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Plastic pollution in rivers has increased over the years and contributes to the pollution of the oceans. But knowledge of macroplastic flows in small, tidal-influenced urban rivers in the Amazon is still unclear, mainly due to a lack of understanding of the processes that control transport in rivers. Here, we provide the first estimate of the floating macroplastic flows in two tidally influenced urban rivers, based on continuous observations over a 12-h period. This period includes a tidal cycle (high and low tide), and the observation took place from a fixed bridge located on both rivers. A total of 8682 items of solid waste were observed in urban rivers, of which 80% were plastic. We found a bidirectional transport of waste throughout the tidal cycle, with maximum amounts of -198.5 items.hour -1 during high tide and 498.6 items.hour -1 during low tide. The largest quantities (1046.89) of items occurred during the ebb tide. These rivers in an Amazonian metropolis can contribute around 25.84 kg of macroplastic items per day. The results demonstrate the importance of tidal dynamics in the transport of waste in Amazonian rivers and indicate that urban rivers act as plastic exporters in the region., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The vascular repair, a pivotal element of the spinal cord (SC) injury response, has been notably neglected in zebrafish research. Here, we detail the extraction and dissection of whole-mount zebrafish SCs and the optimized whole-mount immunofluorescence staining and clearing protocols for the visualization of SC structures, such as the vascular network. Additional downstream applications of these samples, from gelatin embedding to cryosectioning and tissue staining, can be done after clearing reversion and are also described in this work. For complete details on the use and execution of this protocol, please refer to Ribeiro et al. 1 ., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background and Objectives: Scaphocephaly is a craniofacial deformity caused by the premature fusion of the sagittal suture, which can affect skull growth and shape. For decades, surgical treatment or craniosynostosis has involved open procedures, ranging from the removal of a single suture to complex cranial remodeling techniques with large skin incisions. Since the 1990s, endoscopic approaches have emerged as potentially less invasive options. This study aimed to evaluate the efficacy of and differences between endoscopic scaphocephaly correction techniques., Methods: A comprehensive search was conducted on PubMed, Embase, Web of Science, and Scopus for clinical trials and observational studies analyzing endoscopic correction of scaphocephaly and describing the procedure. The outcomes analyzed included pre- and postoperative cephalic indexes, operation time, blood loss, number of transfusions, complications, and subgroup analysis., Results: Thirty-two studies involving 1566 patients (mean age at the time of surgery: 3.3 months) were included. Overall, the cephalic index showed a significant increase in the mean difference of 7.58 (95% CI 6.35-8.80; P < .01), and when analyzed by subgroups based on the size of the removed strip (≤2 and >2 cm), there was no significant difference in the cephalic index. In addition, the analysis of lateral osteotomies showed no difference in CI between the subgroups., Conclusion: Our results suggest that less invasive techniques, involving smaller incisions and excisions, can achieve comparable success with traditional techniques. These findings have significant implications for clinical practice, underscoring the importance of exploring less invasive options for scaphocephaly correction to improve patient outcomes and reduce morbidity., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Posterior reversible encephalopathy syndrome is a rare syndrome involving the subcortical cerebral white matter. We describe the case of a 63-year-old male patient with relapsing remitting multiple sclerosis under interferon beta therapy and acute onset of atypical unilateral posterior reversible encephalopathy syndrome mimicking a relapse. This case highlights the importance of clinical suspicion for multiple sclerosis mimics, namely in older patients, which may need disease modifying treatment suspension and directed treatment in order to achieve better clinical prognosis., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Migraine is a cyclic condition with attacks consisting mainly of intense headaches, sensory intolerance, and nausea or vomiting. Loss of consciousness during attacks is often attributed exclusively to a neurally mediated reflex to pain, although it may also be due to migraine's autonomic impairment, with cardiac conduction abnormalities, probably in relation to a degree of reduced sympathetic function. We report the case of a 51-year-old woman presenting episodes of syncope exclusively after vomiting during migraine attacks. A 24-hour Holter monitoring performed during a migraine attack disclosed an intermittent complete atrioventricular block coincident with an episode of syncope. The patient was implanted with a pacemaker without further syncopes on subsequent attacks. This case highlights the importance of clinical suspicion and investigation of syncope during migraine attacks. Recurrent syncope during migraine should not be attributed to pain to avoid misdiagnosis and ensure the treatment of other important causes of syncope.

Academic psychiatry is essential for advancing mental health understanding and treatments. However, women encounter more obstacles hindering their progress in academia than men. This Editorial aims to highlight these obstacles and propose strategies to address them, advocating for a more supportive environment for women psychiatrists' ongoing growth and development. The importance of supportive environments, fair access to opportunities and structural changes, including initiatives for mentorship, funding and flexible work arrangements, are crucial. Collaboration among governments, institutions and organisations is needed to enhance research infrastructure and promote gender equality. Encouraging and recognising women's contributions in research fosters inclusivity and innovation. Prioritising these efforts is vital for the existence, well-being and success of women in academic psychiatry.

Competing Interests: Declaration of interests MCD declares support from the Commission for travel expenses to attend research group meetings; she is President of the European Union of Medical Specialists Section of Psychiatry, a European Exam Board member, Secretary of the European Psychiatric Association Section on Women's Mental Health, and a Member of the European Psychiatric Association Publications Committee. NS declares being a member of Executive Board and Secretary for Education and Scientific Publications of the World Psychiatric Association. RWB declares royalties from the LexisNexis textbook of Guardianship in medical assistance; she was a member of the Osmind Community Advisory Board, and the American Psychiatric Association Executive Committee. HYL received financial support from World Psychiatric Association to attend the World Congress in Vienna; and is the Chair for the Council on Communications (unpaid), Chair for the Board Board of Radius Omaha (unpaid), and the co-Chair for the Medical Student Working Group (unpaid). LJDP has received honoraria from Boehringer-Ingelheim and Viatris; and has a leadership role at the European Psychiatric Association; European College of Neuropsychopharmacology, European Psychiatric Association Board and Education Committee, European College of Neuropsychopharmacology Workshop Committee, and Belgian College of Neuropsychopharmacology and Biological Psychiatry Board. AL-B declares financial support from WHO for attending two Commissioners meetings. BLL is the owner of Bennett L. Leventhal, MD, PC, a personal professional corporation providing clinical, scientific, and business consulting, largely in the health care and mental health field, and is a Board Member and Chair of the Research Committee of the Brain Research Foundation: he has worked in Ukraine on a voluntary basis. SC is a Deputy Chair of the Committee on Bioethics of Scientific Research. AL-B and DC are WHO staff members. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy, or views of WHO. All other authors declare no competing interests.

Introduction: Volunteering represents an opportunity for social transformation and social cohesion. Portugal is one of the European countries with fewer volunteering initiatives. Generally, society distances itself from individuals with mental illness and prison inmates, therefore, stigma becomes one of the barriers to social reintegration. However, volunteering can be a beneficial intervention helping individuals in their reintegration., Objectives: This study aims to compare the differences and similarities in the attitudes of volunteers toward volunteering with people with mental illness and prisoners., Methods: A supplementary qualitative secondary analysis was conducted using transcripts from 39 semi-structured individual interviews with volunteers regarding support of inmates in prison and two focus groups with volunteers regarding support of people with mental illness. Data analysis was conducted through an inductive thematic analysis., Results: Four themes emerged from the analysis: 'Volunteer motivation and characteristics', 'Volunteer's role', 'Volunteering relationship and its impact', and 'Challenges faced by volunteers'. There were several similarities between the perspectives toward volunteering in prisons and in mental health care, including the need for specific training in the area and the positive attitudes and behaviors of both groups of volunteers toward volunteering with the individuals supported. The differences were related to the characteristics necessary to be a volunteer, the activities carried out with the individuals supported and the difficulties faced by volunteers., Conclusion: These findings show overall positive attitudes toward volunteering in mental health and in prisons., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Dá Mesquita, Oliveira and Pinto da Costa.)

Background: Subthreshold depression is a risk factor for major depression and is associated with increased morbidity and mortality, especially in older adults. There is emerging evidence that digital interventions, including self-help interventions, may reduce depressive symptoms. We aimed to evaluate the effectiveness of a mobile messaging intervention at reducing subthreshold depressive symptoms among older adults in Brazil., Methods: PRODIGITAL was a single blind, two-arm, individually randomised controlled trial conducted in 46 primary care clinics in the city of Guarulhos, Brazil. Individuals aged 60+ years were contacted by phone following a randomly ordered list for a screening assessment. Those who presented with anhedonia and/or depressed mood (Patient Health Questionnaire (PHQ)-2≥1), and who subsequently scored between 5 and 9 on the PHQ-9 were invited to participate. The intervention arm received the 'Viva Vida' digital self-help intervention consisting of automated multi-media messages sent via WhatsApp. Forty-eight audio and visual messages based on psychoeducation and behavioural activation were automatically delivered over six weeks. The control arm received a single message containing information about depression. The primary outcome was the difference in mean PHQ-9 scores between treatment arms at the three-month follow-up. All primary analyses were performed according to allocated arm with imputed data. The trial is registered with ReBEC, RBR-6c7ghfd., Findings: Participants were recruited between 8 September 2021 and 19 August 2022. Of the 454 participants enrolled, 223 were randomised to the intervention arm, 231 to the control arm. Participants' mean age was 65.3 years (SD 5.0) and 64.0% (n = 292) were female. A total of 385 (84.8%) completed the three-month follow-up assessment; no difference in mean PHQ-9 scores between the treatment arms was observed (adjusted difference: -0.61; 95% CI: -1.75, 0.53; p  = 0.29)., Interpretation: These results demonstrate that the Viva Vida digital self-help intervention did not help to improve subthreshold depressive symptoms amongst older adults. Further research is needed to understand why this self-help intervention was not effective in this population, and to explore how it might be adapted to achieve this goal., Funding: São Paulo Research Foundation and UK Joint Global Health Trials., Competing Interests: We declare no competing interests., (© 2024 The Author(s).)

Background: People with severe mental illness (SMI) have worse physical health than the general population. There is evidence that support from volunteers can help the mental health of people with SMI, but little evidence regarding the support they can give for physical health., Aims: To evaluate the feasibility of an intervention where volunteer 'Health Champions' support people with SMI in managing their physical health., Method: A feasibility hybrid randomised controlled trial conducted in mental health teams with people with SMI. Volunteers delivered the Health Champions intervention. We collected data on the feasibility of delivering the intervention, and clinical and cost-effectiveness. Participants were randomised by a statistician independent of the research team, to either having a Health Champion or treatment as usual. Blinding was not done., Results: We recruited 48 participants: 27 to the intervention group and 21 to the control group. Data were analysed for 34 participants. No changes were found in clinical effectiveness for either group. Implementation outcomes measures showed high acceptability, feasibility and appropriateness, but with low response rates. No adverse events were identified in either group. Interviews with participants found they identified changes they had made to their physical health. The cost of implementing the intervention was £312 per participant., Conclusions: The Health Champion intervention was feasible to implement, but the implementation of the study measures was problematic. Participants found the intervention acceptable, feasible and appropriate, and it led them to make changes in their physical health. A larger trial is recommended, with tailored implementation outcome measures.

Background: Elderly patients comprise an increasing proportion of patients undergoing surgery, and they require special attention due to age-related physiological changes. Propofol is the traditional agent for anaesthesia, and recently, remimazolam, a novel ultra-short-acting benzodiazepine, has emerged as an alternative to propofol in general anaesthesia., Objectives: We aim to compare remimazolam vs . propofol for general anaesthesia in elderly patients regarding hypotension, induction characteristics, haemodynamics and recovery outcomes., Design: Meta-analysis with sensitivity and trial sequential analyses (TSA) to assess inconsistencies. Risk ratios and mean differences with 95% confidence intervals (95% CIs) were computed using a random effects model. Subgroups and meta-regression according to anaesthesia methods were also performed., Data Sources: We systematically searched MEDLINE, Embase and Cochrane for randomised controlled trials (RCTs) up to January 1, 2024., Eligibility Criteria: Patients at least 60 years old, comparing remimazolam vs . propofol for general anaesthesia., Results: Eleven RCTs (947 patients) were included. Compared with propofol, remimazolam was associated with lower postinduction and intra-operative hypotension (RR 0.41, 95% CI 0.27 to 0.62, P  < 0.001) and incidence of bradycardia (risk ratio 0.58, 95% CI 0.34 to 0.98, P  = 0.04), with a higher heart rate ( P  = 0.01). The incidence of injection pain was lower ( P  < 0.001), but remimazolam was associated with a longer time to loss of consciousness ( P  < 0.001) and a higher bispectral index at loss of consciousness ( P  = 0.04). No differences were found for mean arterial pressure, emergence time, extubation time and incidence of emergence agitation. The TSA was consistent and achieved the required information size for hypotension., Conclusions: Remimazolam significantly reduced the risk of hypotension, bradycardia and injection pain, despite an increase in the time to loss of consciousness. Remimazolam appears to be an effective and well tolerated alternative to propofol in elderly patients undergoing general anaesthesia., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society of Anaesthesiology.)

Maternal influences on children's diet have been widely studied, while paternal and household frameworks require further research. This study aimed to evaluate how individual, socioeconomic and household characteristics at birth and 7 years (y) impact children's fruit and vegetable (FV) and energy-dense foods (EDF) intake at 10y, distinguishing maternal and paternal effects. The sample included 2750 children evaluated at 7 and 10y in the Portuguese birth cohort Generation XXI. The children's food intake was assessed through a Food Frequency Questionnaire at both ages, where 4 food groups were defined: FV, 'Sweet foods', 'Salty snacks', and 'Soft drinks'. The associations between food intake at 7y, parents' and children's characteristics, and food intake at 10y were evaluated via binary logistic regression models. Offspring of older mothers with higher age and education, who live with siblings and had higher family income were likelier to have 5 servings of FV daily at 10y. Children eating 5 portions/day of FV at 7y had higher odds of keeping this pattern at 10y. Higher maternal age and education, and father's education decreased the odds of having soft drinks daily at 10y. Higher family income was linked with lower odds of weekly salty snacks and daily sweet foods at 10y. In conclusion, parental education, maternal age, living with siblings, and higher family income influenced children's FV and EDF intake at 10y. Mothers' effects appear to impact children's food intake more than fathers'., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Emergence agitation following general anesthesia poses significant risks to both patients and medical staff. While extensive research has explored the efficacy of magnesium sulfate (MgSO4) in managing pediatric emergence agitation, its effectiveness in adults remains uncertain. Therefore, this meta-analysis seeks to evaluate the efficacy of MgSO4 in mitigating emergence agitation following general anesthesia in adult populations., Evidence Acquisition: A systematic search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases to identify randomized controlled trials (RCTs) comparing MgSO4 or placebo infusion during surgical procedures involving adult patients under general anesthesia. Key outcomes assessed included the incidence of emergence agitation, agitation severity scores, extubation duration, and postoperative nausea and vomiting (PONV). Statistical analyses were conducted using Review Manager 5.4.1 (Cochrane, London, UK), with heterogeneity evaluated using I2 statistics. Significance was defined at P<0.05 for Odds Ratios (OR), mean differences (MD), and standard mean differences (SMD)., Evidence Synthesis: Five RCTs encompassing 605 participants were included. MgSO4 resulted in a lower emergence agitation incidence (OR=0.29 [95% CI: 0.12;0.72]; P=0.007). There were no significant differences between groups for patient's agitation severity scores (SMD=-0.69 [95% CI: -1.82; 0.44]; P=0.23), extubation time (MD=1.16 [95% CI: -1.06; 3.37]; P=0.30), or PONV incidence (OR=0.52 [95% CI: 0.15-1.76]; P=0.29)., Conclusions: Magnesium sulfate infusion during general anesthesia was associated with lower incidence of emergence agitation in adults. However, no significant differences were observed regarding emergence agitation severity scores, PONV, or extubation time.

Autism spectrum disorder (ASD) etiology probably involves a complex interplay of both genetic and environmental risk factors, which includes pre- and perinatal exposure to environmental stressors. Thus, this study evaluated the effects of prenatal exposure to valproic acid (VPA) combined with maternal deprivation (MD) on behavior, oxidative stress parameters, and inflammatory state at a central and systemic level in male and female rats. Pregnant Wistar rats were exposed to VPA during gestation, and the offspring were submitted to MD. Offspring were tested for locomotor and social behavior; rats were euthanized, where the cerebellum, posterior cortex, prefrontal cortex, and peripheric blood were collected for oxidative stress and inflammatory analysis. It was observed that young rats (25-30 days old) exposed only to VPA presented a lower social approach when compared to the control group. VPA + MD rats did not present the same deficit. Female rats exposed to VPA + MD presented oxidative stress in all brain areas analyzed. Male rats in the VPA and VPA + MD groups presented oxidative stress only in the cerebellum. Regarding inflammatory parameters, male rats exposed only to MD exhibited an increase in pro-inflammatory cytokines in the blood and in the cortex total. The same was observed in females exposed only to VPA. Animals exposed to VPA + MD showed no alterations in the cytokines analyzed. In summary, gestational (VPA) and perinatal (MD) insults can affect molecular mechanisms such as oxidative stress and inflammation differently depending on the sex and brain area analyzed. Combined exposition to VPA and MD triggers oxidative stress especially in female brains without evoking an inflammatory response., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Same-day discharge (SDD) after Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) faces resistance due to possible undetected postoperative complications. These present with changes in vital signs, which continuous remote monitoring devices can detect. This study compared continuous vital signs monitoring using the Isansys Patient Status Engine™ with standard nursing vital signs measurements to assess the device's reliability in postoperative surveillance of patients undergoing LRYGB. We conducted a pilot study including patients who underwent LRYGB. During their hospital stay, patients were continuously monitored using the Isansys Patient Status Engine™ with Lifetouch™, Lifetemp™, and Nonin Pulse Oximeter™ sensors. The heart rate (HR), body temperature, and oxygen saturation (SpO 2 ) collected by the device were compared with standard nursing assessments. Thirteen patients with a mean body mass index of 41.5 ± 4.4 kg/m 2 were included. No major complications occurred. The median HR assessed by standard and continuous monitoring did not significantly differ (75.5 [69-88] vs. 77 [66-91] bpm, p = 0.995), nor did the mean values of SpO 2 (94.7 ± 2.0 vs. 93.7 ± 1.8%, p = 0,057). A significant difference was observed in median body temperature between the nursing staff and the monitoring device (36.3 [36.1-36.7] vs. 36.1 [34.5-36.6] degrees Celsius, p = 0.012), with a tendency for lower temperature measurements by the device. In conclusion, this is the first study on continuous postoperative surveillance using the Isansys Patient Status Engine™ monitoring device for LRYGB patients. Our results introduce a novel tool for more efficient surgery. Prospective randomized experimental studies are warranted to evaluate this method's efficacy and safety., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Autism spectrum disorder (ASD) is characterized by repetitive behaviors and deficits in social interaction. Its etiology is not completely clear, but both genetic and environmental factors contribute to and influence its development and course. The increased number of autism cases in recent years has been strongly associated with increased exposure to heavy metals. Mercury (Hg) has gained prominence in the scientific literature as a result of its presence as an urban pollutant and well-described neurotoxicity. This review assessed the relationship between Hg exposure in the pre- and post-natal period and ASD. The systematic review identified observational clinical studies and pre-clinical trials in journals indexed in the PubMed, Embase, ProQuest, and LILACS databases. The aim of this study was to investigate the association between exposure to Hg and ASD and to define the critical period of exposure. A total of 57 articles were selected for this review, with 35 articles (61.40%) identifying a positive association between ASD and Hg, while 22 articles (38.60%) did not find the same outcome. The biological samples most used to analyze Hg body burdens were hair (36.84%) and blood (36.84%). Most case-control studies found an increase in Hg levels in individuals with ASD who were exposed to a polluted environment in the post-natal period. Taken together, the studies suggest that these patients have a deficient detoxification system, and this could worsen the symptoms of the disorder. However, new studies addressing the influence of Hg on the post-natal nervous system and its relationship with ASD should be carried out., (© 2024 International Society for Neurochemistry.)

Objectives: Prisoners' common mental disorders (CMDs) and their social contacts are a complex and significant concern. We have systematically investigated the relationship between social contacts (i.e. perceived, and objective social support, and loneliness) and prisoners' mental health., Study Design: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA)., Methods: A protocol was developed and registered in PROSPERO (CRD42023372942). A search strategy was applied across four databases (namely MEDLINE [via OVID SP], APA PsycINFO, Scopus, and Web of Science). The quality assessment entailed the critical appraisal skills program (CASP) Checklist for cohort studies. The data were presented through a narrative synthesis., Results: After screening, 32 studies that fulfilled the inclusion criteria were included in this review. Most were cross-sectional (k = 27), while five had a longitudinal design. The total number of study participants was 10,613. The majority of the studies reported negative correlations between perceived and objective social support and symptoms of common mental disorders (CMDs), specifically, depression, anxiety, and post-traumatic stress disorder (PTSD). The included studies appeared to indicate a correlation between loneliness and PTSD symptoms., Conclusions: The lack of social support was linked to the development or exacerbation of CMDs in prisoners. Initiatives, such as reducing visitation barriers and providing access to technology for remote communication, can assist prisoners in strengthening their support systems and enhancing their opportunities for reintegration into society., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Mercury contamination from gold mining in the Amazon poses significant environmental and health threats to the biome and its local populations. The recent expansion of non-industrial mining areas has severely impacted territories occupied by traditional communities. To address the lack of sampling data in the region and better understand mercury dynamics, this study used the probabilistic model SERAFM to estimate the mercury distribution and bioaccumulation in fish. The analysis covered 8,259 sub-basins across three major Amazonian basins: the Branco, Tapajós and Xingu rivers. The findings revealed increasing downstream mercury levels, with notable accumulations in the main watercourses influenced by methylation processes and mining releases. The projected concentrations showed that an average of 27.47% of the sub-basins might not comply with Brazilian regulations, rising to 52.38% in the Branco and Tapajós river basins separately. The risk assessment of fish consumption based on the projections highlighted high mercury exposure levels among traditional communities, particularly indigenous populations, with an average of 49.79% facing an extremely high risk in the Branco and Tapajós river basins. This study demonstrated SERAFM's capacity to fill information gaps in the Amazon while underscoring the need for enhanced data collection, culturally sensitive interventions and regulatory updates to mitigate mercury contamination in gold mining-affected areas.

Background: Anal cancer is caused by human papillomavirus (HPV), particularly HPV-16, and is preceded by anal high-grade squamous intraepithelial lesions (HSILs). The incidence of anal cancer is highest among men who have sex with men (MSM) living with HIV (MSMLWH) and increases with age. However, most previous studies of anal HPV infection and anal HSIL were performed on men under 50 years old, and relatively little is known about HSIL among older MSMLWH or MSM not living with HIV (MSM-Not-LWH)., Setting: We enrolled MSM who were aged 50+ during 2018-2022 in San Francisco, CA., Methods: One hundred twenty-nine MSMLWH and 109 MSM-not-LWH participated. All participants had anal HPV DNA testing (Atila Biosystems) and high-resolution anoscopy with a biopsy of visible lesions., Results: Among MSMLWH, 47% had anal HSIL, 19% had HPV-16, and 51% had other oncogenic anal HPV types (excluding HPV-16). Among MSM-not-LWH, 37% had anal HSIL, 22% had HPV-16, and 34% had other oncogenic anal HPV types. Increasing age was not statistically associated with prevalent HSIL, HPV-16, or other oncogenic HPV infections in MSMLWH or MSM-not-LWH. HPV-16 (odds ratio: 45.1, 95% confidence interval: 15.8-129); other oncogenic HPV types (odds ratio: 5.95, 95% confidence interval: 2.74-12.9) were associated with increased odds of anal HSIL, adjusted for age, income, education, and HIV status., Conclusion: The prevalence of oncogenic anal HPV, anal HPV-16, and anal HSIL remains very high in older MSMLWH and MSM-not-LWH. With recent evidence showing that treating anal HSIL prevents anal cancer, MSM aged 50+ should be considered for anal cancer screening., Competing Interests: The authors have no funding or conflicts of interest to disclose., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Gene expression analysis is essential for understanding the mechanisms involved in plant development. Here, we developed M2WISH, a protocol based on MicroWave treatment for Wholemount mRNA In Situ Hybridization in Arabidopsis. By permeabilizing tissues without damaging cellular organization this protocol results in high and homogeneous hybridization yields that enable systematic analysis of gene expression dynamics. Moreover, when combined with cellular histochemical staining, M2WISH successfully provides a cellular resolution of gene expression. Thus, we demonstrate the robustness of M2WISH with 10 genes on roots, aerial meristems, leaves, and embryos in the seed. We applied M2WISH to study the spatial dynamics of WUSCHEL (WUS) and CLAVATA3 (CLV3) expression during in vitro meristematic conversion of roots into shoot apical meristems. Thus, we showed that shoot apical meristems could arise from two different types of root structures that differed by their CLV3 gene expression patterns. We constructed 3D cellular representations of WUS and CLV3 gene co-expression pattern and stressed the variability inherent to meristem conversion. Thus, this protocol generates a large amount of data on the localization of gene expression, which can be used to model complex systems., (© 2024 Society for Experimental Biology and John Wiley & Sons Ltd.)

Spinal cord injury triggers a strong innate inflammatory response in both non-regenerative mammals and regenerative zebrafish. Neutrophils are the first immune population to be recruited to the injury site. Yet, their role in the repair process, particularly in a regenerative context, remains largely unknown. Here, we show that, following rapid recruitment to the injured spinal cord, neutrophils mostly reverse migrate throughout the zebrafish body. In addition, promoting neutrophil inflammation resolution by inhibiting Cxcr4 boosts cellular and functional regeneration. Neutrophil-specific RNA-seq analysis reveals an enhanced activation state that correlates with a transient increase in tnf-α expression in macrophage/microglia populations. Conversely, blocking neutrophil recruitment through Cxcr1/2 inhibition diminishes the presence of macrophage/microglia at the injury site and impairs spinal cord regeneration. Altogether, these findings provide new insights into the role of neutrophils in spinal cord regeneration, emphasizing the significant impact of their immune profile on the outcome of the repair process., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: Smokeless tobacco use remains prevalent in rural and medically underserved populations, leading to increased rates of tobacco-related cancers and chronic disease. While access to effective cessation programs is limited, text-based interventions may offer a delivery approach with broad reach. This two-armed randomized control trial (RCT) assessed the efficacy of #EnufSnuff.TXT, a text-based smokeless tobacco cessation intervention, in rural and medically underserved communities., Methods: We conducted a two-arm RCT assessing #EnufSnuff.TXT, a text-based scheduled reduction intervention paired with text-based cessation support messages compared with the modified Enough Snuff intervention comprised of a cessation education booklet and bi-weekly motivational text messages. We recruited participants via social media and surveyed participants at three and six months post-randomization. The primary outcome was self-reported seven-day point prevalence abstinence at six months., Results: We recruited and randomized 532 participants. At three months post randomization, the quit rate was significantly higher in #EnufSnuff.TXT arm compared to the Enough Snuff arm for intent-to-treat (ITT) cases (29.2% vs 19.0%, OR=1.75, p=0.0066). The quit rate at six months post randomization remained higher in #EnufSNuff.TXT compared to Enough Snuff for ITT cases (23.1% vs 20.9%, OR=1.14, p=0.5384), although no longer significantly different., Conclusion: This is the first large-scale text-based cessation clinical trial for individuals in underserved areas who use smokeless tobacco. The #EnufSnuff.TXT intervention performed better in the short term, however both interventions yielded similar quit-rates at 6-months post randomization. Future research should focus on improving long-term abstinence in the #EnufSNuff.TXT intervention., Implications: Text-based cessation approaches have the potential to increase access to cessation interventions in rural and medically underserved areas and reduce tobacco-related chronic disease morbidity and mortality. Our study shows short-term efficacy from the first ever randomized controlled trial of a smokeless tobacco cessation intervention, #EnufSnuff.TXT, for rural and medically underserved residents in the United States. Our #EnufSnuff.TXT Intervention offers a scalable solution to reach and provide much needed access to cessation interventions in medically underserved, rural communities in the United States. This work provides the foundation for further inquiry on augmented text-based approaches to increase cessation in this at-risk group., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The bacterial composition of and the circulation of antimicrobial resistance genes (ARGs) in waste from Brazilian swine farms are still poorly understood. Considering that antimicrobial resistance (AMR) is one of the main threats to human, animal, and environmental health, the need to accurately assess the load of ARGs released into the environment is urgent. Therefore, this study aimed to characterize the microbiota in a swine farm in southern Brazil and the resistome in swine farm wastewater treated in a series of waste stabilization ponds (WSPs). Samples were collected from farm facilities and the surrounding environment, representing all levels of swine manure within the treatment system. Total metagenomic sequencing was performed on samples from WSPs, and 16S-rDNA sequencing was performed on all the collected samples. The results showed increased bacterial diversity in WSPs, characterized by the presence of Caldatribacteriota, Cloacimonadota, Desulfobacterota, Spirochaetota, Synergistota, and Verrucomicrobiota. Furthermore, resistance genes to tetracyclines, lincosamides, macrolides, rifamycin, phenicol, and genes conferring multidrug resistance were detected in WSPs samples. Interestingly, the most abundant ARG was linG, which confers resistance to the lincosamides. Notably, genes conferring macrolide (mphG and mefC) and rifamycin (rpoB&#95;RIF) resistance appeared in greater numbers in the late WSPs. These drugs are among the high-priority antibiotic classes for human health. Moreover, certain mobile genetic elements (MGEs) were identified in the samples, notably tnpA, which was found in high abundance. These elements are of particular concern due to their potential to facilitate the dissemination of ARGs among bacteria. In summary, the results indicate that, in the studied farm, the swine manure treatment system could not eliminate ARGs and MGEs. Our results validate concerns about Brazil's swine production system. The misuse and overuse of antimicrobials during animal production must be avoided to mitigate AMR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The ventriculoperitoneal shunt placement procedure is common throughout the world, with a prevalence of approximately 30,000 procedures per year in the United States (5). However, the rate of complications is still important and must be remembered, with a percentage of 11 to 25% after the first year of implantation. Abdominal complications are described in 5-47% of the cases (6), and the abdominal pseudocyst is one of them. We present the case of a patient colonized by multidrug-resistant bacteria, who underwent exteriorization surgery of a ventriculoperitoneal shunt. Intraoperatively, a blue coloration was observed in the catheter, a phenomenon previously described in urinary infections (1)(2) but not before in pathologies of the central nervous system. Our objective is to present an atypical case of dysfunction of the ventriculoperitoneal shunt, whose diagnosis couldbe evidenced through the coloration of the catheter exteriorized in surgery., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Excessive amounts of reactive oxygen species (ROS) lead to macromolecular damage and high levels of cell death with consequent pathological sequelae. We hypothesized that switching cell death to a tissue regenerative state could potentially improve the short-term and long-term detrimental effects of ROS-associated acute tissue injury, although the mechanisms regulating oxidative stress-induced cell fate decisions and their manipulation for improving repair are poorly understood. Here, we show that cells exposed to high oxidative stress enter a poly (ADP-ribose) polymerase 1 (PARP1)-mediated regulated cell death, and that blocking PARP1 activation promotes conversion of cell death into senescence (CODIS). We demonstrate that this conversion depends on reducing mitochondrial Ca2 + overload as a consequence of retaining the hexokinase II on mitochondria. In a mouse model of kidney ischemia-reperfusion damage, PARP inhibition reduces necrosis and increases transient senescence at the injury site, alongside improved recovery from damage. Together, these data provide evidence that converting cell death into transient senescence can therapeutically benefit tissue regeneration., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: X (previously known as "Twitter") serves as a platform for open discussions on mental health, providing an avenue for scrutinizing public perspectives regarding psychiatry, psychology and their associated professionals., Objective: To analyze the conversations happening on X about psychiatrists, psychologists, and their respective disciplines to understand how the public perception of these professionals and specialties has evolved over the last 15 years., Methods: We collected and analyzed all tweets posted in English or Spanish between 2007 and 2023 referring to psychiatry, psychology, neurology, mental health, psychiatrist, psychologist, or neurologist using advance topic modelling and sentiment analysis., Results: A total of 403,767 tweets were analyzed, 155,217 (38%) were in English and 248,550 (62%) in Spanish. Tweets about mental health and mental health professionals and disciplines showed a consistent volume between 2011 and 2016, followed by a gradual increase from 2016 through 2022. The proportion of tweets discussing mental health doubled from 2016 to 2022, increasing from 20% to 67% in Spanish and from 15% to 45% in English. Several differences were observed on the volume of tweets overtime depending on the language they were written. Users associated each term with varied topics, such as seeking for help and recommendation for therapy, self-help resources, medication and side effects, suicide prevention, mental health in times of crisis, among others. The number of tweets mentioning these topics increased by 5-10% from 2016 to 2022, indicating a growing interest among the population. Emotional analysis showed most of the topics were associated with fear and anger., Conclusion: The increasing trend in discussions about mental health and the related professionals and disciplines over time may signify an elevated collective awareness of mental health. Gaining insights into the topics around these matters and user's corresponding emotions towards them presents an opportunity to combat the stigma surrounding mental health more effectively., Competing Interests: JD-E is Business Unit Director CNS & WHC at Adamed Pharma. However, Adamed Pharma has not participated of this research work. Dr. RR-J has been a consultant for, spoken in activities of, or received grants from: Instituto de Salud Carlos III, Fondo de Investigación Sanitaria FIS, Centro de Investigación Biomédica en Red de Salud Mental CIBERSAM, Madrid Regional Government S2010/BMD-2422 AGES; S2017/BMD-3740, JanssenCilag, Lundbeck, Otsuka, Pfizer, Ferrer, Juste, Takeda, Exeltis, Casen-Recordati, Angelini, Rovi. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Domingo-Espiñeira, Varaona, Montero, Lara-Abelenda, Gutierrez-Rojas, Fernández del Campo, Rodriguez-Jimenez, Pinto da Costa, Ortega, Alvarez-Mon and Alvarez-Mon.)

A role for vitamin D in immune modulation and in cancer has been suggested. In this work, we report that mice with increased availability of vitamin D display greater immune-dependent resistance to transplantable cancers and augmented responses to checkpoint blockade immunotherapies. Similarly, in humans, vitamin D-induced genes correlate with improved responses to immune checkpoint inhibitor treatment as well as with immunity to cancer and increased overall survival. In mice, resistance is attributable to the activity of vitamin D on intestinal epithelial cells, which alters microbiome composition in favor of Bacteroides fragilis , which positively regulates cancer immunity. Our findings indicate a previously unappreciated connection between vitamin D, microbial commensal communities, and immune responses to cancer. Collectively, they highlight vitamin D levels as a potential determinant of cancer immunity and immunotherapy success.

Background: Domestic violence (DV) is a serious and prevalent public health problem with devastating consequences for the victims and their families. Whilst the number of cases reported to the authorities has risen in recent years, many victims still chose not to present a complaint. In Portugal, to address this, DV became a public crime. As victims of DV present multiple health problems and frequently seek professional help, family doctors are in a privileged position to detect and report cases of DV to the authorities. However, little is known about what motivates these professionals to report or not the DV cases they encounter in their practice to the authorities., Methods: We conducted semi-structured interviews with family doctors from all regional health administrations of continental Portugal. Interviews occurred between July 2020 and September 2022, were conducted in person or remotely, audio recorded, transcribed, and analysed using thematic analysis. Content analysis was conducted to assess the agreement or disagreement regarding mandatory reporting in each of the themes and subthemes., Results: Fifty-four family doctors took part in this study (n = 39 women, n = 15 men). The main themes that arose from the analysis were: "Barriers related to the physician's activity," "Barriers related to the victim or aggressor," "Facilitators related to the physician's activity," "Facilitators related to the victim or aggressor." Although different barriers were described, most doctors agreed with the mandatory reporting of DV cases., Conclusions: Family doctors encounter multiple barriers and facilitators when considering reporting a DV case to the authorities. The results of this study can help develop new interventions to address the barriers described by the doctors, increasing their compliance with mandatory reporting, the protection of victims and the just persecution of the aggressor., (© 2024. The Author(s).)

Background: The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders., Methods: The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions., Results: About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15-20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome., Conclusions: The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.

In 2020, during the early days of the COVID-19 pandemic, the British Journal of Psychiatry ( BJPsych ) established a series of free online teaching sessions called BJPsych Journal Clubs. Their educational purpose is two-fold: (a) to provide junior psychiatrists with a friendly but large-scale platform to evaluate and critically appraise recent articles published in the BJPsych and (b) to present new research findings in an open and accessible manner. In this paper, we discuss our framework, the challenges we encountered, how the original model is evolving based on feedback from trainees, and tips for success when delivering international online journal clubs.

Scalable solutions to treat depression in older adults in low-resourced settings are urgently needed. The PRODIGITAL-D pragmatic, single-blind, two-arm, individually randomized controlled trial assessed the effectiveness of a mobile messaging psychosocial intervention in improving depressive symptomatology among older adults in socioeconomically deprived areas of Guarulhos, Brazil. Older adults (aged 60+ years) registered with 24 primary care clinics and identified with depressive symptomatology (9-item Patient Health Questionnaire (PHQ-9) scores ≥ 10) received the 6-week Viva Vida intervention based on psychoeducation and behavioral activation (n = 298) or a single message (n = 305). No health professional support was offered. The primary outcome was improvement from depressive symptomatology (PHQ-9 < 10) at 3 months. Of the 603 participants enrolled (mean age = 65.1 years; 451 (74.8%) women), 527 (87.4%) completed the follow-up assessment. In the intervention arm, 109 of 257 (42.4%) participants had an improved depressive symptomatology, compared with 87 of 270 (32.2%) participants in the control arm (adjusted odds ratio = 1.57; 95% confidence interval = 1.07-2.29; P = 0.019). No severe adverse events related to trial participation were observed. These results demonstrate the usefulness of a digital messaging psychosocial intervention in the short-term improvement from depressive symptomatology that can potentially be integrated into primary care programs for treating older adults with depression. Brazilian Registry of Clinical Trials registration: ReBEC ( RBR-4c94dtn )., (© 2024. The Author(s).)

Background: Training and practice in neuropsychiatry varies across the world. However, little is known about the experiences and opinions of early career psychiatrists (ECPs) across different countries regarding neuropsychiatry., Aims and Method: To investigate neuropsychiatry training experiences, practices and opinions among ECPs across different countries. An online survey was distributed to ECPs in 35 countries across the world., Results: A total of 522 participants took part in this study. Responses show that neuropsychiatry is integrated to a variable extent in psychiatric training curricula across the world. Most respondents were not aware of the existence of neuropsychiatric training or of neuropsychiatric units. Most agreed that training in neuropsychiatry should be done during or after the psychiatry training period. Lack of interest among specialty societies, lack of time during training, and political and economic reasons are regarded as the main barriers., Clinical Implications: These findings call for an improvement in the extent and in the quality of neuropsychiatry training across the world.

Introduction: Nigeria, with an estimated 40 million people living with mental disorders, faces a critical shortage of psychiatrists to address the significant burden. Despite psychotherapy being integral to psychiatric training, it lacks structure, consistency and adequate supervision. This is alarming, particularly given the substantial demand for specialized psychotherapeutic support among those with mental illness., Methodology: A cross-sectional study utilised an online survey targeting early career psychiatrists recruited from the Early Career Psychiatrists section of the Association of Psychiatrists in Nigeria., Results: The questionnaire was distributed to 252 early career psychiatrists across Nigeria, with a 42.9% response rate, of which 50% were male, with 73.2% trainees and 26.8% early career psychiatrists. While 52.8% had received some psychotherapy training, only 2.8% were qualified psychotherapists. Notably, only 27.6% of those with psychotherapy training had over 100 hours of training. Factors such as receiving psychotherapy training during postgraduate training and having supervised psychotherapy training were found significant for having independent psychotherapy training., Conclusions: There is little emphasis on psychotherapy training in the postgraduate training in Nigeria. Those who had full training in psychotherapy were self-sponsored. Structured, supervised and mandatory psychotherapy within psychiatry training curriculum is recommended., Competing Interests: The authors declare none., (© The Author(s) 2024.)

Conventional dendritic cells (cDCs) include functionally and phenotypically diverse populations, such as cDC1s and cDC2s. The latter population has been variously subdivided into Notch-dependent cDC2s, KLF4-dependent cDC2s, T-bet + cDC2As and T-bet - cDC2Bs, but it is unclear how all these subtypes are interrelated and to what degree they represent cell states or cell subsets. All cDCs are derived from bone marrow progenitors called pre-cDCs, which circulate through the blood to colonize peripheral tissues. Here, we identified distinct mouse pre-cDC2 subsets biased to give rise to cDC2As or cDC2Bs. We showed that a Siglec-H + pre-cDC2A population in the bone marrow preferentially gave rise to Siglec-H - CD8α + pre-cDC2As in tissues, which differentiated into T-bet + cDC2As. In contrast, a Siglec-H - fraction of pre-cDCs in the bone marrow and periphery mostly generated T-bet - cDC2Bs, a lineage marked by the expression of LysM. Our results showed that cDC2A versus cDC2B fate specification starts in the bone marrow and suggest that cDC2 subsets are ontogenetically determined lineages, rather than cell states imposed by the peripheral tissue environment., (© 2024. The Author(s).)

Background: Nigeria's shortage of psychiatrists is exacerbated due to health worker migration., Aim: This study explores migration experiences and tendencies among early-career psychiatrists in Nigeria., Methods: We conducted a cross-sectional survey covering Nigeria's six geopolitical zones, using a 61-item online questionnaire assessing short-term mobility, long-term migration experiences and migration attitudes. Data was analysed using IBM SPSS version 29., Results: Of 228 early-career psychiatrists surveyed, 9.7% had short-term mobility and 8.0% had long-term migration experiences. However, 85.8% had 'ever' considered migration, 69.2% were planning to leave 'now', and 52.9% had taken 'practical migration steps'. Over half (52.7%) said they would be working abroad in 5 years, with 25.2% indicating they would migrate within a year. The top reasons to leave were financial and academic, while personal and cultural factors were the key reasons to stay. Income dissatisfaction (OR = 2.27, 95%, CI = 1.05-4.88) predicted planning to leave 'now', while being in a relationship (OR = 3.46, 95%CI = 1.06-11.30) predicted taking 'practical migration steps'. Attractive job features were good welfare (85.4%) and high salaries (80.3%). Improvements in finances (90.8%) and work conditions (86.8%) were requested., Conclusions: Systemic changes to address psychiatrists' migration from Nigeria are needed., Competing Interests: The authors declare none., (© The Author(s) 2024.)

Background: Following the onset of the COVID-19 pandemic, healthcare trusts began to implement remote working arrangements, with little knowledge of their impact on staff well-being., Aims: To investigate how remote working of healthcare workers during the pandemic may have been associated with stress, productivity and work satisfaction at that time, and associations between loneliness, workplace isolation, perceived social support and well-being., Method: A questionnaire was developed to explore remote working and productivity, stress and work satisfaction during time spent working remotely. Associations between current loneliness, workplace isolation and well-being, and the influence of perceived social support, were explored with perceived social support as a potential moderator., Results: A total of 520 participants responded to the study, of whom 112 were men (21.5%) and 406 were women (78.1%), with an age range of 21-77 years (mean 40.0, s.d. = 12.1). Very few (3.1%) worked remotely before the COVID-19 pandemic, and this had increased significantly (96.9%). Those who worked ≥31 h a week remotely reported higher stress and lower workplace satisfaction at that time, compared with office work, yet also felt more productive. Current loneliness, workplace isolation and perceived social support were cross-sectionally associated with lower current well-being., Conclusions: Those who worked more hours a week remotely during the pandemic reported increased stress, which may be related to the lack of resources in place to support this change in work.

Background: The COVID-19 pandemic placed great strain on healthcare professionals, leading to a substantial impact and a redistribution of the workforce. Despite the active involvement of the Eastern Mediterranean Region Office (EMRO) and the World Health Organization in managing mental health crises, there is a knowledge gap concerning the working conditions and training opportunities available for early career psychiatrists (ECPs) during the pandemic period., Objectives: This study aims to investigate the impact of the COVID-19 pandemic on ECPs and how it affected their well-being, employment, and educational opportunities., Methods: A mixed methods study has been conducted in Iran, Egypt, and Tunisia, three EMRO member countries. It includes a cross-sectional survey with self-reported questions, and a qualitative study with individual in-depth interviews., Discussion: The findings of this study will raise awareness to the working conditions of ECPs within the EMRO region and its member societies, both during the COVID-19 pandemic and beyond. The results will serve as a basis for encouraging supervisors and policymakers to mitigate the pandemic's impact on psychiatric training, strengthen healthcare systems' preparedness, and equip early career psychiatrists with the necessary skills to deal with the mental health consequences of the COVID-19 pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Hosseini, Hajebi, Shalbafan, Ghannadi, Larnaout, Nofal, Gondek and Pinto da Costa.)

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Background: Hikikomori refers to the extreme isolation of individuals in their own homes, lasting at least six months. In recent years social isolation has become an important clinical, social, and public health problem, with increased awareness of hikikomori around the globe. Portuguese is one of the six most spoken languages in the world, but no studies have analysed the content regarding this phenomenon expressed in Portuguese., Objective: To explore the hikikomori phenomenon on Twitter in Portuguese, utilising a mixed-methods approach encompassing content analysis, emotional analysis, and correlation analysis., Methods: A mixed methods analysis of all publicly available tweets in the Portuguese language using a specific keyword (hikikomori) between 1st January 2008 and 19th October 2022. The content analysis involved categorising tweets based on tone, content, and user types, while correlation analysis was used to investigate user engagement and geographical distribution. Statistical analysis and artificial intelligence were employed to classify and interpret the tweet data., Results: Among the total of 13,915 tweets generated, in terms of tone 10,731 were classified as "negative", and 3184 as "positive". Regarding content, "curiosities" was the most posted, as well as the most retweeted and liked topic. Worldwide, most of the hikikomori related tweets in Portuguese were posted in Europe, while "individuals with hikikomori" were the users most active posting. Regarding emotion analysis, the majority of tweets were "neutral"., Conclusions: These findings show the global prevalence of the discourse on hikikomori phenomenon among Portuguese speakers. It also indicates an increase in the number of tweets on this topic in certain continents over the years. These findings can contribute to developing specific interventions, support networks, and awareness-raising campaigns for affected individuals., (© 2024. The Author(s).)

Mixotrophic plankton can comprise a substantial portion of the plankton community compared to phytoplankton and zooplankton. However, there is a gap in the understanding of conditions that influence mixotroph prevalence and activity in situ because current methods often over- or underestimate mixotroph abundance. A labeled prey-tracer method was utilized to identify active mixotrophs present at two locations in a temperate estuary over a year. The tracer method was combined with light microscopy data to estimate active mixotroph abundance and proportion. This study estimated that actively grazing mixotrophic taxa were more abundant in the spring and autumn compared to summer. Dinoflagellates typically dominated the mixotrophic taxa except during autumn at the low salinity location when cryptophytes dominated. Further analysis suggested that active mixotroph abundances might not be only regulated by environmental conditions favorable to mixotrophy but, instead, environmental conditions favorable to different mixotrophs utilization of phagotrophy. By focusing on mixotrophic taxa that were identified to be actively grazing at time of sampling, this study provided a more nuanced estimation of mixotroph abundance, increasing the understanding of how mixotrophic abundance and proportion in situ are influenced by the planktonic community composition and environmental factors., (© The Author(s) 2024. Published by Oxford University Press on behalf of FEMS.)

Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

People with psychosis often experience social isolation due to stigma. Several volunteering programmes that exist in the community to support patients expect in-person meetings, requiring greater availability and commitment. This study investigated the acceptability and feasibility of remote volunteering over a smartphone for people with psychosis over 12 weeks, exploring its potential impact on both patients and volunteers. A total of 36 participants took part in the study. In the first phase, six participants were recruited in less than three weeks in London. All established contact with their match, and there were no study withdrawals. In the second phase, 30 additional participants were recruited in four weeks, across the United Kingdom. Most patients and volunteers reported that they primarily used audio calls to make contact, followed by text messages, WhatsApp messages and video calls. There were improvements in patients' scores of quality of life, self-esteem, social contacts and symptoms, and in volunteers' ratings of quality of life, physical activity, self-esteem, social comparison, and social distance towards people with mental illness. This study demonstrates that it is feasible, acceptable and safe to remotely connect volunteers and people with psychosis who are afar. Trial registration: ISRCTN17586238 (registration date: 28/09/2018)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Pinto da Costa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Compulsory treatment involves the hospital admission of individuals with mental disorders in appropriate facilities through judicial decisions. However, limited information is available regarding the similarities and differences in compulsory treatment legislation in Portuguese-speaking countries., Aims: To analyse the commonalities and differences in compulsory treatment legislation in Portuguese-speaking countries, where Portuguese is the primary official language, including Angola, Brazil, Cape Verde, East Timor, Guinea-Bissau, Mozambique, Portugal, and São Tomé and Príncipe., Methods: A comparative analysis of the specific legislation on compulsory treatment in Portuguese-speaking countries was conducted. National development plans were analysed in countries lacking legislation. A purposive sampling of mental health professionals was contacted to gather information on the countries under study., Results: Among the eight Portuguese-speaking countries examined, specific legislation regarding compulsory treatment was found only in Brazil, Cape Verde, and Portugal. These countries, with the lowest poverty rates, exhibited a notable degree of homogeneity in the criteria supporting compulsory treatment, ensuring the protection of individual rights. In contrast, in Angola, East Timor, Guinea-Bissau, Mozambique, and São Tomé and Príncipe, compulsory treatment primarily relies on mental health development plans, resulting in significant variations in the presented criteria., Conclusions: The significant disparities in compulsory treatment policies among Portuguese-speaking countries, with only Brazil, Cape Verde, and Portugal having specific legislation, underscore the need for a collective effort to establish more consistent procedures and safeguard individual rights., Competing Interests: Declaration of Competing Interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Despite several advantages compared to haemodialysis (HD), peritoneal dialysis (PD) remains an underused dialysis technique due to its high technique failure rate related to membrane fibrosis and peritonitis events. Previous work has suggested a harmful role for the complement system in these processes, highlighting the need for a more comprehensive examination in PD., Methods: Plasma levels of C1q, mannose-binding lectin (MBL), Properdin, Factor D, C3d/C3-ratio and soluble membrane attack complex (sC5b-9) were determined in PD patients ( n = 55), HD patients ( n = 41), non-dialysis chronic kidney disease (CKD) patients ( n = 15) and healthy controls ( n = 14). Additionally, C1q, MBL, Properdin, Factor D and sC5b-9 levels were assessed in the peritoneal dialysis fluid (PDF). In a subgroup, interleukin-6, matrix metalloproteinase-2 (MMP-2), myeloperoxidase (MPO) and elastase were measured in the PDF., Results: PD patients had significantly higher systemic levels of sC5b-9 compared to healthy controls, CKD and HD patients ( p < 0.001). Plasma levels of C1q and C3d/C3-ratios were significantly associated with systemic sC5b-9 levels ( p < 0.001). Locally, sC5b-9 was detected in the PDF of all PD patients, and levels were approximately 33% of those in matched plasma, but they did not correlate. In the PDF, only Properdin levels remained significantly associated with PDF sC5b-9 levels in multivariate analysis ( p < 0.001). Additionally, PDF levels of sC5b-9 positively correlated with elastase, MPO and MMP-2 levels in the PDF ( p < 0.01)., Conclusions: Our data reveal both systemic and local complement activation in PD patients. Furthermore, these two processes seem independent considering the involvement of different pathways and the lack of correlation., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: FP currently owns or owned stock in ChemoCentryx, Apellis Pharmaceuticals and Omeros Corporation. The other authors declared no conflict of interest.

Submitral aneurysm is a rare type of non-ischaemic ventricular aneurysm. We describe the case of a 26-year-old woman with progressive dyspnoea for approximately 1 year who was diagnosed with a ruptured submitral aneurysm in the left atrium with severe regurgitation. The patient underwent aneurysm correction and mitral valve repair, and post-operative echocardiography showed no residual abnormalities. The patient remains asymptomatic.

Introduction: With the growing use of remote appointments within the National Health Service, there is a need to understand potential barriers of access to care for some patients. In this observational study, we examined missed appointments rates, comparing remote and in-person appointments among different patient groups., Methods: We analysed adult outpatient appointments at Imperial College Healthcare NHS Trust in Northwest London in 2021. Rates of missed appointments per patient were compared between remote versus in-person appointments using negative binomial regression models. Models were stratified by appointment type (first or a follow-up)., Results: There were 874,659 outpatient appointments for 189,882 patients, 29.5% of whom missed at least one appointment. Missed rates were 12.5% for remote first appointments and 9.2% for in-person first appointments. Remote and in-person follow-up appointments were missed at similar rates (10.4% and 10.7%, respectively). For remote and in-person appointments, younger patients, residents of more deprived areas, and patients of Black, Mixed and 'other' ethnicities missed more appointments. Male patients missed more in-person appointments, particularly at younger ages, but gender differences were minimal for remote appointments. Patients with long-term conditions (LTCs) missed more first appointments, whether in-person or remote. In follow-up appointments, patients with LTCs missed more in-person appointments but fewer remote appointments., Discussion: Remote first appointments were missed more often than in-person first appointments, follow-up appointments had similar attendance rates for both modalities. Sociodemographic differences in outpatient appointment attendance were largely similar between in-person and remote appointments, indicating no widening of inequalities in attendance due to appointment modality., Competing Interests: Declaration of conflicting interestsThe authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: BH is an employee of eConsult Health Ltd, a provider of electronic consultations for NHS primary, secondary and urgent/emergency care. Other authors have no conflicts of interest to disclose.

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.