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51.
Clinical utility of ICD‐11 diagnostic guidelines for high‐burden mental disorders: results from mental health settings in 13 countries
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Geoffrey M. Reed Jared W. Keeley Tahilia J. Rebello Michael B. First Oye Gureje José Luis Ayuso‐Mateos Shigenobu Kanba Brigitte Khoury Cary S. Kogan Valery N. Krasnov Mario Maj Jair de Jesus Mari Pratap Sharan Dan J. Stein Min Zhao Tsuyoshi Akiyama Howard F. Andrews Elson Asevedo Majda Cheour Tecelli Domínguez‐Martínez Joseph El‐Khoury Andrea Fiorillo Jean Grenier Nitin Gupta Lola Kola Maya Kulygina Itziar Leal‐Leturia Mario Luciano Bulumko Lusu J. Nicolás I. Martínez‐López Chihiro Matsumoto Mayokun Odunleye Lucky Umukoro Onofa Sabrina Paterniti Shivani Purnima Rebeca Robles Manoj K. Sahu Goodman Sibeko Na Zhong Wolfgang Gaebel Anne M. Lovell Toshimasa Maruta Kathleen M. Pike Michael C. Roberts María Elena Medina‐Mora 《World psychiatry》2018,17(3):306-315
In this paper we report the clinical utility of the diagnostic guidelines for ICD‐11 mental, behavioural and neurodevelopmental disorders as assessed by 339 clinicians in 1,806 patients in 28 mental health settings in 13 countries. Clinician raters applied the guidelines for schizophrenia and other primary psychotic disorders, mood disorders (depressive and bipolar disorders), anxiety and fear‐related disorders, and disorders specifically associated with stress. Clinician ratings of the clinical utility of the proposed ICD‐11 diagnostic guidelines were very positive overall. The guidelines were perceived as easy to use, corresponding accurately to patients’ presentations (i.e., goodness of fit), clear and understandable, providing an appropriate level of detail, taking about the same or less time than clinicians’ usual practice, and providing useful guidance about distinguishing disorder from normality and from other disorders. Clinicians evaluated the guidelines as less useful for treatment selection and assessing prognosis than for communicating with other health professionals, though the former ratings were still positive overall. Field studies that assess perceived clinical utility of the proposed ICD‐11 diagnostic guidelines among their intended users have very important implications. Classification is the interface between health encounters and health information; if clinicians do not find that a new diagnostic system provides clinically useful information, they are unlikely to apply it consistently and faithfully. This would have a major impact on the validity of aggregated health encounter data used for health policy and decision making. Overall, the results of this study provide considerable reason to be optimistic about the perceived clinical utility of the ICD‐11 among global clinicians. 相似文献
52.
The ICD‐11 developmental field study of reliability of diagnoses of high‐burden mental disorders: results among adult patients in mental health settings of 13 countries
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Tahilia J. Rebello Jared W. Keeley María Elena Medina‐Mora Oye Gureje José Luis Ayuso‐Mateos Shigenobu Kanba Brigitte Khoury Cary S. Kogan Valery N. Krasnov Mario Maj Jair de Jesus Mari Dan J. Stein Min Zhao Tsuyoshi Akiyama Howard F. Andrews Elson Asevedo Majda Cheour Tecelli Domínguez‐Martínez Joseph El‐Khoury Andrea Fiorillo Jean Grenier Nitin Gupta Lola Kola Maya Kulygina Itziar Leal‐Leturia Mario Luciano Bulumko Lusu J. Nicolas I. Martínez‐López Chihiro Matsumoto Lucky Umukoro Onofa Sabrina Paterniti Shivani Purnima Rebeca Robles Manoj K. Sahu Goodman Sibeko Na Zhong Michael B. First Wolfgang Gaebel Anne M. Lovell Toshimasa Maruta Michael C. Roberts Kathleen M. Pike 《World psychiatry》2018,17(2):174-186
Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD‐11). The present study assessed inter‐diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization – schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear‐related disorders, and disorders specifically associated with stress – among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint‐rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD‐11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD‐11 diagnostic guidelines was superior to that previously reported for equivalent ICD‐10 guidelines. These data provide support for the suitability of the ICD‐11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD‐11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD‐11 by WHO member states. 相似文献
53.
Aloma Nogueira Rebello Da Silva Gabriel Rodrigues Coutinho Pereira Lorena Giannini Alves Moreira Catielly Ferreira Rocha Joelma Freire De Mesquita 《Journal of cellular biochemistry》2019,120(10):17822-17830
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease that is characterized by the selective loss of motor neurons. Approximately 5% to 10% of patients with ALS have a family history of the disease, and approximately 20% of familial amyotrophic lateral sclerosis (fALS) cases are associated with mutations in Cu/Zn superoxide dismutase (SOD1). In this study, we evaluated the structural and functional effects of human A4F and A4V SOD1 protein mutations. We performed an in silico analysis using prediction algorithms of nonsynonymous single-nucleotide polymorphisms (nsSNPs) associated with the fALS development. Our structural conservation results show that the mutations analyzed (A4V and A4F) were in a highly conserved region. Molecular dynamics simulations using the Linux GROMACS package revealed how these mutations affect protein structure, protein stability, and aggregation. These results suggest that there might be an effect on the SOD1 function. Understanding the molecular basis of disease provides new insights useful for rational drug design and advancing our understanding of the ALS development. 相似文献
54.
55.
Camila Malta Romano Isabel M. V. Guedes de Carvalho-Mello Leda F. Jamal Fernando Lucas de Melo Atila Iamarino Marco Motoki Jo?o Renato Rebello Pinho Edward C. Holmes Paolo Marinho de Andrade Zanotto the VGDN Consortium 《PloS one》2010,5(6)
Hepatitis C virus (HCV) infects 170 million people worldwide, and is a major public health problem in Brazil, where over 1% of the population may be infected and where multiple viral genotypes co-circulate. Chronically infected individuals are both the source of transmission to others and are at risk for HCV-related diseases, such as liver cancer and cirrhosis. Before the adoption of anti-HCV control measures in blood banks, this virus was mainly transmitted via blood transfusion. Today, needle sharing among injecting drug users is the most common form of HCV transmission. Of particular importance is that HCV prevalence is growing in non-risk groups. Since there is no vaccine against HCV, it is important to determine the factors that control viral transmission in order to develop more efficient control measures. However, despite the health costs associated with HCV, the factors that determine the spread of virus at the epidemiological scale are often poorly understood. Here, we sequenced partial NS5b gene sequences sampled from blood samples collected from 591 patients in São Paulo state, Brazil. We show that different viral genotypes entered São Paulo at different times, grew at different rates, and are associated with different age groups and risk behaviors. In particular, subtype 1b is older and grew more slowly than subtypes 1a and 3a, and is associated with multiple age classes. In contrast, subtypes 1a and 3b are associated with younger people infected more recently, possibly with higher rates of sexual transmission. The transmission dynamics of HCV in São Paulo therefore vary by subtype and are determined by a combination of age, risk exposure and underlying social network. We conclude that social factors may play a key role in determining the rate and pattern of HCV spread, and should influence future intervention policies. 相似文献
56.
57.
Lúcia Rebello Dillenburg Luís Mauro Gonçalves Rosa Morgana Mósena 《Trees - Structure and Function》2010,24(4):705-711
Araucaria angustifolia exhibits cryptogeal germination, where the root–hypocotyl axis emerges first and penetrates into the soil. In Araucaria bidwillii, the whole process of transferring reserves from the seed to the seedling takes place before shoot emergence, and there is
a major storage of these reserves in the underground hypocotyl, which assumes a tuberous form. In A. angustifolia, the shoot emerges before seed reserves are depleted. Though it does not grow like a tuber, the hypocotyl of A. angustifolia grows thicker than the adjacent taproot during initial growth, and we hypothesize that it may act as a major sink for seed
reserves during this stage. The study tests this hypothesis by evaluating changes in the mass of different plant parts during
initial growth. Four harvests were conducted during a ~6-month period to compare the dry mass of different fractions (attached
seed, seedling, its shoot and root and the hypocotyl) of seedlings growing under darkness and high light. While seed reserves
were still being depleted, the hypocotyl mass showed an initial increase and then a reduction. This was more abrupt when light
was available. After seed mass had stabilized, the mass of the hypocotyl continued to decrease in the dark-grown seedlings,
but showed a second increase in the light-grown ones. Results confirm the hypothesis that the hypocotyl represents a major
sink for the seed reserves of A. angustifolia, acting as an underground storage structure for the growing seedling. Its reserves seem to be important for sustaining initial
shoot growth and might also act as a storage sink for photosynthates. 相似文献
58.
Cíntia Bittar Ana Carolina Gomes Jardim Lilian Hiromi Tomonari Yamasaki Claudia Márcia Aparecida Carareto Jo?o Renato Rebello Pinho Philippe Lemey Isabel Maria Vicente Guedes de Carvalho-Mello Paula Rahal 《PloS one》2013,8(4)
Background
Hepatitis C is a disease spread throughout the world. Hepatitis C virus (HCV), the etiological agent of this disease, is a single-stranded positive RNA virus. Its genome encodes a single precursor protein that yields ten proteins after processing. NS5A, one of the non-structural viral proteins, is most associated with interferon-based therapy response, the approved treatment for hepatitis C in Brazil. HCV has a high mutation rate and therefore high variability, which may be important for evading the immune system and response to therapy. The aim of this study was to analyze the evolution of NS5A quasispecies before, during, and after treatment in patients infected with HCV genotype 3a who presented different therapy responses.Methods
Viral RNA was extracted, cDNA was synthesized, the NS5A region was amplified and cloned, and 15 clones from each time-point were sequenced. The sequences were analyzed for evolutionary history, genetic diversity and selection.Results
This analysis shows that the viral population that persists after treatment for most non-responder patients is present in before-treatment samples, suggesting it is adapted to evade treatment. In contrast, the population found in before treatment samples from most end-of-treatment responder patients either are selected out or appears in low frequency after relapse, therefore changing the population structure. The exceptions illustrate the uniqueness of the evolutionary process, and therefore the treatment resistance process, in each patient.Conclusion
Although evolutionary behavior throughout treatment showed that each patient presented different population dynamics unrelated to therapy outcome, it seems that the viral population from non-responders that resists the treatment already had strains that could evade therapy before it started. 相似文献59.