Academic achievement of children and adolescents with oral clefts

描述（由申请人提供）：唇裂和/或腭裂（CL-P）是常见的出生缺陷，发生率约为1/500至1/2500。无其他重大出生缺陷或综合征的非综合征型是最常见的，通过增加死亡率和某些慢性病的风险，对受影响个体的健康造成早期和长期的不良影响。NSCL-P也可能降低教育，心理和经济成就。了解非小细胞L-P对教育成就的影响是需要了解的途径，通过非小细胞L-P影响健康和心理社会和经济表现的教育对这些结果的重要影响。此外，获得对非小细胞肺癌影响的准确估计以及它们如何因社会经济、人口和健康背景而变化，对于确定需求和制定具有成本效益的政策和干预措施以改善受影响个人的福祉至关重要。然而，关于NSCL-P对受影响个体的教育成就的影响仍然未知。一些研究报告了对生命早期和整个成年期的认知表现和/或教育成就的不利影响。然而，这些研究受到小的临床样本，缺乏适当的对照组，以及忽略随时间变化的横断面设计的限制。此外，这些研究中没有一项确定了可能与NSCL-P对教育成就的影响相互作用并改变其影响的社会经济，人口统计学或健康因素。拟议的研究将确定NS CL-P对唇裂儿童和青少年教育成就的影响，并评估这些影响如何因社会经济，人口统计和健康背景而异。这项研究是高度创新的，采用了独特的，现有的数据基础设施，以实现研究的具体目标，并解决了以前的研究的几个局限性。我们将研究通过爱荷华州先天性和遗传性疾病登记处（IRCID）确定的来自爱荷华州的口裂患者的大样本人群，以及多个对照组，包括来自全国出生缺陷和预防研究（NBDPS）的兄弟姐妹、同学和未受影响的儿童。这种多对照组方法提供了显着的方法学优势，比以往的研究。我们使用爱荷华州大学开发和维护的客观标准化爱荷华州学校测试来衡量教育成就，该测试具有很高的可靠性和有效性。我们将评估阅读、数学、语言和科学的分数以及综合分数。我们还将把出生记录数据和NBDPS关于怀孕期间健康、社会经济和人口特征以及风险因素的调查数据联系起来。此外，我们还采用纵向设计研究了非典型肺炎-P对教育成就的影响及其随年龄的变化。该研究将增加有关非小细胞肺癌对教育成就的影响以及改善受影响个体长期结果的方法的重要知识。 公共卫生相关性：本研究将确定唇腭裂对受影响儿童和青少年的教育成就的影响，以便更好地了解他们的教育需求并制定有效的干预措施。这项研究还将确定改变这种影响的因素，以及可能受到公共政策和干预措施影响的因素，以提高受影响个人的教育成就。

DESCRIPTION (provided by applicant): Cleft lip and/or palate (CL-P) are common birth defects occurring in about 1/500 to 1/2500 births. Nonsyndromic (NS) forms occurring without other major birth defects or syndromes are the most common and impose large early and long-term adverse effects on the health of affected individuals by increasing the risks for mortality and certain chronic conditions. NSCL-P may also reduce educational, psychosocial, and economic achievement. Understanding the NSCL-P effects on educational achievement is needed for understanding the pathways through which NSCL-P affects health and psychosocial and economic performance given the important effects of education on these outcomes. Furthermore, obtaining accurate estimates of the NSCL-P effects and how they vary by socioeconomic, demographic and health backgrounds is essential for identifying needs and developing cost-effective policies and interventions to improve the wellbeing of affected individuals. However, much remains unknown about the NSCL-P effects on the educational achievement of affected individuals. A few studies report adverse effects on cognitive performance and/or educational achievement early in life and throughout adulthood. However, these studies are limited by small clinic-based samples, lack of appropriate control groups, and cross-sectional designs that ignore changes over time. Furthermore, none of these studies identifies socioeconomic, demographic or health factors that may interact with and modify the effects of NSCL-P on educational achievement. The proposed study will identify the impacts of NS CL-P on the educational achievement of children and adolescents with oral clefts and assess how these impacts vary by socioeconomic, demographic and health backgrounds. The study is highly innovative by employing a unique, existing data infrastructure to implement the study Specific Aims and by addressing several of the limitations of previous studies. We will study a large population-based sample of individuals with oral clefts from Iowa identified through the Iowa Registry for Congenital and Inherited Disorders (IRCID) and multiple control groups including siblings, classmates, and unaffected children from the National Birth Defects and Prevention Study (NBDPS). This multi-control group approach provides significant methodological advantages over previous studies. We measure educational achievement using the objective standardized Iowa school tests that were developed and are maintained at the University of Iowa and have high reliability and validity. We will evaluate scores on Reading, Mathematics, Language, and Science as well as overall composite scores. We will also link data from birth records and NBDPS survey data on health and socioeconomic and demographic characteristics and risk factors during pregnancy. Furthermore, we study the effects of NSCL-P on educational achievement and its changes with age using longitudinal designs. The study will add significant knowledge about the NSCL-P effects on educational achievement and about ways to improve the long-term outcomes of affected individuals. PUBLIC HEALTH RELEVANCE: This study will identify the impact of oral clefts on the educational achievement of affected children and adolescents in order to better understand their educational needs and develop effective interventions. The study will also identify factors that modify this impact and that may be influenced by public policies and interventions in order to improve the educational achievement of affected individuals.