Revisión escéptica del estado de la neuroimagen en el trastorno por déficit de atención e hiperactividad / Skeptical review of the state of neuroimaging in attention deficit hyperactivity disorder

Resumen El trastorno por déficit de atención e hiperactividad (TDAH) ha sido estudiado por medio de resonancia magnética durante más de 30 años, superando 2200 artículos en PubMed. Sin embargo, todavía no se entienden bien las bases cerebrales del TDAH. Esto refleja la dificultad de replicar resultados, que afecta a casi todos los esfuerzos científicos. Los factores que contribuyen a resultados falsos positivos incluyen tamaños de muestra pequeños y la superabundancia de métodos analíticos. En el campo de la genética mole cular, estos retos conllevaron a la adopción del requisito de compartir los datos genéticos inmediatamente para que la comunidad pueda trabajar de forma conjunta, y que se apliquen métodos rigurosos tomando en cuenta la verdadera cantidad de pruebas estadísticas. Esto ha producido resultados más creíbles, aunque con tamaños de efecto muy reducidos respecto a los anteriores. En este breve resumen se usan dos consorcios, uno internacional llamado ENIGMA (Enhancing Neuro-Imaging Genetics through Meta-Analysis), y el otro norteamericano llamado ABCD (Adolescent and Cognitive Behavior Development Study), para ilustrar este movimiento a la ciencia abier ta. Aquí se revisa la primera cosecha de hallazgos, aunque todavía limitados a análisis transversales. Ya que ABCD fue diseñado como esfuerzo longitudinal, la combinación con la maduración continua del campo promete transformar nuestro entendimiento de la patofisiología de TDAH (probablemente también alterando la definición diagnostica al largo plazo) para acercarnos al día en el cual la neuroimagen sea útil en la clínica.

Abstract Attention-deficit/hyperactivity disorder (ADHD) has been the focus of magnetic resonance imaging studies for more than 30 years, with more than 2200 articles listed in PubMed. Nevertheless, the brain substrates of ADHD remain poorly understood. This reflects the crisis of replicability across nearly all scientific endeavors, deriving from factors such as small sample sizes combined with a proliferation in analytical approaches, yielding high rates of false positive results. The field of molecular genetics confronted this by adopting open and immedi ate sharing of raw data and insistence on rigorous corrections for multiple comparisons. These strategies are yielding more robust genetic findings, albeit with much smaller effect sizes than before. This brief review focuses on two recent consortium efforts, i.e., the international Enhancing Neuro-Imaging Genetics through Meta-Analysis (ENIGMA), and the U.S. Adolescent Behavior & Cognitive Developm ent Study (ABCD). Both embrace the culture of open science, and are beginning to yield credible findings, despite being limited initially to cross-sectional analyses. As the field continues to mature, these and other ongoing longitudinal large-scale studies are poised to transform our understanding of the pathophysiology of ADHD to bring closer the day when neuroimaging can contribute to clinical utility.

La replicabilidad en la investigación psicológica: una reflexión / Replicability in psychological research: a reflection / Replicability in psychological research: a reflection

RESUMEN Introducción : En los últimos años, la ciencia psicológica ha sufrido una crisis de confianza que ha sido marcada por la baja tasa de replicabilidad demostrada en proyectos colaborativos que intentaron cuantificar esta problemática, evidenciando la dificultad para realizar replicaciones y la existencia de un posible exceso de falsos positivos publicados en la literatura científica. Método : Este artículo de opinión tuvo como objetivo realizar una revisión del panorama de la crisis de replicabilidad en psicología, así como también a sus posibles causas. Conclusiones : Se inició desde el estado de la crisis de replicabilidad, luego se destacaron algunas posibles causas y sus repercusiones en el avance de la ciencia psicológica, debatiendo sobre diversos temas asociados, como los sesgos individuales por parte de los investigadores, la falta de incentivos a los estudios de replicabilidad y los estándares de prioridad que actualmente tendrían las revistas por los estudios novedosos y positivos. Finalmente se mencionan las alternativas existentes para revertir esta situación, entre ellas la apertura a nuevos enfoques estadísticos, la reestructuración de incentivos y el desarrollo de políticas editoriales que faciliten los medios para las replicaciones.

ABSTRACT Background : In recent years, psychological science has suffered a crisis of confidence that has been marked by the low rate of replicability demonstrated in collaborative projects that attempted to quantify this problem, evidencing the difficulty in making replications and the existence of a possible excess of false positives published in the scientific literature. Method : This opinion article aimed to review the panorama of the replicability crisis in psychology, as well as its possible causes. Conclusions : It began from the state of the replicability crisis, then some possible causes and their repercussions on the advancement of psychological science were highlighted, discussing various associated issues, such as individual biases on the part of researchers, the lack of incentives to replicability studies and the priority standards that journals would currently have for novel and positive studies. Finally, the existing alternatives to reverse this situation are mentioned, among them the opening to new statistical approaches, the restructuring of incentives and the development of editorial policies that facilitate the means for replication.

ABSTRACT Background : In recent years, psychological science has suffered a crisis of confidence that has been marked by the low rate of replicability demonstrated in collaborative projects that attempted to quantify this problem, evidencing the difficulty in making replications and the existence of a possible excess of false positives published in the scientific literature. Methods : This opinion article aimed to review the panorama of the replicability crisis in psychology, as well as its possible causes. Conclusions : It began from the state of the replicability crisis, then some possible causes and their repercussions on the advancement of psychological science were highlighted, discussing various associated issues, such as individual biases on the part of researchers, the lack of incentives to replicability studies and the priority standards that journals would currently have for novel and positive studies. Finally, the existing alternatives to reverse this situation are mentioned, among them the opening to new statistical approaches, the restructuring of incentives and the development of editorial policies that facilitate the means for replication.

RESUMEN Introducción : En los últimos años, la ciencia psicológica ha sufrido una crisis de confianza que ha sido marcada por la baja tasa de replicabilidad demostrada en proyectos colaborativos que intentaron cuantificar esta problemática, evidenciando la dificultad para realizar replicaciones y la existencia de un posible exceso de falsos positivos publicados en la literatura científica. Método : Este artículo de opinión tuvo como objetivo realizar una revisión del panorama de la crisis de replicabilidad en psicología, así como también a sus posibles causas. Conclusiones : Se inició desde el estado de la crisis de replicabilidad, luego se destacaron algunas posibles causas y sus repercusiones en el avance de la ciencia psicológica, debatiendo sobre diversos temas asociados, como los sesgos individuales por parte de los investigadores, la falta de incentivos a los estudios de replicabilidad y los estándares de prioridad que actualmente tendrían las revistas por los estudios novedosos y positivos. Finalmente se mencionan las alternativas existentes para revertir esta situación, entre ellas la apertura a nuevos enfoques estadísticos, la reestructuración de incentivos y el desarrollo de políticas editoriales que faciliten los medios para las replicaciones.

Validade e concordância do diabetes mellitus referido em idosos / Validity and concordance of self-reported diabetes mellitus by the elderly

Resumo Este estudo teve como objetivo verificar a validade e a concordância do relato de diabetes mellitus (DM) na população idosa do município de Campina Grande/PB. Trata-se de um estudo transversal, domiciliar, realizado com 362 idosos de 60 anos ou mais de idade cadastrados na Estratégia Saúde da Família do município de Campina Grande/PB. Para verificar a validade e confiabilidade do relato foi realizado o cálculo de sensibilidade, especificidade e valores preditivos positivo (VPP) e negativo (VPN) em relação às variáveis demográficas e socioeconômicas. Utilizou-se o teste Kappa para verificar a concordância entre o diagnóstico e o relato da doença. Entre os participantes deste estudo, 67,4% eram mulheres. Foi verificada prevalência de DM diagnosticado de 14,1% e de DM referido de 18,1%. Foi observada moderada sensibilidade (58,8%), excelente especificidade (87,8%), moderado VPP (44,8%) e excelente VPN (92,7%), além de concordância moderada do relato de DM (Kappa = 0,413; p < 0,001). Observou-se neste estudo que devido à moderada validade e concordância do relato do DM entre os idosos, não é aconselhável que o DM referido seja utilizado como indicador de prevalência da doença na população estudada.

Abstract The scope of this study was to verify the validity and concordance of self-reported diabetes (DM) by the elderly in Campina Grande, State of Paraíba. It involved a cross-sectional home-based study, conducted with 362 elderly people aged 60 years of age and above registered in the Family Health Strategy (FHS) Program in Campina Grande, State of Paraíba. A sensitivity calculation, specificity and positive predictive value (PPV) and negative predictive value (NPV) in relation to demographic and socioeconomic variables was carried out to verify the validity and reliability of self-reported DM. The Kappa test was used to verify the concordance between the diagnosis and the reporting of the disease. Among the study participants, 67.4% were women. The prevalence of diagnosed DM of 14.1% and self-reported DM of 18.1% was observed Moderate sensitivity (58.8%), excellent specificity (87.8%), moderate PPV (44.8%) and excellent NPV (92.7%), and moderate concordance of self-reported DM (Kappa = 0.413 p < 0.001) was observed. In this study, due to moderate validity and concordance of self-reported DM among the elderly, it is considered not to be advisable that self-reported DM should be used as a disease prevalence indicator in the population studied.

Introducing a Maternal Child Health Handbook in the Province of Dajabon, Dominican Republic: Prospects and Issues from the Perspectives of Sustainability and Replicability / 国際保健医療

<b>Introduction</b><br>In the Caribbean country of the Dominican Republic, specifically in the northwestern Province of Dajabón bordering Haiti, a Maternal and Child Health (MCH) handbook, “History of My Health” was introduced through the technical cooperation of the Inter-American Development Bank's Japan Program with the leadership of the Provincial Office of the Secretary of Health. This report describes the implementation process and results, examines the project's sustainability and replicablility, and shares good practices and lessons learned.<br><b>Activities</b><br>The implementation of the project can be divided into three phases: first, development of a Dominican version of MCH handbook, local awareness raising, capacity building of health personnel, and the establishment of monitoring system were areas of high priority; the second phase centered around the improvement of MCH handbook with participatory approach and the continuation of the capacity building of health personnel; and the last phase focused on the sustainability through local management-precisely securing recurrent costs of the project.<br><b>Results</b><br>The evaluation and regular monitoring visits revealed positive results: as for pregnant women, the handbooks were well accepted for their friendliness, simplicity, durability and mobility, and the rate of their receiving antenatal and postpartum cares at designated clinics or hospitals increased; as for newborns and children, the immunization coverage improved while common problems such as diarrhea decreased; and as for health personnel, the handbook helped clarify the division of work and enhanced their sense of responsibility, communication, and continuity and integration of service. Currently, 359 trained health personnel use MCH handbook in all of the 22 health establishments in the Province, covering around 98% of the target population.<br><b>Conclusions</b><br>To achieve self-sustainability, this pilot project suggests that the use of MCH handbook needs to be institutionalized through the bottom-up approach and to integrate into the existing rural and national health care system through the top-down approach.