Effects of yoga on impulsivity in patients with and without mental disorders: a systematic review.

BACKGROUND: Yoga can be used as a complementary intervention to conventional treatments, whether pharmacological or non-pharmacological. Sustained practice of yoga can generate a series of benefits for individuals' quality of life and improve their physical fitness. OBJECTIVE: To investigate the potential effects of yoga as an adjunct intervention in conditions involving impulse control issues, such as attention deficit hyperactivity disorder (ADHD), borderline personality disorder, bipolar affective disorder, and substance use disorders. METHODS: We performed a systematic review of placebo-controlled, randomized trials of yoga in patients with impulsivity. PubMed, Web of Science, and Science Direct databases were searched for trials published up to January, 2023. Data were extracted from published reports and quality assessment was performed per Cochrane recommendations. RESULTS: Out of 277 database results, 6 RCT were included in this systematic review. To assess the level of attention and impulsiveness, the following scales were analyzed: Barratt Impulsiveness, UPPS-P Impulsive Behavior scale, Conners' Continuous Performance Test IIª and Conners' Parent Rating Scale-Revised: Long. CONCLUSIONS: Yoga didn't have a significant improvement in impulsivity when compared to placebo. There are many tools to assess impulsivity, but they mean different concepts and domains consisting in a weakness on comparison of yoga effects. PROSPERO REGISTRATION: CRD42023389088.

Parent training for disruptive behavior symptoms in attention deficit hyperactivity disorder: a randomized clinical trial.

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) affects 5% of children and 2.5% of adults worldwide. Comorbidities are frequent, and Oppositional Defiant Disorder (ODD) reaches 50%. Family environment is crucial for the severity of behaviors and for prognosis. In middle-income countries, access to treatment is challenging, with more untreated children than those under treatment. Face-to-face behavioral parent training (PT) is a well-established intervention to improve child behavior and parenting. Method: A clinical trial was designed to compare PT-online and face-to-face effects to a waiting list group. Outcomes were the ADHD and ODD symptoms, parental stress and styles, and quality of life. Families were allocated into three groups: standard treatment (ST), ST + PT online, and ST + Face-to-Face PT. We used repeated measures ANOVA for pre × post treatment analysis corrected for multiple comparisons. Results and discussion: Parent training was effective in reducing symptoms of ADHD (p = 0.030) and ODD (p = 0.026) irrespective of modality (p = 1.000). The combination of ST and PT was also associated with better quality of life in the physical domain for patients (p = 0.009) and their parents (p = 0.050). In addition to preliminary data, online intervention seems effective for parenting and improving social acceptance of children. The potential to reach many by an online strategy with a self-directed platform may imply effectiveness with a low cost for public health to support parents' symptoms management.

Safety and efficacy of repetitive stimulation of the left dorsolateral prefrontal cortex using transcranial focused ultrasound in treatment-resistant depressed patients: A non-inferiority randomized controlled trial protocol.

BACKGROUND: About 30% of patients diagnosed with major depressive disorder fail with the mainstream pharmacological treatment. Patients who do not achieve clinical remission of symptoms, even with two different antidepressants, are classified with treatment-resistant depression (TDR). This condition imposes an additional burden with increased Disability Adjusted Life Years. Therefore, complementary treatments, such as neuromodulation, are necessary. The transcranial focused ultrasound (tFUS) has emerged in the past few years as a reliable method for non-invasive neuromodulation in humans and may help treat TRD. This study aims to propose a research protocol for a non-inferiority randomized clinical trial of TDR with tFUS. METHODS: Patients with documented TRD will be screened upon entering the TRD outpatient clinic at UFMG (Brazil). One hundred patients without a clinical history of other psychiatric illness, anatomical abnormalities on magnetic resonance imaging (MRI), or treatment with electroconvulsive therapy will be invited to participate. Patients will be randomized (1:1) into two groups: 1) treatment with a previously established protocol of transcranial magnetic stimulation; and 2) treatment with a similar protocol using the stimulation. Besides regular consultations in the outpatient clinic, both groups will attend 7 protocolled spaced days of brain stimulation targeted at the left dorsolateral prefrontal cortex. They will also be submitted to 4 sessions of image studies (2 MRIs, 2 positron-emission tomography), 3 of neuropsychological assessments (at baseline, 1 week and 2 months after treatment), the Montgomery-Åsberg Depression Rating Scale to analyze the severity of depressive symptoms. DISCUSSION: This clinical trial intends to verify the safety and clinical efficacy of tFUS stimulation of the dorsolateral prefrontal cortex of patients with TRD, compared with a previously established neuromodulation method.

Children and adolescents' quality of life in repeated cross-sectional studies during the COVID-19.

During the COVID-19 pandemic, internalizing and externalizing symptoms have impacted the quality of life of children and adolescents. This cross-sectional study evaluated children's quality of life using parental reports, observing associations with mental health problems and sociodemographic variables. Some behavioral measures were linked to lower quality of life, particularly depression symptoms, relationship problems, and inattention. Multiple regression models indicated that reduced children's quality of life (R2 = 36%) was associated with higher levels of internalizing (r = -0.46) and externalizing (r = -0.23) behavioral problems and younger parents (r = -0.08). Children with previous mental disorder diagnoses had lower quality of life than those without (p < 0.001). In summary, children's quality of life during the COVID-19 pandemic was linked to current mental health, parental age, and previous history of mental disorders.

Follow-up of cognitive impairment and inflammatory profile in individuals with mild COVID-19.

Individuals who experience mild COVID-19 can suffer from long-lasting cognitive symptoms. Notably, 26% of these individuals experience difficulties with visuospatial abilities six months after infection. However, among those who initially exhibited visuoconstructive impairments, 66% showed improvement or complete reversal over time. Additionally, changes in cytokine levels, particularly CCL11, HGF, and CXCL10, were observed. These results suggest a potential link between ongoing cognitive issues and elevated levels of pro-inflammatory cytokines, which merits further investigation.

Can the inner eye canthus temperature be used as an alternative method to measure core temperature in sleep-deprived individuals?

Core temperature is used in several situations, including studies on biological rhythms and circadian markers of physical performance. Measuring the inner eye canthus (Tco) temperature is a method proposed to identify core temperature, but it has shown little concordance in physical exercise situations and has not yet been used in studies with measurements taken throughout the day. The objective of this study was to compare the measurements and daily behavior of Tco obtained by infrared thermography with rectal temperature (Tre) during a prolonged waking protocol. Eleven male individuals participated in the study, who remained in the laboratory for at least 38 h using an actigraph to determine the wakefulness time and were monitored during the entire period. The Tre and Tco measurements were performed every 3 h. The ANOVA was used for repeated measurements followed by Bonferroni's post-hoc test to find the limits of concordance/proximity, while the Bland and Altman method and the Intraclass Correlation Coefficient were used to establish the reliability between the pairs. The significance level adopted was p < 0.05. The results demonstrate significant differences, low levels of concordance and unsatisfactory reliability levels between Tco and Tre at all 13 analyzed moments, in addition to not showing measurement reliability when all data are used together with the 143 temperature measurements. Daily behavior analysis shows moments with similar behavior with an increase in Tco and Tre, but at other times the behavior was the opposite, with a decrease in one measurement and an increase in the other. Based on the results presented, it is not recommended to use the inner eye canthus temperature as a substitute for rectal temperature for measuring core temperature at different times of the day or in sleep-deprived individuals.

Translation and validity of the Multidimensional Individual and Interpersonal Resilience Measure.

OBJECTIVE: to translate, culturally adapt and validate the Multidimensional Individual and Interpersonal Resilience Measure to Brazilian Portuguese. METHOD: after initial translation, the pre-final version underwent rigorous cultural adaptation procedures. As a result, the final adapted version was submitted to a validity study. RESULTS: adaptation procedures provided equivalence between the pre-final and the original versions in semantic, idiomatic, experiential and conceptual terms. A total of 187 older adults were included in the validity study. Exploratory factorial analysis (EFA) generated a model of five factors ((RMSEA = 0.030; TLI = 0.959; X2 = 151.590 p> 0.05). Final version showed adequate consistency (Cronbach's α = 0.705) and test-retest reliability (ICC=0.835). No statistically significant correlation was found between resilience and sociodemographic and epidemiological variables assessed in this study. CONCLUSION: EMRII-BR is a valid and reliable instrument for measuring resilience in Brazilian older adults.

Psychometric properties of the Brazilian Portuguese version of the UPPS-P impulsive behavior scale for children and adolescents.

OBJECTIVE: To translate and validate the version for children and adolescents of the UPPS-P scale into Brazilian Portuguese. METHOD: After a five-step translation process, the final draft was submitted to a panel of 12 different specialties experts. Subsequently, the application of the scale was applied concomitantly with the "Swanson, Nolan, and Pelham Scale - Version IV" (SNAP-IV) and the "Child and Adolescent Behavior Inventory" (CABI) scale to analyze the correlation between them. Content Validity Index (CVI) and reliability were estimated by calculating internal consistency and analyzing its test-retest stability. RESULTS: The items whose CVI was lower than 80% underwent a detailed analysis to verify the reason for the bad evaluation. Five items (3, 7, 11, 22 and 35) scored below 80% and were reassessed. There was high internal consistency in all parameters: Lack of premeditation (McDonald's omega = 0.806; Cronbach's alpha = 0.801), Negative Urgency (McDonald's omega = 0.838; Cronbach's alpha = 0.836), Sensation seeking (McDonald's omega = 0.826; Cronbach's alpha = 0.810), Lack of Perseverance (McDonald's omega = 0.800; Cronbach's alpha = 0.799) and Positive Urgency (McDonald's omega = 0.936; Cronbach's alpha = 0.934). A strong correlation was observed between UPPS-P features and impulsivity in behavioral assessments. CONCLUSIONS: The Brazilian Portuguese version of the UPPS-P scale is a good instrument to assess impulsivity in children and adolescents.

The associations between screen time and mental health in adolescents: a systematic review.

BACKGROUND: Adolescents have extensive use of screens and, they have common complains related to mental health. Here a systematic review was done to understand the association between screen time and adolescent's mental health. METHOD: This review was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses - PRISMA. An update search was performed in January 2023 with the following keywords: "screen time," "adolescent," and "mental health" on PubMed, PsycINFO and Scopus databases. RESULTS: 50 articles were included, most have found associations between screen exposure and mental health in adolescents. The most used device by adolescents was the smartphone and the use on weekdays was associated with diminished mental well-being. Social media use was negatively associated with mental well-being and, in girls, associated at higher risk for depression. CONCLUSION: Excessive screen time in adolescents seems associated with mental health problems. Given the profusion and disparity of the results, additional studies are needed to clarify elements such as the screen content or the interaction of adolescents with different screen devices. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022302817.

Decision-making styles during stressful scenarios: The role of anxiety in COVID-19 pandemic.

Introduction: Decision-making is not purely rational but highlighted by the influence of intuitive and emotional processes. Recently, researchers have focused more attention on understanding which environmental and personal features influence decision-making processes, and how. Objective and methods: On this study, we investigate whether Trait Anxiety moderates the impact of Post-Traumatic Stress (PTS) symptoms reported during COVID-19 pandemic on decision-making styles. Results: The study included 1,358 Brazilian participants (80% women) aged between 20 and 74 (M = 41.11; SD = 11.23) who responded to an online survey between May and August of the year 2021 of COVID-19 pandemic to The State-Trait Anxiety Inventory, The Decisions Styles Scale, The Impact of Event Scale - Revised and questions related to COVID-19. Through moderation analysis, we observed that experiencing PTS is associated with a higher tendency to biased/heuristic decision-making processes. Discussion: Trait Anxiety seems to influence how people respond to PTS symptoms on decision-making related processes. Subjects with higher Trait Anxiety reported lower tendency to appeal to rationality, especially under higher reported levels of PTS. Meanwhile, lower Trait Anxiety subjects exhibited more reason-based decision-making under higher rates of PTS. This work contributes to a deeper understanding of the interplay among environmental and individual differences on decision-making styles and helps to identify factors of vulnerability for poorer cognitive functioning on stressful scenarios.

Selective visuoconstructional impairment following mild COVID-19 with inflammatory and neuroimaging correlation findings.

People recovered from COVID-19 may still present complications including respiratory and neurological sequelae. In other viral infections, cognitive impairment occurs due to brain damage or dysfunction caused by vascular lesions and inflammatory processes. Persistent cognitive impairment compromises daily activities and psychosocial adaptation. Some level of neurological and psychiatric consequences were expected and described in severe cases of COVID-19. However, it is debatable whether neuropsychiatric complications are related to COVID-19 or to unfoldings from a severe infection. Nevertheless, the majority of cases recorded worldwide were mild to moderate self-limited illness in non-hospitalized people. Thus, it is important to understand what are the implications of mild COVID-19, which is the largest and understudied pool of COVID-19 cases. We aimed to investigate adults at least four months after recovering from mild COVID-19, which were assessed by neuropsychological, ocular and neurological tests, immune markers assay, and by structural MRI and 18FDG-PET neuroimaging to shed light on putative brain changes and clinical correlations. In approximately one-quarter of mild-COVID-19 individuals, we detected a specific visuoconstructive deficit, which was associated with changes in molecular and structural brain imaging, and correlated with upregulation of peripheral immune markers. Our findings provide evidence of neuroinflammatory burden causing cognitive deficit, in an already large and growing fraction of the world population. While living with a multitude of mild COVID-19 cases, action is required for a more comprehensive assessment and follow-up of the cognitive impairment, allowing to better understand symptom persistence and the necessity of rehabilitation of the affected individuals.

Translation and validity of the Multidimensional Individual and Interpersonal Resilience Measure / Tradução e validação do Multidimensional Individual and Interpersonal Resilience Measure / Traducción y validación del Multidimensional Individual and Interpersonal Resilience Measure

ABSTRACT Objective: to translate, culturally adapt and validate the Multidimensional Individual and Interpersonal Resilience Measure to Brazilian Portuguese. Method: after initial translation, the pre-final version underwent rigorous cultural adaptation procedures. As a result, the final adapted version was submitted to a validity study. Results: adaptation procedures provided equivalence between the pre-final and the original versions in semantic, idiomatic, experiential and conceptual terms. A total of 187 older adults were included in the validity study. Exploratory factorial analysis (EFA) generated a model of five factors ((RMSEA = 0.030; TLI = 0.959; X2 = 151.590 p> 0.05). Final version showed adequate consistency (Cronbach's α = 0.705) and test-retest reliability (ICC=0.835). No statistically significant correlation was found between resilience and sociodemographic and epidemiological variables assessed in this study. Conclusion: EMRII-BR is a valid and reliable instrument for measuring resilience in Brazilian older adults.

RESUMO Objetivo: traduzir, adaptar culturalmente e validar o Multidimensional Individual and Interpersonal Resilience Measure para o português brasileiro. Método: após a tradução inicial, a versão pré-final passou por rigorosos procedimentos de adaptação cultural. Como resultado, a versão final adaptada foi submetida a um estudo de validade. Resultados: os procedimentos de adaptação proporcionaram equivalência entre as versões pré-final e original em termos semânticos, idiomáticos, experienciais e conceituais. Um total de 187 idosos foram incluídos no estudo de validade. A análise fatorial exploratória (AFE) gerou um modelo de cinco fatores ((RMSEA = 0,030; TLI = 0,959; X2 = 151,590 p> 0,05). A versão final apresentou consistência adequada (α de Cronbach = 0,705) e confiabilidade teste-reteste (ICC=0,835). Não foi encontrada correlação estatisticamente significativa entre a resiliência e as variáveis sociodemográficas e epidemiológicas avaliadas neste estudo. Conclusão: o EMRII-BR é um instrumento válido e confiável para mensurar a resiliência em idosos brasileiros.

RESUMEN Objetivo: traducir, adaptar culturalmente y validar el Multidimensional Individual and Interpersonal Resilience Measure para el portugués brasileño. Método: después de la traducción inicial, la versión pre-final pasó por rigurosos procedimientos de adaptación cultural. Como resultado, la versión final adaptada fue sometida a un estudio de validez. Resultados: los procedimientos de adaptación proporcionaron equivalencia entre las versiones pre-final y original en términos semánticos, idiomáticos, experienciales y conceptuales. Un total de 187 ancianos fueron incluidos en el estudio de validez. El análisis factorial exploratorio (AFE) generó un modelo de cinco factores ((RMSEA = 0,030; TLI = 0,959; X2 = 151,590 p> 0,05). La versión final mostró adecuada consistencia (α de Cronbach = 0,705) y confiabilidad prueba-reprueba (ICC=0,835). No se encontró correlación estadísticamente significativa entre la resiliencia y las variables sociodemográficas y epidemiológicas evaluadas en este estudio. Conclusión: EMRII-BR es un instrumento válido y confiable para medir la resiliencia en ancianos brasileños.

Psychometric properties of the Brazilian Portuguese version of the UPPS-P impulsive behavior scale for children and adolescents

Abstract Objective: To translate and validate the version for children and adolescents of the UPPS-P scale into Brazilian Portuguese. Method: After a five-step translation process, the final draft was submitted to a panel of 12 different specialties experts. Subsequently, the application of the scale was applied concomitantly with the "Swanson, Nolan, and Pelham Scale - Version IV" (SNAP-IV) and the "Child and Adolescent Behavior Inventory" (CABI) scale to analyze the correlation between them. Content Validity Index (CVI) and reliability were estimated by calculating internal consistency and analyzing its test-retest stability. Results: The items whose CVI was lower than 80% underwent a detailed analysis to verify the reason for the bad evaluation. Five items (3, 7, 11, 22 and 35) scored below 80% and were reassessed. There was high internal consistency in all parameters: Lack of premeditation (McDonald's omega = 0.806; Cronbach's alpha = 0.801), Negative Urgency (McDonald's omega = 0.838; Cronbach's alpha = 0.836), Sensation seeking (McDonald's omega = 0.826; Cronbach's alpha = 0.810), Lack of Perseverance (McDonald's omega = 0.800; Cronbach's alpha = 0.799) and Positive Urgency (McDonald's omega = 0.936; Cronbach's alpha = 0.934). A strong correlation was observed between UPPS-P features and impulsivity in behavioral assessments. Conclusions: The Brazilian Portuguese version of the UPPS-P scale is a good instrument to assess impulsivity in children and adolescents.

Online parent training platform for complementary treatment of disruptive behavior disorders in attention deficit hyperactivity disorder: A randomized controlled trial protocol.

BACKGROUND: Attention Deficit/Hyperactivity Disorder (ADHD) is associated with a diversity of impairments and Oppositional Defiant Disorder (ODD) is a very frequent comorbidity. Parent Training, as an evidence-based intervention, seems effective in reducing externalizing/disruptive behaviors, possibly leading to a better prognosis. This clinical trial aims to evaluate the effectiveness of an online parent training model as a complementary treatment for ADHD and ODD. METHODS: Patients and their families will be screened upon their entry into the Research Center of Impulsivity and Attention (NITIDA) at UFMG-Brazil. Ninety families whose children are male, between 6-12 years old, and have significant externalizing symptoms and whose primary caregiver have complete high school education will be invited to participate. Families will be randomized (1:1) into 03 groups: 1) standard care; 2) standard care + face-to-face parent training; 3) standard care + online parent training. Interventions are analogous, differing only in delivery format. In the face-to-face format, the intervention will be conducted by a specialized therapist and the online format will be carried out through a platform. There will be six sessions/modules, arranged on a weekly basis. Measures of externalizing symptoms, parental and children quality of life, parental stress and parenting style will be collected at baseline and after the intervention. DISCUSSION: This clinical trial intends to verify the effects of a new, online, model of an evidence-based intervention, which would allow a wider access in the Brazilian context. TRIAL REGISTRATION: Registered on Brazilian Registry of Clinical Trials (ReBEC). Number: RBR-6cvc85. July 24th (2020) 05:35 pm.

The mental health of Brazilian healthcare professionals during the COVID-19 pandemic: a longitudinal study.

OBJECTIVE: To compare the distress level among Brazilian healthcare professionals during the coronavirus disease 2019 (COVID-19) pandemic and estimate risks by sex, age, and occupation. METHODS: In a longitudinal cohort design, a nationally distributed online survey was used to collect data from 10,490 active healthcare professionals who worked during the pandemic. Participants were mostly female, aged 18 to 82 years; 13 different health professions and all states of Brazil were represented. RESULTS: The most frequent professions were psychology, dentistry, and nursing. The Brief Symptom Inventory (BSI) score suggested an increased distress perception among health professionals. Females showed poorer mental health than males, but the absolute rise in Global Severity Index (GSI) score was larger in males than in females. Younger adults reported more symptoms of psychological distress than older adults. The most impacted age group was between 30-39 years. Nurse technicians presented the highest risk of distress. CONCLUSION: Health professionals are essential to overcoming the pandemic; thus, their mental health status should be monitored, and features associated with increased distress should be identified. Our findings suggest distress risk should be stratified by occupation, age, and sex. Health professionals showed an increased distress perception. Women, individuals between the ages of 30 and 39, nursing personnel, and physicians were more likely to report distress compared with other health professionals.

Transiently Nav1.8-expressing neurons are capable of sensing noxious stimuli in the brain.

While current research highlights the role of Nav1. 8 sensory neurons from the peripheral nervous system, the anatomical and physiological characterization of encephalic Nav1.8 neurons remains unknown. Here, we use a Cre/fluorescent reporter mouse driven by the Nav1.8 gene promoter to reveal unexpected subpopulations of transiently-expressing Nav1.8 neurons within the limbic circuitry, a key mediator of the emotional component of pain. We observed that Nav1.8 neurons from the bed nuclei of the stria terminalis (BST), amygdala, and the periaqueductal gray (vPAG) are sensitive to noxious stimuli from an experimental model of chronic inflammatory pain. These findings identify a novel role for central Nav1.8 neurons in sensing nociception, which could be researched as a new approach to treating pain disorders.

The mental health of Brazilian healthcare professionals during the COVID-19 pandemic: a longitudinal study

Objective: To compare the distress level among Brazilian healthcare professionals during the coronavirus disease 2019 (COVID-19) pandemic and estimate risks by sex, age, and occupation. Methods: In a longitudinal cohort design, a nationally distributed online survey was used to collect data from 10,490 active healthcare professionals who worked during the pandemic. Participants were mostly female, aged 18 to 82 years; 13 different health professions and all states of Brazil were represented. Results: The most frequent professions were psychology, dentistry, and nursing. The Brief Symptom Inventory (BSI) score suggested an increased distress perception among health professionals. Females showed poorer mental health than males, but the absolute rise in Global Severity Index (GSI) score was larger in males than in females. Younger adults reported more symptoms of psychological distress than older adults. The most impacted age group was between 30-39 years. Nurse technicians presented the highest risk of distress. Conclusion: Health professionals are essential to overcoming the pandemic; thus, their mental health status should be monitored, and features associated with increased distress should be identified. Our findings suggest distress risk should be stratified by occupation, age, and sex. Health professionals showed an increased distress perception. Women, individuals between the ages of 30 and 39, nursing personnel, and physicians were more likely to report distress compared with other health professionals.

Social Determinants in Self-Protective Behavior Related to COVID-19: Association Rule-Mining Study.

BACKGROUND: Human behavior is crucial in health outcomes. Particularly, individual behavior is a determinant of the success of measures to overcome critical conditions, such as a pandemic. In addition to intrinsic public health challenges associated with COVID-19, in many countries, some individuals decided not to get vaccinated, streets were crowded, parties were happening, and businesses struggling to survive were partially open, despite lockdown or stay-at-home instructions. These behaviors contrast with the instructions for potential benefits associated with social distancing, use of masks, and vaccination to manage collective and individual risks. OBJECTIVE: Considering that human behavior is a result of individuals' social and economic conditions, we investigated the social and working characteristics associated with reports of appropriate protective behavior in Brazil. METHODS: We analyzed data from a large web survey of individuals reporting their behavior during the pandemic. We selected 3 common self-care measures: use of protective masks, distancing by at least 1 m when out of the house, and handwashing or use of alcohol, combined with assessment of the social context of respondents. We measured the frequency of the use of these self-protective measures. Using a frequent pattern-mining perspective, we generated association rules from a set of answers to questions that co-occur with at least a given frequency, identifying the pattern of characteristics of the groups divided according to protective behavior reports. RESULTS: The rationale was to identify a pool of working and social characteristics that might have better adhesion to behaviors and self-care measures, showing these are more socially determined than previously thought. We identified common patterns of socioeconomic and working determinants of compliance with protective self-care measures. Data mining showed that social determinants might be important to shape behavior in different stages of the pandemic. CONCLUSIONS: Identification of context determinants might be helpful to identify unexpected facilitators and constraints to fully follow public policies. The context of diseases contributes to psychological and physical health outcomes, and context understanding might change the approach to a disease. Hidden social determinants might change protective behavior, and social determinants of protective behavior related to COVID-19 are related to work and economic conditions. TRIAL REGISTRATION: Not applicable.

The Autism Spectrum Quotient in a sample of Brazilian adults: analyses of normative data and performance.

Autism spectrum disorder (ASD) is characterized by difficulties in social interaction and inflexible behaviors/interests. To quantify ASD traits in adults with preserved intelligence, the Autism Spectrum Quotient (AQ) was developed, which is a self-report instrument and one of the most used and recommended tools. Objectives: We aimed to present a descriptive analysis of the AQ in a sample of Brazilian adults with neurotypical development (n=385) and investigate how the scale performs in a clinical subsample (n=33). Methods: We recruited 1,024 participants. They answered the Self-Reporting Questionnaire-20 (SRQ-20), AQ, and about their psychiatric record. Then, we selected 385 participants without any psychiatric diagnosis to describe the distribution of the ASD traits. To investigate the AQ performance, we evaluated 33 adults with ASD and 19 adults with neurotypical development from the total sample (n=1,024). Results: ASD traits were normally distributed in the population, with high internal consistency. Of a total of 91 men, volunteers with 32 points (clinical cutoff point) or more scored higher than 93% of the control sample. Of a total of 294 women, those who got a clinical score on the scale scored higher than 97%. In the clinical subsample (n=33), the positive predictive value (PPV) of the AQ was 0.84, and the negative predictive value (NPV) was 0.7. Conclusions: The study population has a different profile compared to the original study regarding the AQ scale. ASD traits were normally distributed in the neurotypical sample, and the scale seems to have a satisfactory performance to predict ASD. Future studies are required to adequate the use of the scale in the Brazilian population.

O transtorno do espectro do autismo (TEA) é caracterizado por dificuldades na interação social e comportamentos/interesses inflexíveis. Com o intuito de quantificar os traços de TEA em adultos com inteligência preservada, foi desenvolvido o quociente do espectro do autismo (QA), um instrumento de autorrelato muito utilizado e recomendado. Objetivos: Nosso objetivo foi apresentar uma análise descritiva do QA em uma amostra de adultos brasileiros com desenvolvimento neurotípico (n=385) e investigar o desempenho da escala em uma subamostra clínica (n=33). Métodos: Foram recrutados 1.024 participantes, que responderam ao Self-Reporting Questionnaire-20 (SRQ-20), ao QA e a questões sobre o seu histórico psiquiátrico. Em seguida, selecionamos 385 participantes sem qualquer diagnóstico psiquiátrico para descrever a distribuição dos traços de TEA. Para investigar o desempenho do QA, avaliamos 33 adultos com TEA e 19 adultos com desenvolvimento neurotípico da amostra total (n=1024). Resultados: As características do TEA apresentaram distribuição normal na amostra, com alta consistência interna. Do total de 91 homens, os voluntários com 32 pontos (ponto de corte clínico) ou mais pontuaram acima de 93% da amostra de controle. De 294 mulheres, aquelas que obtiveram pontuação clínica na escala pontuaram acima de 97%. Na subamostra clínica (n=33), o valor preditivo positivo do QA foi de 0,84 e o valor preditivo negativo foi de 0,7. Conclusões: A população estudada apresenta um perfil diferente comparada à população do estudo original, no que se refere à escala QA. Os traços de TEA foram normalmente distribuídos na amostra neurotípica, e a escala parece ter um desempenho satisfatório para predizer autismo. Estudos futuros são necessários para adequar o uso da escala na população brasileira.

The Autism Spectrum Quotient in a sample of Brazilian adults: analyses of normative data and performance / O quociente do espectro do autismo em uma amostra de adultos brasileiros: análises de dados normativos e de desempenho

ABSTRACT. Autism spectrum disorder (ASD) is characterized by difficulties in social interaction and inflexible behaviors/interests. To quantify ASD traits in adults with preserved intelligence, the Autism Spectrum Quotient (AQ) was developed, which is a self-report instrument and one of the most used and recommended tools. Objectives: We aimed to present a descriptive analysis of the AQ in a sample of Brazilian adults with neurotypical development (n=385) and investigate how the scale performs in a clinical subsample (n=33). Methods: We recruited 1,024 participants. They answered the Self-Reporting Questionnaire-20 (SRQ-20), AQ, and about their psychiatric record. Then, we selected 385 participants without any psychiatric diagnosis to describe the distribution of the ASD traits. To investigate the AQ performance, we evaluated 33 adults with ASD and 19 adults with neurotypical development from the total sample (n=1,024). Results: ASD traits were normally distributed in the population, with high internal consistency. Of a total of 91 men, volunteers with 32 points (clinical cutoff point) or more scored higher than 93% of the control sample. Of a total of 294 women, those who got a clinical score on the scale scored higher than 97%. In the clinical subsample (n=33), the positive predictive value (PPV) of the AQ was 0.84, and the negative predictive value (NPV) was 0.7. Conclusions: The study population has a different profile compared to the original study regarding the AQ scale. ASD traits were normally distributed in the neurotypical sample, and the scale seems to have a satisfactory performance to predict ASD. Future studies are required to adequate the use of the scale in the Brazilian population.

RESUMO. O transtorno do espectro do autismo (TEA) é caracterizado por dificuldades na interação social e comportamentos/interesses inflexíveis. Com o intuito de quantificar os traços de TEA em adultos com inteligência preservada, foi desenvolvido o quociente do espectro do autismo (QA), um instrumento de autorrelato muito utilizado e recomendado. Objetivos: Nosso objetivo foi apresentar uma análise descritiva do QA em uma amostra de adultos brasileiros com desenvolvimento neurotípico (n=385) e investigar o desempenho da escala em uma subamostra clínica (n=33). Métodos: Foram recrutados 1.024 participantes, que responderam ao Self-Reporting Questionnaire-20 (SRQ-20), ao QA e a questões sobre o seu histórico psiquiátrico. Em seguida, selecionamos 385 participantes sem qualquer diagnóstico psiquiátrico para descrever a distribuição dos traços de TEA. Para investigar o desempenho do QA, avaliamos 33 adultos com TEA e 19 adultos com desenvolvimento neurotípico da amostra total (n=1024). Resultados: As características do TEA apresentaram distribuição normal na amostra, com alta consistência interna. Do total de 91 homens, os voluntários com 32 pontos (ponto de corte clínico) ou mais pontuaram acima de 93% da amostra de controle. De 294 mulheres, aquelas que obtiveram pontuação clínica na escala pontuaram acima de 97%. Na subamostra clínica (n=33), o valor preditivo positivo do QA foi de 0,84 e o valor preditivo negativo foi de 0,7. Conclusões: A população estudada apresenta um perfil diferente comparada à população do estudo original, no que se refere à escala QA. Os traços de TEA foram normalmente distribuídos na amostra neurotípica, e a escala parece ter um desempenho satisfatório para predizer autismo. Estudos futuros são necessários para adequar o uso da escala na população brasileira.