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1.
PLoS One ; 15(10): e0239796, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33002074

RESUMO

Since the end of 2019, an outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), originating in the Chinese city of Wuhan has spread rapidly worldwide causing thousands of deaths. Coronavirus disease (COVID-19) is supported by SARS-CoV-2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Italy has been the first European country recording an elevated number of infected forcing the Italian Government to call for total lockdown. The lockdown had the aim to limit the spread of infection through social distancing. The purpose of this study is to analyze how the pandemic has affected the patient's accesses to the Ophthalmological Emergency Department of a tertiary referral center in central-northern Italy, during the lockdown period. The charts of all patients that came to the Emergency Department during the lockdown period (March 10 -May 4, 2020) have been retrospectively collected and compared with those in the same period of 2019 and the period from 15 January- 9 March 2020. A significant reduction of visits during the lockdown has been observed, compared with those of pre-lockdown period (reduction of 65.4%) and with those of the same period of 2019 (reduction of 74.3%). Particularly, during the lockdown, minor and not urgency visits decreased whereas the undeferrable urgency ones increased. These pieces of evidence could be explained by the fear of patients to be infected; but also revealed patients misuse of emergency services.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Adolescente , Adulto , Idoso , Betacoronavirus , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Classificação Internacional de Doenças , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Retrospectivos , Adulto Jovem
2.
Washington, D.C.; OPS; 2020-10-15. (OPS/IMS/EIH/COVID-19/20-0005).
Não convencional em Espanhol | PAHO-IRIS | ID: phr-52848

RESUMO

Propósito del documento: Este documento describe la certificación y clasificación (codificación) de muertes relacionadas con COVID-19. El objetivo principal es identificar todas las muertes debidas a COVID-19. La sección que se dirige específicamente a las personas que completan el certificado médico de causa de muerte debe distribuirse por separado de las instrucciones de codificación.


Assuntos
Infecções por Coronavirus , Coronavirus , Betacoronavirus , Controle de Infecções , Classificação Internacional de Doenças , Estatísticas de Saúde , Mortalidade
3.
Brasília, D.F.; OPAS; 2020-09-08. (OPAS-W/BRA/COVID-19/20-106).
Não convencional em Português | PAHO-IRIS | ID: phr2-52641

RESUMO

Este informe técnico descreve sobre a declaração de óbito e a classificação [codificação da mortalidade segundo a Classificação Internacional de Doenças (CID)] das mortes relacionadas à COVID-19. O objetivo principal é identificar todas as mortes por COVID-19 em todos os países, incluindo aqueles que ainda não seguem as normas e padrões internacionais da OMS para declarações de óbito e codificação da mortalidade segundo a CID. Também aborda a questão relacionada à estimativa de todas as mortes associadas à pandemia da COVID-19. O documento está dividido em três seções: identificação das mortes por COVID-19; codificação de mortes por COVID-19; e mensuração e notificação da mortalidade bruta no contexto da pandemia da COVID-19 (mortalidade excessiva).


Assuntos
Infecções por Coronavirus , Coronavirus , Pandemias , Atestado de Óbito , Classificação Internacional de Doenças , Causas de Morte , Betacoronavirus
4.
BMC Public Health ; 20(1): 1464, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32993588

RESUMO

BACKGROUND: The winter pressure often experienced by NHS hospitals in England is considerably contributed to by severe cases of seasonal influenza resulting in hospitalisation. The prevention planning and commissioning of the influenza vaccination programme in the UK does not always involve those who control the hospital budget. The objective of this study was to describe the direct medical costs of secondary care influenza-related hospital admissions across different age groups in England during two consecutive influenza seasons. METHODS: The number of hospital admissions, length of stay, and associated costs were quantified as well as determining the primary costs of influenza-related hospitalisations. Data were extracted from the Hospital Episode Statistics (HES) database between September 2017 to March 2018 and September 2018 to March 2019 in order to incorporate the annual influenza seasons. The use of international classification of disease (ICD)-10 codes were used to identify relevant influenza hospitalisations. Healthcare Resource Group (HRG) codes were used to determine the costs of influenza-related hospitalisations. RESULTS: During the 2017/18 and 2018/19 seasons there were 46,215 and 39,670 influenza-related hospital admissions respectively. This resulted in a hospital cost of £128,153,810 and £99,565,310 across both seasons. Results showed that those in the 65+ year group were associated with the highest hospitalisation costs and proportion of in-hospital deaths. In both influenza seasons, the HRG code WJ06 (Sepsis without Interventions) was found to be associated with the longest average length of stay and cost per admission, whereas PD14 (Paediatric Lower Respiratory Tract Disorders without Acute Bronchiolitis) had the shortest length of stay. CONCLUSION: This study has shown that influenza-related hospital admissions had a considerable impact on the secondary healthcare system during the 2017/18 and 2018/19 influenza seasons, before taking into account its impact on primary health care.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Influenza Humana/economia , Vacinação/economia , Adulto , Inglaterra , Feminino , Recursos em Saúde , Hospitalização/estatística & dados numéricos , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Estações do Ano , Vacinação/estatística & dados numéricos
5.
Rehabilitation (Stuttg) ; 59(4): 237-250, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32851609

RESUMO

Due to significant changes in the new ICD-11 classification, stress-related disorders have advanced further into clinical and scientific focus. In contrast to the ICD-10 classification, complex posttraumatic stress disorder as well as prolonged grief have been established as independent diagnoses. Additionally, the diagnostic criteria for adjustment disorder were newly conceptualized and refined. Stress-related disorders have a high relevance for out- and inpatient rehabilitation centers. Posttraumatic stress disorder (PTSD) has a 1-year-prevalence in Germany of 1-2%. Comorbidities such as depression or anxiety disorders are common. PTSD may also result from physical illness and can in turn complicate the course of the disease or even lead to chronification of symptoms. The most effective treatment is a trauma-focused psychotherapy, which usually takes place in an outpatient setting. Psychosomatic inpatient rehabilitation is a valuable resource in the treatment plan of PTSD. The optimal point is mostly following the acute therapy when reintegration to work and social life is the aim. As rehabilitation centers can provide a safe therapeutic setting for patients, allowing them to open up about their trauma, it can pave the way to a trauma focused treatment. Additionally, socio-medical aspects of trauma-related disorders will be touched upon in this overview.


Assuntos
Transtornos de Ansiedade/psicologia , Transtornos Psicofisiológicos/psicologia , Transtornos de Estresse Pós-Traumáticos/reabilitação , Alemanha , Humanos , Classificação Internacional de Doenças , Transtornos de Estresse Pós-Traumáticos/psicologia
6.
JAMA Netw Open ; 3(8): e2017703, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32797176

RESUMO

Importance: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes are used to characterize coronavirus disease 2019 (COVID-19)-related symptoms. Their accuracy is unknown, which could affect downstream analyses. Objective: To compare the performance of fever-, cough-, and dyspnea-specific ICD-10 codes with medical record review among patients tested for COVID-19. Design, Setting, and Participants: This cohort study included patients who underwent quantitative reverse transcriptase-polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 at University of Utah Health from March 10 to April 6, 2020. Data analysis was performed in April 2020. Main Outcomes and Measures: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ICD-10 codes for fever (R50*), cough (R05*), and dyspnea (R06.0*) were compared with manual medical record review. Performance was calculated overall and stratified by COVID-19 test result, sex, age group (<50, 50-64, and >64 years), and inpatient status. Bootstrapping was used to generate 95% CIs, and Pearson χ2 tests were used to compare different subgroups. Results: Among 2201 patients tested for COVD-19, the mean (SD) age was 42 (17) years; 1201 (55%) were female, 1569 (71%) were White, and 282 (13%) were Hispanic or Latino. The prevalence of fever was 66% (1444 patients), that of cough was 88% (1930 patients), and that of dyspnea was 64% (1399 patients). For fever, the sensitivity of ICD-10 codes was 0.26 (95% CI, 0.24-0.29), specificity was 0.98 (95% CI, 0.96-0.99), PPV was 0.96 (95% CI, 0.93-0.97), and NPV was 0.41 (95% CI, 0.39-0.43). For cough, the sensitivity of ICD-10 codes was 0.44 (95% CI, 0.42-0.46), specificity was 0.88 (95% CI, 0.84-0.92), PPV was 0.96 (95% CI, 0.95-0.97), and NPV was 0.18 (95% CI, 0.16-0.20). For dyspnea, the sensitivity of ICD-10 codes was 0.24 (95% CI, 0.22-0.26), specificity was 0.97 (95% CI, 0.96-0.98), PPV was 0.93 (95% CI, 0.90-0.96), and NPV was 0.42 (95% CI, 0.40-0.44). ICD-10 code performance was better for inpatients than for outpatients for fever (χ2 = 41.30; P < .001) and dyspnea (χ2 = 14.25; P = .003) but not for cough (χ2 = 5.13; P = .16). Conclusions and Relevance: These findings suggest that ICD-10 codes lack sensitivity and have poor NPV for symptoms associated with COVID-19. This inaccuracy has implications for any downstream data model, scientific discovery, or surveillance that relies on these codes.


Assuntos
Codificação Clínica/normas , Infecções por Coronavirus/diagnóstico , Tosse/diagnóstico , Dispneia/diagnóstico , Registros Eletrônicos de Saúde , Febre/diagnóstico , Classificação Internacional de Doenças , Pneumonia Viral/diagnóstico , Adulto , Idoso , Betacoronavirus , Codificação Clínica/métodos , Estudos de Coortes , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Tosse/etiologia , Dispneia/etiologia , Feminino , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Reação em Cadeia da Polimerase , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Utah/epidemiologia
7.
Rev Saude Publica ; 54: 76, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32813869

RESUMO

OBJECTIVE To estimate the trends of fall-related hospitalization, mortality, and lethality among older adults in Brazil and regions. METHODS This is a descriptive study based on data from the Hospital Information System of the Brazilian Unified Health System. We included records of every older adult, aged 60 years or older, hospitalized for accidental fall from January, 1998 to November, 2015 in all Brazilian regions. We selected the codes E885, E886, E880, E884, E884 from the International Classification of Diseases, 9th revision, and W01, W03, W10, W17, W18 from the 10th revision, and calculated fall-related hospitalization and mortality rates per 100,000 inhabitants, as well as lethality. To estimate trends, we applied the Prais-Winsten regression for time series analysis. RESULTS During the period, 1,192,829 fall-related hospitalizations occurred, among which 54,673 had a fatal outcome; lethality was 4.5%. Hospitalization rates showed upward trends, with seasonality, in Brazil (11%), and in the Northeast (44%), Midwest (13%), and South regions (14%). The North showed a decreasing hospitalization rate (48%), and the Southeast a stationary one (3%). CONCLUSIONS In Brazil, fall-related hospitalizations, mortality, and lethality among older adults showed an upward trend from 1998 to 2015, with seasonal peaks in the second and third quarters. Considering we are in plain demographic transition, to improve hospital healthcare and encourage falls prevention programs among older adults is essential.


Assuntos
Acidentes por Quedas/mortalidade , Hospitalização/estatística & dados numéricos , Acidentes por Quedas/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Estações do Ano , Índice de Gravidade de Doença
8.
Psychiatr Danub ; 32(2): 145-150, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32796778

RESUMO

On June 18th, 2018, the World Health Organization officially released its new International Classification of Diseases (ICD-11) for preview; it was presented on World Health Assembly in May 2019 for adoption by Member States. Since ICD 11 is planned to come into effect and be officially used as from January 1st, 2022, this early sneak peek allows health care professionals enough time to prepare for the new classification and all the changes it brings along. ICD 11 moves away from stigmatizing practices of psychiatrization of transgender persons and finally excludes issues of gender identity from the chapter on mental and behavioral disorders. This reconceptualization consequently sets the stage for different roles of psychiatrists in meeting transgender patients' health care needs. This article addresses the most important changes to the ICD related to Gender incongruence, a new nosological entity formerly known as Gender Identity Disorder or Gender Dysphoria. The paper offers an overview of the current and future positions of transgender health issues through contemporary medical conceptualization and classification. It aims to eliminate barriers to quality care for transgender patients, by attending to the recognized knowledge gaps and by providing recommendations for psychiatrists and other health care professionals who commonly receive low levels of exposure to transgender content in their education.


Assuntos
Disforia de Gênero , Classificação Internacional de Doenças , Pessoas Transgênero , Transexualidade , Feminino , Identidade de Gênero , Humanos , Masculino
9.
Alerta (San Salvador) ; 3(2)ago.12, 2020. ilus
Artigo em Espanhol | LILACS, BISSAL | ID: biblio-1117104

RESUMO

Objetivo. Describir la asignación del diagnóstico psiquiátrico realizado por psicólogos en un hospital de San Salvador. Metodología. Estudio transversal analítico de 307 consultas de salud mental entre adolescentes menores de 18 años que recibieron atención en el Hospital Nacional "Enfermera Angélica Vidal de Najarro". Se digitalizaron las consultas del período 2014-2016. Se utilizó regresión logística multinomial y pruebas de chi-cuadrado globales para evaluar la asignación diagnóstica por bloque CIE-10 de tres psicólogos. Se controló la edad y el sexo del paciente, la fecha y el servicio hospitalario que generó la consulta. Resultados. En el modelo multinomial ajustado, el chi-cuadrado global para el efecto de cada psicólogo fue estadísticamente significativo; el efecto de cada psicólogo mostró una especificidad de resultado al comparar los diagnósticos del bloque F30-F39 con los diagnósticos del bloque F40-F49, de la CIE-10, fueron los más prevalentes en la muestra. Los valores ajustados para las probabilidades de diagnóstico por bloque CIE-10 sugieren variabilidad cuantitativa en el diagnóstico según el psicólogo que lo proporciona. Conclusiones. Se identifica variación en la asignación diagnóstica por bloques CIE-10 entre los psicólogos que trabajan en un hospital urbano de segundo nivel en San Salvador. Esto deberá estudiarse con mayor profundidad


Objective. To describe the psychiatric diagnoses made by psychologists at a hospital in San Salvador. Methodology. A cross-sectional analytical study of 307 medical consultations of adolescents' mental health (≤18 years old) provided at the "Enfermera Angélica Vidal de Najarro National Hospital." Handwritten registry Consultations from 2014 to 2016 were digitalized. Multinomial logistic regression and global chi-squared tests were used to evaluate diagnostic assignment by each ICD-10 block made by three professional psychologists. Patients' age and sex were controlled as well as date and type of service provided. Results. In the adjusted multinomial model, the global chi-squared for the effect of each psychologist was statistically significant, and the effect of each psychologist showed outcome specificity when diagnostic blocks F30-39 were compared with blocks F40-49, which were the most prevalent ICD-10 blocks in the sample. The adjusted probability values by ICD-10 diagnostic block suggest quantitative variability in diagnostic patterns according to the psychologist providing the diagnosis. Conclusions. Signs of a significant variation in ICD-10 block diagnostic assignment among psychologists working in an urban secondary hospital in San Salvador were detected, which should be carefully study


Assuntos
Psicologia , Classificação Internacional de Doenças , Saúde Mental
10.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32848030

RESUMO

BACKGROUND AND OBJECTIVES: The increase in neonatal abstinence syndrome (NAS) has underscored the need for NAS surveillance programs, but many rely on passive surveillance using unverified diagnosis codes. Few studies have evaluated the validity of these codes, and no study has assessed the recently proposed Council of State and Territorial Epidemiologists (CSTE) case definition. The Florida Birth Defects Registry investigated the accuracy of International Classification of Diseases, 10th Revision, Clinical Modification codes related to NAS (P96.1 and P04.49) and assessed the sensitivity of the CSTE case definition. METHODS: We identified a sample of infants born during 2016 coded with P96.1 and/or P04.49. Record review was completed for 128 cases coded with P96.1, 68 with P04.49, and 7 with both codes. Lacking consensus regarding a gold standard definition of NAS, we used clinical data to classify each case using the Florida and CSTE definitions. The code-specific accuracy was measured by using the positive predictive value (PPV). The clinical characteristics indicative of NAS were compared for case classification based on both definitions. RESULTS: By using the Florida definition, the overall PPV was 68% but varied by code: 95.3% for P96.1 and 13.2% for P04.49. The overall (47.8%) and code-specific PPVs were lower by using the CSTE definition. Comparison of clinical characteristics demonstrated that 60.7% of cases classified as no NAS by using the CSTE definition had robust clinical signs of NAS. In our sample, the CSTE case definition underestimated NAS prevalence. CONCLUSIONS: Only the P96.1 International Classification of Diseases, 10th Revision, Clinical Modification code displayed high accuracy. Discordance in NAS case definitions and surveillance methodologies may result in erroneous comparisons and conclusions that negatively impact NAS-related surveillance and research.


Assuntos
Classificação Internacional de Doenças/normas , Síndrome de Abstinência Neonatal/diagnóstico , Confiabilidade dos Dados , Feminino , Florida , Humanos , Recém-Nascido , Síndrome de Abstinência Neonatal/classificação , Valor Preditivo dos Testes , Gravidez , Complicações na Gravidez , Sistema de Registros , Estudos Retrospectivos , Sensibilidade e Especificidade , Transtornos Relacionados ao Uso de Substâncias/complicações
11.
J Headache Pain ; 21(1): 98, 2020 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-32762715

RESUMO

BACKGROUND: Previous studies found an association between migraine and dementia, which are two leading causes of disability. However, these studies did not differentiate between migraine types and did not investigate all prevalent dementia subtypes. The main objective of this national register-based study was to investigate whether migraine was a risk factor for dementia. Additionally, we explored potential differences in dementia risk for migraine with and without aura. METHODS: We obtained data on birth cohorts born between 1935 and 1956 (n = 1,657,890) from Danish national registers. Individuals registered with migraine before age 59 (n = 18,135) were matched (1:5) on sex and birthdate with individuals without migraine (n = 1,378,346). Migraine was defined by International Classification of Diseases (ICD) diagnoses and dementia was defined by ICD diagnoses and anti-dementia medication. After matching, 62,578 individuals were eligible for analysis. For the statistical analyses, we used Cox regression models and adjusted for socio-demographic factors and several psychiatric and somatic morbidities. RESULTS: During a median follow-up time of 6.9 (IQR: 3.6-11.2) years, 207 individuals with migraine developed dementia. Compared with individuals without migraine, we found a 50% higher rate of dementia among individuals with migraine (HR = 1.50; 95% CI: 1.28-1.76). Individuals without aura had a 19% higher rate of dementia (HR = 1.19; 95% CI: 0.84-1.70), and individuals with aura had a two times higher rate of dementia (HR = 2.11; 95% CI: 1.48-3.00). CONCLUSIONS: Our findings support the hypothesis that migraine is a midlife risk factor for dementia in later life. The higher rate of dementia in individuals with a hospital-based diagnosis of migraine with aura emphasizes the need for studies on pathological mechanisms and potential preventative measures. Furthermore, given that only hospital-based migraine diagnoses were included in this study, future research should also investigate migraine cases derived from the primary healthcare system to include less severe migraine cases.


Assuntos
Demência/etiologia , Transtornos de Enxaqueca/complicações , Feminino , Seguimentos , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
12.
Artigo em Russo | MEDLINE | ID: mdl-32827364

RESUMO

Despite attempts of improving actual system of morbidity and mortality accounting, the study research established significant real data distortion. These differences do not allow to assess in fullness complete picture of actual morbidity and mortality. Hence, improvement of approaches to increasing efficiency of indices data registration. The study was carried out in 2017-2019 on the bases of medical organizations of the Ministry of Internal Affairs of Russia. The study assessed quality of encoding of morbidity of 28 061 case histories/out-patient records. The size needed to obtain reliable results was determined using the Lopez-Jimenez formula. The statistical data was processed by MS Excel and Statistica-6 software. The most common errors were associated with non-rubricated and incorrectly rubricated diagnoses (53.2%, n = 2860). The second most common error in the structure of incorrectly formulated diagnosis was associated with using non-informative terms (14.6%, n = 785). The errors regarding non-observance of the ICD 10 revision requirements followed resulting in using and wordings not corresponding to modern classification (10.6%, n = 568). A number of errors was associated with unspecified localization of process (3.6%, n = 195) and other rarely occurring causes (2.6%, n = 139). The results of study permitted to conclude that one of the most promising directions of modernization of the encoding system is the automated encoding system.


Assuntos
Classificação Internacional de Doenças , Pacientes Ambulatoriais , Humanos , Morbidade , Federação Russa , Mudança Social
13.
Artigo em Russo | MEDLINE | ID: mdl-32827365

RESUMO

The encoding of cases of disease and death is the translation of clinical diagnoses into alphanumeric code with observance of certain rules. Properly selected ICD-10 codes ensure reliability of statistical data that undoubtedly affects quality of managerial decisions. The article considers results of analysis of information from primary medical documentation (in-patient medical record, discharged patient statistical record) and its comparing with the ICD-10 codes. The detailed analysis of encoding errors is presented. The structure of hospital morbidity and mortality of patients of palliative care department of multidisciplinary hospital is analyzed.


Assuntos
Classificação Internacional de Doenças , Registros Médicos , Hospitais , Humanos , Morbidade , Reprodutibilidade dos Testes
14.
Stud Health Technol Inform ; 272: 280-283, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32604656

RESUMO

World Health Organisation (WHO) has updated the International Classification of Diseases to version 11 (ICD-11) which was recently adopted for use by countries in 2019. ICD-11 can be used in Electronic Medical Records (EMR) systems with support of extended technologies like Application Program Interface (API). Integration of ICD-11 in Rwandan EMR (OpenMRS) in two health facilities was conducted in July-October 2019. Findings indicated that adapting ICD11-API in EMR is feasible. More than 50% of diagnoses were recorded using ICD-11. Healthcare providers perceived ICD-11 API as easy to learn and useful for harmonization of diagnosis, data reporting and insurance reimbursement. Integration of ICD-11 API in EMR can be scaled up to all hospitals for use in Rwanda and other countries using similar system.


Assuntos
Registros Eletrônicos de Saúde , Classificação Internacional de Doenças , Hospitais de Distrito , Ruanda , Software
15.
Zh Nevrol Psikhiatr Im S S Korsakova ; 120(6. Vyp. 2): 5-12, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32729685

RESUMO

The concepts of schizophrenia and other primary psychotic disorders have been changed a lot since their beginnings more than century ago due to many factors such as the dominance of a certain hypothesis during a particular period of time, the development of new clinical research and specific treatments as well as different understanding of the boundaries between mental disorders. It was appeared the diagnosis of schizophrenia spectrum disorders which still based only on clinical symptoms. Whether psychotic disorders can be better represented dimensionally or categorically remains a challenging question. Regarding schizophrenia and other primary psychotic disorders, there are some important changes in DSM-5 and ICD-11 concerning the use of quantitative assessment of psychopathological domains, course of psychosis and remission as well as giving more attention to cognitive issues. The main differences between these classifications are the structure of corresponding sections and different criteria of some disorders. Before the ICD-11 implementation in 2022 into clinical practice, it is highly recommended to conduct a set of trainings for clinicians along with the comments to Diagnostic guidelines for Schizophrenia and other primary psychotic disorders.


Assuntos
Transtornos Psicóticos , Esquizofrenia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Classificação Internacional de Doenças , Psicopatologia
16.
PLoS One ; 15(7): e0235714, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628718

RESUMO

BACKGROUND: Peptic ulcer is a widespread disease, frequently complicated by perforation and bleeding. Administrative databases are useful tool to perform epidemiological and drug utilization studies, but they need a validation process based on a comparison with the original data contained in the medical charts. Our aim was to evaluate the accuracy of the ICD-9 codes in identifying patients with peptic ulcer and gastrointestinal hemorrhage in the regional administrative database of Umbria. METHODS: The index test of our study was the hospital discharge abstract database of the Umbria region (Italy), while the reference standard was the clinical information collected in the medical charts. The study population were adult patients with a hospital discharge for peptic ulcer or gastrointestinal hemorrhage in the period 2012-2014. A random sample of cases and non-cases was selected and the corresponding medical charts were reviewed. Cases of peptic ulcer were confirmed based on endoscopy, radiology, and surgery, while adjudication of gastrointestinal hemorrhage was based on presence of hematemesis, melena, and rectal bleeding. RESULTS: Overall, we reviewed 445 clinical charts of cases and 80 clinical charts of non-cases. The diagnostic accuracy results were: code 531 (gastric ulcer), sensitivity and NPV 98%, specificity 88%, and PPV 91%; code 532 (duodenal ulcer), sensitivity and NPV 100%, specificity and PPV 98%; code 534 (gastrojejunal ulcer), sensitivity and NPV 100%, specificity 70%, and PPV 45%; code 578 (gastrointestinal hemorrhage), sensitivity 96%, specificity 90%, PPV and NPV 94%. CONCLUSIONS: Our results showed a high level of diagnostic accuracy for most of the codes considered. The ICD-9 code 534 of gastrojejunal ulcer had a lower level of specificity and PPV due to false positives, being mainly misclassifications for coding errors. These validated codes can be used for future epidemiological studies and for health services research.


Assuntos
Codificação Clínica/normas , Bases de Dados Factuais/estatística & dados numéricos , Hemorragia Gastrointestinal/diagnóstico , Classificação Internacional de Doenças/normas , Úlcera Péptica/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade
17.
MMWR Morb Mortal Wkly Rep ; 69(29): 951-955, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32701936

RESUMO

Opioid use disorder and neonatal abstinence syndrome (NAS) increased in Massachusetts from 1999 to 2013 (1,2). In response, in 2016, the state passed a law requiring birth hospitals to report the number of newborns who were exposed to controlled substances to the Massachusetts Department of Public Health (MDPH)* by mandating monthly reporting of International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnostic codes related to maternal dependence on opioids (F11.20) or benzodiazepines (F13.20) and to newborns affected by maternal use of drugs of addiction (P04.49) or experiencing withdrawal symptoms from maternal drugs of addiction (P96.1) separately.† MDPH uses these same codes for monthly, real-time crude estimates of NAS and uses P96.1 alone for official NAS state reporting.§ MDPH requested CDC's assistance in evaluating the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of either maternal or newborn codes to identify substance-exposed newborns, and of newborn exposure codes (both exposure [P04.49] or withdrawal [P96.1]) and the newborn code for withdrawal alone (P96.1) to identify infants with NAS cases related to three exposure scenarios: 1) opioids, 2) opioids or benzodiazepines, and 3) any controlled substance. Confirmed diagnoses of substance exposure and NAS abstracted from linked clinical records for 1,123 infants born in 2017 and their birth mothers were considered the diagnostic standard and were compared against hospital-reported ICD-10-CM codes. For identifying substance-exposed newborns across the three exposure scenarios, the newborn exposure codes had higher sensitivity (range = 31%-61%) than did maternal drug dependence codes (range = 16%-41%), but both sets of codes had high PPV (≥74%). For identifying NAS, for all exposure scenarios, the sensitivity for either newborn code (P04.49 or P96.1) was ≥92% and the PPV was ≥64%; for P96.1 alone the sensitivity was ≥79% and the PPV was ≥92% for all scenarios. Whereas ICD-10-CM codes are effective for NAS surveillance in Massachusetts, they should be applied cautiously for substance-exposed newborn surveillance. Surveillance for substance-exposed newborns using ICD-10-CM codes might be improved by increasing the use of validated substance-use screening tools and standardized facility protocols and improving communication between patients and maternal health and infant health care providers.


Assuntos
Classificação Internacional de Doenças , Síndrome de Abstinência Neonatal/diagnóstico , Efeitos Tardios da Exposição Pré-Natal/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto , Feminino , Hospitais , Humanos , Recém-Nascido , Masculino , Massachusetts/epidemiologia , Síndrome de Abstinência Neonatal/epidemiologia , Gravidez , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Sensibilidade e Especificidade , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
18.
PLoS One ; 15(7): e0236241, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716957

RESUMO

BACKGROUND: Early-Onset Schizophrenia (EOS) is rare but severe mental health disorder in children and adolescents. Diagnosis of schizophrenia before the age of 18 years remains complex and challenging, especially in young children. In France, there are no recent reliable epidemiological data about the prevalence of EOS. The present study evaluates the EOS rate in a target clinical population of children and adolescents in psychiatric and medico-social care centres in the South-East of France. METHODS: Psychiatric and medico-social centres for children and adolescent in the geographical area have been contacted, and after receiving their agreement to participate in the study, eligible patients corresponding to inclusion criteria were selected based on patients' medical records. Main inclusion criteria were age 7 to 17 years and intelligence quotient > 35. EOS categorical diagnosis was assessed by Kiddie-SADS Present and Lifetime psychosis section. RESULTS: 37 centres participated and 302 subjects have been included in the study. The main result was the categorical diagnosis of EOS in 27 subjects, corresponding to a rate of 8.9% in the study population. Half of the patients presented mild to moderate intellectual deficiency. Interestingly, only 2.3% had a diagnosis of schizophrenia spectrum disorder noted in their medical records before standardized assessment. CONCLUSIONS: The results of the study highlight the importance of using a standardized diagnostic tool for the diagnosis of schizophrenia in the paediatric population. In fact, EOS might be underdiagnosed in children and adolescents with neurodevelopmental disorders and subnormal cognitive functioning. TRIAL REGISTRATION: NCT01512641. Registered 19 January 2012; https://clinicaltrials.gov/ct2/show/NCT01512641.


Assuntos
Assistência à Saúde , Esquizofrenia/epidemiologia , Psicologia do Esquizofrênico , Idade de Início , Criança , Cognição , Estudos Transversais , Escolaridade , Feminino , França/epidemiologia , Geografia , Humanos , Recém-Nascido , Testes de Inteligência , Classificação Internacional de Doenças , Masculino , Gravidez , Esquizofrenia/tratamento farmacológico , Esquizofrenia/reabilitação , Fatores Socioeconômicos
19.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 55(7): 494-500, 2020 Jul 09.
Artigo em Chinês | MEDLINE | ID: mdl-32634889

RESUMO

Oral rare diseases are characterized by low prevalence and complex clinical features. It is not clear that which kind of diseases belong to oral rare diseases. In order to make a consensus and improve the level of diagnosis and treatment of oral rare diseases, Duan Xiaohong, the first chair of Society of Oral Genetic Diseases and Rare Diseases, Chinese Stomatological Association, progosed the first edition of oral rare diseases list, and the whole society discussed the list and finally made an agreement. The list includes 139 rare diseases with typical oral and craniofacial characteristics, and provides their Chinese names, English names, International Classification of Diseases 11th Revision (ICD-11) codes, Online Mendelian Inheritance in Man (OMIM) numbers, prevalence and simple interpretations.


Assuntos
Medicina Bucal , Doenças Raras , Consenso , Humanos , Classificação Internacional de Doenças , Prevalência
20.
Neurology ; 95(6): e697-e707, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32616677

RESUMO

OBJECTIVE: In UK Biobank (UKB), a large population-based prospective study, cases of many diseases are ascertained through linkage to routinely collected, coded national health datasets. We assessed the accuracy of these for identifying incident strokes. METHODS: In a regional UKB subpopulation (n = 17,249), we identified all participants with ≥1 code signifying a first stroke after recruitment (incident stroke-coded cases) in linked hospital admission, primary care, or death record data. Stroke physicians reviewed their full electronic patient records (EPRs) and generated reference standard diagnoses. We evaluated the number and proportion of cases that were true-positives (i.e., positive predictive value [PPV]) for all codes combined and by code source and type. RESULTS: Of 232 incident stroke-coded cases, 97% had EPR information available. Data sources were 30% hospital admission only, 39% primary care only, 28% hospital and primary care, and 3% death records only. While 42% of cases were coded as unspecified stroke type, review of EPRs enabled a pathologic type to be assigned in >99%. PPVs (95% confidence intervals) were 79% (73%-84%) for any stroke (89% for hospital admission codes, 80% for primary care codes) and 83% (74%-90%) for ischemic stroke. PPVs for small numbers of death record and hemorrhagic stroke codes were low but imprecise. CONCLUSIONS: Stroke and ischemic stroke cases in UKB can be ascertained through linked health datasets with sufficient accuracy for many research studies. Further work is needed to understand the accuracy of death record and hemorrhagic stroke codes and to develop scalable approaches for better identifying stroke types.


Assuntos
Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Isquemia Encefálica/epidemiologia , Coleta de Dados/métodos , Conjuntos de Dados como Assunto , Atestado de Óbito , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Reino Unido/epidemiologia
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