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HEALTH Sleeping babies on their backs can lead to flat-head syndrome. Photo: Corbis

LAB REPORT ................................... Jeanette Wang Social media offers clue to how diseases spread The biological spread of diseases is intertwined with how society responds to those contagions, suggests a new study in Science. Based on this, study author Chris Bauch, a professor of applied mathematics at the University of Waterloo in Ontario, Canada, devised a method to tap social media such as Facebook and Twitter for vital clues on how we respond socially to a new disease control measure, or the threat of infectious disease. “We can create [mathematical] models from this data that allows researchers to observe how social contagion networks interact with betterknown biological contagion networks,” says Bauch. “Predictive modelling isn’t perfect, but it can help gauge how people will respond to disease control measure.”

Having babies sleep on their back protects against Sudden Infant Death Syndrome, but can cause flat spots on their skulls. Sunory Dutt finds out what can be done to avoid the condition

Out of

shape 600%


n the early 1990s, the American Academy of Pediatrics launched a Back to Sleep programme that recommended placing babies on their backs in bed to reduce the risk of Sudden Infant Death Syndrome (Sids). Since then, the percentage of infants sleeping face-up has increased dramatically, and the overall incidence of Sids has more than halved. But placing babies in the supine position for long periods of time has led to an increase in positional plagiocephaly, commonly known as flat-head syndrome. The condition is believed to be a cosmetic problem which doesn’t affect the baby’s brain. In the US, prior to 1992, plagiocephaly among infants below 12 months old was reportedly 5 per cent, a 2006 study by the University of Texas found. But the study authors say that in recent years craniofacial centres and primary care providers in the US have reported an increase up to 600 per cent in referrals for the condition. According to a recent study by Calgary’s Mount Royal University published in the journal Pediatrics, nearly half of 440 babies studied between seven and 12 weeks of age had the condition. Of the babies found to exhibit flat-head syndrome, the study found that 78 per cent had a mild form, while 19 per cent of cases were classified as moderate, and the

remaining 3 per cent were severe. More than three in five babies had plagiocephaly on the right side of the head. In Hong Kong, figures are not readily available, but according to Dr Simon Wong, a specialist in paediatrics, flat-head syndrome is very common. “I am not aware of any local studies on this subject but I suspect the incidence would be similar to those of the Western world,” he says. The condition arises because a baby’s skull is still soft enough to be moulded and to change shape if there is constant pressure on one area of their head, according to Britain’s National Health Service. The skull is made of plates of bone, which only start to strengthen and fuse together as the child grows older. Babies are also being placed in reclining carriers, car seats, and swings now more than ever, making them even more vulnerable to developing the condition in the first few months of life. Plagiocephaly is even

None ... have negative longterm outcome, and none required surgery DR SIMON PONG, PAEDIATRICS SPECIALIST

more common with multiple or premature births as premature infants with prolonged hospital stays are at risk. The abnormal head shape itself will not result in any developmental abnormalities if the skull sutures are not fused, as the brain still has sufficient room for growth. Dr Hannah Tsang Yee-Hoi, a specialist in paediatrics at International Doctors Limited, Hong Kong, says treatment for positional plagiocephaly is primarily cosmetic. Studies have shown that a baby’s head shape usually improves spontaneously after the first six months, if there is no other underlying condition which is causing the positional plagiocephaly. There is improved head control between four to six months of age, which results in better movement and a lower tendency to remain in a fixed position. Wong says the vast majority of cases do not need aggressive treatment. The skull’s shape gradually improves with simple measures, six to nine months later. “Babies with isolated positional plagiocephaly have excellent long-term outcome,” he says. “They do not have increased risk of hearing, visual, cognitive impairment. Their skull shape may not be as round as children with ‘normal’ heads but the appearance will improve with time. None of my patients with isolated positional plagiocephaly have negative long-term outcome and none

Referrals for the condition to by putting a required surgery.” medical centres in the US favourite toy on But if there is have risen by this much their less an underlying in recent years favoured side. cause for the fixed Another tactic is head position, turning babies around in treatment of that the crib so that they naturally cause is essential. For example, turn towards their caregivers improved head shape will be and the activity in the room. seen after treatment and Tummy time – supervised correction for congenital time with a baby lying on its torticollis (an abnormal, belly – can also help prevent asymmetrical head or neck flat-head syndrome. position), because the child will There’s also the Tortle beanie be able to move his or her head invented by paediatrician and more freely. neonatologist Dr Jane Scott. She Tsang adds that it’s suggests that getting babies to important to note that there are wear the beanie for six to eight syndromal disorders – such as anxiety and depression – that are hours a day, along with counter positioning techniques, can help linked with both flat head and prevent and treat the early stages developmental delay. of flat-head syndrome. The window of opportunity Dr Faisal Nahdi, consultant to correct flat head syndrome is paediatrician, Rainbow Group of usually zero to six months, after Hospitals, Hyderabad, India, which treatment is less effective. says most of the children she has By the end of the first year, a seen have responded well to a baby’s skull has hardened and “conservative approach”. most therapies have little effect If a baby is beyond the after this time. Hence, window to try counter positional prevention is key. therapy, there is a high rate of The most common form of success with treatment that is a treatment is counter combination of helmet and positioning. Parents should physical therapy. Such cases are change the baby’s head referred to a paediatric positioning after each feeding, neurologist for further alternating sides so that one management, which includes does not become favoured. corrective helmets and caps. Alternating the arm in which the Sometimes when the uneven baby is being held while feeding, head shape is more severe or and the side from which he or where counter positioning does she is approached during diaper not work, a cranial remodelling changes also helps. helmet may help. An orthotist As babies gets older and makes a cast of the baby’s head strong enough to move on their to create the helmet. own, parents can try attracting them to alternate sides, perhaps


Is meat feasting a kidney buster? ............................................... Sasha Gonzales Q: Can eating too much animal protein damage your kidneys? The straight answer: No, but… The facts: The consumption of animal protein has skyrocketed over the past couple of decades. According to the World Health Organisation, the enormous surge in population growth, rising incomes and urbanisation has led to a growing demand for high-quality animal protein. Annual meat production was about 218 million tonnes annually between 1997 and 1999, and this figure is expected to increase to 376 million tonnes by 2030. A high-protein diet has also become more popular in recent years. The Atkins Diet and the Zone Diet, for example, which focus on protein-rich foods such as meat, fish and eggs, are thought to combine rapid weight loss with the satisfaction of feeling full. Many followers of high-protein diets have been warned that eating large amounts of meat could have a negative effect on their kidneys. However, as long as your renal function is not impaired, there is no reason to worry that consuming large amounts of animal protein will overload your kidneys, says Dr Winnie Mui, a general practitioner at Doctor Lauren Bramley & Partners in Central.

A study published in The International Journal of Sport Nutrition and Exercise Metabolism in 2001 revealed that a high protein intake by athletes does not harm renal function. If your kidney function is impaired, however, a highprotein diet is probably not for

you. Protein toxicity occurs when the body is unable to get rid of potentially toxic wastes caused by protein metabolism. In people with normal kidney function, the kidneys work to excrete the by-products of protein metabolism. But individuals with kidney disease

As long as your renal function is not impaired, there is no need to worry

Photo: Corbis

who consume a lot of meat will struggle to rid their body of this waste. Others at high risk of protein toxicity include people with hypertension, diabetes, and those over the age of 65. The association between a high-protein diet and kidney damage is therefore both true and false. Studies have shown a correlation between an increase in animal protein intake and certain diseases. Heart disease, cancer, constipation and diverticulitis have all been linked to the excess and sustained consumption of meat. Therefore, Mui recommends that active people consume no more than 0.8 of a gram to one gram of protein per kilogram of their body weight per day. This constitutes part of a balanced diet. It is also wise to vary your protein sources. Dairy products and certain plant foods such as legumes and beans are rich in protein. There are also protein supplements in the form of powders, drinks and snack bars. Before embarking on a high-protein diet, consult your physician to see if it’s right for you. Mui recommends getting regular physical exams, including blood and urine tests to make sure your kidneys are functioning healthily. If you consume a lot of animal protein, it is also important to get your weight and blood pressure checked.

Nipple shot gets to the nub in cancer treatment A new experimental technique for breast cancer treatment and prevention could spare the healthy regions of the body, and reduce the side effects typically observed with traditional chemotherapy. This is achieved by injecting therapeutics via the nipple, a procedure that offers direct access to the most common origin of breast cancer, the milk ducts. The method has been demonstrated on mice and appears in the Journal of Visualised Experiments. “It also prevents drug breakdown by the liver, which can rapidly reduce effective drug levels,” says Dr Silva Krause, one of the researchers behind the method.

Gene deletions linked with autism Using powerful genetic sequencing technology, a team of investigators have scanned the genome of more than 800 individuals and discovered those diagnosed with autism spectrum disorder (ASD) were more likely to have gene deletions than were people without the disorder. Led by researchers at the Icahn School of Medicine at Mount Sinai, New York, the team reports in the American Journal of Human Genetics that their analysis suggests the deletions may result in the miswiring and altered activity of brain neurons. “But of the extra deletions we see in ASD not all are due to genetic inheritance,” says lead investigator Joseph Buxbaum. “Some occur during the development of the egg or sperm, and deletions that develop in this way tend to be associated with the disorder.”

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