Defense Health Agency

About: Defense Health Agency is a government organization based out in Falls Church, Virginia, United States. It is known for research contribution in the topics: Health care & Population. The organization has 295 authors who have published 350 publications receiving 3062 citations.

Myocarditis Following Immunization With mRNA COVID-19 Vaccines in Members of the US Military.

Abstract: Importance Myocarditis has been reported with COVID-19 but is not clearly recognized as a possible adverse event following COVID-19 vaccination. Objective To describe myocarditis presenting after COVID-19 vaccination within the Military Health System. Design, Setting, and Participants This retrospective case series studied patients within the US Military Health System who experienced myocarditis after COVID-19 vaccination between January and April 2021. Patients who sought care for chest pain following COVID-19 vaccination and were subsequently diagnosed with clinical myocarditis were included. Exposure Receipt of a messenger RNA (mRNA) COVID-19 vaccine between January 1 and April 30, 2021. Main Outcomes and Measures Clinical diagnosis of myocarditis after COVID-19 vaccination in the absence of other identified causes. Results A total of 23 male patients (22 currently serving in the military and 1 retiree; median [range] age, 25 [20-51] years) presented with acute onset of marked chest pain within 4 days after receipt of an mRNA COVID-19 vaccine. All military members were previously healthy with a high level of fitness. Seven received the BNT162b2-mRNA vaccine and 16 received the mRNA-1273 vaccine. A total of 20 patients had symptom onset following the second dose of an appropriately spaced 2-dose series. All patients had significantly elevated cardiac troponin levels. Among 8 patients who underwent cardiac magnetic resonance imaging within the acute phase of illness, all had findings consistent with the clinical diagnosis of myocarditis. Additional testing did not identify other etiologies for myocarditis, including acute COVID-19 and other infections, ischemic injury, or underlying autoimmune conditions. All patients received brief supportive care and were recovered or recovering at the time of this report. The military administered more than 2.8 million doses of mRNA COVID-19 vaccine in this period. While the observed number of myocarditis cases was small, the number was higher than expected among male military members after a second vaccine dose. Conclusions and Relevance In this case series, myocarditis occurred in previously healthy military patients with similar clinical presentations following receipt of an mRNA COVID-19 vaccine. Further surveillance and evaluation of this adverse event following immunization is warranted. Potential for rare vaccine-related adverse events must be considered in the context of the well-established risk of morbidity, including cardiac injury, following COVID-19 infection.

Microvascular Injury in the Brains of Patients with Covid-19.

Abstract: Microvascular Changes in the Brain in Covid-19 High-resolution MRI and histopathological study of the brains of patients who had died from Covid-19 showed punctate hyperintensities and punctate or ...

Prediction Models for Suicide Attempts and Deaths: A Systematic Review and Simulation.

Abstract: Importance Suicide prediction models have the potential to improve the identification of patients at heightened suicide risk by using predictive algorithms on large-scale data sources. Suicide prediction models are being developed for use across enterprise-level health care systems including the US Department of Defense, US Department of Veterans Affairs, and Kaiser Permanente. Objectives To evaluate the diagnostic accuracy of suicide prediction models in predicting suicide and suicide attempts and to simulate the effects of implementing suicide prediction models using population-level estimates of suicide rates. Evidence Review A systematic literature search was conducted in MEDLINE, PsycINFO, Embase, and the Cochrane Library to identify research evaluating the predictive accuracy of suicide prediction models in identifying patients at high risk for a suicide attempt or death by suicide. Each database was searched from inception to August 21, 2018. The search strategy included search terms for suicidal behavior, risk prediction, and predictive modeling. Reference lists of included studies were also screened. Two reviewers independently screened and evaluated eligible studies. Findings From a total of 7306 abstracts reviewed, 17 cohort studies met the inclusion criteria, representing 64 unique prediction models across 5 countries with more than 14 million participants. The research quality of the included studies was generally high. Global classification accuracy was good (≥0.80 in most models), while the predictive validity associated with a positive result for suicide mortality was extremely low (≤0.01 in most models). Simulations of the results suggest very low positive predictive values across a variety of population assessment characteristics. Conclusions and Relevance To date, suicide prediction models produce accurate overall classification models, but their accuracy of predicting a future event is near 0. Several critical concerns remain unaddressed, precluding their readiness for clinical applications across health systems.

Integrated Behavioral Health in Primary Care: Step-by-Step Guidance for Assessment and Intervention

Abstract: As many as 70 per cent of primary care visits in the United States are related to behavioral health needs. And many common medical problems seen in primary care involve poor health habits that may have initiated or exacerbated the symptoms, yet medical providers often lack the training or time to help patients manage these behaviors. The authors of this book draw on years of experience to provide practical information for behavioral care practitioners who wish to work effectively in this fast-paced setting.Interwoven through each chapter are practical tips for success and traps to avoid. The book includes a rich array of reproducible assessment questions, patient handouts, and sample scripts. All of these help the clinician condense the traditional 50-minute session into the 30-minute consultations typical of managed care. Each chapter addresses a single clinical topic or content area following the 5A's model of assessment and intervention: Assess, Advise, Agree, Assist and Arrange. Detailed guidance is provided for these common health problems: generalized anxiety disorder, panic disorder, posttraumatic stress disorder, depression, tobacco use, weight issues, sleep problems, diabetes, asthma, irritable bowel syndrome, cardiovascular disorders, pain disorders, sexual problems, and health anxiety. Special chapters cover cultural competency, special concerns for older adults, women's health, and 'health anxiety'.This comprehensive book belongs on the bookshelf of a range of clinicians including psychologists and social workers, as well as family physicians, physician assistants, nurses, and health care educators.

Competencies for psychology practice in primary care.

Abstract: This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.