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Birch McKinney posted an update 6 months, 2 weeks ago
Objective The study aimed to assess the transverse craniofacial dimensions of patients (age, 7-14 years) with unilateral cleft lip and palate (UCLP), compare these dimensions with those of noncleft individuals, and identify the correlations between the nasal and maxillary transverse widths of patients with UCLP. Design A cross-sectional study. Participants Eighty patients operated on for complete UCLP (UCLP group; 35 girls, 45 boys; median age 10.7 years) and 80 age- and sex-matched noncleft individuals (control group; 35 girls, 45 boys; median age 10.7 years). Interventions Interorbital, bizygomatic, nasal, maxillary skeletal, maxillary molar, mandibular molar, and antegonial width measurements were performed using posteroanterior cephalometric radiographs. Intergroup comparisons were conducted by using the independent samples t-test and Mann-Whitney U test. Correlation between the variables was examined using Pearson correlation analysis. Results The bizygomatic, maxillary skeletal and molar, mandibular molar, and antegonial widths in the UCLP group were significantly less than those in the control group (P less then .05). A positive correlation was found between the maxillary skeletal and nasal widths (r = 0.550, P less then .001) and between the maxillary molar and nasal widths (r = 0.560, P less then .001). Conclusions In individuals with UCLP, the bizygomatic, maxillary skeletal and molar, mandibular molar, and antegonial widths were significantly less than those in noncleft individuals. As the maxillary skeletal and dental widths presented a positive correlation with the nasal width, a decrease in nasal width must be considered when maxillary constriction is noted.Concordance in caregivers’ and children’s reports of children’s trauma-related symptoms is often low, and symptom discrepancies are associated with negative clinical implications. The aim of the current study was to examine the degree of concordance between children’s and caregivers’ reports of trauma-related difficulties and determine whether any child or family characteristics were associated with symptom agreement. Three hundred thirteen trauma-exposed children (M = 9.55, SD = 1.77; 65.2% girls, 51.3% Black) and their nonoffending caregivers seeking treatment were included in the study. Children’s and caregivers’ reports of trauma-related difficulties were related, but low intraclass correlation coefficients indicated poor concordance across symptoms. Child’s gender was associated with levels of concordance for several trauma-related difficulties (e.g., anxiety, depression, anger, dissociation, and sexual concerns), with lower symptom agreement for girls. Child’s age, minority status, and relationship to caregiver emerged as factors related to levels of concordance for certain trauma-related symptoms. Child’s gender, age, minority status, and relationship to caregiver may predict symptom discordance for select trauma-related difficulties, whereas other family factors such as caregiver marital status and income may be unrelated. BMS-354825 Given the importance of caregiver-child concordance in treatment success, additional research should investigate other factors that may influence trauma-related symptom agreement.Objective To evaluate characteristics of congenital heart disease (CHD) in patients with cleft lip and/or palate (CL/P) and assess potential associations with cleft outcomes. Design Retrospective review of all patients with CL/P who underwent primary cleft treatment from 2009 to 2015. Setting Children’s Hospital Los Angeles, a tertiary hospital. Patients Exclusion criteria included microform cleft lip diagnosis, international patients, and patients presenting for secondary repair or revision after primary repair at another institution. Main outcomes measured Patient demographics, prenatal and birth characteristics, CL/P characteristics, syndromic status, postoperative complications, and other outcomes were analyzed relative to CHD diagnoses and management. Patients with CL/P with (+CHD) were compared to those without (-CHD) CHD using χ2 tests and analysis of variance. Results Among 575 patients with CL/P, 83 (14.4%) had CHD. Congenital heart disease rates were significantly higher in patients with cleft palate (CP) compared to other cleft types (χ2, P = .009). Eighty-one (97.6%) out of 83 +CHD patients were diagnosed prior to initial CL/P surgical assessment. Twenty-three (27.7%) +CHD patients required surgical repair of 10 cardiac anomalies prior to cleft care. Congenital heart disease was associated with delayed CP repair and increased rates of fistula in isolated patients with CP. Conclusions Congenital heart disease is known to be more prevalent in patients with CL/P. These data suggest the condition is particularly increased in patients with CP. Severe forms of CHD are diagnosed and treated prior to cleft care however postoperative fistula may be more common in patients with CHD. Therefore, careful attention is required for patient optimization and palatal flap dissection in patients with coexisting CHD and CL/P.There is a growing body of research that underscores that young child welfare-involved children are a unique vulnerable subgroup of children. The decision to provide postinvestigation child welfare services is consequential to children’s safety and well-being and has fiscal implications for organizations. Despite the potential ramifications of the decision, there is little known about the factors associated with the ongoing services provision for young children. This study uses secondary data analysis of the Canadian Incidence Study of Reported Child Abuse and Neglect 2008 to explore what case and worker factors predict the provision of ongoing child welfare services. Multilevel modeling was used to assess the relationship between independent variables and the decision to provide ongoing services; analyses included 2,296 children and 555 workers. Case and worker characteristics, including worker training and worker position, predicted ongoing child welfare services suggesting that further research examining the role of what worker characteristics impact child welfare decisions is warranted and essential.