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Objective Objective measures of neighborhood quality are associated with physical and mental health outcomes for older adults, but the relationship between perceived neighborhood quality and cognitive health has not been fully explored. Furthermore, positive and negative neighborhood characteristics may influence cognition through different mechanisms. The present study aimed to determine whether perceptions of neighborhood quality predict cognitive functioning in two domains, above and beyond individual-level risk factors, in a nationally representative sample of older adults. Method Using cross-sectional weighted data from 13,919 participants aged 51 and older from the Health and Retirement Study, linear regression models tested independent associations between perceived neighborhood quality (physical disorder and social cohesion) and cognition (episodic memory and semantic verbal fluency), controlling for sociodemographic characteristics, chronic disease burden, and depressive symptoms. Interaction terms tested whether neighborhood social cohesion moderated the relationship between neighborhood physical disorder and each cognitive outcome. Results Perception of greater neighborhood physical disorder was significantly associated with worse episodic memory, while perception of lower neighborhood social cohesion was significantly associated with worse semantic fluency. There were no significant interactions between physical disorder and social cohesion. Conclusions Results provide preliminary evidence for different mechanisms underlying associations between aspects of neighborhood quality and cognition (e.g. stress vs. social interaction). Additional intervention work is needed to determine whether improving neighborhood physical conditions and promoting social cohesion at the neighborhood level could reduce cognitive morbidity among older adults. [ABSTRACT FROM AUTHOR]

Objective: Living in a dangerous and disadvantaged neighborhood is consistently linked with poor health outcomes; however, few studies have investigated psychosocial mechanisms of this relationship. We hypothesized that a specific facet of depression-anhedonia-would partially explain the relationship between stressful neighborhoods and poor health in youth with asthma.Method: 156 youths provided reports on their depressive symptoms, daily asthma symptoms, and peak expiratory flow rate (PEFR). Caregivers provided reports on neighborhood characteristics.Results: Youth residing in more at-risk neighborhoods experienced more symptoms of depression, greater asthma symptoms (both during the day and night), and marginally lower PEFR. Indirect effect analyses revealed that the relationship between neighborhood stress and youth asthma symptoms was partially explained by a key symptom of depression, anhedonia.Conclusions: These findings suggest that the neighborhood-health link is partially explained by symptoms of depression tapping into difficulties experiencing pleasure and motivation. [ABSTRACT FROM AUTHOR]

Objectives: To assess patient movement characteristics in children and young adults and the impact on CBCT image quality. Methods: During 33 CBCT examinations, the patients (age: average, 14 years; range, 9-25 years) who had moved were identified by video observation [movement group (MG)]. The CBCT data sets were matched with those of 33 non-moving patients according to age, diagnostic task, examined region, field of view and voxel resolution [non-movement group (N-MG)]. Three observers scored the videos of MG, regarding motional state second by second (moving/non-moving), and movement characteristics: duration (in seconds), complexity (uniplanar or multiplanar) and distance (<3/≥3≤10/>10 mm). The observers blindly assessed axial sections of the 66 examinations individually, categorizing the image quality (appropriate/acceptable/inappropriate). Next, the observers blindly assessed axial sections of the matched-pairs images simultaneously, deciding which image in the pair had the highest image quality or if it was impossible to decide. The relationship between image quality and movement/movement characteristics was evaluated. Results: When the 66 CBCT images were evaluated individually, no relationship between image quality and movement was found. However, based on the matched-pairs assessment, accumulated number (≤2 vs ≥3, p = 0.039), duration (≤5 s vs ≥6 s, p = 0.024) and complexity (uniplanar vs multiplanar, p = 0.046) of movements had an impact on image quality; the more severe the movement, the more often the image quality was assessed lower in the MG. Conclusions: Axial CBCT images of young patients who moved during examination did not always present lower quality than images originating from non-moving patients. Image quality was, however, significantly lower in the moving patients when movement occurred several times, had a long duration or was multiplanar. [ABSTRACT FROM AUTHOR]

Background There is limited information on clinical manifestations of atopic eczema ( AE) and non- AE in teenagers. Objectives To describe the characteristics of adolescent eczema in the general population and to identify potential differences between AE and non- AE in teenagers. Methods Overall, 3108 teenagers were included from the population-based BAMSE cohort and 2529 of these teenagers provided blood samples for analysis of specific IgE. At age 16 years, the teenagers answered questionnaires regarding the symptoms of eczema, asthma and rhinitis for the previous year. Results The prevalence of eczema in adolescence was 9·6% ( n = 297). More girls than boys had eczema (12·5% vs. 6·5%; P < 0·001). The age at onset was usually within the first 2 years of life (48·8%), but onset in adolescence was also common (25·6%). Eczema was mild in 72·7% of cases, moderate in 16·8% and severe in 10·4%. Body folds were most frequently affected (73·4%). More than half of the teenagers with eczema had AE (59%). The teenagers with AE had more severe and more chronic eczema. Onset in infancy was most common in AE and onset in adolescence was most common in non- AE. There were no major differences in location or seasonal variance between AE and non- AE in adolescence. Conclusions AE is more common than non- AE among teenagers. More than one in four teenagers with eczema has moderate-to-severe disease. Onset in adolescence is common, especially for non- AE. AE in adolescence has an earlier onset and is more chronic and more severe than non- AE. [ABSTRACT FROM AUTHOR]

Objective: The role of the incretin hormones in the pathophysiology of maturity onset diabetes of the young (MODY) is unclear. Design: We studied the postprandial plasma responses of glucagon, incretin hormones (glucagon-like peptide 1 (GLP1) and glucose-dependent insulinotropic polypeptide (GIP)) and dipeptidyl-peptidase 4 (DPP4) enzymatic activity in patients with glucokinase (GCK) diabetes (MODY2) and hepatocyte nuclear factor 1a (HNF1A) diabetes (MODY3) as well as in matched healthy individuals (CTRLs). Subjects and methods: Ten patients with MODY2 (mean age±S.E.M. 43±5 years; BMI 24±2 kg/m2; fasting plasma glucose (FPG) 7.1 ±0.3 mmol/l: HbA1c 6.6±0.2%), ten patients with MODY3 (age 31 ± 3 years; BMI 24± 1 kg/m²; FPG 8.9 ±0.8 mmol/l; HbA1c 7.0±0.3%) and ten CTRLs (age 40± 5 years; BMI 24± 1 kg/m²; FPG 5.1 ±0.1 mmol/l; HbA1c 5.3±0.1%) were examined with a liquid test meal. Results: All of the groups exhibited similar baseline values of glucagon (MODY2: 7±1 pmol/l; MODY3: 6± 1 pmol/l; CTRLs: 8 ± 2 pmol/l, P=0.787), but patients with MODY3 exhibited postprandial hyperglucagonaemia (area under the curve (AUC) 838 ± 108 minx pmol/l) as compared to CTRLs (182 ± 176 min X pmol/l, P=0.005) and tended to have a greater response than did patients with MODY2 (410± 154 min Xpmol/l, P=0.063). Similar peak concentrations and AUCs for plasma GIP and plasma GLP1 were observed across the groups. Increased fasting DPP4 activity was seen in patients with MODY3 (17.7 ± 1.2 mU/ml) vs CTRLs (13.6±0.8 mU/ml, P=0.011), but the amount of activity was similar to that in patients with MODY2 (15.0±0.7 mU/ml, P=0.133). Conclusion: The pathophysiology of MODY3 includes exaggerated postprandial glucagon responses and increased fasting DPP4 enzymatic activity but normal postprandial incretin responses both in patients with MODY2 and in patients with MODY3. [ABSTRACT FROM AUTHOR]

Objective No studies have examined psychological functioning among youth with spina bifida (SB) living in a developing country where access to mental health resources is often scarce. This study compared self-reported psychological functioning between youth with SB living in Colombia, South America, and a demographically matched comparison group of healthy Colombian children. Methods 22 children with SB and 22 comparison children completed assessments of depression and anxiety. Most (68.81%) participants were male, and the sample had a mean age of 13.25 years (SD=2.65 years). Results Results revealed that children with SB reported greater total symptoms of depression (p<.05), but fewer worry-related symptoms of anxiety (p<.05). In addition, mean total scores for both depression and anxiety were in the nonclinical range for youth with SB. Conclusions These findings highlight the need for targeted mental health (i.e., depression) services for poor children with SB living in Colombia. [ABSTRACT FROM AUTHOR]

Despite acne being an almost universal condition in younger people, relatively little is known about its epidemiology. We sought to review what is known about the distribution and causes of acne by conducting a systematic review of relevant epidemiological studies. We searched Medline and Embase to the end of November 2011. The role of Propionibacterium acnes in pathogenesis is unclear: antibiotics have a direct antimicrobial as well as an anti-inflammatory effect. Moderate-to-severe acne affects around 20% of young people and severity correlates with pubertal maturity. Acne may be presenting at a younger age because of earlier puberty. It is unclear if ethnicity is truly associated with acne. Black individuals are more prone to postinflammatory hyperpigmentation and specific subtypes such as 'pomade acne'. Acne persists into the 20s and 30s in around 64% and 43% of individuals, respectively. The heritability of acne is almost 80% in first-degree relatives. Acne occurs earlier and is more severe in those with a positive family history. Suicidal ideation is more common in those with severe compared with mild acne. In the U.S.A., the cost of acne is over 3 billion dollars per year in terms of treatment and loss of productivity. A systematic review in 2005 found no clear evidence of dietary components increasing acne risk. One small randomized controlled trial showed that low glycaemic index (GI) diets can lower acne severity. A possible association between dairy food intake and acne requires closer scrutiny. Natural sunlight or poor hygiene are not associated. The association between smoking and acne is probably due to confounding. Validated core outcomes in future studies will help in combining future evidence. [ABSTRACT FROM AUTHOR]

Objective The current study examined the associations between catastrophizing and pain intensity, psychological adjustment, functional ability, and community participation in youths with physical disability and chronic pain. Methods Participants consisted of 80 youths, aged 8–20 years, with cerebral palsy (n = 34), neuromuscular disease (n = 22), or spina bifida (n = 24). Measures from a cross-sectional survey included demographic, pain, and disability information, the Pain Catastrophizing Scale, the Child Health Questionnaire, and the Functional Disability Inventory. Results Results suggested that catastrophizing was significantly associated with pain intensity and psychological adjustment; however, catastrophizing did not demonstrate significant associations with functional ability or community participation. Conclusions The study extends previous findings of significant associations between catastrophizing and both pain intensity and psychological adjustment to samples of youths with chronic pain and disabilities not previously examined. Further research that examines the causal association between catastrophizing and outcomes in youths with chronic pain and physical disability is warranted. [ABSTRACT FROM AUTHOR]

Background: To describe the morphology of glucose curve during the oral glucose tolerance test (OGTT) and any association with glucose tolerance, insulin action and secretion in obese youth. Study design: Cross-sectional. Methods: OGTT data of 553 patients were analysed. Subjects were divided in groups based on the morphology (i.e. monophasic, biphasic, triphasic and upward monotonous) of glucose curve. Insulin action was estimated by the homeostasis model assessment of insulin resistance, the insulin sensitivity, the muscle insulin sensitivity and the hepatic insulin resistance indexes (HIRI), and the oral glucose insulin sensitivity (OGIS). Insulin secretion was estimated by the insulinogenic index (IGI). Disposition index, including the insulin secretion-sensitivity index-2, and areas under glucose (AUCG) and insulin (AUCI) curves were computed. Results: In patients with normal glucose tolerance (n=522), prevalent morphology of the glucose curve was monophasic (n=285, 54%). Monophasic morphology was associated with the highest concentration of 1 h plasma glucose (P<0.0001) and AUCG (P<0.0001); biphasic morphology with better insulin sensitivity as estimated by OGIS (P<0.03) and lower AUCI (P<0.0001); triphasic morphology with the highest values of HIRI (P<0.02) and IGI (P<0.007).By combining morphologies of glucose and insulin curves or time of the glucose peak, a deeper characterisation of different phenotypes of glucose metabolism emerged. Conclusions: Morphologies of the glucose curve seem reflecting different metabolic phenotypes of insulin action and secretion, particularly when combined with morphologies of insulin curve or time of glucose peak. Such findings may deserve validation in cohort study, in which glucose metabolism would be estimated by using gold standard techniques. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify independent factors associated with early (30-day) mortality and in surviving patients, identify factors for late (1-year) mortality following primary coronary artery bypass graft (CABG) surgery and to test the interaction with age. Methods: An analysis of a single centre''s data contribution to the Society for Cardiothoracic Surgery in Great Britain and Ireland database was performed. Data on consecutive patients aged ≥75 years (n =659) and aged 60–74 years (n =3024) undergoing primary CABG surgery (1999–2005) were analysed. One-year mortality data were collected using the Office of National Statistics (ONS) tracking system. Factors associated with early and late mortality were identified using Cox regression; hazard ratios (HRs) and 95% confidence intervals (CIs) are presented. Results: The proportion of patients aged ≥75 years increased by 10% over 5 years (2000–2005). One-year mortality in the elderly showed a significant linear decrease from 15% to 7% (p =0.01) while mortality in the younger cohort remained static at 2–4%. Early mortality in the elderly group was 5% compared to 1.8% in the younger group (p <0.001), while late mortality was 4.1% vs 1.8%, respectively (p <0.001). Factors independently associated with early mortality were age ≥75 years, HR 2.0 (95% CI 1.28, 3.11); female gender; angina (CSS III–IV); and cardiopulmonary bypass duration >97minutes. Arrhythmia and renal impairment were risk factors common in both early and late mortality models. Risk factors for late mortality also included ventricular ejection fraction <30%, non-elective surgery and arteriopathy. Age was not an independent risk factor for late mortality. Conclusion: Mortality in elderly patients showed a substantial improvement, but remained over twice that of younger patients. The difference in factors associated with early and 1-year morality suggests the need for effective short- and long-term strategies, particularly in the management of chronic diseases such as heart and renal failure. [Copyright &y& Elsevier]

Abstract: Objective: Cardiac surgery is higher risk in the elderly. It has been suggested that preoperative left ventricular systolic dysfunction (LVSD) and cardiopulmonary bypass (CPB) affect elderly and young patients differently. This study investigates the predictive risk of preoperative LVSD and CPB time for operative mortality in the two groups of patients. Methods: We reviewed the data for 2616 consecutive patients aged ≥70 years and 4078 young patients who had coronary artery bypass grafting (CABG) and/or valve surgery between March 1998 and January 2007. Subgroups defined by severity of LVSD (ejection fraction >0.50 [mild], 0.31–0.50 [moderate] and ≤0.30 [severe]) were analysed. Logistic regression models were constructed to identify risk factors among elderly and young patients. Results: Elderly patients were higher risk and more often underwent valve operation. Moderate and severe LVSD were present in 22% (n =566) and 6% (n =155) of elderly compared to 18% (n =739) and 5% (n =215) of young patients (p =0.001). Operative mortality for CABG was higher in elderly patients with mild (2.3% vs 0.7%, p <0.0001), moderate (4.7% vs 2.3%, p =0.04) and severe LVSD (13.5% vs 8.8%, p =0.01). Although CPB times for similar procedures were equivalent for the two groups, procedure-specific mortality rates were higher among elderly patients for all operations. Whereas age (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.03–1.15, p =0.002) and CPB time (OR 1.01, 95% CI 1.0–1.02, p <0.0001) were predictors for operative mortality for the elderly, they (age [OR 1.0, 95% CI 0.96–1.05, p =0.87], CPB time [OR 1.0, 95% CI 1.0–1.01, p =0.17]) were not for young patients. Moderate LVSD was a risk factor for young patients (OR 3.01, 95% CI 1.45–6.26, p =0.003) but not for the elderly (OR 1.33, 95% CI 0.77–2.29, p =0.30). Conclusion: Differences in the significance of risk factors between elderly and young patients contribute to the disproportionate operative mortalities. Our data showed that age and CPB duration increased the risk of operative mortality only in the elderly, but the impact of moderate, unlike severe, LVSD was tempered. Further studies are warranted to investigate more biocompatible bypass systems in elderly patients, and if current risk stratification should, perhaps, be revised for elderly patients. [Copyright &y& Elsevier]

Parental monitoring has been defined as "a set of correlated parenting behaviors involving attention to and tracking of the child's whereabouts, activities, and adaptations." This construct is of significant interest due to its relatedness to a broad range of youth risk behaviors, including risky sexual behavior, substance abuse, and poor adherence. However, to date, measures of parental monitoring are largely absent from the chronic illness literature. The present article focuses upon two key problems in the operationalization of the monitoring construct to date: (a) poor conceptual specificity in parenting constructs such as monitoring, overprotection, and over-involvement when used to date among youth with chronic conditions and (b) the confounding of existing measures of parental monitoring with items evaluating parental knowledge of youth activities, which has resulted in a lack of data regarding the mechanisms by which parents obtain their information. Recommendations for the future development of monitoring measures are discussed. [ABSTRACT FROM AUTHOR]

Objective To examine the relationship between a cumulative risk model and caregiver quality of life (QOL) in pediatric asthma and determine whether caregiver QOL is predicted by a linear or quadratic model of cumulative risk. Methods One hundred and ninety-three families of children between the ages of 5 and 12 years with mild to severe asthma completed a background questionnaire and measures of QOL, asthma severity, family burden, and family stress. A cumulative risk model based on risk factors from these measures was calculated for each caregiver. Results The cumulative risk model significantly predicted caregiver QOL as a quadratic function. Caregivers with numerous risk factors experienced a dramatic worsening of QOL. Conclusions Findings suggest that caregiver QOL is best predicted by the interaction and not the summation of these factors. Interventions focused on one area of family risk may be effective in reducing poor QOL in caregivers of children with asthma. [ABSTRACT FROM AUTHOR]

Objective To assess the quality of life and psychosocial functioning among pediatric patients with Glycogen Storage Disease (GSD) types 1a and 1b. Methods Thirty-one youth with GSD types 1a and 1b and 42 healthy controls participated. Quality of life ratings from the GSD types 1a and 1b sample were compared with a previously reported clinical comparison sample. Children completed measures of quality of life, loneliness, family functioning, and sibling relationship quality (e.g., warmth, conflict). Parents completed measures of parental distress, parenting stress, child adaptive behavior, and child emotional and behavioral functioning. Results Quality of life was generally lower in youth with GSD relative to healthy controls but similar to those with a chronic illness. Children with GSD were rated as having more internalizing symptoms, social problems, and lower independent functioning relative to healthy controls. Parents reported greater distress and parenting stress relative to healthy controls. Conclusions The presence of GSD types 1a and 1b are associated with reduced quality of life and independent functioning, and elevated levels of internalizing distress and parental stress relative to healthy peers. Relative to their children, parents generally reported that their child was more impaired, which suggests the need for multiple informants during assessment and active parental involvement during psychological treatment. These points should be kept in mind when assessing and treating youth with this disease and their families as psychological interventions that target areas of concern (e.g., adherence, coping with having a chronic disease) may be helpful for improving child and family outcomes. [ABSTRACT FROM AUTHOR]

Objectives This study tested the directionality of the association between sleep and health outcomes in youth with asthma. Method Thirty-eight youth with asthma (aged 9-19) completed a daily diary study on sleep, asthma symptoms, peak expiratory flow (PEF) measures, and salivary cortisol samples. Results Greater quantity of sleep predicted lower PEF% [β(32) = -.33, p = .02], and lower daily cortisol output [β(33) = - .31, p = .07] the following day. Additionally, poorer self-reported sleep quality predicted more severe symptoms the next day [β(33) = .27, p = .05]. In contrast, PEF%, cortisol, and asthma symptoms did not significantly predict self-reported sleep quantity or quality the next night. Conclusions Results suggest that sleep may affect subsequent health outcomes, rather than asthma impacting subsequent sleep, indicating the potential benefits of targeting sleep behaviors in youth with asthma. [ABSTRACT FROM AUTHOR]

Background: The appropriate treatment for a sporadic endocrine turnout may be different from those that present as part of the multiple endocrine neoplasia type 1 (MEN1) syndrome. As primary hyperparathyroidism (pHPT) and pancreaticoduodenal endocrine tumours (PETs) are the most common organ manifestations of MEN1, the prevalence of germline mutations in the MEN1 gene was determined in young patients with apparently sporadic pHPT or PETs. Methods: Eighteen of 705 patients with pHPT and 11 of 93 patients with PETs operated on between 1987 and 2001 had no family history of MEN1, only one organ manifestation and were aged 40 years or less at the time of diagnosis. Fifteen patients with pHPT and eight with PETs agreed to MEN1 gene mutation analysis, which was performed by single-strand conformational variant analysis and direct DNA sequencing. Results: Two of 15 patients (13.3 (95 per cent confidence interval (c.i.) 1·6 to 40·4)per cent) with apparently sporadic pHPT had a MEN1 germline mutation. Both mutations were found in patients with pHPT due to multiglandular disease, whereas the remaining 13 patients had a solitary adenoma. None of the eight patients with PETs carried a MEN1 germline mutation. Conclusion: Sporadic pHPT due to multiglandular disease in patients younger than 40 years may represent the first organ manifestation of MEN1 despite a negative family history. [ABSTRACT FROM AUTHOR]

Type 1 diabetes mellitus is a chronic metabolic disorder and is one of the most common chronic diseases in childhood. The study discussed in this article examined the extent to which family structure is significantly associated with health in youths with Type 1 diabetes. A convenience sample of 155 children with diabetes and their mothers completed face-to-face interviews: multiple regression analyses were conducted. Findings demonstrated that family structure remains' a significant predictor of youths' health when statistically controlling for race, child's age, family socioeconomic status, and adherence. Social workers in outpatient medical settings are in a unique position to develop family-oriented strategies targeting this neglected area of primary care. [ABSTRACT FROM AUTHOR]

Background Early-life exposure to antibiotics is associated with childhood asthma. We previously reported that a dramatic drop in infant antibiotic use is correlated with a decline in asthma incidence in children in British Columbia (BC). This study aims to see whether antibiotic exposure predicts asthma at a fine geographic scale after adjustment for known covariates. Methods We used prescribing data from BC PharmaNet, a population-based database capturing all outpatient prescribing for BC population (n = 4.7 million). Prescribing rates for infants <1 year were calculated as prescriptions per 1000 population per year using age and sex-specified denominator estimates. Age-adjusted aggregate asthma incidence data for children 1–4 years were obtained from the BC Ministry of Health Chronic Disease Registry. The disease identification uses a standard case definition making using of diagnostic codes (ICD9-493 and ICD10-J45) in BC's universal hospital and physician billing databases and relevant asthma-specific drug data from BC PharmaNet. We modeled the association between antibiotic prescribing rate and asthma incidence in 91 Local Health Areas using multivariable Poisson regression employing a generalized linear mixed-effects model adjusting for covariates. Results Between 2000 and 2014, the annual asthma incidence (ages 1–4 years) fell 26% from 27.3 (95% CI: 26.5–28.0) to 20.2 (95% CI: 19.5–20.8) per 1000 population. For children aged 1–4 years in 2000, the average proportion of infants exposed to one or more courses of antibiotics fell from 66.9 to 32.1% over the same interval. Antibiotic was a significant predictor of asthma rate (IRR=1.24 per 10% absolute increase in antibiotic prescribing; 95% CI: 1.19–1.27). Other covariates that remained significant in the model included male sex (IRR=1.56; 95% CI: 1.53–1.58), and atmospheric particulate matter PM 2.5 (IRR=1.08 per interquartile increase; 95% CI: 1.06–1.10). Conclusion Our findings suggest that antibiotic exposure in the first year of life increases the risk of being diagnosed with asthma later in childhood. This is congruent with similar findings at the individual level in a prospective cohort of Canadian children that also points to a pathway through altered gut microbiota. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

The author comments on the article "How Implicit Motives and Everyday Self-Regulatory Abilities Shape Cardiovascular Risk in Youth," by Craig K. Ewart, Gavin J. Elder, and Joshua M. Smyth. The author says that the study has raised important questions on the psychological processes and content associated with cardiovascular diseases' psychological risk factors. She adds that the findings suggest the role of motivational goals in the prediction of ambulatory systolic blood pressure in adolescents.

Background In France, pneumococcal vaccination in adults is recommended for risk groups (chronic conditions/immunosuppression). We conducted a study on invasive pneumococcal disease (IPD) in adults to identify factors associated with disease severity and death. Methods We included IPD cases, excluding meningitis, from 25 acute care hospitals in 6 regions. We defined severe cases as those with shock or severe sepsis or intensive care unit admission/mechanical ventilation. We included deaths occurring within 30 days of hospitalization. Infectious disease specialists collected clinical/microbiological data on cases. Results During 2014–2017, 908 nonmeningitis IPD cases were diagnosed; 48% were severe, 84% had comorbidities, 21% died. Ninety percent of cases with comorbidities who previously sought health care were not vaccinated against pneumococcus. Compared with previously healthy cases, the risk of severe IPD increased from 20% (adjusted risk ratio [aRR], 1.2; 95% confidence interval [CI], 1.0–1.4) in cases with 1–2 chronic diseases to 30% (aRR, 1.3; 95% CI, 1.0–7.0) in those with >2 chronic diseases. Among risk groups, 13-valent pneumococcal conjugate vaccine (PCV13) serotypes and 23-valent pneumococcal polysaccharide vaccine (PPSV23) nonPCV13 serotypes were more likely to induce severe IPD compared with nonvaccine serotypes (aRR, 1.5; 95% CI, 1.3–1.9; aRR, 1.3; 95% CI, 1.0–1.5, respectively). Conclusions We observed a cumulative effect of concurrent comorbidities on severe IPD. Vaccine serotypes were more likely to induce severe IPD among risk groups. The missed opportunities for vaccination underscore the need to enhance vaccination in risk groups. [ABSTRACT FROM AUTHOR]

The author comments on a study which investigated the difference between atopic and nonatopic eczema in adolescence, published in the journal in October 2015. Topics discussed include the characteristics of adolescent group with atopic eczema, the clinical signs of eczema in adolescents, and public health challenge of managing eczema in adolescence. The difference between location and seasonality in adolescents with atopic and nonatopic eczema is noted.