Height gain after two-years-of-age is associated with better cognitive capacity, measured with Raven's coloured matrices at 15-years-of-age in Malawi.

Stunting is a measure of chronic undernutrition, and it affects approximately 160 million children worldwide. Cognitive development of stunted children is compromised, but evidence about the association between height gain in late childhood and adolescent cognitive capacity is scarce. We aimed to determine the association between height gains at different ages, including late childhood, and cognitive capacity at 15-years-of-age. We conducted a prospective cohort study in a rural African setting in Southern Malawi. The study cohort was enrolled between June 1995 and August 1996. It originally comprised mothers of 813 fetuses, and the number of children born live was 767. These children were followed up until the age of 15 years. The anthropometrics were measured at one and 24-months-of-age and 15-years-of-age, and cognitive capacity of participants was assessed at 15-years-of-age with Raven's Coloured Matrices score, mathematic test score, median reaction time (RT) (milliseconds) and RT lapses. The associations between growth and the outcome measures were assessed with linear regression. Raven's Coloured Matrices score was predicted by height gain between 24 months and 15-years-of-age (coefficient 0.85, P = 0.03) and (coefficient 0.69, P = 0.06), but not by earlier growth, when possible confounders were included in the model. The association weakened when school education was further added in the model (coefficient = 0.69, P = 0,060). In conclusion, in rural Malawi, better growth in late childhood is likely to lead to better cognitive capacity in adolescence, partly through more school education. In light of these results, growth promotion should not only be limited to early childhood.

Pilot Study of a Palliative Care and Medical Oncology Co-Rounding Model for Advanced Cancer Inpatients in a Tertiary Hospital in Singapore.

OBJECTIVE: Our aim was to obtain initial estimates of the effect of a palliative care and medical oncology co-rounding model on hospital length of stay, proportion of patients reviewed by specialist palliative care (SPC), and proportion of patients who were readmitted within 7 and 30 days of hospital discharge. BACKGROUND: Earlier timing of palliative care improves patient outcomes, but current consultative models of palliative care service delivery are not feasible for widespread implementation. METHODS: We conducted a pilot pre-post intervention study of a palliative care and medical oncology co-rounding model of care in the inpatient hospital setting. All patients admitted under the care of an inpatient oncology team during the study period were included. Hospital length of stay, proportion of patients reviewed by SPC, and readmission data were retrieved from the electronic administrative database. RESULTS: There were 595 unique patients (352 in the "consultative" group and 243 in the "co-rounding" group). There was no significant difference in the proportion of patients who were reviewed by a SPC physician (consultative model 21.02% vs. co-rounding model 25.10%, p = 0.243). The hospital length of stay was shorter for the co-rounding group (median 3 days, interquartile range 2-7 days) compared with the consultative group (median 4 days, interquartile range 2-7 days) (p = 0.025). There was no significant difference in proportion of patients readmitted within 30 days of hospital discharge (consultative model 29.78% vs. co-rounding model 28.90%, p = 0.773). DISCUSSION: In our target population, the co-rounding model was associated with a shorter hospital length of stay.

Bimodal skin reactivity to histamine in atopic children in Singapore: influence of specific sensitizations.

Histamine skin prick test (SPT) is used as the 'golden standard' for positive control in in vivo immediate type hypersensitivity testing. The skin reactivity to histamine can, however, be modulated by a bevy of extraneous factors. We aimed to define whether histamine skin reactivity in atopic children in Singapore is influenced by age, ethnic origin, gender, environmental exposure or specific sensitization patterns. A retrospective analysis of children, with specific aeroallergen sensitization (as measured by at least one allergen-specific SPT with a wheal size > 3 mm compared with the negative control) from the outpatient speciality clinic of the KK Children's Hospital, during 06/2002-06/2003. A total of 315 patients were included, 235 (75%) were males, 252 (80%) were Chinese, age mean was 7.7 yr (range: 2-15). Patients were referred to the SPT with a diagnosis of one or more of: allergic rhinitis 287 (91%), asthma 112 (36%) or atopic dermatitis 60 (19%). The mean histamine response showed a bimodal distribution, independent of age, ethnic origin, gender or phenotypical expression of allergic disease. Histamine skin reactivity was higher in atopic patients with polysensitization (mean 5.0 mm vs. 2.9 mm in monosensitized patients, p < 0.001), and in patients with mould sensitization (mean 5.1 mm vs. 3.3 mm in patient not sensitized to moulds, p < 0.001). The presence of passive smoking increased the likelihood of a diminished histamine skin response. Histamine skin response data strongly suggested the presence of two heterogeneous subpopulations. Children with polysensitization and mould sensitization were more likely to show a large significant histamine response, whereas children with passive smoke exposure, showed a diminished skin reactivity to histamine.