O trabalho apresenta o risco de óbito, baseado no estudo da comorbidade, nos pacientes internados nos hospitais gerais que oferecem assistência hospitalar na região de Ribeirão Preto adstrita ao Departamento Regional de Saúde XIII - DRS XIII. O risco de óbito foi estimado por meio do cálculo do Índice de Comorbidade de Charlson (ICC). O ICC emprega pesos de 0 a 6 a comorbidades selecionadas, ponderando o risco de morrer. Quanto maior for a pontuação do estrato do paciente, maior a chance de morrer. Para análise, foi desenvolvida uma ferramenta computacional que automatiza o cálculo do índice a fim de auxiliar os gestores na tomada de decisão. Assim, obtivemos a distribuição dos casos estudados por estrato ICC e ICCI - outra abordagem do índice ICC, quando a idade é considerada junto ao vetor de comorbidades - para o ano de 2011. Notamos que para o cálculo do ICC, a curva de risco de óbito não seguiu o previsto por Charlson, cuja mortalidade deveria aumentar à medida que a pontuação do estrato aumenta, porém, a distribuição de casos por ICCI seguiu esse conceito. Por fim, estudamos a distribuição espacial dos casos de alta gravidade que nos mostrou as cidades pólos e subpólos da região em assistência hospitalar. O indicador e a automatização de seu cálculo apresentou-se um bom auxílio na tomada de decisão nas questões de saúde. / The work presents the risk of death, based on the study of comorbidity in hospitalized patients in general hospitals that offer hospital care in the region of Ribeirao Preto enrolled in Regional Department of Health 13th - DRS XII. The risk of death was estimated by means of the calculation of the Index of Charlson Comorbidity (ICC). The ICC employs weights from 0 to 6 the comorbidities selected, considering the risk of dying. The higher the score on the stratum of the patient, the greater the chance of dying. For analysis, a computational tool that automates the calculation of the index was developed, in order to assist managers in decision making. Thus, we obtained the distribution of cases studied by stratum ICC and ICCI - another approach to the ICC index, when the age is considered along the vector of comorbidities - for the year 2011. We note that for the calculation of the ICC, the curve of risk of death did not follow the prescribed by the Charlson index, whose mortality should increase as the score of the stratum increases, however, the distribution of cases by ICCI followed this concept. The indicator and the automation of its calculation proved to be a good aid in decision-making on health issues.

BACKGROUND: Morbidity, defined as disease history, is an important and well-known confounder in epidemiologic studies. Numerous methods have been developed over the last 30 years to measure morbidity via valid and reliable processes. OBJECTIVE: The goal of the current study was to evaluate, via comparative predictive validity assessment, the Centers for Medicaid and Medicare Studies Hierarchical Condition Category (CMS-HCC) comorbidity model for its ability to improve the prediction of 12-month all-cause mortality among a Medicare population compared to previously published comorbidity index models. There were three specific aims: (1) challenge the current state of risk adjustment among aged populations via an evaluation of the comparative predictive validity of one novel and four existing models to predict all-cause mortality within 12 months among a heterogeneous population of Medicare beneficiaries; (2) Investigate the comparative predictive validity of the five models to predict all-cause mortality within 12 months among two homogenous populations diagnosed with ischemic heart disease and selected cancers, including prostate cancer, lung cancer, colorectal cancer, breast cancer, pancreas cancer, and endometrial cancer; and (3) measure each comorbidity model's ability to control for a known example of confounding by indication. METHODS: A retrospective cohort design was used for all specific aims. Study 1 included 257,641 Medicare beneficiaries enrolled in three Medicare Advantage prescription drug health plans in Alabama, Florida, or Ohio in 2010 and 2011. Study 2 limited analysis to 14,260 and 66,440 beneficiaries with administrative evidence of selected cancers or ischemic heart disease in 2010, respectively. Study 3 limited analysis to the beneficiaries with ischemic heart disease. For each participant, comorbidity risk scores for the following five models were generated using administrative data from 2010: an age/sex model, the Romano adaption of the Charlson Comorbidity Index (CCI) model, the Putnam adaptation of the Chronic Disease Score Model (CDS), the CMS version of the Hierarchical Condition Category (CMS-HCC) model, and the Agency for Healthcare Research and Quality (AHRQ) adaptation of the Elixhauser model. The prospective predictive validity of the models to predict all-cause mortality during 2011 was compared via the c statistic test. Participants with ischemic heart disease were randomly allocated retrospectively to either 1) a group that had "received" a hypothetical "Drug A" in 2010 or 2) a group that had "received" a hypothetical "Drug B" in 2010. In order to evaluate the impact of confounding by indication, a weighting factor was applied to the randomization process in order to force the 33,220 participants randomized to "Drug A" to have a 2.736 times higher likelihood of having at least one acute inpatient hospitalization in 2010. Each comorbidity model's ability to control for the contrived confounding by indication was evaluated via relative risk of death. RESULTS: The CMS-HCC model had statistically significant higher c-statistic values than all four existing comorbidity indices among the heterogeneous Medicare Advantage population (N=257,641) and the homogeneous populations with breast cancer (N=4,160) and prostate cancer (N=6,594). The CMS-HCC model displayed similar performance for lung cancer (N=1,384), colorectal cancer (N=1,738), endometrial cancer (N=232), and ischemic heart disease (N=66,640) and statistically significant lower performance for pancreas cancer (N=152). The log-transformed CMS-HCC model was the only model to generate a non-significant association between exposure to "Drug A" and subsequent mortality. CONCLUSION: In general, the CMS-HCC model is the preferred comorbidity measure due to its predictive performance. However, other comorbidity models may be optimal for diseases with low prevalence and/or high mortality. Researchers should carefully and thoughtfully select a comorbidity model to assess the existence and direction of confounding. The CMS-HCC model should be log-transformed when used as a dependent variable since the score is a ratio level measurement that displays a normal distribution when log transformed. The resulting score is less likely to violate the assumptions (i.e. violations of normality) of common statistical models due to extreme values. The national availability of CMS-HCC scores for all Medicare beneficiaries provides researchers with access to a new tool to measure co-morbidity among older Americans using an empirically weighted, single score. In terms of policy, it is recommended that CMS produce CMS-HCC scores for all Medicare beneficiaries on a rolling 12 month basis for each month during the year. The availability of monthly scores would increase the ease of use of the score, as well as help facilitate more rapid adoption of the tool.

Thesis (Ph. D.)--West Virginia University, 2007. / Title from document title page. Document formatted into pages; contains xvi, 354 p. : ill. (some col.). Vita. Includes abstract. Includes bibliographical references (p. 243-262).

Source: Masters Abstracts International, Volume: 46-01, page: 0335. Adviser: Alanna Morrison. Includes bibliographical references.

This investigation examined several dimensions of personality functioning in a longitudinal sample of females. These data are part of an existing project evaluating female development across 3 different time points starting in adolescence and transitioning into adulthood. Subjects were categorized into a clinical group (females with a high degree of psychiatric comorbidity) and a normal control group. All participants were initially recruited when they were between 14-18 years of age, and were followed up twice when they were 19-23, and 24-28. In an attempt to explore possible heterogeneity in personality trait development, the research is presented as three separate studies examining the following: (1) fluctuations in mean-level and rank order stability estimates across time; (2) the validity of established personality trends relative to their association with antisocial behavior; and (3) mechanisms that may contribute to personality trait consistency across development such as neighborhood context. This is the first study to investigate personality functioning across time in females who are disturbed in multiple areas of social and psychological functioning. Results highlight the importance of considering distinct subgroups of the general population when exploring developmental trends in personality.

In the pathophysiology of traumatic brain injury (TBI), the amygdala remains understudied, despite involvement in processing emotional and stressful stimuli associated with anxiety disorders, such as post-traumatic stress disorder (PTSD). Because the basolateral amygdala (BLA) integrates inputs from sensory and other limbic structures coordinating emotional learning and memory, injury-induced changes in circuitry may contribute to psychiatric sequelae of TBI. This study quantified temporal changes in dendritic complexity of BLA neurons after experimental diffuse TBI, modeled by midline fluid percussion injury. At post-injury days (PIDs) 1, 7, and 28, brain tissue from sham and brain-injured adult, male rats was processed for Golgi, glial fibrillary acidic protein (GFAP), or silver stain and analyzed to quantify BLA dendritic branch intersections, activated astrocytes, and regional neuropathology, respectively. Compared to sham, brain-injured rats at all PIDs showed enhanced dendritic branch intersections in both pyramidal and stellate BLA neuronal types, as evidenced by Sholl analysis. GFAP staining in the BLA was significantly increased at PID1 and 7 in comparison to sham. However, the BLA was relatively spared from neuropathology, demonstrated by an absence of argyrophilic accumulation over time, in contrast to other brain regions. These data suggest an early and persistent enhancement of dendritic complexity within the BLA after a single diffuse TBI. Increased dendritic complexity would alter information processing into and through the amygdala, contributing to emotional symptoms post-TBI, including PTSD.

The purpose of this study was to examine how professionals describe the interaction between psychiatry and addiction care when it comes to clients/patients  who suffer from comorbidity of substance abuse and diagnosed mental illness. In this study we posed the following questions: How do the care personnel within psychiatric treatment and substance abuse care describe the current state of the collaboration between them? Which pros and cons do the personnel within the two sectors describe regarding collaboration? Based on six interviews; three among professionals in psychiatry and three in addiction care, the overall result shows that the informants believe that the existing cooperation works well but can be developed. The study also shows that concerted individual plans (SIP) as a tool can generate positive results for clients/patients within both organizations. SIP is also an opportunity for the professionals to go beyond the current confidentiality that exists between the client/patient and organization and thus better able to collaborate around a client/patient. The conclusion is that cooperation can be favored or discriminated against by the staff's attitudes towards individuals who suffer from comorbidity, political decisions, maneuver and professional, personal experience and knowledge of each other's professions. / Syftet med denna studie var att undersöka hur yrkesverksamma inom psykiatrin och beroendevården beskriver samverkan mellan organisationerna angående personer som lider av samsjuklighet av missbruk och diagnostiserad psykisk ohälsa. Frågeställningarna var: Hur beskriver vårdpersonalen inom psykiatrin och beroendevården att samverkan fungerar? Vilka fördelar respektive nackdelar beskriver personalen inom de olika verksamheterna att det finns med samverkan? Utifrån sex intervjuer, tre bland anställda inom psykiatrin respektive tre i beroendevården, visar det övergripande resultatet att informanterna anser att den befintliga samverkan fungerar bra men kan utvecklas. Studien visar även att samordnade individuella planer (SIP) som verktyg kan generera positiva resultat för klienterna/patienterna inom de båda organisationerna. SIP är också en möjlighet för de professionella att få möjlighet att häva rådande tystnadsplikt som finns mellan klienten/patienten och organisationen och därigenom bättre kunna samverka kring en klient/patient. Slutsatsen är att samverkan kan gynnas eller missgynnas av personalens attityder gentemot individer som lider av samsjuklighet, politiska beslut, handlingsutrymmet samt yrke, personlig erfarenhet och kunskap om varandras professioner.

In everyday life, people are interacting with the Internet. The emergence of this phenomenon has been positively contributing to the rapid development of our society in the last decades. However, negative reports about excessive usage are coming to the surface and questions about potential negative consequences are being raised. Internet addiction (IA) has been suggestedas a new type of disorder. There is a new field of research emerging with the aim to investigate its nature. This review compiles the most relevant literature on neuroimaging techniques used to identify the underlying neurobiological mechanisms of IA. Based on identified comorbidity between IA and attention-deficit hyperactivity disorder (ADHD), a comparison between the neural correlates of IA and ADHD is attempted, in order to illustrate the importance of bringing more attention to IA. The findings present structural, functional and neurochemical alterations in brain regions associated with emotional processing, cognitive control and reward processing. Similarities between the two disorders interms of structural and functional alterations in regions associated with emotional processing and cognitive control are highlighted.Limitations regarding lack of consensus of the operational definition, narrow selection criteria of participants and a need for subcategories inside the term IA are pointed out. The thesis concludes that as of now the discovered alterations may be considered as biological markers underlying the disorder and IA is a field of research worthy of more attention.

A identificação de genes responsáveis por doenças humanas pode fornecer conhecimentos sobre mecanismos patológicos e psicológicos que são essenciais para o desenvolvimento de novos diagnósticos e terapias. Sabemos que uma doença é raramente uma consequência de uma anormalidade num único gene, porém reflete desordens de uma rede intra e intercelular complexa. Muitas metodologias conhecidas na Bioinformática são capazes de priorizar genes relacionados a uma determinada doença. Algumas abordagens também podem validar a pertinência ou não destes genes em relação à doença estudada. Uma abordagem de priorização de genes é a investigação a partir de doenças que acometem pacientes ao mesmo tempo, as comorbidades. Existem muitas fontes de dados biomédicos que podem ser utilizadas para a coleta de comorbidades. Desta forma, podemos coletar pares de doenças que formam comorbidades epidemiológicas e assim analisar os genes de cada doença. Esta análise serve para expandirmos a lista de genes candidatos de cada uma dessas doenças e justificarmos a relação gênica entre essas comorbidades. O objetivo principal deste projeto é o de integração dos dados epidemiológicos e genéticos para a realização da predição de genes causadores de doenças. Isto se dará através do estudo de comorbidade destas doenças. / The identification of genes responsible for human diseases can provide knowledge about pathological and physiological mechanisms that are essential for the development of new diagnostics and therapeutics. It is known that a disease is rarely a consequence of an abnormality in a single gene, but reflects complex intra and intercellular network disorders. Many methodologies known in Bioinformatics are able to prioritize genes related to a particular disease. Some approaches can also validate how appropriate or not these genes are relative to a disease. An approach for prioritizing genes is the research from diseases afecting patients at the same time, i.e. comorbidities. There are many sources of biomedical data that can be used to collect comorbidities and analyse genes of each disease. We can also expand the list of candidate genes for each singular disease and justify the genetic relationship of these comorbidities. The main objective of this project is the integration of epidemiologic and genetic data to perform the prediction of causing genes through the study of comorbidity of these illnesses.

O uso problemático de álcool tem sido apontado como problema de saúde pública. A prevalência de dependência de álcool é maior em pessoas com transtornos psiquiátricos. Esta comorbidade pode trazer sérias implicações para a identificação, tratamento e reabilitação do indivíduo doente. O presente estudo teve como objetivo identificar o uso problemático de álcool em pacientes com transtornos psiquiátricos, a partir da realidade clínica assistencial terciária de um serviço universitário. Foi realizado um estudo transversal, com uma amostra clínica ambulatorial composta por 127 indivíduos em tratamento por um dos seguintes diagnósticos: esquizofrenia, transtorno afetivo bipolar, depressão e transtornos de ansiedade. Os dados foram colhidos através de entrevista com o paciente e também através do prontuário. As informações coletadas foram: dados sócio-demográficos, história psiquiátrica, problemas de saúde, características familiares e registros do prontuário relacionados ao diagnóstico do paciente e ao consumo de álcool. Foi aplicado o instrumento de rastreamento CAGE e realizada a entrevista estruturada em conformidade com os diagnósticos da CID-10 para uso nocivo e dependência de álcool. A fim de aumentar a sensibilidade do CAGE,trabalhou-se com o ponto de corte ¡Ý1. Da amostra total, 6,3% fazem uso nocivo de álcool e 3,9% são dependentes, de acordo com os critérios da CID-10. Quarenta e três pessoas (33,9%) pontuaram positivo no CAGE, o que indica a possibilidade de uso problemático de álcool em algum momento de suas vidas. Os fatores sócio-demográficos que mostraram relação com o uso problemático de álcool foram: ser homem, ter menos de 40 anos de idade, não ter companheiro(a) e não ser praticante de religião. Ao se comparar médias de escore no CAGE, entre os quatro grupos diagnósticos estudados, encontrou-se que a maior média foi a do grupo de esquizofrenia, seguida pelo de transtornos ansiosos, transtorno afetivo bipolar e, por último, depressão. Foi encontrada uma relação entre pontuação no CAGE e idade de início da enfermidade. Entre os pacientes que pontuaram positivo no CAGE, 60,5% não tinham registros, em seus prontuários, de uso de álcool. Sugere-se a disseminação de informações a respeito da comorbidade entre transtornos psiquiátricos e uso problemático de álcool na formação de profissionais de saúde, assim como treinamento para uso de instrumentos de rastreamento do uso problemático de álcool. / The problematic use of alcohol is becoming recognised as a serious public health problem. The prevalence of alcohol dependence is higher in persons with a psychiatric disorder. This comorbidity has serious implications for the identification, treatment and rehabilitation of the person. The aim of this research is to identify the problematic use of alcohol among individuals with psychiatric disorders by evaluating patients attending a psychiatric outpatient clinic at a university hospital. A transversal study was carried out, with a clinical sample composed of 127 individuals in treatment for one of the following disorders: schizophrenia, bipolar disorder, depression and anxiety disorders. The data was gathered from the patient’s records and through interview. The information collected was: sociodemographic data, psychiatric history, health problems, family characteristics and information from the records concerning the patient’s diagnosis and their previous alcohol use. The screening instrument CAGE was applied along with a structured interview based on the ICD-10 criteria for harmful use and alcohol dependence. In order to increase the sensitivity of CAGE the cut off point ¡Ý1 was used. It was found that 6.3% of patients met the criteria for harmful alcohol use and 3.9% for dependence (ICD-10). Forty-three persons (33,9%) scored positive with CAGE, indicating the possibility of problematic use of alcohol at a point in their lives. The sociodemographic factors that showed an association with problematic use of alcohol were: to be male, to be less than 40 years of age, to be without a partner and not to be practicing a religion. When the mean averages of CAGE scores for the four studied diagnostic groups were compared, the schizophrenia group scored higher, followed by the anxiety disorder group, bipolar disorder group and the depression group. A relationship was found between CAGE scores and patient age at the onset of the disorder. Among patients that scored positive with CAGE, 60,5% did not have any history, in their records, of alcohol use. It is suggested that information regarding comorbidity between psychiatric disorders and problematic use of alcohol be disseminated among health professionals, in conjunction with training in the use of screening instruments for problematic use of alcohol.