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PURPOSE: There are differences in epidemiology, etiology, and outcome in status epilepticus (SE) between developing and developed countries, which limits generalizability. We evaluated factors related to outcome at 3 months in SE patients in a developing country- Ecuador. METHODS: Retrospective analysis of a prospectively collected dataset of patients treated for SE at a single hospital over 4 years, recording on 107 patients and 109 episodes, including clinical, demographic, and prognosis assessments. RESULTS: Hospital mortality was 33%, and 38% at 3 months. Glasgow Coma Scale score pretreatment ≤12 (odds ratio = 7.7), Charlson Index of comorbidities ≥3 (odds ratio = 5.6) and brain lesion (odds ratio = 6.4) predicted high disability. History of epilepsy was associated with favorable outcome in general, and showed a positive impact on survival rates (odds ratio = 0.3), while Glasgow Coma Scale scores pretreatment ≤12 (odds ratio = 4.1) and refractory SE (odds ratio = 2.1) were associated with reduced survival rates. Acute symptomatic etiology was the most common cause of SE (58%). Etiologies with structural brain lesion showed a significantly lower survival rate (Log ranks = 0.04 and 0.003) compared to other groups. CONCLUSION: Mortality rate at 3 months for SE patients was high. Glasgow Coma Scale, Charlson Index, and brain lesions were associated with unfavorable outcome, including mortality. Overall, the results were similar to those reported in more developed countries, but some differences, including overall higher mortality, prevalence of nonconvulsive SE, and lack of association of age with outcome were evident.

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Abstract Introduction: In research, a simple measure of general cognitive ability is often required. One method is the Matrix Matching Test, a brief, free-to-use, language-free assessment of general cognitive ability or intelligence in adults, which taps both fluid and crystalized processes. We investigated its reliability and validity with adolescent participants. Method: The Matrix Matching Test was administered to 111 participants, aged 12 to 17 (46% female). Subsamples also completed two standard measures of cognitive ability: Vocabulary (crystalized) and Matrix Reasoning (fluid) tests from the Wechsler Intelligence Scale for Children IV (WISC-IV). Results: The Matrix Matching Test was found to have acceptable internal consistency and good retest reliability. Criterion validity was indicated by its ability to distinguish between psychosocially deprived participants living in foster care (n = 40) and controls, and by its positive correlation with grade point average. There were large positive correlations between the Matrix Matching Test and the standard measures of Vocabulary, and Matrix Reasoning, suggesting convergent validity. Conclusions: Our preliminary evidence suggests that The Matrix Matching Test is a reliable and valid measure of general cognitive ability for ages 12 to 17.

Resumen Introducción: En ámbitos de investigación, el uso de una herramienta de medición general de habilidad cognitiva es comúnmente requerido. Una de estas herramientas es el Matrix Matching Test, una evaluación de habilidad cognitiva o inteligencia para adultos que es corta, de uso gratuito y no tiene impedimentos de lenguaje. Esta herramienta evalúa los procesos fluidos, así como los procesos cristalizados de la inteligencia adulta. Investigamos la confiabilidad y la validez de esta herramienta con participantes adolescentes. Método: Se administró la herramienta Matrix Matching Test a 111 participantes de edades entre 12 y 17 años (46 % mujeres). Los subgrupos además completaron dos medidas de habilidad cognitiva del más alto estándar obtenidos de la Escala de inteligencia de Wechsler para Niños IV (WISC-IV): Vocabulario (cristalizada) y Matrices (fluida). Resultados: Se encontró que el Matrix Matching Test tiene una consistencia interna aceptable y buena confiabilidad retest. Se indicó el criterio de validez por su capacidad para distinguir entre participantes habitantes en hogares sustitutos (n = 40) y participantes del grupo control. Asimismo, existe una correlación positiva con el GPA. Además, se encontró correlaciones positivas fuertes entre el Matrix Matching Test y las mediciones de más alto estándar de Vocabulario y Matrices, lo que sugiere una validez convergente. Conclusiones: Nuestra evidencia preliminar sugiere que el Matrix Matching Test es una medida confiable y válida para las habilidades cognitivas generales en edades de 12 a 17 años.

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BACKGROUND: Few studies have evaluated the incidence, predisposing factors and impact of healthcare-associated infections (HCAIs) in relation to outcomes among patients with status epilepticus (SE). OBJECTIVE: To investigate the variables associated with development of HCAIs among patients with SE and the impact of factors relating to HCAIs on mortality at three months. METHODS: This study was a retrospective analysis on our prospectively collected dataset, from November 2015 to January 2019. The sample included all consecutive patients diagnosed with SE who were treated at Hospital Eugenio Espejo during that period. In total, 74 patients were included. Clinical variables such as age, etiology of SE, Charlson comorbidity index (CCI), hospital length of stay, refractory SE (RSE) and outcomes were analyzed. RESULTS: HCAIs were diagnosed in 38 patients (51.4%), with a preponderance of respiratory tract infection (19; 25.7%). Prolonged hospital length of stay (OR=1.09; 95%CI 1.03-1.15) and CCI≥2 (OR=5.50; 95%CI 1.37-22.10) were shown to be independent variables relating to HCAIs. HCAIs were associated with an increased risk of mortality at three months, according to Cox regression analysis (OR=2.23; 95%CI 1.08-4.58), and with infection caused by Gram-negative microorganisms (OR=3.17; 95%CI 1.20-8.39). Kaplan-Meier curve analysis demonstrated that HCAIs had a negative impact on the survival rate at three months (log rank=0.025). CONCLUSIONS: HCAIs are a common complication among Ecuadorian patients with SE and were related to a lower survival rate at three months. Prolonged hospital length of stay, RSE and CCI≥2 were associated with the risk of developing HCAIs.

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ABSTRACT Background: Few studies have evaluated the incidence, predisposing factors and impact of healthcare-associated infections (HCAIs) in relation to outcomes among patients with status epilepticus (SE). Objective: To investigate the variables associated with development of HCAIs among patients with SE and the impact of factors relating to HCAIs on mortality at three months. Methods: This study was a retrospective analysis on our prospectively collected dataset, from November 2015 to January 2019. The sample included all consecutive patients diagnosed with SE who were treated at Hospital Eugenio Espejo during that period. In total, 74 patients were included. Clinical variables such as age, etiology of SE, Charlson comorbidity index (CCI), hospital length of stay, refractory SE (RSE) and outcomes were analyzed. Results: HCAIs were diagnosed in 38 patients (51.4%), with a preponderance of respiratory tract infection (19; 25.7%). Prolonged hospital length of stay (OR=1.09; 95%CI 1.03-1.15) and CCI≥2 (OR=5.50; 95%CI 1.37-22.10) were shown to be independent variables relating to HCAIs. HCAIs were associated with an increased risk of mortality at three months, according to Cox regression analysis (OR=2.23; 95%CI 1.08-4.58), and with infection caused by Gram-negative microorganisms (OR=3.17; 95%CI 1.20-8.39). Kaplan-Meier curve analysis demonstrated that HCAIs had a negative impact on the survival rate at three months (log rank=0.025). Conclusions: HCAIs are a common complication among Ecuadorian patients with SE and were related to a lower survival rate at three months. Prolonged hospital length of stay, RSE and CCI≥2 were associated with the risk of developing HCAIs.

RESUMEN Antecedentes: Pocos estudios han evaluado la incidencia, los factores predisponentes y el impacto de las infecciones asociadas a los cuidados de salud (IACS) en pacientes con Estatus Epiléptico (EE). Objetivo: Evaluar los factores predisponentes de IACS en pacientes con EE y su impacto evolutivo después de tres meses. Métodos: Se realizó un análisis retrospectivo de los datos recogidos prospectivamente en nuestra base de datos, desde noviembre de 2015 hasta enero de 2019. Se incluyeron todos los pacientes diagnosticados y consecutivamente tratados con EE, en el Hospital Eugenio Espejo, durante ese periodo. En total, 74 pacientes fueron incluidos. Se analizaron variables clínicas y evolutivas. Resultados: Las IACS fueron identificadas en 38 pacientes (51,4%), con predominio de infecciones respiratorias (25,7%). Los factores asociados con el desarrollo IACS fueron la estadía hospitalaria prolongada (OR=1,09, IC95% 1,03-1,15) y el índice de Charlson (ICH)≥2 (OR=5,50, IC95% 1,37-22,10). La regresión de Cox demostró un incremento significativo de la mortalidad en los pacientes con IACS (OR=2,23, IC95% 1,08-4,58) y en las causadas por gérmenes gram-negativos (OR=3,17, IC95% 1,20-8,39). La curva de Kaplan Meier evidenció el impacto desfavorable de las IACS (log rank=0.025) en la evolución de los pacientes después de los tres meses. Conclusiones: Las IACS fueron complicaciones frecuentes en los pacientes ecuatorianos con EE y fueron asociadas con una menor supervivencia después de los tres meses. Las variables como la estadía hospitalaria prolongada, el EE refractario y el ICH≥2 fueron identificados como factores de riesgo para sufrir una IACS.

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The Tower Test in the Delis-Kaplan Executive Function System (D-KEFS) is a widely-used assessment of executive function in young people. It is similar to other Towers of Hanoi type tasks, for which doubts regarding the reliability of the test have been previously raised. Here, we present data on the internal consistency, unidimensionality, and test-retest reliability of the D-KEFS Towers Test based on an Ecuadorian sample of 264 children and adolescents. In general, the Tower Test appeared to have poor reliability. This may be caused by the combination of very simple and more difficult trials within the same assessment. Nevertheless, one measure, the Time-Per-Move Ratio, appeared to be sufficiently reliable for clinical or research use, and neuropsychological studies have suggested that the Time-Per-Move Ratio may also be the performance measure most sensitive to neurological impairment.

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Socio-economic status (SES) is linked to the development of cognitive abilities, particularly language and executive processes. It is unclear whether these represent a single or independent correlates. We studied 110 Ecuadorian youths aged 12-17 with measures of SES, language, executive function, and theory of mind (ToM), a.k.a. mentalizing. A subsample gave hair samples to estimate recent cortisol levels. Restricting analyses to reliable measures, SES was highly associated with language skill, and to a lesser extent with executive function and ToM performance. However, those latter associations were attenuated and non-significant when language ability was controlled for statistically. Systemic cortisol levels were not associated with SES, but were significantly and negatively correlated with ToM, independent of variation in language skills. We conclude that language development underlies most of the impact of SES on executive function and ToM ability of adolescents, but that stress-related cortisol may have an independent, direct effect on mentalizing.

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Abstract A classical distinction in cognitive science is between fluid and crystalized abilities. Fluid ability is captured by many common executive function and intelligence tests. Crystalized ability, on the other hand, can be measured quite simply via lexical decision tasks including the English-language Spot-the-Word Test. However, no similar Spanish-language test has been available up to now. This paper presents a Spanish-language Lexical Decision Task that is quick to administer and was tested on sample of 139 normal adult participants. Results indicate that the new test has good internal consistency and test-retest reliability. An analysis of the correlations between this new test and demographic variables, as well as with the subtests of the Wechsler Adult Intelligence Scale suggest that it is a valid measure of crystalized-verbal ability. It also appears to be a brief but valid assessment of intelligence in general, and its positive correlation with academic achievement establishes predictive validity. The new test has the potential to be a useful research tool to rapidly measure reading ability, crystalized-verbal ability, and intelligence in Spanish speaking adults.

Resumen Una distinción clásica en la ciencia cognitiva es entre las habilidades fluidas y cristalizadas. La habilidad fluida es medida por muchas funcionas ejecutivas y tests de inteligencia. Por otro lado, la habilidad cristalizada puede ser medida sencillamente mediante una tarea de decisión léxica, como en la versión en inglés conocida como Spot-the-Word Test. Sin embargo, hasta ahora no ha habido una versión similar de este test en español. Aquí les presento una Tarea de Decisión Léxica en español que es de rápida aplicación. Esta fue aplicada en una muestra de 139 participantes, adultos normales. Los resultados indican que este nuevo test tiene buena consistencia interna y confiabilidad test-retest. Los análisis de las correlaciones entre este nuevo test y las variables demográficas, al igual que con las sub pruebas de las Escala de Inteligencia de Wechsler para Adultos, sugiere que es una medida confiable de la habilidad verbal cristalizada. También parece ser una breve, pero válida evaluación de inteligencia en general, con validez predictiva establecida por sus correlaciones positivas con el logro académico. Este nuevo test tiene potencial para ser una herramienta útil para medir rápidamente habilidad de lectura, habilidad verbal cristalizada e inteligencia en adultos hispanohablantes.

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BACKGROUND: People experiencing homelessness are at increased risk of neurological disorder due to multiple factors such as substance abuse, infection, and higher rates of serious mental illness and traumatic brain injury. This could affect cognitive and language skills. Indeed, past research has suggested that certain language-related skills tend to be lower in people experiencing homelessness. However, that research has compared homeless samples with age-matched normative samples and not with samples of people from similar socio-economic backgrounds. Therefore, it is unclear whether homelessness is even a relevant factor, or if adults who are homeless tend to have appropriate linguistic skills relative to their social and educational background. AIMS: To compare the language skills of a group of adults with histories of homelessness with an education-matched control group. It was hypothesized that participants with histories of homelessness would have worse language performance than their matched controls. METHODS & PROCEDURES: A quasi-experimental design was employed involving 17 adults with histories of homelessness, mainly rough sleeping, in the city of Quito in Ecuador, and a sample of 16 adults who had never been homeless. All were assessed with measures of head injury, substance dependence, affective disorder and language skills. A paired-sample analysis was performed on homeless and control participants matched for educational background, used as an index of socio-economic background. OUTCOMES & RESULTS: The mean years of formal education was low in both the homeless sample (mean = 5.82 years) and the control sample (mean = 6.75 years). There were no differences between the groups for any demographic or clinical factors, nor for a measure of expected or 'premorbid' ability based on single-word reading, nor for current non-verbal cognitive functioning. In contrast, the homeless group scored significantly worse than the control group on measures of auditory comprehension and oral expression. CONCLUSIONS & IMPLICATIONS: Adults with histories of homelessness may have worse language skills than would be expected based on their educational backgrounds and non-verbal cognitive abilities. It is possible that some of this lower language ability is pathological, in the form of either a developmental language disorder or an acquired impairment. As such, some adults who are homeless may benefit from therapy directed at clinical language disorders.

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The concept of intelligence as a measurable trait of intellectual function continues to be an important issue in psychology. Traditionally, a core field of differential psychology and widely employed in applied settings, it is also important in various research fields. Here, I describe development of a new assessment of general intelligence of adults that has no language component and can be administered in about 10 minutes. A total sample of 176 adult participants, from various settings, was assessed with a set of matrix tasks that involved either visuospatial (fluid) or semantic (crystallized) reasoning. The internal consistency was acceptable (α = .748), and there was good four-week test-retest reliability ( r = .931). Concurrent validity was demonstrated by a high correlation between the new test and the (seven-subtest version) Wechsler Adult Intelligence Scale-IV (WAIS-IV) scores ( r = .889). A principal component analysis also suggested that the new test measures the same latent construct as the WAIS-IV-thought to be general intelligence. Predictive validity was shown in a subsample of 60 undergraduates by a medium-sized correlation between test scores and grade point average data ( r = .396). These preliminary results suggest that the Matrix Matching Test may be a useful research tool.

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Socioeconomic status (SES) is known to have a considerable influence on the development of neuropsychological functions. In particular there is strong evidence for less efficient development of prefrontal-cortex-related functions in children raised in low-SES households. "Street children" are a common feature of low SES in many low- and middle-income countries, and some researchers have suggested that the unique life experiences of street children may drive their neurocognitive development. This study compares a group of 36 former street children in Quito, Ecuador with a control group of 26 never street-connected schoolchildren. All children were assessed with a range of neuropsychological tests. Although the street children group performed significantly below the level of the control group on all measures, they did not demonstrate a generalized lower ability. By controlling the effects of fluid intelligence it was found that there are relatively independent effects on visuospatial ability and executive planning ability. Furthermore, the executive function test scores in general are significantly less affected than the other cognitive functions and may be temporary effects caused by recent substance abuse within the street child sample. The findings generally support results from other countries suggesting that low SES is associated with negative effects on neuropsychological development. However, they also suggest that the local social and economic context, such as in the case of street children, might mitigate the harmful effects of low SES on the development of some executive functions.

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Resumen Objetivo: La valoración premórbida de la función cognitiva es esencial para la interpretación de la presencia y severidad del deterioro cognitivo. El método más confiable para evaluar esto en países hispanohablantes es el Word Accentuation Test (WAT) / Test de Acentuación de Palabras (TAP), ya que predice los resultados de pruebas de inteligencia mediante una regresión linear. Resultados: En una muestra ecuatoriana, el TAP tiene buena consistencia interna y confiabilidad test-retest. La correlación del TAP con los puntajes del WAIS-IV es alta (r=.827), permitiendo el desarrollo de una ecuación de regresión para estimar las puntuaciones de CI. Además, se encontró que una muestra de pacientes con demencia funcionaba normalmente en el TAP en comparación con el grupo de control. Esto sugiere que el rendimiento del TAP se mantiene en la presencia de una enfermedad neurológica con un deterioro cognitivo y puede usarse para valorar inteligencia premórbida. Conclusiones: El TAP tiene buenas propiedades psicométricas y puede ser utilizado para estimar puntuaciones de pruebas de inteligencia en participantes sanos. También puede valorar puntajes de inteligencia premórbida en pacientes con enfermedades neurológicas o psiquiátricas, permitiendo una interpretación clara de la gravedad del deterioro. Esta evaluación podría utilizarse en contextos clínicos y de investigación.

Abstract Objectives: Premorbid estimation of cognitive function is essential for the interpretation of the presence and severity of actual cognitive impairment. The most reliable method in Spanish speaking countries is with the Word Accentuation Test (WAT) / Test de Acentuación de Palabras (TAP). This is used to predict intelligence test scores by linear regression. Results: In an Ecuadorian sample the TAP was found to have good internal consistency and test-retest reliability. The correlation of the TAP with WAIS-IV full IQ scores was high (r= .827), allowing the development of a regression equation to estimate IQ scores from TAP performance. Furthermore, a sample of dementia patients was found to perform normally on the WAT compared to a matched control group. This suggests that WAT performance holds in the presence of neurological illness with associated cognitive impairment. Conclusions: The WAT has good psychometric properties and can be used to rapidly estimate actual intelligence test scores in healthy participants. It can also estimate premorbid intelligence scores in patients with neurological or psychiatric illnesses, allowing a clearer interpretation of the severity of impairment. This simple assessment could be used in various research and clinical contexts.

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BACKGROUND: The occurrence of personality disorder among community supervised offenders may have important implications for their management. There is, however, a dearth of contextual information on personality disorder in such populations. AIMS: This study aimed to identify demographic, substance use and forensic features that distinguish community-sentenced offenders with personality disorder from those without. METHODS: One hundred and seventy-three offenders under community supervision were screened for personality disorder using the Standardised Assessment of Personality--Abbreviated Scale. Alcohol and drug misuse, demographic and forensic data were also recorded. RESULTS: Nearly half of the sample (82, 47%) had probable personality disorder. Compared with those without personality disorder, they were younger, more likely to be unemployed, less likely to be divorced, more likely to have been convicted of robbery and more likely to be alcohol or illicit drug misusers, as well as under drug rehabilitation requirements. Multivariate analyses confirmed that only alcohol and drug abuse were independently associated with personality disorder in this group, and only the latter was significant. CONCLUSIONS: In this broadly representative sample of offenders serving community sentences in a defined geographical area, those with personality disorder were not more likely to attract higher risk of recidivism ratings, but they were more likely to have problems with heavy alcohol and/or illicit drug misuse.

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BACKGROUND: There is a dearth of information on suicidal thoughts and acts or other acts of deliberate self-harm by offenders under community supervision. AIMS: The objective of this study is to estimate lifetime and one month prevalence of deliberate self-harm and to determine ongoing risk among offenders in the community under probation supervision. METHODS: One hundred and seventy-three randomly selected offenders under supervision by the probation service in one county in England were screened for mental illness. All 88 screened cases and a one-in-five sample of non-cases were interviewed according to the Mini International Neuropsychiatric Inventory Module-B. False negatives (n = 17) were used to weight calculations and estimate prevalence for the whole group. RESULTS: A third of the interviewed sample (n = 56) had a lifetime history of suicide attempts, and 9 (5%) had self-harmed in the month prior to interview. Lifetime suicide history was associated with suicidal ideation and deliberate self-harm in the prior month. CONCLUSIONS AND IMPLICATIONS: Our adjusted findings indicate that 25-40% of offenders serving all or part of their sentence in the community have a lifetime history of self-harm, which is similar to the rate among prisoners, and are at very much higher risk of further such acts or completed suicide than the general population. At a time of change in delivery of probation services the implications are that rates of suicide and other forms of deliberate self-harm should be continually assessed in all probation areas, particularly with reference to service changes;the relationship between deliberate acts of self-harm, suicidal ideation and completion of suicide should be investigated prospectively in larger studies;probation services are likely to need mental health expertise to manage these risks.

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