Cleft lip with or without a cleft palate (CLP) and cleft palate alone (CPA) are common birth defects, with a combined birth prevalence of about 1 to 2/1,000. Affected children have a number of medical issues and potential complications, and therefore require a wide variety of healthcare specialists beyond plastic surgeons and dental specialists. For this reason, the best environment in which to deliver this care is a multidisciplinary cleft clinic (MCC) that features a team of healthcare providers, including audiology, pediatric otolaryngology, speech pathology, occupational/feeding therapy, and genetics. In this setting, the many medical issues that these children face are comprehensively addressed in the most convenient manner, as all the specialists can be seen in a single busy day. Furthermore, the referring primary care provider (PCP) will receive a concise letter that documents the team evaluation, including future management plans and recommendations for therapy. Unfortunately, few papers are available in the literature that review the workings of these clinics. In this paper we will provide such an overview, discussing the management issues for children with CLP/CPA, and how these are addressed by members of the MCC.
We analyzed nutrient levels in amniotic fluid obtained during the second trimester of normal, uncomplicated pregnancies from 221 women who delivered apparently healthy infants and from 8 with neural tube defect (NTD) pregnancies. Folate was measured by microbiological assay, vitamin B12 by a radiobinding method, and zinc, copper and iron by atomic absorption spectrophotometry. We found that the mean amniotic fluid nutrient levels of normal pregnancies were 24.7nmol/l for folate, 600pmol/l for vitamin B12, and 1.7, 1.9, and 9.0 μmol/l for zinc, copper and iron, respectively. Amniotic fluid folate, zinc, copper and iron levels of NTD pregnancies were similar to those found during normal pregnancy, however, vitamin B12 levels were markedly lower than those of normal pregnancies.
1. The metabolism of 65Zn administered intramuscularly (Expt 1) or enterally (Expt 2) at the beginning of pregnancy in rats given a control or marginal-Zn diet was measured. In Expt 2 a comparison was also made between pregnant and non-pregnant rats. The loss of 65Zn (assumed to represent labile body Zn) was markedly reduced in animals fed on a marginal-Zn diet compared with controls, and this effect occurred very rapidly, i.e. within 48 h of introducing the marginal-Zn diet. Pregnancy itself had a much less important effect on 65Zn turnover than diet. Transfer of 65Zn to the litter was significantly greater in the animals fed on a marginal-Zn diet compared with controls but total Zn transfer was reduced.2. The effect of length of time on a marginal-Zn diet on fetal growth and composition was examined. Compared with controls, fetal weight was significantly greater in litters from mothers fed on a marginal-Zn diet during the last 4, 7 or 14 d of pregnancy, but no different in litters from mothers fed on a marginal-Zn diet throughout pregnancy. There were no differences in the proportions of protein or fat in the fetuses from mothers fed on the control or marginal-Zn diets but the Zn concentration was lower in litters from mothers fed on a marginal-Zn diet during part or ail of the pregnancy when compared with controls.3. The transfer of "Zn from mothers to litters during birth and the first 3 d of lactation was measured. There were no differences in maternal or litter 65Zn just before or just after birth, but within 72 h maternal 65Zn had significantly decreased and litter 65Zn increased. Increases in litter size were associated with greater total litter 65Zn but reduced individual fetal 65Zn.4. These experiments demonstrate the importance of an adequate daily supply of Zn during pregnancy. Although there is room for adaptation to a marginal-Zn intake (by reducing Zn excretion) the maintenance of Zn homeostasis is only possible in the absence of other forms of stress, such as pregnancy, to the body. The consequence of insufficient Zn at times of rapid fetal growth on carbohydrate and lipid metabolism warrants further investigation.
The purpose of this study was to test the hypothesis that the duration of episodes of unipolar depression increases with age at onset. On the basis of elevated scores on a self-report depression measure, 2,020 persons were selected from a larger community sample to be interviewed and diagnosed using the Schedule for Affective Disorders and Schizophrenia-Research Diagnostic Criteria procedures. Of the 2,020 persons, 865 had a history of one or more episodes of unipolar depression. The potential effects of the following variables (singly and in interaction) on duration of episode were assessed by means of multiway frequency table analysis and chi-square: age at onset, sex of subject, interval since occurrence of the episode, and type of disorder (major vs. minor depressive disorder). The hypothesis that duration of episodes of depression increases with age at onset was not supported. Women were more likely to have multiple episodes, but did not have longer lasting episodes.
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