RESUMO
We compared case definitions for suspected, probable, and confirmed coronavirus disease (COVID-19), as well as diagnostic testing criteria, used in the 25 countries with the highest reported case counts as of October 1, 2020. Of the identified countries, 56% followed World Health Organization (WHO) recommendations for using a combination of clinical and epidemiologic criteria as part of the suspected case definition. A total of 75% of identified countries followed WHO recommendations on using clinical, epidemiologic, and diagnostic criteria for probable cases; 72% followed WHO recommendations to use PCR testing to confirm COVID-19. Finally, 64% of countries used testing eligibility criteria at least as permissive as WHO. We observed marked heterogeneity in testing eligibility requirements and in how countries define a COVID-19 case. This heterogeneity affects the ability to compare case counts, transmission, and vaccine effectiveness, as well as estimates derived from case surveillance data across countries.
Assuntos
COVID-19 , Eficácia de Vacinas , Técnicas e Procedimentos Diagnósticos , Humanos , SARS-CoV-2 , Organização Mundial da SaúdeRESUMO
Objectives This report documents the results of a validation study conducted to assess the reliability of two algorithms applied to the 2016 National Hospital Care Survey. One algorithm identifies opioid-involved and opioid overdose hospital encounters, and the other identifies encounters with patients that have substance use disorders and selected mental health issues. These algorithms use both medical codes and natural language processing to identify encounters. Methods To validate the algorithms, medical record abstraction was performed on a stratified sample of 900 hospital encounters from the 2016 National Hospital Care Survey. The abstractors recorded their determinations of opioid involvement, opioid overdose, substance use disorder, and mental health issues on a standard form. Abstractors' determinations were compared with algorithm output to assess the overall performance using F-score and Matthews correlation coefficient. The latter provided a secondary measure of performance. The 2016 National Hospital Care Survey data are unweighted and not nationally representative. Results Overall algorithm performance varied by topic and by metric. The opioid-involvement algorithm achieved the highest performance, performing well with an F-score of 0.95, followed by the substance use disorder algorithm (F-score of 0.79), the mental health issues algorithm (F-score of 0.68), and the opioid overdose algorithm (F-score of 0.48). Assessment by Matthews correlation coefficient indicated an overall poorer level of performance, ranging from a high of 0.57 for the mental health issues algorithm to a low of 0.33 for the opioid-involvement algorithm. The causes of false positives and false negatives likewise varied, including both overly broad code and keyword inclusions as well as incompleteness of data submitted to the National Hospital Care Survey. Conclusion The validation study illustrates which aspects of the developed algorithms performed well and which aspects should be altered or discarded in future iterations. It further emphasizes the importance of data completeness, therefore laying the groundwork for improvements to future survey analyses.
Assuntos
Overdose de Drogas , Overdose de Opiáceos , Humanos , Estados Unidos , Analgésicos Opioides/efeitos adversos , Reprodutibilidade dos Testes , Algoritmos , Registros Eletrônicos de SaúdeRESUMO
This report documents the development of the 2016 National Hospital Care Survey (NHCS) Co-occurring Disorders Algorithm, which can be used to identify patients with an opioid-involved hospital encounter who had lifetime diagnoses of both a substance use disorder and a selected mental health issue. Lifetime diagnoses are defined as diagnoses at any point in the past or during the current encounter. This algorithm was created to complement the earlier NHCS Enhanced Opioid Identification Algorithm designed to improve the classification of patients with opioid-involved hospital encounters.
Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Hospitais , Humanos , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Prevalência , Estados Unidos/epidemiologiaRESUMO
The crew of USS Kidd experienced a COVID-19 outbreak identified in April 2020. This is the earliest documented COVID-19 study with RT-PCR, serology, and pre-exposure test data on the entirety of the exposed population (n=333). Case definitions included 121 confirmed (36.3% of crewmembers) and 18 probable (5.4% of crewmembers) based on laboratory diagnostic test results. At the time of testing positive, 62 (44.6%) cases reported no symptoms. Hispanic ethnicity (AOR: 2.71, CI: 1.40-5.25) and non-smoker status (AOR: 2.28, CI: 1.26-4.12) were identified as statistically significant risk factors. This study highlights the value of rapid, onboard diagnostic testing to quickly identify an outbreak and enumerate cases, as well as the serological testing to flag potential cases missed with standard viral case identification methodologies.
Assuntos
COVID-19 , Militares , Humanos , Navios , Estudos Soroepidemiológicos , Surtos de DoençasRESUMO
This report demonstrates the use of National Hospital Care Survey (NHCS) data to describe characteristics of patients experiencing opioid-involved hospital encounters with co-occurring disorders, defined as lifetime diagnoses of both a substance use disorder (SUD) and a selected mental health issue (MHI), that is, diagnosed at any point in the past or during the present encounter.
Assuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Substâncias , Analgésicos Opioides/uso terapêutico , Hospitais , Humanos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estados Unidos/epidemiologiaRESUMO
Objectives This report documents the development of the 2016 National Hospital Care Survey (NHCS) Enhanced Opioid Identification Algorithm, an algorithm that can be used to identify opioid-involved and opioid overdose hospital encounters. Additionally, the algorithm can be used to identify opioids and opioid antagonists that can be used to reverse opioid overdose (naloxone) and to treat opioid use disorder (naltrexone).
Assuntos
Analgésicos Opioides , Overdose de Opiáceos , Analgésicos Opioides/efeitos adversos , Hospitais , Humanos , Naloxona/uso terapêutico , Overdose de Opiáceos/epidemiologia , Avaliação de Resultados em Cuidados de Saúde , Estados Unidos/epidemiologiaRESUMO
Purpose-This report compares 2014 National Hospital Care Survey (NHCS) emergency department (ED) data with national estimates of ED visits due to opioid use (i.e., "opioid-involved visits") from the 2013-2015 National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine the potential of researching the impact and outcomes of opioid use on hospital EDs with non-nationally representative NHCS data. The 2014 NHCS data are also linked to records in the 2014 and 2015 National Death Index (NDI) to examine mortality after the opioid-involved ED visit. Methods-A previously published algorithm, which uses a list of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes and external-cause-of-injury codes denoting opioid use, was used to identify opioid-involved visits in NHCS and NHAMCS, which are compared by sex and age. Weighted percentage estimates and their 95% confidence intervals (CIs) are shown for all demographic characteristics using NHAMCS data. Unweighted percentages are presented for all demographic and health care characteristics using NHCS data. Standard errors and CIs are also presented for the NHCS unweighted percentages as a measure of variability. Results-The percentage of opioid-involved ED visits from NHCS fell within measures of statistical variation from NHAMCS by sex and several age groups. Less consistency of NHCS results compared with NHAMCS was seen for sex-specific age groups. NHCS has a higher percentage of opioid-involved ED visits and a higher percentage of opioid-involved ED visits for those aged 25-34, but a lower percentage for those aged 25 and under. NHCS data show that 19.2% of patients with any opioid-involved ED visit made two or more such visits, and 1.2% died within 30 days post-discharge.
Assuntos
Assistência ao Convalescente , Analgésicos Opioides , Assistência Ambulatorial , Serviço Hospitalar de Emergência , Feminino , Pesquisas sobre Atenção à Saúde , Hospitais , Humanos , Masculino , Alta do Paciente , Estados Unidos/epidemiologiaRESUMO
The present study extended the findings of Muris et al. [Muris, P., Meesters, C., Merckelbach, H., & Hulsenbeck, P. (2000). Worry in children is related to perceived parental rearing and attachment. Behavior Research and Therapy, 38, 487-497] regarding the relations between perceived parental rearing behaviors, self-reported attachment style, and worry in a community sample to a clinical sample of anxious children. Sixty-four children and adolescents, aged 7-18 years, with a primary anxiety disorder completed (a) the EMBU-C, a questionnaire measuring perceptions of parental rearing behaviors, (b) a single-item measure of attachment style, and (c) an index of worry severity. Findings revealed that child rated parental rearing behaviors, particularly parental rejection, were positively related to child worry. Self-reported attachment style was also related to worry, such that children who classified themselves as ambivalently attached reported higher levels of worry than did children who classified themselves as securely attached. Parenting style and attachment were found to make independent contributions to worry. The results are compared to those from Muris et al.'s community study, and implications for future research are discussed.
Assuntos
Transtornos de Ansiedade/psicologia , Educação Infantil/psicologia , Apego ao Objeto , Poder Familiar/psicologia , Psicologia da Criança , Estresse Psicológico/psicologia , Adolescente , Adulto , Transtornos de Ansiedade/diagnóstico , Criança , Coleta de Dados , Feminino , Humanos , Masculino , Relações Pais-Filho , Rejeição em Psicologia , Autoimagem , Estresse Psicológico/diagnóstico , Inquéritos e QuestionáriosRESUMO
This study examined the psychometric properties of the Spence Children's Anxiety Scale child- and parent-report forms in a sample of 85 children from the community and 85 children with anxiety disorders matched on sex and age. Results indicated that both versions of the scale had good internal reliability, with the exception of the physical injury fears subscale. All subscales and the total scores of both versions discriminated children in the anxious group from community controls. Strong correlations between child and parent reports supported the concurrent validity of the measure. Furthermore, convergent and divergent validity of the scales were supported by significant correlations with negative affect and physiological hyperarousal to a greater extent than with positive affect indicating that SCAS and SCAS-P measured anxiety rather than depressive symptoms. Mean differences with research from other countries were apparent for selected subscales and supported the need for culture-specific norms.
Assuntos
Transtornos de Ansiedade/diagnóstico , Pais/psicologia , Adolescente , Fatores Etários , Transtornos de Ansiedade/psicologia , Criança , Grupos Controle , Coleta de Dados , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Modelos Psicológicos , Transtornos Fóbicos/diagnóstico , Transtornos Fóbicos/psicologia , Escalas de Graduação Psiquiátrica , Psicologia da Criança , Psicometria , Reprodutibilidade dos Testes , Estudos de Amostragem , Inquéritos e QuestionáriosRESUMO
This case series describes the use of an intensive 5-day treatment for obsessive-compulsive disorder (OCD) with three adolescents. The treatment is based on traditional cognitive-behavioral therapy consisting primarily of exposures and response prevention (ERP) and involves 10 sessions over 5 days. In addition, the treatment emphasizes instructing the adolescent and the parents on how to conduct ERP at home following the completion of the 5 days of therapy. The treatment is designed for adolescents who do not have local access to mental health practitioners with expertise in ERP for OCD. The three patients who participated in the experimental program each experienced substantial improvements in their OCD symptoms and overall functioning. The present study suggests that brief, 5-day intensive treatment may be an effective means of delivering CBT for adolescents with OCD and may be of use to mental health practitioners who provide services to large catchments.
Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Obsessivo-Compulsivo/terapia , Adolescente , Feminino , Humanos , Inteligência , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/psicologia , População Rural , Fatores de Tempo , Escalas de WechslerRESUMO
This report describes the development of methods to identify emergency department (ED) visits involving substance use. Two different algorithms are compared using claims data from the 2013 National Hospital Care Survey (NHCS), a facility-based survey. While NHCS was designed to produce national estimates, this report is based on 2013 data, which are not nationally representative.
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Serviço Hospitalar de Emergência , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Algoritmos , Criança , Pré-Escolar , Cuidados Críticos , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Cognitive-behavioral therapy (CBT) and pharmacotherapy are the most well-established treatments for childhood anxiety disorders. This study examined how parents (N=71) seeking treatment for their child's anxiety disorder perceive the acceptability, believability, and effectiveness of these treatments. While both treatments were perceived favorably, CBT was rated as more acceptable, believable, and effective in the short- and long-term. Children's treatment history influenced parents' perceptions of pharmacotherapy, with parents of children with no treatment history perceiving medication treatment as less acceptable and believable than parents of children with a history of medication alone or in combination with behavior therapy. No effect of treatment history was found for perceptions of CBT. Significant positive correlations emerged between parents' perceived acceptance and believability for pharmacotherapy and child age and level of dysfunction due to their child's anxiety, respectively. The level of the child's anxiety was not significantly correlated with parents' perceptions of either CBT or pharmacotherapy. Our results suggest that parents of anxious children prefer CBT to medication for the treatment of their child's anxiety disorder. Directions for future research are discussed.
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Ansiolíticos/uso terapêutico , Transtornos de Ansiedade/terapia , Atitude Frente a Saúde , Terapia Cognitivo-Comportamental , Pais/psicologia , Adolescente , Transtornos de Ansiedade/tratamento farmacológico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , PsicometriaRESUMO
The number of emergency department (ED) visits rose 44% from 1991 through 2010, even as the number of hospital EDs declined 10% over the same period. As a result, EDs have increasingly experienced overcrowding and longer waiting times. However, little is known about which ED patients visit, how often patients go to the ED closest to their home, and how differences in geography, patient demographics, and hospital characteristics are associated with ED selection patterns.
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Serviço Hospitalar de Emergência/estatística & dados numéricos , Adolescente , Adulto , Idoso , Geografia Médica , Pesquisas sobre Atenção à Saúde , Humanos , Pessoa de Meia-Idade , Estados Unidos , População Urbana , Adulto JovemRESUMO
PURPOSE: Despite the availability of several active combination regimens for advanced colorectal cancer (CRC), the 5-year survival rate remains poor at less than 10%, supporting the development of novel therapeutic approaches. In this study, we focused on the preclinical assessment of a rationally based combination against KRAS-mutated CRC by testing the combination of the MEK inhibitor, selumetinib, and vorinostat, a histone deacetylase (HDAC) inhibitor. EXPERIMENTAL DESIGN: Transcriptional profiling and gene set enrichment analysis (baseline and posttreatment) of CRC cell lines provided the rationale for the combination. The activity of selumetinib and vorinostat against the KRAS-mutant SW620 and SW480 CRC cell lines was studied in vitro and in vivo. The effects of this combination on tumor phenotype were assessed using monolayer and 3-dimensional cultures, flow cytometry, apoptosis, and cell migration. In vivo, tumor growth inhibition, (18)F-fluoro-deoxy-glucose positron emission tomography (FDG-PET), and proton nuclear magnetic resonance were carried out to evaluate the growth inhibitory and metabolic responses, respectively, in CRC xenografts. RESULTS: In vitro, treatment with selumetinib and vorinostat resulted in a synergistic inhibition of proliferation and spheroid formation in both CRC cell lines. This inhibition was associated with an increase in apoptosis, cell-cycle arrest in G(1), and reduced cellular migration and VEGF-A secretion. In vivo, the combination resulted in additive tumor growth inhibition. The metabolic response to selumetinib and vorinostat consisted of significant inhibition of membrane phospholipids; no significant changes in glucose uptake or metabolism were observed in any of the treatment groups. CONCLUSION: These data indicate that the rationally based combination of the mitogen-activated protein kinase/extracellular signal-regulated kinase inhibitor, selumetinib, with the HDAC inhibitor vorinostat results in synergistic antiproliferative activity against KRAS-mutant CRC cell lines in vitro. In vivo, the combination showed additive effects that were associated with metabolic changes in phospholipid turnover, but not on FDG-PET, indicating that the former is a more sensitive endpoint of the combination effects.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Benzimidazóis/farmacologia , Neoplasias Colorretais/tratamento farmacológico , Inibidores de Histona Desacetilases/farmacologia , Ácidos Hidroxâmicos/farmacologia , Mutação , Proteínas Proto-Oncogênicas/genética , Proteínas ras/genética , Animais , Apoptose/efeitos dos fármacos , Benzimidazóis/administração & dosagem , Ciclo Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Movimento Celular/efeitos dos fármacos , Proliferação de Células/efeitos dos fármacos , Análise por Conglomerados , Neoplasias Colorretais/genética , Neoplasias Colorretais/metabolismo , Feminino , Perfilação da Expressão Gênica , Inibidores de Histona Desacetilases/administração & dosagem , Humanos , Ácidos Hidroxâmicos/administração & dosagem , Ligantes , Camundongos , Camundongos Nus , Ressonância Magnética Nuclear Biomolecular , Tomografia por Emissão de Pósitrons , Proteínas Proto-Oncogênicas/metabolismo , Proteínas Proto-Oncogênicas p21(ras) , Transdução de Sinais/efeitos dos fármacos , Vorinostat , Ensaios Antitumorais Modelo de Xenoenxerto , Proteínas ras/metabolismoRESUMO
BACKGROUND: A plethora of agents is in early stages of development for colorectal cancer (CRC), including those that target the insulin-like growth factor I receptor (IGFIR) pathway. In the current environment of numerous cancer targets, it is imperative that patient selection strategies be developed with the intent of preliminary testing in the latter stages of phase I trials. The goal of this study was to develop and characterize predictive biomarkers for an IGFIR tyrosine kinase inhibitor, OSI-906, that could be applied in CRC-specific studies of this agent. METHODS: Twenty-seven CRC cell lines were exposed to OSI-906 and classified according to IC(50) value as sensitive (
Assuntos
Biomarcadores Tumorais/análise , Sistemas de Liberação de Medicamentos , Perfilação da Expressão Gênica , Imidazóis/farmacologia , Inibidores de Proteínas Quinases/farmacologia , Pirazinas/farmacologia , Receptor IGF Tipo 1/antagonistas & inibidores , Animais , Linhagem Celular Tumoral , Resistencia a Medicamentos Antineoplásicos , Ensaios de Seleção de Medicamentos Antitumorais , Estudos de Viabilidade , Feminino , Dosagem de Genes , Técnicas de Silenciamento de Genes , Genes ras , Humanos , Camundongos , Camundongos Nus , Mutação , Proteínas Proto-Oncogênicas B-raf , Receptor IGF Tipo 1/genética , Reprodutibilidade dos Testes , Ensaios Antitumorais Modelo de XenoenxertoRESUMO
The effect of vascular endothelial growth factor (VEGF) ligands and cediranib on tumor cell proliferation, migration, and invasion was determined. It has recently been suggested that autocrine signaling through the VEGF receptor (VEGFR) pathway may play a role in tumor cell survival, invasion, and migration. The purpose of the present study was to determine the expression of VEGFRs and VEGFR ligands in a panel of gastrointestinal carcinoma cells. Additionally, we evaluated the effects of VEGF autocrine signaling on tumor cell proliferation, migration, and invasion utilizing cediranib (AZD2171), a pan-VEGFR inhibitor. Five colorectal, three pancreatic, and two hepatocellular carcinoma cell lines were screened for VEGFR and VEGF expression by several methods. Expression of VEGFR-1 and VEGFR-3 was cell line-dependent, whereas VEGFR-2 was not detected. Secretion of VEGF-A was detected in the supernatants of all cell lines whereas VEGF-C secretion was detected in the Panc-1, MiaPaca2, and Hep1 cells only. Tumor cells showed increased migratory activity, but not proliferation, when stimulated with VEGFs. The pan-VEGFR inhibitor cediranib (100 nmol/L) inhibited tumor cell migration and invasion, with no effects on proliferation. Cediranib decreased VEGFR-1 and VEGFR-3 phosphorylation as well as activation of downstream effectors. VEGFR-1 and VEGFR-3 expression was detected in all the gastrointestinal carcinoma cells evaluated. Although activation of the VEGF pathway did not affect cell proliferation, our data indicate that this pathway seems to play a role in tumor cell migration and invasion in these cell lines. Therefore, inhibition of VEGFR by cediranib may represent a clinically relevant treatment option for gastrointestinal tumors.