Browsing by Author "Gadelha, A."

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    Andes network-studying early psychosis in Latin America
    (2019) Crossley, Nicolás; Guinjoan, S.; Rivera, G.; Jackowski, A.; Gadelha, A.; Elkis, H.; Louza, M.; Gama, C.; Evans-Lacko, S.; Castaneda, C.P.; Undurraga Fourcade, Eduardo Andrés; Cordoba, R.; Bressan, R.
    Background Our knowledge about schizophrenia is largely based on studies in developed countries such as the United States, Western Europe or Japan. Their findings have pointed to several risk factors or modulators of response which unfortunately are more prevalent and stronger in low and middle-income countries. These include exposure to violence and trauma, poor perinatal care, or limited (and potentially late) access to healthcare. In this context, there is a pressing need to raise information from these countries about psychosis. We here present to the SIRS community the Latin American Consortium ANDES whose main aim is to study early psychosis within the Latin American context. Methods This is a descriptive study characterizing the groups and the cohorts of patients included that are part of the ANDES network. Results 15 different groups from 6 different countries from Latin America are part of the network, including Argentina, Bolivia, Brazil, Chile, Colombia and Mexico. The network includes several early intervention clinical services, such as those in São Paulo and Santiago, who receive jointly around 5 new cases of first episode a week. ANDES also integrates three groups studying ultra-high-risk subjects (2 in São Paulo, 1 in Mexico). All groups have already acquired data from studies on first episode patients whose characteristics will be presented. Available data includes clinical and sociodemographic information from more than 1,000 patients, cognitive assessments using MATRICS from more than 500 patients, and 600 MRI T1 scans, DTI and resting-state fMRI (350 patients and 250 controls). Discussion ANDES is a unique opportunity to study psychosis in deprived settings which are frequently less represented in research publications. The inequality present in Latin America provides opportunities to study the effect of exposures to an adverse environment within this population.
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    Cost-effectiveness of early intervention in psychosis in low- and middle-income countries: economic evaluation from São Paulo, Brazil
    (2024) Aceituno, D.; Razzouk, D.; Jin, H.; Pennington, M.; Gadelha, A.; Bressan, R.; Noto, C.; Crossley, N.; Prina, M.
    Aims The effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services are well established in high-income countries but not in low- and middle-income countries (LMICs). Despite the scarcity of local evidence, several EIP services have been implemented in LMICs. Local evaluations are warranted before adopting speciality models of care in LMICs. We aimed to estimate the cost-effectiveness of implementing EIP services in Brazil.Methods A model-based economic evaluation of EIP services was conducted from the Brazilian healthcare system perspective. A Markov model was developed using a cohort study conducted in Sao Paulo. Cost data were retrieved from local sources. The outcome of interest was the incremental cost-effectiveness ratio (ICER) measured as the incremental costs over the incremental quality-adjusted life-years (QALYs). Sensitivity analyses were performed to test the robustness of the results.Results The study included 357 participants (38% female), with a mean (SD) age of 26 (7.38) years. According to the model, implementing EIP services in Brazil would result in a mean incremental cost of 4,478 Brazilian reals (R$) and a mean incremental benefit of 0.29 QALYs. The resulting ICER of R$ 15,495 (US dollar [USD] 7,640 adjusted for purchase power parity [PPP]) per QALY can be considered cost-effective at a willingness-to-pay threshold of 1 Gross domestic product (GDP) per capita (R$ 18,254; USD 9,000 PPP adjusted). The model results were robust to sensitivity analyses.Conclusions This study supports the economic advantages of implementing EIP services in Brazil. Although cultural adaptations are required, these data suggest EIP services might be cost-effective even in less-resourced countries.
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    Default mode network maturation and psychopathology in children and adolescents
    (2016) Sato, J.; Salum, G.; Gadelha, A.; Crossley, Nicolás; Vieira, G.; Manfro, G.; Zugman, A.; Picon, F.; Pan, P.; Hoexter, M.; Anes, M.; Moura, L.; Del'Aquilla, M.; Amaro, E.; Mcguire, P.; Lacerda, A.
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    Implementation of early psychosis services in Latin America: A scoping review
    (John Wiley and Sons Inc, 2021) Aceituno Farías, David; Mena, C.; Vera, N.; González Valderrama, A.; Gadelha, A.; Diniz, E.; Crossley, Nicolás; Pennington, Mark; Prina, M.
    The evidence of the effectiveness and cost-effectiveness of early intervention for psychosis (EIP) services has motivated their implementation worldwide. However, complex interventions of such EIP services require local adaptations to successfully match population needs and cultural differences. Latin America is a heterogenous region where EIP services are progressively being adopted. Our aim is to map such initiatives in the region with a focus on implementation outcomes. Methods: A scoping review following the Preferred Reporting Items for Systematic review and Meta-Analysis extension for Scoping Reviews guidelines was conducted. International and regional databases were searched for publications describing EIP programmes in the region. Besides mapping the services, we described implementation outcomes based on the Standards for Reporting Implementation Studies Checklist. Results: Ten articles describing seven EIP initiatives from the region were found. Four countries were represented: Argentina, Brazil, Chile and Mexico. The implementation outcomes reporting was heterogenous, although it was possible to ascertain EIP services are feasible and adequate for the region's context. Also, there is some evidence of effectiveness in terms of reducing hospitalizations and improving symptoms. Information about fidelity measures was scarce and there was no information about costs or cost-effectiveness. Conclusions: Only a small proportion of Latin American countries have adopted EIP services. Although these programmes seem to be feasible and effective, data on other implementation outcomes, such as fidelity, cultural appropriateness, cost-effectiveness and affordability are not available. This might in part explain why this effective approach has not been yet scaled-up at nationwide levels.