Prevalence and Factors Associated with Behavioral Problems in 5-Year-Old Children Born with Cleft Lip and/or Palate from the Cleft Collective.

OBJECTIVES: To determine the UK prevalence of behavioral problems in 5-year-old children born with isolated or syndromic cleft lip and/or palate (CL/P) compared to the general population and identify potentially associated factors. DESIGN: Observational study using questionnaire data from the Cleft Collective 5-Year-Old Cohort study and three general population samples. MAIN OUTCOME MEASURE: The Strengths and Difficulties Questionnaire (SDQ). PARTICIPANTS: Mothers of children (age: 4.9-6.8 years) born with CL/P (n = 325). UK general population cohorts for SDQ scores were: Millennium Cohort Study (MCS) (n = 12 511), Office of National Statistics (ONS) normative school-age SDQ data (n = 5855), and Avon Longitudinal Study of Parents and Children (ALSPAC) (n = 9386). RESULTS: By maternal report, 14.2% of children born with CL/P were above clinical cut-off for behavioral problems, which was more likely than in general population samples: 7.5% of MCS (OR = 2.05 [1.49-2.82], P < 0.001), 9.8% of ONS (OR = 1.52 [1.10-2.09], P = 0.008), and 6.6% of ALSPAC (OR = 2.34 [1.70-3.24], P < 0.001). Children in the Cleft Collective had higher odds for hyperactivity, emotional and peer problems, and less prosocial behaviors. Maternal stress, lower maternal health-related quality of life and family functioning, receiving government income support, and maternal smoking showed evidence of association (OR range: 4.41-10.13) with behavioral problems, along with maternal relationship status, younger age, and lower education (OR range: 2.34-3.73). CONCLUSIONS: Findings suggest elevated levels of behavioral problems in children born with CL/P compared to the general population with several associated maternal factors similar to the general population.

Emergent Complications of Rheumatoid Arthritis.

BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease resulting in polyarthritis and systemic effects that may result in morbidity and mortality. OBJECTIVE: This review provides the emergency physician with an updated analysis of acute complications seen with RA, as well as an evidence-based approach to the management of these complications. DISCUSSION: While the joint characteristics of RA are commonly recognized, the extra-articular manifestations may be overlooked. Of most concern to the emergency clinician is the involvement of the airway, cardiovascular, and pulmonary systems; however, RA can affect all organ systems. In addition, complications can arise from the specific therapies used to treat RA. Certain patient populations can have atypical presentations of the disease or may have an exaggerated response to the medications. An understanding of the involvement of these organ systems and complications can direct physicians to a broader differential that can identify disease processes that may have otherwise gone unnoticed. It is not necessarily the role of the clinician to diagnose RA in its earliest phases or initiate long-term immunosuppressive therapy from the emergency department; however, detection of some of the disease's characteristics can lead to earlier referral to specialists to begin therapy and potentially avoid life-threatening complications. If those problems are encountered in the emergency department, this review aims to provide insight into management of those conditions. CONCLUSIONS: Prompt recognition of the acute complications of RA is crucial to treat these conditions. This review investigates these issues in a succinct manner for emergency clinicians.