A user-centred approach to developing bWell, a mobile app for arm and shoulder exercises after breast cancer treatment

Purpose: The study aim was to develop a mobile application (app) supported by user preferences to optimise self-management of arm and shoulder exercises for upper-limb dysfunction (ULD) after breast cancer treatment. Methods: Focus groups with breast cancer patients were held to identify user needs and requirements. Behaviour change techniques were explored by researchers and discussed during the focus groups. Concepts for content were identified by thematic analysis. A rapid review was conducted to inform the exercise programme. Preliminary testing was carried out to obtain user feedback from breast cancer patients who used the app for 8 weeks post-surgery. Results: Breast cancer patients’ experiences with ULD and exercise advice and routines varied widely. They identified and prioritised several app features: tailored information, video demonstrations of the exercises, push notifications, and tracking and progress features. An evidence-based programme was developed with a physiotherapist with progressive exercises for passive and active mobilisation, stretching and strengthening. The exercise demonstration videos were filmed with a breast cancer patient. Early user testing demonstrated ease of use, and clear and motivating app content. Conclusions: bWell, a novel app for arm and shoulder exercises was developed by breast cancer patients, health care professionals and academics. Further research is warranted to confirm its clinical effectiveness. Implications for Cancer Survivors: Mobile health has great potential to provide patients with information specific to their needs. bWell is a promising way to support breast cancer patients with exercise routines after treatment and may improve future self-management of clinical care

Going with the Flow: Detection of Drift in Response to Hypo-Saline Stress by the Estuarine Benthic Diatom Cylindrotheca closterium

Avoidance response is a well-known mechanism for escaping environmental stress. For organisms with reduced active movement, such as benthic microalgae, drifting could be a specifically selected mean of avoiding less favorable environments. To test this hypothesis, a system was developed to assess if hypo-saline stress triggers drift in the estuarine benthic diatom Cylindrotheca closterium. Concurrently, the effects of salinity on growth inhibition were also investigated in order to compare the sensitivity of this endpoint with the drift response, and to estimate the immediate population decline caused by both drift and population growth responses. It was verified that the salinity value that inhibited the algal population growth by 50% (IGS50) was 19, while the salinity value that triggered the drift response by 50% of the population (TDS50) was 15. These results indicate that drift is an identifiable response triggered to escape stressful environments. The combination of the two responses (population growth and drift) showed that population decline based exclusively on the inhibition of population growth may result in an underestimation of the risk, compared with the decline when drifting to avoid stress is also taken into account.This study was partially funded by the “Fundação para a Ciência e a Tecnologia” (FCT, Portugal) through a postdoctoral fellowship (reference SFRH/BPD/74044/2010) to C.V.M. Araújo, through the SALTFREE project (contract PTDC/AAC-CLI/111706/2009) and through “Ciência 2007 - Human Potential Operational Program” (POPH) and “Quadro de Referência Estratégico Nacional” (QREN) through the European Social Fund (ESF) and the Spanish Ministry of Education and Science (MEC) funds

Recent invasion by a non-native cyprinid (common bream Abramis brama) is followed by major changes in the ecological quality of a shallow lake in southern Europe

We present an example of how an invasion by a non-native cyprinid (common bream, Abramis brama (Pisces: Cyprinidae), hereafter bream) in a natural shallow lake in southern Europe (Lake Montorfano, northern Italy) may have adversely affected the state of the lake’s ecosystem. In less than two decades, bream became the most abundant species and characterized by a stunted population with asymptotic length 33.5 cm, an estimated mean length at first maturity of 19.6 cm, a total mortality rate of 0.64 year−1 and a diet overwhelmingly dominated by microcrustaceans. Following bream establishment, nutrients and phytoplankton biomass rose, the proportion of Cyanobacteria by numbers increased markedly and water transparency decreased. Total zooplankton abundance increased with a marked increase in small cladocerans and copepods, whereas the abundance of large herbivorous cladocerans did not change. The coverage of submerged macrophytes declined, as did the abundance of native pelagic zooplanktivorous fish. The composition of the fish community shifted towards a higher proportion of zoobenthivorous species, such as bream and pumpkinseed (Lepomis gibbosus). Our results indicate that bream affected water quality through bottom-up mechanisms, while top-down effects were comparatively weak. Selective removal of bream and perhaps stocking of native piscivores might improve the ecological status of the lake

Situação de crianças e adolescentes brasileiros em relação à saúde mental e à violência The situation of Brazilian children and adolescents with regard to mental health and violence

Este artigo reflete sobre as violências cometidas contra crianças e adolescentes brasileiros e suas repercussões sobre a saúde mental, propondo um debate sobre a necessidade das políticas públicas de saúde priorizarem temáticas de tamanha relevância. No país, tem-se verificado que a discussão dos temas "violência e problemas de saúde mental em crianças e adolescentes" vem ocorrendo de forma fragmentada e pouco consistente. Este trabalho traz uma seleção não sistemática de estudos epidemiológicos desenvolvidos em escolas e comunidades brasileiras sobre o assunto. A ampla variedade e a prevalência da violência familiar e comunitária e dos problemas de saúde mental são apontadas, ressaltando-se as diferenças metodológicas dos métodos de aferição e a concentração de estudos nas regiões sul e sudeste do país. A ainda escassa rede de atendimento para os problemas aqui tratados é sinalizada, assim como a falta de preocupação com a prevenção do transtorno mental e com a promoção da saúde mental.<br>This article reflects about the situation of mental health and violence against Brazilian children and adolescents, proposing a discussion about the need for public health policies including these extremely relevant issues in their priority agenda. In Brazil, the debate about this problem has occurred in a fragmented and not very consistent way. This article presents a non-systematic selection of epidemiological investigations on this subject conducted in Brazilian schools and communities. The great variety and prevalence of familiar and community violence and of mental health problems is pointed out and the methodological differences between the studies and the concentration of studies in the South and Southeastern regions of the country are emphasized. The article still highlights to the scarce service network for dealing with this kind of problem and the lack of concern with the prevention of mental disorders and promotion of mental health