Do baseline participant characteristics impact the effectiveness of a mobile health intervention for depressive symptoms? A post-hoc subgroup analysis of the CONEMO trials.

OBJECTIVE: To ascertain whether sociodemographic and health-related characteristics known from previous research to have a substantive impact on recovery from depression modified the effect of a digital intervention designed to improve depressive symptoms (CONEMO). METHODS: The CONEMO study consisted of two randomized controlled trials, one conducted in Lima, Peru, and one in São Paulo, Brazil. As a secondary trial plan analysis, mixed logistic regression was used to explore interactions between the treatment arm and subgroups of interest defined by characteristics measured before randomization - suicidal ideation, race/color, age, gender, income, type of mobile phone, alcohol misuse, tobacco use, and diabetes/hypertension - in both trials. We estimated interaction effects between the treatment group and these subgroup factors for the secondary outcomes using linear mixed regression models. RESULTS: Increased effects of the CONEMO intervention on the primary outcome (reduction of at least 50% in depressive symptom scores at 3-month follow-up) were observed among older and wealthier participants in the Lima trial (p = 0.030 and p = 0.001, respectively). CONCLUSION: There was no evidence of such differential effects in São Paulo, and no evidence of impact of any other secondary outcomes in either trial. CLINICAL TRIAL REGISTRATION: NCT02846662 (São Paulo, Brazil - SP), NCT03026426 (Lima, Peru - LI).

Transparency of subnational governments: the impact of inequality on transparency / Transparencia de los gobiernos subnacionales: el impacto de la desigualdad en la transparencia / Transparência dos governos subnacionais: o impacto da desigualdade na transparência

Abstract What are the effects of extractive informal institutions on the horizontal accountability process in a developing democracy? This paper presents evidence about the harmful effects of extractive informal institutions on horizontal accountability within subnational governments in Brazil. After three decades of free and competitive elections, the institutional design of oversight institutions for state governments has hardly changed. We explore the hypothesis that more extractive informal institutions, measured by the level of income inequality, is associated with decreasing transparency levels. Given its extensive social, political, and economic diversity embedded in an overall centralized formal institutional framework, Brazil provides an appropriate setting to test the hypothesis that extractive informal institutions responsible for increased income inequality can undermine horizontal accountability in new democracies.

Resumen ¿Cuáles son los efectos de las instituciones informales extractivas sobre el proceso de accountability horizontal en una democracia en desarrollo? Este artículo presenta evidencia sobre los efectos dañinos de las instituciones informales extractivas sobre la accountability horizontal dentro de los gobiernos subnacionales en Brasil. Después de tres décadas de elecciones libres y competitivas, el diseño institucional de las instituciones de supervisión de los gobiernos estatales apenas ha cambiado. Exploramos la hipótesis de que las instituciones informales más extractivas, medidas por el nivel de desigualdad de ingresos, están asociadas con niveles decrecientes de transparencia. Dada su amplia diversidad social, política y económica integrada en un marco institucional formal, general y centralizado, Brasil proporciona un entorno apropiado para probar la hipótesis de que las instituciones informales extractivas, responsables de una mayor desigualdad de ingresos, pueden socavar la accountability horizontal en las nuevas democracias.

Resumo Quais são os efeitos das instituições informais extrativas no processo de accountability horizontal numa democracia em desenvolvimento? Este artigo apresenta evidências sobre os efeitos nocivos das instituições informais extrativistas na accountability horizontal dos governos subnacionais no Brasil. Após três décadas de eleições livres e competitivas, o desenho institucional das instituições de fiscalização dos governos estaduais praticamente não mudou. Exploramos a hipótese de que instituições informais mais extrativas, medidas pelo nível de desigualdade de renda, estão associadas a níveis decrescentes de transparência. Dada a sua extensa diversidade social, política e econômica, inserida num quadro institucional formal centralizado, o Brasil oferece um cenário apropriado para testar a hipótese de que as instituições informais extrativas responsáveis pelo aumento da desigualdade de rendimentos podem minar a accountability horizontal nas novas democracias.

A Mobile Health Intervention for Patients With Depressive Symptoms: Protocol for an Economic Evaluation Alongside Two Randomized Trials in Brazil and Peru.

BACKGROUND: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. OBJECTIVE: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. METHODS: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top-down and bottom-up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. RESULTS: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. CONCLUSIONS: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26164.

A importância do crescimento econômico local na escolha do chefe do Executivo no Brasil / La importancia del crecimiento económico local en la elección del jefe del Ejecutivo en Brasil / The importance of local economic growth on the elections of Brazilian chief executives of governments

Resumo A investigação dos fatores que influenciam a escolha do chefe do Executivo no Brasil é uma questão de vital importância. Neste artigo, apresentam-se evidências de que o crescimento econômico local no último ano de governo possui impacto positivo na porcentagem de votos obtidos pelo incumbente em uma amostra da população dos municípios brasileiros, com dados das eleições presidenciais e municipais de 2000 a 2010. Usamos a expansão real do PIB municipal como medida do crescimento econômico local e testamos a hipótese de que os eleitores em um município premiam os incumbentes, ou seus respectivos candidatos, que tiveram bom desempenho econômico no último ano de mandato. A hipótese se baseia na teoria econômica do voto que sugere que os incumbentes têm mais chances de vencer uma reeleição, ou eleger seu sucessor, quando a economia está em um bom momento. Na análise utilizamos as abordagens para dados em painel, além de análise multinível, de modo a melhor explorar a heterogeneidade existente no fenômeno do voto econômico e com isso inferir a existência de efeitos do crescimento econômico na proporção de votos obtidos pelo incumbente e como esses efeitos podem variar em relação a partidos, unidades da federação, circunscrição eleitoral e outras variáveis.

Resumen La investigación de los factores que influyen en la elección del jefe del Ejecutivo en Brasil es un asunto de vital importancia en la literatura. En este artículo, presentamos evidencia de que el crecimiento económico local en el último año del gobierno tiene un impacto positivo en el porcentaje de votos obtenidos por el incumbente en una muestra de los municipios brasileños, con datos relativos a las elecciones presidenciales y municipales de 2000 a 2010. Utilizamos el crecimiento real del PIB municipal como medida de crecimiento económico local para poner a prueba la hipótesis de que los votantes en una ciudad tienden a recompensar el titular y sus candidatos que tuvieron un buen desempeño económico en el último año de mandato. La hipótesis se base en la teoría económica de la votación que sugiere que los titulares tienen más probabilidades de ganar la reelección, o elegir a su sucesor, cuando la economía está en un buen momento. En el análisis se utiliza los métodos de datos de panel y el análisis multinivel con el fin de aprovechar mejor la heterogeneidad existente en el fenómeno del voto económico y con ello inferir la existencia de efectos del crecimiento económico sobre la proporción de votos obtenidos por el incumbente y cómo estos efectos pueden variar en relación a partidos, las unidades de la federación, circunscripción electoral y otras variables.

Abstract The motives for choosing the government's chief executive are of vital importance in a democratic society. In this article, evidence is presented of how local economic growth in the last year of government has a positive impact on the percentage of votes obtained by the incumbent in a population sample of Brazilian municipalities, with data of the presidential and municipal elections of 2000 to 2010. Real GDP growth of the city is used as a measure of local economic growth to test the hypothesis that voters in a municipality tend to reward incumbents and their candidates, if they had good economic performance in the last year of their mandate. The hypothesis is based on the economic theory of voting, suggesting that incumbents are more likely to win re-election, or elect their successor, when the economy is good. Panel and Multilevel models are used to detail the effects and the impact of economic growth in the proportion of votes obtained by the incumbent. The multilevel analysis was used in order to better explore existing heterogeneity in the economic voting phenomenon and thereby infer how economic growth effects may vary among parties, the federation units, constituency and other variables.

Internal Consistency and Convergent Validity of the Portuguese Versions of the Global Appraisal of Individual Needs-Initial and Short Screener: Validity of the Portuguese GAIN-I and SS.

The goal of this article is to present evidence on the internal consistency and convergent validity of the Brazilian Portuguese versions of the Global Appraisal of Individual Needs-"Initial" and "Short Screener" versions. METHODS: One hundred sixty-eight individuals from an inpatient service and/or a community-based outpatient service located in São Paulo were interviewed using the Brazilian Portuguese versions of the instruments. The internal consistency of the instruments scales was computed, along with evidence for the convergent validity between corresponding subscales of the Initial and Short Screener instruments. RESULTS: Cronbach's alpha values for both instruments' total scale scores were greater than .7. The Short Screener scales showed strong-to-moderate correlations with corresponding subscales of the Initial. The General Individual Severity Scale from the Initial and Total Disorder Screener from the Short Screener have convergent validity with each other (ρ = 0.801). CONCLUSIONS: The Brazilian Portuguese instrument scales showed evidence for internal consistency and convergent validity performing similarly to the American English versions.