Feasibility and acceptability of psychosocial care forunsuccessful fertility treatment

Introduction Many people undergo fertility treatment to have biological children, but around four in ten patients complete all treatment cycles without having the children they desire. This triggers intense grief from which patients report taking on average 2 years to recover. Fertility guidelines and regulators stress the need to support patients through this process, but there is a scarcity of evaluated interventions to this end and evidence about when and how to offer care is lacking. This study explored patients' and healthcare professionals' (HCPs) experiences of and views about provision of psychosocial care (to patients facing unsuccessful fertility treatment, i.e., care provided by a mental health professional to address the emotional, cognitive, behavioural, relational and social needs that patients have at this stage of treatment). Methods Five qualitative online focus groups were conducted with Portuguese participants: three with patients waiting to initiate or undergoing their last cycle of in vitro fertilization/intracytoplasmic sperm injection or having completed it within the last 2 months without achieving a pregnancy and two with HCPs working at fertility clinics. Focus groups were recorded and transcribed verbatim, and data were analysed with Framework Analysis. Results Thirteen patients and nine HCPs participated. Analysis resulted in 1293 codes, systematically organized into 13 categories, 4 themes and 1 metatheme. The latter showed high consensus about the need for psychosocial care for unsuccessful treatment, but perceived challenges in its implementation. Themes reflected (1) consensual demand for psychosocial care at all stages of treatment but particularly at the end, (2) high perceived acceptability of integrating preventive care initiated during treatment with early psychosocial care only for those patients who experience unsuccessful treatment, (3) perceived challenges of implementing psychosocial care for unsuccessful treatment at clinics and (4) suggestions to promote its acceptability and feasibility. Conclusion Patients and HCPs perceive that clinics should improve care provision across the whole treatment pathway and in particular for unsuccessful fertility treatment. Suggestions were made to inform future research focusing on the development and evaluation of psychosocial interventions to this end. Patient or Public Contribution Patients and HCPs participated in the focus groups. Two HCPs also revised the manuscript.Thanks are due to nurse Cláudia Coelho for supporting this project and to patients and healthcare professionals who participated in the focus groups. The authors are also grateful to the European Social Fund and Portuguese Foundation for Science and Technology, I.P. (FCT; Fundação para a Ciência e a Tecnologia) for supporting the present study, through the Portuguese State Budget. Mariana Sousa-Leite has a doctoral fellowship (SFRH/BD/144429/2019), Raquel Costa has a postdoctoral fellowship (SFRH/BPD/117597/2016), and the EPI Unit, ITR and CIPsi (PSI/01662) are also funded by FTC, in the scope of the projects UIDB/04750/2020, LA/P/0064/2020 and UIDB/PSI/01662/2020, respectively

Uma visão crítica sobre a utilização de cortinas de ar em estabelecimentos comerciais climatizados

Tendo por base um conjunto de ensaios realizados numa instalação experimental especialmente concebida para o efeito, é avaliada a influência de alguns parâmetros geométricos e dinâmicos sobre a eficácia da vedação térmica alcançada com a utilização de aparelhos de cortina de ar. A informação recolhida permitiu estabelecer diversas recomendações sobre a selecção, instalação e operação deste tipo de aparelho, as quais, na prática, nem sempre são seguidas, conforme se pode antever dos dados preliminares recolhidos em vistorias técnicas realizadas a estabelecimentos comerciais que utilizam este tipo de solução

A Paraneoplastic Syndrome to Remember: A Case of Disseminated Intravascular Coagulation in Lung Cancer

Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by the widespread activation of coagulation. It can present as an acute life-threatening emergency or as a chronic process. Mortality is highly dependent on the reversibility of the aetiology and degree of coagulation impairment, so treatment of the underlying cause is vital. The authors present the case of a 57-year-old man whose inaugural presentation of lung cancer was chronic DIC, characterized by three thrombotic events, followed by acute DIC, culminating in death. Metastatic lung cancer was diagnosed only after death

Structural study of the interaction of vanadate with the ligand 1,2-dimethyl-3-hydroxy-4-pyridinone (Hdmpp) in aqueous solution

The interaction of vanadate with the ligand 1,2-dimethyl-3-hydroxy-4-pyridinone (Hdmpp) was studied in aqueous solution using a combination of multinuclear NMR and EPR spectroscopies, as well as potentiometry and cyclic voltammetry. The different species in solution were identified and characterized, and their pKa values and stability constants determined. The vanadium complexes formed in solution are strongly dependent on media composition (ionic strength, presence of buffer), pH and metal-to-ligand ratio (M:L). Two major species -- V(V)/dmpp and V(V)/(dmpp)2 -- are formed in a 140 mM NaCl solution within the pH range 4.5 to 9.0, when M:L=1:2. In the presence of excess ligand (M:L<=1:5), only the 1:2 complex is present, and at pH<4 paramagnetic species are detected by EPR in solution, thus indicating a reducing capacity of the ligand. Cyclic voltammetry shows that redox processes in solution are not just electron transfer, but are accompanied by chemical reactions. The pKa values and stability constants were determined both by 51V NMR spectroscopy and potentiometry. The present results have a particular interest in the understanding of the aqueous solution chemistry in aerobic conditions of bis(1,2-dimethyl-3-hydroxy-4-pyridinonato) oxovanadium(IV) complex, VO(dmpp)2, a vanadium compound with potential insulin-mimetic properties.http://www.sciencedirect.com/science/article/B6TGG-40X8DKT-3C/1/3226f220763b348a4f3d74ae0fcd0e2

Feasibility randomized controlled trial of a self-guided online intervention to promote psychosocial adjustment to unmet parenthood goals

STUDY QUESTION Is it feasible to implement and evaluate an online self-guided psychosocial intervention for people with an unmet parenthood goal (UPG), aimed to improve well-being, in an online randomized controlled trial (RCT)? SUMMARY ANSWER The evaluation of an online bilingual self-guided psychosocial intervention for people with a UPG is feasible, reflected by high demand, good acceptability, good adaptation and promise of efficacy, but minor adjustments to the intervention and study design of the RCT should be made to enhance practicality. WHAT IS KNOWN ALREADY Self-identifying as having a UPG, defined as being unable to have children or as many as desired, is associated with impaired well-being and mental health. Practice guidelines and regulatory bodies have highlighted the need to address the lack of evidence-based support for this population. It is unknown if MyJourney (www.myjourney.pt), the first online self-guided intervention for people with UPGs, can be implemented and evaluated in an RCT. STUDY DESIGN, SIZE, DURATION To evaluate the feasibility of MyJourney, we conducted a registered, two-arm, parallel group, non-blinded feasibility RCT, with a 1:1 computer-generated randomized allocation and embedded qualitative process evaluation. Participants were included between November 2020 and March 2021. Assessments were made before randomization (T1), 10 weeks (T2) and 6 months after (T3, intervention group only). Participants allocated to the intervention group received an email to access MyJourney immediately after randomization. Participants in the waitlist control group were given access to MyJourney after completing the 10-week assessment (T2). PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were recruited via social media advertising of MyJourney and its feasibility study. People who self-identified as having a UPG could click on a link to participate, and of these 235 were randomized. Outcome measures related to demand, acceptability, implementation, practicality, adaptation and limited efficacy were assessed via online surveys. The primary outcome in limited efficacy testing was hedonic well-being, measured with the World Health Organisation Wellbeing Index (WHO-5). MAIN RESULTS AND THE ROLE OF CHANCE Participation and retention rates were 58.3%, 31.7% (T2) and 45.2% (T3, intervention group only), respectively. Of participants invited to register with MyJourney, 91 (76.5%) set up an account, 51 (47.2%) completed the first Step of MyJourney, 12 (11.1%) completed six Steps (sufficient dose) and 6 (5.6%) completed all Steps within the 10-week recommended period. Acceptability ranged from 2.79 (successful at supporting) to 4.42 (easy to understand) on a 1 (not at all) to 5 (extremely acceptable) scale. Average time to complete sufficient dose was 15.6 h (SD = 18.15) and to complete all Steps was 12.4 h (SD = 18.15), with no differences found for participants using MyJourney in Portuguese and English. Modified intention-to-treat analysis showed a moderate increase in well-being from T1 to T2 in the intervention group (ηp2 = 0.156, mean difference (MD) = 9.300 (2.285, 16.315)) and no changes in the control group (ηp2 = 0.000, MD = 0.047 (−3.265, 3.358)). Participants in the process evaluation reported MyJourney was needed and answered their needs for support (reflecting high demand and acceptability), the recommended period to engage with MyJourney was short, and their engagement was influenced by multiple factors, including personal (e.g. lack of time) and MyJourney related (e.g. reminders). LIMITATIONS, REASONS FOR CAUTION Participants were mostly white, well-educated, employed, childless women. Non-blinded allocation, use of self-reported questionnaire assessments and high attrition in the intervention group could have triggered bias favourable to positive evaluations of MyJourney and resulted in low power to detect T2 to T3 changes in limited efficacy outcomes. WIDER IMPLICATIONS OF THE FINDINGS MyJourney can proceed to efficacy testing, but future work should eliminate barriers for engagement and explore strategies to maximize adherence. Entities wanting to support people with UPGs now have a freely accessible and promising resource that can be further tested and evaluated in different settings

Fatores preditores do fenômeno de reinternações de pacientes esquizofrênicos, com transtorno afetivo e psicose não orgânica

OBJECTIVE: The aim of the study was to identify the variables that predict the revolving door phenomenon in psychiatric hospital at the moment of a second admission. METHODS: The sample consisted of 3,093 patients who have been followed during 5 to 24 years after their first hospital admission due to schizophrenia, and affective or psychotic disorders. Those who had had four or more admissions during the study period were considered as revolving door patients. Logistic regression analyses were used to assess the impact of gender, age, marital status, urban conditions, diagnosis, mean period of stay on the first admission, interval between the first and second admissions on the patterns of hospitalization. RESULTS: The variables with the highest predictive power for readmission were the interval between first and second admissions, and the length of stay in the first admission. CONCLUSIONS: These data may help public health planners in providing optimal care to a small group of patients with more effective utilization of the available services.OBJETIVO: Identificar as variáveis preditoras do fenômeno de reinternações (recidividade) em hospital psiquiátrico no momento da segunda internação. MÉTODOS: A amostra consistiu em 3.093 pacientes com diagnósticos de esquizofrenia, transtorno afetivo e psicose não orgânica acompanhados durante um período de, no mínimo, 5 anos e, no máximo, 24 anos. Foram considerados pacientes recidivistas os que tiveram 4 ou mais internações no período do estudo. Foi utilizado o modelo de regressão logística para análise do impacto das variáveis sexo, idade, estado civil, cidade de residência, diagnóstico, tempo de permanência na primeira internação, tempo entre a primeira e a segunda internação, segundo o padrão de re-hospitalização. RESULTADOS: As variáveis com maior poder de predição foram tempo entre a primeira e a segunda internação, tempo de permanência na primeira internação e diagnóstico de esquizofrenia. CONCLUSÕES: Os resultados são importantes para o planejamento de saúde pública, com o intuito de promover melhores cuidados a um grupo de pacientes pequeno, mas com um alto impacto na utilização do serviço

The persistence landscape and some of its properties

Persistence landscapes map persistence diagrams into a function space, which may often be taken to be a Banach space or even a Hilbert space. In the latter case, it is a feature map and there is an associated kernel. The main advantage of this summary is that it allows one to apply tools from statistics and machine learning. Furthermore, the mapping from persistence diagrams to persistence landscapes is stable and invertible. We introduce a weighted version of the persistence landscape and define a one-parameter family of Poisson-weighted persistence landscape kernels that may be useful for learning. We also demonstrate some additional properties of the persistence landscape. First, the persistence landscape may be viewed as a tropical rational function. Second, in many cases it is possible to exactly reconstruct all of the component persistence diagrams from an average persistence landscape. It follows that the persistence landscape kernel is characteristic for certain generic empirical measures. Finally, the persistence landscape distance may be arbitrarily small compared to the interleaving distance.Comment: 18 pages, to appear in the Proceedings of the 2018 Abel Symposiu

Predicting trajectories of behavioral adjustment in children diagnosed with acute lymphoblastic leukemia

Purpose Previous research showed that children with cancer are at risk for developing behavioral adjustment problems after successful treatment; however, the course of adjustment remains unclear. This study focuses on adjustment trajectories of children during treatment for acute lymphoblastic leukemia (ALL) and aims to distinguish subgroups of patients showing different trajectories during active treatment, and to identify sociodemographic, medical, and psychosocial predictors of the distinct adjustment trajectories. Methods In a multicenter longitudinal study, 108 parents of a child (response rate 80 %) diagnosed with ALL were assessed during induction treatment (T0), after induction/consolidation treatment (T1), and after end of treatment (T2). Trajectories of child behavioral adjustment (Child Behavior Checklist; CBCL) were tested with latent class growth modeling (LCGM) analyses. Results For internalizing behavior, a three-trajectory model was found: a group that experienced no problems (60 %), a group that experienced only initial problems (30 %), and a group that experienced chronic problems (10 %). For externalizing behavior, a three-trajectory model was also found: a group that experienced no problems (83 %), a group that experienced chronic problems (12 %), and a group that experienced increasing problems (5 %). Only parenting stress and baseline QoL (cancer related) were found to contribute uniquely to adjustment trajectories. Conclusions The majority of the children (77 %) showed no or transient behavioral problems during the entire treatment as reported by parents. A substantial group (23 %) shows maladaptive trajectories of internalizing behavioral problems and/or externalizing behavioral problems. Screening for risk factors for developing problems might be helpful in early identification of these children

Coordinated Multiwavelength Observations of V410Tau

In November 2001 we undertook a coordinated observing campaign to study the connection between X-ray and optical variability in the weak-line T Tauri star V410Tau. The observing plan included three 15 ksec observations with Chandra using the Advanced CCD Imaging Spectrometer for Spectroscopy scheduled for different phases of the known 1.87 d starspot cycle. Photometric and spectroscopic monitoring of V410Tau involving telescopes on three different continents was scheduled simultaneously with the Chandra exposures.Comment: 3 pages, Poster Proceedings of "1st Potsdam Thinkshop on Sunspots and Starspots", Potsdam, Germany, May 200

Urinary incontinence related to perineal muscle strength in the first trimester of pregnancy: cross-sectional study

Objective To analyze pelvic floor muscle strength (PFMS), urinary continence and quality of life related to urinary incontinence (UI) of women in the first trimester of pregnancy. Method Cross-sectional study with a sample of 500 women who started prenatal care in a complementary healthcare facility in Guarulhos, state of São Paulo, from 2012 and 2013. Pelvic floor muscle strength was evaluated through perineometry. The pregnant women who presented UI answered the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). Results It was found that maternal age (OR=1.06; CI95% 1.02-1.11) and prior UI (OR=15.12; 95%CI 8.19-27.92) are the variables that, in tandem, best explain the occurrence of UI at the beginning of pregnancy. The mean score on the ICIQ-SF was 8.2 (SD=3.9), considered a moderate impact on quality of life. Conclusion Older pregnant women with prior UI are more likely to have UI in the first trimester of pregnancy.
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