Publications by authors named "Paula Matos"

54 Publications

Genetic atypical hemolytic uremic syndrome in children: a 20-year experience from a tertiary center.

J Bras Nefrol 2021 May 12. Epub 2021 May 12.

Centro Hospitalar Universitário do Porto, Centro Materno-Infantil do Norte, Unidade de Nefrologia Pediátrica, Porto, Portugal.

Introduction: Atypical hemolytic uremic syndrome (aHUS) is a rare disorder characterized by the triad of microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury, which primarily affects preschool-aged children. This study's aim was to describe the clinical profile, management, and long-term outcome of the genetic aHUS patients admitted to a tertiary care pediatric nephrology center during 20 years.

Methods: We performed a retrospective analysis of the clinical records of all aHUS patients younger than 18 years with identified genetic mutations. Data on clinical features, genetic study, therapeutic interventions, and long-term outcomes were reviewed.

Results: Five cases of aHUS with an identified genetic mutation were included; all were inaugural cases with the youngest being 4 months old. Complement factor H gene mutation was identified in four patients. Therapeutic plasma exchange was performed for acute management in 4 patients, one of whom also needed acute renal replacement therapy (peritoneal dialysis). All patients went on complete remission, 2 had more than one relapse but only 1 of these progressed to chronic kidney disease during the follow-up period (median (25th-75th percentile), 136 (43.5-200.5) months).

Conclusion: In children, the prognosis of renal function seems to be strongly dependent on the genetic background, thus being crucial to perform genetic study in all aHUS cases. In our cohort, 2 patients presented genetic mutations not previously described. Recent innovations on the genetic field leading to the identification of new mutations has lead to a better understanding of aHUS pathogenesis, but further studies, focusing on the genotype-phenotype correlation, with longer follow-up periods, are needed.
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http://dx.doi.org/10.1590/2175-8239-JBN-2020-0199DOI Listing
May 2021

Functional Traits in Lichen Ecology: A Review of Challenge and Opportunity.

Microorganisms 2021 Apr 6;9(4). Epub 2021 Apr 6.

DIFAR, University of Genova, Viale Cembrano, 4, I-16148 Genova, Italy.

Community ecology has experienced a major transition, from a focus on patterns in taxonomic composition, to revealing the processes underlying community assembly through the analysis of species functional traits. The power of the functional trait approach is its generality, predictive capacity such as with respect to environmental change, and, through linkage of response and effect traits, the synthesis of community assembly with ecosystem function and services. Lichens are a potentially rich source of information about how traits govern community structure and function, thereby creating opportunity to better integrate lichens into 'mainstream' ecological studies, while lichen ecology and conservation can also benefit from using the trait approach as an investigative tool. This paper brings together a range of author perspectives to review the use of traits in lichenology, particularly with respect to European ecosystems from the Mediterranean to the Arctic-Alpine. It emphasizes the types of traits that lichenologists have used in their studies, both response and effect, the bundling of traits towards the evolution of life-history strategies, and the critical importance of scale (both spatial and temporal) in functional trait ecology.
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http://dx.doi.org/10.3390/microorganisms9040766DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067525PMC
April 2021

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

Eur J Cancer Care (Engl) 2020 Nov 7;29(6):e13315. Epub 2020 Sep 7.

Center for Psychology at University of Porto, Porto, Portugal.

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.
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http://dx.doi.org/10.1111/ecc.13315DOI Listing
November 2020

Validation of a Portuguese Version of the Aspiration Index for Adolescents (AI).

Span J Psychol 2020 Sep 8;23:e32. Epub 2020 Sep 8.

Universidade de Trás-os-Montes e Alto Douro (Portugal).

Intrinsic and extrinsic types of motivation have been widely studied, and their importance on both developmental and educational practices has led to the development of assessment tools. The Aspiration Index scale (AI; Grouzet et al., 2005), which was developed to measure people`s life aspirations, was translated and validated into Portuguese. A sample of 1,359 adolescents, age ranged from 12 to 18 years-old, participated in the present study. Results showed that a factor structure with the eleven subscales of the AI does not fit the data. However we gathered support for a three-factor structure that organized the items in terms of whether aspirations are intrinsically, extrinsically or self-transcendent oriented. Internal consistency and temporal stability yielded good results. The predictive and criterion validities were demonstrated by significant associations with theoretically supported measures of satisfaction with life and father and mother attachment. The multi-group confirmatory factor analysis showed that this structure was invariant across gender. These results suggest that the AI is a reliable measure to assess different types of life aspirations and can be used in future research with adolescents in Portugal.
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http://dx.doi.org/10.1017/SJP.2020.22DOI Listing
September 2020

Systematic review of the factor structure and measurement invariance of the patient health questionnaire-9 (PHQ-9) and validation of the Portuguese version in community settings.

J Affect Disord 2020 11 17;276:220-233. Epub 2020 Jul 17.

Digital Human-Environment Interaction Lab, Lusófona University of Porto, Portugal.

Background: This research sought to review studies that examined the factor structure of the PHQ-9 using a confirmatory factor analysis approach (Study 1); to review studies that tested the measurement invariance of the PHQ-9 (Study 2); to examine the psychometric properties of the European Portuguese version in the general population (Study 3).

Methods: Using PRISMA guidelines, a search was performed on Web of Science, PsycINFO, and Scopus from 2001 to August 2019. Assessment of eligibility criteria and data extraction were conducted by two independent researchers (Studies 1 and 2). In Study 3, data were collected from 1479 Portuguese adults, using a cross-sectional design. The BDI-II and the GDS-15 were administered to examine convergent validity.

Results: The systematic review identified four-factor models of the PHQ-9 (Study 1). Nineteen studies supported a one-factor model, whereas 12 found evidence for a two-factor model. Both models were supported in general, clinical, psychiatric, and international samples. Study 2 identified ten studies that examined PHQ-9 measurement invariance across 18 groups. The PHQ-9 measurement invariance was fully supported across studies. Study 3 revealed that a two-factor model showed a close fit to data in the European Portuguese version of the PHQ-9. Measurement invariance, reliability, and convergent and divergent validity were also established.

Limitations: Study 3 did not include a gold standard measure of depression to evaluate PHQ-9 diagnostic properties.

Conclusions: Conceptual implications of the findings are discussed, and recommendations for using the Portuguese version of the PHQ-9 as a screening measure in community settings are also highlighted.
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http://dx.doi.org/10.1016/j.jad.2020.06.066DOI Listing
November 2020

Spatially modelling the risk areas of chronic exposure to hydrothermal volcanic emissions using lichens.

Sci Total Environ 2019 Dec 12;697:133891. Epub 2019 Aug 12.

Faculty of Sciences and Technology, University of the Azores, 9501-801 Ponta Delgada, Portugal; Centre for Ecology, Evolution and Environmental Changes, and Azorean Biodiversity Group (cE3c-GBA), University of the Azores, 9501-801 Ponta Delgada, Portugal.

Human populations living in volcanically active areas are chronically exposed to volcanogenic air pollution, potentially contributing to long-term adverse health effects. However, mapping chronic exposure is difficult due to low spatial resolution of monitoring data on air pollutants and the need for time integration. To overcome these problems, lichens were tested as ecological indicators of hydrothermal volcanic air pollution, considering their bioaccumulation capacity over time, by transplanting them from a reference area to several sites (n = 39) in a volcanic area. The test was developed at Furnas volcano (Azores, Portugal). A stratified sampling design was followed using previous measurements of soil CO flux at ground level and the distance to the main fumarolic fields. After 6 months of exposure, lichen transplants were analyzed for S isotopic ratio (δS), which strongly related with the distance to fumarolic fields on a logarithmic regression, serving as an appropriate hydrothermal exposure biomarker. Considering kriging interpolated δS values as tracer of airborne hydrothermal emissions and habitational areas as proxy of ongoing human presence, a map was built relating both information per area unit to spatially model risk areas. It was estimated that 26% of habitational areas in the study area stand at high or very high risk of outdoors chronic exposure to airborne hydrothermal emissions. This methodologic approach to produce chronic exposure risk maps is applicable to other volcanically active and inhabited areas of the world, with time-integration and high spatial resolution, contributing in this way for spatially focusing future human health assessments.
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http://dx.doi.org/10.1016/j.scitotenv.2019.133891DOI Listing
December 2019

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

Attach Hum Dev 2020 Apr 22:1-16. Epub 2020 Apr 22.

Faculty of Psychology and Educational Sciences, Center for Psychology, University of Porto, Porto, Portugal.

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, 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.
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http://dx.doi.org/10.1080/14616734.2020.1752438DOI Listing
April 2020

How much matching there is in functional, phylogenetic and taxonomic optima of epiphytic macrolichen communities along a European climatic gradient?

Sci Total Environ 2020 Apr 7;712:136533. Epub 2020 Jan 7.

Área de Biodiversidad y Conservación, Departamento de Biología, Geología, Física y Química Inorgánica, ESCET, Universidad Rey Juan Carlos, c/Tulipán s/n, 28933 Móstoles, Spain.

Adopting an integrative approach that explicitly includes the different facets of biodiversity is crucial to assess the response of biological communities to changing environments. The identification of the optimal climatic conditions where communities maximize their functional, phylogenetic and taxonomic diversity is useful to compare whether the optima of the different facets of biodiversity match. Using a wide climatic gradient across Europe, we quantified the functional, phylogenetic and taxonomic diversity of epiphytic macrolichen communities, which are valuable early-warning ecological indicators. We ordinated 22 environmental variables and simultaneously illustrated non-parametric regressions of the diversity metrics against the climatic space using the 'hilltop plot' method to detect the climatic conditions in which the different diversity facets peaked and to compare the match between them. Functional diversity predicted at least part of the peaks of phylogenetic and taxonomic diversity, but phylogenetic and taxonomic hotspots did not overlap. Epiphytic macrolichen communities maximized their functional and phylogenetic diversity in the southernmost forests, with the Mediterranean region appearing as a biodiversity hotspot. Regarding the studied traits, photobiont type and growth form showed clearly defined optima while the quantitative physiological traits and families' optima did not show this pattern in response to climate. The different facets of biodiversity were not surrogates of each other highlighting the need for an integrative approach to assess the effect of environmental changes on communities and to establish conservation priorities. As functional traits mediated the response of lichen communities to climate, preserving high functional diversity might indirectly preserve high phylogenetic and taxonomic diversity. Relevant ecological indicators useful to develop rapid assessment methods to evaluate the effects of climatic changes include the photobiont type and growth form. The lack of relation between quantitative traits and climate call for further research to unveil their role as ecological indicators of small-scale variables or as effect traits.
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http://dx.doi.org/10.1016/j.scitotenv.2020.136533DOI Listing
April 2020

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.

Clin Psychol Psychother 2020 Mar 14;27(2):214-219. Epub 2020 Jan 14.

HEI-Lab, Faculty of Psychology, Education and Sports, Lusófona University of Porto, Porto, Portugal.

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.
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http://dx.doi.org/10.1002/cpp.2420DOI Listing
March 2020

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

J Pers 2020 08 15;88(4):748-761. Epub 2019 Nov 15.

Center for Psychology at University of Porto, Porto, Portugal.

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.
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http://dx.doi.org/10.1111/jopy.12523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7383855PMC
August 2020

Elaboration of countertransference experience and the workings of the working alliance.

Psychotherapy (Chic) 2020 06 29;57(2):141-150. Epub 2019 Aug 29.

Center for Psychology at University of Porto, Faculty of Psychology and Education Science, University of Porto.

Alliance may impact psychotherapy outcomes both as a precondition that enables therapeutic work and an evolving process that is therapeutic in itself. This study examined the participation of the elaboration of countertransference experience (ECE) in alliance variation between therapist-client dyads early in therapy and within dyads over time. A total of 44 session assessments nested within 12 dyads were modeled through longitudinal multilevel analyses and utilized to examine the associations between the ECE dimensions of Immersion and Reflection and alliance components across 4 time points within the first 10 sessions of psychotherapy. Results supported the importance of initial ECE to explain differences in alliance between dyads, the particular relevance of ECE with clients presenting lower levels of personality organization, and the effect of personality difficulties on alliance change. Unexpected results were found concerning the correlations between ECE and alliance and their covariation over time. In conclusion, ECE dimensions appear to be involved in alliance formation, both in initial differences between dyads and in changes over time within the same case. ECE seems particularly important with more personality-disturbed clients. Future research should disentangle therapist and client contributions and examine the participation of ECE in the resolution of alliance ruptures. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/pst0000250DOI Listing
June 2020

Prevention of Initial Depressive Disorders Among at-Risk Portuguese Adolescents.

Behav Ther 2019 07 6;50(4):743-754. Epub 2018 Dec 6.

Emory University. Electronic address:

This study evaluated whether Arnarson and Craighead's (2009, 2011) developmentally based behavioral and cognitive program that prevented the initial episode of depressive disorders among Icelandic adolescents could be adapted to prevent depressive disorders among "at-risk" Portuguese adolescents. One hundred sixty-eight Portuguese mid-adolescents (primarily 14 to 15 years old), who had subsyndromal symptoms of depression but who had never met criteria for a depressive disorder, were identified by classroom screening with the CDI and subsequent K-SADS-PL interview. All 168 adolescents were offered participation in the 14-week prevention program; 70 agreed to participate in the program, and 98 agreed to participate only in an assessment control group. Psychological disorders were evaluated at baseline, 6-, 12-, 18-, and 24-month assessments. During the 2-year follow-up period, 12 students in the assessment-only group experienced an initial depressive disorder versus 2 in the prevention group. Survival analyses indicated a significantly lower rate of initial episodes of depressive disorders, χ(1) = 4.261, p = .039, among the prevention group participants compared to the assessment only comparison group. The hazard ratio was .207, and the NNT was 11. Survival analyses indicated no significant differences between the prevention condition and the assessment only condition in the occurrence of other psychiatric disorders, χ2(1) = 1.080, p =.299. The findings indicate the program can be successfully adapted for use in Portuguese schools, and they provide a preliminary indication that those "at-risk" adolescents who chose to participate in the program, compared to those who chose to participate only in the assessments, developed fewer initial episodes of depressive disorders over the course of 24 months. The program effects were similar to the outcomes of the prior study of this program in Iceland. As in the Icelandic version of the program, its effects appeared to be specific to the depressive disorders for which the program was designed.
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http://dx.doi.org/10.1016/j.beth.2018.11.005DOI Listing
July 2019

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

Eur J Cancer Care (Engl) 2019 Sep 30;28(5):e13078. Epub 2019 Apr 30.

Center for Psychology at University of Porto, Porto, Portugal.

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.
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http://dx.doi.org/10.1111/ecc.13078DOI Listing
September 2019

Modeling the provision of air-quality regulation ecosystem service provided by urban green spaces using lichens as ecological indicators.

Sci Total Environ 2019 May 2;665:521-530. Epub 2019 Feb 2.

Centre for Ecology, Evolution and Environmental Changes, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal. Electronic address:

The UN Sustainable Development Goals states that urban air pollution must be tackled to create more inclusive, safe, resilient and sustainable cities. Urban green infrastructures can mitigate air pollution, but a crucial step to use this knowledge into urban management is to quantify how much air-quality regulation can green spaces provide and to understand how the provision of this ecosystem service is affected by other environmental factors. Considering the insufficient number of air quality monitoring stations in cities to monitor the wide range of natural and anthropic sources of pollution with high spatial resolution, ecological indicators of air quality are an alternative cost-effective tool. The aim of this work was to model the supply of air-quality regulation based on urban green spaces characteristics and other environmental factors. For that, we sampled lichen diversity in the centroids of 42 urban green spaces in Lisbon, Portugal. Species richness was the best biodiversity metric responding to air pollution, considering its simplicity and its significative response to the air pollutants concentration data measured in the existent air quality monitoring stations. Using that metric, we then created a model to estimate the supply of air quality regulation provided by green spaces in all green spaces of Lisbon based on the response to the following environmental drivers: the urban green spaces size and its vegetation density. We also used the unexplained variance of this model to map the background air pollution. Overall, we suggest that management should target the smallest urban green spaces by increasing green space size or tree density. The use of ecological indicators, very flexible in space, allow the understanding and the modeling of the provision of air-quality regulation by urban green spaces, and how urban green spaces can be managed to improve air quality and thus improve human well-being and cities resilience.
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http://dx.doi.org/10.1016/j.scitotenv.2019.02.023DOI Listing
May 2019

Local topographic and edaphic factors largely predict shrub encroachment in Mediterranean drylands.

Sci Total Environ 2019 Mar 1;657:310-318. Epub 2018 Dec 1.

Centre for Ecology, Evolution and Environmental Changes, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, C2, Piso 5, 1749-016 Lisboa, Portugal. Electronic address:

Shrub encroachment influences several ecosystem services in drylands worldwide. Yet, commonly used strategies to reduce encroachment show a low medium-term success, calling for a better understanding of its causes. Previous works identified multiple drivers responsible for this phenomenon, including anthropogenic and environmental causes. However, the relative effect of climate, topography and edaphic factors on shrub encroachment is not fully understood nor has been properly quantified in Mediterranean Basin drylands. Also, understanding how these drivers lead to changes in plant communities' functional traits associated to shrub encroachment is crucial, considering traits influence ecosystem processes and associated ecosystem services. Here, we studied the understory of a Mediterranean dryland ecosystem composed of savanna-like Holm-oak woodlands, along a regional climatic gradient. We specifically assessed (i) how climatic, topographic and edaphic factors influence understory relative shrub cover (RSC) and (ii) their direct and indirect effects (via RSC) on plant functional traits. We studied the mean and diversity of 12 functional traits related to plant regeneration, establishment, and dispersal, at the community-level. We found that, under similar low-intensity land use, topographic and edaphic factors, namely slope variations and soil C:N ratio, were the most important predictors of shrub encroachment, determining communities' functional characteristics. Climate, namely summer precipitation, had a much lesser influence. Our model explained 52% of the variation in relative shrub cover. Climate had a stronger effect on a set of functional traits weakly involved in shrub encroachment, related to flowering and dispersal strategies. We show that shrub encroachment is largely predicted by topo-edaphic factors in Mediterranean drylands subject to conventional low-intensity land use. Hence, management strategies to reduce encroachment need to take these drivers into account for efficient forecasting and higher cost-effectiveness. Our results suggest that climate change might not greatly impact shrub encroachment in the Mediterranean Basin, but may affect functional structure and reduce functional diversity of plant communities, thus affecting ecosystem functioning.
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http://dx.doi.org/10.1016/j.scitotenv.2018.11.475DOI Listing
March 2019

Selecting lichen functional traits as ecological indicators of the effects of urban environment.

Sci Total Environ 2019 Mar 10;654:705-713. Epub 2018 Nov 10.

Graduate Program in Ecology, Universidade Federal do Rio Grande do Sul, Av. Bento Gonçalves, 9500, CEP 90650-001 Porto Alegre, Rio Grande do Sul, Brazil.

Air pollution and the urban heat island effect are known to directly affect ecosystems in urban areas. Lichens, which are widely known as good ecological indicators of air quality and of climatic conditions, can be a valuable tool to monitor environmental changes in urban environments. The objective of this work was to select lichen functional traits and functional groups that can be used as ecological indicators of the effects of urbanization, with emphasis in the Southern subtropics, where this had never been done. For that, we assessed lichen functional composition in urban sites with different population density, which was considered as proxy for grouping sites in two levels of urbanization (low and medium/high). This a priori grouping was based on their significantly differences on air pollutants and land cover. Urbanization and air pollution showed to affect all lichen functional traits, with different responses depending on the functional group. Medium/high density urbanization was associated to an increase on the mean relative abundance of lichens with chlorococcoid green algae, foliose narrow lobes, soredia as the main reproduction strategy, pruinose thallus and containing secondary metabolites for chemical protection. Lower density urbanization showed a higher relative frequency of cyanolichens and lichens with Trentepohlia as the main algae, loosely attached crustose thallus and isidia as the main reproductive structure. The differences found on photobiont and growth form traits in response to the environmental variables used as proxies of microclimatic conditions (forest cover and number of trees around the sampling units), enabled us to detect the urban heat island effect (drier conditions in more urbanized sites).
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http://dx.doi.org/10.1016/j.scitotenv.2018.11.107DOI Listing
March 2019

How Routine Patient-Centered Monitoring Relates to Therapeutic Gains in Family Therapy: A Single-Case Study.

J Marital Fam Ther 2019 Oct 16;45(4):606-620. Epub 2018 Oct 16.

University of Porto.

As routine outcome monitoring systems develop, questions emerge about how therapists incorporate feedback into their practice, and how this relates to therapeutic gains. A case of covert grief was monitored in each session with the Personal Questionnaire and the Helpful Aspects of Therapy instruments. At 4 months follow-up, the Change Interview was administered. Individualized items facilitated access to the private views and needs of each member, which was useful for case formulation and ongoing personalization of the intervention. Qualitative feedback of treatment experiences helped therapists confirm the impacts of interventions, monitor therapeutic alliance, reformulate clinical hypothesis, and plan sessions. Therapists followed a critical triangulation process to decide the clinical meaning of feedback, according to his/her intervention model, expertise, and case-specific context.
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http://dx.doi.org/10.1111/jmft.12359DOI Listing
October 2019

Prenatal diagnosis of suprarenal mass by magnetic resonance imaging: a case series.

J Matern Fetal Neonatal Med 2019 Nov 15;32(22):3882-3886. Epub 2018 May 15.

b Department of Obstetrics, Paulista School of Medicine , Federal University of São Paulo (EPM-UNIFESP) , São Paulo , Brazil.

The aim of this study was to evaluate the perinatal outcomes and postnatal follow-up of prenatally diagnosed suprarenal masses (SRMs) evaluated by magnetic resonance imaging (MRI). Thirteen fetuses with SRMs detected during routine prenatal ultrasound screening were evaluated by MRI between February 2007 and May 2015. The prenatal characteristics of the masses, complications of the pregnancies, and related malformations were collected as the postnatal clinical, radiological, and pathological data. The median gestational age at MRI was 30 weeks (18-41), and birth weight was 3285 (1700-3750) g. The mean follow-up period was 6 years (1.3-10). We observed 69.2% of the masses, which were predominantly cystic (69.2%), located on the left side. Associated malformations were found in 23% of the fetuses, with congenital heart defects being more prevalent. During the pregnancy, 15.4% of the fetuses had involution of the SRM, and one fetus had surgical treatment and different ultrasound and MRI diagnoses. Of the 69.2% of the cases, spontaneous resolution occurred in 30.7% during the first year of life and 38.4% the masses presented without modifications or signs of regression since the neonatal period. Prenatal SRMs were associated with congenital heart defects. Spontaneous regression and absence of modifications in the masses were commonly observed in the long-term follow-up of the SRMs.
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http://dx.doi.org/10.1080/14767058.2018.1471679DOI Listing
November 2019

The Diagnosing Challenge of a Positive ANCA Vasculitis in the Paediatric Age.

Case Rep Pediatr 2017 19;2017:2962794. Epub 2017 Dec 19.

Paediatric and Neonatal Intensive Care Service, Centro Materno Infantil do Norte, Centro Hospitalar do Porto, Porto, Portugal.

ANCA-positive systemic vasculitides, rare in paediatric age, present multiorganic involvement. A female teenager presented with a history of subglottic stenosis diagnosed at the age of 12. From the investigation carried out, we highlight hematoproteinuria and negative ANCAs. At 15 years old, she was admitted for gastrointestinal symptoms and respiratory distress. She presented poor peripheral perfusion, pulmonary haemorrhage, respiratory failure, and severe renal insufficiency. She was started mechanical ventilation and emergency haemodialysis. The immunological study revealed ANCA MPO positive. A presumptive diagnosis of ANCA-positive vasculitis was made, and she was started corticotherapy, cyclophosphamide, and plasmapheresis. A renal biopsy, performed later, showed crescentic glomerulonephritis with chronicity signs. Positive ANCA vasculitis may progress slowly or suddenly. The diagnosis was confirmed by a biopsy; however, we can make a presumptive diagnosis based on clinical findings and in a positive ANCA test in order to start an early treatment and decrease the associated morbimortality.
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http://dx.doi.org/10.1155/2017/2962794DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749263PMC
December 2017

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

Clin Psychol Psychother 2018 May 4;25(3):427-439. Epub 2018 Feb 4.

Center for Psychology at University of Porto, Porto, Portugal.

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.
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http://dx.doi.org/10.1002/cpp.2177DOI Listing
May 2018

Trajectories of parental engagement in early childhood among dual-earner families: Effects on child self-control.

Dev Psychol 2018 04 20;54(4):731-743. Epub 2017 Nov 20.

Faculty of Psychology and Educational Sciences, Center for Psychology, University of Porto.

Parental engagement in positive activities with the child may show significant variation across time, assuming a crucial influence on child development. In dual-earner families, work-family conflict can interfere with parental engagement, with negative consequences for children's behavior. The current study examined the change trajectories of mothers' and fathers' engagement in early childhood, analyzing whether these trajectories are influenced by parents' work-family conflict and whether they predict child behavioral self-control. Data from 156 four-year-old children (67 girls) from dual-earner families were collected annually for 3 consecutive years, through mothers', fathers', and teachers' reports. Results from latent growth curve analysis revealed mothers' engagement remained stable across time while fathers' engagement had a significant increase over time. The negative association between work-family conflict and parental engagement was constant over time both for mothers and fathers. For mothers, initial levels of engagement positively predicted child behavioral self-control. As for fathers, both the initial level and positive change in engagement positively predicted child self-control. These findings emphasize the role of parental engagement in fostering child behavioral adjustment, underlining the need for considering work-family dynamics to understand changes in parental engagement. (PsycINFO Database Record
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http://dx.doi.org/10.1037/dev0000458DOI Listing
April 2018

Balancing clinical risk with countertransference management protects Alliance.

Res Psychother 2017 Oct 27;20(3):279. Epub 2017 Oct 27.

Center for Psychology at University of Porto.

The working alliance has been recognized as a predictor of psychotherapy outcome across therapeutic orientations. Despite mixed findings regarding the effect of problem severity on the alliance formation, there is evidence suggesting that therapist factors may interfere in this association. This study examined how clients' baseline clinical features affected the early alliance and the possible role of therapists' countertransference management as a mediator. Thirteen therapeutic dyads were assessed at 2 different time points. Clients' clinical dimensions were assessed prior to the 2nd session, and therapists' countertransference management and clients' ratings of the alliance were measured after the 2nd session. Positive associations were found between clients' subjective wellbeing, social functioning, risk, and global psychological distress and countertransference management dimensions and total score. Empathy-based countertransference management suppressed the negative impact of clinical risk on alliance. Our findings suggest that clinical problems activate countertransference management, which in turn may buffer their negative effect on alliance.
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http://dx.doi.org/10.4081/ripppo.2017.279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451367PMC
October 2017

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

Environ Res 2018 01 15;160:306-313. Epub 2017 Oct 15.

Centre for Ecology, Evolution and Environmental Changes, Faculdade de Ciências, Universidade de Lisboa, Campo Grande, 1749-016 Lisboa, Portugal; Centro de Recursos Naturais e Ambiente, Instituto Superior Técnico, Universidade de Lisboa; Av. Rovisco Pais 1049-001 Lisboa Portugal. Electronic address:

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.
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http://dx.doi.org/10.1016/j.envres.2017.10.006DOI Listing
January 2018

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

Psychooncology 2018 02 31;27(2):367-375. Epub 2017 May 31.

Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.

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.
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http://dx.doi.org/10.1002/pon.4451DOI Listing
February 2018

Ecological impacts of atmospheric pollution and interactions with climate change in terrestrial ecosystems of the Mediterranean Basin: Current research and future directions.

Environ Pollut 2017 Aug 29;227:194-206. Epub 2017 Apr 29.

Lancaster Environment Center, Lancaster University, Lancaster LA1 4YQ, UK.

Mediterranean Basin ecosystems, their unique biodiversity, and the key services they provide are currently at risk due to air pollution and climate change, yet only a limited number of isolated and geographically-restricted studies have addressed this topic, often with contrasting results. Particularities of air pollution in this region include high O levels due to high air temperatures and solar radiation, the stability of air masses, and dominance of dry over wet nitrogen deposition. Moreover, the unique abiotic and biotic factors (e.g., climate, vegetation type, relevance of Saharan dust inputs) modulating the response of Mediterranean ecosystems at various spatiotemporal scales make it difficult to understand, and thus predict, the consequences of human activities that cause air pollution in the Mediterranean Basin. Therefore, there is an urgent need to implement coordinated research and experimental platforms along with wider environmental monitoring networks in the region. In particular, a robust deposition monitoring network in conjunction with modelling estimates is crucial, possibly including a set of common biomonitors (ideally cryptogams, an important component of the Mediterranean vegetation), to help refine pollutant deposition maps. Additionally, increased attention must be paid to functional diversity measures in future air pollution and climate change studies to establish the necessary link between biodiversity and the provision of ecosystem services in Mediterranean ecosystems. Through a coordinated effort, the Mediterranean scientific community can fill the above-mentioned gaps and reach a greater understanding of the mechanisms underlying the combined effects of air pollution and climate change in the Mediterranean Basin.
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http://dx.doi.org/10.1016/j.envpol.2017.04.062DOI Listing
August 2017

Marital adjustment in the context of female breast cancer: A systematic review.

Psychooncology 2017 Dec 16;26(12):2019-2029. Epub 2017 May 16.

Center for Psychology at University of Porto, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.

Objective: Breast cancer (BC) diagnosis and subsequent treatments present significant challenges and distress for both patients and their partners. This can lead to difficulties in marital relationships and, consequently, decreases in marital adjustment and psychosocial adaptation to BC for both partners. Our objective was to systematically review studies assessing marital adjustment in the context of female BC to understand which factors are associated with marital adjustment in both patients and partners and characterize the measures used to assess marital adjustment within these studies.

Methods: This systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. English, peer-reviewed articles exploring factors associated with marital adjustment in the context of female BC were considered for inclusion.

Results: Fourteen studies were included. Results evidenced that psychosocial variables play an important role on marital adjustment. Specifically, open and constructive communication, more social support, and supportive dyadic coping were found to be associated with higher levels of marital adjustment. Other variables such as self-efficacy, sexual functioning, and psychological adjustment were also positively associated with marital adjustment.

Conclusions: Most studies evidenced an association between psychosocial variables and marital adjustment for both women and their partners. Some important dimensions such as communication patterns, coping strategies, and social support dynamics were identified as potential targets for psychological interventions. Some variables, however, were explored only in a few studies, which limit our conclusions. Future studies should explore the role these variables and other relational and emotional variables play in promoting marital adjustment after BC.
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http://dx.doi.org/10.1002/pon.4432DOI Listing
December 2017

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

Psychooncology 2017 Nov 18;26(11):1929-1935. Epub 2017 Jun 18.

Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal.

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.
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http://dx.doi.org/10.1002/pon.4409DOI Listing
November 2017

The emotion regulation questionnaire in women with cancer: A psychometric evaluation and an item response theory analysis.

Psychooncology 2017 Oct 26;26(10):1647-1653. Epub 2017 Jan 26.

Faculty of Psychology and Education Sciences, Center for Psychology, University of Porto, Porto, Portugal.

Objective: Emotion regulation is thought to play an important role in adaptation to cancer. However, the emotion regulation questionnaire (ERQ), a widely used instrument to assess emotion regulation, has not yet been validated in this context. This study addresses this gap by examining the psychometric properties of the ERQ in a sample of Portuguese women with cancer.

Methods: The ERQ was administered to 204 women with cancer (mean age = 48.89 years, SD = 7.55). Confirmatory factor analysis and item response theory analysis were used to examine psychometric properties of the ERQ.

Results: Confirmatory factor analysis confirmed the 2-factor solution proposed by the original authors (expressive suppression and cognitive reappraisal). This solution was invariant across age and type of cancer. Item response theory analyses showed that all items were moderately to highly discriminant and that items are better suited for identifying moderate levels of expressive suppression and cognitive reappraisal. Support was found for the internal consistency and test-retest reliability of the ERQ. The pattern of relationships with emotional control, alexithymia, emotional self-efficacy, attachment, and quality of life provided evidence of the convergent and concurrent validity for both dimensions of the ERQ.

Conclusion: Overall, the ERQ is a psychometrically sound approach for assessing emotion regulation strategies in the oncological context. Clinical implications are discussed.
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http://dx.doi.org/10.1002/pon.4356DOI Listing
October 2017

Experiencing an Intimate Partner's Breast Cancer: Attachment, Caregiving, and Burden in Men.

Psychiatry 2016 ;79(3):236-248

Objective: This study examined interrelationships among adult attachment orientations, caregiving, and caregiver burden in men of female partners with breast cancer, and tested whether caregiving patterns mediated associations between men's attachment orientations and their self-reported caregiver burden.

Method: The participants were 124 male partners of women with breast cancer. These participants completed assessments related to attachment, caregiving, and caregiver burden. Path models examined the associations between constructs and tested mediational effects.

Results: Findings demonstrated significant associations between men's adult attachment orientations and their experience of caregiver burden. In addition, the maintenance of proximity in caregiving completely mediated the respective associations of attachment security and attachment avoidance to caregiver health problems, on one hand, and to the caregiver's self-esteem (e.g., another indicator for caregiver burden), on the other. Moreover, we found a direct effect of attachment avoidance on health problems.

Conclusions: This study highlighted the importance of addressing adult attachment dispositions and caregiving to understanding the relational processes implicated in caregiver burden. The results support the conclusion that men's adult attachment orientations and caregiving patterns toward their female partners with breast cancer are relevant contributors to men's perceptions of caregiver burden.
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http://dx.doi.org/10.1080/00332747.2016.1158003DOI Listing
June 2017

The Generalized Problematic Internet Use Scale 2: Validation and test of the model to Facebook use.

J Adolesc 2017 Jan 19;54:51-59. Epub 2016 Nov 19.

Faculty of Psychology and Educational Sciences, University of Porto, Portugal. Electronic address:

The main goals of the present study were to test the psychometric properties of a Portuguese version of the GPIUS2 (Generalized Problematic Internet Use Scale 2, Caplan, 2010), and to test whether the cognitive-behavioral model proposed by Caplan (2010) replicated in the context of Facebook use. We used a sample of 761 Portuguese adolescents (53.7% boys, 46.3% girls, mean age = 15.8). Our results showed that the data presented an adequate fit to the original model using confirmatory factor analysis. The scale presented also good internal consistency and adequate construct validity. The cognitive-behavioral model was also applicable to the Facebook context, presenting good fit. Consistently with previous findings we found that preference for online social interaction and the use of Facebook to mood regulation purposes, predicted positively and significantly the deficient self-regulation in Facebook use, which in turn was a significant predictor of the negative outcomes associated with this use.
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http://dx.doi.org/10.1016/j.adolescence.2016.11.007DOI Listing
January 2017