Inventário de Depressão Infantil (CDI): uma revisão de artigos científicos brasileiros

Despite the consensus among health professionals regarding the recognition of depressive symptoms in childhood and adolescence, their diagnosis still presents difficulties. The literature points to the Children’s Depression Inventory (CDI) as a widely used instrument to measure this construct. This article reviews the scientific articles about the CDI published in Brazilian journals from 2000 to 2010. It was found that most of the research studies were conducted after 2005, in school settings, with both boys and girls, and aimed to evaluate the association of depressive symptoms and psychosocial variables. The studies reported good reliability indices for the CDI, however, there were differences regarding its factorial structure. New studies are necessary to prove the validity of the CDI as a useful measure to evaluate depressive symptoms in children and adolescents.Key words: review, childhood depression, CDI, evaluation.Apesar do consenso entre profissionais da saúde quanto ao reconhecimento dos sintomas depressivos na infância e na adolescência, seu diagnóstico ainda apresenta dificuldades. A literatura aponta o Inventário de Depressão Infantil (CDI) como um instrumento bastante utilizado para medir este construto. O presente estudo revisa os artigos científicos sobre o CDI, publicados em periódicos brasileiros no período de 2000 a 2010. Verificou-se que a maior parte das pesquisas foi conduzida a partir de 2005, no contexto escolar, com meninos e meninas e com o objetivo de verificar a associação de sintomas depressivos e variáveis psicossociais. As pesquisas reportaram bons índices de confiabilidade para o CDI, contudo, houve diferenças quanto à sua estrutura fatorial. Evidencia-se, assim, a necessidade de novos estudos que apontem novas evidências de validade do CDI como um instrumento útil para avaliar sintomas depressivos em crianças e adolescentes.Palavras-chave: revisão, depressão infantil, CDI, avaliação

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p<0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status