 1.34 [CI 1.23, 1.45]) were at greater risk of SMM. Women with a pre-existing medical condition (OR 2.10 [CI 1.88, 2.33]), a multiple birth (OR 2.54 [CI 2.26, 2.82]) and a prior caesarean delivery (OR 2.08 [CI 1.93, 2.23]) were also at increased risk. CONCLUSION The risk factors identified are not modifiable at the individual level; therefore, provider and system-level factors may be the most appropriate target for preventing SMM.
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Affiliation(s)
- Kristen E Gray
- Department of Epidemiology, University of Washington School of Public Health, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Fred Hutchinson Cancer Research Institute, Seattle, WA 98195-7236, USA.
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Affiliation(s)
- E R Wallace
- Center for Bioethics, University of South Carolina, Columbia 29208, USA
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Abstract
Philosophical perspectives are deeply relevant to psychiatric theorization, investigation, and practice. There is no better instance of this than the perennially vexing mind-body problem. This essay eschews reductionist, dualist, and identity-theory attempts to resolve this problem, and offers an ontology--"monistic dual-aspect interactionism"--for the biopsychosocial model. The profound clinical, scientific, and moral consequences of positions on the mind-body relation are examined. I prescribe a radically biological cure for psychiatry's--and all medicine's--chronic dogmatism and fragmentation.
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Affiliation(s)
- E R Wallace
- Medical College of Georgia, Augusta 30912-3800
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Abstract
Adolf Grünbaum's (1984) The Foundations of Psychoanalysis has received extensive attention in psychoanalytic and philosophical circles. Aspects of Grünbaum's argument are reviewed and criticized. While his volume is an important contribution to the epistemological assessment of psychoanalysis, it reflects serious shortcomings in at least four areas: its treatment of the role of suggestion in the analytic enterprise, its scrutiny of the psychoanalytic genetic method, its appreciation of analytic methodology as actually practiced, and, above all, its predication on a unidimensional, positivistic vision of science. Alternative approaches to the philosophy of psychoanalysis are suggested.
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Affiliation(s)
- E R Wallace
- Department of Psychiatry and Health Behavior, Medical College of Georgia
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Abstract
Philosophical perspectives, although eminently relevant to clinical investigation and practice, are rarely brought to bear on psychiatric topics. The author attempts to raise professional consciousness of core issues in the philosophy of science by examining the status of truth, theory, and observation in psychiatry. He evaluates prominent approaches to the problem of knowledge, particularly those of the "subjectivists" and "relativists," such as Schafer and Spence, and the "empiricists" and "inductivists," such as the proponents of DSM-III. Drawing on contemporary philosophy of science, the work of William James, and the classical Greek conviction that more truth resides in the middle than at either extreme, the author mediates between these rival points of view.
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Affiliation(s)
- E R Wallace
- Medical College of Georgia, Augusta 30912-7300
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Wallace ER. Mind-body. Monistic dual aspect interactionism. J Nerv Ment Dis 1988; 176:4-21. [PMID: 3275738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
It is difficult to imagine a more perennially vexing topic to philosophers, scientists, and physicians than the mind-body problem. Recent literature bears out its continued vital interest for psychiatrists. This article briefly recapitulates the major perspectives on the problem, examines the relationship of meaning and mind to psychosocial and biological explanatory programs and to materiality, and promotes a monistic dual aspect interactionist approach to mind and body in health and illness. From this thesis conclusions are drawn in regard to the ultimate possibility of a psychiatric unitary field theory, the question of the autonomy of the psychological and biological explanatory programs, and the identity of the psychiatrist.
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Affiliation(s)
- E R Wallace
- Department of Psychiatry and Health Behavior, Medical College of Georgia, Augusta 30912-7300
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Abstract
This essay reexamines the age-old "determinism-free will" problem from a psychoanalytic perspective. The first section recapitulates the author's (1985) earlier argument on the nature of causation in psychoanalysis; the second part examines the compatibility of determinism and freedom; and the final section looks at the ethical ramifications of the issues at hand. The author exposits his adherence to universal determinism and attempts to answer the question, "What sort of possibility and ethics are permitted in a deterministic universe?"
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Wallace ER. Relevance without presentism. "Mental illness and American society, 1875-1940." By Gerald Grob. Essay review. J Hist Med Allied Sci 1984; 39:374-377. [PMID: 6389683 DOI: 10.1093/jhmas/39.3.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Wallace ER. "Shrinking history: on Freud and the failure of psychohistory." Essay review. Clio Med 1983; 17:247-52. [PMID: 6191916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Wallace ER. Historiography in history and psychoanalysis. Bull Hist Med 1983; 57:247-266. [PMID: 6347292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Wallace ER. The primal parricide. Bull Hist Med 1980; 54:153-165. [PMID: 7397445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Wallace ER. Freud and religion. Am J Psychiatry 1979; 136:237-8. [PMID: 760564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wallace ER. Freud's mysticism and its psychodynamic determinants. Bull Menninger Clin 1978; 42:203-22. [PMID: 354711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Wallace ER, Rothstein W. Toward a reconciliation between psychiatry and clinical psychology. Hosp Community Psychiatry 1977; 28:618-9. [PMID: 885512 DOI: 10.1176/ps.28.8.618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Wallace ER, Staton MA. Acute hypertension after abrupt withdrawal of antipsychotic medication. South Med J 1977; 70:395. [PMID: 850802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
An 18-year-old patient with catatonic schizophrenia developed hypertension when administration of antipsychotic medication was discontinued. Elevated blood pressure was sustained for three days until it was discovered that intramuscular administration of benztropine mesylate immediately reduced it to normal. The fact that the hypertension was not noted earlier while the patient was receiving the antipsychotic drugs suggests that it was a withdrawal phenomenon.
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Abstract
Many writers have commented on the lack of Freud's usual level of logic and powers of persuasion in Moses and Monotheism. The majority attribute it to the significance of dynamic determinants in Freud himself--most notably, identification with Moses. Fromm (1972) says "one must assume that Freud's preoccupation with Moses was rooted in the deep unconscious identification with him" (p. 79). Unfortunately, the situation is much more complex. Although many pertinent observations have been made, what is needed is a detailed dissection of the text, a correlation with elements from Freud's personal life, and an overall psychoanalytic synthesis of the data. This paper makes a beginning in that direction, incorporating the ideas of other investigators with those of the author--but it is hoped that much more detailed analysis and biographical correlation will follow. There is a wealth of information about Freud in Moses and Monotheism and no one paper will exhaust it. In this examination no attempt will be made to evaluate Moses and Monotheism for its literary, psychohistorical, or scientific merit. The focus is on the psychodynamic determinants of Freud's essay.
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Abstract
Freud's most controversial tenet is the death instinct. Although it appears full blown in 1920, it was doubtless nurtured for years in his mind. In its indissoluble relation to the repetition compulsion and Nirvana principle, Thanatos is the bedrock of much of Freud's later philosophy. This paper is an examination of the motivations for the idea, an exegesis of Freud's writings on the subject, and a review of critical opinion.
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