Specific Medical Conditions Research Articles

The Metabolic Syndrome and the Relevance of Nutrients for its Onset.

Metabolic Syndrome is a pathological condition characterized by the copresence of various dysmetabolic and pathological processes including hypertension, dyslipidemia, type 2 diabetes mellitus, obesity, and cardiovascular complications. Because these conditions manifest themselves differently in a given patient, the ensuing pathophysiological state varies from patient to patient. Consequently, the order in which signs and symptoms manifest themselves can vary, making difficult to establish cause-effect relationship, and efficacious treatment and prevention options. Furthermore, the available therapeutic options do not necessarily apply in an effective manner to all patients due to the modality of the syndrome's onset and progression, and the fact that each patient presents different clinical manifestations. Where do the metabolic disturbances originate? Genetic predisposition, maternal health, age, and ethnicity are possible influential factors, which put individuals at higher risk for developing metabolic defects. More recently, dietary factors and deficiency in key macro- and micro-nutrients have been indicated as key players in the onset and progression of the disease. We revised all possible patents applying to this topic. Aside from pharmacological agents used to treat specific medical conditions, no patents were observed to be registered for specific dietary macro- and micro-nutrients. The present review attempts to provide a framework to help the reader understand the causes behind the development of the metabolic syndrome and its complication.

Depression in older adults: prevalence and risk factors in a primary health care sample

Background: Depression in the geriatric population has been identified as a significant problem in view of the associated negative outcomes regarding poor functioning, increased perception of poor health and increased utilisation of medical services. Significantly associated with increased morbidity and mortality, depression has been found to be an independent cause of disability as well as adding to disability due to primary physical illnesses. Early identification and treatment of depression reduces medical costs and lessens caregiver burden. Epidemiological data and prevalence rates of geriatric depression in Africa are limited, although such data are vital to mobilise and plan government mental health initiatives aimed at screening and early intervention. Objective: To determine the prevalence of depression and associated clinical and socio-demographic factors amongst older adult patients attending a primary health care clinic in the Ethekwini District in Kwa-Zulu Natal, South Africa. 
 
 Methods: The 15-item Geriatric Depression Scale and a socio-demographic questionnaire were administered in English to 255 geriatric outpatients, randomly selected, at a local community clinic in Durban. 
 
 Data analysis: Data were analysed using SPSS version 23®. Descriptive statistics were used to summarise the sample demographics and response rate and non-parametric statistics were used to test for associations and differences.
 
 Results: A Cronbach’s alpha for the GDS was calculated (p = 0.793). Some 40% of participants screened positive for depression. Female gender, widowhood and a negative subjective health status rating were significantly associated with depression and marriage appeared to be protective (p < 0.001). Participants with a poor subjective health rating were 21 times more likely to be depressed and widowhood conferred an almost fourfold increased risk of being depressed, with widows at greater risk than widowers. No association between depression and specific medical conditions was identified.
 
 Conclusion: There is a high rate of undetected depression among the elderly attending a local primary health care clinic with widowhood and poor subjective health being strong predictors of mood disorders. The findings warrant replication in bigger samples.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1272250

P064: Coastal family practice residency: simulation curriculum needs assessment survey

Introduction/Innovation Concept: Medical simulation is becoming increasingly useful for healthcare education. Simulation-based crisis resource management (CRM) has been shown to produce improvements in skill acquisition, communication and team behaviors. Simulation has become a key component of most Family Practice (FP) residency programs and many programs are moving towards developing formal simulation curriculums. The Coastal FP Residency is a relatively new and unique program with a large emphasis on rural medicine. Graduates have gone on to practice in remote areas with less access to supports for critically ill patients. Therefore, an effective simulation curriculum, focused on Emergency Medicine, is of great importance to this program. Methods: To develop our curriculum, Kern’s framework for medical education was selected given its prior success in similar endeavors. The first step of this approach involves a needs assessment, which we accomplished in the form of an online survey. The questionnaire included pre-defined topics pertaining to the training needs of FP Residents destined for Rural Practice with respect to technical skills, CRM skills, specific medical conditions and categories of medical conditions. Classification of answers included multiple choice, 5-point Likert scales as well as an option for free-text answers. The survey was distributed to pre-identified participants including stakeholders/educators within the Coastal FP residency program as well as simulation education leads for FP residencies throughout British Columbia (BC). Current residents, as well as program graduates were also asked to complete the survey. Curriculum, Tool, or Material: The results of this survey were used to develop formal goals and objectives which were in turn used to write or adapt 24 cases for the curriculum. Cases from categories (e.g. Pediatrics) rated as “Extremely Important” on the Likert scale were included proportionally more in the curriculum. The cases were also designed to assess/practice a higher proportion of CRM elements considered important and to address commonly identified difficulties in resuscitation. Cases were developed, where possible, using local or national guidelines and are currently in the stage of peer review (by a minimum of two peers). Conclusion: The curriculum will be implemented in July 2017 and we will transition towards the evaluation phase. Our goal is to develop and distribute formalized needs assessments to rural FP residencies across BC so that they may develop dynamic, formal curriculums of their own.

Value-Based Insurance Design Pharmacy Benefits for Children and Youth With Special Health Care Needs: Principles and Opportunities.

Value-based insurance design (VBID) represents an innovative approach to health insurance coverage. In the context of pharmacy benefits, the goal of VBID is to minimize access barriers to the most effective and appropriate treatments for specific medical conditions. Both private and public insurance programs have explored VBID pharmacy projects primarily for medical conditions affecting adults. To date, evidence for VBID pharmacy programs for children and youth with special health care needs (CYSHCN) appears lacking. There appears to be potential for VBID concepts to be applied to pharmacy coverage benefiting CYSHCN. An overview of VBID pharmacy principles and guiding principles are presented. Opportunities for the creation of pharmacy programs with a value-based orientation and challenges to the redesign of pharmacy benefits are identified. VBID pharmacy coverage principles may be helpful to improve medication use and important clinical outcomes while lowering barriers to medication use for the population of CYSHCN. Pilot projects of VBID pharmacy benefits for children and youth should be explored. However, many questions remain.

Insomnia and Multimorbidity in the Community Elderly in China.

To examine the comorbidity between insomnia and medical conditions. This cross-sectional study was conducted in community adults, aged ≥ 60 years, who resided in one of four major cities in northern China. Sociodemographic and clinical data were collected simultaneously. A total of 3,176 elderly adults (1,292 male, mean ± standard deviation age 70.2 ± 6.8 years; 1,884 female, 68.8 ± 6.7 years) were interviewed. The prevalence of specific medical conditions in both people with insomnia and people without insomnia was detected. Significantly higher proportions of arrhythmia, hypertension, cerebral hemorrhage, migraine, and hyperlipidemia were observed in people with insomnia than in people without insomnia. Moreover, a significantly higher proportion of insomnia was seen in elderly people with arrhythmia and migraine. We also found that elderly people with insomnia who took sleep medications reported a higher prevalence of coexisting arrhythmia, hypertension, and migraine, even after adjusting for age, sex, and depression. Our results indicate associations between insomnia and medical conditions in the community elderly in China. People who complained of insomnia had poorer physical health conditions. Sleep medication may not be a covariate that influences the comorbidity of some specific physical conditions. Trial name: The study of diagnosis and treatment of senile dementia in Hebei Province; URL: http://www.chictr.org.cn/showproj.aspx?proj=8194; Registration number: ChiCTR-RRC-11001345.

Signalling hypoxia by protein hydroxylation: Transcriptional architecture of the HIF response

Animal use a set of 2‐oxoglutarate dependent dioxygenases to signal cellular oxygen levels to the transcription factor, HIF, via the post‐translational hydroxylation of specific prolyl and asparaginyl residues. These hydroxylations promote the inactivation and proteolytic destruction of HIF and hence regulate a broad range of cellular and systemic responses to hypoxia. The involvement of this system in a many medically important physiological responses presents both an opportunity and challenge, particularly in defining how the system operates to generate co‐ordinated physiological responses, and in understanding how it might be manipulated therapeutically in specific medical conditions. Advances in the understanding of the pan‐genomic architecture of the HIF transcriptional response, will be described together with the implications of activating such extensive pathways in cancer, and mechanisms that modulate the oncogenic output of HIF pathway activation.

Identifying Local Hot Spots of Pediatric Chronic Diseases Using Emergency Department Surveillance

ObjectiveTo use novel geographic methods and large-scale claims data to identify the local distribution of pediatric chronic diseases in New York City. MethodsUsing a 2009 all-payer emergency claims database, we identified the proportion of unique children aged 0 to 17 with diagnosis codes for specific medical and psychiatric conditions. As a proof of concept, we compared these prevalence estimates to traditional health surveys and registry data using the most geographically granular data available. In addition, we used home addresses to map local variation in pediatric disease burden. ResultsWe identified 549,547 New York City children who visited an emergency department at least once in 2009. Though our sample included more publicly insured and uninsured children, we found moderate to strong correlations of prevalence estimates when compared to health surveys and registry data at prespecified geographic levels. Strongest correlations were found for asthma and mental health conditions by county among younger children (0.88, P = .05 and 0.99, P < .01, respectively). Moderate correlations by neighborhood were identified for obesity and cancer (0.53 and 0.54, P < .01). Among adolescents, correlations by health districts were strong for obesity (0.95, P = .05), and depression estimates had a nonsignificant, but strong negative correlation with suicide attempts (−0.88, P = .12). Using SaTScan, we also identified local hot spots of pediatric chronic disease. ConclusionsFor conditions easily identified in claims data, emergency department surveillance may help estimate pediatric chronic disease prevalence with higher geographic resolution. More studies are needed to investigate limitations of these methods and assess reliability of local disease estimates.

American Academy of Asthma, Allergy & Immunology membership experience with venom immunotherapy in chronic medical conditions and pregnancy, and in young children.

Few data exist regarding the use of venom immunotherapy (VIT) in specific high-risk chronic medical conditions and pregnancy, and in young children. A Web-based survey was sent to American Academy of Asthma Allergy & Immunology members to explore their VIT experience in potential high-risk medical conditions and pregnancy, and in young children. Major problems were defined as "activation of underlying disease and/or VIT not well tolerated (systemic adverse events) and/or VIT discontinued for medical reasons." Results were expressed descriptively. A total of 697 of 5123 surveys (14%) were completed: 87% of the respondents were based in the United States, and 28% worked in an academic setting. Most respondents (71%) believed that pregnancy was a contraindication for starting VIT. Most were comfortable continuing VIT (51%) if the woman became pregnant after starting therapy. Of the allergists who treated children, many would give VIT down to age 5 years (42%) or younger, ages 1-4 years (35%). The following list is of the specific medical condition, the number of allergists who used VIT in patients with this condition, and the percentage who reported major problems: severe asthma, 212 (4.2%); hypertension, 287 (1.1%); coronary artery disease, 222 (3.6%); arrhythmias, 136 (3.4%); cerebrovascular disease, 104 (5.1%); cancer in remission, 166 (0%); cancer stable but still under treatment, 44 (7.2%); a history of bone marrow transplantation, 15 (4.9%); a history of solid organ transplantation, 29 (3.6%); human immunodeficiency virus, 53 (1.4%); acquired immunodeficiency syndrome, 24 (6.2%); stable autoimmune disease, 164 (2.8%); mastocytosis, 66 (18.4%); elevated serum tryptase, 101 (10.8%); immunodeficiency 59 (2.5%). Many allergists were comfortable using VIT in young children and continuing but not starting pregnant women on VIT. VIT was commonly used in patients with hypertension, coronary artery disease, arrhythmias, cancer in remission, and stable autoimmune disease. Major problems were most frequently reported in use with mastocytosis, elevated tryptase, and cancer still under treatment.

MotorBrain: A mobile app for the assessment of users’ motor performance in neurology

Background and ObjectiveHuman motor skills or impairments have been traditionally assessed by neurologists by means of paper-and-pencil tests or special hardware. More recently, technologies such as digitizing tablets and touchscreens have offered neurologists new assessment possibilities, but their use has been restricted to a specific medical condition, or to stylus-operated mobile devices. The objective of this paper is twofold. First, we propose a mobile app (MotorBrain) that offers six computerized versions of traditional motor tests, can be used directly by patients (with and without the supervision of a clinician), and aims at turning millions of smartphones and tablets available to the general public into data collection and assessment tools. Then, we carry out a study to determine whether the data collected by MotorBrain can be meaningful for describing aging in human motor performance. MethodsA sample of healthy participants (N= 133) carried out the motor tests using MotorBrain on a smartphone. Participants were split into two groups (Young, Old) based on their age (less than or equal to 30 years, greater than or equal to 50 years, respectively). The data collected by the app characterizes accuracy, reaction times, and speed of movement. It was analyzed to investigate differences between the two groups. ResultsThe app does allow measuring differences in neuromotor performance. Data collected by the app allowed us to assess performance differences due to the aging of the neuromuscular system. ConclusionsData collected through MotorBrain is suitable to make meaningful distinctions among different kinds of performance, and allowed us to highlight performance differences associated to aging. MotorBrain supports the building of a large database of neuromotor data, which can be used for normative purposes in clinical use.

Labia minora hypertrophy: causes, impact on women's health, and treatment options.

We provide a review of the literature about the onset and development of hypertrophy of the labia minora, together with some expert opinions on the appropriateness of labiaplasty. We searched PubMed and used popular search engines, with a greater emphasis on the physiology and hormone-mediated metabolism of these structures, and less emphasis on their surgical treatment. We describe major embryological, cytological, and biochemical features of this anatomical part and summarize the clinical aspects of its hypertrophy, evaluating types of discomfort reported by women and the medical treatments available. Also, based on what is known about the artificial elongation and spontaneous hypertrophy of the inner labia, we illustrate and discuss the main biological factors that may trigger this medical condition. There are not enough data identifying a clear inheritance of inner labia hypertrophy in the absence of other pathological conditions; instead, we found indirect evidence for an association with transient episodes of local inflammation either before birth or during puberty. We also analyze the role played by estrogen receptors and other factors with regard to the onset of this condition and highlight the importance of their timing in determining the size of women's labia minora. Remarkably, most cases of enlarged labia minora should be considered as outliers that are within the physiological range of size variation described for these structures. We generally advise against surgical treatment of labia minora, especially in young, pre-pubertal girls, unless specific medical conditions are also present and/or the psychological impact on the patient is deemed particularly negative.

Antibiotic prophylaxis for systemic diseases in dental treatment, recommended or not recommended: A survey among dental students

Background: To prevent infectious complications from transient bacteremia in patients with specific medical conditions, antibiotic prophylaxis is considered. Although many guidelines for antibiotic prophylaxis have been published; recommendations are often unclear. This study was conducted to assess the confidence of the dental students in administering antibiotics for the patients with systemic diseases. Materials and Methods: A cross-sectional, descriptive questionnaire survey employing cluster random sampling was conducted among dental colleges in Chennai. The questionnaire comprised eight simulated cases of patients with different medical conditions, the following dental procedures such as scaling, simple extraction, and root canal treatment, and visual analog scale (VAS) were used to assess how confident are the interns in their decision to administer antibiotics. Chi-square test was used difference in decision across gender, and independent samples t-test was used to test the overall confidence in decision in the administration of antibiotics. P Results: Response rate in the present study was 76.6%, n = 353 study participants participated in the present study. The overall mean in confidence assessments for the study participants was 75.6 mm on the VAS and the range was 64–86 mm. Study participants differ in their opinion in the administration of antibiotic prophylaxis for dental treatment in the management of patients with systemic diseases (P Conclusion: Although the study participants are generally aware of antibiotic prophylaxis, they were not clear in their decision in administration of antibiotics and their level of confidence is also low.

Ageing and mental health: changes in self-reported health due to physical illness and mental health status with consecutive cross-sectional analyses

ObjectivesIt is known that self-reported health (SRH) declines with increasing age and that comorbidity increases with age. We wished to examine how age transfers its effect to SRH through comorbid...

M43 - Comorbid Medical Conditions In Individuals With Major Psychiatric Disorders

Background People with major psychiatric disorders (MPD) (schizophrenia, bipolar disorder major, depressive disorder), particularly with mood disorders, have higher prevalence of comorbid medical conditions, such as obesity, diabetes and cardiovascular diseases. There are a limited number of cross-national studies on comorbid mental and medical conditions. Although, it is well documented that people with MPD have an excess mortality rates. About 60% of this excess mortality is due to medical conditions, being cardiovascular disease the primary cause. Comorbid mental and medical conditions are associated with substantial individual and societal economic cost. The aim of this study is to examine the prevalence of medical conditions in people with MPD compare with a psychiatrically healthy control group. Methods The sample is part of the PISMA-ep, a cross-sectional study of a representative sample of the Andalusian population (Spain). The sample included 1005 participants with diagnosis of a major psychiatric disorder and 3502 psychiatrically healthy controls. A standard medical disorders checklist, of the kind commonly used in national health surveys including 21 self reported specific medical conditions was given to all participants. In addition, self-reported weight and height were obtained to calculate their body mass index (BMI), defined as weight in kilograms divided by height in meters squared (kg/m2). We carried out contingency table analyses and binary logistic regressions to examine the prevalence of the 21 medical conditions both in individuals with MPD and controls. The regression analyses were adjusted by affected status, BMI, gender and age. The statistical analyses were performed with the SPSS 15.0 software. Results There were no statistically significant differences in BMI in the MPD group compared to controls (t=1.20, d.f= 4492, p=0.2306). In the MPD group, chronic pain, migraine, rhinitis and hypertension had the highest lifetime prevalence (24.3%, 14.7%, 13.7% and 13.2%, respectively) compare to controls. In controls, the highest lifetime prevalences where found for chronic pain, hypertension, rhinitis and hypercholesterolemia (12.5%, 11%, 8.3% and 7.5%, respectively). In contrast, embolism and epilepsy had the lowest lifetime prevalences in both groups. Nineteen medical disorders were significantly more frequent in the MPD group. In particular, the highest significant differences were found for chronic pain, asthma, migraine, vertigo, rhinitis and arthritis (p Discussion Lifetime prevalence of medical disorders was significantly higher in the MPD group compare to psychiatrically healthy controls in the vast majority of the diseases. This study highlights the importance of address medical conditions in people with major psychiatric disorders.

An Exhaustive Method for Researching Articular Orthosis Mechanisms at the Conceptual Design Stage

Population aging in recent years has increased the number of people needing orthoses to assist or rehabilitate a failing joint or limb. However, as these are a class 1 medical device, orthosis development is mainly based on companies’ empirical knowledge and this can often result in usage problems and consequently, in the most extreme cases, in the devices being abandoned. Additionally, since articular orthoses may enable a movement to be performed, this imposes additional development restrictions which should be considered during the conceptual design stage of product development. As there are limited design tools available for the conceptual design stage and existing design methods are not well adapted to the development of these demanding medical devices, the development of articular orthoses may lead to inaccurate and maladjusted concepts, ill-adapted to the user's needs, and consequently, a source of discomfort. The aim of the design method proposed here is to help the mechanical designer during the conceptual design stage by taking into account from the beginning of the development process the way articular orthoses are used in life situations and at significant moments. Additionally, based on the theory of mechanisms, concepts such as the number of components, degrees of freedom and degrees of hyperstatism can be considered. This provides an exhaustive list of possible concepts for the articular mechanism which are subsequently screened according to different criteria related to the specific limb anatomy and specific medical conditions of the user in order to optimize concept choice. On this basis, this study develops an exhaustive research method to reach a large number of possible articular mechanisms to perform the desired articular movement for a specific orthosis, also taking into account the specific human body part.

Teens and Technology Transforming Acne Treatment.

Although the Internet contains many health Web sites with valid information, it also contains sites with false information. To learn whether high school students searching health care information believe they are using evidence-based sites and to understand their topics of interest, frequently navigated sites, and trust/confidence in the credibility of information found. Cross-sectional. Students at a private high school answered an anonymous survey inquiring about their belief that they were using evidence-based sites, topics of interest, search engines of choice, and their trust in information obtained. Descriptive statistics and multivariate analysis of variance were used to compare trends across grade levels. Of 705 students enrolled, 24.7% were absent or declined to participate. For the remaining students, 497 completed the surveys, representing a response rate of 70.5% (497/705) and a participation rate of 93.6% (497/531). Overall, 82% of students communicated that they believed they were using evidence-based sources when searching for health information (p < 0.0006). Findings showed that 42% searched general health information, and 43% investigated specific medical conditions; topics related to skin and acne were researched significantly more often (p < 0.05). Overall, most students (80%) reported using Google as their number 1 search engine (p < 0.004), 38% reported using WebMD Search (p < 0.0002), and 50% of students used Wikipedia (not significant). Most students trust health information they learn from the Internet. We found it chilling that less than half of students obtained their information from a Web site with health care professionals' oversight.

Sudden unexpected death in epilepsy.

People with epilepsy have increased risk of premature death, and their life expectancy may reduce by 2-10 yr. Population- and hospital-based studies have shown that the excess mortality in epilepsy is not entirely explained by deaths directly attributable to epilepsy such as accidents and drowning during a seizure. It is also significantly contributed by deaths from other causes such as cardiac deaths, deaths due to malignancies and other causes. It had recently been recognized that sudden unexpected deaths in epilepsy (SUDEP) contributed to a small yet important proportion of mortality in epilepsy. SUDEPs are deaths (witnessed or unwitnessed) unrelated to trauma, drowning or status epilepticus and not attributable to any specific medical conditions. Several factors related to epilepsy and drug therapy have been found to be associated with higher risk of SUDEP.

Clinical Characteristics, Health Care Utilization and Costs Among Men with Primary or Secondary Hypogonadism in a US Commercially Insured Population

IntroductionHypogonadism is broadly associated with increases in chronic comorbid conditions and health care costs. Little is known about the specific impact of primary and secondary hypogonadism on health care costs. AimTo characterize the health care cost and utilization burden of primary and secondary hypogonadism in a population of US men with commercial insurance. MethodsNewly diagnosed patients with International Classification of Diseases, Ninth Revision, Clinical Modification codes associated with specific medical conditions known to have a high prevalence of testosterone deficiency (ie, relating to primary or secondary hypogonadism) or who had fills for testosterone replacement therapy from January 1, 2007 through April 30, 2013 were identified in administrative claims data from the HealthCore Integrated Research Database. A cohort of patients without hypogonadism was matched on demographics and comorbidities. The matched hypogonadism and non-hypogonadism cohorts (n = 5,777 in each cohort) were compared during a 12-month follow-up period. Main Outcome MeasuresDirect health care expenditures and utilization were assessed for all causes and for hypogonadism-related claims. Costs included out-of-pocket patient expenditures and those paid by the insurer. ResultsHypogonadism and matched non-hypogonadism cohorts were similar in demographics (mean age = 50 years) and diagnosed comorbid conditions in the 12 months preceding the index date. In the year after the index date, mean all-cause expenditures for patients with hypogonadism increased by 62% (from $5,425 to $8,813) compared with 25% for the matched controls (from $4,786 to $5,992; P < .01 for follow-up difference between groups). Approximately 16% of total mean costs ($1,377), primarily outpatient and pharmacy costs, were identifiable as related to hypogonadism. ConclusionThese data from a population of US men with commercial insurance coverage showed a greater resource use burden for patients with primary and secondary hypogonadism compared with similar patients without hypogonadism. Additional management might be required to address unmet need and decrease the cost burden for patients with hypogonadism.

Immunizing Patients With Adverse Events After Immunization and Potential Contraindications to Immunization: A Report From the Special Immunization Clinics Network.

For patients who have experienced adverse events following immunization (AEFI) or who have specific medical conditions, there is limited evidence regarding the best approach to immunization. The Special Immunization Clinics (SICs) Network was established to standardize patient management and assess outcomes after reimmunization. The study objective was to describe the first 2 years of the network's implementation. Twelve SICs were established across Canada by infectious diseases specialists and allergists. Inclusion criteria were as follows: local reaction ≥ 10 cm, allergic symptoms < 24 hours postimmunization, neurologic symptoms and other AEFI or medical conditions of concern. Eligible patients underwent a standardized evaluation, causality assessment was performed, immunization recommendations were made by expert physicians and patients were followed up to capture AEFI. After individual consent, data were transferred to a central database for analysis. From June 2013 to May 2015, 151 patients were enrolled. Most were referred for prior AEFI (132/151, 87%): 42 (32%) for allergic-like reactions, 31 (23%) for injection-site reactions, 20 (15%) for neurologic symptoms and 39 (30%) for other systemic symptoms. Nineteen patients (13%) were seen for underlying conditions that complicated immunization. Reimmunization was recommended for 109 patients, 60 of whom (55%) were immunized and followed up. Eleven patients (18%) experienced recurrence of their AEFI; none were serious (eg, resulting in hospitalization, permanent disability or death). The most frequent reasons for referral to a SIC were allergic-like events and injection site reactions. Reimmunization was safe in most patients. Larger studies are needed to determine outcomes for specific types of AEFI.

Precision wildlife medicine: applications of the human-centred precision medicine revolution to species conservation.

The current species extinction crisis is being exacerbated by an increased rate of emergence of epizootic disease. Human-induced factors including habitat degradation, loss of biodiversity and wildlife population reductions resulting in reduced genetic variation are accelerating disease emergence. Novel, efficient and effective approaches are required to combat these epizootic events. Here, we present the case for the application of human precision medicine approaches to wildlife medicine in order to enhance species conservation efforts. We consider how the precision medicine revolution, coupled with the advances made in genomics, may provide a powerful and feasible approach to identifying and treating wildlife diseases in a targeted, effective and streamlined manner. A number of case studies of threatened species are presented which demonstrate the applicability of precision medicine to wildlife conservation, including sea turtles, amphibians and Tasmanian devils. These examples show how species conservation could be improved by using precision medicine techniques to determine novel treatments and management strategies for the specific medical conditions hampering efforts to restore population levels. Additionally, a precision medicine approach to wildlife health has in turn the potential to provide deeper insights into human health and the possibility of stemming and alleviating the impacts of zoonotic diseases. The integration of the currently emerging Precision Medicine Initiative with the concepts of EcoHealth (aiming for sustainable health of people, animals and ecosystems through transdisciplinary action research) and One Health (recognizing the intimate connection of humans, animal and ecosystem health and addressing a wide range of risks at the animal-human-ecosystem interface through a coordinated, collaborative, interdisciplinary approach) has great potential to deliver a deeper and broader interdisciplinary-based understanding of both wildlife and human diseases.

Health Maintenance Deficits in a Fully Insured Population of Adolescents With Chronic Medical Conditions.

The current national monitoring of routine wellness care and vaccine uptake does not provide data on health maintenance among pediatric populations with chronic medical conditions. In this case-control study that analyzes wellness visits and vaccine uptake among adolescents, ages 16 to 18 years, we identified 938 without (controls) and 74 with (cases) 1 of 12 specific chronic medical conditions. The PPSV23 (23-valent pneumococcal polysaccharide vaccine) is recommended by the Advisory Committee on Immunization Practices for these 12 conditions and served as a measure of uptake for medically indicated vaccines. Our controls were twice as likely as cases to have a documented well visit in the past year, and there was a significantly higher proportion of controls than cases vaccinated with Tdap (tetanus toxoid, reduced diphtheria toxoid, acellular pertussis), MCV-4 (quadrivalent meningococcal conjugate), and HPV (human papillomavirus), all P < .05. More than 60% of cases failed to receive PPSV23. Adolescents with chronic medical conditions are at high risk of neglecting routine health maintenance.