The network model of psychopathology suggests that central and bridge symptoms represent promising treatment targets because they may accelerate the deactivation of the network of interactions between the symptoms of mental disorders. However, the evidence confirming this hypothesis is scarce. This study re-analyzed a convenience sample of 51 cross-sectional psychopathological networks published in previous studies addressing diverse mental disorders or clinically relevant problems. In order to address the hypothesis that central and bridge symptoms are valuable treatment targets, this study simulated five distinct attack conditions on the psychopathological networks by deactivating symptoms based on two characteristics of central symptoms (degree and strength), two characteristics of bridge symptoms (overlap and bridgeness), and at random. The differential impact of the characteristics of these symptoms was assessed in terms of the magnitude and the extent of the attack required to achieve a maximum impact on the number of components, average path length, and connectivity. Only moderate evidence was obtained to sustain the hypothesis that central and bridge symptoms constitute preferential treatment targets. The results suggest that the degree, strength, and bridgeness attack conditions are more effective than the random attack condition only in increasing the number of components of the psychopathological networks. The degree attack condition seemed to perform better than the strength, bridgeness, and overlap attack conditions. Overlapping symptoms evidenced limited impact on the psychopathological networks. The need to address the basic mechanisms underlying the structure and dynamics of psychopathological networks through the expansion of the current methodological framework and its consolidation in more robust theories is stressed.

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Sjögren's syndrome (SS) is an autoimmune disease most commonly characterized by ocular and oral dryness. Despite the high prevalence of SS, generation and perpetuation of this disease is still unclear in many aspects. Inflammation, nonetheless, seems to play a central role in this pathology especially in the form of Th-1, Th-2 and Th-17 cytokines release within different aspects, concentrations and connections involved in the maintenance of the syndrome. Moreover, the chronically created pro-inflammatory environment appears to promote glandular atrophy and irreparable architectural modifications. The establishment of germinal centers (GC) in SS are considered the main reason for the 16-times increased probability of lymphoproliferative disease development in these patients. SS is also interconnected with numerous others auto-inflammatory and autoimmune diseases, many of them representing the first clear sign of a dysregulated immune system. Despite the recent advances, treatment options are still insufficient. This overview aims to better elucidate this local and systemic disease, which can be of vital use not only for SS but also to other rheumatic pathological conditions.

Objectives To translate the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE) to the European Portuguese spoken language and to verify its reliability and validity. Methods Cultural adaptation and linguistic translation from English to European Portuguese, revision of translations, semantics equivalence, and grammar correction of the Portuguese wording were made. Readability of the Portuguese version was verified and the analysis of internal consistency and correlation with the subscale “physician–patient relationship” of the Portuguese version of European Task Force on Patient Evaluation of General Practice Care Scale (EuroPEP) were made. Reliability was tested by intertemporal stability and internal consistency. Validity of criteria and construction was also verified. Results The Portuguese translation was adapted to the 8th or 9th grade level, easy to understand. There was the need to change the visual appearance of the scale, answers below sentences. Interclass correlation coefficient for reliability varied between 0.737 and 1.000 and Cronbach’s α between 0.806 and 0.877. Validity was verified by comparing values of socio-demographic variables for JSPPPE index and for EuroPEP with no differences. Correlation values between the total score and its five items varied from 0.806 to 0.934. Criterion validity against EuroPEP had a correlation of 0.831. Conclusion This study fulfilled the necessary steps to translate, verify the validity and the reliability of the Portuguese version of the JSPPPE, with minimum layout alteration. All five items were maintained. The authors recommend the use of the JSPPPE in research and clinical practice.