Susana Coimbra

Erythroid Disturbances Before and After Treatment of Portuguese Psoriasis Vulgaris Patients

AbstractBackground: A few studies in psoriasis vulgaris patients have reported changes suggesting red blood cell (RBC) damage is linked to neutrophil activation, oxidative stress, and psoriasis worsening. Objective: The aim of this study was to evaluate erythroid disturbances in Portuguese psoriasis vulgaris patients, before, during, and after treatment. Methods: Across-sectional study (n = 73 patients vs 40 healthy control subjects) followed by a longitudinal study (n = 47 patients)was performed, with assessments before, and at 3, 6, and 12weeks of therapy (10 patients started topical treatment, 17 narrow-band UVB, and 20 photochemotherapy [psoralen plus UVA; PUVA]). Evaluations included hematologic data, total bilirubin levels,membrane-bound hemoglobin (MBH),membrane protein band 3 profile, total plasma antioxidant status (TAS), lipid peroxidation (thiobarbituric acid [TBA] assay), elastase, lactoferrin, and C-reactive protein (CRP). Results: Before treatment, patients presented with higher leukocyte/neutrophil and reticulocyte counts, elastase, lactoferrin, TBA, TBA/TAS, reticulocyte production index, total bilirubin and MBH values, lower RBC and hematocrit, higher percentages of high-molecular-weight aggregates, and lower percentages of band 3 monomer. After treatment, we observed a reversal in most of the parameters. However, patients still presented with values suggestive of accelerated RBC damage, removal, and production, as most of the parameters were still higher than those in the control group; the same occurred with CRP. Conclusion: Our data suggest that psoriasis vulgaris triggers an inflammatory response, with release of acutephase reactants, reactive oxygen species, cationic proteins, and proteases, leading to enhanced RBC damage/ aging and, ultimately, to enhanced RBC removal. These assumptions were strengthened by the observation that, with treatment, all of these changeswere reversed, the inflammation was reduced, the production of reticulocytes was increased, and the RBCs presented changes usually observed in younger/less damaged RBCs. These erythroid changes were enhanced with PUVA therapy, probably due to the more pronounced clearing of the lesions, as suggested by Psoriasis Area and Severity Index (PASI) scores. Finally, after treatment, a residual inflammation still persisted that might contribute to the observed erythroid disturbances.

Social Skills, Social Support and Well-Being in Adolescents of Different Family Configurations

There is no consensus in the literature regarding the influence of family configuration on the psychological well-being of adolescents. Based on the perception of adolescents, this study evaluates the influence of family configuration, social skills and social support appraisals as potential predictors of adolescent psychological well-being. The participants were 454 adolescents aged between 13 and 17 years from nuclear, separated and remarried families. The adolescents were students in the first and second years of public high school. The data were collectively obtained in the classroom using the Social Skills Inventory for Adolescents, the Social Support Appraisal Scale and the Psychological Well-being Scale. The results indicated that family configuration is not associated with the psychological well-being of adolescents. The social skills of empathy, self-control, civility, social resourcefulness and affective approach as well as the social support appraisals from friends and family were the best predictors of adolescent psychological well-being. The implications of the results are discussed with respect to future research and interventions.

Validation of a Portuguese Version of the Snyder Hope Scale in a Sample of High School Students

C. R. Snyder conceptualized hope as a cognitive construct that reflects people’s motivation and capacity to strive toward personally relevant goals. Using this definition, Snyder and colleagues developed and validated the Hope Scale (HS). This study is the first study to examine the psychometric properties of the HS in a sample of high school students (N = 1,012 Portuguese students). Reliability, factor structure, and criterion-related validity were investigated. The results support the psychometric properties of the scale, as well as the two-factor structure of Agency and Pathways. Findings from this study suggest that the HS can be used with high school students and Portuguese-speaking samples.

Discrimination and Mental Health Among Gay, Lesbian, and Bisexual Youths in Portugal: The Moderating Role of Family Relationships and Optimism

ABSTRACT This study investigates associations between mental health, perception of discrimination (unfair treatment and personal rejection), and family environment dimensions—satisfaction, intimacy, admiration, and conflict in the relationships with the mother and the father, and familial optimism—in a sample of 84 gay, lesbian, and bisexual (GLB) Portuguese adolescents. Results show that participants with higher levels of mental health experience less discrimination, feel more respected by their fathers, have fewer conflicts with both parents, and belong to families with higher levels of optimism. No significant differences were found with regard to satisfaction and intimacy in the relationships with both parents and in the perception of admiration by the mothers. Conflict with parents moderated the relation between discrimination and mental health. Having frequent experiences of conflict with parents was found to exacerbate the negative impact of occasional acts of discrimination on mental health. Results highlight the relevance of a positive family environment as a protection mechanism in the face of discrimination, and the need to lower the levels of homophobia and heterosexism in social contexts in order to promote the well-being of GLB adolescents.

Confirmatory factor analysis of the Generalized Self-Efficacy Scale in Brazil and Portugal

This study aims to evaluate the construct validity, internal consistency and cross-cultural invariance of the Generalized Self-Efficacy Scale-Portuguese version (GSE) in a Brazilian and Portuguese sample. The GSE is composed of 10 items, designed to parsimoniously and comprehensively assess self-efficacy beliefs to deal with a wide range of stress-inducing situations. The construct validity (factorial, convergent and discriminant) and internal consistency of the instrument were established within a sample of 304 Portuguese adolescents (study 1) and a sample of 477 Brazilian adolescents (study 2). Then, the invariance of the GSE was tested in a sample of Brazilian adolescents (study 3), using Multigroup Confirmatory Factor Analysis (MGCFA). In the first two studies, the construct validity of the GSE was demonstrated in its three components and the reliability of the scales was confirmed based on satisfactory levels of internal consistency. In the third study, the cross-cultural invariance of the instrument was established. This work adds to previous research on generalized self-efficacy instruments, with good psychometric qualities. Moreover, comparisons can now be made with confidence using this instrument among adolescent samples from Portugal and Brazil.

Resilience in the face of peer victimisation and discrimination: The who, when and why in five patterns of adjustment

Victimisation has a negative effect on psychosocial functioning. Based on the resilience theory, and with a sample of 2975 Portuguese students, the present study aims to: i) identify patterns of adjustment in the face of peer victimisation and perceptions of discrimination; ii) explore the association between the patterns of adjustment and the characteristics of participants (the who) and of the victimisation (the when and why). Cluster analysis revealed five patterns of adjustment: Unchallenged; Externally Maladjusted; Internally Maladjusted; Resilient, and At-Risk. The results suggest that there is no complete resilience in the face of social victimisation. Group differences were found regarding: i) gender, type of course, sexual orientation, ethnicity, nationality, parental educational level and religious beliefs; ii) the age at which peer victimisation was more frequent, and; iii) the motives underlying discrimination. Globally considered, peer victimisation is representative of the wider cultural environment and interventions should also target social prejudices.

Adaptação da Escala de Discriminação Quotidiana para Jovens Portugueses

O objetivo deste estudo foi a adaptacao da Escala de Discriminacao Quotidiana para a populacao jovem portuguesa. Apos traducao, ajustes semânticos aos itens, inclusao de dois itens para aumento da validade de constructo e a afericao da validade facial, os itens da escala foram respondidos por 2996 jovens estudantes do ensino secundario em Portugal. A Analise Fatorial Exploratoria (AFE) revelou uma estrutura de dois fatores - Tratamento Injusto e Rejeicao Pessoal - com quatro itens cada (sete itens da escala original e um formulado neste estudo). A Analise Fatorial Confirmatoria (AFC) validou um modelo hierarquico, em que os dois fatores observados na AFE estao subordinados a um fator latente de segunda ordem, a Percepcao de Discriminacao. A escala permite diferenciar a discriminacao percepcionada por grupos alvo de preconceito social, observando-se diferencas significativas nos valores reportados entre pessoas negras e brancas e entre jovens lesbicas, gays, bissexuais e participantes heterossexuais. O instrumento explica parcialmente variacoes ao nivel de saude mental, observando-se uma correlacao negativa moderada entre a discriminacao percepcionada e a saude mental. Os resultados sugerem que a versao adaptada da escala apresenta validade de constructo, sendo bastante apropriada para avaliar e comparar a percepcao de discriminacao de jovens.

Waldenström's macroglobulinemia - a review

A macroglobulinemia de Waldenstrom (MW) e uma doenca linfoproliferativa dos linfocitos B, caracterizada por um linfoma linfoplasmocitico na medula ossea e por hipergamaglobulinemia monoclonal de tipo IgM. Foi descrita pela primeira vez em 1944, por Jan Gosta Waldenstrom, que descreveu dois doentes com hemorragia oronasal, adenopatias, anemia, trombocitopenia, velocidade de sedimentacao eritrocitaria e viscosidade serica elevadas, radiografia ossea normal e medula ossea infiltrada por celulas linfoides. A MW e uma doenca rara com um percurso clinico normalmente indolente, atingindo principalmente os individuos com idades entre 63 e 68 anos. A maioria dos doentes apresenta sintomas e manifestacoes clinicas relacionadas com a hiperviscosidade, resultante da gamopatia monoclonal IgM e/ou com as citopenias, resultantes da infiltracao medular pelo linfoma. O diagnostico diferencial com outros linfomas e essencial para a avaliacao do prognostico e a abordagem terapeutica. O tratamento dos doentes com MW assintomatica nao melhora a qualidade de vida do doente nem aumenta a sua sobrevivencia, recomendando-se o acompanhamento clinico. Para o tratamento dos doentes sintomaticos, sao usados agentes alquilantes, analogos das purinas e anticorpos monoclonais anti-CD20. No entanto, a doenca e incuravel e a resposta a terapeutica nem sempre e favoravel. Estudos relativamente recentes mostram resultados promissores com o bortezomibe, um inibidor dos proteossomas, e alguns doentes respondem a talidomida. Nos doentes com recidivas ou refratarios a terapeutica, pode-se indicar o transplante autologo. O objetivo deste trabalho e descrever, de forma detalhada, o conhecimento atual sobre a fisiopatologia da MW, as principais manifestacoes clinicas, o diagnostico, o prognostico e o tratamento.

Envolvimento paterno: validade interna da versão brasileira do Inventory of Father Involvement

Father involvement: Internal validity of the Brazilian version of the Inventory of Father Involvement Extensive evidence points to the importance of father-child relationship in the development and for the wellbeing of children, mothers and fathers. Father involvement is multidimensional and includes direct and indirect father-child involvements. In order to progress in this area, a valid measure of this construct, like the Inventory of Father Involvement (IFI), is needed in Brazil. The objective of this study was to investigate the structure of factors and internal reliability of the Brazilian version of IFI (IFI-BR). A sociodemographic questionnaire and the IFI-BR were filled in by 200 men who had fiveto ten-year-old children. The results prove internal validity of the IFI-BR and confirms a structure of factors very similar to that of the original IFI, including eight of the nine original first-order factors and a general second-order factor, with indicators of internal reliability that were adequate for these eight factors.

Resilience in LGB Youths: A Systematic Review of Protection Mechanisms

Considerando las disparidades observadas en varios indicadores de ajuste entre jovenes gais, lesbianas y bisexuales y jovenes heterosexuales, ha sido enfatizada en la literatura la necesidad de identificar los mecanismos que promueven la resiliencia entre las minorias sexuales. Esta revision sistematica trato de responder la pregunta: ?cuales son los mecanismos de proteccion contra la homofobia entre los jovenes LGB? De las 147 referencias localizadas en la busqueda sistematica, 13 estudios fueron analizados. Los mecanismos de proteccion identificados fueron ordenados segun dos criterios: especificos a la orientacion sexual o generales, y considerando su nivel de expresion, personales, relacionales o contextuales. Los resultados demuestran que la mayoria de estos mecanismos son exclusivamente promotores del ajuste positivo en la presencia del riesgo. Los mecanismos de proteccion generales se revelan mas a menudo compensatorios de los riesgos que los especificos.