Day 2 :
KK Women’s and Children’s Hospital, Singapore
Time : 9:00 to 9:45
I have been working in the Department of General Paediatrics in KK Women’s and Children’s Hospital, Singapore, since 2007, with keen interest in general paediatric patient care, and both undergraduate and postgraduate education.
At present, I am also involved in KidSTART, a pilot collaboration between Early Childhood Development Agency (ECDA) and KK Women’s and Children’s Hospital aiming to help disadvantaged families and children by identifying early developmental issues, growth delays, maternal mental health issues. Through early interventions, the pilot project hopes to achieve better integration of such families into the community agencies, rectifying paediatric growth and developmental delays through counselling and referral to tertiary institutions, to ensure good outcomes for them.
Community Paediatrics is a recognized subspecialty overseas, and is a relatively new concept in Singapore. The American Academy of Pediatrics (AAP) defines it as the philosophy of delivery of child health care with the principles of high accessibility, holistic vision, collaboration with parents, interagency care and teamwork, advocacy directed at the needs of all children, and a preventive orientation. It synthesizes clinical practice with public health principles directed towards providing optimal health care to a given child within the context of the family, school, and community.
Research has also shown that experiences in a child’s early years can significantly influence his/her physical, cognitive and social development. In particular, children from vulnerable circumstances may face developmental challenges compared to their peers. On the other hand, a stronger parent-child relationship and holistic early childhood development can bring about positive impact on the child’s lifelong outcomes and narrow the developmental gaps.
KidSTART is a pilot program which aims to provide support and create a conducive environment for learning and development for Singaporean children from economically disadvantaged families. The components include a home visitation programme, a supported playgroup programme and enhanced support to pre-schools. Children from eligible families can attend one or more of these components. Through these interventions, KidSTART hopes to ensure that children benefit from warm and nurturing relationships, age-appropriate and holistic child development, and a safe and secure home environment to grow up in. For home visitation, each at-risk expectant mother and her child will be given integrated support in the domains of health, child development and social services.
In summary, there is a need to give children from these families in Singapore a good start in life. The programme is currently at the pilot stage. The creation of an integrated sustainable working model will allow for future up-scaling of such model across the entire country.
- General Pediatrics | Pediatric Nutrition and Obesity | Pediatric Psychology | Neonatology | Pediatric Infectious diseases
King Saud University, Saudi Arabia
Abdulrahman Al-Frayh has his expertise in Paediatric Allergy and Pulmonology. He is a respected Professor and also a Consultant at the same time. His research interest involved Bronchial Asthma, Paediatric Allergy and Pulmonology, Promotion of Breast feeding and growth and nutrition/children in development countries. He has authored or co-authored, published and presented over 190 papers and meeting abstracts in the field of Allergy & Immunology in both national and international journals.
Statement of the Problem: Prevalence of asthma and other allergic symptoms has increased in the Pediatric populations in Saudi Arabia. Apart from traditional living in areas, the hot temperature force the families to spend more time indoors. Methodology & Theoretical Orientation: In order to evaluate the impact of indoor allergens in the community, a nationwide study of various allergy and asthma sensitizers and triggers, mainly inhabiting the indoor environment, was conducted simultaneously in several cities of Saudi Arabia in 2015-2016, including coastal and non-coastal regions. The project (RAC# 2170 023) was supported by NSTIP (13-BIO814-20) and approved by American Association for Advancement of Sciences (AAAS). This is the first ever simultaneous study of major indoor allergenic components nationwide. A total of 560 house dust samples from 164 patients and 396 control homes were collected from seven regions. Samples were sieved and extracted in PBS-PH-8 and analyzed by ELISA using different antibodies. The targeted allergens included Dermatophagoides pteronyssinus (Der p 1), Dermatophagoides farinae (Der f 1), Blattella germanica (Bla g 1 –group 1), Blattella germanica (Bla g 2 – group 2, Felis domesticus (Fel d1), Rattus norvegicus (Rat n1) and Blomia tropicalis (Blo t 5). Findings: The analyses of data between patients and controls and coastal verses non-coastal regions revealed quantitative variations in their threshold values. Chi-square test and odd ratio to test the association between cases and controls as well as detection rate in coastal and non-coastal cities were conducted. Significant levels for Bla g 1 in Makkah (p<.0001) and Riyadh (p<0.0006), Rat n 1 (p<.0001) and Blo t 5 (p<0.0038) for Riyadh were obtained. The results will help health care directorates, allergists and hospitals in selection of appropriate diagnostic test panels and their therapeutic and preventive approach on regional basis
KK Women’s and Children’s Hospital
One-third of infants have ear anomalies and less than one-third self-correct. Correction of ear deformities by molding exploits the plasticity of the auricular cartilage due to circulating maternal estrogen during early infancy.
We assess the efficacy of non-surgical ear molding in the correction of ear deformities and determine the factors that affect its outcome.
This is a prospective study over a three-year period. Consecutive full-term infants who underwent ear molding were recruited. Primary outcome was successful correction of ear anomaly. Secondary outcomes included complications and maintenance of ear shape. Factors identified include type of anomaly, age and duration of application, and breastfeeding.
Sixty-seven patients with a total of 105 ears were recruited. The anomalies were classified into deformations (66.7%) and malformations (33.3%). The median age group of presentation was zero to seven days old (67%). Average duration of application was 4.1 weeks. Successful correction was achieved in 86% of patients. Ear deformations achieved a significantly higher rate of successful outcome (98%) compared to malformations (64%) (p=0.01). Skin complications were common (46%) and attributed to our tropical climate. Patients with complications were of a higher mean age (22.1 days), compared to patients with no complications (10.6 days) (p=0.03).
Ear molding is an effective non-surgical option for the treatment of ear anomalies, especially in ear deformations where successful correction was achieved in 98% of infants. Type of anomaly is an important predictor of successful correction. Early initiation of ear molding has a crucial role in minimizing complications.
Yeditepe University Faculty of Medicine, Turkey
Sema Yilmaz has completed her Medical Education from Istanbul University, Cerrahpasa Medical Faculty, and Zeynep Kamil Maternity and Children's Hospital, Istanbul, Turkey. Currently she is working as Assistant Professor in Pediatric Hematology/Oncology department, Yeditepe University Faculty of Medicine, Turkey. She has published 23 articles in reputed journals and has Research Experience in Cancer Biology and Therapeutics Program, Harvard Medical School, USA. She has Volunteer Experiences in MD Anderson Cancer Center, Houston, Tx, USA, University of Texas, Hermann Hospital, Tx, USA, John Hopkin’s Children Hospital, Baltimore, USA and Istituto Giannina Gaslini, Italy.
Aim: To investigate hypoxia-inducible factor-1α (Hif-1α) polimorphism in children with Acute Respiratory Distress Syndrome (ARDS).
Objectives: ARDS may resulted in by pulmonary and extrapulmonary causes. In the present study, we examined whether hypoxia-inducible factor-1α (HIF-1α) polymorphisms are associated with the Acute Respiratory Distress Syndrome.
Subjects/ Methods: Twenty two patients with ARDS and 11 non-ARDS controls were examined in pediatric intensive care unit in Cukurova University Hospital. Blood samples were collected from subjects. Polymerase chain reaction-restriction fragment length polymorphism was used to assess the C1772T and G1790A polymorphisms in the HIF-1α gene, and differences in genotypes between the 2 groups were compared.
Results: C1772T polymorphism was not observed between pulmonary ARDS cases and non-ARDS controls. Particularly, G1790A polymorphism was significantly different in between pulmonary ARDS and non-ARDS cases. In addition, G1790A polymorphism was statistically related to the extensity of ARDS in lung parenchyma in ARDS patients (p<0,05).
Conclusion: Our results indicated that Hif-1α G1790A polymorphism was associated with an increased susceptibility to pulmonary ARDS in children. The investigating of G1790A polymorphism seen commonly could lead pediatricians to predict the extensity of ARDS early in lung tissue.
Ministry Of Health, Sri Lanka
High prevalence of child undernutrition is a well-known issue in rural areas. The objective of this study was to describe the prevalence and associated factors among children aged 1-5 years in Siyambalanduwa MOH area in Moneragala District.
A community based cross-sectional study was conducted among 421 child-mother pairs in Siyambalanduwa MOH area using two stage cluster sampling method with a cluster size of 36. Children of mothers who cannot communicate in Sinhala were excluded. Data were collected by pre tested interviewer administered questionnaire and conducting anthropometric measurements according to WHO guidelines. Statistical analysis was done using SPSS 20. The chi-square test was used, and P<0.05 was considered for statistically significant.
Overall 41% of children aged 1-5 years were undernourished in Siyambalanduwa MOH area. Among the study subjects 24% were underweight, 25.7% were stunted, 16.4% were wasted,9.2% were both underweight &stunted, 6.8% were both, underweight & wasted ,0.5% were both, stunted & wasted and 9.9% were underweight & stunted &wasted. Only the low total monthly income (P<0.001) and low birth weight (P<0.001) were significantly associated with child undernutrition. Among parents or caregivers 18.6% had good knowledge, 35.6% had favorable attitudes and 12.6% had good practices related to child nutrition. None of the above three factors were significantly associated with child undernutrition.
Conclusions and recommendations
Prevalence of undernutrition among children aged 1-5 years is high and urgent efforts to reduce undernutrition should be a priority.Future studies should focus on assessing how to reduce the burden with low cost appropriate interventions.
Uraan – Paediatric Therapy Services, Pakistan
Zahrah Khimani has completed her MSc in Clinical Neuropsychology from University of Bangor, UK. She is Master Neuro Linguistic Practitioner - Licensed (USA) and Specialised in Cognitive Behaviour Therapy (USA). At present she is working as a Senior Behaviour Therapist at Aga Khan University Hospital and Senior Clinical Psychologist at Karachi Vocational Training Centre. She ia also working as A-Level Psychology Faculty at Foundation Public School. She is the founder and and CEO of URAAN-Paediatric Therapy Services
Objective: In Pakistan, there is an extreme dearth of awareness about the developmental needs of children, especially those suffering with ADHD is sorely lacking. A comprehensive analysis of the published empirical research literature of Pakistan demonstrates that no studies so far have been conducted on the significance of parents and teachers knowledge of ADHD. This study is an initial step to create awareness and tolerance for all those children who are different. The primary purpose of this study is to explore the existing knowledge and understanding (if any) of parents and teachers about ADHD. Moreover to inquire, how their cognition and belief towards mental health services for ADHD influences their decision to seek psychological assistance and medical help for their child’s treatment.
Methods: Purposive sampling technique was used to select primary students (6-8 years) from lower middle class schools from three different towns of Karachi, Pakistan. Ten Focus group interviews were conducted to collect data from 150 (semi-literate) parents and teachers (untrained).
Findings: The findings of the study shows cognitive dysfunction of parents due to stigmatization of learning disabilities, societal pressure and rigid thinking (tunnel vision). There is a 2:1 ratio proportion of fathers & mother in laws hindering the treatment as compared to the mother. 80% of the mothers in the focus group outlined/suggested lack of decision making (especially in case of children) in a male dominant society. Moreover, mothers attributed lack of guidance/professional help/inclusive schools in Pakistan as compared to the west (developed nations) where ADHD treatment is much more common. While 45% of the fathers attributed lack of finances and overload of responsibilities. This concludes that parents disregard the needs of their child over societal needs.
National Research Centre, Egypt
I have completed my PhD at the age of 30 years from Ain Shams Univesity. I have published more than 13 papers in reputed journals and have been serving as an editorial board member of four journals.
Obesity is a multifactorial disease, associated with metabolic disorders and chronic low-grade inflammation. Circulating procalcitonin (PCT) is produced by adipose tissue and several cell types following cytokine stimulation. Procalcitonin is well known as a biomarker of infection, sepsis and severe systemic inflammation. Recently it has a potential as a marker for chronic low-grade inflammation in obese population. We aim in the current study to evaluate the role of serum PCT as an inflammatory biomarker in diagnosis of obesity-related low-grade inflammation.
Method: In this case control study, 50 obese and 50 normal weight children and adolescents aged 6–16 years were enrolled. Anthropometric parameters and blood pressure were measured in all study subjects. The body composition was evaluated by Body mass index (BMI), body circumferences and skinfold thickness Fasting blood samples were collected for measurement of lipid profile, blood glucose, insulin, high sensitivity-CRP (Hs-CRP) and serum procalcitonin. Serum (PCT) levels were assessed using enzyme linked immunosorbent assay. Insulin resistance was represented as the homeostatic model assessment value (HOMA-IR).
Obese participants had increased (BMI) z-score, blood pressure, insulin resistance (HOMA-IR) and higher concentrations of serum PCT, total cholesterol, triglycerides, glucose and Hs-CRP than control group. On correlation analysis, procalcitonin had significant positive correlation with (BMI) z-score (P=0.03), waist circumference (WC) (P=0.05), Hs-CRP (P=0.02)), total cholesterol (P=0.04), triglycerides (P<0.001) and (HOMA-IR) (P<0.001) in obese group.
The increased serum procalcitonin concentrations were closely related to measures of adiposity, Hs-CRP and insulin resistance, suggesting that PCT may be an excellent biomarker for obesity related chronic low-grade inflammation in children and adolescents.
University of the Witwatersrand, South Africa
Mercy Manyema is an early career public health researcher whose areas of interest include non-communicable disease prevention, childhood and adult obesity and early child development. She has been involved in several projects including the evaluation of the potential of a sugar-sweetened beverage tax to reduce obesity, diabetes and stroke in South Africa, and a study to map the gaps between expert, stakeholder, and public understandings of early childhood development in South Africa. She is currently studying for a PhD in Public Health focusing on the impact of adverse childhood events on adult health and well-being.
Statement of the Problem: Adverse childhood experiences (ACEs) have emerged as a significant public health problem in the past two decades, and are highly prevalent in high income countries. Literature suggests an increased risk of mental health problems in those who experience childhood adversity. The objectives of this study were to describe the distribution of retrospectively reported ACEs in a cohort of young adults and investigate the association between ACEs and psychological distress. Methodology & Theoretical Orientation: Data from the Birth to Twenty Cohort Plus were used to determine the prevalence of ACEs (retrospectively measured) and of psychological distress in young adults aged 22 years. Hierarchical regression was employed to determine the association between the two and the role of adult stress events in the relationship. Findings: 88% of the sample (n=1223) reported at least one ACE before the age of 18 years while 28% reported psychological distress. Compared to experiencing no ACEs, having 4 or more ACEs increased the risk of psychological distress five times, OR 5.45 (95% CI 3.10-9.57). The effect of ACEs attenuated after the addition of adult stress to the model signifying possible mediation of the association between ACEs and PD through adult stressors. Conclusion & Significance: Adverse childhood experiences are high in the cohort and are positively associated with psychological distress in young adulthood. Adult life stress may moderate the link between ACEs and psychological distress. Interventions to reduce the burden of poor mental health may need to not only address adult life stress but also the experience of childhood adversity.
Elaine Joy O. Viernes graduated from pediatric residency training in a government hospital in the Philippines. She is from a rural town where pregnancy in adolescents is a norm. She hopes to contribute to the holistic care of pregnant adolescents thru her research.
Background of the study: Screening for antepartum depression is not routinely integrated in prenatal care despite its high prevalence rate and adverse maternal and neonatal outcomes.
Methods: A cross-sectional descriptive study of 143 pregnant adolescents age 12 to 18 years old was conducted at the OB-Gyne outpatient department of a tertiary hospital. Participants were enrolled to complete a self-administered socio-demographic and obstetric questionnaires and the validated Filipino version of the Edinburgh Postnatal Depression Scale. The presence of depression was assessed using the validated EPDS cut-off score of > 13.
Results: The prevalence of antepartum depression during the time of the study was 23.1%. The mean EPDS score among the depressed group is 15.12 + 0.918. Pregnant teens with low monthly household income were at an increased risk of antepartum depression. Conversely, those currently studying and in their third trimester were less likely at risk for depression during pregnancy.
Conclusion: A significant proportion of pregnant adolescents were at risk of developing antepartum depression. The lack of predisposing risk factors does not rule out the possibility of depression during pregnancy; thus, screening through a validated tool should be integrated in antenatal care. Early detection and appropriate intervention for depression in pregnant teenagers is crucial to prevent the associated adverse maternal and child outcomes.
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