Despite several criticisms surrounding the DSM classification in psychiatry, a significant bulk of research on mental conditions still operates according to two core assumptions: a) homogeneity, that is the idea that mental conditions are sufficiently homogeneous to justify generalization; b) additive comorbidity, that is the idea that the coexistence of multiple conditions in the same individual can be interpreted as additive. In this paper we take autism research as a case study to show that, despite a plethora of criticism, (...) psychiatric research often continues to operate in accordance with this model. Then we argue that such a model runs into problems once facts about comorbidity are taken into account. Finally, we offer some suggestions on how to tackle the challenge raised by comorbidity and its impact on heterogeneity. To do so, we explore transdiagnostic stratification accounts and network models to show that combining these approaches can move us in the right direction. (shrink)

In spite of a considerable progress in comorbidity research and huge literature on it, this phenomenon is one of the greatest epistemological, research and clinical challenges to contemporary psychiatry and medicine. Mental disorders are very often comorbidly expressed, both among themselves and with various sorts of somatic diseases and illnesses. Therefore, comorbidity studies have been expected to be an impetus to research on the validity of current diagnostic systems as well as on establishing more effective and effi cient (...) treatment within the frame of person centered transdisciplinary psychiatry and integrative medicine. This review focuses fi rst on conceptual chaos and different connotations, then on transdisciplinary perspectives of comorbidity and multimorbidity. The authors compiled an extensive set of various views and perspectives, dilemmas and controversies, in order to evaluate what we know and what we don’t about comorbidity, what comorbidity is and what comorbidity is not, what are facts and what are non-facts on comorbidity and multimorbidity. (shrink)

Jakovljevic and Crnčevic review the concept of comorbidity in relation to mental disorders, which is timely. Yet they seem to ignore a longstanding and important notion of comorbidity, highlighted in psychiatry particularly by Sigmund Freud. The ignored notion is that of compensatory comorbidity. Compensatory comorbidity is a special case of compensatory phenomena in relation to disrupted health.

In this article, we propose the Fair Priority Model for COVID-19 vaccine distribution, and emphasize three fundamental values we believe should be considered when distributing a COVID-19 vaccine among countries: Benefiting people and limiting harm, prioritizing the disadvantaged, and equal moral concern for all individuals. The Priority Model addresses these values by focusing on mitigating three types of harms caused by COVID-19: death and permanent organ damage, indirect health consequences, such as health care system strain and stress, as well as (...) economic destruction. It proposes proceeding in three phases: the first addresses premature death, the second long-term health issues and economic harms, and the third aims to contain viral transmission fully and restore pre-pandemic activity. -/- To those who may deem an ethical framework irrelevant because of the belief that many countries will pursue "vaccine nationalism," we argue such a framework still has broad relevance. Reasonable national partiality would permit countries to focus on vaccine distribution within their borders up until the rate of transmission is below 1, at which point there would not be sufficient vaccine-preventable harm to justify retaining a vaccine. When a government reaches the limit of national partiality, it should release vaccines for other countries. -/- We also argue against two other recent proposals. Distributing a vaccine proportional to a country's population mistakenly assumes that equality requires treating differently situated countries identically. Prioritizing countries according to the number of front-line health care workers, the proportion of the population over 65, and the number of people with comorbidities within each country may exacerbate disadvantage and end up giving the vaccine in large part to wealthy nations. (shrink)

RD, a 32-year-old male, was admitted to the hospital with hypoxic COVID pneumonia–a potentially life-threatening condition characterized by dangerously low levels of oxygen in the body- during one of the pandemic’s surges. While RD’s age gave the clinical team hope for his prognosis, his ability to recover was complicated by his being unvaccinated and having multiple comorbidities, including diabetes and obesity. His condition worsened to the point that he required extracorporeal membrane oxygenation (ECMO), a machine that maintains the functioning of (...) a person’s heart and lungs. -/- Given its scarcity–only 264 of the over 6,000 hospitals in the United States offer ECMO, according to the Extracorporeal Life Support Organization–as well as its high cost and the inadequate supply of staff required to maintain it, ECMO primarily serves as a bridge to support critically ill patients until they can receive an organ transplant or implanted medical device. For RD, ECMO was started to support him until he could be evaluated for, and possibly receive, a bilateral lung transplant. Despite its intended use as a treatment of last resort, some patients can remain on ECMO for weeks or months. And some are awake, alert, and capable of medical decision-making. -/- RD was one such patient. However, the transplant evaluation committee ruled out RD’s candidacy for bilateral lung transplantation, based on his poor potential for recovery and a lack of family and friends to provide post-transplant support. This determination raised the prospect of continued ECMO treatment being a bridge to nowhere. But RD was comfortable on ECMO and wanted to remain in the ICU. The ICU intensivist contacted the ethics consult service with questions about whether continued ECMO support was medically and ethically inappropriate. (shrink)

Context — Children and adults with psychopathic traits and conduct or oppositional defiant disorder demonstrate poor decision making and are impaired in reversal learning. However, the neural basis of this impairment has not previously been investigated. Furthermore, despite high comorbidity of psychopathic traits and attention deficit/hyperactivity disorder, to our knowledge, no research has attempted to distinguish neural correlates of childhood psychopathic traits and attention-deficit/hyperactivity disorder. Objective—To determine the neural regions that underlie the reversal learning impairments in children with psychopathic (...) traits plus conduct or oppositional defiant disorder. Design — Case-control study. Setting — Government clinical research institute. Participants — Forty-two adolescents aged 10 to 17 years: 14 with psychopathic traits and oppositional defiant disorder or conduct disorder, 14 with attention-deficit/hyperactivity disorder only, and 14 healthy controls. Main Outcome Measure — Blood oxygenation level–dependent signal as measured via functional magnetic resonance imaging during a probabilistic reversal task. Results — Children with psychopathic traits showed abnormal responses within the ventromedial prefrontal cortex (Brodmann area 10) during punished reversal errors compared with children wit hattention deficit/hyperactivity disorder and healthy children (P < .05 corrected for multiple comparisons). Conclusions — To our knowledge, this study provides the first evidence of abnormal ventromedial prefrontal cortex responsiveness in children with psychopathic traits and demonstrates this dysfunction was not attributable to comorbid attention-deficit/hyperactivity disorder. These findings suggest that reversal learning impairments in patients with developmental psychopathic traits relate to abnormal processing of reinforcement information. (shrink)

The importance of the working document is that it allows the analysis of the information and the status of cases associated with (SARS-CoV-2) COVID-19 as open data at the municipal, state and national level, with a daily record of patients, according to a age, sex, comorbidities, for the condition of (SARS-CoV-2) COVID-19 according to the following characteristics: a) Positive, b) Negative, c) Suspicious. Likewise, it presents information related to the identification of an outpatient and / or hospitalized patient, attending to (...) their medical development, identifying: a) Recovered, b) Deaths and c) Active, in Phase 3 and Phase 4, in the five main population areas speaker of indigenous language in the State of Veracruz - Mexico. The data analysis is carried out through the application of a data mining algorithm, which provides the information, fast and timely, required for the estimation of Medical Care Scenarios of (SARS-CoV-2) COVID-19, as well as for know the impact on the indigenous language speaking population in Veracruz. For this purpose, the following study zones are presented: a) Totonacapan Zone, b) Huasteco from the Tantoyuca Zone, c) Otomi from the Inxhuatlan de Madero Zone, d) Nahuatl from the Zongolica Zone, e) Nahuatl from the Chicontepec Zone, f) Nahualt from the Pajapan Zone and g) Popoluca from the Soteapan Zone. This data article presents the information as of August 1, 2020 corresponding to the Totonacapan Area. (shrink)

The importance of the working document is that it allows the analysis of the information and the status of cases associated with (SARS-CoV-2) COVID-19 as open data at the municipal, state and national level, with a daily record of patients, according to a age, sex, comorbidities, for the condition of (SARS-CoV-2) COVID-19 according to the following characteristics: a) Positive, b) Negative, c) Suspicious. Likewise, it presents information related to the identification of an outpatient and / or hospitalized patient, attending to (...) their medical development, identifying: a) Recovered, b) Deaths and c) Active, in Phase 3 and Phase 4, in the five main population areas speaker of indigenous language in the State of Veracruz - Mexico. The data analysis is carried out through the application of a data mining algorithm, which provides the information, fast and timely, required for the estimation of Medical Care Scenarios of (SARS-CoV-2) COVID-19, as well as for know the impact on the indigenous language speaking population in Veracruz. For this purpose, the following study zones are presented: a) Totonacapan Zone, b) Huasteco from the Tantoyuca Zone, c) Otomi from the Inxhuatlan de Madero Zone, d) Nahuatl from the Zongolica Zone, e) Nahuatl from the Chicontepec Zone, f) Nahualt from the Pajapan Zone and g) Popoluca from the Soteapan Zone. This data article presents the information as of August 1, 2020 corresponding to the Otomi of the Ixhuatlan de Madero area. (shrink)

The importance of the working document is that it allows the analysis of the information and the status of cases associated with (SARS-CoV-2) COVID-19 as open data at the municipal, state and national level, with a daily record of patients, according to a age, sex, comorbidities, for the condition of (SARS-CoV-2) COVID-19 according to the following characteristics: a) Positive, b) Negative, c) Suspicious. Likewise, it presents information related to the identification of an outpatient and / or hospitalized patient, attending to (...) their medical development, identifying: a) Recovered, b) Deaths and c) Active, in Phase 3 and Phase 4, in the five main population areas speaker of indigenous language in the State of Veracruz - Mexico. The data analysis is carried out through the application of a data mining algorithm, which provides the information, fast and timely, required for the estimation of Medical Care Scenarios of (SARS-CoV-2) COVID-19, as well as for know the impact on the indigenous language speaking population in Veracruz. For this purpose, the following study zones are presented: a) Totonacapan Zone, b) Huasteco from the Tantoyuca Zone, c) Otomi from the Inxhuatlan de Madero Zone, d) Nahuatl from the Zongolica Zone, e) Nahuatl from the Chicontepec Zone, f) Nahualt from the Pajapan Zone and g) Popoluca from the Soteapan Zone. This data article presents the information as of August 1, 2020 corresponding to the Popoluca from the Soteapan Area. (shrink)

Three common ethical principles for establishing the limits of parental authority in pediatric treatment decision making are the harm principle, the principle of best interest, and the threshold view. This paper consider how these principles apply to a case of a premature neonate with multiple significant comorbidities whose mother wanted all possible treatments, and whose health care providers wondered whether it would be ethically permissible to allow him to die comfortably despite her wishes. Whether and how these principles help to (...) understand what was morally right for the child is questioned. The paper concludes that the principles were of some value in understanding the moral geography of the case, but that the case reveals common bioethical principles for medical decision making are problematically value-laden because they are inconsistent with the widespread moral value of medical vitalism. (shrink)

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients’ perceptions regarding cessation of cancer screening. Information on older adults’ views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening.

Current health care standards, in many countries, Australia included, are regrettably poor. Surprisingly, practitioners and treating teams alike in mental health and disability sectors, in particular, make far too many basic care-related mistakes, in addition to the already abundant diagnostic mistakes that cause and amplify great harm. In part, too many practitioners also fail to distinguish adverse effects for what they are and all too often treat adverse effects, instead, as comorbidities. Diagnostic failures are dangerous, the result of which generates (...) and perpetuates harms that are extremely costly in terms of patient welfare, in addition to the financial burden placed on everyone. In this essay, I contend that the authority bestowed upon psychiatry is misplaced. Subsequently, this misplaced authority affects the governing and investigatory institutions reliant and informed by psychiatry. The examination process undertaken in this investigation traces the metaphysics of psychiatric disorders relative to the Diagnostic-Statistical-Manual (DSM) in all its iterations and to the epistemological construction process that serves to underpin the fundamentals of psychiatric practice. There exists a crisis of confidence in psychiatric practice and I urge drastic reform be undertaken to arrest the damage. (shrink)

Importance: Patients with remitted major depressive disorder (MDD) were previously found to display abnormal functional magnetic resonance imaging connectivity (fMRI) between the right superior anterior temporal lobe (RSATL) and the subgenual cingulate cortex and adjacent septal region (SCSR) when experiencing self-blaming emotions relative to emotions related to blaming others (eg, "indignation or anger toward others"). This finding provided the first neural signature of biases toward overgeneralized self-blaming emotions (eg, "feeling guilty for everything"), known to have a key role in cognitive (...) vulnerability to MDD. It is unknown whether this neural signature predicts risk of recurrence, a crucial step in establishing its potential as a prognostic biomarker, which is urgently needed for stratification into pathophysiologically more homogeneous subgroups and for novel treatments. -/- Objective: To use fMRI in remitted MDD at baseline to test the hypothesis that RSATL-SCSR connectivity for self-blaming relative to other-blaming emotions predicts subsequent recurrence of depressive episodes. -/- Design, setting, and participants: A prospective cohort study from June 16, 2011, to October 10, 2014, in a clinical research facility completed by 75 psychotropic medication-free patients with remitted MDD and no relevant comorbidity. In total, 31 remained in stable remission, and 25 developed a recurring episode over the 14 months of clinical follow-up and were included in the primary analysis. Thirty-nine control participants with no personal or family history of MDD were recruited for further comparison. -/- Main outcomes and measures: Between-group difference (recurring vs stable MDD) in RSATL connectivity, with an a priori SCSR region of interest for self-blaming vs other-blaming emotions. -/- Results: We corroborated our hypothesis that during the experience of self-blaming vs other-blaming emotions, RSATL-SCSR connectivity predicted risk of subsequent recurrence. The recurring MDD group showed higher connectivity than the stable MDD group (familywise error-corrected P < .05 over the a priori SCSR region of interest) and the control group. In addition, the recurring MDD group also exhibited RSATL hyperconnectivity with the right ventral putamen and claustrum and the temporoparietal junction. Together, these regions predicted recurrence with 75% accuracy. -/- Conclusions and relevance: To our knowledge, this study is the first to provide a robust demonstration of an fMRI signature of recurrence risk in remitted MDD. Additional studies are needed for its further optimization and validation as a prognostic biomarker. (shrink)

Objective: The objective of this study was to evaluate the clinical efficacy and appropriateness of colistin therapy in patients with hematological malignancies. -/- Methods: Age, gender, type of hematologic malignancy, and potential carbapenem-resistant microorganism risk factors were all noted in this retrospective study. In empirical and agent-specific treatment groups, differences in demographic features, risk factors, treatment responses, and side effects were compared. -/- Results: Sixty-three patients were included, 54% were male, and the median age was 49. In the last three (...) months, the hospitalization rate history was 68%, and four patients had a hospitalization history in the ICU. Carbapenem-resistant K. pneumoniae colonization was present in 22 patients (35%). Gram-negative microorganisms were isolated in 34 patients (54%). The carbapenem, quinolone, and colistin resistance rates were 82%, 76%, and 4% respectively. Clinical and microbiological response rates were 60% and 69%. 7 and 28-day mortality rates were 17% and 35%. There was no significant difference in demographic data and comorbidities in empirical (n=48) and agent-specific (n=15) treatment groups. The rate of carbapenem and glycopeptide treatments before colistin was higher in the empirical treatment group (p = 0.004; p = 0.001). The rate of starting combined antibiotics was higher in the empirical treatment group (p = 0.016). Two of the patients developed renal failure in the first week after treatment. -/- Conclusion: The use of empirical colistin may be unavoidable given the risk considerations. Shortly, colistin-resistant strains may also be a factor affecting treatment success negatively. (shrink)

To date, diagnosing Attention Defi cit Hyperactivity Disorder remains indeed one of the most controversial issues in contemporary psychiatry and behavioural sciences. Most of the conceptual problems regarding the validity of this diagnostic category arise from the heterogeneity of syndromal pictures and the high rate of comorbidity observed in subjects diagnosed with ADHD at all stages of the longitudinal course of the disorder. In this regard, DSM 5 increased complexity by allowing a diagnosis of comorbidity between ADHD and (...) autism spectrum disorders while these two diagnoses were mutually exclusive in DSM-IV-TR. (shrink)

The world population is aging rapidly. Fear of falling among the elderly constitute a significant problem in health care. Among community-dwelling elderly, fear of falling is frequent, with prevalence ranging from 3% to 85% % in community-based epidemiologic studies. The aim of this review is to reveal the prevalence and risk factors of fear of falling (FOF) among elderly. The review has identified that age, sex, physical performance, comorbidity, a history of falls, hearing impairment, poor self-related health and depressive (...) symptoms affect fear of falling. The consequences that develop as a result of a fear of falling can include: loss of confidence, decreased quality of life, mobility or activity restriction and the development of deconditioning, leading to loneliness, depression, and anxiety, subsequent falls and physical, psychological and mental function declines. Maintenance of physical function and pain management might be important for older adults with fear of falling. (shrink)

The importance of the working document is that it allows the analysis of the information and the status of cases associated with (SARS-CoV-2) COVID-19 as open data at the municipal, state and national level, with a daily record of patients, according to a age, sex, comorbidities, for the condition of (SARS-CoV-2) COVID-19 according to the following characteristics: a) Positive, b) Negative, c) Suspicious. Likewise, it presents information related to the identification of an outpatient and / or hospitalized patient, attending to (...) their medical development, identifying: a) Recovered, b) Deaths and c) Active, in Phase 3 and Phase 4, in the five main population areas speaker of indigenous language in the State of Veracruz - Mexico. The data analysis is carried out through the application of a data mining algorithm, which provides the information, fast and timely, required for the estimation of Medical Care Scenarios of (SARS-CoV-2) COVID-19, as well as for know the impact on the indigenous language speaking population in Veracruz. For this purpose, the following study zones are presented: a) Totonacapan Zone, b) Huasteco from the Tantoyuca Zone, c) Otomi from the Inxhuatlan de Madero Zone, d) Nahuatl from the Zongolica Zone, e) Nahuatl from the Chicontepec Zone, f) Nahualt from the Pajapan Zone and g) Popoluca from the Soteapan Zone. This data article presents the information as of August 1, 2020 corresponding to the Huasteco Area. Keywords (SARS-CoV-2) COVID-19, Algorithm (SARS-CoV-2) COVID-19, Mexico, identification of patients, Huasteco Area . (shrink)

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute (...) hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use. (shrink)

The public health crisis is started with emergence of new coronavirus on 11 February 2020 which triggered as coronavirus disease-2019 (COVID-19) pandemics. The causative agent in COVID-19 is made up of positively wrapped single-stranded RNA viruses ~ 30 kb in size. The epidemiology, clinical features, pathophysiology, and mode of transmission have been documented well in many studies, with additional clinical trials are running for several antiviral agents. The spreading potential of COVID-19 is faster than its two previous families, the severe (...) acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV). Apart from clinical manifestation, comorbid status is playing key role for prevalence of COVID-19 infection and mortalities. The comorbid effects associated with COVID-19 are diabetes, cardiovascular, digestive, hepatitis-B, cerebrovascular, hypertension, liver injury, coronary heart disease, cancer, rheumatoid arthritis, and neurological impairment. Antimalarial drugs (chloroquine and hydroxychloroquine), remdesivir, Tocilizumab, clopinavir/ritonavir, convalescent plasma therapy, spike protein-angiotensin-converting enzyme 2 (ACE2) inhibitors, human monoclonal antibodies, mRNA-1273, mesenchymal stem cells, Indian and Chinese traditional medicine, small molecules antioxidant, natural products and dietary supplements, high doses of vitamin-E, -C, -D, minerals, flavonoids,and IFN-beta are therapeutic intervention running to develop treatment against COVID-19. Although clinical usage of these therapeutic agents against COVID-19 is well documented, cytokine storms, absence of appropriate animal model have limited its therapeutic use. This review explores the clinical information currently available on COVID-19 on the mechanisms of infection, prevention, management, comorbid status, and current drug treatment options. (shrink)

Background: A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identification of vulnerabilities and the required changes that the healthcare management system should undergo. Objectives: This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends. Methods: Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. Individuals (...) were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period. Results: In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media. Conclusions: Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics. (shrink)

Coronavirus disease (Covid-19) is an infectious disease caused by the SARS-CoV-2 virus. Spreading rate of mutated corona virus (delta variant) during second wave was very fast. Most of the people infected with the COVID-19 virus experienced mild to moderate to severe respiratory illness. Although patients in the second wave were younger but the duration of hospitalization and case fatality rate were lower than those in the first wave. During first wave of Covid-19 it was observed that persons above 55 years (...) of age and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease and cancer were more susceptible to develop serious illness but in second it was observed that person between 30 to 55 years along with old age and younger people suffering from hypertension, diabetes and respiratory diseases were more susceptible to this covid-19 virus. The most frequent signs and symptoms in both waves were fever, dyspnea, pneumonia, and cough, and the most relevant comorbidities were cardiovascular diseases, type 2 diabetes mellitus, and chronic neurological diseases. Every country has lost its human resources due to covid-19 virus which not only disturb the social life but economic conditions are also very badly affected. Now we use the resources so rapidly that may create economic imbalance in future. The psychological effect is an essential component of disaster management of infectious pandemics. (shrink)