Multimedia Battery for Assessment of Cognitive and Basic Skills in Mathematics (BM-PROMA).

Learning mathematics is a complex process that requires the development of multiple domain-general and domain-specific skills. It is therefore not unexpected that many children struggle to stay at grade level, and this becomes especially difficult when several abilities from both domains are impaired, as in the case of mathematical learning disabilities (MLD). Surprisingly, although MLD is one of the most common neurodevelopmental disorders affecting schoolchildren, most of the diagnostic instruments available do not include assessment of domain-general and domain-specific skills. Furthermore, very few are computerized. To the best of our knowledge, there is no tool with these features for Spanish-speaking children. The purpose of this study was to describe the protocol for the diagnosis of Spanish MLD children using the BM-PROMA multimedia battery. BM-PROMA facilitates the evaluation of both skill domains, and the 12 tasks included for this purpose are empirically evidence-based. The strong internal consistency of BM-PROMA and its multidimensional internal structure are demonstrated. BM-PROMA proves to be an appropriate tool for diagnosing children with MLD during primary education. It provides a broad cognitive profile for the child, which will be relevant not only for diagnosis but also for individualized instructional planning.

Piloting the Response to Intervention Model in the Canary Islands: Prevention of Reading and Math Learning Disabilities.

The main objective of this study was to examine the effectiveness of an intervention implemented by elementary school teachers within the context of the Response to Intervention (RtI) model. For this purpose, a Tier 2 or secondary intervention was implemented by Spanish-speaking teachers in grades K-3 after receiving training to implement RtI components with fidelity. A total of 1,923 at-risk students were assigned to treatment (in reading, n = 542; in math, n = 483) or control (in reading, n = 406; in math, n = 492). Teachers were provided with a support system that included two web-based training programs for reading (i.e., Letra program) and math (i.e., Primate program). Implementation fidelity was analyzed using direct observations and self-reports. All students were assessed three times during the academic year. A hierarchical linear growth modeling was conducted, and differences in the growth rate of reading and math performance were analyzed between at-risk students who have received the intervention and those who have not received it. Children at-risk in the intervention condition appeared to benefit more than at-risk children in the control condition. Moreover, findings indicate that the earlier the intervention, the greater the percentage of students who leave the situation of risk of learning difficulties in reading and math.

Analyzing the role of fidelity of RTI Tier 2 reading intervention in Spanish kindergarten and first grade students.

This study examined the role of fidelity in the reading outcomes within a Tier 2 intervention implemented by Spanish kindergarten and first grade school teachers. For this purpose, differences in reading performance growth were analyzed among at-risk students who received a Tier 2 intervention with high fidelity, at-risk students who received the same intervention with medium fidelity, and an at-risk control group that did not receive a Tier 2 intervention. Implementation fidelity was analyzed using direct observations and self-reports. All students were assessed three times during the academic year. Hierarchical linear modeling analyses were conducted to explore differences in growth rate. The at-risk children in the intervention condition showed a higher growth compared to at-risk children in the control condition, and specifically when the intervention was delivered with a high degree of fidelity.

Universal Screening for Prevention of Reading, Writing, and Math Disabilities in Spanish.

The purpose of this study was to describe a Spanish protocol that includes reading, writing, and math Curriculum-Based Measures (CBMs) aimed at early detection of students at risk of presenting learning disabilities (LD). Early identification of LD is a critical component of the Response to Intervention (RtI) model. In early grades, the screening of foundational skills mentioned above can provide a data-based guideline for identifying students requiring a more intensive response-based intervention before starting elementary school. We designed different CBMs based on indicators of basic early reading, writing, and math skills [Indicadores de Progreso de Aprendizaje en Lectura, Escritura y Matemáticas, IPAL, IPAE, and IPAM respectively] that aim to fulfill the twofold objective of universal screening and evaluation of the Spanish students' progress. For reading, IPAL includes alphabetic principle, phonological awareness, concepts about print, and riddles in kindergarten. In first and second grades, IPAL includes alphabetic principle, nonsense words fluency, maze sentences, and oral reading fluency. In addition, it includes phonemic segmentation for first grade and prosody for second grade. For writing, IPAE includes copying letters, writing allographs, dictated letters, dictated words with arbitrary spelling, dictated words with rule-based spelling, dictated nonsense words, dictated sentences, writing sentences, and writing a story for first-third grades. Finally, for math, IPAM includes number comparison, missing number, number identification, quantity array, and counting aloud for kindergarten, and number comparison, multi-digit computation, missing number, single-digit computation, and place value for first-third grades.

DENV and ZIKV detection in patients with acute febrile syndrome in Córdoba, Colombia.

OBJECTIVE: To determine simultaneous circulation of DENV serotypes and ZIKV in Córdoba, Colombia, during 2015 and 2016. MATERIAL AND METHODS: A total of 294 samples from patients with clinical diagnosis of febrile syndrome compatible with dengue were collected between June 2015 and December 2016. All samples were tested for DENV and ZIKV by RT-PCR using C6/36 cells culture supernatant. RESULTS: Thirty-three percent of the samples were positive (97/294); from these, 61.8% were positive for DENV and 31% were positive for Zika. The predominant serotype was DENV-2 (70.1%), followed by DENV-3 (8.9%), DENV-4 (6%), and DENV-1 (3%). DENV/ZIKV coinfection was identified in 7.2% of the cases associated with DENV-1 and DENV-3 serotypes. The confirmed cases of dengue, Zika, and DENV/ZIKV coinfections were clinically mild and self-limited. CONCLUSIONS: We reported the co-circulation of all four DENV serotypes, with a higher frequency of DENV-2, and ZIKV introduction in Córdoba department-Colombia in August 2015. This scenario favored the appearance of DENV/ZIKV coinfections.

Identifying the HLA DRB1-DQB1 molecules and predicting epitopes associated with high-risk HPV infection clearance and redetection.

Several determining factors are involved in HPV infection outcomes; human leukocyte antigen (HLA) polymorphisms have been described as related factors. This study has ascertained the effect of genetic variation on HLA-DRB1 and DQB1 genes on HPV-16/-18/-31/-33/-45 and -58 clearance and redetection in Colombian women. PCR and qPCR were used for viral identification and the Illumina MiSeq system was used for HLA-typing of cervical samples (n = 276). Survival models were adjusted for identifying alleles/haplotypes related to HPV clearance/redetection; L1/L2 protein-epitope binding to MHC-II molecules was also predicted. Significant associations suggested effects favouring or hampering clearance/redetection events depending on the viral type involved in infection, e.g. just DRB1*12:01:01G favoured HPV-16 (coeff: 4.8) and HPV-45 clearance (coeff: 12.65) whilst HPV-18 (coeff: 2E-15), HPV-31 (coeff: 8E-17) and HPV-58 hindered elimination (coeff: 1E-14). An effect was only observed for some alelles when configured as haplotypes, e.g. DRB1*04:07:01G (having the greatest frequency in the target population) was associated with DQB1*02:01:1G or *03:02:03. Epitope prediction identified 23 clearance-related peptides and 29 were redetection-related; eight might have been related to HPV-16/-18 and -58 persistence and one to HPV-18 elimination. HLA allele/haplotype relationship with the course of HPV infection (clearance/redetection) depended on the infecting HPV type, in line with the specific viral epitopes displayed.

Assessing Foundational Reading Skills in Kindergarten: A Curriculum-Based Measurement in Spanish.

Early identification of learning difficulties is a critical component of the Response to Intervention (RtI) model. In kindergarten, the screening of foundational reading skills can provide a data-based guideline for identifying students requiring a more intensive response-based intervention before starting elementary school. This study examines the classification accuracy and best predictors of a set of Spanish curriculum-based measures administered during kindergarten. The study's sample included 189 students tested in the fall, winter, and spring. Receiver operating characteristic (ROC) analysis was conducted. The composite score of the curriculum-based measurement (CBM) revealed area under the ROC curve (AUC) values of 0.83, 0.97, and 0.94 in the fall, winter, and spring, respectively. Phonemic awareness and letter-sound knowledge were the only isolated measures that demonstrated excellent AUC values throughout kindergarten. Logistic regression models showed that, when entered simultaneously, all measures were significant predictors of reading risk at some moment of the school year.

Using next-generation sequencing for characterising HLA-DRB1 and DQB1 loci in a cohort of Colombian women.

The Colombian population is characterised by a high genetic diversity, secondary to the ethnic mixture arising from colonisation. Unfortunately, few reports are available regarding HLA-DRB1 and DQB1 diversity in Colombia to date. HLA-DRB1 and DQB1 diversity was identified in this study using next-generating sequencing (NGS) on a cohort of Colombian women. Cervical samples taken from 276 women were used for typing DRB1 and DQB1 loci by Illumina MiSeq. Allele and haplotype frequencies were calculated using an expectation-maximisation algorithm. Hardy-Weinberg Equilibrium and linkage disequilibrium (LD) between loci were evaluated. Forty-seven DRB1 alleles and 14 DQB1 alleles were identified. DRB1*04:07:01G and DQB1*03:02:01G alleles occurred most frequently in the target population. Significant LD was found in 44 out of the 144 identified haplotypes, within which DRB1*04:07:01G-DQB1*03:02:01G occurred most frequently (6.56%). The alleles and haplotypes found with NGS agreed with that found in previous reports involving lower resolution for the Colombian population, and greater genetic variability was found, especially concerning DRB1. Comparing allele and haplotype frequency distribution in the target population to that of other populations denoted HLA system intra- and inter-population diversity.

High frequency of toxigenic Clostridium difficile and Clostridium perfringens coinfection among diarrheic patients at health care facility-onset (HCFO) and community-onset (CO) centers in Bogotá, Colombia.

BACKGROUND: The aim of this study was to evaluate the frequency of toxigenic C. difficile and C. perfringens infections at health care facility-onset (HCFO) and community-onset (CO), in two health care centers (HCC) in Bogotá, Colombia. A total of 220 stool samples from patients presenting diarrhea acquired at HCFO or CO were analyzed by several PCR tests. RESULTS: We found that 65.5% (n = 144) of the population had C. difficile infection, followed by toxigenic C. difficile with 57.3% (n = 126), and finally toxigenic C. perfringens with a frequency of 32.7% (n = 72). CONCLUSIONS: This study is the first molecular detection and characterization of C. difficile and C. perfringens in HCFO and CO in Latin America and demonstrates a relevant frequency of these two species, including coinfection and strikingly diverse toxigenic profiles, especially in the CO.

Micro-epidemiology of mixed-species malaria infections in a rural population living in the Colombian Amazon region.

Malaria outbreaks have been reported in recent years in the Colombian Amazon region, malaria has been re-emerging in areas where it was previously controlled. Information from malaria transmission networks and knowledge about the population characteristics influencing the dispersal of parasite species is limited. This study aimed to determine the distribution patterns of Plasmodium vivax, P. malariae and P. falciparum single and mixed infections, as well as the significant socio-spatial groupings relating to the appearance of such infections. An active search in 57 localities resulted in 2,106 symptomatic patients being enrolled. Parasitaemia levels were assessed by optical microscopy, and parasites were detected by PCR. The association between mixed infections (in 43.2% of the population) and socio-spatial factors was modelled using logistic regression and multiple correspondence analyses. P. vivax occurred most frequently (71.0%), followed by P. malariae (43.2%), in all localities. The results suggest that a parasite density-dependent regulation model (with fever playing a central role) was appropriate for modelling the frequency of mixed species infections in this population. This study highlights the under-reporting of Plasmodium spp. mixed infections in the malaria-endemic area of the Colombian Amazon region and the association between causative and environmental factors in such areas.

New Insights into Clostridium difficile (CD) Infection in Latin America: Novel Description of Toxigenic Profiles of Diarrhea-Associated to CD in Bogotá, Colombia.

Clostridium difficile (CD) produces antibiotic associated diarrhea and leads to a broad range of diseases. The source of CD infection (CDI) acquisition and toxigenic profile are factors determining the impact of CD. This study aimed at detecting healthcare facility onset- (HCFO) and community-onset (CO) CDI and describing their toxigenic profiles in Bogotá, Colombia. A total of 217 fecal samples from patients suffering diarrhea were simultaneously submitted to two CDI detection strategies: (i) in vitro culture using selective chromogenic medium (SCM; chromID, bioMérieux), followed verification by colony screening (VCS), and (ii) molecular detection targeting constitutive genes, using two conventional PCR tests (conv.PCR) (conv.16S y conv.gdh) and a quantitative test (qPCR.16s). The CD toxigenic profile identified by any molecular test was described using 6 tests independently for describing PaLoc and CdtLoc organization. High overall CDI frequencies were found by both SCM (52.1%) and conv.PCR (45.6% for conv.16S and 42.4% for conv.gdh), compared to reductions of up to half the frequency by VCS (27.2%) or qPCR.16S (22.6%). Infection frequencies were higher for SCM and conv.16S regarding HCFO but greater for CO concerning conv.gdh, such differences being statistically significant. Heterogeneous toxigenic profiles were found, including amplification with lok1/3 primers simultaneously with other PaLoc markers (tcdA, tcdB or tcdC). These findings correspond the first report regarding the differential detection of CDI using in vitro culture and molecular detection tests in Colombia, the circulation of CD having heterogeneous toxigenic profiles and molecular arrays which could affect the impact of CDI epidemiology.

Persistence, clearance and reinfection regarding six high risk human papillomavirus types in Colombian women: a follow-up study.

BACKGROUND: The design of new healthcare schemes which involve using molecular HPV screening means that both persistence and clearance data regarding the most prevalent types of HR-HPV occurring in cities in Colombia must be ascertained. METHODS: This study involved 219 HPV positive women in all of whom 6 types of HR-HPV had been molecularly identified and quantified; they were followed-up for 2 years. The Kaplan-Meier survival function was used for calculating the time taken for the clearance of each type of HPV. The role of a group of independent variables concerning the time taken until clearance was evaluated using a Cox proportional-hazards regression model or parametric (log-logistic) methods when necessary. Regarding viral load, the Wilcoxon rank-sum test was used for measuring the difference of medians for viral load for each type, according to the state of infection (cleared or persistent). The Kruskal-Wallis test was used for evaluating the change in the women's colposcopy findings at the start of follow-up and at the end of it (whether due to clearance or the end of the follow-up period). RESULTS: It was found that HPV-18 and HPV-31 types had the lowest probability of becoming cleared (1.76 and 2.75 per 100 patients/month rate, respectively). Women from Colombian cities other than Bogotá had a greater probability of being cleared if they had HPV-16 (HR 2.58: 1.51-4.4 95% CI) or HPV-58 (1.79 time ratio: 1.33-2.39 95% CI) infection. Regarding viral load, HPV-45-infected women having 1 × 106 to 9.99 × 109 viral copies had better clearance compared to those having greater viral loads (1.61 time ratio: 1.01-2.57 95% CI). Lower HPV-31 viral load values were associated with this type's persistence and changes in colposcopy findings for HPV-16 gave the worst prognosis in women having low absolute load values. CONCLUSIONS: HPV infection clearance in this study was related to factors such as infection type, viral load and the characteristics of the cities from which the women came. Low viral load values would indicate viral persistence and a worse prognosis regarding a change in colposcopy findings.

Human papillomavirus detection in women with and without human immunodeficiency virus infection in Colombia.

BACKGROUND: HIV infection leads to a decreasing immune response, thereby facilitating the appearance of other infections, one of the most important ones being HPV. However, studies are needed for determining associations between immunodeficiency caused by HIV and/or the presence of HPV during the course of cervical lesions and their degree of malignancy. This study describes the cytological findings revealed by the Papanicolaou test, laboratory characteristics and HPV molecular profile in women with and without HIV infection. METHODS: A total of 216 HIV-positive and 1,159 HIV-negative women were invited to participate in the study; PCR was used for the molecular detection of HPV in cervical samples. Statistical analysis (such as percentages, Chi-square test and Fisher's exact test when applicable) determined human papillomavirus (HPV) infection frequency (single and multiple) and the distribution of six types of high-risk-HPV in women with and without HIV infection. Likewise, a logistic regression model was run to evaluate the relationship between HIV-HPV infection and different risk factors. RESULTS: An association was found between the frequency of HPV infection and infection involving 2 or more HPV types (also known as multiple HPV infection) in HIV-positive women (69.0% and 54.2%, respectively); such frequency was greater than that found in HIV-negative women (44.3% and 22.7%, respectively). Statistically significant differences were observed between both groups (p = 0.001) regarding HPV presence (both in infection and multiple HPV infection). HPV-16 was the most prevalent type in the population being studied (p = 0.001); other viral types had variable distribution in both groups (HIV-positive and HIV-negative). HPV detection was associated with <500 cell/mm(3) CD4-count (p = 0.004) and higher HIV-viral-load (p = 0.001). HPV-DNA detection, <200 cell/mm(3) CD4-count (p = 0.001), and higher HIV-viral-load (p = 0.001) were associated with abnormal cytological findings. CONCLUSIONS: The HIV-1 positive population in this study had high multiple HPV infection prevalence. The results for this population group also suggested a greater association between HPV-DNA presence and cytological findings. HPV detection, together with low CD4 count, could represent useful tools for identifying HIV-positive women at risk of developing cervical lesions.

Classical molecular tests using urine samples as a potential screening tool for human papillomavirus detection in human immunodeficiency virus-infected women.

Human papillomavirus (HPV) is the main risk factor associated with the development of cervical cancer (CC); however, there are other factors, such as immunosuppression caused by the human immunodeficiency virus (HIV), that favor progression of the illness. This study was thus aimed at evaluating the functionality of classical PCR-based molecular tests for the generic identification of HPV DNA (GP5+/GP6+, MY09/MY11, and pU1M/2R primers, individually or in combination) using cervical and urine samples from 194 HIV-positive women. Infected samples were tested with type-specific primers for six high-risk types (HPV-16, -18, -31, -33, -45, and -58) and two low-risk types (HPV-6 and -11). HPV infection prevalence rates were 70.1% for the cervical samples and 63.9% for the urine samples. HPV-16 was the most prevalent viral type in the cervical and urine samples, with higher rates of multiple infections than single infections detected in such samples. HPV DNA detection by PCR (mainly with the pU1M/2R primer set) in urine samples was positively associated with abnormal cytological findings (atypical squamous cells of undetermined significance/squamous intraepithelial lesions [ASCUS/SIL]). It was determined that the operative characteristics for detection of cytological abnormalities were similar for cervical and urine samples. This suggested using PCR for the detection of HPV DNA in urine samples as a potential screening strategy for CC prevention in future prevention and control programs along with currently implemented strategies for reducing the impact of the disease, i.e., urine samples are economical, are easy to collect, have wide acceptability among women, and have operative characteristics similar to those of cervical samples.

Human papillomavirus detection from human immunodeficiency virus-infected Colombian women's paired urine and cervical samples.

Infection, coinfection and type-specific human papillomavirus (HPV) distribution was evaluated in human immunodeficiency virus (HIV)-positive women from paired cervical and urine samples. Paired cervical and urine samples (n = 204) were taken from HIV-positive women for identifying HPV-DNA presence by using polymerase chain reaction (PCR) with three generic primer sets (GP5+/6+, MY09/11 and pU1M/2R). HPV-positive samples were typed for six high-risk HPV (HR-HPV) (HPV-16, -18, -31, -33, -45 and -58) and two low-risk (LR-HPV) (HPV-6/11) types. Agreement between paired sample results and diagnostic performance was evaluated. HPV infection prevalence was 70.6% in cervical and 63.2% in urine samples. HPV-16 was the most prevalent HPV type in both types of sample (66.7% in cervical samples and 62.0% in urine) followed by HPV-31(47.2%) in cervical samples and HPV-58 (35.7%) in urine samples. There was 55.4% coinfection (infection by more than one type of HPV) in cervical samples and 40.2% in urine samples. Abnormal Papanicolau smears were observed in 25.3% of the women, presenting significant association with HPV-DNA being identified in urine samples. There was poor agreement of cervical and urine sample results in generic and type-specific detection of HPV. Urine samples provided the best diagnosis when taking cytological findings as reference. In conclusion including urine samples could be a good strategy for ensuring adherence to screening programs aimed at reducing the impact of cervical cancer, since this sample is easy to obtain and showed good diagnostic performance.

The diagnostic performance of classical molecular tests used for detecting human papillomavirus.

Cervical samples were evaluated for human papillomavirus (HPV) presence using the hybrid capture-2 (HC2) assay and the polymerase chain reaction (PCR) with three different primer sets (GP5+/6+, MY09/11 and pU1M/2R). PCR results were compared to HC2 and results of all assays were compared to cytological and colposcopy findings. Post-test probability was assessed in individual assays and test combinations. HPV-DNA prevalence was 36.5% with HC2 and 55.2% with PCR. MY09/11 detected HPV-DNA in 38% of samples, GP5+/6+ in 19.1% and pU1M/2R in 16.4%. pU1M/2R and HC2 had the highest concordance (75.31%, k=0.39 in the whole population; 74.1%, k=0.5 in women with abnormal cytology). pU1M/2R had the best diagnostic performance, including optimal post-test probabilities and cervical abnormality detection (individually or in a panel of tests). Women positive for pU1M/2R may be at higher risk of disease progression; the assay performance when combined with a Pap smear in cervical cancer screening programs should be evaluated.

Frequency of human papillomavirus infection, coinfection, and association with different risk factors in Colombia.

PURPOSE: The aims of this study were to provide new insights into infection patterns of six high-risk human papillomaviruses (HR-HPV-16, -18, -31, -33, -45, and -58) and two low-risk HPV types (LR-HPV-6 and -11), their association with risk factors and coinfection. METHODS: Cervical samples of 2110 women were tested for the presence of HPV-DNA by polymerase chain reaction. Statistical analyses were performed to determine viral-type frequencies in single and multiple infections and association between infection and different risk factors. RESULTS: HPV-16 was the most prevalent type among the studied population, followed by HPV-31. This last viral type showed a variable distribution between the different cities evaluated. The results showed distinct type-specific distributions among regions and a high association between absence of pregnancies, cities as Girardot and Leticia, the indigenous ethnicity, and coinfection. CONCLUSIONS: The results showed a variable distribution of HPV types according to the geographical region analyzed. In addition, data suggest that some sociodemographic-factors such as ethnicity, number of pregnancies, lifetime number of sexual partners, and geographic region were significantly associated, and our results showed little differences between single and multiple infections by HPV with regard to risk factors. Furthermore, these results provide relevant information that will allow assessing in further studies the impact that vaccination programs on these populations and the selective pressure would have on the distribution of HPV types.