Hugo Cogo-Moreira

Childhood Trauma Questionnaire (CTQ) in Brazilian Samples of Different Age Groups: Findings from Confirmatory Factor Analysis

The Childhood Trauma Questionnaire (CTQ) is internationally accepted as a key tool for the assessment of childhood abuse and neglect experiences. However, there are relative few psychometric studies available and some authors have proposed two different factor solutions. We examined the dimensional structure and internal consistency of the Brazilian version of the CTQ. A total of 1,925 participants from eight different clinical and non-clinical samples including adolescents, adults and elders were considered in this study. First, we performed Confirmatory Factor Analysis to investigate the goodness of fit of the two proposed competitive factor structure models for the CTQ. We also investigated the internal consistency of all factors. Second, multi-group analyses were used to investigate measurement invariance and population heterogeneity across age groups and sex. Our findings revealed that the alternative factor structure as opposed to the original factor structure was the most appropriate model within adolescents and adults Brazilian samples. We provide further evidence for the validity and reliability of the CTQ within the Brazilian samples and report that the alternative model showed an improvement in fit indexes and may be a better alternative over the original model.

Effectiveness of Music Education for the Improvement of Reading Skills and Academic Achievement in Young Poor Readers: A Pragmatic Cluster-Randomized, Controlled Clinical Trial

Introduction Difficulties in word-level reading skills are prevalent in Brazilian schools and may deter children from gaining the knowledge obtained through reading and academic achievement. Music education has emerged as a potential method to improve reading skills because due to a common neurobiological substratum. Objective To evaluate the effectiveness of music education for the improvement of reading skills and academic achievement among children (eight to 10 years of age) with reading difficulties. Method 235 children with reading difficulties in 10 schools participated in a five-month, randomized clinical trial in cluster (RCT) in an impoverished zone within the city of São Paulo to test the effects of music education intervention while assessing reading skills and academic achievement during the school year. Five schools were chosen randomly to incorporate music classes (n = 114), and five served as controls (n = 121). Two different methods of analysis were used to evaluate the effectiveness of the intervention: The standard method was intention-to-treat (ITT), and the other was the Complier Average Causal Effect (CACE) estimation method, which took compliance status into account. Results The ITT analyses were not very promising; only one marginal effect existed for the rate of correct real words read per minute. Indeed, considering ITT, improvements were observed in the secondary outcomes (slope of Portuguese = 0.21 [p<0.001] and slope of math = 0.25 [p<0.001]). As for CACE estimation (i.e., complier children versus non-complier children), more promising effects were observed in terms of the rate of correct words read per minute [β = 13.98, p<0.001] and phonological awareness [β = 19.72, p<0.001] as well as secondary outcomes (academic achievement in Portuguese [β = 0.77, p<0.0001] and math [β = 0.49, p<0.001] throughout the school year). Conclusion The results may be seen as promising, but they are not, in themselves, enough to make music lessons as public policy.

The Impact of Antipsychotic Polytherapy Costs in the Public Health Care in Sao Paulo, Brazil

Introduction Guidelines for the treatment of psychoses recommend antipsychotic monotherapy. However, the rate of antipsychotic polytherapy has increased over the last decade, reaching up to 60% in some settings. Studies evaluating the costs and impact of antipsychotic polytherapy in the health system are scarce. Objective To estimate the costs of antipsychotic polytherapy and its impact on public health costs in a sample of subjects with psychotic disorders living in residential facilities in the city of Sao Paulo, Brazil. Method A cross-sectional study that used a bottom-up approach for collecting costs data in a public health provider´s perspective. Subjects with psychosis living in 20 fully-staffed residential facilities in the city of Sao Paulo were assessed for clinical and psychosocial profile, severity of symptoms, quality of life, use of health services and pharmacological treatment. The impact of polytherapy on total direct costs was evaluated. Results 147 subjects were included, 134 used antipsychotics regularly and 38% were in use of antipsychotic polytherapy. There were no significant differences in clinical and psychosocial characteristics between polytherapy and monotherapy groups. Four variables explained 30% of direct costs: the number of antipsychotics, location of the residential facility, time living in the facility and use of olanzapine. The costs of antipsychotics corresponded to 94.4% of the total psychotropic costs and to 49.5% of all health services use when excluding accommodation costs. Olanzapine costs corresponded to 51% of all psychotropic costs. Conclusion Antipsychotic polytherapy is a huge economic burden to public health service, despite the lack of evidence supporting this practice. Great variations on antipsychotic costs explicit the need of establishing protocols for rational antipsychotic prescriptions and consequently optimising resource allocation. Cost-effectiveness studies are necessary to estimate the best value for money among antipsychotics, especially in low and middle income countries.

Dengue-4 false negative results by Panbio ® Dengue Early ELISA assay in Brazil

BACKGROUND Dengue is a serious public health problem in numerous countries. The ability to rapidly diagnosis dengue is important for patient triage and management. Detection of dengue viral protein, NS1, represents a new approach to dengue diagnosis. OBJECTIVE The present study aims to evaluate if there are false negative results using the NS1 Ag rapid assay (Panbio(®) Dengue Early ELISA) in two different epidemiological situations (epidemic and non-epidemic). STUDY DESIGN 220 serum samples from patients with clinical symptoms of classical dengue fever were tested by NS1 antigen capture ELISA and Multiplex-Nested-PCR. RESULTS In samples collected in a non-epidemic period we found a 100% agreement of ELISA and RT-PCR in dengue negative samples and 85% agreement of ELISA and RT-PCR in dengue positive samples. But when we tested samples during an epidemic period (large DENV-4 outbreak) we found 15% false negative results (p<0.05) in dengue negative samples. CONCLUSIONS Due to false negative results for DENV-4, the sole use of the Panbio(®) Dengue Early ELISA assay as a screening method for monitoring circulating dengue serotypes must be reevaluated.

EACOL (Scale of Evaluation of Reading Competence by the Teacher): evidence of concurrent and discriminant validity

Aim The study aimed to provide information about the concurrent and discriminant validation of the Scale of Evaluation of Reading Competence by the Teacher (EACOL), which is composed of 27 dichotomous items concerning reading aloud (17 items) and reading silently (10 items). Samples Three samples were used in this validation study. The first was composed of 335 students with an average age of 9.75 years (SD = 1.2) from Belo Horizonte (Minas Gerais State), Brazil, where the full spectrum of reading ability was assessed. The second two samples were from São Paulo city (São Paulo State), Brazil, where only children with reading difficulties were recruited. The first São Paulo sample was labeled “SP-screening” and had n = 617, with a mean age of 9.8 years (SD = 1.0), and the other sample was labeled “SP-trial” and had n = 235, with a mean age of 9.15 years (SD = 0.05). Methods Results were obtained from a latent class analysis LCA, in which two latent groups were obtained as solutions, and were correlated with direct reading measures. Also, students’ scores on the Wechsler Intelligence Scale and on the Strengths and Difficulties Questionnaire tested the discriminant validation. Results Latent groups of readers underlying the EACOL predicted all direct reading measures, while the same latent groups showed no association with behavior and intelligence assessments, giving concurrent and discriminant validity to EACOL, respectively. Conclusion EACOL is a reliable screening tool which can be used by a wide range of professionals for assessing reading skills.

Angiotensin converting enzyme activity is positively associated with IL-17a levels in patients with schizophrenia

Previous studies of our group showed increased plasmatic Angiotensin-I Converting Enzyme (ACE) activity in schizophrenia (SCZ) patients compared to healthy controls, which was also associated to poor cognitive functioning. The ACE main product angiotensin II (Ang-II) has pro-inflammatory properties. Activated immune-inflammatory responses in SCZ and their association with disease progression and cognitive impairments are also well-described. Therefore, we examined here the association of plasma ACE activity and inflammatory mediators in 33 SCZ patients and 92 healthy controls. Non-parametric correlations were used to investigate the association of the enzyme activity and the peripheral levels of immune inflammatory markers as interleukins, tumor necrosis factor (TNF-α), and interferon (IFN-γ). Although no significant correlations could be observed for ACE activity and measured cytokines levels in healthy controls, a significant positive correlation for ACE enzymatic activity and IL-17a levels was observed in SCZ patients. Correcting for gender did not change these results. Moreover, a significant association for ACE activity and IFN-γ levels was also observed. To our knowledge, this is the first study to show a significant association between higher ACE activity and the levels of cytokines, namely IL-17a and IFN-γ, in patients with SCZ.

Reduction of anterior cingulate in adults with urban violence- related PTSD

BACKGROUND To evaluate differences in limbic structure volume of subjects exposed to urban violence during adulthood, between those who developed posttraumatic stress disorder (with PTSD) and resilient matched controls (without PTSD). METHODS Limbic volumetric measures of 32 subjects with PTSD and 32 subjects without PTSD who underwent brain MRI were analyzed in an epidemiological study in the city of Sao Paulo. The hippocampus, amygdala, cingulate, and parahipocampal gyri volumes were estimated using FreeSurfer software. We also investigated the association between limbic volumetric measurements, symptom´s severity, and early life stress history (measure by Early Trauma Inventory - ETI). RESULTS Subjects with PTSD presented reduced volume of the right rostral part of the anterior cingulate, compared to subjects without PTSD, after controlling for intracranial volume, ETI, and depressive symptoms. Subjects with PTSD presented larger bilateral hippocampus and right amygdala, but secondary to the higher ETI. In PTSD group there was a positive correlation between ETI with bilateral hippocampus, bilateral amygdala, and left parahippocampus. LIMITATIONS First, the cross-sectional study design precludes causal interpretation of limbic structure reduction in PTSD, consequence of PTSD, or other life events. Finally, since the sample size was not sufficiently large, we could not observe whether or not limbic structure volume could be related to the type of trauma. CONCLUSIONS The present study provides evidence of a reduced anterior cingulate volume in subjects with PTSD than in resilient subjects exposed to urban violence. Enlargement of hippocampus and amygdala volume was observed in subjects with PTSD, however secondary to early trauma experience.

A new index for the assessment of transverse sinus stenosis for diagnosing idiopathic intracranial hypertension

Background and purpose To assess the role of MR venography (MRV) for detecting transverse sinus stenosis, to determine the importance of this finding in idiopathic intracranial hypertension (IIH), and to propose an index that contributes to this diagnosis. Materials and methods We retrospectively assessed consecutive intracranial MRV of patients aged >18 years diagnosed with IIH according to the diagnostic criteria, between January 2010 and July 2012. The assessments were randomly analyzed by three radiologists. Stenoses in the right and left transverse sinuses were independently classified according to the following scale: 0, normal; 1, stenosis <33%; 2, stenosis 33–66%; 3, stenosis >66%; and 4, hypoplasia or agenesis. We established an index based on multiplication of the stenosis scale values for each transverse sinus. A point and range estimate of the sensitivity, specificity, and the area under the receiver operating characteristic curve was performed to obtain cut-off points to differentiate between controls and patients. Results 63 individuals were included in this study: 32 (50.8%) diagnosed with IIH (31 (96.9%) women and 1 (3.1%) man) and 31 (49.2%) controls. According to all of the examiners, the IIH group showed a higher degree of stenosis than the control group. Index values ≥4 for a diagnosis of IIH had a sensitivity and specificity of 94.7% and 93.5%, respectively. Conclusions MRV should be used to assess patients with suspected IIH, and bilateral transverse sinus stenosis should be considered for the diagnosis. The stenosis classifying index proposed here is a fast and accessible method for diagnosing IIH.

Latent class analysis of reading, decoding, and writing performance using the Academic Performance Test: concurrent and discriminating validity

Aim To explore and validate the best returned latent class solution for reading and writing subtests from the Academic Performance Test (TDE). Sample A total of 1,945 children (6–14 years of age), who answered the TDE, the Development and Well-Being Assessment (DAWBA), and had an estimated intelligence quotient (IQ) higher than 70, came from public schools in São Paulo (35 schools) and Porto Alegre (22 schools) that participated in the ‘High Risk Cohort Study for Childhood Psychiatric Disorders’ project. They were on average 9.52 years old (standard deviation = 1.856), from the 1st to 9th grades, and 53.3% male. The mean estimated IQ was 102.70 (standard deviation = 16.44). Methods Via Item Response Theory (IRT), the highest discriminating items (‘a’>1.7) were selected from the TDE subtests of reading and writing. A latent class analysis was run based on these subtests. The statistically and empirically best latent class solutions were validated through concurrent (IQ and combined attention deficit hyperactivity disorder [ADHD] diagnoses) and discriminant (major depression diagnoses) measures. Results A three-class solution was found to be the best model solution, revealing classes of children with good, not-so-good, or poor performance on TDE reading and writing tasks. The three-class solution has been shown to be correlated with estimated IQ and to ADHD diagnosis. No association was observed between the latent class and major depression. Conclusion The three-class solution showed both concurrent and discriminant validity. This work provides initial evidence of validity for an empirically derived categorical classification of reading, decoding, and writing performance using the TDE. A valid classification encourages further research investing correlates of reading and writing performance using the TDE.

Assessing risk of bias in randomized controlled trials of methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD)

To test how reliable the tool recommend by Cochrane Collaboration for assessing risk of bias systematic reviews of randomized clinical trials is in the context of methylphenidate for children and adolescents with attention deficit hyperactivity disorder. Confirmatory factor analysis was used to evaluate a unidimensional model for the 7 indicators, applied to 184 Randomized Clinical Trial (RCTs) within a 2015 Cochrane systematic review titled “Methylphenidate for children and adolescents with attention deficit hyperactivity disorder.” A unidimensional model resulted in excellent adequacy indices, but only 2 indicators had very high factor loadings and low measurement errors. In terms of content, the 7 indicators showed poor reliability (ω = 0.642); however, the set of indicators was precise in evaluating studies with a high amount of bias risk. The Cochrane model of risk of bias as it is, exhibited good fit indices but the majority of the items were not reliable to adequately capture risk of bias in the context of clinical trials of methylphenidate for ADHD.