Tessier 30 Facial Clefts—A Literature Review of 72 Cases (1996-2020), Suggested Treatment Protocol, Outcome Measures, Minimum Dataset for Future Case Reports, and Registries

Introduction: Tessier 30 facial cleft is a rare anomaly presenting in the soft and hard tissues over the central lower face. Owing to the rarity of cases and difficulty of treatment, there is no universally accepted surgical management strategy. The last comprehensive literature review of Tessier 30 clefts was in 1996. This report aims to update the literature to inform decision-making on treating Tessier 30 cases. Methodology: A literature search was performed. PubMed, SCOPUS, and OVID databases were searched. A total of 72 cases in 51 articles were analyzed, looking at demographics, extent of cleft, parent health, family history, procedures, follow-up, existence of other anomalies, and stages of repair. Results: Surgeons are increasingly choosing to repair Tessier 30 defects in one rather than multiple stages. Of the 72 cases studied, only 31 had documented the completed repair of the cleft. All completed soft tissue only defects were repaired in 1 stage of repair (n = 11). Where both soft tissue and mandible was involved (n = 20), 55% (n = 11) had undergone 1-stage repair to address the Tessier 30 cleft. Discussion: We argue that a single-stage approach is preferable to multistage. Primary mucogingivoperiosteoplasty should be undertaken in children at the time of management of the soft tissue cleft. The timing of this procedure should be in the latter half of the first year of life, as this is when mandibular symphyseal fusion normally occurs. We have suggested a treatment protocol and we hope that future case reports use our minimum data set.

Snail host parental investment throughout a Schistosoma mansoni infection

Parental investment theory describes the ability of organisms to respond to an environmental challenge by increasing the fitness of future offspring. Utilizing life history changes, organisms can maximize fitness by increasing their total reproductive output or by investing more into the success of fewer offspring. In cases where parasitic infections result in castration of their host, increased reproductive effort known as fecundity compensation has been demonstrated in a variety of organisms. This response appears predictive of expected future reproductive losses. Organisms struggling with an environmental pathogen, may attempt to better prepare their offspring for the environment they are experiencing through transgenerational immune priming (TGIP). In immune priming, primary infection lowers the prevalence and intensity of a subsequent infection by the same pathogen. Transgenerational immune priming carries pathogen resistance into further generations without genotypic changes. The focus of this study was to determine whether invertebrate parental investment into offspring parasite resistance varies over the course of an infection. Utilizing the snail host Biomphalaria glabrata and its trematode parasite Schistosoma mansoni, offspring were reared from specific time intervals in the parent’s infection and subsequently exposed to the same pathogen when each cohort reached the same age- 12 weeks. Differences in infection prevalence and intensity were expected based on when the offspring were born during their parent’s infection. A trade-off was predicted between the number of offspring produced in a cohort and offspring resistance to future infections. Offspring born during the period of fecundity compensation were predicted to exhibit lower resistance due to a dilution of individual investment by parents into a larger offspring pool. While our results did not support TGIP, there were differences in offspring prevalence, as well as an indication that parent health may interact with genetics in offspring resistance. Results suggest that parental condition can influence resistance of B. glabrata offspring to S. mansoni but that TGIP may not be operating in this system.

Health literacy as a predictor of road traffic injury prevention

Background Road traffic injuries impose a substantial health burden among children. Health literacy is one of the most important determinants of non-communicable disease prevention. Parent health literacy is connected with their knowledge and behaviors regarding children road traffic injuries (CRTI) prevention. The aim of this study was to explore health literacy, knowledge and behaviors of mothers' in Croatia regarding CRTI prevention. Methods This population based cross-sectional questionnaire study was done during 2019 in convenient sample of mothers of school aged children. Sociodemographic data and data about knowledge and behaviors of mothers regarding CRTI prevention were collected by the use of specially designed questionnaire. Croatian version of the Newest Vital Sign screening test (NVS-HR) was used for heath literacy determination. Results There were 814 mothers' median age 36.0 (interquartile range 32.0. - 39.0). According to NVS-HR there were 17.7%, 26.5% and 55.8% of mothers with low, intermediate and adequate health literacy level, respectively. The higher levels of health literacy were connected with younger age of mothers (37 years old or less) (P = 0.027); urban area of settlement (P < 0.001); living with a partner (P = 0.018); higher educational level of mothers (P < 0.001) and with better self-perceived economic status (P = 0.009). The study revealed poor positive correlation between mothers' health literacy and their knowledge regarding CRTI prevention (rho=0.170; P < 0.001). The study further showed that there was no correlation between mothers' health literacy and their behavior regarding CRTI prevention (rho=0.072; P = 0.041). Finally, the study revealed poor positive correlation between mothers' knowledge and behavior regarding CRTI prevention (rho=0.193; P < 0.001). Conclusions The level of health literacy affects mothers' knowledge about CRTI prevention. Further studies are needed to better understand the underlying reasons for established association. Key messages Low parent health literacy is one of the predictors of poor parent knowledge about children road traffic injuries prevention. It is necessary to identify and to address low parent health literacy in preventive strategies directed towards children road traffic injury prevention.

We Asked, They Told Us: The Use of an Electronic Survey to Address Parental Health Concerns for Children

Population health includes medical conditions and social determinants of health, and it can be measured through community health needs assessments (CHNAs). A pediatric hospital utilized a survey to ask parents to rank different health topics based on the severity they present to children in the St. Louis Metropolitan for 2 installments of a CHNA (2016 and 2019). Between November 2015 and April 2016, 1156 parents and, between May 2018 and September 2018, 1022 parents responded to the Parent Health Concerns Survey. Respondents were most likely to be 25 to 44 years old, white, educated, have an income of at least $60 000, and work-related insurance. The top needs identified in 2016 and 2018 were lack of exercise and bullying, respectively. Depression saw the largest increase. Emerging topics in 2018 include tobacco/smoking, depression, and health insurance access. Our findings suggests that pediatricians should be prepared to address concerns across a wide variety of topics.