The lack of accessible plasma biomarkers to identify target populations limits the promise of precision medicine for Alzheimer’s Disease (AD). Amnestic mild cognitive impairment (aMCI) is an important risk for AD and often occurs years before the onset of AD.

Based on an emerging mechanistic model of mitochondrial mechanisms of brain plasticity, we studied the role of acetylcarnitine and free-carnitine levels assayed in plasma as potential markers of cognitive dysfunction in subjects with aMCI or early-AD.

We used available samples from two independent cohorts well characterized for clinical and neuropsychological characteristics together with ultraperformance liquid chromatography-tandem mass spectrometry and computational approaches. Cerebrospinal fluid (CSF) measures of b-amyloid accumulation and t-Tau levels were also available and used in computational modeling.

Within the primary cohort, our data showed decreased levels of carnitine in relation to cognitive function as assessed by using the Mini Mental Status Exam (MMSE) in women but not men with CI as compared to age- and sex-matched HC. Furthermore, the magnitude of carnitine deficiency reflected the severity of cognitive dysfunction in a sex-specific manner (women: p = 0.015; men: p = 0.441). Our data also replicated the prior finding of decreased LAC levels in both women and men with AD, supporting the robustness of the study samples assayed in our new study. Using computational approaches, we found that the integration of these mitochondrial measures with canonical CSF biomarkers improves diagnostic accuracy. A second cohort provides a validation of the sex-specific relationship between free-carnitine deficiency and the severity of cognitive dysfunction.

Taken together with prior mechanistic studies in rodents, the current findings support future research on the development of individualized treatment models targeting sex-specific changes in mitochondrial metabolism.

None Declared

Health Psychology is aggregated to clinical studies providing physicians, nurses, and psychotherapists with psychodynamics of sick persons, facilitating interpersonal relationships and greater adherence to treatments. How do people deal with illness and treatment from what they symbolize in experiences of becoming ill? Watch & Wait Protocol for patients with rectal cancer is an active surveillance as an alternative approach in surgical medical management. Patients are followed with physical examinations, endoscopy, and imaging. Observation carried out through periodic examinations aims to avoid surgery stage while rectal cancer is maintained.

To interpret emotional meanings attributed by patients, after adhering to the W&W protocol for rectal cancer, to life experiences of watching and waiting for the disease course.

Clinical-Qualitative Method (Turato. Portuguese Psychos. J, 2000 2(1): 93-108). For data collection, the first author used Semi-Directed Interview with Open-ended Questions In-Depth and Field Notes, after acculturation. Sample closed by information saturation (Fontanella et al. Cad Saude Publica. 2008; 24(1): 17-27). Interviews conducted by the first author, a female psychologist. We employed the Seven Steps of the Clinical-Qualitative Content Analysis (Faria-Schützer et al. Cien Saude Colet. 2021; 26(1): 265-274) to construct categories. Theoretical framework was the Balintian Medical Psychology. Findings were validated by peer reviewers from Lab of Clinical-Qualitative Research.

Sample had 10 patients, 3 female and 7 male, from 52 to 77 years. Interviews carried out from October 2022 to March 2023. We constructed 03 categories: 1) Fate out of hands - “I get sick just coming in here.” There is an apprehension experienced in each medical evaluation to check the clinical condition because the symbol of waiting is not having the own destiny in the hands. 2) Psychic defence - “Sometimes I even thought if I had to live on a grant for the rest of my life or die!” Imagining the worst is a psychic defence because if this probability occurs, the mind has already begun its elaboration. 3) Life upside down - “I was going to have the surgery, use a bag, my life was going to be upside down.” Anxiety generated by waiting is a mental disorganizing.

Attitudes of observing and waiting carry different symbolisms to those who work with scientific thinking and who experience the observation of their own disease and the wait for what conduct they will receive. Observing oneself in illness requires acceleration of changes in ego identity. Waiting in front of illness asks the ego to think the worst. It is not a volitional choice. Preparing for the worst is a defensive necessity in the emotional sphere to avoid surprises that take to mental rupture.

None Declared

Addressing mental and physical health problems and promoting wellbeing in educational settings is a global priority. Teachers present a high risk of stress and burnout, which negatively impacts their professional performance as well as their mental and physical health. Compassion-based interventions have been found effective in promoting psychosocial and physiological wellbeing.

The current paper presents preliminary findings of the impact of a 6-module Compassionate Mind Training intervention for Teachers (CMT-T) on immunological markers and the Conserved Transcriptional Response to Adversity (CTRA; a gene expression signature that involves a group of 53 genes: pro-inflammatory genes, type I interferon response and genes related to antibody synthesis).

A pilot non-controlled study was conducted in a sample of public-school teachers in Portugal (n=36). Participants were assessed at 4 time-points: 1) Extended Baseline Control_M0, in order to establish a within-subjects psychological and biophysiological baseline (8 weeks before the start of the CMT-T); 2) Pre-intervention_M1 (8-weeks after M0); 3) Post-intervention_M2 (8-weeks after M1); and 4) Follow-up_M3 (3 months after the CMT-T end). In all assessment moments, participants completed a set of psychological self-report measures and were assessed in immunological and epigenetic biological markers through the collection of blood. After M1, teachers completed the 8-week group CMT-T intervention and given access to its resources and materials. They were instructed to practice daily and incorporate the teachings in their personal and professional lives. All assessments and the CMT-T intervention took place at the schools.

Preliminary data on the impact of CMT-T on Immune Response Profiling revealed that teachers’ Natural Killer (i.e., NK) cells were decreased after the CMT-T intervention. In regard to the CTRA gene expression, results showed that type one interferon response genes (e.g., IFI16, IFI27L2, IFITM2, IFITM3, IFITM4P) were decreased after the intervention. In addition, we observed that the gene c-Jun, a pro-inflammatory gene, had a decreased expression after the CMT-T intervention.

These preliminary findings seem to corroborate previous studies involving the type one interferon response, the pro-inflammatory genes and antibody synthesis genes in a signature involving 53 genes previously described as the CTRA gene signature. Furthermore, our results suggest that cultivating compassion using a compassion focused intervention may have a positive impact on markers of the immune system response, associated with how our bodies respond to stress, infection and cancer, as well as, on reducing the expression of genes related to our bodies’ response to stress and inflammation.

None Declared

Humanistic studies applied to the health-illness clinic go beyond explaining cause-effect relationships among disease phenomena, treatments, and preventions. Qualitative research aims to understand symbolic relationships built in life experiences among the manifestations and the people. How to act in front of a person whose physical appearance and odour can be unpleasant, such as in the HNC - Head Neck Cancer? Or whose life history may have been marked by deviant behaviours and negligence in self-care?

To interpret emotional meanings attributed through open interviews conducted with relatives about the domestic care of patients with HNC under clinical treatment.

Sample composed of family caregivers of patients with HNC, sent sequentially by colleagues from the clinical service who were informed of the research. The study used the Clinical-Qualitative Method (Turato. Portuguese Psychos. J, 2000 2(1): 93-108). Semi-Directed Interview with Open-ended Questions In-Depth and Field Notes was used for data collection. The employ of the Seven Steps of the Clinical-Qualitative Content Analysis (Faria-Schützer et al. Cien Saude Colet. 2021; 26(1): 265-274) has permitted the understanding of the topics. Sample closed with 12 persons according to the information saturation strategy (Fontanella et al. Cad Saude Publica. 2008; 24(1): 17-27), conducted by the first author, a female psychologist. To interpret the empirical material, we use Medical/Health Psychology, the psychodynamics of relationships of the Balintian framework, disease and illness while modes of un-health, psychic defence mechanisms against anguish. Validation by peers from the Lab of Clinical-Qualitative Research Laboratory, at the State University of Campinas.

For this presentation, we listed three categories from the free-floating re-readings: (1) Certain need to recognize the care provided as a handling strategy with effort, putting in this ‘validation’ their relief regarding natural suffering of the care process; (2) Caregiver’s psychological fantasies of omnipotence in the care process, frequently perceiving the reality a phenomenologically and necessarily distorted by the caregiver. (3) Moments of impotence feeling in front of the finitude reality that it knows will arrive.

The family caregivers can present certain emotional defences, such as subtle magical thinking, in which they distort the reality experienced as a management strategy and validation of their care. They act so to alleviate their psychological and existential suffering. Group meetings with family members to talk openly about the difficulties on the psychological management of patients with HNC, coordinated by a psychotherapist, are effective as a space for creativity in daily management at home and a space for catharsis.

None Declared

Digital interventions have been found to be successful in preventing occupational mental health concerns, however, they seem to be affected by attrition bias through high attrition rates and differential attrition. Differential attrition arises when the rates of participant dropouts differ across different treatment conditions and is considered a significant challenge to internal validity.

We aimed at systematically review and meta-analyse differential attrition of digital mental health interventions in the workplace setting.

On January 2, 2022, we performed a search in the following electronic databases: PubMed, Scopus, and Web of Science Core. We utilized a combination of terms from five distinct areas, namely mental health, intervention, workplace, implementation, and study design. The study encompassed adult employees who took part in a randomized control trial aimed at preventing mental health issues in the workplace through an online intervention. A team of six reviewers collaborated on the study selection process, while two independent researchers conducted the data extraction for the selected studies. We performed a meta-analysis of the log-transformed relative attrition rates of the included studies using a random-effects model with limited maximum-likelihood (REML) estimation to account for the degree of heterogeneity.

A total of 19 studies were included in the meta-analysis. For baseline to post-intervention, the average total attrition was 26.27% (SD = 21.16%, range = 0 – 66.3%) and the random effects model revealed a higher attrition rate in the intervention group compared to the control group, with a pooled risk ratio of 1.05 (95% CI: 1.01 - 1.10, p = .014). For baseline to follow-up measurement the average total attrition was 27.71% (SD = 20.80%, range = 0 – 67.78%), however, in this case the random effects model did not indicate a higher attrition in the intervention group when compared to the control group (pooled risk ratio = 1.05, 95% CI: 0.98 – 1.12, p = .183).

There is an indication of higher attrition in the intervention group as compared to the control group in occupational e-mental health interventions from baseline to post-intervention, however this does not seem to be the case for baseline to follow-up attrition. These results should be taken into account in the design process of studies and statistical analyses should be adapted to counteract the bias that could result from differential attrition.

None Declared

The comorbidity between Schizophrenia and Obsessive-Compulsive Symptoms represents almost 25% of schizophrenic patients and it is believed that almost 12% match the diagnostic criteria for Obsessive-Compulsive Disorder. Some second-generation antipsychotics may worsen or even induce those symptoms, which makes the treatment of this patients a difficult challenge.

To assess the link between Schizophrenia and Obsessive-Compulsive Symptoms, to discuss the diagnostic challenges and treatment options. To present a clinical case report of a schizophrenic patient with Obsessive-Compulsive Symptoms, which improved with proper treatment.

We performed a non-systematic review of the existent literature with the keywords “Schizophrenia” and “Obsessive-Compulsive Symptoms”. Description of a clinical case report.

We present the case report of a male, 21 years old, single, diagnosed with Schizophrenia. In the past year, he was admitted twice in a psychiatric ward for persecutory and mystic delusions, which lead him to erratic behaviour. Since his adolescence he manifested repeated washing and compulsive cleaning associated with the fear of being contaminated with multiple diseases. Those compulsions worsened when he started being treated with antipsychotics. However, with therapeutic adjustments and with the introduction of an antidepressant we were able to control those symptoms.

Some antipsychotics may induce or even aggravate Obsessive-Compulsive Symptoms in psychotic patients. It is of extreme relevance to differentiate those symptoms as comorbid in Schizophrenia or if they existed prior to the first positive symptoms, since they can be representative of an Obsessive-Compulsive Disorder. Understanding this diagnostic and treatment complexity enables us to be more familiar with the development of Obsessive-Compulsive Symptoms in schizophrenic patients.

None Declared

Prior mechanistic studies in rodents showed decreased levels of the pivotal mitochondrial metabolite acetyl-L-carnitine (LAC) in relation to cognitive deficits and depressive-like behavior (Neuron 2017, 10.1016/j.neuron.2017.09.020, PNAS 2013, 10.1073/pnas.1216100110), providing the basis for the current translational study.

The main objective of this work was to ascertain the role of this specific mitochondrial signaling pathway in subjects with cognitive impairments (CI), and potential sex differences in these mechanisms.

We used computational approaches, ultraperformance liquid chromatography–tandem mass spectrometry (UPLC-MS/MS) and available plasma samples from a well-characterized cohort of 71 subjects, including subjects with CI and age- and sex-matched cognitively healthy controls (HC).

Our newest findings showed decreased levels of LAC in subjects with CI as compared to age- and sex-matched HC. We also found important sex differences in carnitine levels in relation to cognitive function as assessed by using the Mini Mental Status Exam (MMSE). Specifically, the degree of carnitine deficiency reflected the severity of cognitive dysfunction in a sex-specific manner. Using computational approaches, we found that the integration of these mitochondrial measures with canonical biomarkers improves diagnostic accuracy.

The current findings of sex differences in carnitine deficiency in subjects with CI suggest a possible sex-specific mitochondrial phenotype of vulnerability to cognitive dysfunction, and point to LAC-related mitochondrial metabolism as a new signaling pathway of cognitive regulation.

None Declared

The COVID-19 outbreak imposed several periods of lockdown to stop the pandemic, with a determinant impact on access to mental health services. In Portugal, the first State of Emergency was declared on the 18th of March 2020, with the obligation of mandatory confinement and circulation restriction. Restrictive measures were alleviated on the 2nd of May 2020.

We aimed to investigate the impact of the first confinement on the maintenance or loss of psychiatric and psychological follow-up. Also, we aimed to explore the outcomes in the mental health of losing psychiatric or psychological consultations.

We conducted an online survey among the Portuguese population to evaluate demographic, clinical and mental health variables (STAI, DASS-21, PHQ, OCI-R, Quality of Life [QoL] and PSS). Individuals were invited to answer the survey at two timepoints: third week of March 2020 and third week of May 2020. Concerning the first timepoint, we used independent t-tests to compare the mental health variables in the individuals who loss and who did not lose consultations. Then, we evaluated the impact of losing consultations across time in those individuals who continued responding in the second timepoint, through a Linear Fixed Model. All the analyses were performed using JASP software.

From the total sample (n=2040), 334 individuals (84.4% female gender) had psychiatric and/or psychological consultations previously to the confinement. In March 2020, the individuals who maintained the consultations (35.0%) showed best mental health indicators in the QoL Self Evaluation (p=0.002), QoL Satisfaction (p=0.037), STAI State (p<0.001), DASS-21 (p=0.001), PHQ (p<0.001), OCI-R (p=0.002) and PSS (p<0.001). Among the matched individuals who answered the survey in May 2020 (n=93), we found that the group who maintained follow-up (n=24) did not improve significantly more than the other group (n=69) for any of the mental health variables in study.

The results indicate that stopping psychiatric and psychological follow-up represented worse mental health outcomes at the beginning of the first confinement. However, anxiety feelings improved at the end of the first confinement, which happened independently of psychiatric/ psychological follow-up.

None Declared

In a mass-casualty incident (MCI) involving children, there is a need to apply accurate triage tools in order to help those who require important care, and at the same time, to avoid unnecessary use of resources. Thus, it is discussed which would be the best triage device to use in these situations. One of the most used is a modification of Simple Triage and Rapid Treatment, JumpSTART, whose performative quality this review focuses on.

This review sought to compare the performance parameters of JumpSTART with other triage algorithms used in pediatric disaster victims.

This systematic review was performed according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and registered with the PROSPERO database of systematic reviews with the number CRD42021258415. The last update of the search in the databases was on August 12, 2021 and resulted in six documents to be analyzed. The inclusion criteria included the peer-reviewed academic papers in English, Portuguese, Spanish, and Italian languages, and the databases used were PubMed, Scopus, MEDLINE/Bireme (Virtual Library of Health), Web of Science, and CINAHL, which executes the query on the topic, keywords, or abstracts. Also to be included, documents that were available with full-text access through CAPES, Google, or Google Scholar. Books, non-academic research, and content in languages other than the presented ones were represented as exclusion criteria. The Joanna Briggs Institute (JBI) checklists were used to evaluate the methodological quality of the retrieved studies. The results were presented through narrative synthesis. This review was not funded.

Of the collected publications, five articles were used to carry out this review, with the addition of an extra article captured by citation tracking. The findings from the obtained results were that JumpSTART was the preferred tool and presented the fastest speed of use. Only one of the five studies that dealt with accuracy showed JumpSTART as the most accurate algorithm, while three of the other four showed its inferiority in most aspects. In one study, no significant difference was observed amongst the chosen protocols.

There is insufficient evidence to validate JumpSTART as a universal triage tool, given the disparities in the results obtained from the comparisons. No tool performed satisfactorily well, therefore there is an urgent need to create a reliable algorithm.