Objective
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.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Objective
This retrospective study aimed to evaluate the prevalence and risk factors for low bone mineral density (BMD) at diagnosis in Asian adolescent females with anorexia nervosa (AN) and ...atypical AN.
Method
We analyzed the BMD results for 213 patients between 10 and 18 years of age, with AN and atypical AN receiving care at a pediatric hospital in Singapore. We used linear regression analyses to determine if type of eating disorder, premorbid weight, and duration of amenorrhea were risk factors for low BMD. For a subset of patients with repeat BMD evaluation, we used paired t‐tests to assess the impact of weight or menstrual restoration on the change in BMD.
Results
The prevalence of BMD height‐for‐age Z‐scores <−2 at presentation was higher in patients with AN (13.0%) than atypical AN (2.3%) (p = .034). In multivariate regression, a diagnosis of atypical AN was protective against low BMD at the lumbar spine (B = 0.394, p = .009) and total body less head (B = 0.774, p = .010). Duration of amenorrhea was not associated with BMD across all sites. For those with repeat BMD measures, there was significantly less deterioration in the BMD Z‐scores for patients with weight or menstrual restoration (R = −0.22 ± 0.59, NR = −0.69 ± 0.43, p = .029).
Conclusions
Duration of amenorrhea was not associated with BMD in this sample. A diagnosis of AN was correlated with lower BMD than atypical AN. Further research is needed to better understand the relationship between amenorrhea, weight status, and bone health in Asian adolescents with eating disorders.
Public Significance
In this sample, 13% of Asian adolescents with AN and 2.3% of Asian adolescents with atypical AN have low BMD. In our study population, duration of amenorrhea was not correlated with BMD. Among adolescents with AN, a history of being underweight at the highest pre‐morbid BMI, is correlated with low BMD. It is important for physicians to take a thorough weight history in evaluating bone health in this population.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Objective
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 χ2 = 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.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
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.
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).
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).
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.
Objective
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.
Full text
Available for:
BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Background
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.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
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.
BackgroundEarly childhood is a critical period for brain and biological development. Children with adverse childhood experiences (ACES) including maltreatment are at a high risk of developmental, ...behavioural and health problems lasting into adulthood. Anchor, a home visitation programme was commenced to support these children aged 0–3 years old who have been maltreated and their families.Objectives1.To review the uptake of the families into the programme 2. To understand the profile of the children and their families enrolled into the programmeMethodsChildren enrolled into the programme undergo baseline evaluation of their health, development and behavior through ASQ-3 (Ages and Stages Questionnaire, Third Edition), ASQ: SE 2 (Ages and Stages Questionnaire: Social Emotional, Second Edition), CBCL (Child Behavior Checklist), YCPC (Young Child PTSD Checklist) and M-CHAT (Modified Checklist for Autism in Toddler, Revised). The primary caregiver undergoes evaluation of mental health through PHQ-9 (Patient Health Questionnaire-9) and GAD-7 (General Anxiety Disorder-7), and an assessment of bonding with the child using PICCOLO (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes). After multidisciplinary team discussion of the above assessments, cases are tiered. The frequency of home visitation is determined based on the tiering of the case and the intervention plan is developed in discussion with the family using the principles of family centered practice. Their needs are identified early and supported with relevant home-based interventions. These children and their caregivers are also referred to medical and community services, as deemed necessary.ResultsBy December 2020, a total of 121 cases were referred to Anchor. 57 (42%) of these cases are actively followed up by the programme. Approximately 15% of the referred families were not keen on the programme, while 3 of the families withdrew from Anchor. The remaining cases includes those that are pending enrolment and those rejected by the team as the family was being supported through other services. Physical abuse was the most common reason for referral. Approximately 50% of the children had a significant developmental delay (2 standard deviation) in at least 1 developmental domain and a third of them had delays in 2 or more domains on the ASQ-3 assessment. Based on ASQ: SE, 33% of these children were reported to have mild to significant social-emotional developmental delays. 48% of the children were reported with behavioral and emotional concerns in CBCL assessments. 30% of the children had incomplete vaccination. A third of caregivers had mental wellness concerns as indicated by PHQ-9 and GAD-7 scores. M-CHAT and PICCOLO results are being analysed and will be presented in the conference.ConclusionsAnchor programme and its holistic evaluation showed that children with ACES and their families are a vulnerable group with high needs. It is imperative that these needs are identified in a timely manner to ensure that targeted support services are provided through home visitation and inter-agency collaboration.
BackgroundChildhood obesity is one of the most common and serious public health issues in the twenty-first century. Overweight and obese children are more likely to stay obese into adulthood and ...develop cardiovascular diseases at a younger age. Now, pediatricians have to manage these conditions that were once regarded as adult diseases.ObjectivesThe main aims are: 1. Identify knowledge gaps in medical, dietary, exercise and psychological aspects of childhood obesity; 2. Highlight the challenges in treating obese patients.MethodsThis is a single-center, cross sectional quantitative survey of pediatricians and pediatric residents working in the largest tertiary children hospital in Singapore (KK Women’s and Children’s Hospital). Baseline demographic data as well as participants’ knowledge in medical, dietary, physical activity and psychological aspects of childhood obesity were collected using a 32-question survey. A group of medical and allied health professionals designed and reviewed the survey. The correct answers for BMI cut-offs for obesity and overweight, healthy balanced diet in proportion of plate, recommended sugar intake, physical activity for children were defined according to national and international guidelines. Junior doctors comprised of house officers, medical officers and junior residents. Senior doctors were made up of senior residents and pediatricians.ResultsA total of 123 doctors were surveyed (46% were juniors). Both juniors and seniors tend to encounter overweight and obese patients on weekly basis. The most common challenge cited during patient consultations was patient motivation-related. Expectedly, the seniors perceived themselves to be more comfortable and knowledgeable compared to juniors. Other common challenges were lack of time and other medical conditions taking precedence over weight concerns. Physical activity recommendation was the weakest area, followed by dietary advice. There was no significant differences in medical, dietary, physical activity and psychological knowledge associated with obesity between junior and senior doctors.ConclusionsThere were similar knowledge gaps in all domains of childhood obesity between junior and senior doctors. Physical activity recommendation is the weakest area. Patient motivation is the commonest challenge faced. Hence, future education programs should target all doctors and focus on motivational interviewing.
Our public pediatric tertiary hospital in Singapore has been a part of a robust public health response to coronavirus 19 that has been calibrated in a timely manner to the evolving international ...situation. As of mid-March, Singapore remains in a containment mode with enhanced surveillance and limited community spread. Within this context, our service for pediatric eating disorder care has had to make significant adaptations to our models of service delivery as well as respond to the changing psychosocial needs of our patients. Given infection control requirements, we have instituted modular staffing for our inpatient and outpatient settings, necessitating task shifting and an increased use of technology for communication. Because of the reduced outpatient capacity and the need to minimize nonurgent trips to the hospital, we have implemented telemedicine and have leveraged on partnerships with school counselors and other community partners. “Coronaphobia” has influenced our patients' willingness to attend visits and worsened existing health anxiety for some. Responsiveness to families' and patients' health and financial concerns has been essential. As coronavirus 19 impacts more countries, our institution's experience can provide insight into challenges and possible adaptations to providing ongoing care for eating disorder patients in this environment.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
PDF
