[Autism: associated medical conditions]. / Autismo: condiciones médicas asociadas.

Autism will accompany people throughout life with variations in its evolution and is frequently associated with other neurodevelopmental disorders (intellectual disability, attention deficit hyperactivity disorder, motor clumsiness, language disorder), neuropsychiatric disorders (depression, anxiety, schizophrenia, catatonia), epilepsy, sleep disorders, gastrointestinal disorders. In addition to the disorders typical of autism, we must consider an entire range of conditions, since their identification and adequate treatment will allow a better quality-of-life for people with autism. In 35% of cases, we can identify neurogenetic conditions which will allow us to prevent or identify associated medical entities. In this work we will analyze two groups, in a purely organizational way, medical conditions associated with defined entities (Down, Angelman, Fragile X, Rett, Phelan-McDermid and Timothy syndromes) and those that can be consistently associated in people with autism without an identified entity.

El autismo acompañará a las personas a lo largo de toda la vida, con variaciones en su evolución, está frecuentemente asociado a otros trastornos del neurodesarrollo (discapacidad intelectual, trastorno de déficit de atención e hiperactividad, torpeza motriz, trastorno del lenguaje), trastornos neuropsiquiátricos (depresión, ansiedad, esquizofrenia, catatonía), epilepsia, trastornos de sueño, trastornos gastrointestinales. Además de los trastornos propios del autismo, debemos tener en cuenta todo este abanico de condiciones, ya que su identificación y tratamiento permitirán una mejor calidad de vida. En el 35% de los casos podemos identificar entidades neurogenéticas, lo cual permitirá prevenir o identificar más rápidamente condiciones médicas asociadas. En este trabajo analizaremos dos grupos, de forma puramente organizativa, las condiciones médicas asociadas a entidades definidas (síndromes de Down, Angelman, X frágil, Rett, Phelan-McDermid y Timothy) y las que pueden asociarse consistentemente en personas con autismo sin una entidad identificada.

Risk assessment of patients with underlying health conditions who present for IVF treatment.

The increasing number of women with underlying health conditions seeking in vitro fertilization (IVF) necessitates a comprehensive risk assessment framework tailored to their needs. This review aims to provide a practical framework for IVF specialists to systematically assess and manage the risks associated with medically complex patients. The GRASP mnemonic (Genetics, Retrieval, Anaesthetics, Stimulation, Pregnancy) is introduced to facilitate a thorough risk assessment process. The review emphasizes the importance of obtaining detailed medical histories, corroborating information from other healthcare providers, and involving maternal medicine specialists in pre-pregnancy counselling. Furthermore, it highlights the ethical considerations of informed consent, advocating for fertility specialists to take a central role in coordinating care and ensuring patient understanding of risks. Continuous health evaluation throughout the IVF process and clear communication of risks are crucial for improving patient outcomes.

Incidence and risk factors for invasive fungal infections in patients initiating TNF-alpha inhibitors for inflammatory bowel disease and rheumatoid arthritis.

In a commercial claims database analysis, <0.5% of patients with inflammatory bowel disease or rheumatoid arthritis developed an IFI within one year of initiating TNF-alpha therapy. Histoplasmosis was the most common IFI type. Overall IFI incidence varied based on region, underlying conditions, and use of certain immunosuppressive medications.

Universal substance use care for adolescents with chronic medical conditions: a protocol to examine equitable implementation determinants and strategies for SBIRT at a pediatric hospital.

BACKGROUND: Adolescents with chronic medical conditions (CMC) use alcohol and marijuana at levels equal to or even greater than their peers without CMC and are more likely to initiate substance use at 14 years or younger. Approximately 33% of adolescents with CMC binge drink alcohol and 20% use marijuana. When using substances, adolescents with CMC are at elevated risk for problem use and adverse consequences given their medical conditions. Although there has recently been progress integrating substance use services into adult hospitals, there has been almost no implementation of standardized substance use services into pediatric hospitals for adolescents with CMC. Screening, Brief Intervention, and Referral to Treatment (SBIRT) for adolescents is an evidence-based, public health approach to promote the early detection and intervention of risky alcohol use in high-risk youth. This paper describes a study protocol combining two leading implementation science frameworks, the Consolidated Framework for Implementation Research (CFIR) and the Health Equity Implementation framework (HEIF), to engage pediatric hospital partners (hospital staff and clinicians, patients with CMC, and caregivers) to identify and specify contextual determinants of SBIRT implementation, which can be used to derive implementation strategies to optimize SBIRT adoption, reach, and fidelity. METHOD: This study will use semi-structured interviews and focus groups with pediatric hospital partners (e.g., hospital staff and clinicians, adolescent patients, and caregivers) to identify SBIRT implementation determinants, using semi-structured interview and focus group guides that integrate CFIR and HEIF dimensions. DISCUSSION: Understanding implementation determinants is one of the first steps in the implementation science process. The use of two determinant frameworks highlighting a comprehensive set of determinants including health equity and justice will enable identification of barriers and facilitators that will then map on to strategies that address these factors. This study will serve as an essential precursor to further work evaluating the feasibility of and the degree of engagement with SBIRT among this vulnerable pediatric population.

Association Between Neighborhood Context and Psychotropic Polypharmacy Use Among High-Need Children.

OBJECTIVE: The authors explored whether neighborhood context is associated with psychotropic polypharmacy and psychotherapy among a cohort of children with high needs for psychiatric and general medical care. METHODS: Electronic health record data from a large health care system were used in a cross-sectional design to examine psychotropic polypharmacy and psychotherapy in 2015-2019 among children ages 2-17 years (N=4,017) with geocoded addresses. Inclusion criteria were a diagnosis of a mental health condition, an intellectual and developmental disability, or a complex medical condition and one or more clinical encounters annually over the study period. Polypharmacy was defined as two or more psychotropic drug class prescriptions concurrently for ≥60 days. Psychotherapy was defined as receipt of any psychotherapy or adaptive behavior treatment. Neighborhood context (health, environment, education, and wealth) was measured with the Child Opportunity Index. Multilevel generalized linear mixed models with random intercept for census tracts were used to assess the associations between individual and neighborhood characteristics and psychotropic polypharmacy and psychotherapy. RESULTS: Moderate (vs. low) child opportunity was associated with higher odds of polypharmacy (adjusted OR [AOR]=1.79, 95% CI=1.19-2.67). High (vs. low) child opportunity was associated with higher odds of psychotherapy (AOR=2.15, 95% CI=1.43-3.21). Black (vs. White) race (AOR=0.51, 95% CI=0.37-0.71) and Hispanic ethnicity (AOR=0.44, 95% CI=0.26-0.73) were associated with lower odds of polypharmacy. CONCLUSIONS: Among high-need children, neighborhood Child Opportunity Index, race, and ethnicity were significantly associated with treatment outcomes in analyses adjusted for clinical factors. The findings underscore concerns about structural disparities and systemic racism and raise questions about access.

Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis-Part 2.

This article explores the various challenges systemic conditions can pose before and during orthodontic treatment. Cardiovascular conditions like infective endocarditis require antibiotic prophylaxis before certain orthodontic procedures are started. Patients with bleeding disorders require special considerations in regards to viral infection risk and maintenance of excellent atraumatic oral hygiene. Orthodontists play an important role in early identification of signs and symptoms of eating disorders and should deal with these patients sensitively. Congenital disorders, craniofacial anomalies, and nutritional deficiencies require special considerations and should be addressed appropriately before orthodontic treatment is started.

Development of the International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) Grade-Based Guidelines on the Surgical Treatment of Obesity Using Multimodal Strategies: Design and Methodological Aspects.

Background: The prevalence of obesity is already a worldwide health concern. The development of straightforward guidelines regarding the whole available armamentarium (i.e., medical, endoscopic, and surgical interventions in conjunction with a guidance program) is paramount to offering the best multimodal approach to patients with obesity. Methods: The International Federation for Surgery of Obesity and Metabolic Disorders-European Chapter (IFSO-EC) identified a panel of experts to develop the present guidelines. The panel formulated a series of clinical questions (based on the patient, intervention, comparison, and outcome conceptual framework), which have been voted on and approved. A GRADE methodology will be applied to assess the quality of evidence and formulate recommendations employed to minimize selection and information biases. This approach aims to enhance the reliability and validity of recommendations, promoting greater adherence to the best available evidence. Results: These guidelines are intended for adult patients with a body mass index (BMI) ≥ 30 kg/m2 who are candidates for metabolic bariatric surgery (MBS). The expert panel responsible for developing these guidelines comprised 25 panelists (92% were bariatric surgeons) and 3 evidence reviewers, with an average age of 50.1 ± 10.2 years. The panel focused on 3 key questions regarding the combined use of structured lifestyle interventions, approved obesity management medications, and endoscopic weight loss procedures with MBS. Conclusions: The complexity of obesity as a chronic disease requires a comprehensive knowledge of all the available and feasible therapeutic options. The IFSO-EC society felt the urgent need to develop methodologically valid guidelines to give a full picture and awareness of the possible surgical and non-surgical therapeutic strategies employed with a multimodal approach.

An Overview of the ADReSS-M Signal Processing Grand Challenge on Multilingual Alzheimer's Dementia Recognition Through Spontaneous Speech.

The ADReSS-M Signal Processing Grand Challenge was held at the 2023 IEEE International Conference on Acoustics, Speech and Signal Processing, ICASSP 2023. The challenge targeted difficult automatic prediction problems of great societal and medical relevance, namely, the detection of Alzheimer's Dementia (AD) and the estimation of cognitive test scoress. Participants were invited to create models for the assessment of cognitive function based on spontaneous speech data. Most of these models employed signal processing and machine learning methods. The ADReSS-M challenge was designed to assess the extent to which predictive models built based on speech in one language generalise to another language. The language data compiled and made available for ADReSS-M comprised English, for model training, and Greek, for model testing and validation. To the best of our knowledge no previous shared research task investigated acoustic features of the speech signal or linguistic characteristics in the context of multilingual AD detection. This paper describes the context of the ADReSS-M challenge, its data sets, its predictive tasks, the evaluation methodology we employed, our baseline models and results, and the top five submissions. The paper concludes with a summary discussion of the ADReSS-M results, and our critical assessment of the future outlook in this field.

Assessment of Depressive Symptoms and Sociodemographic Correlates of Adult Patients Attending a National Health Insurance Clinic at a Tertiary Hospital, Southwest Nigeria.

Background: Depression affects individuals across all age groups, genders, and socio-economic backgrounds. Socio-demographic correlates of depression may include factors such as age, gender, education level, income, and marital status. These factors, including the presence of chronic diseases, have been shown to impact the prevalence and severity of depression. This study assessed the prevalence of depressive symptoms and its association with socio-demographic correlates and co-morbid chronic medical conditions among adult patients attending a National Health Insurance Clinic of a tertiary health facility in Southwest Nigeria. Methodology: A hospital-based descriptive cross-sectional study was conducted between April - May 2023 in which 250 consenting adult patients were recruited using a systematic random sampling technique. Respondents' information on socio-demographic profiles and awareness of co-morbid medical conditions were assessed using semi-structured interviewer-administered questionnaires. Depressive symptoms were determined using the Patient Health Questionnaire. Data were analyzed using SPSS version 20. The strength of the association between independent and dependent variables was measured using chi-square and the p-value was set as <0.05. Results: The mean age of respondents was 38.96±13.096 years (range: 18-80 years). There were 159 (63.6%) females. The prevalence of depressive symptoms was 44.8%. There was a statistically significant association between age, gender, marital status, monthly income, presence of chronic diseases, and depressive symptoms. Conclusion: The prevalence of depressive symptoms among adult patients attending the National health insurance clinic was 44.8%. These findings call for health policies to integrate and strengthen mental health in NHIA primary care.

Quantification of referrals received at two emergency-capable hyperbaric medicine centers.

Emergency hyperbaric oxygen treatment capability is limited in the United States, and there is little documentation of calls received by centers available 24 hours a day, seven days a week, 365 days a year. Our study aimed to calculate the number of calls received for urgent hyperbaric oxygen (HBO2). We logged calls from two HBO2 chambers on the East Coast of the United States that serve a densely populated region in 2021. The total number of emergency calls was 187 at the University of Maryland (UMD) and 127 at the University of Pennsylvania (UPenn). There were calls on 180/365 (46%) days during the study period at UMD and 239/365 (63%) days at UPenn. The most common indication was carbon monoxide toxicity. The peak month of calls was March. Emergency HBO2 calls are common, and more centers must accept emergency cases. Data from geographically diverse centers would add generalizability to these results and capture more diving-related emergencies.

Should surgical inpatients still wear compression stockings?

Surgical inpatients are at increased risk of venous thromboembolism (VTE). Current national guidelines recommend a combination of pharmacological (chemoprophylaxis) and mechanical thromboprophylaxis to reduce VTE risk. For most patients, mechanical thromboprophylaxis is provided via application of graduated compression stockings (GCS). This editorial reviews the evidence surrounding the efficacy and safety of GCS in VTE prevention, and makes a recommendation regarding their continued use in surgical inpatients.

Survey comparing the treatment of central retinal artery occlusion with hyperbaric oxygen in Australia and New Zealand with the recommended guidelines as outlined by the Undersea and Hyperbaric Medical Society.

Introduction: Central retinal artery occlusion (CRAO) presents suddenly causing painless loss of vision that is often significant. Meaningful improvement in vision occurs in only 8% of patients with spontaneous reperfusion. Hyperbaric oxygen treatment (HBOT) is considered to be of benefit if commenced before retinal infarction occurs. The Undersea and Hyperbaric Medical Society (UHMS) guidelines on the management of CRAO were last amended in 2019. This survey questioned Australian and New Zealand (ANZ) hyperbaric medicine units (HMUs) about the incidence of CRAO cases referred and compared their subsequent management against the UHMS guidelines. Methods: An anonymous survey via SurveyMonkey® was sent to all 12 ANZ HMUs that treat emergency indications, allowing for multiple choice and free text answers regarding their management of CRAO. Results: One-hundred and forty-six cases of CRAO were treated in ANZ HMUs over the last five years. Most (101/146) cases (69%) were initially treated at a pressure of 284 kPa. This was the area of greatest difference noted in CRAO management between the UHMS guidelines and ANZ practice. Conclusions: Few ANZ HMUs strictly followed the UHMS guidelines. We suggest a more simplified management protocol as used by the majority of ANZ HMUs.

Impact of pre-existing medical conditions on mortality in geriatric trauma: a nationwide study in Japan.

PURPOSE: To investigate the relationship between pre-existing medical conditions and outcomes in elderly trauma patients in Japan. METHODS: This multicenter observational study utilized data from the Japan Trauma Data Bank (JTDB) from 2019 to 2020. The primary outcome was in-hospital mortality. Factors associated with in-hospital mortality were identified using multivariate logistic regression analysis, from which adjusted odds ratios (AOR) and 95% confidence intervals (CI) were determined. RESULTS: Of the participants during the study period, 19,598 patients were included in the analysis. Among the pre-existing medical conditions, moderate or severe liver disease showed the strongest positive association with in-hospital mortality (AOR: 7.087, 95% CI: 3.194-15.722), followed by multiple malignancies (AOR: 3.490, 95% CI: 1.046-11.641), congestive heart failure (AOR: 2.572, 95% CI: 1.920-3.445), and moderate or severe renal disease (AOR: 2.256, 95% CI: 1.584-3.215). CONCLUSION: Data from JTDB suggests that pre-existing conditions like moderate or severe liver disease, congestive heart failure, and moderate or severe renal disease in elderly trauma patients are positively correlated with in-hospital mortality.

Safety, Tolerability, and Immunogenicity of aH5N1 Vaccine in Adults with and without Underlying Medical Conditions.

Influenza pandemics pose a serious risk to the global population, with the potential for high morbidity and mortality. An adjuvanted H5N1 vaccine (aH5N1) has been approved for prophylaxis against the avian influenza virus H5N1, which is a likely cause of future pandemics. In this phase-III, stratified, randomized, controlled, observer-blind, multicenter study, we evaluated the safety and immunogenicity of aH5N1 in four separate groups of adults: adults 18-60 years of age who were healthy or had high-risk medical conditions and older adults ≥61 years of age who were healthy or had high-risk medical conditions. Subjects were randomly assigned to aH5N1 or the comparator, adjuvanted trivalent seasonal influenza vaccine (aTIV). Antibody responses to aH5N1 were increased in all four subgroups and, within each age stratum, largely consistent between healthy subjects and those with medical conditions. Injection-site pain was reported by 66-73% of younger and 36-42% of older-aH5N1 recipients, and fatigue and myalgia were reported by 22-41% of subjects across age and health subgroups. No serious adverse events or deaths were considered related to the study vaccine. In conclusion, aH5N1 increased antibody responses regardless of age or health status and demonstrated a clinically acceptable safety and tolerability profile.

A Systematic Review of Risk factors for Sleep Apnea.

Background: Sleep apnea, a prevalent global health issue, is characterized by repeated interruptions in breathing during sleep. This systematic review aggregates global data to outline a comprehensive analysis of its associated risk factors. Purpose: The systematic review underscores the global prevalence of sleep apnea and the universal importance of its early detection and management by delineating key risk factors contributing to its development. Material and Methods: We conducted a thorough systematic review of international medical databases up to July 31, 2023, including PubMed, Medline, and Cochrane Library, to ensure a wide-ranging collection of data reflective of various populations. Results: The systematic review identifies several risk factors such as obesity, age, gender, neck circumference, family history, smoking, alcohol use, underlying medical conditions, and nasal congestion, highlighting their prevalence across diverse demographics globally. Conclusion: Emphasizing lifestyle modifications and proactive interventions, our findings advocate for global health strategies to mitigate the risk of sleep apnea and enhance sleep health worldwide.

Obesity in U.S. low-income veterans:Prevalence, clinical characteristics, and homelessness.

OBJECTIVE: Obesity is associated with lower socioeconomic status. To date, however, scarce research has examined the prevalence, comorbidity, and incremental burden of obesity in relation to medical, psychiatric, functional, and homelessness measures among low-income veterans. METHODS: A nationally representative sample of 1004 low-income U.S. veterans was examined. Bivariate and multivariable analyses were conducted to assess relationships between obesity and medical and psychiatric comorbidities, functioning, and homelessness measures. RESULTS: The prevalence estimate of obesity among low-income U.S. veterans was 38.2% (confidence interval (CI): 34.2; 42.2), which is higher than previously reported for the general U.S. veteran population. It was particularly high among young, females with children. Obesity was associated with co-occurring medical (chronic pain, diabetes, sleep disorders, high blood pressure, heart disease) and psychiatric (trauma- and anxiety-related) conditions, poor functioning, and current psychiatric medication use. Veterans with obesity were less likely to have current savings and more likely to have current debt. They also were more likely to have experienced evictions and foreclosures and less likely to use active coping or positive reframing as a means of dealing with stressful situations. CONCLUSION: The prevalence of obesity among U.S. veterans is high. Specific demographic groups particularly vulnerable to developing obesity warrant targeted interventions. Modifying weight management programs, understanding coping styles, and assessing, monitoring, and treating obesity in low-income veterans may help improve overall health and quality of life in multiple domains.

Health-related quality of life and self-reported health status in adolescents with chronic health conditions before transfer of care to adult health care: an international cohort study.

BACKGROUND: Heath-related quality of life (HRQoL) is lower in adolescents with chronic health conditions compared to healthy peers. While there is evidence of some differences according to the underlying condition and gender, differences by measure and country are poorly understood. In this study we focus on the differences in HRQoL in adolescents with various chronic medical conditions in the year before transfer of care to adult health services. We also study the associations of two different HRQoL measurements to each other and to self-reported health. METHODS: We recruited 538 adolescents from New Children`s Hospital, Helsinki, Finland, and the Royal Children`s Hospital, Melbourne, Australia in 2017-2020. We used two validated HRQoL measurement instruments, Pediatric Quality of Life Inventory (PedsQL) and 16D, and a visual analog scale (VAS) for self-reported health status. RESULTS: In total, 512 adolescents (50.4% female, mean age 17.8 [SD 1.2] years), completed the survey measures. Higher HRQoL was reported in males than females in both countries (PedsQL 79.4 vs. 74.1; 16D 0.888 vs. 0.846), and in adolescents from Finland than Australia (80.6 vs. 72.2 and 0.905 vs. 0.825, p < 0.001 for all). Adolescents with diabetes, rheumatological, nephrological conditions and/or organ transplants had higher HRQoL than adolescents with neurological conditions or other disease syndromes (p < 0.001). PedsQL and 16D scores showed a strong correlation to each other (Spearman correlation coefficient r = 0.81). Using the 7-point VAS (1-7), 52% (248 of 479) considered their health status to be good (6-7) and 10% (48 of 479) rated it poor (1-2). Better self-reported health was associated with higher HRQoL. CONCLUSIONS: The HRQoL of transition aged adolescents varies between genders, diagnostic groups, and countries of residence. The association between self-reported health and HRQoL suggests that brief assessment using the VAS could identify adolescents who may benefit from in-depth HRQoL evaluation. TRIAL REGISTRATION: Trial registration name The Bridge and registration number NCT04631965 ( https://clinicaltrials.gov/ct2/show/NCT04631965 ).

Role of child demographic, executive functions, and behavioral challenges on feelings about parenting among parents of youth with Down syndrome.

BACKGROUND: Living with a child with Down syndrome (DS) influences the entire family, including caregivers. AIMS: This study examined positive and negative caregiver feelings about parenting youth with DS and to what extent children's demographic, cognitive, behavioral characteristics, and co-occurring medical conditions are associated with those parental feelings. Specifically, the mediatory role of child behavioral challenges on the relationship between child executive functioning (EF) and parent feelings about parenting a child with DS was examined in a mediation analysis model. METHODS AND PROCEDURES: Parents of 113 youth with DS aged 6 to 17 year rated their positive and negative feelings about parenting, and their child's behavioral challenges and EF. OUTCOMES AND RESULTS: Externalizing and Internalizing behavioral challenges and emotional and behavioral regulations of EF were significantly associated with positive and negative parent feelings. Child behavioral challenges fully mediated the relationship between child EF and caregiver feelings about parenting, after controlling for identified covariates of child demographics. CONCLUSIONS AND IMPLICATIONS: Findings have implications for understanding the role of EF, through its impact on behavioral challenges, on the feelings of caregivers about parenting a child with DS. These findings play a role in understanding outcomes of interventions targeted at EF and behavioral challenges, in the context of other child variables.

Knowledge, Attitudes, and Coverage of Recommended Vaccinations in Individuals with Chronic Medical Conditions: A Cross-Sectional Telephone Survey in Italy.

BACKGROUND: This cross-sectional survey investigated the knowledge, attitudes, and coverage of recommended vaccinations among a random sample of patients with chronic medical conditions, at higher risk of vaccine-preventable diseases (VPDs), in Italy. METHODS: The survey was conducted via telephone-based interviews. RESULTS: Multinomial regression analysis showed that the patients who believed that VPDs were severe were more likely to know one recommended vaccination; those who believed that VPDs were severe and those who were advised from a general practitioner (GP) were more likely to know two vaccinations; those who were older, graduated, with more time from diagnosis, who believed that VPDs were severe, who did not need additional information, and who were advised from a GP were more likely to know three or four vaccinations. Patients who knew at least one vaccination, who perceived themselves at risk, and who were advised from a GP were more likely to have received one vaccination; those who knew more than one vaccination and who were advised from a GP were more likely to receive two or three vaccinations. Among the unvaccinated, patients who were unmarried/not cohabiting, those who needed information, and who believed that vaccinations were useful and safe were more willing to receive the recommended vaccinations. CONCLUSIONS: Educational interventions are needed to improve the adherence of individuals with chronic medical conditions.

Implementing a social work care coordination model for children and youth with special health care needs in a rural-urban health system.

This retrospective chart review examined care coordination among pediatric patients with varying levels of medical complexity who received care in a rural-urban health system. Care coordination utilization across patient acuity levels was examined for meaningful differences in frequency and duration of care coordination services. Results indicated that patients with more severe medical complexity had increased frequency and duration of care coordination services, as well as different patterns of care coordination activity utilization. This model of pediatric outpatient care coordination provides a flexible and highly targeted approach for stratification of care and services based on the needs of the individual patient.