Public involvement in chronic respiratory diseases research: A qualitative study of patients', carers' and citizens' perspectives.

INTRODUCTION: Patient and public involvement (PPI) initiatives involving patients with chronic respiratory disease (CRD) are rare. Therefore, this study aimed to explore the perspectives of patients with CRD, carers and interested citizens regarding the relevance and need for a PPI network and suggestions for its implementation. METHODS: A qualitative study based on focus groups was conducted. Recruitment occurred through invitations on social media platforms and to patients who have participated in previous asthma studies of the team. Three focus groups were conducted, via video conference, using a semi-structured guide. Thematic analysis was performed by two independent researchers and discussed with the extended team. RESULTS: Fifteen patients with CRD, one carer and one interested citizen (13 females, median 36 (range: 18-72) years) participated. All participants acknowledged the importance of implementing a collaborative network and demonstrated interest in being integrated. Participants acknowledged the importance of their involvement in several phases of the research cycle. The main aim identified for this network was to facilitate communication between patients and researchers. Participants regarded the integration of patients, carers, researchers and healthcare professionals from different scientific areas as relevant. The use of digital platforms to attract members and support the work, together with group dynamics and regular meetings, were some of the most relevant practical considerations for implementing the network. The identified facilitators for their engagement were sharing experiences, researchers' and healthcare professionals' support and feedback and schedule flexibility. The identified barriers included the amount of time dedicated, low health/digital literacy and the potential detachment of nondiagnosed patients or those with low symptom impact in daily life. CONCLUSION: Patients, carers and citizens acknowledged the relevance of implementing a collaborative network and demonstrated interest in active participation in every stage of the health research cycle. A deeper knowledge of the barriers and facilitators identified in this study could support implementing these initiatives in Portugal. PATIENT OR PUBLIC CONTRIBUTION: This study was designed by a research team that included one patient with asthma and one carer. They were specifically involved in building the study protocol and the interview guide. They also gave feedback regarding the electronic consent form and the short sociodemographic questionnaire created, namely by removing noncontributing words or phrases and rewording expressions. The lay summary was written by another patient with asthma. All participants of this study were invited to implement and integrate the ConectAR network-a collaborative network of research in respiratory health. PUBLIC SUMMARY: In Portugal, chronic respiratory patients do not have an active role as 'coinvestigators'. This study aimed to acknowledge if patients and citizens considered a patient and public involvement network useful, whose main purpose would be to facilitate communication between patients and researchers. A study based on online group interviews was carried out with patients with chronic respiratory diseases and interested citizens, both recruited on social media platforms. Participants considered that bringing together patients, carers, researchers and healthcare professionals is valuable because sharing different experiences and perspectives may help patients to improve their daily lives and increase research quality. In conclusion, patients agree that implementing a collaborative network with researchers and healthcare professionals and participating in the health research cycle is quite preponderant. Acknowledging what can help and deter this network may be beneficial to implementing this type of initiative in Portugal.

Stability and Change in Adolescents' Sense of Agency: Contributions of Sex, Multiple Risk, Pandemic Stress, and Attachment to Parents.

Although literature states that individual, relational, and contextual factors contribute to adolescents' sense of agency, more research is needed to clarify and understand how adolescents develop this belief over time. The current study examined the stability/change trajectories of the sense of agency during adolescence, specifically across high school, analyzing whether attachment to parents over time, adolescents' sex, cumulative risk in baseline, and pandemic-related stress explained these trajectories. The sample included 467 Portuguese adolescents (40.7% were males; Mage = 15.58 years, SD = 0.80), evaluated three times across 18 months. This work yielded three significant findings. First, adolescents' sense of agency significantly increased over time, with significant between-subject variance at the initial levels but not at the growth rate. Second, attachment to parents consistently links to adolescents' sense of agency across time, despite the differential contributions from attachment to mothers and fathers. Third, boys reported greater growth in the sense of agency than girls. Adolescents' cumulative risk at T1 predicted lower initial levels of sense of agency, whereas higher pandemic-related stress predicted less growth of the sense of agency. These findings emphasize the contributions of individual and family characteristics and the role of the broader social context in shaping the development of adolescents' sense of agency. The findings underline the need to consider further the differential influences of adolescents' relationships with mothers and fathers to understand changes in adolescents' sense of agency.

Working time arrangements and exhaustion: The role of recovery experiences and satisfaction with the schedule.

Working time arrangements may be a source of strain and entail negative consequences for workers, one of which can be exhaustion. Based on the job demands-resources and the conservation of resources theories, this study explores recovery experiences from work and satisfaction with the work schedule as possible resources that may prevent or minimize such negative consequences. With a sample of 386 workers (n = 287 women; 99 men) and using a cluster analysis, we identified five working time arrangements: fixed standardized, part-time, irregular standardized, flexible standardized, and nonstandard work schedule (NWS). A one-way ANOVA found that workers in the irregular standardized schedule report higher exhaustion compared to the fixed standardized and the part-time. Exhaustion of workers in NWS is higher compared to the part-time workers. A multiple linear regression analysis found that the link between recovery experiences and exhaustion varies according to the working time arrangement. Lastly, an interaction analysis confirmed the moderator effect of satisfaction with the work schedule in the relationship between recovery experiences and exhaustion for the whole sample. When this analysis was performed separately for each cluster, this effect was only significant for NWS and by disentangling this finding by recovery dimensions, only relaxation had a significant interaction effect. This study clarifies the links between different recovery experiences and exhaustion, and points to the importance of satisfaction with the work schedule in facilitating recovery under demanding working time arrangements. Results are discussed considering the complex nature of the work-family interface.

RFC1-Related Disorder: In Vivo Evaluation of Spinal Cord Damage.

BACKGROUND: RFC1-related disorder is a novel heredodegenerative condition with a broad phenotypic spectrum. Its neuropathological bases are not yet fully understood, particularly regarding the pattern, extent, and clinical relevance of spinal cord (SC) damage. OBJECTIVES: The objectives were to determine the SC structural signature in RFC1-related disorder in vivo and to identify potential clinical correlates for these imaging abnormalities. METHODS: We enrolled 17 subjects with biallelic RFC1 (AAGGG)n expansions and 11 age- and sex-matched healthy controls that underwent multimodal magnetic resonance imaging SC acquisitions in a 3T Philips Achieva scanner. Both global morphometry and tract-specific analyses were then performed across all cervical levels. Between-group comparisons were assessed using nonparametric tests. RESULTS: In the patient group, mean age and disease duration were 62.9 ± 9.3 and 9.3 ± 4.0, respectively. Compared to controls, patients had remarkable SC cross-sectional area reduction along all cervical levels but anteroposterior flattening only in the lower cervical levels. There was also prominent SC gray matter atrophy. Diffusivity abnormalities were identified in the dorsal columns but not in the lateral corticospinal tracts. Disease severity did not correlate with these imaging parameters. CONCLUSION: SC damage is a hallmark of RFC1-related disorder and characterized by gray as well as white matter involvement. In particular, dorsal columns are severely and diffusely affected. The clinical correlates of these imaging abnormalities still deserve additional investigations. © 2022 International Parkinson and Movement Disorder Society.

Clinical and Genetic Characterization of Brazilian Patients with Ataxia and Oculomotor Apraxia.

BACKGROUND: Ataxia with oculomotor apraxia (AOA) is characterized by early-onset cerebellar ataxia associated with oculomotor apraxia. AOA1, AOA2, AOA3, and AOA4 subtypes may present pathogenic variants in APTX, SETX, PIK3R5, and PNKP genes, respectively. Mutations in XRCC1 have been found to cause autosomal recessive spinocerebellar ataxia-26 (SCAR26) now considered AOA5. OBJECTIVES: To examine a cohort of Brazilians with autosomal recessive cerebellar ataxia plus oculomotor apraxia and determine the frequencies of AOA subtypes through genetic investigation. METHODS: We evaluated clinical, biomarkers, electrophysiological, and radiological findings of 52 patients with AOA phenotype and performed a genetic panel including APTX, SETX, PIK3R5, PNKP, and XRCC1. RESULTS: We found pathogenic variants in SETX (15 patients), PNKP (12), and APTX (5). No mutations in PIK3R5 or XRCC1 were identified. CONCLUSIONS: AOA2 and AOA4 were the most common forms of AOA in Brazil. Mutations in PIK3R5 and XRCC1 were not part of this genetic spectrum. © 2022 International Parkinson and Movement Disorder Society.

Relations between child self-control, maternal relational frustration, and teacher-child conflict: a longitudinal study with children from dual-earner families.

This longitudinal study follows children from dual-earner families in 4 time-points, covering the early childhood period. We examined the influence of work-family conflict (WFC) on maternal relational frustration (RF) towards the child, and investigated the reciprocal relations among maternal RF, children's self-control (SC), and teacher-child (TC) conflict over time. Participants were 214 children (97 girls; M age = 4.00 years), their mothers, and teachers. Mothers reported their own WFC and RF, whereas teachers reported child SC and T-C conflict. Results from a cross-lagged panel model indicated the experience of WFC positively predicted maternal RF. Maternal RF and T-C conflict were negatively related to the child later SC abilities. Conversely, children who displayed SC difficulties were more likely to experience later maternal RF and T-C conflict. There was evidence supporting the bidirectional effects of child SC and T-C conflict across time. Moreover, maternal RF and T-C conflict were indirectly linked, via child SC. The findings are consistent with a transactional view of development, stressing the importance of contextual factors to the quality of caregiving relationships and highlighting the complex and reciprocal relations between child regulatory competence and the quality of relationships with distinct caregivers.

Communication concerns in mothers with cancer: Development and psychometric properties of a new measure.

OBJECTIVE: This study aimed to present the development of the Communication Concerns in Parents with Cancer Scale (CCPCS) and to evaluate its psychometric properties in mothers with cancer. METHODS: Two hundred and twenty-nine mothers with cancer participated in this study. Participants reported on parenting concerns, depressive and anxiety symptoms and quality of life. An exploratory factor analysis (EFA) was performed to explore the factor structure of the new scale. Concurrent and convergent validity, internal consistency and test-retest reliability were evaluated/obtained. To measure invariance according to type of cancer and time passed since diagnosis, a multi-group analysis was used. RESULTS: EFA suggested that the scale comprised one factor that explained 75.63% of the total variance. The developed CCPCS had high internal consistency. Communication concerns were positively associated with other parenting concerns, as well as anxiety and depression symptoms. Test of measurement invariance showed scalar invariance for type of cancer, and residual invariance for time passed since diagnosis. CONCLUSION: The CCPCS seems to be a promising scale to measure communication concerns in mothers with cancer for clinical and research purposes. Knowing the impact of communication concerns in the mother's process of adaptation to cancer can provide clues for the psycho-oncological care offered.

Adolescents' attachment, quality of relationships with residential caregivers, and emotion regulation.

INTRODUCTION: Adolescents in residential care are more likely to report insecure and especially disorganized attachments, which lead to difficulties in emotion regulation and compromise the quality of their interpersonal relationships. In residential care, it is expected that sensitive and responsive caregivers are able to help adolescents regulate their feelings of distress, enabling them to experience a sense of emotional security. The present study sought to analyze the effects of the quality of attachment on emotion regulation and to test the moderating effect of quality of relationship (from adolescents' and caregivers' perspectives) on this association. METHODS: The sample involved 306 adolescents, 12-18 years of age, living in residential care and 70 caregivers. RESULTS: The findings underscored the importance of the quality of the relationship with residential caregivers on adolescents' emotion regulation competencies over time. The results also showed that the quality of relationship (emotional closeness) as perceived by the caregivers moderated the association between adolescents' attachment avoidance levels and their emotion regulation strategies. CONCLUSIONS: The results are discussed according to attachment theory, and underscore the role the relationship with caregivers plays in the affective reorganization of adolescents living in residential care.

The Perceptions of Students and Lecturers on the Use of Animals in Biomedical Science Undergraduate Education in Brazil.

The use of animals in research and education is a controversial topic that has raised extensive debates. Undergraduate students (n = 404) and lecturers (n = 62) from biomedical science schools at the Federal University of Goiás (UFG) in the municipality of Goiânia, Jataí and Catalão, Goiás, Brazil, were asked about their knowledge and opinions on bioethics, the use and importance of animals in education, the replacement of animal use with non-animal alternatives, and the current legislation of the National Council for the Control of Animal Experimentation (CONCEA) that bans animal use in some practical classes within technical and higher education (i.e. Resolution No. 53/2021). Most students and lecturers agreed not only that animal use can contribute to education, but also that it is important to replace this animal use with innovative non-animal alternatives where appropriate. The lecturers emphasised that the replacement of animal models will be possible only with the provision of appropriate training to improve the skills of educators in their use, as well as ensuring reliable access to suitable facilities and materials.

Brain Structural Signature of RFC1-Related Disorder.

BACKGROUND: The cerebellar ataxia, neuropathy, and vestibular areflexia syndrome was initially described in the early 1990s as a late-onset slowly progressive condition. Its underlying genetic cause was recently mapped to the RFC1 gene, and additional reports have expanded on the phenotypic manifestations related to RFC1, although little is known about the pattern and extent of structural brain abnormalities in this condition. OBJECTIVE: The aim is to characterize the structural signature of brain damage in RFC1-related disorder, correlating the findings with clinical symptoms and normal brain RFC1 expression. METHODS: We recruited 22 individuals with molecular confirmation of RFC1 expansions and submitted them to high-resolution 3T magnetic resonance imaging scans. We performed multimodal analyses to assess separately cerebral and cerebellar abnormalities within gray and white matter (WM). The results were compared with a group of 22 age- and sex-matched controls. RESULTS: The mean age and disease duration of patients were 62.8 and 10.9 years, respectively. Ataxia, sensory neuronopathy, and vestibular areflexia were the most frequent manifestations, but parkinsonism and pyramidal signs were also noticed. We found that RFC1-related disorder is characterized by widespread and relatively symmetric cerebellar and basal ganglia atrophy. There is brainstem volumetric reduction along all its segments. Cerebral WM is also involved-mostly the corpus callosum and deep tracts, but cerebral cortical damage is rather restricted. CONCLUSION: This study adds new relevant insights into the pathophysiological mechanisms of RFC1-related disorder. It should no longer be considered a purely cerebellar and sensory pathway disorder. Basal ganglia and deep cerebral WM are additional targets of damage. © 2021 International Parkinson and Movement Disorder Society.

Subthalamic Nucleus Deep Brain Stimulation Lessens Acquired Dystonia: Report of Two Patients and Systematic Review of Published Cases.

INTRODUCTION: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an efficient treatment of primary dystonia. Few studies have reported the effect of STN-DBS on secondary or acquired dystonia. METHODS: We reported 2 patients with acquired dystonia treated by subthalamic DBS and followed up for 24 months, besides providing a systematic review and meta-analysis of published series. RESULTS/CONCLUSIONS: Both patients had thalamic vascular or autoimmune lesions within the ventral and the pulvinar nuclei. A reduction of 67.2% on the Burke-Fahn-Marsden Dystonia Rating Scale and 90% improvement in disability scores were shown in the first patient, while the second patient showed a lower reduction in both dystonia symptoms (28.6%) and disability scores (44%). Both patients had a significant mean improvement in the quality of life (62.5% in the first and 57.9% in the second) and were free of drugs postoperatively. A systematic review showed a mean follow-up of 13 months in 19 patients, including our 2 patients. The review showed a significant Burke-Fahn-Marsden Dystonia Scale (BFMDRS) score median reduction of 19 points (52.4%; confidence interval [CI]: 11.0-25.0) and a significant median reduction of 6 points in disability scores (44.5%; 95% CI: 4.0-14.0), thereby improving quality of life. Age at surgery was inversely correlated with postoperative improvement (r = 0.63; p = 0.039). Hemidystonia had a nonsignificant better improvement than generalized dystonia (55.3 vs. 43.5%; p = 0.4433). No association between etiology and postoperative improvement and no serious complications were found. Although few data reported so far, subthalamic DBS is likely efficient for acquired dystonia.

Teacher-child dependency in preschool: links with teacher-child closeness, conflict and children's effortful control.

Dependency is a scarcely investigated dimension of teacher-child (T-C) relationships that can reflect a lack of security and obstruct children's autonomous exploration in the school context. We examined the within- and cross-time associations between T-C dependency, closeness, and conflict, and children's effortful control, an ability related to children's self-regulation. Data were collected during the preschool period at two time-points (T1 and T2) 1-year apart. Participants were 199 children (44% girls, M age = 47.47) attending 46 middle-class preschool classrooms. Results from path analyses indicated that, though marginally significant, there was a positive association between T-C dependency and conflict at T1. At T2, dependency was positively related to both conflict and closeness. Dependency at T1 positively predicted children's effortful control at T2. This study clarifies the interconnection between T-C dependency, closeness and conflict, and the unique contribution of dependency onchildren's effortful control. Findings are discussed considering the socio-cultural meaning of dependency.

The Parenting Concerns Questionnaire: A validation study with Portuguese parents with cancer.

OBJECTIVES: To examine the psychometric properties of the Parenting Concerns Questionnaire (PCQ) in a sample of Portuguese parents with cancer. METHODS: The PCQ was completed by 209 adults with cancer, who are parents of at least one minor child. Participants reported on parenting concerns, depressive and anxiety symptoms, parental stress as well as quality of life. Confirmatory factor analysis and Item Response Theory (IRT) were used to assess the psychometric properties of the PCQ. Cronbach's alpha was used to examine its reliability. Pearson correlation coefficients provided information regarding convergent validity. Criterion validity was analysed. RESULTS: Confirmatory factor analysis confirmed the original three-factor structure. IRT indicated that most of the items were highly discriminant and better identified as moderate versus low or high levels of parenting concerns in the three dimensions of PCQ. The pattern of associations with depressive and anxiety symptoms, parental stress, and quality of life provided evidence for the convergent validity. The PCQ differentiated between parents with and without depressive symptoms. CONCLUSION: Exploring parenting concerns provides additional relevant information about the experiences and the potential psychological distress experienced by these parents with cancer. The PCQ can be an important tool to identify parents with cancer who might benefit from psychological support regarding parenting.

Attachment, emotion regulation, and well-being in couples: Intrapersonal and interpersonal associations.

OBJECTIVE: There is a well-established link in the literature between secure romantic attachment orientation and psychological well-being. The underlying processes of this link and the couple interplay between attachment and well-being are notably less explored. Using a dyadic framework, this study examines both couple members' emotion regulation strategies as potential mediators of this link. METHOD: One hundred and nineteen heterosexual couples completed self-report measures on attachment style, psychological well-being, tendency to suppress emotions, and emotion expression. Analyses were performed using the actor-partner interdependence mediation model that distinguishes between intrapersonal and interpersonal influences. RESULTS: Results showed that controlling for relationship length, there was an intrapersonal indirect effect of attachment avoidance on psychological well-being through emotion suppression. Moreover, interpersonal indirect effects were found (a) with individual attachment avoidance being associated with partner's psychological well-being through own emotion expression and (b) individual's attachment anxiety being associated with partner's psychological well-being through both own's emotion expression and partner's emotion suppression. CONCLUSIONS: These findings highlight the complex associations among attachment, emotion regulation, and well-being and point out the role of emotion regulation as a potential underlying pathway explaining these associations. The results suggest the importance of considering the relational nature of emotional and attachment dynamics in couples.

Are measures of marital satisfaction valid for women with depressive symptoms? The examination of factor structure and measurement invariance of the Couple Satisfaction Index-4 across depression levels in Portuguese women.

Marital satisfaction (MS) is a key indicator of mental and physical health. Factor structure of MS measures in individuals with clinical levels of depression as well as their measurement invariance across groups with different levels of depressive symptoms were not yet explored. The lack of evidence of measurement invariance might compromise valid comparisons between individuals with elevated and minimal depressive symptoms in MS. This study examined the factor structure of the Couple Satisfaction Index-4 (CSI-4) among women with clinical levels of depression, tested the CSI-4 measurement invariance across depression levels groups, and investigated CSI-4 convergent and divergent validity. Participants were 891 heterosexual married/cohabiting women who were assigned into one of two groups based on assessment of their levels of depressive symptoms. Participants completed the CSI-4 and self-reported measures used to examine convergent and divergent validity. Support was found for the factor structure of the CSI-4 for the total sample and both elevated depressive symptoms and minimal depressive symptoms groups. Subsequent multigroup confirmatory factor analyses supported the measurement invariance of the CSI-4 across depression levels groups. The CSI-4 revealed excellent values of internal consistency and convergent and divergent validity. Our findings suggest that CSI-4 produces comparable response patterns across depression groups and thus meaningful comparisons between groups can be performed.

Experiences of breast cancer patients and helpful aspects of supportive-expressive group therapy: A qualitative study.

OBJECTIVE: This study explored the experiences and perceived changes of breast cancer (BC) patients after participating in 16-weekly sessions of Supportive-Expressive Group Therapy (SEGT). METHODS: A semi-structured interview adapted from Elliott's Client Change Interview was carried out with 12 women (aged 33-60 years) with BC, about 6 months after completing the treatment. RESULTS: Content analysis identified four main themes: expectations and motivations to participate in SEGT, group processes and experiences, perceived changes enhanced by SEGT and perceptions about the therapeutic relationship. The most helpful aspects of SEGT mentioned by participants were as follows: the expression/normalisation of feelings, thoughts and reactions; the improvement of social support; and the learning opportunities obtained through sharing of experiences among participants. Additionally, participants mentioned that SEGT contributed to improve personal and social skills, such as the capacity to express emotions and the ability to establish satisfactory interpersonal relationships. CONCLUSIONS: Based on the participants' experiences, SEGT seems to be an effective intervention to support women facing BC during the initial phase of cancer. The use of SEGT by health care professionals is encouraged, but the specific needs/problems of each group member should be carefully attended.

Mothers with breast cancer: A mixed-method systematic review on the impact on the parent-child relationship.

OBJECTIVE: To systematically review and integrate the findings from quantitative and qualitative studies on parenting and parent-child relationships in families where mothers had breast cancer (BC). METHODS: Ten different databases were searched from inception to January 2016. All authors assessed these data independently. Full-text, peer-reviewed articles exploring parenting and/or mother-child relationships in families where the mother had BC, regardless of cancer stage, were considered for inclusion. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS: From 116 studies, 23 were deemed eligible for inclusion. Five of them were quantitative, 15 were qualitative, and 1 study used a mixed-method approach. Most studies analysed the mother's perceptions about the experience of having BC in parenting and in the parent-child relationship. The majority of studies explored experiences and perspectives on the parent-child relationship in mothers with minor children, although a minority of studies included adult children. Additionally, a few studies (17%) addressed perceptions and experiences of women with advanced stage cancer. Three main themes were found: priorities and concerns of patients, decision-making processes about sharing the diagnosis with their children, and mother-child relationship and parenting after mother's diagnosis. CONCLUSIONS: Findings indicated that the diagnosis of BC is accompanied by an array of challenges that affect parental roles and parenting. Further studies are needed to explore these issues more sensitively. For now, however, the evidence suggests that the families of women with BC, and particularly the women themselves, may benefit from informal and formal support aimed at helping them cope effectively with this challenging life event.

Green spaces are not all the same for the provision of air purification and climate regulation services: The case of urban parks.

The growing human population concentrated in urban areas lead to the increase of road traffic and artificial areas, consequently enhancing air pollution and urban heat island effects, among others. These environmental changes affect citizen's health, causing a high number of premature deaths, with considerable social and economic costs. Nature-based solutions are essential to ameliorate those impacts in urban areas. While the mere presence of urban green spaces is pointed as an overarching solution, the relative importance of specific vegetation structure, composition and management to improve the ecosystem services of air purification and climate regulation are overlooked. This avoids the establishment of optimized planning and management procedures for urban green spaces with high spatial resolution and detail. Our aim was to understand the relative contribution of vegetation structure, composition and management for the provision of ecosystem services of air purification and climate regulation in urban green spaces, in particular the case of urban parks. This work was done in a large urban park with different types of vegetation surrounded by urban areas. As indicators of microclimatic effects and of air pollution levels we selected different metrics: lichen diversity and pollutants accumulation in lichens. Among lichen diversity, functional traits related to nutrient and water requirements were used as surrogates of the capacity of vegetation to filter air pollution and to regulate climate, and provide air purification and climate regulation ecosystem services, respectively. This was also obtained with very high spatial resolution which allows detailed spatial planning for optimization of ecosystem services. We found that vegetation type characterized by a more complex structure (trees, shrubs and herbaceous layers) and by the absence of management (pruning, irrigation and fertilization) had a higher capacity to provide the ecosystems services of air purification and climate regulation. By contrast, lawns, which have a less complex structure and are highly managed, were associated to a lower capacity to provide these services. Tree plantations showed an intermediate effect between the other two types of vegetation. Thus, vegetation structure, composition and management are important to optimize green spaces capacity to purify air and regulate climate. Taking this into account green spaces can be managed at high spatial resolutions to optimize these ecosystem services in urban areas and contribute to improve human well-being.

Mentalizing countertransference? A model for research on the elaboration of countertransference experience in psychotherapy.

As a construct, the elaboration of countertransference experience (ECE) is intended to depict the implicit and explicit psychological work to which therapists submit their experiences with clients. Through ECE, defined as a mentalizing process of a particular kind, therapists' experiences are presumed to acquire and increase in mental quality and become available for meaning-making and judicious clinical use. In this paper, we claim that such an ongoing process facilitates engagement with common therapeutic factors, such as the therapeutic alliance and countertransference management, enhancing therapist responsiveness in psychotherapy. We synthesize relevant literature on countertransference, mentalization, and, in particular, therapists' mentalization, informed by a systematic literature review. As a result, we propose a model for assessing ECE in psychotherapy, comprising 6 diversely mentalized countertransference positions (factual-concrete, abstract-rational, projective-impulsive, argumentative, contemplative-mindful, and mentalizing), 2 underlying primary dimensions (experiencing, reflective elaboration), and 5 complementary dimensions of elaboration. Strengths and limitations of the model are discussed.

Attachment and posttraumatic growth after breast cancer: A dyadic approach.

OBJECTIVE: Cancer poses unique challenges for the couple relationship. From a relational perspective, successful adaptation may be less dependent on the circumstances of being the "patient" or the "caregiver" than on how couples successfully integrate cancer into their relationship. In this article, we study posttraumatic growth through attachment theory, which provides a useful framework to explore the role of intimate processes dyadically. METHOD: The sample comprised 84 heterosexual married and cohabitating couples. Women were in adjuvant treatment for breast cancer or in the posttreatment phase. Both members of the couple completed measures of attachment and posttraumatic growth. Path models were used to examine associations between the constructs through the application of the actor-partner interdependent model. Moreover, time since diagnosis was examined within the actor-partner interdependent model as a possible moderator affecting the attachment-posttraumatic growth associations. RESULTS: Partners' attachment security was an important predictor of individual posttraumatic growth for both members of the couple, while individuals' own attachment security was not associated with their posttraumatic growth for either member of the couple. The partner's effects were equal across gender. Additionally, time since breast cancer diagnosis did not affect the pattern of results. CONCLUSION: Findings support the assessment of the couple dyadically and corroborate an attachment approach of the couple as an interdependent unit. Implications of the study for interventions assisting couples in oncological setting are discussed.