'What if we never make it!? What's going to happen to us?': Routine psychosocial care to promote patients' adjustment to the end of unsuccessful fertility treatment

Around four in every ten people undergoing in vitro fertilisation (IVF) end treatment without a live birth - referred to as end of unsuccessful fertility treatment (EoT). There is a lack of accessible, evidence-based care to support these patients. The present thesis aimed to develop and evaluate psychosocial care initiatives to promote patients’ adjustment to EoT, including preventive (i.e., to inform and prepare patients for EoT) and early intervention (i.e., to support patients in the aftermath of EoT) care. The work followed the Medical Research Council (MRC) framework to develop complex interventions. A cross-sectional mixed-methods online survey investigated patients’ willingness and preferences to receive EoT psychosocial care. Cross-sectional focus groups, a prospective pilot feasibility single-arm trial, and a definitive registered (ISRCTN85897617) multicentre RCT, evaluated the acceptability, feasibility and efficacy of Beyond Fertility: a brief face-to-face psychosocial intervention integrating EoT preventive and early intervention care. Cross-sectional multi-country focus groups with stakeholders’ involvement evaluated the acceptability and feasibility of multi-lingual web-based educational resources to promote the routine implementation of EoT preventive care at fertility clinics. Results showed stakeholders’ high acceptability and demand for routine EoT psychosocial care at clinics; patients’ high willingness to receive EoT preventive care early in treatment, but staff’s concerns about its adequacy; Beyond Fertility was considered needed and acceptable; RCT-modified intention to treat analysis revealed Beyond Fertility was not efficacious in ameliorating declines in quality of life (primary outcome), mental health and well-being (secondary outcomes); Implementation practicalities regarding identifying iii patients reaching the treatment ends; web-based resources were considered highly needed and adequate (now freely accessible for public use). Findings suggest a need for a normative change in fertility clinics towards the routine implementation of EoT preventive and early intervention care, providing foundational knowledge about the acceptability, feasibility and efficacy of its content, time and delivery mode. Keywords: Assisted reproductive technology, IVF, end of unsuccessful fertility treatment, intervention development and evaluation, preventive care, early intervention care, quality of life, mental health, well-being

Fertility preservation to prevent age-related fertility decline: systematic review

Background: Fertility Preservation (FP) to prevent age-related fertility decline has been subject of great discussion, concerning ethical, legal and religious questions. The present study aims to provide a systematic revision of the contributes in the literature on fertility preservation to prevent age-related fertility decline, namely on 1) what characterize women that consider FP but did not make a decision yet and the women that have actually done it, specifically their individual characteristics and reasons, as well as 2) the knowledge and attitudes of the general practitioners (GPs) about FP, since they are the first-line agents in its disclosure. Methods: An electronic search in three databases was performed, following the procedure of PRISMA, using the keywords: (“oocyte freezing”, “cryopreserve oocytes”, “fertility preservation”, “oocyte vitrification”) and (“age-related fertility decline”, “agerelated fertility loss”, “decline in fertility age”). Nine studies were selected and included in this systematic review. Results: The percentage of women who considered FP as a future option varied according to the studies (15.1% - 31.5%). Women generally performed cryopreservation of oocytes at a later age (approximately 36 to 38 years old) from the recommended period to optimize the technique. The desire to find a suitable partner to share parenting was the main reason that led the women to perform this procedure. In general, GPs have a limited knowledge on FP. Conclusions: In order to provide the necessary conditions for women of childbearing age to make conscious and informed reproductive decisions, fertility procedures need to be more disseminated, namely toward GPs

Avaliação de um modelo de intervenção em crise no uso de substâncias psicoativas

Este trabalho tem como objectivo contribuir para a avaliação do programa Kosmicare, um programa de intervenção na crise induzida por substâncias psicoactivas, implementado num grande festival bienal de música electrónica que acontece em Portugal no período do verão. Os dados recolhidos dizem respeito à edição de 2010 do referido festival. A avaliação deste programa é feita tanto através da avaliação de processo, que visa compreender até que ponto a intervenção decorreu como o esperado, como da avaliação dos resultados, que nos permite inferir se a intervenção permitiu alcançar os objectivos do programa. A metodologia de avaliação adoptada é mista para conseguirmos adquirir uma percepção do fenómeno mais ampla (Ramos, 2006). Neste sentido, utilizamos tanto a estatística descritiva como a análise de conteúdo no tratamento dos dados. A avaliação do Kosmicare permitiu-nos verificar que os programas que implementam este tipo de intervenção são na prática muito mais do que um serviço para a intervenção em crise relacionada com o uso de substâncias. A concepção de crise neste contexto específico de intervenção é muito mais ampla e multideterminada devido às diferentes variantes de crise e de situações às quais estes programas têm de dar resposta: crise induzida pela experiência intencional ou acidental com substâncias psicoativas, crise mental com uso de substâncias, crise mental sem uso de substâncias, situações de não crise e crise pessoal sem uso de substâncias. Sendo ainda um campo pouco explorado, não existe consenso quanto ao espaço da intervenção em crise no contexto dos níveis de intervenção já conhecidos para o campo dos usos de substâncias. Os resultados deste trabalho reforçam, no entanto, a ideia de que os programas de intervenção em crise sejam programas de promoção e prevenção do risco para a saúde e para a saúde mental associado aos usos de substâncias em contextos recreativos.This work aim is to contribute for the Kosmicare evaluation program, which intervenes on crisis related to the use of psychoactive drugs. It takes place in a big trance festival that is held every two years during summer time in Portugal. The collected data for this study are from the 2010 edition of this festival. The evaluation of this program is made as much trough the process evaluation, which goal is to comprehend if the intervention has occurred as planned, as well as the outcomes evaluation which alloud us to prove if the intervention has been able to achieve his goals. The evaluation method adopted is mixed to achieve a broader perception of the phenomena (Ramos, 2006). Therefore, we’ve used the descriptive statistic as well as the content analysis in the data treatment. The Kosmicare evaluation gave us the chance to verify that programs of this kind are beyond a service for intervention in crisis related with the use of psychoactive drugs. In this particular context of intervention the crisis conception is much more wide and multidetermined due to the different type of crisis and situations which programs have to give response: crisis related to the intentional or accidental use of psychoactive drugs, mental crisis with or without the use of psychoactive substances, personal crisis without use of psychoactive substances and situations not related to any sort of crisis. Considered an unexplored field, there is no consent about the space of the crisis intervention in the context of the different levels, already known, for the field of the use of psychoactive drugs. The results of this work give strenght to the ideia that this programs of crisis intervention are programs for promotion and risk preventing to health and mental health, associated to the use of psychoactive drugs in recreational contexts

Discussing the possibility of fertility treatment being unsuccessful as part of routine care offered at clinics: patients’ experiences, willingness, and preferences

STUDY QUESTION: Are patients willing to discuss the possibility of treatment being unsuccessful as part of routine care offered at clinics, and what are the factors associated with this willingness? SUMMARY ANSWER: Nine in every 10 patients are willing to discuss this possibility as part of routine care, with willingness being associated with higher perceived benefits, lower barriers, and stronger positive attitudes towards it. WHAT IS KNOWN ALREADY: Fifty-eight percent of patients who complete up to three cycles of IVF/ICSI in the UK do not achieve a live birth. Offering psychosocial care for unsuccessful fertility treatment (PCUFT), defined as assistance and guidance on the implications of treatment being unsuccessful, could reduce the psychosocial distress patients experience when it happens, and promote positive adjustment to this loss. Research shows 56% of patients are willing to plan for an unsuccessful cycle, but little is known about their willingness and preferences towards discussing the possibility of definitive unsuccessful treatment. STUDY DESIGN, SIZE, DURATION The study was of cross-sectional design, comprising a theoretically driven and patient-centred bilingual (English, Portuguese) mixed-methods online survey. The survey was disseminated via social media (April 2021–January 2022). Eligibility criteria included being aged 18 or older, waiting to or undergoing an IVF/ICSI cycle, or having completed a cycle within the previous 6 months without achieving a pregnancy. Out of 651 people accessing the survey, 451 (69.3%) consented to participate. From these, 100 did not complete 50% of the survey questions, nine did not report on the primary outcome variable (willingness), and 342 completed the survey (completion rate 75.8%, 338 women). PARTICIPANTS/MATERIALS, SETTING, METHODS: The survey was informed by the Health Belief Model (HBM) and Theory of Planned Behaviour (TPB). Quantitative questions covered sociodemographic characteristics and treatment history. Quantitative and qualitative questions gathered data on past experiences, willingness, and preferences (with whom, what, how and when) to receive PCUFT, as well as theory-informed factors hypothesized to be associated with patients’ willingness to receive it. Descriptive and inferential statistics were used on quantitative data about PCUFT experiences, willingness, and preferences, and thematic analysis was applied to textual data. Two logistic regressions were used to investigate the factors associated with patients’ willingness. MAIN RESULTS AND THE ROLE OF CHANCE: Participants were, on average, 36 years old and most resided in Portugal (59.9%) and the UK (38.0%). The majority (97.1%) were in a relationship for around 10 years, and 86.3% were childless. Participants were undergoing treatment for, on average, 2 years [SD = 2.11, range: 0–12 years], with most (71.8%) having completed at least one IVF/ICSI cycle in the past, almost all (93.5%) without success. Around one-third (34.9%) reported having received PCUFT. Thematic analysis showed participants received it mainly from their consultant. The main topic discussed was patients’ low prognosis, with the emphasis being put on achieving a positive outcome. Almost all participants (93.3%) would like to receive PCUFT. Reported preferences indicated that 78.6% wanted to receive it from a psychologist/psychiatrist/counsellor, mostly in case of a bad prognosis (79.4%), emotional distress (73.5%), or difficulties in accepting the possibility of treatment being unsuccessful (71.2%). The preferred time to receive PCUFT was before initiating the first cycle (73.3%), while the preferred format was in an individual (mean = 6.37, SD = 1.17; in 1–7 scale) or couple (mean = 6.34, SD = 1.24; in 1–7 scale) session. Thematic analysis showed participants would like PCUFT to provide an overview of treatment and all possible outcomes tailored to each patient’s circumstances and to encompass psychosocial support, mainly focused on coping strategies to process loss and sustain hope towards the future. Willingness to receive PCUFT was associated with higher perceived benefit of building psychosocial resources and coping strategies (odds ratios (ORs) 3.40, 95% CI 1.23–9.38), lower perceived barrier of triggering negative emotions (OR 0.49, 95% CI 0.24–0.98), and stronger positive attitudes about PCUFT being beneficial and useful (OR 3.32, 95% CI 2.12–5.20)

Women's attitudes and beliefs about using fertility preservation to prevent age-related fertility decline — a two-year follow-up

Objective: The health belief and transtheoretical model were used to describe how women make decisions about fertility preservation (FP) and identify factors that predict their decisions. Methods: This is a two-year prospective study with 107 childless women aged 30–37. Women filled an online survey assessing individual factors, intentions to do FP, variables of the health belief model, FP decisional stage and FP behaviour. Results: Women s intentions, desire and number of children wanted decreased, fertility knowledge and perceived susceptibility to infertility increased and perceived severity of infertility decreased. A low number of women progressed through the stages of the decision-making process. Only 14% reached a decision and all decided not to do FP. Women’s baseline intentions to do FP predicted their decision. Conclusion: Women at the optimal age range to do FP (28–35 years) do not engage in decision-making about it, which reflects their initial low intentions to do FP. Women’s decision about FP is influenced by their perceptions about the technique. Pratical implications: Women with a high desire for parenthood and within the optimal age range to do FP should receive accurate information about it and could benefit from prompts to engage in active decision making about doing it.(undefined

Feasibility and acceptability of psychosocial care for unsuccessful 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

OpenEHR como solução para o Regulamento Geral de Proteção de Dados

Introdução: As preocupações relacionadas com a privacidade e proteção de dadospessoais resultaram em reformas da legislação existente na UE. O Regulamento Geralde Proteção de Dados visa reformar as medidas existentes sobre o tema da proteçãode dados pessoais dos cidadãos da União Europeia, com forte incidência nos direitose liberdades das pessoas no estabelecimento de regras para o processamento dedados pessoais. O OpenEHR é uma norma que incorpora muitos princípios deinteroperabilidade e segurança de software para registos eletrónicos de saúde.Objetivo: Este trabalho tem como objetivo compreender até que ponto a normaopenEHR pode ser considerada uma solução para os requisitos necessários ao RGPD.Métodos: Foi feito uma lista de requisitos para um SIS compatível com o RGPD euma identificação das funcionalidades openEHR. Os requisitos foram categorizados ecomparados com as funcionalidades.Resultados: Os requisitos identificados para os sistemas foram combinados com asfuncionalidades openEHR, o que resultou em 15 requisitos combinados com o openEHR. Todas as funcionalidades identificadas coincidem em pelo menos umrequisito.Discussão: O openEHR é uma solução para o desenvolvimento de um SIS quereforça a privacidade e proteção de dados pessoais, garantindo que estes sejamcontemplados no desenvolvimento do sistema. As instituições podem garantir que oseu SIS seja compatível com o RGPD, salvaguardando a qualidade dos dados médicose, como resultado, a prestação dos cuidados de saúde

Procriação Medicamente Assistida em Ciclo Natural: Avaliação dos Resultados de um Departamento de Medicina da Reprodução

Introdução: As técnicas de procriação medicamente assistida em ciclo natural têm sido investigadas, sobretudo em mulheres com má resposta à estimulação ovárica convencional, observando-se melhor recetividade endometrial, custo inferior e possibilidade de realização de ciclos sucessivos. Como desvantagens salientam-se: menor eficácia por ciclo de tratamento e maior taxa de cancelamento. O objetivo definido para este trabalho foi determinar a taxa de gravidez evolutiva em mulheres inférteis, submetidas a procriação medicamente assistida em ciclo natural. Material e Métodos: Estudo retrospetivo de 149 ciclos de procriação medicamente assistida sem estimulação ovárica de 50 mulheres inférteis, entre janeiro de 2011 e outubro de 2014. Resultados: As mulheres submetidas a procriação medicamente assistida em ciclo natural tinham, em média, 36,1 anos. Aproximadamente metade (46,0%) dos ciclos realizaram-se em más respondedoras. No dia do desencadeamento da ovulação o diâmetro médio do folículo foi 17,5 mm. Cancelaram-se 23 ciclos (15,4%) previamente ao desencadeamento. Em 8 ciclos (5,3%) ocorreu ovulação entre o desencadeamento e a punção folicular. Na maioria dos ciclos (n = 118; 79,2%) efetuou-se punção folicular, realizando-se técnica de procriação medicamente assistida em 71 (47,6%), maioritariamente injeção intracitoplasmática. A taxa de fecundação global foi 63,8%. Em 40 ciclos (26,8%) houve transferência embrionária. A taxa de implantação e de gravidez evolutiva por transferência embrionária foram de 35,0% e 25,0%, respetivamente. A maioria das gestações ocorreu em más respondedoras, conforme critérios de Bolonha. Discussão: Apesar de a taxa de gravidez por ciclo iniciado ser de 6,7%, a taxa de gravidez evolutiva por transferência embrionária é bastante satisfatória, sendo mulheres com respostas desfavoráveis em tratamentos prévios. As taxas relativamente elevadas de cancelamento do ciclo são atenuadas pela simplicidade e menor custo destes ciclos. Conclusão: Os resultados obtidos neste trabalho demonstram que as técnicas de procriação medicamente assistida em ciclo natural podem ser uma alternativa de tratamento à estimulação ovárica em doentes com mau prognóstico, cuja alternativa seria o recurso à doação de ovócitos

Bioactivity of Asclepias curassavica, Equisetum spp. and Rosmarinus officinalis Extracts Against Leaf-Cutting Ants

Chemical control of leaf-cutting ants is widely used, but alternative control with toxic plant extracts is promising. Substances with insecticidal potential extracted from plants have numerous ecological advantages. This study evaluated the insecticidal and/or fungicidal potential of the plants Asclepias curassavica (tropical milkweed), Rosmarinus officinalis L. (Lamiaceae) (rosemary) and Equisetum spp. (horsetail) for control of the leaf-cutting ant Atta sexdens rubropilosa Forel, 1908 (Hymenoptera: Formicidae). Forty laboratory-reared colonies of Atta sexdens rubropilosa were used. The plants were collected, dried out in a circulating air oven for 48 hours, ground, and macerated in 96o ethanol until exhaustion. After filtration, the products were evaporated under reduced pressure to obtain the ethanolic extracts. Acceptance of the reagent, topical application of the extracts, and application of baits containing 4% of the plant extracts were tested. The results showed that all plant extracts tested negatively influenced the development of the fungus garden. Baits produced with Asclepias curassavica caused the highest mortality of the colonies within 7 days. In conclusion, the ethanolic extracts of Asclepias curassavica, Rosmarinus officinalis and Equisetum spp. exhibit insecticidal (contact and ingestion) and fungicidal activity in colonies of the leaf-cutting ant Atta sexdens rubropilosa

Installation of Vegetable Based Roof Gardens in Schools From Recyclable Materials: A Study

The study aimed to reflect on the socio-environmental issues and the action of the gardens in urban/school spaces, considering garden as a methodological instrument for the interdisciplinary activities related to family farming, using the descriptive methodology and study of literary review with proposals of gardens using recyclable materials depicted through images created using the software AutoCAD. Through the study, it was possible to plan gardens using recyclable materials in environments of small spaces. The crops employed will be vegetables for school meals. The activities carried out in the garden contribute to the change in the habits and attitudes of students regarding the perception they possess of nature, the formation of awareness of respect and care, the need to conserve the environment and stimulate the pursuit of improvement of quality of life in other ways of seeing the activities performed by their own parents in the field