Tobacco smoke exposure and respiratory morbidity in young children.

OBJECTIVE: Secondhand smoke exposure is a potentially preventable cause of significant respiratory morbidity in young children. Our study aimed to quantify respiratory morbidity in young children exposed to secondhand smoke to identify potentially modifiable factors. MATERIALS AND METHODS: This study was embedded in a prospective birth cohort study of pregnant women and their children from fetal life onwards in Singapore (Growing Up in Singapore Towards healthy Outcomes, or GUSTO). Data on prenatal, antenatal and postnatal active and secondhand tobacco smoke exposure were obtained by an investigator-administered questionnaire for the periods before pregnancy, at 26-28 weeks' gestation and 24 months after delivery. Data on respiratory morbidity (wheezing episodes, croupy cough, nebuliser use, snoring) and other morbidity (fever, hospitalisation, ear infection) of the child was collected at week 3 and at months 3, 6, 9, 12, 15, 18 and 24 after delivery. Information on parental atopy and potential confounders such as socioeconomic status and maternal educational level were also obtained. Statistical analysis of the data was performed to quantify any significant differences in incidence of respiratory morbidity in children exposed to tobacco smoke in utero and postdelivery, compared with those in smoke-free environments. RESULTS: Women who smoked regularly prior to pregnancy comprised 12.5% (n=155) of the study population; this number fell to 2.3% (n=29) during pregnancy. Mothers exposed to secondhand smoke in the household before pregnancy comprised 35.7% of the study population (n=441) and 31.5% (n=389) were exposed during pregnancy. Postnatally, the prevalence of secondhand tobacco smoke exposure from birth to 2 years of age was 29% (n=359). Participants of Malay ethnicity (p<0.001), mothers with no or primary level education (p<0.001) and mothers with low socioeconomic status (p<0.001) had the highest exposure to tobacco smoke. Offspring secondhand smoke exposure at home by 12 months and by 24 months of age was associated with an increase in hospital admissions due to respiratory disease (RR 1.89, 95% CI 1.02 to 3.50, p=0.04 by 12 months and RR 1.64, 95% CI 1.05 to 2.55, p=0.03 by 24 months) as well as all-cause hospitalisation (RR 1.57, 95% CI 1.14 to 2.17, p=0.01 by 12 months and RR 1.49, 95% CI 1.17 to 1.90, p=0.001 by 24 months), adjusting for parental atopy and child atopic dermatitis. Participants exposed to secondhand smoke by 12 months postdelivery had a significantly increased risk of having at least one wheezing episode (RR 1.71, 95% CI 1.38 to 2.11, p<0.001). CONCLUSIONS: Secondhand smoke exposure during the prenatal and postnatal periods is associated with increased respiratory morbidity in children. Opportunistic screening and targeted smoking cessation counselling for parents at child hospital admissions and well-child outpatient visits, as well as preconception smoking cessation counselling for future pregnancies, may be beneficial to protect the child from negative health impacts.

Unintentional injuries in infants in Singapore.

INTRODUCTION: To describe the risk factors, causes and outcome of infant injuries so as to guide the formulation of injury prevention strategies specific for Singapore babies less than one year old. METHODS: Demographical, socio-economic data, and data on the circumstances of injury, nature, severity of injury and clinical outcome of all infants less than one year old and who sought medical attention for or died from unintentional childhood injuries or poisoning, at the Emergency Departments of three SingHealth hospitals, two SingHealth primary care polyclinics and the Forensic Medicine Department, Health Sciences Authority during a six-month period, were extracted from a larger Childhood Injuries Surveillance database and analysed. RESULTS: 405 cases of accidental injury and poisoning in infants aged less than one year were seen from February to July 2002. 40.5 percent of injuries occurred when infants were left alone. Most infants were aged between nine months to one year (37 percent), male (57.3 percent), first-born (57.3 percent) and Chinese (69 percent), with no past medical history (96.1 percent). 91 percent of the injuries occurred at home, of which 60.5 percent occurred in the bedroom. Falls were the major mechanism of injury (77 percent). A total of 431 injuries were sustained. 63 percent were head injuries - mainly stable head injuries, which made up 93.1 percent of all the head injuries. 67.5 percent of the cases were discharged without follow-up, while 17.9 percent required hospital admission, mostly to the general ward (98.6 percent of total admissions), and to the neurosurgery department (84.9 percent of total admissions). There were two fatalities in this study population. The mechanisms and patterns of injury changed with increasing motor ability of the infants. CONCLUSION: Parents and caregivers of infants should be taught and reminded about the age specific measures in injury prevention as their wards go through the various developmental stages in the first year of life. Emphasis should be placed on close caregiver supervision, identifying potential injury hazards in the home, fall prevention, adopting safe infant care practices and the safe use of infant care products.

Refeeding oedema in anorexia nervosa.

Refeeding oedema in patients with anorexia nervosa is a known but yet under-reported and poorly-understood condition. We illustrate this condition in a 19-year-old girl with anorexia nervosa who developed bipedal oedema after she was started on nutritional therapy. It is important to be aware of the differential diagnoses of oedema in such cases, which includes heart failure and previous diuretic abuse. Refeeding oedema generally resolves spontaneously but some individuals may require treatment.

Genetic analysis of growth inhibition by GAL4-L kappa B-alpha in Saccharomyces cerevisiae.

I kappa B proteins bind to and regulate Rel/NF- kappa B transcription factors. We showed previously that a fusion protein (GAL4-p40) containing the DNA-binding domain of GAL4 and sequences of chicken l kappa B-alpha (p40) inhibits growth in the yeast Saccharomyces cerevisiae. We now show that p40 must be bound to DNA to inhibit yeast growth, p40 proteins, bound to DNA either as GAL4 or LEXA fusion proteins, inhibit yeast growth. In contrast, p40 proteins that cannot bind to DNA, such as full-length p40, a GAL4-l kappa B fusion protein containing a mutant GAL4 DNA-binding domain, and a fusion protein (GAD-p40) containing the transcriptional activation domain of GAL4 fused to p40, each failed to inhibit cell growth. As with GAL4-VP16, GAL4-p40 needs a functional cellular ADA2 gene to exert its growth-inhibitory effect in S. cerevisiae. Using a high copy suppression strategy, we have isolated three S. cerevisiae genes that restore normal growth to yeast expressing GAL4-p40 or LEXA-p40. We have termed these rescuing genes collectively as SIK genes, for "Suppressors of 1 kappa B." Expression of the SIK genes specifically suppresses the growth-inhibitory activity of GAL4-p40 and LEXA-p40 because SIK gene expression cannot block GAL4-VP16-mediated growth inhibition in S. cerevisiae. SIK1 encodes a novel protein that contains a COOH-terminal repeat that has been found in many microtubule-binding proteins. SIK2 encodes NH2-terminal acetyltransferase, and SIK3 encodes the yeast ribosomal S4 protein. None of the SIK proteins binds directly to p40 sequences in vitro, suggesting that the SIK proteins are likely to act downstream of the direct point of growth inhibition by GAL4-p40. Our results may be useful for devising strategies for identifying vertebrate inhibitors of l kappa B proteins and of other proteins that inhibit growth in S. cerevisiae.