The dynamics of the midgut microbiome in Aedes aegypti during digestion reveal putative symbionts.

Blood-feeding is crucial for the reproductive cycle of the mosquito Aedes aegypti, as well as for the transmission of arboviruses to hosts. It is postulated that blood meals may influence the mosquito microbiome but shifts in microbial diversity and function during digestion remain elusive. We used whole-genome shotgun metagenomics to monitor the midgut microbiome in 60 individual females of A. aegypti throughout digestion, after 12, 24, and 48 h following blood or sugar meals. Additionally, ten individual larvae were sequenced, showing microbiomes dominated by Microbacterium sp. The high metagenomic coverage allowed for microbial assignments at the species taxonomic level, also providing functional profiling. Females in the post-digestive period and larvae displayed low microbiome diversities. A striking proliferation of Enterobacterales was observed during digestion in blood-fed mosquitoes. The compositional shift was concomitant with enrichment in genes associated with carbohydrate and protein metabolism, as well as virulence factors for antimicrobial resistance and scavenging. The bacterium Elizabethkingia anophelis (Flavobacteriales), a known human pathogen, was the dominant species at the end of blood digestion. Phylogenomics suggests that its association with hematophagous mosquitoes occurred several times. We consider evidence of mutually beneficial host-microbe interactions raised from this association, potentially pivotal for the mosquito's resistance to arbovirus infection. After digestion, the observed shifts in blood-fed females' midguts shifted to a sugar-fed-like microbial profile. This study provides insights into how the microbiome of A. aegypti is modulated to fulfil digestive roles following blood meals, emphasizing proliferation of potential symbionts in response to the dynamic midgut environment.

Focusing with colorectal cancer patients: a pilot study of a brief online group intervention.

Introduction: Focusing-Oriented Psychotherapy has had a long history and influence on the field of psychotherapy. By "clearing a space" and "focusing," individuals can enhance their emotional awareness and improve their ability to self-regulate. These tasks are particularly relevant in the context of Psycho-Oncology, although the research on their potential benefits for cancer patients is limited. Furthermore, the application of these tasks in a group or online setting has not been thoroughly explored. Methods: This study aimed to examine the effectiveness of a two-session online intervention based on Focusing for cancer-diagnosed participants and its impact on their mental health and wellbeing. The study involved three participants with a diagnosis of colorectal cancer who were undergoing palliative treatment. We used both qualitative and quantitative methods. PFC-2 was used to assess participants' accomplishment of the task; FMS was used to assess the change in the focusing attitude, while CORE-OM, and PWBS-RV were used as mental health distress and psychological wellbeing measures; participant feedback was collected through questionnaires and a semi-structured interview. Results: The results suggest that the tasks led to greater self-awareness, heightened self-reflection, and a sense of relief for the participants. Discussion: These findings suggest that the group intervention protocol based on online Focusing sessions is potentially useful for broader applications.

Wearables for Monitoring and Postural Feedback in the Work Context: A Scoping Review.

Wearables offer a promising solution for simultaneous posture monitoring and/or corrective feedback. The main objective was to identify, synthesise, and characterise the wearables used in the workplace to monitor and postural feedback to workers. The PRISMA-ScR guidelines were followed. Studies were included between 1 January 2000 and 22 March 2023 in Spanish, French, English, and Portuguese without geographical restriction. The databases selected for the research were PubMed®, Web of Science®, Scopus®, and Google Scholar®. Qualitative studies, theses, reviews, and meta-analyses were excluded. Twelve studies were included, involving a total of 304 workers, mostly health professionals (n = 8). The remaining studies covered workers in the industry (n = 2), in the construction (n = 1), and welders (n = 1). For assessment purposes, most studies used one (n = 5) or two sensors (n = 5) characterised as accelerometers (n = 7), sixaxial (n = 2) or nonaxialinertial measurement units (n = 3). The most common source of feedback was the sensor itself (n = 6) or smartphones (n = 4). Haptic feedback was the most prevalent (n = 6), followed by auditory (n = 5) and visual (n = 3). Most studies employed prototype wearables emphasising kinematic variables of human movement. Healthcare professionals were the primary focus of the study along with haptic feedback that proved to be the most common and effective method for correcting posture during work activities.

Optimizing Contraceptive Prescription in Smoking Women: A Quality Improvement Study.

Introduction Family planning is fundamental in primary care (PC), and informed counseling helps to guide contraceptive choices. Combined hormonal contraceptives (CHC) pose cardiovascular risks, particularly when combined with smoking. According to the World Health Organization, the recommended global clinical decision is to refrain from employing CHC in female smokers aged 35 or older. This study aimed to improve contraception prescription for female smokers aged 35-54 in PC. Methods This study was conducted in a Portuguese Family Health Unit (FHU) from October 2021 to August 2022, and it followed the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) guidelines and the Plan-Do-Study-Act approach. Female smokers aged 35-54 were included and evaluated in three moments: baseline evaluation (October 2021), intermediate evaluation (February 2022), and post-intervention evaluation (August 2022). Interventions involved educating medical staff, creating patient awareness campaigns, and evaluating contraceptive methods. The established quality-defining goal was to decrease the prevalence of female smokers aged 35 or above using CHC to ≤5%. Results CHC prevalence among smoking women aged 35-54 decreased from 16.4% to 8.5% after nine months of the initial intervention. There was an increase in progestogen-only methods usage over time, from 25.7% to 34.0%. Discussion Despite not fully achieving the predefined goal, interventions led to a substantial reduction of CHC use among smoking women aged 35-54. Collaborative efforts between healthcare professionals and patients played a pivotal role in optimizing care and reducing cardiovascular risk. This study underscores the importance of continuous quality improvement, collaborative interventions, and knowledge updates in Family Medicine practice. While conducted in a single FHU, the intervention's multidimensional approach holds the potential for broader applicability. Conclusion In the future, healthcare teams should continue to reflect on achieved results, maintain knowledge, and empower patients in contraceptive method choices. The study contributes to improved care quality and highlights the positive impact on medical practice and patient outcomes.

Validation of the client satisfaction questionnaire: a pilot psychometric analysis in Portuguese routine practice.

Treatment satisfaction has been found to have good therapeu- tic results in psychotherapy, and the 18-item version of the client satisfaction questionnaire (CSQ-18) is one of the most widely used measures to evaluate it. This study sought to carry out a pilot analysis of the psychometric's properties and factorial structure, as well as validate the CSQ-18's applicability to the Portuguese population within the context of routine clinical practice. It also sought to explore the association that treatment satisfaction has with general symptoms, therapeutic alliance, and expectations at an early stage of psychotherapy. The sample comprised 98 clients who were undergoing psychotherapy in a routine practice context. All these clients completed self-reported measures for symptom assessment and therapeutic relationship, namely the clinical out- come routine evaluation-outcome measure, working alliance in- ventory, and credibility/expectancy questionnaire, in addition to the CSQ-18. The semi-confirmatory factorial analysis demon- strated that the CSQ-18 has good psychometric properties and re- vealed an association between treatment satisfaction and therapeutic alliance. The results corroborate the findings of other versions of the measure and present a good adjustment model for the semi-confirmatory factorial analysis.

Optimization of Inhalation Technique Knowledge in the Pharmacies of Matosinhos Municipality, Portugal: An Intervention Project.

INTRODUCTION: The therapeutic approach to the most common respiratory diseases, asthma and chronic obstructive pulmonary disease (COPD), involves the use of inhalation devices. Its use is essential, but incorrect use is frequent, and learning and reviewing the technique is necessary for the adequate management of these diseases. OBJECTIVE: This study aims to increase the knowledge of health professionals from pharmacies in the municipality of Matosinhos, Portugal, about the correct inhalation technique. METHODS: The project developed from May 2022 to June 2023 was based on a training session for pharmacy professionals that took place after professionals completed a questionnaire and after evaluating each participant's inhalation technique by the authors using a checklist. Both were reapplied three months after the first evaluation. RESULTS: Fifteen pharmacies in Matosinhos, Portugal, were invited, of which eight agreed to participate, with a total of 16 health professionals (30.8% of professionals in these pharmacies). We found that professionals questioned and taught users more times about the inhalation technique and that a greater number of professionals considered they knew how to correctly perform the inhalation technique in the second assessment. It was also possible to verify statistically significant differences (p<0.001) between the mean of correct steps in the inhalation technique between the first and second assessments. There was also an improvement in the qualitative analysis of errors in the inhalation technique. In the first assessment, the inhalation devices with the lowest percentage of correct steps were Forspiro® and Respimat®. In the second evaluation, the Diskus® and Ellipta® devices obtained 100% correct steps, with the K-haler® being the device with the lowest percentage. CONCLUSIONS: This study confirms the effectiveness of continuous training for health professionals and the importance of multidisciplinary cooperation in teaching inhalation techniques. Other studies are needed to complement these results, particularly with representative samples of the general population, or assessing the impact of this intervention in patients with respiratory diseases.

Microsurgical Treatment of Anterior Communicating Artery Aneurysms: An Analysis of 74 Consecutive Cases. Approach Side Choice and Outcome Considerations / Tratamento microcirúrgico de aneurismas da artéria comunicante anterior: Uma análise de 74 casos consecutivos. Escolha da abordagem e considerações sobre resultados

Introduction Anterior communicating artery aneurysms (ACoAAs) are intracranial aneurysms whose treatment is still considered a challenging task. Materials and Methods Altogether, 74 patients were included in this study. The variables included age, sex, comorbidities, incidence of subarachnoid hemorrhage (SAH), the Fisher, Hunt-Hess, and WFNS scores, approach side, length of hospital stay, and mortality. We also investigate A1/A2 dimensions, association with approach side choice and the influence of surgeon's experience on the outcome. Results There were 61 patients (82.2%) admitted with SAH and 13 were treated for unruptured aneurysms. The A1 and A2 branches were larger ipsilaterally to the selected approach side (p < 0,001). No deaths occurred in the unruptured aneurysm group. In the SAH group, mortality was strongly correlated with the Hunt-Hess score (p < 0.001), Fisher grade (p < 0.001), and WFNS score (p < 0.001). No significant difference was found in mortality between the right-side and the left-side approaches (p » 0.253). A significant survival difference was identified on the group operated by the senior surgeon versus the non-senior group (p » 0.048). Discussion and Conclusion A1 dominance was identified as a factor associated to the approach side for SAH cases at our center. Understanding the factors involved in brain aneurysm surgery remains a relevant and underexplored subject. Further studies involving larger case series and multicenter collaborations are necessary to elucidate these factors and to determine the external validity of our findings.

Introdução Os aneurismas da artéria comunicante anterior (ACoAA) são aneurismas intracranianos cujo tratamento ainda é considerado uma tarefa desafiadora. Materiais e Métodos Ao todo, 74 pacientes foram incluídos neste estudo. As variáveis incluíram idade, sexo, comorbidades, incidência de hemorragia subaracnóidea (HAS), escala de Fisher, Hunt-Hess e WFNS, lado de abordagem, tempo de internação e mortalidade. Também investigamos as dimensões A1/A2, a associação com a escolha do lado de abordagem e a influência da experiência do cirurgião no resultado. Resultados Foram admitidos 61 pacientes (82,2%) com HAS e 13 foram tratados por aneurismas não rotos. Os ramos A1 e A2 foram maiores ipsilateralmente ao lado de abordagem selecionada (p < 0,001). Nenhuma morte ocorreu no grupo de aneurismas não rotos. No grupo HAS, a mortalidade esteve fortemente correlacionada com a escala de Hunt-Hess (p < 0,001), pontuação de Fisher (p < 0,001) e pontuação WFNS (p < 0,001). Não foi encontrada diferença significativa na mortalidade entre as abordagens direita e esquerda (p » 0,253). Foi identificada diferença significativa de sobrevida no grupo operado pelo cirurgião sênior versus o grupo não sênior (p » 0,048). Discussão e Conclusão A dominância A1 foi identificada como fator associado ao lado de abordagem dos casos de HAS em nosso centro. A compreensão dos fatores envolvidos na cirurgia de aneurisma cerebral permanece um assunto relevante e pouco explorado. Mais estudos envolvendo séries de casos maiores e colaborações multicêntricas são necessários para elucidar esses fatores e para determinar a validade externa de nossas descobertas.

Online consultations in mental healthcare: Modelling determinants of use and experience based on an international survey study at the onset of the pandemic.

Introduction: While online consultations have shown promise to be a means for the effective delivery of high-quality mental healthcare and the first implementations of these digital therapeutic contacts go back nearly two decades, uptake has remained limited over the years. The onset of the COVID-19 pandemic dramatically altered this relative standstill and created a unique turning point, with a massive amount of both professionals and clients having first hands-on experiences with technology in mental healthcare. Objective: The current study aimed to document the uptake of online consultations and explore if specific characteristics of mental health professionals across and beyond Europe could predict this. Methods: An international survey was designed to assess mental health professionals' (initial) experiences with online consultations at the onset of the pandemic: their willingness to make use of them and their prior and current experiences, alongside several personal characteristics. Logistic mixed-effects models were used to identify predictors of the use of online consultations, personal experience with this modality, and the sense of telepresence. Results: A total of 9115 healthcare professionals from 73 countries participated of which about two-thirds used online consultations during the initial COVID-19 outbreak. The current study identifies multiple determinants relating to the use and experience of online consultations, including the professionals' age, experience with the technology before the outbreak, the professional context, and training. Conclusions: Despite strong evidence supporting the relevance of training in digital mental health, this is clearly still lacking. Nevertheless, the COVID-19 pandemic presented a first, and potentially transformative, experience with online consultations for many healthcare professionals. The insights from this study can help support professionals and, importantly, (mental) healthcare organisations to create optimal circumstances for selective and high-quality continued use of online consultations.

Validation of the Brazilian version of the Hinting Task and Facial Emotion Recognition Test (FERT-100) in patients with schizophrenia / Validação da versão brasileira do Hinting Task e do Teste de Reconhecimento de Emoções Faciais (FERT-100) em pacientes com esquizofrenia

ABSTRACT Social cognition is an especially relevant domain in schizophrenia due to its association with functional impairment. However, we still do not have studies that have validated instruments with internationally established psychometric qualities for the Brazilian population. Objectives: This study aimed to present psychometric qualities and contribute to the validation of the Brazilian version of the Hinting Task and Facial Emotion Recognition Test (FERT-100). Methods: A total of 104 stabilized patients living in the community diagnosed with schizophrenia and 89 controls were evaluated. We assess the psychometric properties of Hinting Task and FERT-100 for discriminant construct validity, divergent construct validity, convergent construct validity, concurrent criterion validity, and reliability. Results: There is a statistically significant difference between patients and controls regarding social cognition (Hinting Task: Z=6.85, p<0.001; FERT-100: t=4.88, p<0.001). The main predictors of variation in social cognition were the neurocognitive domains. The associations between social cognition tests and other studied variables are similar to what is found in the literature. Social cognition maintains correlation with functional capacity even when neurocognition is taken into account. Conclusions: The validity of the Brazilian version of Hinting Task and FERT-100 can be determined, since the relationship of these tests with other clinical variables is similar to that observed in the literature.

RESUMO A cognição social é um domínio especialmente relevante na esquizofrenia devido à sua associação com o comprometimento funcional. No entanto, ainda não temos estudos que validaram instrumentos com qualidades psicométricas internacionalmente estabelecidas para a população brasileira. Objetivos: Apresentar as qualidades psicométricas e contribuir para a validação da versão brasileira do Hinting Task e do Teste de Reconhecimento de Emoções Faciais (FERT-100). Métodos: Foram avaliados 104 pacientes estabilizados residentes na comunidade com diagnóstico de esquizofrenia e 89 controles. Avaliou-se as propriedades psicométricas do Hinting Task e FERT-100 para validade de construto discriminante, validade de construto divergente, validade de construto convergente, validade de critério concorrente e confiabilidade. Resultados: Houve uma diferença estatisticamente significativa entre pacientes e controles quanto à cognição social (Hinting Task: Z=6,85; p<0,001. FERT-100: t=4,88; p<0,001). Os principais preditores da variação na cognição social foram os domínios neurocognitivos. As associações entre os testes de cognição social e outras variáveis estudadas são semelhantes às encontradas na literatura. A cognição social mantém correlação com a capacidade funcional mesmo quando a neurocognição é levada em consideração. Conclusões: A validade da versão brasileira do Hinting Task e do FERT-100 pode ser determinada, pois a relação desses testes com outras variáveis clínicas é semelhante à observada na literatura.

Evidências de Validade de Conteúdo da Beck Cognitive Insight Scale, Versão Brasileira (BCIS-BR) / Content Validity Evidence of the Beck Cognitive Insight Scale Brazilian Version (BCIS) / Evidencia de Validez de Contenido de la Beck Cognitive Insight Scale, Versión Brasileña (BCIS-BR)

O insight cognitivo ou clínico refere-se à capacidade de atribuição de sentido aos sintomas presentes em transtornos psicóticos, especialmente naqueles relacionados ao espectro da esquizofrenia. A Beck Cognitive Insight Scale (BCIS) foi desenvolvida com a finalidade de auxiliar o tratamento de pessoas com o insight comprometido. No entanto, este instrumento ainda não foi devidamente adaptado ao contexto brasileiro. Este estudo teve como objetivo fazer a adaptação transcultural da BCIS para o português do Brasil por meio da evidência de validade de conteúdo. Seis juízes avaliaram os itens desta escala quanto à clareza da linguagem, pertinência prática, relevância teórica e relação item-dimensão. A BCIS apresentou concordância satisfatória nos índices de validade de conteúdo e homogeneidade das respostas referente à análise da clareza da linguagem, pertinência prática e relevância teórica e concordância entre item-dimensão teórica, com reformulação de alguns itens. A retrotradução da escala recebeu aval positiva de uma das autoras originais. No entanto, ainda é necessária a verificação das propriedades psicométricas desta versão da BCIS.

Cognitive or clinical insight refers to the ability to assign meaning to symptoms present in psychotic disorders, especially those related to the schizophrenia spectrum. The Beck Cognitive Insight Scale (BCIS) was developed to support the treatment of people with impaired insight. However, this instrument has not yet been adapted to the Brazilian context. This study aimed to make the cross-cultural adaptation of the BCIS into Brazilian Portuguese through evidence of content validity. Six judges evaluated the items of this scale regarding clarity of language, practical relevance, theoretical relevance and item-dimension relatedness. The BCIS presented satisfactory agreement in the indices of content validity and homogeneity of responses regarding the analysis of clarity of language, practical relevance and theoretical relevance and agreement between item-theoretical dimension, reformulating some items. The back-translation of the scale received a positive endorsement from one of the original authors. However, it is still necessary to verify the psychometric properties for this version of the BCIS.

El insight cognitivo o clínico se refiere a la capacidad de asignar un significado a los síntomas presentes en los trastornos psicóticos, especialmente aquellos relacionados con el espectro de la esquizofrenia. La Escala de Insight Cognitivo de Beck (BCIS) fue desarrollada para apoyar el tratamiento de personas con insight comprometido. Sin embargo, este instrumento todavía no ha sido adaptado al contexto brasileño. Este estudio tuvo como objetivo realizar la adaptación transcultural de la BCIS al portugués brasileño mediante pruebas de validez de contenido. Seis jueces evaluaron los ítems de esta escala en cuanto a la claridad del lenguaje, la relevancia práctica, la relevancia teórica y la relación ítem-dimensión. La BCIS presentó una concordancia satisfactoria en los índices de validez de contenido y homogeneidad de respuestas en cuanto al análisis de la claridad del lenguaje, relevancia práctica y relevancia teórica, y concordancia entre ítem-dimensión teórica, reformulando algunos de los ítems. La retraducción de la escala recibió una aprobación positiva de una de las autoras. Todavía es necesario verificar las propiedades psicométricas de esta versión de la BCIS.

Cannabinoid receptor gene polymorphisms and cognitive performance in patients with schizophrenia and controls

Objective: To test the hypothesis that genetic variations of cannabinoid receptors contribute to the pathophysiology of cognitive deficits in schizophrenia. Methods: In this genetic association case-control study, cannabinoid receptor polymorphisms CNR1 rs12720071 and CNR2 rs2229579 were tested for association with neurocognitive performance in 69 patients with schizophrenia and 45 healthy controls. Neurocognition was assessed by the Brief Assessment of Cognition in Schizophrenia (BACS). Results: We found a consistent association between CNR1 rs12720071 polymorphism and the cognitive performance of patients in several cognitive domains. Patients with C/C polymorphism presented significantly worse performance in motor speed, verbal fluency, attention/processing speed and reasoning/problem solving. Conclusion: Although limited, our data support the hypothesis that CNR1 variations may be associated with the pathogenesis of cognitive deficits of schizophrenia.

Childhood trauma is associated with onset of symptoms, functioning and cognition in patients with schizophrenia.

INTRODUCTION: Childhood trauma (CT) is known to be a vulnerability factor for schizophrenia, but the specific impacts of different trauma subtypes on the prognosis of these patients remains unclear. OBJECTIVE: To assess the relationships between the occurrence of overall CT and its subtypes with factors with known prognostic impact on schizophrenia, such as age at onset of symptoms, global functioning, and cognitive impairment in a sample of Brazilian patients. METHODS: One hundred and five stable patients diagnosed with schizophrenia according to DSM-5 criteria were evaluated using the Independent Living Skills Survey (ILSS; self-report global functioning), Schizophrenia Cognition Rating Scale (SCoRS; subjective cognitive impairment), and Childhood Trauma Questionnaire scales (CTQ; perceived overall CT, emotional neglect, physical neglect, physical abuse, and emotional and sexual abuse). Statistical analysis was performed with multivariate linear regression. RESULTS: After controlling for educational level and age, subjective cognitive impairment was directly correlated with overall perceived CT occurrence, emotional abuse, and sexual abuse. Self-report global functioning was inversely correlated with perceived overall CT occurrence, emotional abuse, and sexual abuse. Emotional abuse and physical abuse were also inversely correlated with age at onset of symptoms. CONCLUSIONS: CT can be related to more severe prognoses in schizophrenia, impacting on early onset of symptoms, lower global functioning, and greater cognitive impairment. Subtypes of trauma can be associated with different prognostic risks.

Validation of the Brazilian version of the Hinting Task and Facial Emotion Recognition Test (FERT-100) in patients with schizophrenia.

Social cognition is an especially relevant domain in schizophrenia due to its association with functional impairment. However, we still do not have studies that have validated instruments with internationally established psychometric qualities for the Brazilian population. Objectives: This study aimed to present psychometric qualities and contribute to the validation of the Brazilian version of the Hinting Task and Facial Emotion Recognition Test (FERT-100). Methods: A total of 104 stabilized patients living in the community diagnosed with schizophrenia and 89 controls were evaluated. We assess the psychometric properties of Hinting Task and FERT-100 for discriminant construct validity, divergent construct validity, convergent construct validity, concurrent criterion validity, and reliability. Results: There is a statistically significant difference between patients and controls regarding social cognition (Hinting Task: Z=6.85, p<0.001; FERT-100: t=4.88, p<0.001). The main predictors of variation in social cognition were the neurocognitive domains. The associations between social cognition tests and other studied variables are similar to what is found in the literature. Social cognition maintains correlation with functional capacity even when neurocognition is taken into account. Conclusions: The validity of the Brazilian version of Hinting Task and FERT-100 can be determined, since the relationship of these tests with other clinical variables is similar to that observed in the literature.

A cognição social é um domínio especialmente relevante na esquizofrenia devido à sua associação com o comprometimento funcional. No entanto, ainda não temos estudos que validaram instrumentos com qualidades psicométricas internacionalmente estabelecidas para a população brasileira. Objetivos: Apresentar as qualidades psicométricas e contribuir para a validação da versão brasileira do Hinting Task e do Teste de Reconhecimento de Emoções Faciais (FERT-100). Métodos: Foram avaliados 104 pacientes estabilizados residentes na comunidade com diagnóstico de esquizofrenia e 89 controles. Avaliou-se as propriedades psicométricas do Hinting Task e FERT-100 para validade de construto discriminante, validade de construto divergente, validade de construto convergente, validade de critério concorrente e confiabilidade. Resultados: Houve uma diferença estatisticamente significativa entre pacientes e controles quanto à cognição social (Hinting Task: Z=6,85; p<0,001. FERT-100: t=4,88; p<0,001). Os principais preditores da variação na cognição social foram os domínios neurocognitivos. As associações entre os testes de cognição social e outras variáveis estudadas são semelhantes às encontradas na literatura. A cognição social mantém correlação com a capacidade funcional mesmo quando a neurocognição é levada em consideração. Conclusões: A validade da versão brasileira do Hinting Task e do FERT-100 pode ser determinada, pois a relação desses testes com outras variáveis clínicas é semelhante à observada na literatura.

Emotional processing during the therapy for complicated grief.

OBJECTIVE: Prior research, mainly conducted on depression, observed that clients' improved capability to process their emotions predicted better therapeutic outcomes. The current comparative study aimed to investigate whether emotional processing was related to therapeutic change in complicated grief. METHOD: We analyzed two contrasting cases (good or poor outcome) treated with grief constructivist therapy. In both cases we investigated the association of emotional processing (Experiencing Scale) to (1) therapeutic outcome (Inventory of Complicated Grief), and (2) change in the type of grief-related emotions (Emotions Episodes). RESULTS: The session-by-session growth of clients' emotional processing and the change of grief-related emotions were qualitatively explored throughout both cases. Compared with the poor outcome case, the good outcome case achieved more improvement in the ability to process emotions. Such improvement occurred alongside a deeper change in the type of grief-related emotions aroused, from maladaptive to more adaptive responses. CONCLUSION: Our findings suggest that a higher emotional processing capability may be associated with the transformation of grief-related maladaptive emotions and with the improvement of complicated grief condition.

Adiponectin and Stnfr2 peripheral levels are associated with cardiovascular risk in patients with schizophrenia.

OBJECTIVES: To investigate the association between cytokine peripheral levels and the risk of cardiovascular disease in patients with schizophrenia and controls. METHODS: A sample of 40 patients and 40 control subjects participated in the study. Psychiatric diagnosis was established following structured clinical assessment. The Framingham Score was used to assess cardiovascular risk (CVR). Serum levels of the cytokines IL-1ß, IL-6, IL-8, IL-10, IL-12p70 and TNF-α were determined by cytometric bead array (CBA) technique, and the serum levels of IL-33, sST2, sTNFR1, sTNFR2, Leptin and Adiponectin by Enzyme-Linked Immunosorbent assay (ELISA). RESULTS: Patients with schizophrenia showed greater frequency of moderate CVR when compared with controls (p = 0.14). In addition, patients showed higher levels of sTNFR2 and Adiponectin compared to controls (p = 0.007 and p < 0.001, respectively). Adiponectin and sTNFR2 were associated with CVR only in patients (p = 0.0002 and p = 0.033, respectively). In multivariate analysis controlling for socio-demographic and clinical confounders, illness duration (r = 0.492; p < 0.002) and sTNFR2 (r = 0.665; p < 0.004) were independent predictors of CVR. CONCLUSION: Our results reinforce the concept that patients with schizophrenia are at greater risk to develop cardiovascular diseases, and suggest that the associated chronic low-grade inflammation might play a role in this process.

Cannabinoid receptor gene polymorphisms and cognitive performance in patients with schizophrenia and controls.

OBJECTIVE: To test the hypothesis that genetic variations of cannabinoid receptors contribute to the pathophysiology of cognitive deficits in schizophrenia. METHODS: In this genetic association case-control study, cannabinoid receptor polymorphisms CNR1 rs12720071 and CNR2 rs2229579 were tested for association with neurocognitive performance in 69 patients with schizophrenia and 45 healthy controls. Neurocognition was assessed by the Brief Assessment of Cognition in Schizophrenia (BACS). RESULTS: We found a consistent association between CNR1 rs12720071 polymorphism and the cognitive performance of patients in several cognitive domains. Patients with C/C polymorphism presented significantly worse performance in motor speed, verbal fluency, attention/processing speed and reasoning/problem solving. CONCLUSION: Although limited, our data support the hypothesis that CNR1 variations may be associated with the pathogenesis of cognitive deficits of schizophrenia.

Childhood trauma is associated with age at onset of symptoms, functioning, and cognition in patients with schizophrenia

Abstract Introduction Childhood trauma (CT) is known to be a vulnerability factor for schizophrenia, but the specific impacts of different trauma subtypes on the prognosis of these patients remains unclear. Objective To assess the relationships between the occurrence of overall CT and its subtypes with factors with known prognostic impact on schizophrenia, such as age at onset of symptoms, global functioning, and cognitive impairment in a sample of Brazilian patients. Methods One hundred and five stable patients diagnosed with schizophrenia according to DSM-5 criteria were evaluated using the Independent Living Skills Survey (ILSS; self-report global functioning), Schizophrenia Cognition Rating Scale (SCoRS; subjective cognitive impairment), and Childhood Trauma Questionnaire scales (CTQ; perceived overall CT, emotional neglect, physical neglect, physical abuse, and emotional and sexual abuse). Statistical analysis was performed with multivariate linear regression. Results After controlling for educational level and age, subjective cognitive impairment was directly correlated with overall perceived CT occurrence, emotional abuse, and sexual abuse. Self-report global functioning was inversely correlated with perceived overall CT occurrence, emotional abuse, and sexual abuse. Emotional abuse and physical abuse were also inversely correlated with age at onset of symptoms. Conclusions CT can be related to more severe prognoses in schizophrenia, impacting on early onset of symptoms, lower global functioning, and greater cognitive impairment. Subtypes of trauma can be associated with different prognostic risks.

Online consultations in mental healthcare during the COVID-19 outbreak: An international survey study on professionals' motivations and perceived barriers.

INTRODUCTION: While the general uptake of e-mental health interventions remained low over the past years, physical distancing and lockdown measures relating to the COVID-19 pandemic created a need and demand for online consultations in only a matter of weeks. OBJECTIVE: This study investigates the uptake of online consultations provided by mental health professionals during lockdown measures in the first wave of the COVID-19 pandemic in the participating countries, with a specific focus on professionals' motivations and perceived barriers regarding online consultations. METHODS: An online survey on the use of online consultations was set up in March 2020. The Unified Theory of Acceptance and Use of Technology (UTAUT) guided the deductive qualitative analysis of the results. RESULTS: In total, 2082 mental health professionals from Austria, Belgium, Cyprus, France, Germany, Italy, Lebanon, Lithuania, the Netherlands, Norway, Portugal, Spain, and Sweden were included. The results showed a high uptake of online consultations during the COVID-19 pandemic but limited previous training on this topic undergone by mental health professionals. Most professionals reported positive experiences with online consultations, but concerns about the performance of online consultations in a mental health context (e.g., in terms of relational aspects) and practical considerations (e.g., relating to privacy and security of software) appear to be major barriers that hinder implementation. CONCLUSIONS: This study provides an overview of the mental health professionals' actual needs and concerns regarding the use of online consultations in order to highlight areas of possible intervention and allow the implementation of necessary governmental, educational, and instrumental support so that online consultations can become a feasible and stable option in mental healthcare.

Diploidy within a Haploid Genus of Entomopathogenic Fungi.

Fungi in the genus Metarhizium are soil-borne plant-root endophytes and rhizosphere colonizers, but also potent insect pathogens with highly variable host ranges. These ascomycete fungi are predominantly asexually reproducing and ancestrally haploid, but two independent origins of persistent diploidy within the Coleoptera-infecting Metarhizium majus species complex are known and has been attributed to incomplete chromosomal segregation following meiosis during the sexual cycle. There is also evidence for infrequent sexual cycles in the locust-specific pathogenic fungus Metarhizium acridum (Hypocreales: Clavicipitaceae), which is an important entomopathogenic biocontrol agent used for the control of grasshoppers in agricultural systems as an alternative to chemical control. Here, we show that the genome of the M. acridum isolate ARSEF 324, which is formulated and commercially utilized is functionally diploid. We used single-molecule real-time sequencing technology to complete a high-quality assembly of ARSEF 324. K-mer frequencies, intragenomic collinearity between contigs and single nucleotide variant read depths across the genome revealed the first incidence of diploidy described within the species M. acridum. The haploid assembly of 44.7 Mb consisted of 20.8% repetitive elements, which is the highest proportion described of any Metarhizium species. The long-read diploid genome assembly sheds light on past research on this strain, such as unusual high UVB tolerance. The data presented here could fuel future investigation into the fitness landscape of fungi with infrequent sexual reproduction and aberrant ploidy levels, not least in the context of biocontrol agents.

Portuguese validation of the credibility/expectancy questionnaire in routine practice.

This study aimed to validate and explore the psychometric properties of the credibility/expectancy questionnaire (CEQ) for the Portuguese population in the context of routine practice. The sample includes 87 clients from a university psychotherapy clinic. All clients completed self-report measures to assess credibility and expectation (CEQ), as well as measures of general mental health, depressive symptoms and therapeutic alliance in session 1 and session 2. The exploratory analysis revealed the existence of two factors in CEQ for the Portuguese population, factor 1 credibility and factor 2 expectation. The measure demonstrated good internal consistency, test-retest reliability and good adjustment in the confirmatory analysis. In terms of convergent validity, no significant correlation was found between credibility and expectation and the therapeutic alliance. The results corroborate the CEQ psychometric qualities for the Portuguese population, also showing its applicability in a context of routine practice.