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  • 1
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    Profile of hospitalised maltreated children aged 0 to 3 years and their families
    Medknow ; 2024
    In:  Singapore Medical Journal
    Details
    In: Singapore Medical Journal, Medknow
    Abstract: Maltreatment adversely affects children’s health and development. Knowledge of child maltreatment in early childhood is limited. We studied the demographic factors and health issues in children aged 0–3 years who were hospitalised for maltreatment. Methods: In this retrospective cohort study, health and demographic information was extracted from the electronic medical records of children hospitalised in KK Women’s and Children’s Hospital between January 2018 and June 2019. High-risk groups were children with developmental delay (DD), missed vaccination (MV), low outpatient attendance, high dependency unit (HDU) or intensive care unit (ICU) admission and Child Protection Service (CPS) referral. Chi-square or Fisher’s exact test was used for categorical variables. Mann–Whitney U test was used for skewed quantitative variables. Results: Among the 101 children included in the study, the most common type of abuse and alleged perpetrator were physical abuse and parents, respectively. In addition, 35.6% of the children had pre-existing health conditions before hospitalisation, 58.4% had new health conditions diagnosed during hospitalisation requiring follow-up and 26.7% had maltreatment-related injuries. One-fifth of the children had DDs and another one-fifth had MVs. About 20% of them had defaulted all outpatient appointments. High-risk children mostly lived in rented housing. Their mothers mostly had primary education or lower. Most children admitted to ICU or HDU were 〈 6 months old (8/12 [66.7%] vs. 6–24 months 3/12 [25%] vs. 24–47 months 1/12 [8.3%], P = 0.001). A higher number of children with DD were referred to CPS (63.2%, P = 0.049) than to other agencies. Conclusion: Maltreated children have significant health needs that are not fully met through routine surveillance practices. They are at risk of defaulting their hospital appointment. It is imperative that families at risk of child maltreatment are identified early and their needs holistically evaluated, with care coordinated within the hospital–community support system.
    Type of Medium: Online Resource
    ISSN: 0037-5675 , 2737-5935
    URL: Article
    DOI: 10.4103/singaporemedj.SMJ-2022-052
    Language: English
    Publisher: Medknow
    Publication Date: 2024
    detail.hit.zdb_id: 2060216-9
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  • 2
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    A Case of Atypical Kawasaki Disease With Myositis
    SAGE Publications ; 2015
    In:  Global Pediatric Health Vol. 2 ( 2015-01-01), p. 2333794X1559964-
    Details
    In: Global Pediatric Health, SAGE Publications, Vol. 2 ( 2015-01-01), p. 2333794X1559964-
    Type of Medium: Online Resource
    ISSN: 2333-794X , 2333-794X
    URL: Article
    DOI: 10.1177/2333794X15599649
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2015
    detail.hit.zdb_id: 2785531-4
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  • 3
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    Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore
    Springer Science and Business Media LLC ; 2020
    In:  BMC Pediatrics Vol. 20, No. 1 ( 2020-12)
    Details
    In: BMC Pediatrics, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2020-12)
    Abstract: Coronavirus disease 2019 (COVID-19) has impacted the provision of health services in all specialties. We aim to study the impact of COVID-19 on the utilization of pediatric hospital services including emergency department (ED) attendances, hospitalizations, diagnostic categories and resource utilization in Singapore. Methods We performed a retrospective review of ED attendances and hospital admissions among children 〈  18 years old from January 1st to August 8th 2020 in a major pediatric hospital in Singapore. Data were analyzed in the following time periods: Pre-lockdown (divided by the change in Disease Outbreak Response System Condition (DORSCON) level), during-lockdown and post-lockdown. We presented the data using proportions and percentage change in mean counts per day with the corresponding 95% confidence intervals (CIs). Results We attended to 58,367 children with a mean age of 5.1 years (standard deviation, SD 4.6). The mean ED attendance decreased by 331 children/day during lockdown compared to baseline ( p   〈  0.001), attributed largely to a drop in respiratory (% change − 87.9, 95% CI − 89.3 to − 86.3, p   〈  0.001) and gastrointestinal infections (% change − 72.4, 95%CI − 75.9 to − 68.4, p   〈  0.001). Trauma-related diagnoses decreased at a slower rate across the same periods (% change − 40.0, 95%CI − 44.3 to − 35.3, p   〈  0.001). We saw 226 children with child abuse, with a greater proportion of total attendance seen post-lockdown (79, 0.6%) compared to baseline (36, 0.2%) (p  〈  0.001). In terms of ED resource utilization, there was a decrease in the overall mean number of procedures performed per day during the lockdown compared to baseline, driven largely by a reduction in blood investigations (% change − 73.9, 95%CI − 75.9 to − 71.7, p   〈  0.001). Conclusions We highlighted a significant decrease in infection-related presentations likely attributed to the lockdown and showed that the relative proportion of trauma-related attendances increased. By describing the impact of COVID-19 on health services, we report important trends that may provide guidance when planning resources for future pandemics.
    Type of Medium: Online Resource
    ISSN: 1471-2431
    URL: Article
    DOI: 10.1186/s12887-020-02469-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2041342-7
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  • 4
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    Outcomes of a higher calorie inpatient refeeding protocol in Asian adolescents with anorexia nervosa
    Wiley ; 2021
    In:  International Journal of Eating Disorders Vol. 54, No. 1 ( 2021-01), p. 95-101
    Details
    In: International Journal of Eating Disorders, Wiley, Vol. 54, No. 1 ( 2021-01), p. 95-101
    Abstract: This study aims to compare the outcomes of higher calorie refeeding (HCR) and a lower calorie refeeding (LCR) methods among a diverse sample of young Asian adolescents admitted to a tertiary institution in Asia for management of anorexia nervosa (AN). Method This is a retrospective case control study of Asian adolescents who were managed using an inpatient HCR protocol (2016–2017) and an LCR protocol (2010–2014). Baseline characteristics, daily change in percent median body mass index (%mBMI), and rates of refeeding hypophosphatemia were analyzed between groups. Results A total of 125 adolescents with AN were analyzed with 61 (52%) patients in the HCR group. Mean age was 14.0 years ( SD =1.5) and mean presenting %mBMI was 73.2 ( SD =6.9) with mean length of stay of 11.9 days ( SD = 6.6). Patients in the HCR group had significantly increased rate of change of %mBMI ( M = 0.39, SD = 0.31) than patients in the LCR group ( M = 0.12, SD = 0.43) ( p 〈  .001). There was an increased rate of mild hypophosphatemia in the HCR group (HCR: 46%, LCR: 22%, p = .007) but no difference in rates of moderate hypophosphatemia and no cases of severe hypophosphataemia. Lower presenting %mBMI significantly predicted the phosphate levels ( p = .004). Discussion In a sample of Asian adolescents with AN, use of an HCR protocol was associated with improved rate of inpatient weight gain. There was increased risk of mild hypophosphataemia, but not moderate to severe hypophosphataemia, suggesting that an HCR protocol can be used safely with close monitoring of phosphate levels.
    Type of Medium: Online Resource
    ISSN: 0276-3478 , 1098-108X
    URL: Issue
    URL: Article
    DOI: 10.1002/eat.v54.1
    DOI: 10.1002/eat.23403
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 1492880-2
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  • 5
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    Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents
    Academy of Medicine, Singapore ; 2022
    In:  Annals of the Academy of Medicine, Singapore Vol. 51, No. 5 ( 2022-5-27), p. 292-299
    Details
    In: Annals of the Academy of Medicine, Singapore, Academy of Medicine, Singapore, Vol. 51, No. 5 ( 2022-5-27), p. 292-299
    Abstract: Introduction: Lifestyle activities, such as regular physical activity, are important for good metabolic health and the prevention of non-communicable diseases. Epidemiological studies highlight an increase in the proportion of overweight children in Singapore. A workgroup was formed to develop recommendations to encourage children and adolescents (aged 7–18 years) to adopt a holistic approach towards integrating beneficial activities within a daily 24-hour period for good metabolic and general health. Methods: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to formulate the public health question, assess the evidence and draw conclusions for the guide. The evidence for international 24-hour movement guidelines, and guidelines for physical activity, sedentary behaviour, and sleep and eating habits were reviewed. An update of the literature review from August 2018 to end of September 2020 was conducted through an electronic search of Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Results: Ten consensus statements were developed. The statements focused on the overall aim of achieving good metabolic health through integration of these activities and initiatives: light and moderate- to vigorous-intensity physical activity on a regular basis; muscle- and bone-strengthening activities; limiting sedentary behaviour; regular and adequate sleep; good eating habits and choosing nutritionally balanced foods and drinks; practise safety in exercise; and aiming to achieve more or all aforementioned recommendations for the best results. Conclusion: This set of recommendations provides guidance to encourage Singapore children and adolescents to adopt health-beneficial activities within a 24-hour period. Keywords: Eating habits, metabolic health, physical activity, sedentary behaviour, sleep
    Type of Medium: Online Resource
    ISSN: 0304-4602
    URL: Journal
    URL: Article
    DOI: 10.47102/annals-acadmedsg.
    DOI: 10.47102/annals-acadmedsg.202141
    Language: English
    Publisher: Academy of Medicine, Singapore
    Publication Date: 2022
    detail.hit.zdb_id: 2186627-2
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  • 6
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    Caring for Children and Adolescents With Eating Disorders in the Current Coronavirus 19 Pandemic: A Singapore Perspective
    Elsevier BV ; 2020
    In:  Journal of Adolescent Health Vol. 67, No. 1 ( 2020-07), p. 131-134
    Details
    In: Journal of Adolescent Health, Elsevier BV, Vol. 67, No. 1 ( 2020-07), p. 131-134
    Type of Medium: Online Resource
    ISSN: 1054-139X
    URL: Article
    DOI: 10.1016/j.jadohealth.2020.03.037
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2020
    detail.hit.zdb_id: 2006608-9
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  • 7
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    Implementation of family‐based treatment for Asian adolescents with anorexia nervosa: A consecutive cohort examination of outcomes
    Wiley ; 2021
    In:  International Journal of Eating Disorders Vol. 54, No. 1 ( 2021-01), p. 107-116
    Details
    In: International Journal of Eating Disorders, Wiley, Vol. 54, No. 1 ( 2021-01), p. 107-116
    Abstract: This study describes the implementation of family‐based treatment (FBT) in an eating disorder program in Asia as well as clinical outcomes of Asian adolescents with anorexia nervosa (AN) treated with FBT. Method This retrospective consecutive cohort study of 147 Asian adolescents with AN was compared between those in FBT ( n = 65) versus treatment as usual (TAU) ( n = 82). Variables associated with weight restoration were analyzed between groups. Results Participants' mean age was 14.2 ( SD = 1.5) years and 93% were female. Mean presenting %mBMI was 74.0 ( SD = 7.8) and average illness duration was 7.7 ( SD = 6.1) months. The two groups' baseline characteristics were not significantly different. Weight restoration rates in the FBT group were significantly higher than the TAU group at 6‐, 12‐, and 24‐month time points. A linear mixed model showed the mean %mBMI was significantly higher at 0, 6, 12, and 24 months in the FBT group. The median time to weight restoration for patients on FBT was shorter (FBT: 7.0 months, TAU: 19.0 months; 95% CI [14.5, 23.5] χ 2 = 15.84, p   〈  .001). Within the FBT group, those that completed ≥9 FBT sessions had significantly higher rates of weight restoration at 12 months. Across all participants, those with a lower starting %mBMI were less likely to achieve weight restoration by 12 months. Conclusion FBT can be effectively implemented in a multidisciplinary eating disorder program managing Asian adolescents with AN with improved rates of weight restoration. Further research is needed to understand the predictors and moderators of remission using FBT in Asian adolescents with AN.
    Type of Medium: Online Resource
    ISSN: 0276-3478 , 1098-108X
    URL: Issue
    URL: Article
    DOI: 10.1002/eat.v54.1
    DOI: 10.1002/eat.23429
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 1492880-2
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  • 8
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    Online Resource
    Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study
    JMIR Publications Inc. ; 2021
    In:  Journal of Medical Internet Research Vol. 23, No. 9 ( 2021-9-28), p. e20520-
    Details
    In: Journal of Medical Internet Research, JMIR Publications Inc., Vol. 23, No. 9 ( 2021-9-28), p. e20520-
    Abstract: Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective This study aims to assess the effectiveness of and adolescent engagement with a mobile app–based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo’s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake.
    Type of Medium: Online Resource
    ISSN: 1438-8871
    URL: Article
    DOI: 10.2196/20520
    Language: English
    Publisher: JMIR Publications Inc.
    Publication Date: 2021
    detail.hit.zdb_id: 2028830-X
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  • 9
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    Online Resource
    First presentation of restrictive early onset eating disorders in Asian children
    Wiley ; 2021
    In:  International Journal of Eating Disorders Vol. 54, No. 1 ( 2021-01), p. 81-87
    Details
    In: International Journal of Eating Disorders, Wiley, Vol. 54, No. 1 ( 2021-01), p. 81-87
    Abstract: This study aims to describe the spectrum of children with restrictive early onset eating disorders (EOEDs), defined as below 13 years of age, presenting to a tertiary institution in Asia and comparing them with older adolescents with eating disorders. Methods This is a retrospective case review of Asian children who were treated in an eating disorder center. Baseline characteristics and inpatient management at first presentation of children younger than 13 years of age (EOED) were compared to those in older adolescents. Results A total of 288 patients with restrictive eating disorders were analyzed with 53 (18%) patients having onset younger than age 13 at initial presentation. There were no significant differences in percentage weight loss and hospitalization rates between the two age groups. Patients with EOED presented with significantly shorter duration of symptoms, and lower rates of secondary amenorrhea. More patients with EOED required phosphate supplementation compared to those in older age group. Conclusion Despite having a shorter duration of illness, Asian children with EOED had similar percentage weight loss and rates of admission due to malnutrition as those in older Asian adolescent patients. This study underlined the severity of EOEDs and the need for early recognition and medical assessment.
    Type of Medium: Online Resource
    ISSN: 0276-3478 , 1098-108X
    URL: Issue
    URL: Article
    DOI: 10.1002/eat.v54.1
    DOI: 10.1002/eat.23274
    Language: English
    Publisher: Wiley
    Publication Date: 2021
    detail.hit.zdb_id: 1492880-2
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  • 10
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    Adolescent health in Asia: insights from Singapore
    Walter de Gruyter GmbH ; 2016
    In:  International Journal of Adolescent Medicine and Health Vol. 28, No. 3 ( 2016-08-1), p. 309-313
    Details
    In: International Journal of Adolescent Medicine and Health, Walter de Gruyter GmbH, Vol. 28, No. 3 ( 2016-08-1), p. 309-313
    Abstract: The introduction of adolescent medicine as a medical subspecialty in Singapore was a welcome in an evolving health care system that is unique in terms of both efficiency, in financing and the results achieved in community health outcomes. The Ministry of Health (MOH) already recognized the need to accommodate the health care concerns related to adolescent psychosocial health risk behaviors and an increased prevalence of young people living with chronic illness. The challenge for the pioneer team of physicians trained in adolescent medicine was to develop and sustain a model of care that integrated (i) core clinical services that include quality measures of care to adolescents; (ii) professional development and capacity building needing an expansive teaching agenda at every level of health education; (iii) strong inter-sectorial collaborations within hospital and community partners; and (iv) robust research and evaluation strategies that keep clinical practice relevant and evidence based.
    Type of Medium: Online Resource
    ISSN: 2191-0278 , 0334-0139
    URL: Article
    DOI: 10.1515/ijamh-2016-5015
    Language: Unknown
    Publisher: Walter de Gruyter GmbH
    Publication Date: 2016
    detail.hit.zdb_id: 2602424-X
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