Attenuation of insecticide impact by a small wetland in a stream draining a horticultural basin in Argentina.

Horticulture has greatly increased in Argentina in recent decades mainly due to increasing greenhouse utilization and agrochemical consumption, thus representing a threat to adjacent water bodies. Riparian wetlands, however, could attenuate agrochemical contamination. The present work therefore compared insecticide concentrations in bottom sediments in addition to sediment toxicity to the amphipod Hyalella curvispina and investigated the macroinvertebrate composition upstream and downstream from a natural wetland in a small stream draining a basin undergoing intense horticultural production. The wetland surface was covered by macrophytes, mainly Thypha sp., and the insecticide concentrations measured downstream from the wetland were significantly lower, at roughly 19% of the upstream values. The growth rates of H. curvispina were significantly higher when exposed to the sediments downstream from the wetland, while the macroinvertebrate-assemblage composition was significantly different upstream and downstream: the snail Pomacea canaliculata was the dominant species upstream while the amphipod H. curvispina was dominant downstream. Pomacea canaliculata is often the dominant species in the regional streams draining agriculture and horticultural basins. Hyalella curvispina is sensitive to pesticide toxicity and is often dominant in streams draining extensive livestock basins and within a biosphere reserve. We conclude that riparian wetlands effectively attenuate horticulture contamination in pampean streams and should therefore be preserved and restored.

Psychological impact of COVID-19 pandemic on healthcare workers in a highly burdened area of north-east Italy.

AIMS: Healthcare workers exposed to coronavirus 2019 (COVID-19) patients could be psychologically distressed. This study aims to assess the magnitude of psychological distress and associated factors among hospital staff during the COVID-19 pandemic in a large tertiary hospital located in north-east Italy. METHODS: All healthcare and administrative staff working in the Verona University Hospital (Veneto, Italy) during the COVID-19 pandemic were asked to complete a web-based survey from 21 April to 6 May 2020. Symptoms of post-traumatic distress, anxiety and depression were assessed, respectively, using the Impact of Event Scale (IES-R), the Self-rating Anxiety Scale (SAS) and the Patient Health Questionnaire (PHQ-9). Personal socio-demographic information and job characteristics were also collected, including gender, age, living condition, having pre-existing psychological problems, occupation, length of working experience, hospital unit (ICUs and sub-intensive COVID-19 units vs. non-COVID-19 units). A multivariable logistic regression analysis was performed to identify factors associated with each of the three mental health outcomes. RESULTS: A total of 2195 healthcare workers (36.9% of the overall hospital staff) participated in the study. Of the participants, 35.7% were nurses, 24.3% other healthcare staff, 16.4% residents, 13.9% physicians and 9.7% administrative staff. Nine per cent of healthcare staff worked in ICUs, 8% in sub-intensive COVID-19 units and 7.6% in other front-line services, while the remaining staff worked in hospital units not directly engaged with COVID-19 patients. Overall, 63.2% of participants reported COVID-related traumatic experiences at work and 53.8% (95% CI 51.0%-56.6%) showed symptoms of post-traumatic distress; moreover, 50.1% (95% CI 47.9%-52.3%) showed symptoms of clinically relevant anxiety and 26.6% (95% CI 24.7%-28.5%) symptoms of at least moderate depression. Multivariable logistic regressions showed that women, nurses, healthcare workers directly engaged with COVID-19 patients and those with pre-existing psychological problems were at increased risk of psychopathological consequences of the pandemic. CONCLUSIONS: The psychological impact of the COVID-19 pandemic on healthcare staff working in a highly burdened geographical of north-east Italy is relevant and to some extent greater than that reported in China. The study provides solid grounds to elaborate and implement interventions pertaining to psychology and occupational health.

Using the GHQ-12 to screen for mental health problems among primary care patients: psychometrics and practical considerations.

BACKGROUND: This study explores the factor structure of the Indonesian version of the GHQ-12 based on several theoretical perspectives and determines the threshold for optimum sensitivity and specificity. Through a focus group discussion, we evaluate the practicality of the GHQ-12 as a screening tool for mental health problems among adult primary care patients in Indonesia. METHODS: This is a prospective study exploring the construct validity, criterion validity and reliability of the GHQ-12, conducted with 676 primary care patients attending 28 primary care clinics randomised for participation in the study. Participants' GHQ-12 scores were compared with their psychiatric diagnosis based on face-to-face clinical interviews with GPs using the CIS-R. Exploratory and Confirmatory Factor Analyses determined the construct validity of the GHQ-12 in this population. The appropriate threshold score of the GHQ-12 as a screening tool in primary care was determined using the receiver operating curve. Prior to data collection, a focus group discussion was held with research assistants who piloted the screening procedure, GPs, and a psychiatrist, to evaluate the practicality of embedding screening within the routine clinic procedures. RESULTS: Of all primary care patients attending the clinics during the recruitment period, 26.7% agreed to participate (676/2532 consecutive patients approached). Their median age was 46 (range 18-82 years); 67% were women. The median GHQ-12 score for our primary care sample was 2, with an interquartile range of 4. The internal consistency of the GHQ-12 was good (Cronbach's α = 0.76). Four factor structures were fitted on the data. The GHQ-12 was found to best fit a one-dimensional model, when response bias is taken into consideration. Results from the ROC curve indicated that the GHQ-12 is 'fairly accurate' when discriminating primary care patients with indication of mental disorders from those without, with average AUC of 0.78. The optimal threshold of the GHQ-12 was either 1/2 or 2/3 point depending on the intended utility, with a Positive Predictive Value of 0.68 to 0.73 respectively. The screening procedure was successfully embedded into routine patient flow in the 28 clinics. CONCLUSIONS: The Indonesian version of the GHQ-12 could be used to screen primary care patients at high risk of mental disorders although with significant false positives if reasonable sensitivity is to be achieved. While it involves additional administrative burden, screening may help identify future users of mental health services in primary care that the country is currently expanding.

Predictors and moderators of burden of care and emotional distress in first-episode psychosis caregivers: results from the GET UP pragmatic cluster randomised controlled trial.

AIMS: First-episode psychosis (FEP) is a major life event and can have an adverse impact on the diagnosed individual and their families. The importance of intervening early and providing optimal treatments is widely acknowledged. In comparison to patient groups, literature is scarce on identifying treatment predictors and moderators of caregiver outcomes. This study aimed to identify pre-treatment characteristics predicting and/or moderating carer outcomes, based on data from a multi-element psychosocial intervention to FEP patients and carers (GET-UP PIANO trial). METHODS: Carer demography, type of family relationship, patient contact hours, pre-treatment carer burden, patient perceptions of parental caregiving and expressed emotion (EE) were selected, a priori, as potential predictors/moderators of carer burden and emotional distress at 9 months post treatment. Outcomes were analysed separately in mixed-effects random regression models. RESULTS: Analyses were performed on 260 carers. Only patient perceptions of early maternal criticism predicted reports of lower carer burden at follow-up. However, multiple imputation analysis failed to confirm this result. For treatment moderators: higher levels of carer burden at baseline yielded greater reductions in carer emotional distress at follow-up in the experimental group compared with treatment as usual (TAU). Higher levels of perceived EE moderated greater reductions in carer reports of tension in experimental group, compared with TAU, at follow-up. In younger caregivers (<51 years old), there were greater reductions in levels of worry during the baseline to follow-up period, within the experimental group compared with TAU. CONCLUSION: The study failed to identify significant treatment predictors of FEP carer outcomes. However, our preliminary findings suggest that optimal treatment outcomes for carers at first episode might be moderated by younger carer age, and carers reporting higher baseline levels of burden, and where patients perceive higher levels of negative effect from caregivers.

V348I mutation in UL23 gene of human herpesvirus 1 in a case of herpetic hepatitis and haemophagocytic lymphohistiocytosis.

We herein report the case of a young immunocompetent adult patient with a rapidly fatal haemophagocytic lymphohistiocytosis syndrome related to human herpesvirus 1 (HHV-1) infection, with herpetic hepatitis and persistent high-level viraemia despite treatment with acyclovir. Haemophagocytic lymphohistiocytosis was confirmed in the patient's spleen and bone marrow. HHV-1 DNA was extracted from whole blood and liver biopsy and the UL23 gene was sequenced. A V348I natural polymorphism of the TK protein was found in blood and liver specimens. Further studies are needed to investigate the role of this polymorphism in the development of systemic immune dysregulation.

Pathogenesis and inflammatory response in experimental caprine mastitis due to Staphylococcus chromogenes.

Coagulase-negative staphylococci (CNS) are the most frequently isolated bacteria in cases of subclinical mastitis in dairy cows. CNS species may differ in their pathogenicity, but very little is known about their virulence factors or their immune response in intramammary infections. To our knowledge, no experimental studies into the mastitis pathogenesis caused by CNS have been described in lactating goats. The aim of this study was to induce an experimentally Staphylococcus chromogenes mastitis in lactating goats aimed at verifying if the model can be used to evaluate the inflammatory response, the dynamics of infection and the pathological findings within the first hours of intramammary inoculation. Six Saanen goats in mid-lactation were inoculated with 1 × 107 colony forming units of S. chromogenes. Bacterial growth peaked in milk from the challenged right halves of the mammary glands (RMG) at 4 h post inoculation (PI). Shedding of viable bacteria showed a marked decrease at 12 h PI. An increase in mean somatic cell counts was observed in the milk samples from 8 h PI onwards. Mild clinical signs were evoked by intramammary inoculation. Staphylococcus chromogenes could be isolated in tissue from all RMG. Histological examination of specimens of the RMG and lymph nodes of the goats showed an increased inflammatory response throughout the experiment with respect to control halves. In conclusion, the experimental inoculation of S. chromogenes in lactating goats is capable of eliciting an inflammatory response and capable of causing pathological changes. This research represents a preliminary study for a better knowledge of the mastitis pathogenesis caused by S. chromogenes.

Stress, health and quality of life of female migrant domestic workers in Singapore: a cross-sectional study.

BACKGROUND: There is a global increase in migrant workers. In Singapore, there are over 230,000 migrant domestic workers (MDWs). Female MDWs may experience high levels of stress and social isolation, which may negatively impact on their health and quality of life. There have also been documented cases of abuse and exploitation. However, there is a lack of empirical research with this population. This study aimed to investigate factors impacting on the health and quality of life of female MDWs in Singapore, including socio-demographic and job related characteristics, stress, social isolation, and working management style. METHODS: A cross-sectional survey was carried out with 182 female MDWs in Singapore. The survey examined health and quality of life (WHOQoL-Bréf), social connectedness (the Friendship Scale), and preferred and experienced working management style (the Theory X and Theory Y Questionnaire). Descriptive analyses were carried out in addition to ANOVA, t-tests, and chi-square tests, followed by a multivariate analysis using linear regression. RESULTS: Participants were found to have good overall quality of life and satisfaction with health. Age and working experience were found to be significantly (p < 0.05) associated with overall quality of life and three domains (psychological, social, and environmental health). Agreement between experienced and preferred working management style was also found to be associated with higher quality of life scores (with the exception of the social relationships domain). Though women reported relatively good overall quality of life, more than half of participants reported feeling stressed. In addition, nearly 20% of participants reported being isolated or very isolated. Stress was identified to be associated with isolation. In the multivariate analysis, stress was found to contribute to worse quality of life in all domains except social relationships, after adjusting for confounders. Social connectedness was positively associated with all domains of quality of life, and agreement of working management style was positively associated with physical health, psychological health and environmental quality of life. CONCLUSIONS: The findings serve as an evidence-base pointing to the need for policies aimed at decreasing stress and social isolation among female MDWs in order to improve their health and quality of life.

Do Riparian Buffers Protect Stream Invertebrate Communities in South American Atlantic Forest Agricultural Areas?

We investigated the influence and relative importance of insecticides and other agricultural stressors in determining variability in invertebrate communities in small streams in intensive soy-production regions of Brazil and Paraguay. In Paraguay we sampled 17 sites on tributaries of the Pirapó River in the state of Itapúa and in Brazil we sampled 18 sites on tributaries of the San Francisco River in the state of Paraná. The riparian buffer zones generally contained native Atlantic forest remnants and/or introduced tree species at various stages of growth. In Brazil the stream buffer width was negatively correlated with sediment insecticide concentrations and buffer width was found to have moderate importance in mitigating effects on some sensitive taxa such as mayflies. However, in both regions insecticides had low relative importance in explaining variability in invertebrate communities, while various habitat parameters were more important. In Brazil, the percent coverage of soft depositional sediment in streams was the most important agriculture-related explanatory variable, and the overall stream-habitat score was the most important variable in Paraguay streams. Paraguay and Brazil both have laws requiring forested riparian buffers. The ample forested riparian buffer zones typical of streams in these regions are likely to have mitigated the effects of pesticides on stream invertebrate communities. This study provides evidence that riparian buffer regulations in the Atlantic Forest region are protecting stream ecosystems from pesticides and other agricultural stressors. Further studies are needed to determine the minimum buffer widths necessary to achieve optimal protection.

Influence of childhood trauma on diagnosis and substance use in first-episode psychosis.

BackgroundChildhood trauma has been significantly associated with first-episode psychosis, affective dysfunction and substance use.AimsTo test whether people with first-episode psychosis who had experienced childhood trauma, when compared with those who had not, showed a higher rate of affective psychosis and an increased lifetime rate of substance use.MethodThe sample comprised 345 participants with first-episode psychosis (58% male, mean age 29.8 years, s.d. = 9.7).ResultsSevere sexual abuse was significantly associated with a diagnosis of affective psychosis (χ2 = 4.9, P = 0.04) and with higher rates of lifetime use of cannabis (68% v 41%; P = 0.02) and heroin (20% v 5%; P = 0.02). Severe physical abuse was associated with increased lifetime use of heroin (15% v 5%; P = 0.03) and cocaine (32% v 17%; P = 0.05).ConclusionsPatients with first-episode psychosis exposed to childhood trauma appear to constitute a distinctive subgroup in terms of diagnosis and lifetime substance use.

Species at Risk (SPEAR) index indicates effects of insecticides on stream invertebrate communities in soy production regions of the Argentine Pampas.

We investigated relationships among insecticides and aquatic invertebrate communities in 22 streams of two soy production regions of the Argentine Pampas over three growing seasons. Chlorpyrifos, endosulfan, cypermethrin, and lambda-cyhalothrin were the insecticides most frequently detected in stream sediments. The Species at Risk (SPEAR) pesticide bioassessment index (SPEARpesticides) was adapted and applied to evaluate relationships between sediment insecticide toxic units (TUs) and invertebrate communities associated with both benthic habitats and emergent vegetation habitats. SPEARpesticides was the only response metric that was significantly correlated with total insecticide TU values for all three averaged data sets, consistently showing a trend of decreasing values with increasing TU values (r2=0.35 to 0.42, p-value=0.001 to 0.03). Although pyrethroids were the insecticides that contributed the highest TU values, toxicity calculated based on all insecticides was better at predicting changes in invertebrate communities than toxicity of pyrethroids alone. Crustaceans, particularly the amphipod Hyalella spp., which are relatively sensitive to pesticides, played a large role in the performance of SPEARpesticides, and the relative abundance of all crustaceans also showed a significant decreasing trend with increasing insecticide TUs for two of three data sets (r2=0.30 to 0.57, p-value=0.003 to 0.04) examined. For all data sets, total insecticide TU was the most important variable in explaining variance in the SPEARpesticides index. The present study was the first application of the SPEAR index in South America, and the first one to use it to evaluate effects of pesticides on invertebrate communities associated with aquatic vegetation. Although the SPEAR index was developed in Europe, it performed well in the Argentine Pampas with only minor modifications, and would likely improve in performance as more data are obtained on traits of South American taxa, such as pesticide sensitivity and generation time.

Discrimination in the workplace, reported by people with major depressive disorder: a cross-sectional study in 35 countries.

OBJECTIVE: Whereas employment has been shown to be beneficial for people with Major Depressive Disorder (MDD) across different cultures, employers' attitudes have been shown to be negative towards workers with MDD. This may form an important barrier to work participation. Today, little is known about how stigma and discrimination affect work participation of workers with MDD, especially from their own perspective. We aimed to assess, in a working age population including respondents with MDD from 35 countries: (1) if people with MDD anticipate and experience discrimination when trying to find or keep paid employment; (2) if participants in high, middle and lower developed countries differ in these respects; and (3) if discrimination experiences are related to actual employment status (ie, having a paid job or not). METHOD: Participants in this cross-sectional study (N=834) had a diagnosis of MDD in the previous 12 months. They were interviewed using the Discrimination and Stigma Scale (DISC-12). Analysis of variance and generalised linear mixed models were used to analyse the data. RESULTS: Overall, 62.5% had anticipated and/or experienced discrimination in the work setting. In very high developed countries, almost 60% of respondents had stopped themselves from applying for work, education or training because of anticipated discrimination. Having experienced workplace discrimination was independently related to unemployment. CONCLUSIONS: Across different countries and cultures, people with MDD very frequently reported discrimination in the work setting. Effective interventions are needed to enhance work participation in people with MDD, focusing simultaneously on decreasing stigma in the work environment and on decreasing self-discrimination by empowering workers with MDD.

Influence of Typha domingensis in the removal of high P concentrations from water.

A greenhouse experiment was conducted to evaluate the removal of high P concentration from water by vegetated and unvegetated wetlands. Reactors containing 4 kg of sediment and two plants of Typha domingensis (vegetated treatments) and reactors containing only sediment (unvegetated treatments) were arranged. Reactors were dosed with 100 and 500 mg L(-1) of P-PO4. The studied concentrations tried to simulate an accidental dump. Controls without P addition were also disposed. Water samples were collected periodically and analyzed for phosphorus. Sediment (0-3 (surface), 3-7 (medium) and 7-10 cm (deep)) and plant samples (roots, rhizomes, submerged leaves and aerial leaves) were collected at the beginning and at end of the experiment and were analyzed for total phosphorus. P fractionation was performed in the surface sediment layer. Relative growth rate (RGR) was calculated in each treatment considering initial and final plant height. P was efficiently removed from water in both, vegetated and unvegetated treatments. However, the major P removal was achieved in vegetated treatments. T. domingensis has a high capacity to tolerate and accumulate high P concentrations, especially in leaves, causing P accumulation in sediment to be significantly low in vegetated treatments. P accumulation was produced in the surface sediment layer (0-3 cm) in all treatments, mainly retained as iron-bound P. Present results point the large removal capacity of phosphate of systems planted with T. domingensis. Therefore T. domingensis is suitable for phytoremediation practice, being capable to tolerate high P concentration.

A standardised tool for assessing needs in forensic psychiatric population: clinical validation of the Italian CANFOR, staff version.

BACKGROUND: The Camberwell Assessment of Need - Forensic Version (CANFOR) is a standardised assessment tool specifically designed to assess needs for care in forensic psychiatric populations. The original English version of the instrument has shown good psychometric properties. The aim of this study was to validate the Italian version of the CANFOR-staff tool. METHOD: After translation and back-translation, the Italian CANFOR tool was administered to a sample of 50 forensic psychiatric patients. Convergent validity was tested using the Brief Psychiatric Rating Scale (BPRS) and the Global Assessment of Functioning (GAF) by applying Kendall's tau-b. Inter-rater and test-retest reliabilities were measured by ICCs for need dimensions (total and unmet) and Cohen's kappa coefficients for individual need items. RESULTS: Regarding convergent validity, a higher number of needs (total and unmet) were associated with more severe psychiatric symptoms (BPRS). Higher numbers of unmet needs were also associated with lower levels of global functioning (GAF). ICCs for total and unmet needs scores indicated a good level of agreement for inter-rater reliability and a very good level for test-retest, respectively. Regarding the specific items, inter-rater Cohen's kappa was high (moderate to very good agreement) for 18 items in relation to the presence of a need and for 15 items in the rating of an unmet need, whereas Cohen's kappa for test-retest reliability was very high for all the items in the presence of a need and high for 18 of the unmet need domains. CONCLUSIONS: The Italian version of CANFOR has adequate psychometric properties. It can be considered a promising instrument for the assessment of needs of forensic psychiatric patients.

Self-stigma as a mediator between social capital and empowerment among people with major depressive disorder in Europe: the ASPEN study.

INTRODUCTION: Individual social capital has been recognized as having an important role for health and well-being. We tested the hypothesis that poor social capital increases internalized stigma and, in turn, can reduce empowerment among people with major depressive disorder (MDD). MATERIALS AND METHODS: This is a cross-sectional multisite study conducted on a sample of 516 people with MDD in 19 European countries. Structural Equation Models were developed to examine the direct and indirect effects of self-stigma and social capital on empowerment. RESULTS: Social capital and self-stigma accounted for 56% of the variability in empowerment. Higher social capital was related to lower self-stigma (r=-0.72, P<0.001) which, in turn, partially mediated the relationship between social capital and empowerment (r=0.38, P<0.001). CONCLUSIONS: Social capital plays a key role in the appraisal of empowerment, both directly and through the indirect effect mediated by self-stigma. In order to improve empowerment of people with MDD, we identify strategies to foster individual social capital, and to overcome the negative consequences related to self-stigma for attainment of life goals.

Rapid reconstitution of functionally active 6-sulfoLacNAc(+) dendritic cells (slanDCs) of donor origin following allogeneic haematopoietic stem cell transplant.

The role of dendritic cells (DCs) and macrophages in allogeneic haematopoietic stem cell transplant (HSCT) is critical in determining the extent of graft-versus-host response. The goal of this study was to analyse slanDCs, a subset of human proinflammatory DCs, in haematopoietic stem cell (HSC) sources, as well as to evaluate their 1-year kinetics of reconstitution, origin and functional capacities in peripheral blood (PB) and bone marrow (BM) of patients who have undergone HSCT, and their presence in graft-versus-host disease (GVHD) tissue specimens. slanDCs were also compared to myeloid (m)DCs, plasmacytoid (p)DCs and monocytes in HSC sources and in patients' PB and BM throughout reconstitution. slanDCs accounted for all HSC sources. In patients' PB and BM, slanDCs were identified from day +21, showing median frequencies comparable to healthy donors, donor origin and kinetics of recovery similar to mDCs, pDCs, and monocytes. Under cyclosporin treatment, slanDCs displayed a normal pattern of maturation, and maintained an efficient chemotactic activity and capacity of releasing tumour necrosis factor (TNF)-α upon lipopolysaccharide (LPS) stimulation. None the less, they were almost undetectable in GVHD tissue specimens, being present only in intestinal acute GVHD samples. slanDCs reconstitute early, being donor-derived and functionally competent. The absence of slanDCs from most of the GVHD-targeted tissue specimens seems to rule out the direct participation of these cells in the majority of the local reactions characterizing GVHD.

Executive functioning and psychopathological profile in relatives of individuals with deficit v. non-deficit schizophrenia: a pilot study.

Aims. Heterogeneity of schizophrenia is known to be reflected in neuropsychological functioning of patients, but its expression in relatives is understudied. This study aims at exploring relationship between executive functioning and clinical profiles of first-degree relatives of patients who are classified as having or not having the deficit subtype of schizophrenia (DSRELs v. non-DSRELs), with the prediction of greater executive impairment in DSRELs. Methods. DSRELs (n = 15) and non-DSRELs (n = 40) were compared with community controls (CCs, n = 55) on executive functioning measured by the Wisconsin Card Sorting Test (WCST) and the phonemic verbal fluency (PVF), and clinical measures. Effects of psychopathology and intelligence quotient (IQ) measures were investigated to determine their association with executive performance. Results. DSRELs showed more executive dysfunction on WCST and poorer social functioning than CCs and more severe negative symptoms than non-DSRELs. Differences on WCST-categories achieved (WCST-CA) remained significant after adjustment for clinical confounders and IQ. WCST-CA was associated with apathy and paranoid ideation only within the DSREL subgroup. Conclusions. Executive functioning and negative symptoms are severely impaired in first-degree relatives of deficit syndrome patients, thus suggesting that some neurocognitive deficits in patients may be transmitted within families according to the pathophysiology of the probands.

Abnormalities in amphibian populations inhabiting agroecosystems in Northeastern Buenos Aires Province, Argentina.

The occurrence of abnormalities in amphibians has been reported in many populations, and its increase could be related to environmental pollution and habitat degradation. We evaluated the type and prevalence of abnormalities in 5 amphibian populations from agroecosystems with different degrees of agricultural disturbance (cultivated and reference areas). We detected 9 types of abnormalities, of which the most frequent were those occurring in limbs. The observed prevalence of abnormality in assessed populations from cultivated and reference areas was as follows: Rhinella fernandezae (37.1 and 10.2%, respectively), Leptodactylus latrans adults (28.1 and 9.2%) and juveniles (32.9 and 15.3%), and Hypsiboas pulchellus (11.6 and 2.8%). Scinax granulatus populations did not show abnormalities. Pseudis minuta, which was only detected in the reference area, exhibited a prevalence of 13.3%. For R. fernandezae, L. latrans, and H. pulchellus, generalized linear mixed models showed that prevalence of abnormalities was significantly higher (p < 0.05) in cultivated than in reference areas. L. latrans juveniles were more vulnerable to abnormalities than adults (p < 0.05). The presence of abnormalities in some species inhabiting different agroecosystems suggests that environmental stress factors might be responsible for their occurrence. While we detected pesticides (endosulfan, cypermethrin, and chlorpyrifos) and lower dissolved oxygen levels in ponds of the cultivated area, no data are currently available on how other factors, such as injuries from predators and parasite infections, vary by land use. Further research will be necessary to evaluate possible causes of abnormalities detected in the present study mainly in the context of factor interactions.

A new generation of pragmatic trials of psychosocial interventions is needed.

This Editorial addresses the crucial issue of which research methodology is most suited for capturing the complexity of psychosocial interventions conducted in 'real world' mental health settings. It first examines conventional randomized controlled trial (RCT) methodology and critically appraises its strengths and weaknesses. It then considers the specificity of mental health care treatments and defines the term 'complex' intervention and its implications for RCT design. The salient features of pragmatic RCTs aimed at generating evidence of psychosocial intervention effectiveness are then described. Subsequently, the conceptualization of pragmatic RCTs, and of their further developments - which we propose to call 'new generation' pragmatic trials - in the broader routine mental health service context, is explored. Helpful tools for planning pragmatic RCTs, such as the CONSORT extension for pragmatic trials, and the PRECIS tool are also examined. We then discuss some practical challenges that are involved in the design and implementation of pragmatic trials based on our own experience in conducting the GET UP PIANO Trial. Lastly, we speculate on the ways in which current ideas on the purpose, scope and ethics of mental health care research may determine further challenges for clinical research and evidence-based practice.

Psychosis Incident Cohort Outcome Study (PICOS). A multisite study of clinical, social and biological characteristics, patterns of care and predictors of outcome in first-episode psychosis. Background, methodology and overview of the patient sample.

AIMS: This paper aims at providing an overview of the background, design and initial findings of Psychosis Incident Cohort Outcome Study (PICOS). METHODS: PICOS is a large multi-site population-based study on first-episode psychosis (FEP) patients attending public mental health services in the Veneto region (Italy) over a 3-year period. PICOS has a naturalistic longitudinal design and it includes three different modules addressing, respectively, clinical and social variables, genetics and brain imaging. Its primary aims are to characterize FEP patients in terms of clinical, psychological and social presentation, and to investigate the relative weight of clinical, environmental and biological factors (i.e. genetics and brain structure/functioning) in predicting the outcome of FEP. RESULTS: An in-depth description of the research methodology is given first. Details on recruitment phase and baseline and follow-up evaluations are then provided. Initial findings relating to patients' baseline assessments are also presented. Future planned analyses are outlined. CONCLUSIONS: Both strengths and limitations of PICOS are discussed in the light of issues not addressed in the current literature on FEP. This study aims at making a substantial contribution to research on FEP patients. It is hoped that the research strategies adopted in PICOS will enhance the convergence of methodologies in ongoing and future studies on FEP.

The influence of gender on clinical and social characteristics of patients at psychosis onset: A report from the Psychosis Incident Cohort Outcome Study (PICOS).

BACKGROUND. This paper examined the hypothesis that males with first-episode psychosis (FEP) experience lower pre-morbid adjustment, greater social disability and more self-perceived needs at illness onset than females(by controlling for duration of untreated psychosis, diagnosis, age and symptoms at onset). Results disconfirming this hypothesis were thought to suggest the potentially mediating role of social context in determining the impact of symptoms and disability on the everyday lives of male patients in the early phase of psychosis. METHOD. A large epidemiologically representative cohort of FEP patients (n=517) was assessed within the Psychosis Incident Cohort Outcome Study (PICOS) framework ­ a multi-site research project examining incident cases of psychosis in Italy's Veneto region. RESULTS. Despite poorer pre-morbid functioning and higher social disability at illness onset, males reported fewer unmet needs in the functioning domain than females did. An analysis of help provided by informal care givers showed that males received more help from their families than females did. This finding led us to disconfirm the second part of the hypothesis and suggest that the impact of poorer social performance and unmet needs on everyday life observed in male patients might be hampered by higher tolerance and more support within the family context.CONCLUSIONS. These findings shed new light on rarely investigated sociocultural and contextual factors that may account for the observed discrepancy between social disability and needs for care in FEP patients. They also point to a need for further research on gender differences, with the ultimate aim of delivering gender-sensitive effective mental health care.