The Relationship Between Screen Time and Symptom Severity in Children with ADHD during COVID-19 Lockdown

OBJECTIVES

To investigate the relationship between screen time and symptom severity in children with ADHD during the COVID-19 lockdown.

METHODS

Caregivers of children with ADHD aged 7 to 16 years completed the screen time questionnaire and ADHD rating scales of the SNAP-IV-Thai version during and after the COVID-19 lockdown. The correlation between screen time and ADHD scores was assessed.

RESULTS

Of the 90 children, aged 11.31 ± 2.29 years, enrolled, 74.4% were male, 64.4% were in primary school, and 73% had electronic screens in their bedrooms. After adjusting with other factors, recreational screen time, both on weekdays and on weekend days, were positively correlated with ADHD scores (both inattention and hyperactive/impulsive scores). Studying screen time, on the other hand, was not associated with ADHD symptom severity. Compared to during the lockdown, studying screen time decreased after the lockdown, but recreational screen time and ADHD scores were not changed.

CONCLUSION

Increasing recreational screen time was associated with worsening ADHD symptoms.

Switching efavirenz to rilpivirine in virologically suppressed adolescents with HIV: a multi-centre 48-week efficacy and safety study in Thailand

INTRODUCTION

Efavirenz (EFV) is commonly used for first-line antiretroviral therapy in children and adolescents with HIV, but is associated with neuropsychiatric and metabolic side effects. Rilpivirine (RPV) is better tolerated, and switching from EFV to RPV in virologically suppressed adults has been safe and efficacious, but data in adolescents are limited. Our primary objective was to describe the 48-week immunologic and virologic outcomes in virologically suppressed adolescents switching from EFV- to RPV-based antiretroviral therapy. Secondary objectives included assessment of neuropsychiatric adverse events, quality of life (QOL) and metabolic profiles while on RPV.

METHODS

We conducted an open-label, single-arm, multi-centre study in Thailand in virologically suppressed adolescents aged 12-18 years receiving EFV plus two nucleoside/tide reverse transcriptase inhibitors (NRTIs/NtRTI) for ≥3 months. Participants were switched to an RPV (25 mg) tablet once daily, with the same NRTIs. HIV RNA viral load, CD4 cell count, fasting total cholesterol (TC), triglyceride, glucose, neuropsychiatric adverse events, depression and QOL were assessed over 48 weeks. Data were collected between February 2016 and September 2018.

RESULTS

One hundred and two (52% male) adolescents were enrolled. Median age at entry was 15.5 years (IQR 14.4-17.0), median CD4 count was 664 cells/mm³ (29.9%); 58% were receiving tenofovir-DF and emtricitabine. At weeks 24 and 48, 96 (94.1%) and 94 (92.2%) participants were virologically suppressed, respectively, with no significant change in CD4 cell counts from baseline. Six (5.9%) participants experienced virologic failure, two of whom had RPV-associated mutations (K101E and Y181C) and a lamivudine-associated mutation (M184V/I). There were significant decreases in TC, triglyceride, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) at weeks 24 and 48 and a significant increase in LDL/HDL ratio at week 48 compared to baseline. No substantial changes in EFV-related symptoms, depression score or health-related QOL were observed over time; however, there was significant improvement in performance-based assessments of executive function at week 24.

CONCLUSIONS

A high proportion of adolescents (>92%) remained virologically suppressed up to 48 weeks after switching from EFV to RPV along with no significant change in CD4 cell counts. RPV was well tolerated and associated with improvements in metabolic profiles and executive function.

Prevalence of cognitive dysfunction and its risk factors in children with chronic kidney disease in a developing country

BACKGROUND

Chronic kidney disease (CKD) is associated with cognitive dysfunction. Cognitive function in children with CKD residing in developing countries has not been previously reported.

METHODS

This cross-sectional study included children aged 6-18 years with CKD stages 2-5D and kidney transplant. Cognitive function was assessed by WISC-V for children from 6-16 years of age. In adolescents 17-18 years of age, WAIS-III was used. Factors associated with cognitive dysfunction were identified using multivariable regression analysis.

RESULTS

Thirty-seven children with median age 13.9 (11.3-15.7) years were recruited. The median full-scale intelligence quotient (FSIQ) was 83.0 (71.0-95.0). Below-average cognitive function (FSIQ <90) was identified in 24 children (64.8%), 24.3% of whom had cognitive impairment (FSIQ <70). Most children (94.6%) scored lower than average on at least 1 cognitive domain. Kidney replacement therapy (p = 0.03) and low family income (p = 0.02) were associated with below-average cognitive function in multivariable logistic regression analysis. Children who left school and low family income were significantly associated with cognitive function. The FSIQ of children who had left school was 12.94 points lower than the educated group (p = 0.046). In addition, every 10,000 Thai Baht (approximately 330 United States dollars) increase in family income correlated with 1.58 increase in FSIQ (p = 0.047).

CONCLUSION

Cognitive dysfunction was commonly found in children with CKD. Socioeconomic factors, particularly school attendance and family income, were associated with cognitive dysfunction. Cognitive evaluation is suggested for children with CKD who have socioeconomic risk factors. "A higher resolution version of the Graphical abstract is available as Supplementary information."

Depression and Anxiety in Youth and Young Adults Living with HIV: Frequency and Associated Factors in Thai Setting

Integrative mental health care in HIV patients is an important contributor to successful therapy. This is a cross-sectional study in youth and young adults who attend routine HIV clinic at a tertiary care centre in Bangkok. We recruited 100 youth and 130 young adults living with HIV to evaluate the frequency of depression and anxiety and associated sociodemographic including sexual orientation and health-related behaviours. Overall, about a fifth of the participants had significant depression or anxiety. Interestingly, we found different factors associated with depression in youth and young adults living with HIV. Loss of their father, loss of close relatives or friends, and being unemployed or school exclusion were the factors associate with depression in youth; while dangerous alcohol use, feeling discriminated against and having lipodystrophy were factors in young adults. The understanding of the frequency and different associated factors can inform more effective prevention and treatment strategies.

Psychosocial factors and lack of asthma knowledge undermine child and adolescent adherence to inhaled corticosteroid

This study aimed to evaluate inhaled corticosteroid (ICS) adherence and identify factors associated with non-adherence in pediatric asthma patients. A total of 134 patients aged 8-18 years old were included. At the first visit, patient adherence, asthma knowledge, and outcome expectation data were collected and recorded. Depression, anxiety, and self-esteem were assessed using psychiatric questionnaires. After providing asthma education, reevaluation of adherence and asthma control was performed at one 3- to 6-month follow-up visit. The mean ICS adherence was 75.9 ± 27.5%. Fifty-seven patients (42.5%) were defined as having poor adherence (<75%). "Intentional" and "hectic lifestyle and forgetfulness" were the main reasons for missing ICS doses in mid-late adolescents and children, respectively. Asthma knowledge generally improved with age. Overall, 89% and 67.7% of patients could define symptoms and triggers of asthma, respectively; however, less than 25% understood how asthma affected their body and the chronic nature of asthma. Patients with ICS adherence <75% had unfavorable expectations from asthma treatment (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.01-1.10), and a higher proportion of inhaled short-acting beta-agonist use before exercise (OR: 4.12, 95% CI: 1.27-13.36). Depression and anxiety were frequently found (27.5%) and 23.3%, respectively; p > 0.05). Significant improvement in ICS adherence (p = 0.02) and Asthma Control Test scores (p = 0.02) were observed at the follow-up visit. Patient outcome expectations could be predictors of ICS adherence. Patient education regarding the mechanism and nature of asthma should be considered as an intervention for improving pediatric patient adherence. Psychological evaluation is warranted in pediatric patients with asthma.

Prevalence and Factors Related to Behavioral and Emotional Problems among Preschool Children in Bangkok, Thailand

BACKGROUND

Negative biological and environmental factors results in behavioral and emotional problems that can progress into more serious psychiatric conditions. Despite an increase in identification of behavioral and emotional problems in young children worldwide, epidemiological data in Thai population are limited.

OBJECTIVE

To assess the prevalence of various behavioral and emotional problems and their associated factors in Thai preschoolers in Bangkok.

MATERIAL AND METHOD

A cross-sectional study of 463 preschool children aged 4-6 years was performed from August to October 2014. The psychosocial problems were measured using the parent version of the Strengths and Difficulties Questionnaire (SDQ). Several demographic variables and their associations with the identified problems were also examined and analyzed by Chi-square and Binary logistic regression.

RESULTS

Common behavioral and emotional difficulties reported by parents were eating problems (33.6%), games/TV addiction (28.9%), and sibling rivalry (22.9%). The total difficulties scores of SDQ revealed that 11.9% of children were at risk of behavioral and emotional problems. From the SDQ-subscale-scores analysis, the most prevalent problem was hyperactivity (24%), followed by emotional symptoms (11.9%), prosocial difficulties (11.2%), conduct problems (9.5%), and peer problems (3.7%). Factors associated with the preschool behavioral and emotional problems included parental divorce (OR = 3.3 [95% CI, 1.4-7.9]), severe conflicts in family (OR = 2.7 [95% CI, 1.1-6.6]), parent and child health problems (OR = 2.8 [95% CI, 1.2-6.7] and 2.4 [95% CI, 1.0-5.6], respectively), and chronic illness of family members (OR = 5.13 [95% CI, 2.1-12.4]).

CONCLUSION

Preschool behavioral and emotional problems in Thailand are common. Parents often reported more behavioral problems than emotional ones. Identification of risk factors can imply effective early interventions.

Lactose intolerance in Thai adults

Lactose intolerance is common in Thai adults who ingest cow's milk but its incidence has not been clearly defined The authors evaluated 45 volunteers (15 males, 35 females), aged 21-31 yrs old, who drank one 240-ml box of milk daily. A Lactose tolerance test was performed using a breath-hydrogen test (BHT) after oral intake of 25 g of lactose dissolved in 250 ml of water The presence of gastrointestinal symptoms of lactose intolerance, flatulence, abdominal pain and diarrhea, were recorded Twenty-one subjects (47%) were categorized as lactose malabsorbers and intolerant, two subjects (4%) were malabsorbers but tolerant, and 22 of 45 (49%) were absorbers and tolerant. The incidence of lactose malabsorption was, thus, 51%; symptoms of intolerance were found in 21 of the 23 malabsorbers, making the incidence of lactose intolerance 47%. In the lactose malabsorbant and intolerant group, the more breath-hydrogen (H) the more symptoms observed All subjects who had a negative breath-H2 test had no symptoms. The breath-H2 test should be used as a standard method to evaluate lactose absorption and lactose tolerance. The incidence of lactose intolerance has decreased from the past and the symptoms are not so severe that the people limit the consumption of milk since it is a major source of food containing good quality of protein and calcium.