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This review article summarises the current available literature on sleep patterns and sleep problems in Singapore children. Co-sleeping is a culturally dependent practice and its prevalence in Singapore has been determined to be 73%. Co-sleeping is not associated with significant sleep problems in Singapore children. Snoring and habitual snoring occur in 28.1% and 6.0% of Singapore children, respectively. Habitual snoring in Singapore children was significantly associated with obesity, allergic rhinitis, atopic dermatitis, maternal smoking and breastfeeding. Atopy was the strongest risk factor for habitual snoring in Singapore, and the effect was cumulative. Children attending psychiatric services in Singapore may also have sleep disorders, the highest prevalence being in children with attention deficit hyperactivity disorder. The knowledge on childhood sleep disorders (including obstructive sleep apnoea) amongst the public, patients, parents and future doctors in Singapore are inadequate and there is an urgent need for increased education in this area given the importance of good sleep in children. There is also a need to change parental attitudes about sleep disorders and encourage early medical consultation.
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PMID:Sleep disorders in children: the Singapore perspective. 1879 66

In the last few decades, the prevalence of allergic diseases, asthma, allergic rhinoconjunctivitis and atopic dermatitis in particular, has been observed to increase in urban settings. In addition, epidemiological data show the proportion of overweight individuals to rise in the last two decades. Obesity and overweight are a major public health problem not only in industrialized countries but also in developing ones because the morbidity and mortality rates are greater in the obese. An increased body mass index is considered a risk factor for the occurrence of myocardial infarction, stroke, atherosclerosis, hypertension, insulin resistance, dyslipidemia and some types of carcinoma. An ever greater body of available data point to the possible association of allergic diseases with obesity and overweight. Impaired immune tolerance is considered to be a sequel of immune changes due to the activity of adipokines, bioactive molecules secreted in white adipose tissue. About 50 adipokines are currently known to be secreted in adipose tissue, some of them belonging to the group of cytokines such as tumor necrosis factor alpha and interleukin-6. The association between obesity and allergic diseases has not yet been fully clarified. While the observations recorded to date should not be neglected, additional studies are necessary to help understand the complex function of adipokines involved in allergic events.
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PMID:Obesity and allergic diseases. 1911 Nov 50

The hygiene hypothesis proposes that the growing epidemic of atopic eczema, allergic rhinoconjunctivitis and asthma is related to reduced exposure to microbes at an early age as a result of environmental changes in the industrialized world. These include improved sanitation and living conditions, vaccinations and antimicrobial therapy, together with declining family size and changes in dietary intake. Recent scientific advances demonstrate that the hygiene hypothesis needs to be extended in three respects. Firstly, rigorous research in the field of probiotics points to the importance of the collective composition and the compositional development of the gut microbiota in consolidation of healthy immune responsiveness. Secondly, immunomodulatory and suppressive immune responses have been shown to complement the original immunological basis of the hygiene hypothesis, the so-called T helper 1/T helper 2 paradigm. Thirdly, host-microbe interaction appears to affect the risk of developing not only atopic disease but also other inflammatory Western lifestyle diseases, including obesity. The results of experimental studies suggest that deviations in gut microbiota composition predispose to excessive energy storage and obesity, and, more recently in humans, aberrant compositional development of the gut microbiota has been shown to precede overweight, inviting enormous possibilities to reach preventive and therapeutic applications in weight management.
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PMID:Obesity - extending the hygiene hypothesis. 1971 May 16

Medical and scientific studies have proven that the body's metabolic programming can be influenced by diet and nutrition from early infancy. As a result, the incidence and outcome of several metabolic diseases such as obesity, hypertension and cardiovascular disorders have been found to be associated with birth weight, growth and feeding patterns, and the body composition in early childhood. Exclusive or partial breast feeding for at least 6 months is recommended by the World Health Organization, while the European Society of Pediatric Gastroenterology Hepatology and Nutrition Committee on Nutrition recommends the introduction of complementary foods at 4-6 months of age. The fat content of the diet should not be below 25% of the energy intake in order to maintain ideal growth while dietary proteins above 15% of the energy intake is related to future obesity. Long term benefits of breast feeding include a more ideal serum lipid profile and blood pressure, improved neuro-cognitive scores, and a decreased incidence for atopic dermatitis in children who have family members with atopic diseases. Several studies have also acknowledged the long term benefits for neuro-cognitive development from certain nutrients including long-chain polyunstaturated fatty acids and docosahexaenoic acid. Meat intake has proved to be beneficial to psychomotor development. It is suggested that early introduction for complementary foods before 4 months of age is a risk factor for atopic dermatitis; while no strong evidence showed delaying weaning foods can decrease the risk for allergic diseases.
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PMID:Health consequences of nutrition in childhood and early infancy. 1975 Aug 86

We report the pathological and virological findings of the first autopsy case of the 2009 pandemic influenza (A/H1N1pdm) virus infection in Japan. A man aged 33 years with chronic heart failure due to dilated cardiomyopathy, mild diabetes mellitus, atopic dermatitis, bronchial asthma, and obesity died of respiratory failure and multiple organ dysfunction syndrome. Macroscopic examination showed severe pulmonary edema and microscopically the lung sections showed very early exudative-stage diffuse alveolar damage (DAD). Immunohistochemistry revealed proliferation of the influenza (A/H1N1pdm) virus in alveolar epithelial cells, some of which expressed SAalpha2-3Gal on the cell surface. Influenza (A/H1N1pdm) virus genomic RNA and mRNA were also detected in alveolar epithelial cells. Real-time PCR revealed 723 copies/cell in the left lower lung section from which the influenza (A/H1N1pdm) virus was isolated. Electron microscopic analysis revealed filamentous viral particles in the lung tissue. The concentrations of various cytokines/chemokines in the serum and the autopsied lung tissue were measured. IL-2R, IL-6, IL-8, IL-10, IFN-alpha, MCP-1, and MIG levels were elevated in both. These findings indicated a case of viral pneumonia caused by influenza (A/H1N1pdm) virus infection, showing characteristic pathological findings of the early stage of DAD.
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PMID:The first autopsy case of pandemic influenza (A/H1N1pdm) virus infection in Japan: detection of a high copy number of the virus in type II alveolar epithelial cells by pathological and virological examination. 2009 68

Probiotics exert distinct effects on the intestinal mucosa and the immune system that can be used in preventive and therapeutic settings. There is evidence to support the use of probiotics in necrotizing enterocolitis in preterm infants and pouchitis. Furthermore, the immunomodulatory effects of probiotics seem to ameliorate atopic diseases, in particular atopic dermatitis. The efficacy of probiotics has been shown comparable to Mesalazine regarding the maintenance of remission in ulcerative colitis. In addition there is evidence that probiotics are useful in the prevention of pouchitis or in therapy of irritable bowel syndrome. Recent data indicate that commensals and probiotics could play a role in nutrient fermentation and energy metabolism and may be helpful in the prevention and therapy of obesity.
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PMID:[Usefulness of probiotics in prevention and therapy]. 2016 99

To assess concordance of prevalence rates of asthma, allergic rhinoconjunctivitis and atopic eczema symptoms among adolescents in five Canadian cities. The International Study of Asthma and Allergies in Childhood Phase 3 written questionnaires were answered by 8334 adolescents aged 13 to 14 in Vancouver, Saskatoon, Winnipeg, Hamilton and Halifax, Canada. Prevalence rates of current symptoms ranged from 13.7-33.0% for wheezing, 14.6-22.6% for allergic rhinoconjunctivitis and 8.2-10.4% for atopic eczema. Using Hamilton as reference, the prevalence of wheezing was significantly higher in Halifax (OR = 1.58; 95% CI 1.36-1.84) and Saskatoon (1.27; 1.07-1.50) and significantly lower in Vancouver (0.51; 0.44-0.59). In contrast, allergic rhinoconjunctivitis was significantly more prevalent in Winnipeg (1.39; 1.16-1.68) and Halifax (1.36; 1.14-1.61) and trended lower in Saskatoon (0.81; 0.66-1.00). Atopic eczema was significantly more prevalent in Winnipeg (1.31; 1.01-1.69) and Vancouver (1.28; 1.04-1.58). Multivariable logistic regression analyses showed the region of residence, being born in Canada, recent use of acetaminophen and heavy exposure to traffic exhaust were significantly associated with all three allergic conditions, while obesity and having two or more smokers at home was only associated with increased risk for wheezing. Chinese ethnicity decreased that risk. Among five Canadian centres, the highest prevalence rates of allergic rhinoconjunctivitis or atopic eczema were not observed in the same regions as the highest prevalence rates of wheezing. This disparity in regional variations in the prevalence rates suggests dissimilar risk factors for the development or expression of wheezing (asthma), allergic rhinoconjunctivitis and atopic eczema.
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PMID:Disparate geographic prevalences of asthma, allergic rhinoconjunctivitis and atopic eczema among adolescents in five Canadian cities. 2049 43

Marketing-driven innovation in the field of pediatric nutrition, in particular in the infant formula segment is not sustainable. New benefits of products must be scientifically proven and safety and efficacy of new formulae established in clinical trials. The scientific innovation process of three infant formulae is described. Improvement in protein quality allowed to reduce the protein concentration in whey-based infant formula. Weight gain and BMI of infants fed those formulae corresponds to breastfed infants and is lower than in infants fed traditional formulae with higher protein concentration. A meta-analysis indicates associations between rapid weight gain in infancy and obesity later in life. If infants cannot be exclusively breastfed until 4-6 months of age, feeding low-protein formulae may contribute to positive long-term health outcome with potentially important health economic effects. A partially hydrolyzed whey based formula for prevention of allergic symptoms in children with hereditary risk for allergic diseases was developed more than 25 years ago. The most recent meta-analysis which included 15 randomized clinical trials indicates that the risk of all allergic diseases and atopic dermatitis/eczema is significantly reduced in infants at risk when the partially hydrolyzed formula is fed. The partially hydrolyzed formula had the same protective effect as casein-based high-degree extensively hydrolyzed formula. Because of substantial price differences between the two formulae, feeding the partially hydrolyzed whey formula is cost saving. Hypoallergenic claims can be made in many countries, and international nutrition committees have positively commented the preventive effect of those formulae. Acidified formulae have been widely used during the last decade in replacement feeding programs for infants whose mothers are HIV positive. The formula was innovated by improving whey protein quality and lowering protein concentration. The bacteriostatic properties of the new formula were proven in in vitro tests. Meta-analysis indicated that feeding the formula to immunocompromised infants resulted in growth similar to breastfeeding. The bacteriostatic effects of the acidified formula need to be communicated to health care professionals, but also the risks if replacement feeding is not acceptable, feasible, affordable, sustainable, and safe for mother and infant.
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PMID:Sustainable clinical research, health economic aspects and medical marketing: drivers of product innovation. 2066 21

The different compartments of the gastrointestinal tract are inhabited by populations of micro-organisms. By far the most important predominant populations are in the colon where a true symbiosis with the host exists that is a key for well-being and health. For such a microbiota, 'normobiosis' characterises a composition of the gut 'ecosystem' in which micro-organisms with potential health benefits predominate in number over potentially harmful ones, in contrast to 'dysbiosis', in which one or a few potentially harmful micro-organisms are dominant, thus creating a disease-prone situation. The present document has been written by a group of both academic and industry experts (in the ILSI Europe Prebiotic Expert Group and Prebiotic Task Force, respectively). It does not aim to propose a new definition of a prebiotic nor to identify which food products are classified as prebiotic but rather to validate and expand the original idea of the prebiotic concept (that can be translated in 'prebiotic effects'), defined as: 'The selective stimulation of growth and/or activity(ies) of one or a limited number of microbial genus(era)/species in the gut microbiota that confer(s) health benefits to the host.' Thanks to the methodological and fundamental research of microbiologists, immense progress has very recently been made in our understanding of the gut microbiota. A large number of human intervention studies have been performed that have demonstrated that dietary consumption of certain food products can result in statistically significant changes in the composition of the gut microbiota in line with the prebiotic concept. Thus the prebiotic effect is now a well-established scientific fact. The more data are accumulating, the more it will be recognised that such changes in the microbiota's composition, especially increase in bifidobacteria, can be regarded as a marker of intestinal health. The review is divided in chapters that cover the major areas of nutrition research where a prebiotic effect has tentatively been investigated for potential health benefits. The prebiotic effect has been shown to associate with modulation of biomarkers and activity(ies) of the immune system. Confirming the studies in adults, it has been demonstrated that, in infant nutrition, the prebiotic effect includes a significant change of gut microbiota composition, especially an increase of faecal concentrations of bifidobacteria. This concomitantly improves stool quality (pH, SCFA, frequency and consistency), reduces the risk of gastroenteritis and infections, improves general well-being and reduces the incidence of allergic symptoms such as atopic eczema. Changes in the gut microbiota composition are classically considered as one of the many factors involved in the pathogenesis of either inflammatory bowel disease or irritable bowel syndrome. The use of particular food products with a prebiotic effect has thus been tested in clinical trials with the objective to improve the clinical activity and well-being of patients with such disorders. Promising beneficial effects have been demonstrated in some preliminary studies, including changes in gut microbiota composition (especially increase in bifidobacteria concentration). Often associated with toxic load and/or miscellaneous risk factors, colon cancer is another pathology for which a possible role of gut microbiota composition has been hypothesised. Numerous experimental studies have reported reduction in incidence of tumours and cancers after feeding specific food products with a prebiotic effect. Some of these studies (including one human trial) have also reported that, in such conditions, gut microbiota composition was modified (especially due to increased concentration of bifidobacteria). Dietary intake of particular food products with a prebiotic effect has been shown, especially in adolescents, but also tentatively in postmenopausal women, to increase Ca absorption as well as bone Ca accretion and bone mineral density. Recent data, both from experimental models and from human studies, support the beneficial effects of particular food products with prebiotic properties on energy homaeostasis, satiety regulation and body weight gain. Together, with data in obese animals and patients, these studies support the hypothesis that gut microbiota composition (especially the number of bifidobacteria) may contribute to modulate metabolic processes associated with syndrome X, especially obesity and diabetes type 2. It is plausible, even though not exclusive, that these effects are linked to the microbiota-induced changes and it is feasible to conclude that their mechanisms fit into the prebiotic effect. However, the role of such changes in these health benefits remains to be definitively proven. As a result of the research activity that followed the publication of the prebiotic concept 15 years ago, it has become clear that products that cause a selective modification in the gut microbiota's composition and/or activity(ies) and thus strengthens normobiosis could either induce beneficial physiological effects in the colon and also in extra-intestinal compartments or contribute towards reducing the risk of dysbiosis and associated intestinal and systemic pathologies.
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PMID:Prebiotic effects: metabolic and health benefits. 2092 Mar 76

With the present review, we intend to highlight the importance of considering the age- and development-dependent occurrence of comorbidity in ADHD and to outline distinct trajectories of symptom progression with possible impact on course and outcome of ADHD. The review will focus on introducing the concepts of "developmental epidemiology" and "developmental comorbidity". Psychiatric and non-psychiatric age-dependent comorbidity can be seen in the majority of children, adolescents and adults with ADHD, resulting in a severe impairment of everyday life with considerable functional and psychosocial problems. Concerning the temporal order of occurrence, psychiatric conditions may be present before the appearance of first definite ADHD symptoms ("pre-comorbidity", such as temperament factors, sleep disturbance, autism spectrum disorders and atopic eczema). They may coincide with the time when ADHD symptoms reach a clinically significant level ("simultaneous comorbidity": enuresis, encopresis, developmental dyslexia). The majority of comorbidity, however, appears after the onset of ADHD in the course of disease ("post-comorbidity": tic disorder, depression and suicidality, anxiety disorders, obsessive compulsive disorder, bipolar disorder, conduct and substance use disorders, obesity and personality disorders). The aetio-pathophysiology of ADHD and its comorbid disorders and also the nature of comorbidity itself being highly heterogeneous, we additionally discuss possible models of comorbidity. In the future, longitudinal data on distinct patterns of symptom and comorbidity progression would help to refine disease classification systems, strengthen the power of future genetic studies and finally allow for more specific treatment strategies.
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PMID:Developmental comorbidity in attention-deficit/hyperactivity disorder. 2143 12


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