Adherence to 24-hour integrated activity guidelines among infants, toddlers and preschool children in Singapore.

This study examined children's adherence to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood in infants, toddlers and preschoolers aged 0-6 years. A total of 901 caregivers, comprising 219 infants, 379 toddlers, and 303 preschoolers, provided information regarding their children's physical activity (PA), screen viewing time (SVT), and sleep durations on both weekdays and weekends. Meeting the 24-hour integrated activity guidelines was defined as follows: for infants ≥ 30 minutes per day of tummy time or floor-based play; zero SVT; total sleep of 14-17 hours per day for ages 0-3 months, 12-16 hours per day for ages 4-11 months; for toddlers ≥ 180 minutes of total PA per day; zero SVT under 2 years; <1 hour for ages 2 to less than 3 years; and a total sleep of 11-14 hours per day; for preschoolers ≥ 180 minutes of total PA per day; SVT <1 hour per day; total sleep of 10-13 hours per day for those aged 3-5 years, and 10-11 hours per day for 6-year-olds. Chi-squared tests were used to examine the differences in guideline adherence between weekdays and weekends. Compared to weekdays, during weekends there was a higher proportion of toddlers and preschoolers adhering to the PA guidelines (68.9% vs 50.1%; 78.9% vs 55.4%, respectively, p<0.05), and a lower proportion of toddlers adhering to SVT (38.8% vs 21.8%; p = 0.001). There was a declining adherence to all three activity guidelines as age groups progressed from infants (44.7%) to toddlers (15.8%) and then to preschoolers (9.4%). Concurrently, there was a decrease in adherence to SVT recommendations across the age groups, with adherence rates being highest among infants (83.1%), followed by toddlers (15.8%), and preschoolers (9.4%). Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to SVT guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating SVT among infants and young children.

Adherence to the Singapore Integrated 24-Hour Activity Guidelines by Infants and Toddlers and Its Association With Well-Being.

BACKGROUND: This study estimated the prevalence of Singapore infants and toddlers who met the new Singapore Integrated 24-Hour Activity Guidelines for Early Childhood and examined its association with well-being. METHODS: A total of 267 parents of children aged between 0 and 2 years completed an online questionnaire that consists of the Singaporean Children Lifestyle Questionnaire and either the Pediatric Quality of Life (PedsQL) Inventory Infant Scale or the Strength and Difficulties Questionnaire. Well-being of infants was measured through parent responses to PedsQL and that of toddlers was measured through Strength and Difficulties Questionnaire. Data were benchmarked against age-specific guidelines for physical activity, screen time, and sleep in the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood. RESULTS: A higher percentage of infants (37.3%) than toddlers (20.6%) had met 3 guidelines. In contrast, a lower percentage of infants than toddlers met at least one or did not meet any guidelines (3.8% and 0% for infants vs 22.4% and 1.8% for toddlers, respectively). Infants who met more guidelines had significantly higher parent-reported PedsQL total scale score than infants who met fewer guidelines (P < .05). However, the present study found that the number of guidelines met was not associated to infants' PedsQL scale score and toddlers' total difficulty score (P > .05). CONCLUSION: Adherence to this set of local guidelines should be widely publicized, so parents will have greater awareness and knowledge on cultivating good physical activity, screen time, and sleep habits for their child from a young age.

The Effect of Impact Seizure on the Recovery of Children and Adolescents With Concussion: A Matched Case-Control Study.

OBJECTIVE: Management of sport-related and recreation-related concussions (SRCs) in children and adolescents is challenging as brain maturation affects prognosis. However, impact seizure was removed as a prognosis modifying factor in children and adolescents with SRCs in the 2017 consensus statement on concussion in sport, based mostly on adult literature. Therefore, this study evaluates the association of impact seizure on the recovery in children and adolescents with SRCs. DESIGN: Retrospective matched case-control study. SETTING: Tertiary pediatric sports medicine service, from January 1, 2015, to June 30, 2022. PATIENTS: A cohort of 452 patients, aged 7 to 18 years, with new episode of SRC was seen. From this cohort, 396 patients were included in the analysis, including 22 with impact seizures. Controls were generated using the propensity score matching approach. Patients with moderate or severe traumatic brain injury or incomplete treatment were excluded. INDEPENDENT VARIABLE: Impact seizure during SRC. MAIN OUTCOME MEASURES: Primary outcome was recovery duration in number of days. RESULTS: The median recovery duration was longer in the cases (73 days, interquartile range [IQR] = 38-143 days) as compared with controls (49.5 days, IQR = 30.5-93.5 days). There was no difference in patients with prolonged recovery (ie >28 days) between both groups (OR 1.6, 95% CI, 0.4-6.6, P = 0.505). CONCLUSIONS: Impact seizures prolonged the recovery duration in children and adolescents with SRCs and have a potential concussion modifying prognostic role. These findings could help provide evidence-based management principles for children and adolescents with SRCs in subsequent concussion consensus statements.

24 h Activity Guidelines in Children and Adolescents: A Prevalence Survey in Asia-Pacific Cities.

This study aimed to examine the prevalence of adherence to 24 h activity guidelines in children and adolescents from Asia-Pacific cities. In 1139 children aged 5-18 years, moderate-to-vigorous physical activity (MVPA), screen viewing time (SVT), sleep duration, child weight, height, sex, and age were parent-reported. Descriptive statistics were used to assess the number of guidelines met, and prevalence of adherence to activity guidelines by city and child sex. Prevalence of meeting all three 24 h activity guidelines was low across all countries (1.8-10.3%) (p < 0.05). Children from Thiruvananthapuram, India had the highest [10.3% (95% CI: 6.0-17.0)], while those from Tokyo, Japan had the lowest prevalence [1.8% (95% CI: 0.5-7.0)] of meeting all three guidelines. The highest prevalence of meeting individual MVPA, SVT and sleep guidelines was found in India [67.5% (95% CI: 58.8-75.1)], Kelaniya, Sri Lanka [63.2% (95% CI: 58.7-67.4)] and Kowloon, Hong Kong [59.4% (95% CI: 51.1-65.3)], respectively. Overall, a higher prevalence of boys met all three guidelines, compared to girls [5.9% (95% CI: 4.1-8.1) vs. 4.7% (3.1-6.6), p = 0.32]. The prevalence of adhering to all three activity guidelines was low in all five participating cities, with a higher proportion of boys meeting all guidelines.

Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years.

Background: Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children. Method: Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework. Findings: These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance. Interpretation: Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region. Funding: Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.

Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents.

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 7-17 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.

Asia-Pacific Consensus Statement on integrated 24-hour activity guidelines for children and adolescents.

Non-communicable diseases (NCDs) constitute a significant public health challenge and pose a great burden on health and social systems throughout the world. The Asia-Pacific region is in a vulnerable position as the prevalence of NCDs will inevitably increase with rapid socioeconomic transitions; yet it is ill prepared for this public health challenge as Asian children are among the most physically inactive in the world. Aligned with the WHO's global strategy to control NCDs via preventive measures and health promotion policies, representatives from the Asia-Pacific region came together to develop consensus statement on integrated 24-hour activity guidelines for children and adolescents. These guidelines apply to children and adolescents, aged 5-18 years, in the Asia-Pacific region, regardless of gender, cultural background or socioeconomic status. These guidelines aim to provide the latest evidence-based recommendations, taking a holistic approach to lifestyle activities and adopting a practical perspective by framing these activities within a 24-hour period. Eating and dietary elements were incorporated as they closely influence the energy balance of the movement behaviours and vice versa. By investing in the younger generations through advocacy for healthier lifestyles, we aim to reduce the burden of NCDs in the Asia-Pacific region.

Parental perception and guideline awareness of children's lifestyle behaviours at ages 5 to 14 in Singapore.

INTRODUCTION: There are limited data on the descriptive lifestyle behaviour of school-age children in Singapore. METHODS: A total of 100 parents of children ages 5 to 14 participated in a parents' proxy-reported survey. Frequency of moderate physical activity (PA) and vigorous PA was assessed, while t-tests or chi-square test was used to examine differences between weekdays and weekends for sleep, screen viewing time (SVT) and sedentary behaviour (SB). RESULTS: Of the 100 children (68% of Chinese ethnicity, 59% boys, mean age 9.1±2.9 years), 31% were overweight or obese, with body mass index z-score of >1. For moderate and vigorous PA participation in a typical week, 32.0% and 43.0%, respectively, did not participate, while median (interquartile range) days of participation were 3 (2-3) days/week and 2 (1-3) days/week for a duration of 60 (interquartile range 30-120) minutes/session. When comparing weekends with weekdays, the means (standard deviation) of both SVT and sleep duration were higher on weekends (SVT: 4.1 [2.9] versus 3.3 [3.1] hours/day, P=0.07; sleep: 8.8 [1.5] vs 8.3 [1.3] hours/day, P=0.02), while there were no significant differences for SB. A higher proportion of children had SB of ≥10 hours/day and slept <8 hours/day on weekdays compared with on weekends (SB: 23.5% vs 20.6%, P>0.05; sleep:18.8% vs 2.1%, P<0.05), while the proportion exceeding SVT of 2 hours/day were higher on weekends than on weekdays (63.8% vs 45.4%, P=0.03). Overall, there was higher parental awareness of sleep guidelines (80.0%), but lower awareness of PA (51.0%) and SVT (59.0%) guidelines. CONCLUSION: Lifestyle behaviours were suboptimal in Singapore children compared with existing overseas guidelines, indicating a need for an integrated guideline with greater dissemination.

Compound heterozygous mutations with novel missense ABCA12 mutation in harlequin ichthyosis.

Harlequin ichthyosis (HI) is the most severe form of autosomal recessive congenital ichthyosis, presenting at birth with distinctive facial features and thick, plate-like scales over the entire body. The abnormal skin barrier predisposes the patient to multiple complications, including dehydration and sepsis. Mortality rates of babies with HI have been greatly reduced since the introduction of systemic retinoid therapy. Mutations in ABCA12 have been found to lead to HI. Most of these mutations are truncation or deletion mutations in the conserved region of the protein, leading to severe loss of ABCA12 function. We report a case of HI caused by a compound heterozygous mutation (a known single nucleotide deletion and a novel single nucleotide substitution) in the ABCA12 gene.