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1.
PLoS One ; 15(10): e0240007, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33017438

RESUMO

About 50% of individuals infected with the novel Coronavirus (SARS-CoV-2) suffer from intestinal infection as well as respiratory infection. They shed virus in their stool. Municipal sewage systems carry the virus and its genetic remnants. These viral traces can be detected in the sewage entering a wastewater treatment plant (WTP). Such virus signals indicate community infections but not locations of the infection within the community. In this paper, we frame and formulate the problem in a way that leads to algorithmic procedures homing in on locations and/or neighborhoods within the community that are most likely to have infections. Our data source is wastewater sampled and real-time tested from selected manholes. Our algorithms dynamically and adaptively develop a sequence of manholes to sample and test. The algorithms are often finished after 5 to 10 manhole samples, meaning that-in the field-the procedure can be carried out within one day. The goal is to provide timely information that will support faster more productive human testing for viral infection and thus reduce community disease spread. Leveraging the tree graph structure of the sewage system, we develop two algorithms, the first designed for a community that is certified at a given time to have zero infections and the second for a community known to have many infections. For the first, we assume that wastewater at the WTP has just revealed traces of SARS-CoV-2, indicating existence of a "Patient Zero" in the community. This first algorithm identifies the city block in which the infected person resides. For the second, we home in on a most infected neighborhood of the community, where a neighborhood is usually several city blocks. We present extensive computational results, some applied to a small New England city.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Fezes/virologia , Pandemias , Pneumonia Viral , Características de Residência , Esgotos/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Humanos , Massachusetts , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia
2.
PLoS One ; 15(9): e0239536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32997700

RESUMO

BACKGROUND: The 2019 novel coronavirus disease (COVID-19) has created unprecedented medical challenges. There remains a need for validated risk prediction models to assess short-term mortality risk among hospitalized patients with COVID-19. The objective of this study was to develop and validate a 7-day and 14-day mortality risk prediction model for patients hospitalized with COVID-19. METHODS: We performed a multicenter retrospective cohort study with a separate multicenter cohort for external validation using two hospitals in New York, NY, and 9 hospitals in Massachusetts, respectively. A total of 664 patients in NY and 265 patients with COVID-19 in Massachusetts, hospitalized from March to April 2020. RESULTS: We developed a risk model consisting of patient age, hypoxia severity, mean arterial pressure and presence of kidney dysfunction at hospital presentation. Multivariable regression model was based on risk factors selected from univariable and Chi-squared automatic interaction detection analyses. Validation was by receiver operating characteristic curve (discrimination) and Hosmer-Lemeshow goodness of fit (GOF) test (calibration). In internal cross-validation, prediction of 7-day mortality had an AUC of 0.86 (95%CI 0.74-0.98; GOF p = 0.744); while 14-day had an AUC of 0.83 (95%CI 0.69-0.97; GOF p = 0.588). External validation was achieved using 265 patients from an outside cohort and confirmed 7- and 14-day mortality prediction performance with an AUC of 0.85 (95%CI 0.78-0.92; GOF p = 0.340) and 0.83 (95%CI 0.76-0.89; GOF p = 0.471) respectively, along with excellent calibration. Retrospective data collection, short follow-up time, and development in COVID-19 epicenter may limit model generalizability. CONCLUSIONS: The COVID-AID risk tool is a well-calibrated model that demonstrates accuracy in the prediction of both 7-day and 14-day mortality risk among patients hospitalized with COVID-19. This prediction score could assist with resource utilization, patient and caregiver education, and provide a risk stratification instrument for future research trials.


Assuntos
Infecções por Coronavirus/mortalidade , Modelos Logísticos , Pneumonia Viral/mortalidade , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , New York , Pandemias , Curva ROC , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Estados Unidos
3.
Cogn Behav Neurol ; 33(3): 226-229, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32889955

RESUMO

Coronavirus 2019 (COVID-19) has profoundly impacted the well-being of society and the practice of medicine across health care systems worldwide. As with many other subspecialties, the clinical paradigm in behavioral neurology and neuropsychiatry (BN-NP) was transformed abruptly, transitioning to real-time telemedicine for the assessment and management of the vast majorities of patient populations served by our subspecialty. In this commentary, we outline themes from the BN-NP perspective that reflect the emerging lessons we learned using telemedicine during the COVID-19 pandemic. Positive developments include the ability to extend consultations and management to patients in our high-demand field, maintenance of continuity of care, enhanced ecological validity, greater access to a variety of well-reimbursed telemedicine options (telephone and video) that help bridge the digital divide, and educational and research opportunities. Challenges include the need to adapt the mental state examination to the telemedicine environment, the ability to perform detailed motor neurologic examinations in patients where motor features are important diagnostic considerations, appreciating nonverbal cues, managing acute safety and behavioral concerns in less controlled environments, and navigating intervention-based (neuromodulation) clinics requiring in-person contact. We hope that our reflections help to catalyze discussions that should take place within the Society for Behavioral and Cognitive Neurology, the American Neuropsychiatric Association, and allied organizations regarding how to optimize real-time telemedicine practices for our subspecialty now and into the future.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Doenças do Sistema Nervoso/diagnóstico , Exame Neurológico , Pandemias , Pneumonia Viral , Telemedicina/organização & administração , Humanos , Massachusetts , Neurologia , Neuropsiquiatria
4.
J Prev Med Public Health ; 53(4): 220-227, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32752590

RESUMO

OBJECTIVES: The aim of this study was to assess how different social determinants of health (SDoH) may be related to variability in coronavirus disease 2019 (COVID-19) rates in cities and towns in Massachusetts (MA). METHODS: Data about the total number of cases, tests, and rates of COVID-19 as of June 10, 2020 were obtained for cities and towns in MA. The data on COVID-19 were matched with data on various SDoH variables at the city and town level from the American Community Survey. These variables included information about income, poverty, employment, renting, and insurance coverage. We compared COVID-19 rates according to these SDoH variables. RESULTS: There were clear gradients in the rates of COVID-19 according to SDoH variables. Communities with more poverty, lower income, lower insurance coverage, more unemployment, and a higher percentage of the workforce employed in essential services, including healthcare, had higher rates of COVID-19. Most of these differences were not accounted for by different rates of testing in these cities and towns. CONCLUSIONS: SDoH variables may explain some of the variability in the risk of COVID-19 across cities and towns in MA. Data about SDoH should be part of the standard surveillance for COVID-19. Efforts should be made to address social factors that may be putting communities at an elevated risk.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Determinantes Sociais da Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Massachusetts/epidemiologia , Pandemias , Pobreza/estatística & dados numéricos , Inquéritos e Questionários
5.
BMJ ; 370: m2724, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32784208

RESUMO

OBJECTIVE: To assess temporal trends in the association between newly diagnosed atrial fibrillation and death. DESIGN: Community based cohort study. SETTING: Framingham Heart Study cohort, in 1972-85, 1986-2000, and 2001-15 (periods 1-3, respectively), in Framingham, MA, USA. PARTICIPANTS: Participants with no atrial fibrillation, aged 45-95 in each time period, and identified with newly diagnosed atrial fibrillation (or atrial flutter) during each time period. MAIN OUTCOME MEASURES: The main outcome was all cause mortality. Hazard ratios for the association between time varying atrial fibrillation and all cause mortality were calculated with adjustment for time varying confounding factors. The difference in restricted mean survival times, adjusted for confounders, between participants with atrial fibrillation and matched referents at 10 years after a diagnosis of atrial fibrillation was estimated. Meta-regression was used to test for linear trends in hazard ratios and restricted mean survival times over the different time periods. RESULTS: 5671 participants were selected in time period 1, 6177 in period 2, and 6174 in period 3. Adjusted hazard ratios for all cause mortality between participants with and without atrial fibrillation were 1.9 (95% confidence interval 1.7 to 2.2) in time period 1, 1.4 (1.3 to 1.6) in period 2, and 1.7 (1.5 to 2.0) in period 3 (Ptrend=0.70). Ten years after diagnosis of atrial fibrillation, the adjusted difference in restricted mean survival times between participants with atrial fibrillation and matched referents decreased by 31%, from -2.9 years (95% confidence interval -3.2 to -2.5) in period 1, to -2.1 years (-2.4 to -1.8) in period 2, to -2.0 years (-2.3 to -1.7) in period 3 (Ptrend=0.03). CONCLUSIONS: No evidence of a temporal trend in hazard ratios for the association between atrial fibrillation and all cause mortality was found. The mean number of life years lost to atrial fibrillation at 10 years had improved significantly, but a two year gap compared with individuals without atrial fibrillation still remained.


Assuntos
Fibrilação Atrial/mortalidade , Eletrocardiografia , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Causas de Morte , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Massachusetts/epidemiologia , Pessoa de Meia-Idade , Fatores de Risco , Taxa de Sobrevida/tendências
8.
PLoS One ; 15(8): e0237651, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817684

RESUMO

Body dysmorphic disorder (BDD) is associated with severe comorbidity and impairment. Muscle dysmorphia (MD) is a subtype of BDD which has rarely been assessed outside of undergraduate student samples. Further, there are limited data comparing MD to other psychiatric disorders, including BDD. Thus, the aim of the current study is to explore differences in symptom severity and conformity to masculine norms in men diagnosed with BDD or MD. Men from the greater Boston, Massachusetts area completed a one-time assessment, which included clinician-based structured interviews and self-report questionnaires assessing MD symptom severity, BDD symptom severity, and conformity to traditional masculine norms. The sample was N = 30 men (MD: n = 15; BDD: n = 15). Statistically significant medium to large effects emerged with the MD group experiencing greater MD and BDD symptom severity, and positive attitudes towards the use of violence to solve problems. Although not reaching statistical significance, additional medium-to-large effects also emerged with the MD group reporting greater emotional restriction/suppression, heterosexual self-presentation, and desired sexual promiscuity compared to the BDD group. Findings suggest that men diagnosed with MD may experience greater MD/BDD symptom severity and endorsement of some components of 'traditional' masculine norms, compared to men diagnosed with BDD. Results may suggest that addressing some forms of rigid masculine norms (e.g., use of violence) in therapy could be useful in treating MD; however, additional research comparing clinical samples of men with MD and BDD are needed to guide the nosology, assessment, and treatment of MD.


Assuntos
Transtornos Dismórficos Corporais/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Músculo Esquelético/fisiopatologia , Adulto , Transtornos Dismórficos Corporais/epidemiologia , Transtornos Dismórficos Corporais/fisiopatologia , Boston , Comorbidade , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/fisiopatologia , Humanos , Masculino , Massachusetts , Autorrelato , Índice de Gravidade de Doença , Inquéritos e Questionários , Adulto Jovem
9.
PLoS One ; 15(8): e0237905, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817717

RESUMO

Homelessness is poorly captured in most administrative data sets making it difficult to understand how, when, and where this population can be better served. This study sought to develop and validate a classification model of homelessness. Our sample included 5,050,639 individuals aged 11 years and older who were included in a linked dataset of administrative records from multiple state-maintained databases in Massachusetts for the period from 2011-2015. We used logistic regression to develop a classification model with 94 predictors and subsequently tested its performance. The model had high specificity (95.4%), moderate sensitivity (77.8%) for predicting known cases of homelessness, and excellent classification properties (area under the receiver operating curve 0.94; balanced accuracy 86.4%). To demonstrate the potential opportunity that exists for using such a modeling approach to target interventions to mitigate the risk of an adverse health outcome, we also estimated the association between model predicted homeless status and fatal opioid overdoses, finding that model predicted homeless status was associated with a nearly 23-fold increase in the risk of fatal opioid overdose. This study provides a novel approach for identifying homelessness using integrated administrative data. The strong performance of our model underscores the potential value of linking data from multiple service systems to improve the identification of housing instability and to assist government in developing programs that seek to improve health and other outcomes for homeless individuals.


Assuntos
Pessoas em Situação de Rua/classificação , Habitação/normas , Problemas Sociais/prevenção & controle , Adolescente , Adulto , Idoso , Criança , Gerenciamento de Dados , Feminino , Nível de Saúde , Humanos , Modelos Logísticos , Masculino , Massachusetts , Pessoa de Meia-Idade , Problemas Sociais/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Populações Vulneráveis , Adulto Jovem
10.
Public Health Rep ; 135(1_suppl): 75S-81S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735184

RESUMO

Policies facilitating integration of public health programs can improve the public health response, but the literature on approaches to integration across multiple system levels is limited. We describe the efforts of the Massachusetts Department of Public Health to integrate its HIV, viral hepatitis, sexually transmitted infection (STI), and tuberculosis response through policies that mandated contracted organizations to submit specimens for testing to the Massachusetts State Public Health Laboratory; co-test blood specimens for HIV, hepatitis C virus (HCV), and syphilis; integrate HIV, viral hepatitis, and STI disease surveillance and case management in a single data system; and implement an integrated infectious disease drug assistance program. From 2014 through 2018, the number of tests performed by the Massachusetts State Public Health Laboratory increased from 16 321 to 33 674 for HIV, from 11 054 to 33 670 for HCV, and from 19 169 to 30 830 for syphilis. Service contracts enabled rapid response to outbreaks of HIV, hepatitis A, and hepatitis B. Key challenges included lack of a billing infrastructure at the Massachusetts State Public Health Laboratory; the need to complete negotiations with insurers and to establish a retained revenue account to receive health insurance reimbursements for testing services; and time to train testing providers in phlebotomy for required testing. Investing in laboratory infrastructure; creating billing mechanisms to maximize health insurance reimbursement; proactively engaging providers, community members, and other stakeholders; and building capacity to transform practices are needed. Using multilevel policy approaches to integrate the public health response to HIV, STI, viral hepatitis, and tuberculosis is feasible and adaptable to other public health programs.


Assuntos
Serviços Contratados/organização & administração , Seguro Saúde/organização & administração , Administração em Saúde Pública/métodos , Vigilância em Saúde Pública/métodos , Doenças Sexualmente Transmissíveis/diagnóstico , Serviços Contratados/economia , Serviços Contratados/normas , Política de Saúde , Acesso aos Serviços de Saúde , Hepatite/diagnóstico , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Seguro Saúde/normas , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/legislação & jurisprudência , Reembolso de Seguro de Saúde/normas , Relações Interinstitucionais , Massachusetts , Estudos de Casos Organizacionais , Avaliação de Programas e Projetos de Saúde , Administração em Saúde Pública/economia , Administração em Saúde Pública/legislação & jurisprudência , Administração em Saúde Pública/normas , Sífilis/diagnóstico
11.
Public Health Rep ; 135(5): 571-577, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32795220

RESUMO

OBJECTIVES: Research examining the effect of changes in Medicaid dental benefits on emergency department (ED) use for dental conditions has had mixed results. We examined the effect of changes in Medicaid dental benefits on ED use for nontraumatic dental conditions (NTDCs) among adults in Massachusetts before and after Medicaid dental benefits for adults were eliminated (July 2010) and partially restored (January 2013). METHODS: We used 2009-2013 data from the Massachusetts All-Payer Claims Database. The study population included Medicaid enrollees aged ≥21 who made a visit to the ED for an NTDC that was paid for by Medicaid during the study period. We used an interrupted time-series study design and segmented regression model to assess the effect of the policy changes on ED use for NTDCs. We also conducted a subanalysis by patient age, sex, and geographic location. RESULTS: During the study period, 21 731 Medicaid enrollees aged ≥21 made 35 660 NTDC ED visits. Eliminating comprehensive dental benefits led to a significant increase in the use of EDs for NTDCs. This increase occurred over time (11% increase at 15 months after elimination of comprehensive dental benefits; estimate, 0.64 [95% CI, 0.07-1.21]; P = .03) rather than immediately after the policy change took effect. The partial restoration of certain dental benefits led to a significant decrease in the rate of ED visits for NTDCs over time (15.7% decrease at 5 months after partial restoration of certain dental benefits; estimate, -0.97 [95% CI, -1.83 to -0.11]; P = .03). CONCLUSION: Strengthening dental coverage policies for adult Medicaid enrollees could decrease their reliance on EDs for NTDCs.


Assuntos
Instituições Odontológicas/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Medicaid/economia , Medicaid/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doenças Estomatognáticas/economia , Doenças Estomatognáticas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Massachusetts , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
12.
Public Health Rep ; 135(5): 658-667, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32805192

RESUMO

OBJECTIVES: The health profile of Arab American mothers and infants may differ from that of non-Arab American mothers and infants in the United States as a result of social stigma experienced in the historical and current sociopolitical climate. The objective of our study was to compare maternal health behaviors, maternal health outcomes, and infant health outcomes of Arab American mothers and non-Hispanic white mothers in Massachusetts and to assess the role of nativity as an effect modifier. METHODS: Using data from Massachusetts birth certificates (2012-2016), we conducted adjusted logistic and linear regression models for maternal health behaviors, maternal health outcomes, and infant health outcomes. We used Arab ethnicity as the exposure of interest and nativity as an effect modifier. RESULTS: Arab American mothers had higher odds than non-Hispanic white mothers of initiating breastfeeding (adjusted odds ratio [aOR] = 2.61; 95% CI, 2.39-2.86), giving birth to small-for-gestational-age infants (aOR = 1.28; 95% CI, 1.18-1.39), and having gestational diabetes (aOR = 1.31; 95% CI, 1.20-1.44). Among Arab American mothers, non-US-born mothers had higher odds than US-born mothers of having gestational diabetes (aOR = 1.80; 95% CI, 1.33-2.44) and lower odds of initiating prenatal care in the first trimester (aOR = 0.41; 95% CI, 0.33-0.50). In linear regression models, infants born to non-US-born Arab American mothers weighed 42.1 g (95% CI, -75.8 to -8.4 g) less than infants born to US-born Arab American mothers. CONCLUSION: Although Arab American mothers engage in positive health behaviors, non-US-born mothers had poorer maternal health outcomes and access to prenatal care than US-born mothers, suggesting the need for targeted interventions for non-US-born Arab American mothers.


Assuntos
Árabes/psicologia , Grupo com Ancestrais do Continente Europeu/psicologia , Saúde do Lactente/estatística & dados numéricos , Comportamento Materno/psicologia , Saúde Materna/estatística & dados numéricos , Mães/psicologia , Características de Residência/estatística & dados numéricos , Adulto , Árabes/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Massachusetts , Mães/estatística & dados numéricos
13.
Acad Radiol ; 27(10): 1353-1362, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32830030

RESUMO

RATIONALE AND OBJECTIVES: While affiliated imaging centers play an important role in healthcare systems, little is known of how their operations are impacted by the COVID-19 pandemic. Our goal was to investigate imaging volume trends during the pandemic at our large academic hospital compared to the affiliated imaging centers. MATERIALS AND METHODS: This was a descriptive retrospective study of imaging volume from an academic hospital (main hospital campus) and its affiliated imaging centers from January 1 through May 21, 2020. Imaging volume assessment was separated into prestate of emergency (SOE) period (before SOE in Massachusetts on March 10, 2020), "post-SOE" period (time after "nonessential" services closure on March 24, 2020), and "transition" period (between pre-SOE and post-SOE). RESULTS: Imaging volume began to decrease on March 11, 2020, after hospital policy to delay nonessential studies. The average weekly imaging volume during the post-SOE period declined by 54% at the main hospital campus and 64% at the affiliated imaging centers. The rate of imaging volume recovery was slower for affiliated imaging centers (slope = 6.95 for weekdays) compared to main hospital campus (slope = 7.18 for weekdays). CT, radiography, and ultrasound exhibited the lowest volume loss, with weekly volume decrease of 41%, 49%, and 53%, respectively, at the main hospital campus, and 43%, 61%, and 60%, respectively, at affiliated imaging centers. Mammography had the greatest volume loss of 92% at both the main hospital campus and affiliated imaging centers. CONCLUSION: Affiliated imaging center volume decreased to a greater degree than the main hospital campus and showed a slower rate of recovery. Furthermore, the trend in imaging volume and recovery were temporally related to public health announcements and COVID-19 cases.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Hospitais , Humanos , Massachusetts , Estudos Retrospectivos , Serviços Urbanos de Saúde
15.
Orthopedics ; 43(4): 228-232, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32674173

RESUMO

The SARS-CoV-2 (COVID-19) pandemic has had a global influence on health care. The authors examined the early effect of hospital- and state-mandated restrictions on an orthopedic surgery department and hypothesized that the volume of ambulatory clinic encounters, office and surgical procedures, and cases would dramatically decrease. A retrospective review was performed of all encounters in an orthopedic surgery department at a level I academic trauma center during a 4-week period, from March 16, 2020, to April 12, 2020. The results were compared with two control 4-week periods, February 17, 2020, to March 15, 2020, and March 16, 2019, to April 12, 2019. Weekly volume and work relative value units (RVUs) of clinic encounters, office and surgical procedures, and cases were assessed. The type of ambulatory visit also was recorded. Comparisons of mean weekly volume and RVUs between the study and control periods were performed with Student's t test. Surgical cases were categorized into fracture or dislocation, acute soft tissue or nerve injury, infection, oncology, and elective or nonurgent. After implementation of hospital- and state-mandated restrictions on elective health care, the volume of ambulatory orthopedic surgery clinic encounters decreased by 74% to 77%, the volume of clinic procedures decreased by 95%, and the volume of surgical cases decreased by 88%. The percentage of clinic visits performed via telemedicine increased from 0.3% to 81.2%. Elective surgical cases ceased, and the volume of nonelective surgical cases decreased by 51%. During the first 4 weeks after COVID-19-related restrictions were imposed, an immediate and dramatic effect was observed. Compared with the control periods, significant reductions were seen in the volume of ambulatory encounters, office-based procedures, and surgical cases. In addition, the volume of nonelective surgical cases decreased by 51%. [Orthopedics. 2020;43(4):228-232.].


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Ortopédicos/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Telemedicina/estatística & dados numéricos , Centros Médicos Acadêmicos , Instituições de Assistência Ambulatorial , Betacoronavirus , Humanos , Massachusetts/epidemiologia , Pandemias , Estudos Retrospectivos , Centros de Traumatologia
16.
Public Health Rep ; 135(4): 540-541, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614704
20.
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
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