RESUMEN
OBJECTIVE: There is poor understanding on health care utilization, productivity losses, and burden of adverse childhood experiences (ACEs) in multiethnic Asian populations. Part of this research gap stems from the limited epidemiological data on neglect, emotional abuse, bullying, and dysfunctional home environments. This study estimated health care utilization, productivity losses, and burden of ACEs (at least one exposure and multiple exposures) in Singapore. METHOD: A total of 4,441 adult residents were recruited via door-to-door surveys in a nationally representative study in Singapore. All participants were assessed for ACEs, health care utilization, productivity losses, chronic physical disorders, and mental disorders on structured interviews. Approximation formulas were applied to calculate the estimated cost of ACEs in Singapore. RESULTS: ACEs were prevalent (63.9%) in the Singapore population. Individuals exposed to ≥ 3 ACEs (13.1%) utilized more direct medical care (e.g., primary care doctor and accident and emergency visits) and experienced greater productivity losses than those without ACEs (36.1%). The adjusted excess costs associated with ACEs per person were estimated to be S$767.40 (at least one ACE; 63.9%) and S$2167.84 (≥ 3 ACEs; 13.1%). The adjusted incremental costs of ACEs in the Singapore population were estimated to be S$1.18 billion (at least one ACE) and S$680 million (≥ 3 ACEs) per year. CONCLUSIONS: The health and economic burden of ACEs is substantial in Singapore. Our results highlight the importance of investing in novel, population-based ACEs interventions, and the potential return on investment through preventive care and alleviation of the health care burden. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
RESUMEN
This study aimed to document the safety and efficacy of a single infusion of autologous umbilical cord blood (UCB) in 20 autistic children aged 24-72 months. A pre-post treatment within-subjects open label design was used. At T = 0, 6, 12, and 18 months, participants underwent detailed and structured safety evaluations (via caregiver report), Vineland Adaptive Behavior Scale (Vineland-3), Stanford Binet Intelligence Scale (SB-5), Expressive One-Word Picture Vocabulary Test, Brief Observation of Social Communication Change (BOSCC), Pervasive Developmental Disorder-Behavior Inventory, Repetitive Behavior Scale-Revised, Sensory Experience Questionnaire (SEQ-2.1), Child Behavior Checklist, Clinical Global Impression-Severity and Improvement (CGI-I) Scales, and eye-gaze tracking. UCB infusion was conducted at T = 6 months, hence, 0-6 months was the control period, and 6-18 months the follow-up period. Of 20 children recruited, 19 completed the study and 1 was withdrawn due to UCB not meeting quality control criteria for infusion. There were 15 males and 4 females with an overall mean (SD) age of 4.15 (0.62) years. Mean (SD) cell dose administered was 38.16 (9.82) million cells/kg. None suffered serious adverse events although there were mild behavioral side effects and one unit grew coagulase negative staphylococcus from a post-thaw sample. There were no significant differences in Vineland-3, SB-5, BOSCC, and SEQ-2.1 scores at T = 12 and T = 18 months. Twelve participants had T = 18 CGI-I scores of 2-3 (minimally to much improved), seven participants had scores of 4 (no change). Autologous UCB infusion in autistic children is generally safe but not without risks, including that of infection. In this within-subjects study, some children showed global symptom improvements while others showed no change. Stem cell therapies for autism should only be conducted under strict clinical trial conditions with clear risk discussions.