Day 3 :
- Pediatric Neurology
Children’s National Medical Center, USA
Title: Plausible values of latent variables: A useful approach of data reduction for psychiotric measures
Time : 09:30-09:55
Jichuan Wang has completed his PhD from the Sociology Department, Cornell University and postdoctoral studies from the Population Studies Center, University of Michigan. He is a senior biostatistician at Children’s Research Institute, CNHS. He has published three statistical books and authored/coauthored more than 100 peer-reviewed journal article with more than 30 first-authored. He has been serving as editorial board members of five academic journals.
A challenge in application of Psychotric measures is there are too many variables/items in a scale (e.g., depression, anxiety, …). The often used data reduction approaches are to generate total scale scores or estimated factor scores. The former is simply to sum item scores and the latter is to estimate factor scores from factor analysis model. However, the problems are: the total score does not take into account of measurement errors; and using factor scores or IRT scores as dependent variables in further analysis gives biased slopes (Asparouhov & Muthén, 2010). Such biases can be alleviated by using a recently developed technique - plausible values of latent variables that are a set of generated values of factor scoroes using MCMC Bayesian approach (Mislevy, 1991; Asparouhov & Muthén, 2010). The plausible values can be estimated not only for continuous latent variables (e.g., factors), but also for categorical latent variables (e.g., latent classes). The plausible values of factors or latent class membership can be used as observed variables for further analysis and provide more accurate parameter estimates, compared with the traditional estimates of latent variables (e.g., factor scores or IRT scores). When the plausible values are used in subsequent analysis, multiple imputed plausible value data sets are used and analyzed just like multiple imputations (MI) data sets, i.e., by combining the results across the imputations using Rubin's (1987 ) method. This presentation will demonstrate how to estimate and apply plausible values of depression and anxiety scales using real-world research data.
Cincinnati Children’s Hospital Medical Center, USA
Time : 09:55-10:20
Lin obtained his PhD and MD from Johns Hopkins University and National Taiwan University, respectively. He is trained as a psychiatrist and genetic epidemiologist. He currently holds the position of Assistant Professor at Cincinnati Children’s Hospital Medical Center in Ohio, U.S.A. His publications in the field of neuropsychiatric research have been thus far cited by 1075 studies. His current research interests have been focused on the neurobiological basis of behavioral traits that cur across pediatric psychiatric disorders.
Gene-environment interactions may contribute to the risk of autism spectrum disorder (ASD). Previous evidence has inconclusively suggested that prenatal exposure to some medications may be associated with the risk of ASD. Little is know whether these medications may interact with some ASD-related genes to influence the risk of ASD. I have proposed a novel multi-step approach that combines bioinformatics screening and statistical interaction scans, to identify interactions efficiently supported by convergent lines of evidence. First, we have identified overlapped genes shared by ASD and several class A-C drugs, and quantified the level of attributable risk of each drug in the context of susceptibility to ASD. We found that that ASD-related genes, such as INPP1, KIF5C, and ST7 genes, of which expressions might be perturbed by a terbutaline – a beta 2 adrenergic receptor agonist. Our genome-wide interaction scan on 3,700 cases of ASD provides further discovered several variants in the ST7 (Suppression of Tumorigenicity 7) gene were significantly over-represented in cases with prenatal terbutaline exposure compared to cases without prenatal terbutaline exposure (p < 0.0001). The convergent approach has confirmed that terbutaline may modify the effect of ST7 on the risk of ASD. These findings have also lent some support to the prior findings on the comorbidity link between ASD and cancers. Further research on the impact of terbutaline-induced in-vivo functional changes of the ST7 gene on ASD-like phenotypes is warranted to validate our screening results.
Azerbaijan State Medical University, Azerbaijan
Title: Prevention of cardiac diseases. A new role for the primary care Pediatrician /Family Physician
Time : 10:40-11:05
Andreas Petropoulos graduated from Aristotle University’s Medical School, Greece in 1989. Followed 30 year career as a medical officer, senior Flight Surgeon in the Hellenic Air-Force. Specialized in Aviation & Hyperbaric Medicine, Pediatrics, Fetal, Pediatrics and Congenital Cardiology in USA and Europe. Holds M.Sc in Preventive Cardiology. An AEPC Prevention and Heart Failure/Pulmonary Hypertension, working group’s member. Worked and lectured in Athens and Brussels universities. Currently consults in Fetal, Pediatrics and Congenital Cardiology in Merkezi Klinika and is Associate Professor at the State University and Post Graduate and CME Center in Azerbaijan. His research focuses on prevention, CVD imaging techniques, fetal cardiology, and heart failure.
The aim of this paper is to present to the primary care pediatricians and family practitioners the preventive, diagnostic and therapeutical measures they can apply to lift the burden of cardiac disease in childhood. Although preventive policies are long time applied both to the adult and the pediatric population the burden of cardiovascular diseases is increasing worldwide. Obesity and essential hypertension are the leading conditions in childhood. Do we know how to prevent or treat them? The use of pulse oximetry after the first 36 to 48 hours post birth increases the early detection of critical and cyanotic congenital heart diseases. When present in an initial assessment of a neonate re we aquatint with this screening method? Frequently the primary care providers are asked to evaluate a child before been involved in sports activities. What seems to be the best algorithm and when we shall reefer a child for a specialist consultation? Finally as populations are rapidly migrating around the world, is it time to remember rheumatic fever and its cardiac involvement? All above questions when answered will underline a new role for the primary care pediatrician and family physician.
Southern Medical College, Bangladesh
Time : 11:05-11:30
Jhulan Das Sharma obtained MBBS ,in 1976, FCPS(Fellow of College of Physicians & Surgeons) MD(Doctor of Medicine)& PhD in 1976, 1990, 1998 & 2010 respectively . I worked as Assistant Professor in Pediatrics since 1993 to work in different Medical Colleges of Bangladesh including Institute of Postgraduate Medicine & Research, Dhaka. I worked as Associate Professor since 1999 & presently working as Professor of Pediatrics in Southern Medical College, Chittagong from January 2011. I am involved in teaching & examination of undergraduate & postgraduate examinations for last 15 years. I have 35 publications in different journals.
Abstract: Context: Debate still exists about the necessity of thyroxine replacement in hypothyroxinaemic preterm neonates. The dilemma is that delaying replacement will impair growth and development, especially neurological development while early replacement may have adverse metabolic effect resulting from increased oxygen consumption of preterm newborns suffering from hypoxia. Moreover once replacement is initiated, it may injudiciously be used for prolonged period. Background: Transient hypothyroxinaemia is the most common thyroid dysfunction in preterm postnatals, and is characterized by low sera levels of T4 and FT4. The aetiology is not clear, but may have been due to the withdrawal of maternal placental T4 transfer, expression of temporary HPT axis immaturity, or a nonthyroidal illness. The problem is reported to be present in majority of infants born at less than 30 weeks gestation and is associated with increases in perinatal mortality and morbidity as well as later neurodevelopmental deficits. Objectives: To compare thyroid function in preterm and term neonates and to observe whether preterm neonates with hypothyroxinaemia need thyroxine replacement at the earliest or the treatment may as well be started, with proper follow ups, at about 6 weeks. Methods: An observational study was done during the period of July 2008 to June 2010 in the neonatal and postnatal unit of the Chittagong Medical College Hospital.It focuses on comparison of thyroid function (FT4 and TSH) between preterm and term neonates aged average 7 days with all samples collected after 5 days of life, the time when postnatal TSH surge disappears. One hundred (100) preterm and 50 term infants were selected by convenient sampling. Preterm infants were stratified by postconceptional age. FT4 and TSH estimation were done by the 3rd generation two site chemiluminesent immunometric assay. Serum levels of FT4 and TSH of preterm infants were followed after 6th week (45-50 days) of their age and were compared with their 1st samples (5-11 days). Results: The FT4 level correlated positively with gestational age (p<0.0001, n=150, r=0.61) and differed significantly between adjacent gestational age groups (p=0.0001). No significant differences were found in TSH levels of such age groups of the preterms. TSH level correlated positively with gestational age in the 1st samples but in the 2nd samples significant negative correlation was observed suggesting HPT axis maturity. In preterm neonates subgroup analysis showed highly significant difference in FT4 and TSH levels between 1st and 2nd samples. Conclusion: In preterm infants born at <28 weeks’ gestation, it usually takes more than one month for FT4 levels to reach level equal to those of term infants. In this study, FT4 levels were found to increase in all infants who had initial hypothyroxinaemia and did not receive thyroxine supplementation during the first 6 weeks of postnatal life. This indicates that thyroxine supplementation should be considered if free T4 levels are persistently low after the first 6 weeks of birth. Further studies are needed before clinical application of this finding.
Ministry of Health, Oman
Salah Thabit Al Awaidy is a Communicable Diseases Adviser in Health Affairs, Ministry of Health, Oman. He is a medical doctor and holds a Master’s in Epidemiology. He is currently the adviser of Communicable Disease Surveillance, Elimination and Eradication of Communicable Diseases of Public Health Importance, EPI, vaccine supply chain system and IHR at the Ministry of Health, Oman. He was the Director of Communicable Disease Surveillance and Control at MoH, HQ, Oman between 1997-2011, IHR national focal point 2002-2013 and was a member in several of the professional committees namely: Strategic Advisory Group on Immunization (SAGE), WHO Geneva (2005-2007); Strategic Advisor Group on Vaccine and Store Management Training Courses (2005-2008), WHO Geneva; Strategic TB Advisory Board (STAG) 2007-2011 2014- till date. He also currently serves as IHR Emergency Committee on Polio and MERS-CoV. He has authored or been the co-author of over 35 publications on a large variety of health topics.
Oman has committed to the goal of eliminating measles, rubella and congenital rubella syndrome (CRS) by 2015 year. Elimination is defi ned as the absence of endemic measles and rubella transmission in a defi ned geographical area (e.g. region or country) for ≥12 months in the presence of a well-performing surveillance system and for rubella without the occurrence of Congenital Rubella Syndrome (CRS) cases associated with endemic transmission in the presence of high-quality surveillance system. Strategies to reach this goal included: a) vaccination supplemental activities with the goal of achieving high rates of vaccination coverage; and maintenance of coverage in order to increase population-wide and maintaining high vaccination coverage to increase population-wide immunity; b) syndromic surveillance programs to monitor fever and rash illness syndromes for eff ective detection of cases and serological surveillance; c) integrating these strategies into measles surveillance system; and) high-quality surveillance system, and sensitive for CRS. Measles and rubella was a leading cause of infant and child morbidity and mortality in Oman before the introduction of measles vaccine by 1975 and thereaft er until 1994. With the introduction of a second dose of measles and fi rst rubella vaccines (measles- rubella) in 1994, coverage for fi rst and second doses of measles and rubella vaccines increased more than 95% in 1996 and has been sustained at a level greater than >95% since then. A national measles and rubella (MR) immunization catch-up campaign targeting children ages 15 months to 18 years was conducted in 1994 that achieved 94% coverage. As a result, the incidence of measles and rubella have declined markedly in recent years, to ≤1 case per million persons in 2012 and to zero cases for measles and rubella in 2013 and onward. Similarly, no case of CRS has been notifi ed since 2007. Oman has made signifi cant progress toward measles and rubella elimination and has met the regional elimination goals. However, new challenges faced by Oman, for instance with increased globalization, has led to issues such as outbreaks from imported cases. Additional challenges still remain with regard to increasing identification and immunization of unvaccinated non-Omani workers and their families.