Childhood individual and family modifiable risk factors for criminal conviction: a 7-year cohort study from Brazil

Crime is a major public problem in low- and middle-income countries (LMICs) and its preventive measures could have great social impact. The extent to which multiple modifiable risk factors among children and families influence juvenile criminal conviction in an LMIC remains unexplored; however, it is necessary to identify prevention targets. This study examined the association between 22 modifiable individual and family exposures assessed in childhood (5–14 years, n = 2511) and criminal conviction at a 7-year follow-up (13–21 years, n = 1905, 76% retention rate) in a cohort of young people in Brazil. Population attributable risk fraction (PARF) was computed for significant risk factors. Criminal convictions were reported for 81 (4.3%) youths. Although most children living in poverty did not present criminal conviction (89%), poverty at baseline was the only modifiable risk factor significantly associated with crime (OR 4.14, 99.8% CI 1.38–12.46) with a PARF of 22.5% (95% CI 5.9–36.1%). It suggests that preventing children’s exposure to poverty would reduce nearly a quarter of subsequent criminal convictions. These findings highlight the importance of poverty in criminal conviction, as it includes several deprivations and suggest that poverty eradication interventions during childhood may be crucial for reducing crime among Brazilian youth

A Clinical Rationale for Assessing the Impact of Childhood Sexual Abuse on Adjunctive Subcutaneous Esketamine for Treatment-Resistant Depression

Background: A history of child sexual abuse (CSA) is related to higher suicide rates and poor treatment outcomes in depressed adult patients. Twenty years after the first study investigating the effects of ketamine/esketamine on depression and suicide, there is a lack of data on the CSA effects on this emerging treatment. Here, we assess the impact of CSA on adjunctive subcutaneous (SC) esketamine for treatment-resistant depression (TRD). Methods: A directed acyclic graphic (DAG) was designed to identify clinical confounders between CSA and esketamine predictors of response. The confounders were applied in a statistical model to predict depression symptom trajectory in a sample of 67 TRD outpatients. Results: The patient sample had a relatively high prevalence rate of CSA (35.82%). Positive family history of first-degree relatives with alcohol use disorder and sex were clinical mediators of the effects of esketamine in a CSA adult population. Overall, the presence of at least one CSA event was unrelated to esketamine symptom reduction. Conclusions: Unlike responses to conventional antidepressants and psychotherapy, CSA does not appear to predict poor response to esketamine.publishedVersio

Ketamine for the treatment of depressive symptoms: an analysis of the response trajectory and its applicability in the context of palliative care

Introdução: A cetamina possui ação antidepressiva com taxa de resposta de 65-70%, com importante potencial de uso no contexto de cuidados paliativos, devido a seu rápido início de ação, desejável em fase final de vida. É necessário compreender o efeito da cetamina em subgrupos distintos de pacientes. Respostas heterogêneas foram descritas, entretanto, pouco se sabe sobre o comportamento da escetamina subcutânea. Objetivos: 1- Realizar revisão sistemática da literatura em eficácia e segurança da cetamina para depressão em cuidados paliativos; 2- Avaliar a heterogeneidade na resposta ao tratamento da depressão com escetamina subcutânea e; 3- Descrever um caso clínico onde a cetamina foi utilizada para depressão em cuidados paliativos. Métodos: Foi realizada busca sistemática em 7 bases de dados, incluindo estudos de eficácia e segurança de cetamina, com foco em sintomas depressivos em cuidados paliativos. Setenta pacientes com depressão resistente receberam tratamento com injeções repetidas de escetamina subcutânea, e uma análise por growth mixture modeling foi utilizada para identificar potenciais classes latentes e predizer a trajetória de resposta. Relatamos o caso de um paciente oncológico tratado com escetamina subcutânea para depressão em fase final de vida. Resultados: Na revisão de literatura, foram identificados 32 estudos para síntese final de dados, com bons dados de segurança e eficácia promissora, embora mais voltados ao contexto perioperatório. O modelo latente revelou dois subgrupos distintos: respondedores (79,1%), que demonstraram medidas menores de depressão na primeira avaliação e grande redução dos sintomas; e não-respondedores (20,9%), que demonstraram escores iniciais mais altos de depressão e menor redução sintomática. O paciente descrito em nosso relato de caso evoluiu com remissão do episódio depressivo grave em 7 dias, sustentando resposta até seu óbito. Conclusão: Os achados sugerem uma resposta sistematicamente heterogênea à escetamina, além de grande potencial para uso em cuidados paliativos, sendo necessária melhor delimitação das características responsáveis pela heterogeneidade e realização de maiores ensaios clínicos randomizados focados em depressão em pacientes sob cuidados paliativos.Introduction: Ketamine depicts antidepressant effects with a 65–70% response rate and great potential for use in the palliative care context due to its fast onset of action being highly desirable in end-of-life. It is necessary to understand ketamine’s behaviour in different subgroups of patients. Heterogeneous responses to ketamine have been reported, however, little is known on this matter regarding subcutaneous esketamine. Objectives: 1- To perform a systematic review of the literature regarding efficacy and safety of ketamine for depression in palliative care; 2- To evaluate heterogeneity in the response trajectory of depression treatment with subcutaneous esketamine; 3 – To describe a case report where ketamine is used for palliative care and. Methods: We performed a systematic search in 7 databases, including studies with data on efficacy and safety of various ketamine formulations focused on depressive symptoms within palliative care. Seventy patients with resistant depression were administered repeated subcutaneous esketamine injections, and a growth mixture modeling analysis of the sample was utilized to identify potential latent classes and predict the response trajectory. We report a case of an oncological patient who was treated with subcutaneous esketamine for depression in end-of-life. Results: In the literature review, 32 studies were identified for final data synthesis, with good safety data and promising efficacy, although most studies are focused on a perioperative context. Our model revealed two distinct subgroups: responders (79.1%), those who showed a lower depression score at the first time point and strong decline in symptoms; and non-responders (20.9%), those who showed a higher initial depression score and limited decline in symptoms. The patient described in our case report remitted from the severe depressive episode in 7 days, sustaining the response until his death. Conclusion: These findings suggest a systematically heterogeneous response to esketamine, and an important potential for use in palliative care. Further studies should focus on clinical aspects that might predict this heterogeneity, and randomized clinical trials focused on depressed patients under palliative care should be performed.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Código de Financiamento 00

Scoping Review of the epidemiology of multimorbidity in Brazil - Assessment of the existing evidence

Multimorbidity, which is the co-occurrence of two or more physical and mental health chronic conditions, is a common condition in the general population, tending to increase with popualtion aging. Brazil is undergoing a fast population aging process, which demands more knowledge of public health conditions, including multimorbidity. In spite of the existence of a moderate ammount of studies involving multimorbidity, there is no review of the existing evidence of multimorbidity in Brazil

Longitudinal invariance of psychotic experiences in children and adolescents: What do the data tell us?

BACKGROUND: Psychotic experiences are common in adults, adolescents, and children. While usually self-limited, they can indicate psychosis proneness when persistent. The Community Assessment of Psychic Experiences (CAPE) measures lifetime psychotic experiences in three dimensions. The 20-item subscale addressing positive symptoms (CAPE-positive) is the most widely used. No study investigated its measurement invariance across timepoints during childhood and adolescence. This step is required to conduct reliable comparisons in longitudinal studies with different age groups. METHODS: We used data from the Brazilian High-Risk Cohort, which enrolled 2511 individuals aged 6-12 years from public schools for the baseline evaluation. A 3-year follow-up assessment evaluated 1880 participants. Subjects were rated with the CAPE-positive and we performed, at each wave, a Multigroup Confirmatory Factor Analysis testing Exploratory and Confirmatory Factor Analysis models identified in a previous systematic review, to assess longitudinal invariance. RESULTS: A three-factor solution was the best fitting model, comprising Persecutory Ideation, Bizarre Experiences and Perceptual Abnormalities. The longitudinal invariance analysis of the best-fit model was unsatisfactory, achieving only the metric level of invariance. CONCLUSIONS: Our findings suggest that the CAPE-positive scale has good model fit indices for each evaluated time point individually (children and adolescents), but it is not invariant over time. Identifying which factors affect CAPE latent structure at different time points can improve our understanding of psychosis proneness and how to measure it

A Clinical Rationale for Assessing the Impact of Childhood Sexual Abuse on Adjunctive Subcutaneous Esketamine for Treatment-Resistant Depression

Background: A history of child sexual abuse (CSA) is related to higher suicide rates and poor treatment outcomes in depressed adult patients. Twenty years after the first study investigating the effects of ketamine/esketamine on depression and suicide, there is a lack of data on the CSA effects on this emerging treatment. Here, we assess the impact of CSA on adjunctive subcutaneous (SC) esketamine for treatment-resistant depression (TRD). Methods: A directed acyclic graphic (DAG) was designed to identify clinical confounders between CSA and esketamine predictors of response. The confounders were applied in a statistical model to predict depression symptom trajectory in a sample of 67 TRD outpatients. Results: The patient sample had a relatively high prevalence rate of CSA (35.82%). Positive family history of first-degree relatives with alcohol use disorder and sex were clinical mediators of the effects of esketamine in a CSA adult population. Overall, the presence of at least one CSA event was unrelated to esketamine symptom reduction. Conclusions: Unlike responses to conventional antidepressants and psychotherapy, CSA does not appear to predict poor response to esketamine