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au:Rohde, Luis A.

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Identifying Depression Early in Adolescence: assessing the performance of a risk score for future onset of depression in an independent Brazilian sample Adolescence
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Cunha, Graccielle R.

; Caye, Arthur

; Pan, Pedro

; Fisher, Helen L.

; Pereira, Rivka

; Ziebold, Carolina

; Bressan, Rodrigo

; Miguel, Eurípedes Constantino

; Salum, Giovanni A.

; Rohde, Luis Augusto

; Kohrt, Brandon A.

; Mondelli, Valeria

; Kieling, Christian

; Gadelha, Ary

Brazilian Journal of Psychiatry

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2023, Volume 45 N. 3 Pages 242 - 248

Abstract: En | Text: En | PDF: En

Objective: The Identifying Depression Early in Adolescence Risk Score (IDEA-RS) was recently developed in Brazil using data from the Pelotas 1993 Birth Cohort to estimate the individualized probability of developing depression in adolescence. This model includes 11 sociodemographic variables and has been assessed in longitudinal studies from four other countries. We aimed to test the performance of IDEA-RS in an independent, community-based, school-attending sample within the same country: the Brazilian High-Risk Cohort. Methods: Standard external validation, refitted, and case mix-corrected models were used to predict depression among 1442 youth followed from a mean age of 13.5 years at baseline to 17.7 years at follow-up, using probabilities calculated with IDEA-RS coefficients. Results: The area under the curve was 0.65 for standard external validation, 0.70 for the case mix-corrected model, and 0.69 for the refitted model, with discrimination consistently above chance for predicting depression in the new dataset. There was some degree of miscalibration, corrected by model refitting (calibration-in-the-large reduced from 0.77 to 0). Conclusion: IDEA-RS was able to parse individuals with higher or lower probability of developing depression beyond chance in an independent Brazilian sample. Further steps should include model improvements and additional studies in populations with high levels of subclinical symptoms to improve clinical decision making. Objective IDEARS IDEA RS (IDEA-RS 199 adolescence 1 countries communitybased, communitybased community based, based community-based schoolattending school attending country HighRisk High Methods validation mixcorrected mix 144 135 13 5 13. 177 17 7 17. followup, followup follow up, up follow-up coefficients Results 065 0 65 0.6 070 70 0.7 069 69 dataset miscalibration calibrationinthelarge calibration large 077 77 0. . 0) Conclusion making 19 14 06 6 07

https://doi.org/10.47626/1516-4446-2022-2775

Predictors of gaming disorder in children and adolescents: a school-based study
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Ferreira, Felipe de M.

; Bambini, Beatriz B.

; Tonsig, Gabriela K.

; Fonseca, Lais

; Picon, Felipe A.

; Pan, Pedro M.

; Salum, Giovanni A.

; Jackowski, Andrea

; Miguel, Eurípedes C.

; Rohde, Luis A.

; Bressan, Rodrigo A.

; Gadelha, Ary

Brazilian Journal of Psychiatry

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jun 2021, Volume 43 N. 3 Pages 289 - 292

Abstract: En | Text: En | PDF: En

Objective: To determine whether psychiatric and gaming pattern variables are associated with gaming disorder in a school-based sample. Methods: We analyzed data from the Brazilian High-Risk Cohort for Psychiatric Disorders, a community sample aged 10 to 18, using questionnaires on gaming use patterns. We applied the Gaming Addiction Scale to diagnose gaming disorder and the Development and Well-Being Behavior Assessment for other diagnoses. Results: Out of 407 subjects, 83 (20.4%) fulfilled the criteria for gaming disorder. More role-playing game players were diagnosed with gaming disorder that any other genre. Gaming disorder rates increased proportionally to the number of genres played. Playing online, being diagnosed with a mental disorder, and more hours of non-stop gaming were associated with higher rates of gaming disorder. When all variables (including age and gender) were considered in a logistic regression model, the number of genres played, the number of non-stop hours, the proportion of online games, and having a diagnosed mental disorder emerged as significant predictors of gaming disorder. Conclusion: Each variable seems to add further risk of gaming disorder among children and adolescents. Monitoring the length of gaming sessions, the number and type of genres played, time spent gaming online, and behavior changes may help parents or guardians identify unhealthy patterns of gaming behavior.

https://doi.org/10.1590/1516-4446-2020-0964 336 downloads

Exploring the association between attention-deficit/hyperactivity disorder and entrepreneurship attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity attentiondeficit deficithyperactivity
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Sônego, Márcio

; Meller, Martin

; Massuti, Rafael

; Campani, Fausto

; Amaro, Julia

; Barbosa, Christian

; Rohde, Luis A.

Brazilian Journal of Psychiatry

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apr 2021, Volume 43 N. 2 Pages 174 - 180

Abstract: En | Text: En | PDF: En

Objective: To investigate the association between attention-deficit/hyperactivity disorder (ADHD) symptoms and entrepreneurial profiles and the effects of entrepreneurial characteristics in individuals who screen positive for ADHD and self-identify as entrepreneurs. Methods: We sent 4,341 questionnaires by e-mail to applicants for a career development course for entrepreneurs. We used the propensity score covariate adjustment to balance differences between included and excluded individuals. ADHD symptoms were evaluated with the Adult ADHD Self-Report Scale. The Individual Entrepreneurial Orientation scale was used to assess the entrepreneurial profile of the participants. Impairment from ADHD symptoms was assessed with the Barkley Functional Impairment Scale. Results: Those who screened positive for ADHD had higher risk-taking scores (p-value = 0.016) and lower proactivity (p-value = 0.001) than those who screened negative. Higher inattention scores were related to lower proactivity (p-value < 0.001), while higher hyperactive symptom scores were related to a more generalized entrepreneurial profile (p-value = 0.033). Among ADHD-positive participants, entrepreneurial profile scores were not significantly associated with company profits or impairment. Conclusions: Inattention symptoms were related to less proactivity, whereas hyperactive symptoms were positively associated with a general entrepreneurial orientation. ADHD-positive individuals had a higher risk-taking profile, and these characteristics did not negatively impact their lives. Objective attentiondeficit/hyperactivity attentiondeficithyperactivity attention deficit/hyperactivity deficit hyperactivity (ADHD selfidentify self identify entrepreneurs Methods 4341 4 341 4,34 email e mail SelfReport Self Report Scale participants Results risktaking risk taking pvalue p value 0.016 0016 0 016 0.001 0001 001 negative 0.001, , 0.033. 0033 0.033 . 033 0.033) ADHDpositive impairment Conclusions orientation lives attentiondeficit deficithyperactivity 434 34 4,3 0.01 01 0.00 000 00 003 0.03 03 43 3 4, 0.0 0.

https://doi.org/10.1590/1516-4446-2020-0898 356 downloads

DRD4 genotyping may differentiate symptoms of attention-deficit/hyperactivity disorder and sluggish cognitive tempo
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Bolat, Hilmi

; Ercan, Eyüp S.

; Ünsel-Bolat, Gül

; Tahillioğlu, Akin

; Yazici, Kemal U.

; Bacanli, Ali

; Pariltay, Erhan

; Aygüneş Jafari, Duygu

; Kosova, Buket

; Özgül, Semiha

; Rohde, Luis A.

; Akin, Haluk

Brazilian Journal of Psychiatry

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dec 2020, Volume 42 N. 6 Pages 630 - 637

Abstract: En | Text: En | PDF: En

Objective: Studies to reduce the heterogeneity of attention-deficit/hyperactivity disorder (ADHD) have increased interest in the concept of sluggish cognitive tempo (SCT). The aim of this study was to investigate if the prevalence of two variable-number tandem repeats (VNTRs) located within the 3′-untranslated region of the DAT1 gene and in exon 3 of the dopamine D4 receptor (DRD4) gene differ among four groups (31 subjects with SCT but no ADHD, 146 individuals with ADHD but no SCT, 67 subjects with SCT + ADHD, and 92 healthy controls). Methods: We compared the sociodemographic profiles, neurocognitive domains, and prevalence of two VNTRs in SCT and ADHD subjects versus typically developing (TD) controls. Results: The SCT without ADHD group had a higher proportion of females and lower parental educational attainment. Subjects in this group performed worse on neuropsychological tests, except for psychomotor speed and commission errors, compared to controls. However, the ADHD without SCT group performed significantly worse on all neuropsychological domains than controls. We found that 4R homozygosity for the DRD4 gene was most prevalent in the ADHD without SCT group. The SCT without ADHD group had the highest 7R allele frequency, differing significantly from the ADHD without SCT group. Conclusion: The 7R allele of DRD4 gene was found to be significantly more prevalent in SCT cases than in ADHD cases. No substantial neuropsychological differences were found between SCT and ADHD subjects.

https://doi.org/10.1590/1516-4446-2019-0630 714 downloads

Does ADHD worsen inhibitory control in preschool children born very premature and/or with very low birth weight?
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Lacerda, Bárbara Calil

; Martínez, Sophia B.S.

; Franz, Adelar Pedro

; Moreira-Maia, Carlos Renato

; Silveira, Rita C.

; Procianoy, Renato S.

; Rohde, Luis A.

; Wagner, Flávia

Trends in Psychiatry and Psychotherapy

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dec 2020, Volume 42 N. 4 Pages 340 - 347

Abstract: En | Text: En | PDF: En

Abstract Introduction Deficits in executive functioning, especially in inhibitory control, are present in children born very premature and/or with very low birth weight (VP/VLBW) and in children with attention-deficit/hyperactivity disorder (ADHD). Objective To evaluate whether ADHD imposes additional inhibitory control (IC) deficits in preschoolers born VP/VLBW. Methods 79 VP/VLBW (4 to 7 years) children were assessed for ADHD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children – Present and Lifetime Version (K-SADS-PL). IC was measured with Conners’ Kiddie Continuous Performance Test (K-CPT 2) and the Behavior Rating Inventory of Executive Function – Preschool Version (BRIEF-P).Results: No significant differences were found between ADHD (n = 24) and non-ADHD children (n = 55) for any of the measures (p = 0.062 to p = 0.903). Both groups had deficits in most K-CPT 2 scores compared to normative samples, indicating poor IC and inconsistent reaction times. Conclusions ADHD does not aggravate IC deficits in VP/VLBW children. Either neuropsychological tasks and parent reports of executive functions (EFs) may not be sensitive enough to differentiate VP/VLBW preschoolers with and without ADHD, or these children’s EFs are already so impaired that there is not much room for additional impairments imposed by ADHD.

https://doi.org/10.1590/2237-6089-2019-0075 469 downloads

Population neuroscience: challenges and opportunities for psychiatric research in low- and middle-income countries
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Cirillo, Alessandra

; Diniz, Elton

; Gadelha, Ary

; Asevedo, Elson

; Axelrud, Luiza K.

; Miguel, Eurípedes C.

; Rohde, Luis Augusto

; Bressan, Rodrigo A.

; Pan, Pedro

; Mari, Jair de J.

Brazilian Journal of Psychiatry

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aug 2020, Volume 42 N. 4 Pages 442 - 448

Abstract: En | Text: En | PDF: En

Objective: Population neuroscience is an emerging field that combines epidemiology and neuroscience to study how genes and the environment shape typical and atypical brain functioning. The objective of this study was to review key studies on population neuroscience from low- and middle-income countries (LMICs) and to identify potential gaps vis-à-vis studies conducted in high-income countries. Methods: We conducted a systematic review to search for longitudinal cohort studies investigating the development of psychiatric disorders in children and adolescents in LMICs. We performed an electronic search in the EMBASE and MEDLINE databases from inception to July 5th, 2019. Results: We found six cohorts from four countries that met our search criteria: three cohorts from Brazil, one from China, one from South Africa, and one from Mauritius. Relevant examples of findings from these studies are reported. Conclusion: Our results demonstrate the impact of the valuable science output these cohort designs promote, allowing LMICs to have a share in frontline global psychiatry research. National and international funding agencies should invest in LMIC population neuroscience in order to promote replication and generalization of research from high-income countries.

https://doi.org/10.1590/1516-4446-2019-0761 584 downloads

Impaired Right Ventricular Function in Heart Transplant Rejection
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Carrion, Luciana J. B. M.

; Sperotto, Alice

; Nazario, Raffaela

; Goldraich, Livia A.

; Clausell, Nadine

; Rohde, Luís Eduardo

; Santos, Angela Barreto Santiago

Arquivos Brasileiros de Cardiologia

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apr 2020, Volume 114 N. 4 Pages 638 - 644

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: A prática de triagem para complicações tem proporcionado altas taxas de sobrevida entre pacientes que receberam transplante cardíaco (TC). Objetivos: Visamos avaliar se alterações no strain longitudinal global (SLG) do ventrículo esquerdo (VE) e do ventrículo direito (VD) estão associadas à rejeição celular. Métodos: Pacientes que foram submetidos à TC em um único centro (2015 - 2016; n = 19) foram incluídos nesta análise retrospectiva. Foram avaliados um total de 170 biópsias com ecocardiogramas correspondentes. Foram realizadas comparações entre pares de biópsia/ecocardiograma com nenhuma ou leve (0R/1R) evidência de rejeição celular (n = 130 e n = 25, respectivamente) e aqueles com episódios de rejeição moderada (2R) (n = 15). Foram considerados estatisticamente significativos os valores de p < 0,05. Resultados: A maioria dos pacientes eram mulheres (58%) com idade média de 48 ± 12,4 anos. Em comparação com os ecocardiogramas dos pacientes com rejeição 0R/1R, os pacientes com biópsias 2R apresentaram maior espessura da parede posterior do VE, relação E/e’ e relação E/A, em comparação com o outro grupo. A função sistólica do VE não diferiu entre os grupos. Por outro lado, a função sistólica do VD foi reduzida no grupo 2R em comparação ao outro grupo, quando avaliada por TAPSE, onda S e variação fracional da área do VD. Adicionalmente, SLG VD (−22,97 ± 4,4% no grupo 0R/1R vs. −20,6 ± 4,9% no grupo 2R, p = 0,038) foi reduzido no grupo 2R, em comparação com o grupo 0R/1R. Conclusão: Em pacientes de TC, rejeição celular aguda moderada está associada à disfunção sistólica do VD, avaliado pelo strain do VD, bem como por parâmetros ecocardiográficos convencionais. Vários parâmetros ecocardiográficos podem ser utilizados para realizar triagem para rejeição celular.

Abstract Background: The practice of screening for complications has provided high survival rates among heart transplantation (HTx) recipients. Objectives: Our aim was to assess whether changes in left ventricular (LV) and right ventricular (RV) global longitudinal strain (GLS) are associated with cellular rejection. Methods: Patients who underwent HTx in a single center (2015 - 2016; n = 19) were included in this retrospective analysis. A total of 170 biopsies and corresponding echocardiograms were evaluated. Comparisons were made among biopsy/echocardiogram pairs with no or mild (0R/1R) evidence of cellular rejection (n = 130 and n = 25, respectively) and those with moderate (2R) rejection episodes (n=15). P-values < 0.05 were considered statistically significant Results: Most patients were women (58%) with 48 ± 12.4 years of age. Compared with echocardiograms from patients with 0R/1R rejection, those of patients with 2R biopsies showed greater LV posterior wall thickness, E/e’ ratio, and E/A ratio compared to the other group. LV systolic function did not differ between groups. On the other hand, RV systolic function was more reduced in the 2R group than in the other group, when evaluated by TAPSE, S wave, and RV fractional area change (all p < 0.05). Furthermore, RV GLS (−23.0 ± 4.4% in the 0R/1R group vs. −20.6 ± 4.9% in the 2R group, p = 0.038) was more reduced in the 2R group than in the 0R/1R group. Conclusion: In HTx recipients, moderate acute cellular rejection is associated with RV systolic dysfunction as evaluated by RV strain, as well as by conventional echocardiographic parameters. Several echocardiographic parameters may be used to screen for cellular rejection.

https://doi.org/10.36660/abc.20190054 846 downloads

Neuroimaging adolescents with depression in a middle-income country: feasibility of an fMRI protocol and preliminary results
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Battel, Lucas

; Swartz, Johnna

; Anes, Mauricio

; Manfro, Pedro H.

; Rohde, Luis A.

; Viduani, Anna

; Mondelli, Valeria

; Kieling, Christian

Brazilian Journal of Psychiatry

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feb 2020, Volume 42 N. 1 Pages 6 - 13

Abstract: En | Text: En | PDF: En

Objective: To test the feasibility and to present preliminary results of a neuroimaging protocol to evaluate adolescent depression in a middle-income setting. Methods: We assessed psychotropic medication-free adolescents (age range 14-16 years) with a diagnosis of major depressive disorder (MDD). Participants underwent a comprehensive clinical evaluation and both structural and functional magnetic resonance imaging (fMRI). In this pilot study, a preliminary single-group analysis of resting-state fMRI (rs-fMRI) data was performed, with a focus on the default mode network (DMN), cognitive control network (CCN), and salience network (SN). Results: The sample included 29 adolescents with MDD (mean age 16.01, SD 0.78) who completed the protocol. Only two participants were excluded due to MRI quality issues (head movement), and were not included in the analyses. The scans showed significant connectivity between the medial prefrontal cortex and posterior cingulate cortex (DMN), the ACC and anterior insula (SN), and the lateral prefrontal cortex and dorsal parietal cortex (CCN). Conclusion: We demonstrated the feasibility of implementing a complex neuroimaging protocol in a middle-income country. Further, our preliminary rs-fMRI data revealed patterns of resting-state connectivity consistent with prior research performed in adolescents from high-income countries.

https://doi.org/10.1590/1516-4446-2019-0508 803 downloads

Guideline of the Brazilian Society of Cardiology on Telemedicine in Cardiology - 2019
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Lopes, Marcelo Antônio Cartaxo Queiroga

; Oliveira, Gláucia Maria Moraes de

; Ribeiro, Antonio Luiz Pinho

; Pinto, Fausto J.

; Rey, Helena Cramer Veiga

; Zimerman, Leandro Ioschpe

; Rochitte, Carlos Eduardo

; Bacal, Fernando

; Polanczyk, Carisi Anne

; Halperin, Cidio

; Araújo, Edson Correia

; Mesquita, Evandro Tinoco

; Arruda, José Airton

; Rohde, Luis Eduardo Paim

; Grinberg, Max

; Moretti, Miguel

; Caramori, Paulo Ricardo Avancini

; Botelho, Roberto Vieira

; Brandão, Andréa Araújo

; Hajjar, Ludhmila Abrahão

; Santos, Alexandre Fonseca

; Colafranceschi, Alexandre Siciliano

; Etges, Ana Paula Beck da Silva

; Marino, Bárbara Campos Abreu

; Zanotto, Bruna Stella

; Nascimento, Bruno Ramos

; Medeiros, Cesar Rocha

; Santos, Daniel Vitor de Vasconcelos

; Cook, Daniela Matos Arrowsmith

; Antoniolli, Eduardo

; Souza Filho, Erito Marques de

; Fernandes, Fábio

; Gandour, Fabio

; Fernandez, Francisco

; Souza, Germano Emilio Conceição

; Weigert, Guilherme de Souza

; Castro, Iran

; Cade, Jamil Ribeiro

; Figueiredo Neto, José Albuquerque de

; Fernandes, Juliano de Lara

; Hadlich, Marcelo Souza

; Oliveira, Marco Antonio Praça

; Alkmim, Maria Beatriz

; Paixão, Maria Cristina da

; Prudente, Maurício Lopes

; Aguiar Netto, Miguel A. S.

; Marcolino, Milena Soriano

; Oliveira, Monica Amorim de

; Simonelli, Osvaldo

; Lemos Neto, Pedro A.

; Rosa, Priscila Raupp da

; Figueira, Renato Minelli

; Cury, Roberto Caldeira

; Almeida, Rodrigo Coelho

; Lima, Sandra Regina Franco

; Barberato, Silvio Henrique

; Constancio, Thiago Inocêncio

; Rezende, Wladimir Fernandes de

Arquivos Brasileiros de Cardiologia

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nov 2019, Volume 113 N. 5 Pages 1006 - 1056

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.5935/abc.20190205 5274 downloads

10.

Prevalence, clinical correlates and maternal psychopathology of deliberate self-harm in children and early adolescents: results from a large community study
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Simioni, André R.

; Pan, Pedro M.

; Gadelha, Ary

; Manfro, Gisele G.

; Mari, Jair J.

; Miguel, Eurípedes C.

; Rohde, Luis A.

; Salum, Giovanni A.

Brazilian Journal of Psychiatry

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jan 2018, Volume 40 N. 1 Pages 48 - 55

Abstract: En | Text: En | PDF: En

Objectives: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in children from low- and middle-income countries. We investigated the prevalence of DSH and its clinical and maternal psychopathological associations in Brazilian children (n=2,508, ages 6-14y) in a community-based study. Methods: Participants of the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders (HRC) and their mothers were assessed in structured interviews. Current (last month) and lifetime DSH were estimated, including analysis stratified by age groups. Logistic regressions were performed to investigate the role of the children’s clinical diagnoses and maternal psychopathology on DSH prevalence estimates, adjusting for potential confounding factors. Results: The prevalence of current DSH was 0.8% (children 0.6%, adolescents 1%) and lifetime DSH was 1.6% (1.8% and 1.5%, respectively). Current and lifetime DSH were more frequent in children with depression, attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), even in multiple models accounting for demographic variables and co-occurring psychiatric disorders. Maternal anxiety disorder was strongly associated with current and lifetime DSH in offspring; whereas current DSH, specifically in young children, was associated with maternal mood disorder. Conclusion: Diagnoses of depression, ADHD and ODD were consistently associated with DSH, as was having a mother with anxiety disorder.

https://doi.org/10.1590/1516-4446-2016-2124 1621 downloads

11.

Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS-PL), DSM-5 update: translation into Brazilian Portuguese
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Caye, Arthur

; Kieling, Renata R.

; Rocha, Thiago B.

; Graeff-Martins, Ana S.

; Geyer, Cristiane

; Krieger, Fernanda

; Manfro, Gisele G.

; Brentani, Helena

; Isolan, Luciano

; Rosário, Maria C.

; Grassi-Oliveira, Rodrigo

; Caetano, Sheila C.

; Moriyama, Tais

; Rohde, Luis A.

; Kieling, Christian

Brazilian Journal of Psychiatry

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dec 2017, Volume 39 N. 4 Pages 384 - 386

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1516-4446-2017-2317 3887 downloads

12.

Causes and Predictors of In-Hospital Mortality in Patients Admitted with or for Heart Failure at a Tertiary Hospital in Brazil
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Wajner, André

; Zuchinali, Priccila

; Olsen, Vírgilio

; Polanczyk, Carisi A.

; Rohde, Luis Eduardo

Arquivos Brasileiros de Cardiologia

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oct 2017, Volume 109 N. 4 Pages 321 - 330

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo Fundamento: Apesar da insuficiência cardíaca (IC) apresentar elevada morbimortalidade, são escassos os estudos na América Latina sobre causas e preditores de mortalidade intra-hospitalar. Desconhece-se, também, a evolução de pacientes com IC compensada hospitalizados por outros motivos. Objetivo: Identificar causas e preditores de mortalidade intra-hospitalar em pacientes que internam por IC aguda descompensada (ICAD), comparativamente aqueles que possuem IC e internam por outras condições (ICND). Métodos: Coorte histórica de pacientes internados em um hospital público terciário no Brasil com diagnóstico de IC identificados pelo escore de comorbidade de Charlson (ECCharlson). Resultados: Foram avaliados 2056 pacientes que internaram entre janeiro de 2009 e dezembro de 2010 (51% homens; idade mediana de 71 anos; tempo de permanência de 15 dias). Ocorreram 17,6% de óbitos durante a internação, dos quais 58,4% por causa não cardiovascular (63,6% ICND versus 47,4% ICAD, p = 0,004). As causas infecciosas foram responsáveis pela maior parte dos óbitos e apenas 21.6% das mortes foram atribuídas à IC. Os preditores independentes de mortalidade intra-hospitalar foram semelhantes entre os grupos e incluíram: idade, tempo de permanência, potássio elevado, comorbidades clínicas e ECCharlson. A insuficiência renal foi o preditor de maior relevância em ambos grupos. Conclusão: Pacientes internados com IC apresentam elevada mortalidade intra-hospitalar, independentemente do motivo primário de internação. Poucos óbitos são diretamente atribuídos à IC; Idade, alteração na função renal e níveis séricos de potássio, tempo de permanência, comorbidades e ECCharlson foram preditores independentes de morte intra-hospitalar em hospital terciário brasileiro. (Arq Bras Cardiol. 2017; [online].ahead print, PP.0-0)

Abstract Background: Although heart failure (HF) has high morbidity and mortality, studies in Latin America on causes and predictors of in-hospital mortality are scarce. We also do not know the evolution of patients with compensated HF hospitalized for other reasons. Objective: To identify causes and predictors of in-hospital mortality in patients hospitalized for acute decompensated HF (ADHF), compared to those with HF and admitted to the hospital for non-HF related causes (NDHF). Methods: Historical cohort of patients hospitalized in a public tertiary hospital in Brazil with a diagnosis of HF identified by the Charlson Comorbidity Index (CCI). Results: A total of 2056 patients hospitalized between January 2009 and December 2010 (51% men, median age of 71 years, length of stay of 15 days) were evaluated. There were 17.6% of deaths during hospitalization, of which 58.4% were non-cardiovascular (63.6% NDHF vs 47.4% ADHF, p = 0.004). Infectious causes were responsible for most of the deaths and only 21.6% of the deaths were attributed to HF. The independent predictors of in-hospital mortality were similar between the groups and included: age, length of stay, elevated potassium, clinical comorbidities, and CCI. Renal insufficiency was the most relevant predictor in both groups. Conclusion: Patients hospitalized with HF have high in-hospital mortality, regardless of the primary reason for hospitalization. Few deaths are directly attributed to HF; Age, renal function and levels of serum potassium, length of stay, comorbid burden and CCI were independent predictors of in-hospital death in a Brazilian tertiary hospital.

https://doi.org/10.5935/abc.20170136 4456 downloads

13.

TBARS and BDNF levels in newborns exposed to crack/cocaine during pregnancy: a comparative study
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Mardini, Victor

; Rohde, Luis A.

; Ceresér, Keila M.

; Gubert, Carolina M.

; Silva, Emily G. da

; Xavier, Fernando

; Parcianello, Rodrigo

; Röhsig, Liane M.

; Pechansky, Flávio

; Szobot, Claudia M.

Brazilian Journal of Psychiatry

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sep 2017, Volume 39 N. 3 Pages 263 - 266

Abstract: En | Text: En | PDF: En

Objectives: To compare levels of a marker of lipid peroxidation (thiobarbituric acid reactive substances, TBARS) and brain-derived neurotrophic factor (BDNF) in umbilical cord blood (UCB) between newborns exposed to crack/cocaine in utero (exposed newborns [EN], n=57) and non-exposed newborns (NEN, n=99), as well as in maternal peripheral blood at delivery. Methods: This was a cross-sectional study. Potential confounders, including perinatal parameters, psychopathology, and use of other substances, were assessed. Results: After adjusting for potential confounders, adjusted mean BDNF was significantly higher in EN (3.86 ng/mL, 95% confidence interval [95%CI] 2.29-5.43) than in NEN (0.85 ng/mL, 95%CI 0.47-1.23; p < 0.001; Cohen effect size: 1.12), and significantly lower in crack/cocaine mothers than in control mothers (4.03 ng/mL, 95%CI 2.87-5.18 vs. 6.67 ng/mL, 95%CI 5.60-7.74; p = 0.006). The adjusted mean TBARS level was significantly lower in EN (63.97 µM MDA, 95%CI 39.43-88.50) than NEN (177.04 µM MDA, 95%CI 140.93-213.14; p < 0.001; effect size = 0.84), with no difference between mother groups (p = 0.86). Conclusions: The changes in TBARS levels observed in EN suggest that fetuses exposed to cocaine mobilize endogenous antioxidant routes since very early stages of development. The increase in BDNF levels in EN might indicate changes in fetal development, whereas the changes in BDNF levels in mothers provide evidence of the complex metabolic processes involved in drug use during pregnancy.

https://doi.org/10.1590/1516-4446-2016-2035 1462 downloads

14.

Specific and social fears in children and adolescents: separating normative fears from problem indicators and phobias
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Laporte, Paola P.

; Pan, Pedro M.

; Hoffmann, Mauricio S.

; Wakschlag, Lauren S.

; Rohde, Luis A.

; Miguel, Euripedes C.

; Pine, Daniel S.

; Manfro, Gisele G.

; Salum, Giovanni A.

Brazilian Journal of Psychiatry

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jun 2017, Volume 39 N. 2 Pages 118 - 125

Abstract: En | Text: En | PDF: En

Objective: To distinguish normative fears from problematic fears and phobias. Methods: We investigated 2,512 children and adolescents from a large community school-based study, the High Risk Study for Psychiatric Disorders. Parent reports of 18 fears and psychiatric diagnosis were investigated. We used two analytical approaches: confirmatory factor analysis (CFA)/item response theory (IRT) and nonparametric receiver operating characteristic (ROC) curve. Results: According to IRT and ROC analyses, social fears are more likely to indicate problems and phobias than specific fears. Most specific fears were normative when mild; all specific fears indicate problems when pervasive. In addition, the situational fear of toilets and people who look unusual were highly indicative of specific phobia. Among social fears, those not restricted to performance and fear of writing in front of others indicate problems when mild. All social fears indicate problems and are highly indicative of social phobia when pervasive. Conclusion: These preliminary findings provide guidance for clinicians and researchers to determine the boundaries that separate normative fears from problem indicators in children and adolescents, and indicate a differential severity threshold for specific and social fears.

https://doi.org/10.1590/1516-4446-2016-2064 2770 downloads

15.

Cost-utility analysis of methylphenidate treatment for children and adolescents with ADHD in Brazil
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Maia, Carlos R.

; Stella, Steffan F.

; Wagner, Flavia

; Pianca, Thiago G.

; Krieger, Fernanda V.

; Cruz, Luciane N.

; Polanczyk, Guilherme V.

; Rohde, Luís A.

; Polanczyk, Carísi A.

Brazilian Journal of Psychiatry

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mar 2016, Volume 38 N. 1 Pages 30 - 38

Abstract: En | Text: En | PDF: En

Objective: To perform a cost-utility analysis on the treatment of attention deficit hyperactivity disorder (ADHD) with methylphenidate immediate-release (MPH-IR) in children and adolescents from Brazil. Method: A Markov model was constructed to compare MPH-IR vs. no treatment. A 24-week naturalistic study was conducted to collect transition probabilities and utility data. Effectiveness was expressed as quality-adjusted life-years (QALY), and costs reported in 2014 international dollars (I$). The perspective was the Brazilian Unified Health System as payer, and the time horizon was 6 years. Results: Of 171 patients, 73 provided information at baseline, and 56 at week 24. Considering the MPH-IR monthly cost of I$ 38, the incremental cost-effectiveness ratio (ICER) of treatment was I$ 9,103/QALY for children and I$ 11,883/QALY for adolescents. In two-way sensitivity analysis, considering one Gross National Product per capita (I$ 11,530) as willingness-to-pay, a cost of no-treatment lower than I$ 45/month would render MPH-IR a cost-saving strategy. Discussion: MPH-IR treatment of children and adolescents is cost-effective for ADHD patients from the Brazilian public health system perspective. Both patients and the healthcare system might benefit from such a strategy. Trial registration number: NCT01705613.

https://doi.org/10.1590/1516-4446-2014-1516 3317 downloads

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