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Prevalência da Comorbidade entre Transtornos Mentais Graves e Transtornos Devido ao Uso de Substâncias Psicoativas em São Paulo, Brasil.; Prevalence of comorbidity between severe mental illnesses and substance use disorders in São Paulo, Brazil

Ratto, Lilian Ribeiro Caldas
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 16/03/2001 PT
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OBJETIVOS: O presente estudo visou estimar a prevalência da comorbidade entre transtornos mentais graves e o abuso de substâncias psicoativas, e estudar os fatores associados a essa comorbidade, em pacientes com transtornos mentais graves residentes em São Paulo. MÉTODO: O estudo teve desenho de corte transversal. Vinte serviços de saúde mental (emergências, hospitais psiquiátricos e ambulatórios) foram pesquisados, a fim de identificar todos os pacientes com idade entre 18 e 65 anos, com diagnóstico clínico de transtorno mental grave, que fossem residentes em um dos 7 distritos administrativos escolhidos para o estudo e que tiveram ao menos um contato com o serviço de saúde no período entre 1/9/1997 e 30/11/1997. Os pacientes incluídos foram avaliados quanto a sintomas psiquiátricos, ajustamento social, uso de álcool e uso de substâncias psicoativas, utilizando-se instrumentos padronizados. RESULTADOS: Dos 620 pacientes identificados, 404 foram aleatoriamente selecionados para serem entrevistados. Foi possível entrevistar diretamente 192 (47,9%) indivíduos. A prevalência de comorbidade nos últimos 12 meses foi de 10,4% (I.C. 95%: 6.5 a 15.6), sendo 7,3% para abuso de álcool e 4,7% para abuso de drogas ilícitas...

Obsessive-compulsive disorder: Influence of age at onset on comorbidity patterns

de Mathis, Maria Alice; do Rosario, Maria Conceição; Diniz, Juliana Belo; Torres, Albina Rodrigues; Shavitt, Roseli Gedanki; Ferrão, Ygor Arzeno; Fossaluza, Victor; de Bragança Pereira, Carlos Alberto; Miguel, Eurípedes Constantino
Fonte: Universidade Estadual Paulista Publicador: Universidade Estadual Paulista
Tipo: Artigo de Revista Científica Formato: 187-194
ENG
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Purpose: This study investigates the influence of age at onset of OCS on psychiatric comorbidities, and tries to establish a cut-off point for age at onset. Methods: Three hundred and thirty OCD patients were consecutively recruited and interviewed using the following structured interviews: Yale-Brown Obsessive Compulsive Scale; Yale Global Tic Severity Scale and the Structured Clinical Interview for DSM-IV. Data were analyzed with regression and cluster analysis. Results: Lower age at onset was associated with a higher probability of having comorbidity with tic, anxiety, somatoform, eating and impulse-control disorders. Longer illness duration was associated with lower chance of having tics. Female gender was associated with anxiety, eating and impulse-control disorders. Tic disorders were associated with anxiety disorders and attention-deficit/hyperactivity disorder. No cut-off age at onset was found to clearly divide the sample in homogeneous subgroups. However, cluster analyses revealed that differences started to emerge at the age of 10 and were more pronounced at the age of 17, suggesting that these were the best cut-off points on this sample. Conclusions: Age at onset is associated with specific comorbidity patterns in OCD patients. More prominent differences are obtained when analyzing age at onset as an absolute value. © 2008 Elsevier Masson SAS. All rights reserved.

Hematopoietic cell transplant specific comorbidity index (HCT-CI) como ferramenta na avaliação da mortalidade não relacionada a recidiva em pacientes submetidos a transplante de células tronco hematopoiéticas alogênico; Hematopoietic cell transplant specific comorbidity index as a tool in the assessment of non relapse mortality in patients undergoing allogeneic hematopoietic stem cell transplant

Marcos Paulo Colella
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 16/12/2014 PT
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O Transplante de Células Tronco Hematopoiéticas (TCTH) Alogênico representa uma possibilidade de cura para pacientes portadores de doenças hematológicas malignas e benignas. Porém, como qualquer modalidade de tratamento, apresenta efeitos adversos que podem ser graves, inclusive causando a morte. Com o intuito de se avaliar a influência que as comorbidades teriam na mortalidade não relacionada à recidiva (MNRR), foi criada uma ferramenta, o Índice de Comorbidade específico do Transplante de Células Tronco Hematopoiéticas (Hematopoietic Cell Transplant Specific Comorbidity Index - HCT-CI). Nossos objetivos, portanto, foram validar o HCT-CI na população de pacientes submetidos a TCTH Alogênico em nossa instituição, no período de 1993 a 2010, e avaliar outros fatores de riscos envolvidos na MNRR e na Sobrevida Global (SG). Os prontuários de 457 pacientes foram revistos e as informações referentes às comorbidades contidas no HCT-CI foram registradas. A maioria dos pacientes (59%) recebeu o índice 0, seguido de 30% de pacientes com índice de 1-2 e 11% com índice ≥ 3. Na análise univariada, os pacientes com HCT-CI igual a zero, comparados aos com HCT-CI ≥1, apresentaram uma MNRR de 33% vs. 45% (p=0.01) e SG de 53% vs. 35% (p=0.001); nos pacientes que ao transplante apresentavam doença de baixo risco...

Clinical and epidemiological features of AIDS/tuberculosis comorbidity

Song,Alice Tung Wan; Schout,Denise; Novaes,Hillegonda Maria Dutilh; Goldbaum,Moisés
Fonte: Faculdade de Medicina / Universidade de São Paulo - FM/USP Publicador: Faculdade de Medicina / Universidade de São Paulo - FM/USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2003 EN
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Considering the relevance of AIDS/tuberculosis comorbidity worldwide, especially in Brazil, this study was developed to describe the clinical and epidemiological features of the comorbid cases identified from 1989 to 1997 by the epidemiology service of the Hospital das Clínicas of the Universidade de São Paulo. METHODS: Databases containing information on all identified AIDS/tuberculosis cases cared for at the hospital were used to gather information on comorbid cases. RESULTS: During the period, 559 patients were identified as presenting with AIDS/tuberculosis comorbidity. Risk behavior for AIDS was primarily heterosexual contact (38.9%), followed by intravenous drug use (29.3%) and homosexual/bisexual contact (23.2%). Regarding clinical features, there were higher rates of extrapulmonary tuberculosis when compared to tuberculosis without comorbidity. There was an increase in reporting of AIDS by ambulatory units during the period. Epidemiologically, there was a decrease in the male/female ratio, a predominance in the 20 to 39 year-old age group, and a majority of individuals who had less than 8 years of schooling and had low professional qualifications. CONCLUSIONS: High rates of AIDS/tuberculosis cases at our hospital indicate the need for better attention towards early detection of tuberculosis...

Tertiary treatment for psychiatric comorbidity in headache patients

Savarese, M.; Guazzelli, M.; Prudenzano, M. P.; Carnicelli, M.; Rossi, M.; Cardinali, V.; Genco, S.; Lamberti, P.; Livrea, P.
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
EN
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The presence of significant and confounding psychiatric comorbidity is greater in patients attending headache clinics than in headache patients from the general population. The frequent comorbidity of headache with generalized anxiety disorder can take advantage of the administration of benzodiazepines. With regard to depression–related headache, it’s wellknown that the antidepressive drugs can improve migraine as well as tension–type headache. Antiepileptic drugs give one more good opportunity. The recognition of a psychiatric comorbidity is mandatory for an accurate management of the patient beacause prevents the clinicians from using any drug that might be dangerous for a mysdiagnosed psychiatric disturbance and often permits to administer medications that can efficaciously control both headache and psychiatric disorders.

Mental Disorders, Comorbidity, and Suicidal Behavior: Results from the National Comorbidity Survey Replication

Nock, Matthew K.; Hwang, Irving; Sampson, Nancy A.
Fonte: Nature Publishing Group Publicador: Nature Publishing Group
Tipo: Artigo de Revista Científica
EN_US
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Mental disorders are among the strongest predictors of suicide attempts. However, little is known about which disorders are uniquely associated with suicidal behavior due to high levels of psychiatric comorbidity. We examined the unique associations between individual disorders and subsequent suicidal behavior (suicide ideation, plans, and attempts) using data from the National Comorbidity Survey Replication, a nationally representative household survey of 9,282 US adults. Results revealed that approximately 80% of suicide attempters in the US have a temporally prior mental disorder. Anxiety, mood, impulse-control, and substance disorders all significantly predict subsequent suicide attempts in bivariate analyses (odds ratios=2.7-6.7); however, these associations decrease substantially in multivariate analyses controlling for comorbidity (odds ratios=1.5-2.3) but remain statistically significant in most cases. Disaggregation of the observed effects reveals that depression predicts suicide ideation, but not suicide plans or attempts among those with ideation. Instead, disorders characterized by severe anxiety/agitation (e.g., PTSD) and poor impulse-control (e.g., conduct disorder, substance disorders) predict which suicide ideators go on to make a plan or attempt. These results advance understanding of the unique associations between mental disorders and different forms of suicidal behavior. Future research must further delineate the mechanisms through which people come to think about suicide and progress from suicidal thoughts to attempts.; Psychology

Comorbidity Between Attention Deficit/Hyperactivity Disorder and Obsessive-Compulsive Disorder Across the Lifespan: A Systematic and Critical Review

Abramovitch, Amitai; Dar, Reuven; Mittelman, Andrew; Wilhelm, Sabine
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
EN_US
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Abstract The concept of comorbidity between attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD) has been discussed for two decades. No review, however, has examined this question in light of the stark contrast in disorder-specific phenomenology and neurobiology. We review reported prevalence rates and the methodological, phenomenological, and theoretical issues concerning concomitant ADHD-OCD. Reported co-occurrence rates are highly inconsistent in the literature. Studies aimed at examining the potential for comorbidity have suffered from various methodological problems, including the existence of very few community samples, highly variable exclusionary criteria, and possible clinical misinterpretation of symptoms. Despite numerous studies suggesting an ADHD-OCD comorbidity, thus far etiological (i.e., genetic) backing has been provided only for a pediatric comorbidity. Additionally, inflated rates of ADHD-OCD co-occurrence may be mediated by the presence of tic disorders, and evidence of impaired neuronal maturational processes in pediatric OCD may lead to possibly transient phenotypical expressions that resemble ADHD symptomatology. Thus, clinicians are encouraged to consider the possibility that ADHD-like symptoms resulting from OCD-specific symptomatology may be misdiagnosed as ADHD. This suggestion may account for the lower co-occurrence rates reported in adolescents and adults and for the lack of a theoretical account for comorbidity in these age groups. Existing literature is summarized and critically reviewed...

Comorbidity of chronic disease and potential treatment conflicts in older people dispensed antidepressants

Caughey, G.; Roughead, E.; Shakib, S.; McDermott, R.; Vitry, A.; Gilbert, A.
Fonte: Oxford Univ Press Publicador: Oxford Univ Press
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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Objectives: the study aimed to examine the prevalence of comorbidity, the prescribing of potentially inappropriate medications and treatment conflicts in a large sample of older people who have been dispensed an antidepressant medicine. Methods: a cross-sectional study of administrative claims data from the Department of Veterans’ Affairs, Australia, 1 April–31 July 2007, of veterans aged ≥65 years was conducted. Comorbidities determined using the pharmaceutical-based comorbidity index, Rx-Risk-V. Concomitant medicines that may be potentially inappropriate for patients with depression and areas of treatment conflicts were determined from Australian clinical guidelines or reference compendia. Results: a total of 39,695 subjects were included, with a median of 5 comorbid conditions (inter-quartile range 3–6). Ninety percent of medicine use was attributed to the treatment of comorbid conditions. Eighty-seven percent of the study cohort was identified as having at least one comorbid condition that may cause a potential treatment conflict when an antidepressant is used. Those conditions of most concern included cardiovascular diseases, anxiety disorders, arthritis or pain management and osteoporosis. Conclusion: we observed a high level of potentially inappropriate prescribing and treatment conflicts that may arise when caring for older patients dispensed an antidepressant with comorbidity. These have the potential to place a large number of older people with depression at increased risk for adverse events.; Gillian Elizabeth Caughey...

Mental health and drug and alcohol comorbidity in young people of refugee background: a review of the literature

Posselt, M.; Galletly, C.; de Crespigny, C.; Procter, N.
Fonte: Taylor and Francis Publicador: Taylor and Francis
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
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This review describes the existing knowledge concerning mental health (MH) and drug and alcohol problems in young people of refugee background. We explore the extent to which comorbid MH and alcohol and other drug (AOD) conditions (comorbidity) are likely to be experienced by young people of refugee background and investigate what is known about engaging and supporting young refugees with comorbidity in health services. Much of the literature suggests that young refugees are at a high risk of developing MH and AOD disorders. While it has been established that significant barriers to service engagement and service provision exist for young people of refugee background with one disorder, we suggest the risk may be higher for those experiencing comorbidity as they not only face cultural and linguistic barriers but are also often required to effectively navigate two different service sectors. Directions for future research are discussed.; Miriam Posselt, Cherrie Galletly, Charlotte de Crespigny and Nicholas Procter; Published online: 27 Feb 2013

Accuracy of hospital morbidity data and the performance of comorbidity scores as predictors of mortality

Mnatzaganian, G.; Ryan, P.; Norman, P.; Hiller, J.
Fonte: Pergamon-Elsevier Science Ltd Publicador: Pergamon-Elsevier Science Ltd
Tipo: Artigo de Revista Científica
Publicado em //2012 EN
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OBJECTIVES: The main objectives of this study were to validate the hospital morbidity data (HMD) and to compare the performance of three comorbidity adjusting methods in predicting 1-year and 5-year all-cause mortality in a male general hospital population in Western Australia (WA). STUDY DESIGN AND SETTING: Population-based data were integrated with WA-linked data system. Deyo-Charlson Index, Enhanced-Charlson Index, and Elixhauser's method measured comorbidity. Mortality was modeled using Cox regression, and model discrimination was assessed by Harrell's C statistics. RESULTS: The HMD were most likely to identify major comorbidities, such as cancer, myocardial infarction, diabetes mellitus, and major operations. The presence of comorbidity was independently associated with an increased risk of adverse outcomes. All models achieved acceptable levels of discrimination (Harrell's C: 0.70-0.76). The Enhanced-Charlson Index matched the Deyo-Charlson Index in predicting mortality. Elixhauser's method outperformed the other two. Including information from past admissions achieved nonsignificant improvement in model discrimination. A dose-response effect was observed in the effect of repeated episodes on risk of 5-year mortality. CONCLUSION: Comorbidities diagnosed at different points in time may have different associations with the risk of adverse outcomes. More research is required to integrate the effect of repeated episodes in currently used methods that measure and adjust for comorbidity.; http://www.elsevier.com/wps/find/journaldescription.cws_home/525472/description#description; George Mnatzaganian...

Overweight, Medical Comorbidity and Health-related Quality of Life in a Community Sample of Women and Men

Mond, B.; Baune, B.
Fonte: North Amer Assoc Study Obesity Publicador: North Amer Assoc Study Obesity
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
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Associations among gender, overweight and obesity, medical comorbidity, and health-related quality of life (HRQoL) were examined in a general population sample of 4,181 women and men aged 18–65 years. Anthropometric measurements and medical comorbidity were assessed as part of a computer-assisted physician interview. HRQoL was assessed with the Physical and Mental Component Summary scales of the Medical Outcomes Study Short Form (SF-36 PCS, MCS). General linear models were used to examine the associations among gender, weight status, medical comorbidity, and HRQoL. Controlling for age, social status, the occurrence of specific medical conditions, and the total number of medical conditions, mild obesity was associated with impairment in physical health functioning, as measured by the PCS, among women, whereas impairment in men's physical health was apparent only for moderate obesity. There was no association between weight status and psycho-social functioning, as measured by the MCS, in women, whereas overweight was associated with better perceived psycho-social functioning in men. The findings are consistent with the hypothesis that women suffer a disproportionately large share of the disease burden of overweight and obesity that is not due solely to differences in medical comorbidity. The possibility that aspects of emotional well-being may mediate the association between obesity and physical health functioning warrants further attention in this regard. The findings also indicate the need to stratify data by gender and to include more sensitive measures of psycho-social functioning in future studies.; Jonathan M. Mond and Bernhard T. Baune

The influence of primary care clinic characteristics on the quality of care for depression in patients with different comorbidity profiles

Menear, Matthew
Fonte: Université de Montréal Publicador: Université de Montréal
Tipo: Thèse ou Mémoire numérique / Electronic Thesis or Dissertation
EN
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Dans les services de première ligne, la majorité des personnes atteintes de dépression souffrent également d’autres maladies chroniques comorbides. Offrir des soins de haute qualité à ces patients représente un défi important pour les intervenants en première ligne ainsi que pour le système de santé. Il y a des raisons de croire que les contextes organisationnels dans lesquels les intervenants pratiquent ont une influence importante sur les soins. Cependant, peu d’études ont examiné directement la façon dont les caractéristiques des cliniques facilitent ou entravent les soins offerts aux patients atteints de dépression et de différents types de maladies chroniques comorbides. L’objectif général de ce projet de recherche était donc de mieux comprendre comment différentes caractéristiques des cliniques de première ligne influencent la qualité des soins pour la dépression chez des patients ayant différents profils de comorbidité. La thèse comporte deux études. Tout d'abord, nous avons effectué une revue systématique examinant les relations entre la comorbidité physique chronique et la qualité des soins pour la dépression dans les services de première ligne afin de clarifier la nature de ces relations et d’identifier les facteurs qui pourraient influer sur ces relations. Ensuite...

Psychiatric comorbidity: is more less?

Pincus, Harold Alan; Tew, James D; First, Michael B
Fonte: Masson Italy Publicador: Masson Italy
Tipo: Artigo de Revista Científica
Publicado em /02/2004 EN
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With each successive revision of the DSM and ICD, psychiatric comorbidity has become more prevalent. The 'atheoretical' approaches of the DSM and ICD explicitly encourage multiple diagnoses with few exclusionary hierarchies, in the hope that all clinically relevant information will be captured. However, the current strategy of diagnosing 'maximal' comorbidity may not reflect 'optimal' comorbidity. Many clinicians and health information systems, particularly those in developing countries, have a limited capacity for capturing this diagnostic information, and fail to characterize additional diagnoses that are present. This article will address the evolution of our current diagnostic system as a way of understanding the emergence of comorbid psychiatric diagnoses. Alternative diagnostic approaches (a dimensional system, diagnostic hierarchies, and mixed diagnostic categories) that could be used to address the emergence of comorbid psychiatric diagnoses are considered. Future challenges for the next evolution of DSM and ICD are presented.

The Charlson comorbidity index (CCI) for adjustment of hip fracture mortality in the elderly: analysis of the importance of recording secondary diagnoses

Souza,Rômulo Cristovão de; Pinheiro,Rejane Sobrino; Coeli,Cláudia Medina; Camargo Jr.,Kenneth Rochel de
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2008 EN
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This study evaluates the role of the number of secondary diagnoses for calculating the Charlson comorbidity index (CCI) in risk adjustment of the 90-day mortality rate after hip fracture surgical repair. Comorbidities were selected by reviewing the medical records of 390 patients 50 years of age or older in a teaching hospital in Rio de Janeiro from 1995 to 2000. Logistic regression models were fitted including the variables age, sex, and CCI. The CCI was calculated based on: (1) all patients' comorbidities; (2) only the comorbidity with the highest weight; and (3) a single randomly selected comorbidity. There was a gradient in the prediction of the CCI mortality rate when all comorbidities were used (OR = 6.53; 95%CI: 2.27-18.77, for scores ³ 3). The predictive capacity of the CCI was observed even when it was calculated using only one comorbidity: with the highest weight (OR = 2.83; 95%CI: 1.11-7.22); and randomly selected (OR = 2.90; 95%CI: 1.07-7.81). Using all comorbidities for CCI calculation is important. Severity indices based on a single comorbidity can be useful for risk adjustment procedures.

Service provider barriers to treatment and care for people with mental health and alcohol and other drug comorbidity in a metropolitan region of South Australia

de Crespigny, C.; Groenkjaer, M.; Liu, D.; Moss, J.; Cairney, I.; Procter, N.; Posselt, M.; Jebaraj, H.S.F.; Schultz, T.; Banders, A.; King, R.; Lee, D.; Galletly, C.A.
Fonte: Emerald Publicador: Emerald
Tipo: Artigo de Revista Científica
Publicado em //2015 EN
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Purpose – The purpose of this paper is to elicit clinicians’ and workers’ knowledge, experiences and opinions of key issues pertaining to comorbidity service needs of people aged 12 years and over in a metropolitan region of South Australia. Design/methodology/approach – As one component of a participatory action research project, this qualitative study used semi-structured interviews with mental health (MH) and alcohol and other drug (AOD) clinicians and workers (n=20). Findings – The participants expressed concerns involving stigma towards their clients. They highlighted lack of adequate MH and AOD comorbidity service accessibility and models, regularly available clinical comorbidity workforce development, and practice supervision and skills training. These factors influenced participants’ and their colleagues’ capacity and ability to access and provide appropriate help for people needing integrated treatment and care of their co-existing comorbid conditions. Practical implications – Findings highlight the need for coordinated and integrated, individualised holistic comorbidity services, including treatment and care best suited to Aboriginal people and refugees. Originality/value – This study emphasises the importance of government and non-government MH and AOD services ensuring that comorbidity is responded to collaboratively and systemically. It also demonstrates the importance of professional development.; Charlotte de Crespigny...

ASD Symptom Severity in Adolescence of Individuals Diagnosed with PDD-NOS in Childhood: Stability and the Relation with Psychiatric Comorbidity and Societal Participation

Louwerse, A.; Eussen, M. L. J. M.; Van der Ende, J.; de Nijs, P. F. A.; Van Gool, A. R.; Dekker, L. P.; Verheij, C.; Verheij, F.; Verhulst, F. C.; Greaves-Lord, K.
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
EN
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The current 7-year follow-up study investigated: (1) the stability of ASD severity, and (2) associations of ASD severity in adolescence with (a) childhood and concurrent psychiatric comorbidity, and (b) concurrent societal functioning. The Autism Diagnostic Observation Schedule (ADOS) and the Diagnostic Interview Schedule for Children were administered in childhood (ages 6–12) and in adolescence (ages 12–20) to 72 individuals with a pervasive developmental disorder-not otherwise specified (PDD-NOS). ADOS calibrated severity scores showed a large stability (r = .51). Psychiatric comorbidity in childhood and adolescence were not associated with ASD severity in adolescence. Mental health care use (87 %) and special education needs were high (71 %). Reevaluation of ASD severity and psychiatric comorbidity later in life seem useful when PDD-NOS is diagnosed in childhood.

Subnotificação da comorbidade tuberculose e aids: uma aplicação do método de linkage; Subnotificación de la comorbilidad tuberculosis y sida: una aplicación del método de linkage; Underreporting of the tuberculosis and AIDS comorbidity: an application of the linkage method

Carvalho, Carolina Novaes; Dourado, Ines; Bierrenbach, Ana Luiza
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf; application/pdf
Publicado em 01/06/2011 POR; ENG
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OBJETIVO: Analisar a subnotificação da comorbidade tuberculose (TB) e aids. MÉTODOS: Estudo de vigilância utilizando os registros do Sistema de Informação de Agravos de Notificação de Tuberculose e de aids no Brasil de 2000 a 2005. Registros de TB sem informação da presença de aids foram considerados subnotificações da comorbidade quando pareados a registros de aids que apresentassem ano de diagnóstico de aids igual ou anterior ao ano de notificação da TB, assim como os registros de um mesmo paciente cujos registros anteriores apresentavam essa informação. Criou-se um indicador: comorbidade TB-aids reconhecida, a partir dos registros de TB com a informação de presença de aids. RESULTADOS: A subnotificação de TB-aids foi de 17,7%. Esse percentual variou entre estados. A incorporação dos registros subnotificados aos previamente reconhecidos elevou a proporção de TB-aids no Brasil de 6,9% para 8,4%. As maiores proporções de subnotificação foram observadas no Acre, Alagoas, Maranhão e Piauí (mais de 35% cada) e as menores em São Paulo e Goiás (cerca de 10% cada). CONCLUSÕES: A subnotificação da comorbidade TB-aids encontrada no Brasil deve deflagrar modificações no sistema de vigilância para prover informações aos programas nacionais.; OBJETIVO: Analizar la subnotificación de la comorbilidad tuberculosis (TB) y sida. MÉTODOS: Estudio de vigilancia utilizando los registros del Sistema de Información de Agravios de Notificación de Tuberculosis y de sida en Brasil de 2000 a 2005. Registros de TB sin información de la presencia de sida fueron consideradas subnotificaciones de la comorbilidad cuando se parearon a registros de sida que presentaron año de diagnóstico de sida igual o anterior al año de notificación de la TB...

Uso de medidas de comorbidades para predição de risco de óbito em pacientes brasileiros hospitalizados; Uso de medidas de comorbilidades para predicción de riesgo de óbito en pacientes brasileros hospitalizados; Use of comorbidity measures to predict the risk of death in Brazilian in-patients

Martins, Monica
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf; application/pdf
Publicado em 01/06/2010 POR; ENG
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OBJETIVO: Avaliar o uso de medidas de comorbidade para predizer o risco de óbito em pacientes brasileiros. MÉTODOS: Foram utilizados dados de internações obtidos do Sistema de Informações Hospitalares do Sistema Único de Saúde, que permite o registro de somente um diagnóstico secundário. Foram selecionadas 1.607.697 internações ocorridas no Brasil em 2003 e 2004, cujos diagnósticos principais foram doença isquêmica do coração, insuficiência cardíaca congestiva, doenças cérebro-vasculares e pneumonia. O Índice de Charlson e as comorbidades de Elixhauser foram as medidas de comorbidade utilizadas; o simples registro de algum diagnóstico secundário foi também empregado. A regressão logística foi aplicada para avaliar o impacto das medidas de comorbidade na estimava da chance de óbito. O modelo de base incluiu as seguintes variáveis: idade, sexo e diagnóstico principal. Os modelos de predição de óbitos foram avaliados com base na estatística C e no teste de Hosmer-Lemeshow. RESULTADOS: A taxa de mortalidade hospitalar foi 10,4% e o tempo médio de permanência foi 5,7 dias. A maioria (52%) das internações ocorreu em homens e a idade média foi 62,6 anos. Do total de internações, 5,4% apresentava um diagnóstico secundário registrado...

Comorbidity patterns in dual diagnosis across seven European sites

Charzynska,K.; Hyldager,E.; Baldacchino,A.; Greacen,T.; Henderson,Z.; Laijärvi,H.; Hodges,C.L.; Lack,C.; Sieroslawski,J.; Baeck-Moller,K.
Fonte: The European Journal of Psychiatry Publicador: The European Journal of Psychiatry
Tipo: info:eu-repo/semantics/article; journal article; info:eu-repo/semantics/publishedVersion Formato: text/html; application/pdf
Publicado em 01/12/2011 ENG
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37.08%
Background and Objectives: Psychiatric inpatients with substance use disorders are a significant public health concern due to grave consequences including increased risk of self harm, homicide as well as poor clinical outcome. The present study aims to examine and compare patterns of comorbidity (i.e. concurrent substance use disorders and severe mental illness) among psychiatric inpatients across seven European sites. Methods: 352 patients were included consecutively from psychiatric inpatients units at 7 European sites and interviewed with the Mini- International Neuropsychiatric Interview and the European version of the Addiction Severity Index questionnaires. For analysis the psychiatric diagnostic groups were organized into broader categories. Results: Concurrent alcohol use disorder and mood disorder was found to be the most prevalent comorbidity pattern (30.8%) across Europe. Alcohol or drug use disorder combined with mood disorder was most prevalent among females and in the older age group whereas mixed substance use and psychosis was more frequent among males and younger participants. Finally, differences in comorbidity patterns were found at different European sites. Conclusions: The prevalence of different comorbidity patterns varied across European clinical settings. Significant differences between comorbidity subgroups were found with regard to age and gender.

The Charlson comorbidity index (CCI) for adjustment of hip fracture mortality in the elderly: analysis of the importance of recording secondary diagnoses

Souza,Rômulo Cristovão de; Pinheiro,Rejane Sobrino; Coeli,Cláudia Medina; Camargo Jr.,Kenneth Rochel de
Fonte: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Publicador: Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2008 EN
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This study evaluates the role of the number of secondary diagnoses for calculating the Charlson comorbidity index (CCI) in risk adjustment of the 90-day mortality rate after hip fracture surgical repair. Comorbidities were selected by reviewing the medical records of 390 patients 50 years of age or older in a teaching hospital in Rio de Janeiro from 1995 to 2000. Logistic regression models were fitted including the variables age, sex, and CCI. The CCI was calculated based on: (1) all patients' comorbidities; (2) only the comorbidity with the highest weight; and (3) a single randomly selected comorbidity. There was a gradient in the prediction of the CCI mortality rate when all comorbidities were used (OR = 6.53; 95%CI: 2.27-18.77, for scores ³ 3). The predictive capacity of the CCI was observed even when it was calculated using only one comorbidity: with the highest weight (OR = 2.83; 95%CI: 1.11-7.22); and randomly selected (OR = 2.90; 95%CI: 1.07-7.81). Using all comorbidities for CCI calculation is important. Severity indices based on a single comorbidity can be useful for risk adjustment procedures.