Exercício Físico no tratamento da Espondilite Anquilosante: uma revisão sistemática

O exercício físico é um componente regular no tratamento de várias patologias, entre as quais a espondilite anquilosante (EA). A EA é uma patologia reumática, crónica e sistémica, sem cura conhecida e na qual o exercício físico se tem revelado como terapia essencial no controlo e prevenção de deformidades associadas. No sentido de promover uma prática de acordo com a evidência e de ajudar na tomada de decisões acerca dos cuidados de saúde em pacientes com EA, foi efectuada uma revisão de estudos randomizados controlados tendo por objectivo examinar o papel do exercício físico no tratamento de pacientes com EA. Uma pesquisa computorizada nas bases de dados Cochrane Central,Pubmed/ Medline e PEDro permitiu identificar 13 estudos envolvendo 1.056 pacientes, com classificação metodológica de 5,62 na escala de PEDro. Dos estudos incluídos, 3 avaliaram o efeito aditivo do exercício físico à medicação, 3 compararam os benefícios da prática regular de exercício supervisionado em grupo com os benefícios do exercício físico não supervisionado no domicílio, 5 avaliaram programas de exercício alternativo (hidroterapia e reeducação postural global) ao programa tradicionalmente usado em pacientes do EA e 2 centraram-se sobre o rácio custo/efectividade da terapia. Os estudos incluídos nesta revisão sugerem que o exercício físico é uma terapia benéfica no tratamento de pacientes com EA; este exercício deve ser efectuado em grupo com supervisão de fisioterapeuta. Novas modalidades de exercício, hidroterapia ou exercício baseado na reeducação postural global, parecem oferecer igualmente uma terapia alternativa válida e promissora para pacientes com EA

Non-Linear Abelian Scenarios and Yang-Mills Theory

We present a natural formulation for constructing Yang-Mills theories from the incorporation of non-linearities to the Maxwell's theory of electromagnetism. Our formulation is strongly based on Noether's Theorem and aims to show how the introduction of non-linearities can turn a global invariance into a local symmetry as the more general Yang-Mills type of symmetry

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

Cloud-to-ground lightning in Portugal: patterns and dynamical forcing

An analysis of the cloud-to-ground discharges (CGD) over Portugal is carried out using data collected by a network of sensors maintained by the Portuguese Meteorological Institute for 2003–2009 (7 yr). Only cloud-to-ground flashes are considered and negative polarity CGD are largely dominant. The total number of discharges reveals a considerable interannual variability and a large irregularity in their distribution throughout the year. However, it is shown that a large number of discharges occur in the May–September period (71%), with a bimodal distribution that peaks in May and September, with most of the lightning activity recorded in the afternoon (from 16:00 to 18:00 UTC). In spring and autumn the lightning activity tends to be scattered throughout the country, whereas in summer it tends to be more concentrated over northeastern Portugal. Winter generally presents low lightning activity. Furthermore, two significant couplings between the monthly number of days with discharges and the large-scale atmospheric circulation are isolated: a regional forcing, predominantly in summer, and a remote forcing. In fact, the identification of daily lightning regimes revealed three important atmospheric conditions for triggering lightning activity: regional cut-off lows, cold troughs induced by remote low pressure systems and summertime regional low pressures at low-tropospheric levels combined with a mid-tropospheric cold trough

Dissemination, implementation and impact of the ESHRE evidence-based guidelines

STUDY QUESTION What are the perceptions of ESHRE members about the dissemination, implementation and impact of the first four ESHRE evidence-based guidelines to be published? SUMMARY ANSWER Around 30% of ESHRE members know and use the ESHRE evidence-based guidelines in their routine practice and this is perceived to result in better treatment, better screening/evaluation/diagnosis and better psychosocial and patient-centred care, with on average three in each four members who make changes perceiving that their patients benefit from it. WHAT IS KNOWN ALREADY ESHRE has been developing and disseminating evidence-based guidelines, aiming to improve the quality of fertility care across Europe. However, evidence has shown that guidelines dissemination is not enough to change practice at clinics, with implementation strategies that address local barriers to implementation being recommended. STUDY DESIGN, SIZE, DURATION A cross-sectional study based on an online survey was sent by email to all ESHRE members (n = 7664) and advertised on ESHRE social media (20 February–3 April 2018). The survey was carried out to evaluate their perceptions about the dissemination, implementation and impact of the Management of Endometriosis (ENDO), Routine Psychosocial Care (RPC), Premature Ovarian Insufficiency (POI) and Recurrent Pregnancy Loss (RPL) ESHRE guidelines. PARTICIPANTS/MATERIALS, SETTING, METHODS The survey was advertised via the ESHRE website, social media and email to all ESHRE members. It assessed the dissemination (knowledge the guidelines were published, downloaded), implementation (using guidelines in daily practice, changed practice) and impact (perceived patient benefit, referred patients to the guidelines) of the guidelines, as well as their perceived implementability. Open questions assessed perceived changes in practice, barriers to and desired support for implementation. MAIN RESULTS AND THE ROLE OF CHANCE The final sample consisted of 658 participants (not possible to calculate response rate), with the majority being embryologists, biologists or geneticists (n = 268, 40.7%), followed by clinicians (n = 260, 39.5%), scientists (n = 48, 7.3%), nurses or midwives (n = 30, 4.6%), psychologists, counsellors or social workers (n = 28, 4.3%) and others (e.g. medical student, lab manager, marketing, ethicist; n = 24, 3.6%). The majority knew that ESHRE published the guidelines (82.1% ENDO, 54.6% RPC, 56.6% POI, 59.4% RPL). From these, the majority downloaded it (65.9% ENDO, 52.4% RPC, 54.2% POI, 56.8% RPL), around one-third used it in their routine practice (41.7% ENDO, 29.5% RPC, 33.7% POI) and around one quarter made changes to their practice (30.7% ENDO, 18.9% RPC, 21.5% POI). Overall, <20% of members think that patients benefited from the guideline (19.4% ENDO, 16.3% RPC, 16.1% POI) and very few referred them to it (ENDO 8.9%, 12.8% RPC, 16.1% POI). However, on average every three in every four people who made changes to practice perceived that their patients benefited from it (ENDO 62%, RPC 80%, POI 75%). The main reported changes in practice were better treatment, better screening/evaluation/diagnosis and better psychosocial and patient-centred care. Main perceived barriers to implementation were lack of translation to other languages, guidelines being long and difficult to understand and lack of supporting evidence. Financial constraints and lack of staff expertise were also reported. Participants desired clear support for implementation in the form of step-by-step instructions, more training and support materials for staff and patients and translation to other languages. Results for the clinicians only showed that, despite less knowledge about the RPC guideline, they were more likely to download all the guidelines, to follow them, make changes in their daily practice and refer them to their patients. LIMITATIONS, REASONS FOR CAUTION Respondents were ESHRE members and these are not representative of all European reproductive health professionals. The response rate could not be calculated as ESHRE social media reaches more than just the members. The guidelines are mainly written for clinicians and in this sample the clinicians were under-represented. In addition, missing values increased as participants progressed through each guideline’s questions, with the open-ended questions being answered by only 74–97 participants. The survey assessed perceptions instead of actual practice. Overall, the results may convey a too optimistic picture of the impact of the guidelines. WIDER IMPLICATIONS OF THE FINDINGS ESHRE’s policy of investing in implementation and dissemination is important but insufficient to ensure the guidelines are implemented at clinics across Europe. ESHRE can address perceived barriers that are directly related to the guidelines, in particular lack of translation, as well as provide further support for implementation. This support should be clear and concise, focusing on how to implement the guidelines rather than on what to do. STUDY FUNDING/COMPETING INTEREST(S) None

Potencial de adaptação da lagarta-do-cartucho em milhos transgênicos expressando as proteínas Cry 1A(b) e Cry 1F.

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