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Antisynthetase syndrome (ASyS) is characterised by the association of inflammatory myopathy, interstitial lung disease (ILD), arthritis, Raynaud's phenomenon (RP) or mechanic's hands (MH), with the presence of anti-aminoacyl-tRNA-synthetase antibodies (anti-ARS). It has been suggested that different anti-ARS may be associated with distinct clinical pictures.To characterise the clinical and immunological features of a multicentric nationwide cohort of ASyS patients.This is a multicentre retrospective cohort study including patients with ASyS from nine Portuguese rheumatology centres. Data on patients' demographics, signs and symptoms, laboratory results, pulmonary imaging findings and treatment with immunomodulators were collected. Comparison between patients with different anti-ARS antibodies was made using the Chi-square test for categorical variables and Student's t-test or Man-Whitney test for continuous variables, considering anti-Jo1 positive patients as the reference group.Seventy patients were included (70% female) with a median age in years at disease onset of 52 (15-75) years and median follow-up time of 3 years (range 0-32). The three most common clinical manifestations were ILD (n=53, 75.7%), followed by arthritis (n=43, 61.4%) and myositis (n=37, 52.9%). Forty-three patients were positive for anti-Jo1 (61.4%), 11 for anti-PL12 (15.7%), 10 for anti-PL7 (14.3%), 4 for anti-EJ (5.7%), and 2 for anti-OJ (2.9%) antibodies. Antibody co-positivity with anti-Ro52 antibodies was found in 15 patients (21.4%) and was more prevalent in anti-Jo1 patients. ILD prevalence was similar in the different anti-ARS subgroups, without statistically significant differences. Patients positive for anti-PL7 antibodies had significantly lower risk of presenting arthritis (p =lt; 0.05) and those positive for anti-PL-12 antibodies had a significantly lower risk of presenting myositis than the reference group of anti-Jo1 positive patients (p =lt; 0.05). RP was more frequently found in patients positive for anti-PL-12 than in anti-Jo1-positive patients (p =lt; 0.05). Malignancies were reported in four (5.7%) patients, none of whom were anti-Ro52-positive, and one of such patients had a double malignancy. Only three deaths were reported. Corticosteroids were the most frequently prescribed therapy and the use of immunosuppressive drugs was decided according to the type of predominant clinical manifestation.The three most common clinical manifestations were ILD, followed by arthritis and myositis. Patients positive for anti-PL7 antibodies had significantly lower risk of presenting arthritis and those positive for anti-PL-12 antibodies had a significantly lower risk of presenting myositis than the reference group of anti-Jo1 positive patients. RP was more frequently found in patients positive for anti-PL-12 than in anti-Jo1-positive patients. Corticosteroids were the most frequently prescribed therapy. These results are generally concordant with data retrieved from international cohorts.

Objectives To explore patient-defined flares in psoriatic arthritis (PsA), compared to an increase in disease activity in psoriatic arthritis (DAPSA) and to analyze the validity of a patient-reported flare question. Methods ReFlap (NCT03119805) was a longitudinal study in 14 countries of consecutive patients with definite PsA. Patients were seen twice in the context of usual care, 4.5 ± 2.2 months apart. Flares were reported by patients and physicians at the second visit using a single question. DAPSA worsening was defined as a change to a higher DAPSA category. Agreement between the definitions of worsening was calculated by prevalence adjusted bias adjusted kappa (PABAK). Validity of patient-reported flare was assessed by comparing patients with versus without flare and transition to flares. Results In 222 patients, mean disease duration 10.8 ± 8.3 years, 127 (58.8%) males: disease activity was low (mean DAPSA 11.5 ± 14.0); 63.3% received a bDMARD. Patient-reported flares between the 2 visits were seen in 27% patients (for these patients, mean 2.2 ± 3.7 flares per patient, mean duration 12.6 ± 21.0 days per flare). Physician- reported flares were seen in 17.6% and worsening in DAPSA in 40.1% of patients. Agreement between definitions was moderate (PABAK = 0.32-0.59). Patients in flare had significantly more active disease than patients not in flare for all outcomes (all P < 0.001). At the patient-level, transition to flare state was associated to a worsening in disease activity and impact outcomes. Conclusions Patient flares were frequent and were associated with active and symptomatic disease. These findings provide preliminary validation for patient-reported flares in PsA.

Background. In rheumatoid arthritis (RA), global disease activity is commonly evaluated, from the patient’s and the physician’s perspective, through a 100mm visual analogue scale (VAS) and plays an important role in the assessment of diseases activity and treatment decisions. Our aim was to determine patient-physician discordance in the assessment of disease activity and to explore its determinants. Methods. Cross sectional study including RA patients (ACR/EULAR 2010 classification criteria). The discrepancy between patients-physicians (∆PPhGA) was defined as PGA minus PhGA, and a difference > |20mm| was considered as “discordant”. Correlation between ∆PPhGA and other variables was assessed through Pearson’s correlation and comparison between groups through t-test. Variables with p < 0.05 or considered clinically relevant were included in multivariable linear regression analysis to identify determinants for ∆PPhGA. A p < 0.05 was considered statistically significant. Results. In total, 467 patients with RA were included (81.2% female; mean age 63.9% ± 12.2 years). PGA and PhGA were discordant in 61.7% of the cases. The proportion of concordance increased (p < 0.01) when considering only patients in remission (DAS 28 3V < 2.6). In multivariable analysis (R2adjusted=0.27), VAS-pain-patient (β 0.74, 95% CI 0.62-0.88, p=0.00) and TJC (β 0.16, 95% CI 0.45-0.48, p=0.02) remained associated with a higher ∆PPhGA. Conclusion. Our study confirmed that a significant discrepancy between patients and physicians in the assessment of global disease activity is frequent in clinical practice, and is probably due to valorization of different parameters by the two groups.

Considerado como um tipo de turismo de baixo impacto ambiental, o ecoturismo e feito por pequenos grupos com possibilidade de sustentacao economica, tanto para as unidades de conservacao (UC's) onde ele pode ser praticado, como para as comunidades locais em termos de geracao de renda . O presente artigo tem como objetivo elaborar uma proposta de implantacao do Ecoturismo na Reserva Particular de Patrimonio Natural (RPPN) Fazenda Pantanal, baseada em principios de sustentabilidade ambiental, no municipio de Codo-MA. A metodologia utilizada foram pesquisas documentais, bibliografica e, principalmente, de campo, que foi desenvolvida atraves de pesquisas com perguntas semi-estruturadas, com relatos de experiencias e registros fotograficos. O resultado da pesquisa aponta para a realizacao de um diagnostico ambiental mais preciso e detalhado, que tera como objetivo identificar os fatores fisicos, bioticos e antropicos, da regiao em estudo, bem como as interacoes que eles estabelecem entre si por meio das quais se apreende a dinâmica dos ecossistemas. O diagnostico deve caracterizar as potencialidades e vulnerabilidades da area, face as atividades transformadoras previstas. Dessa forma, conclui-se que a pratica do ecoturismo so torna-se viavel se for adotado um modelo de planejamento e gestao adequada com a participacao de todos, sejam os proprietarios, turistas, comunidades e populacao local, respeitando as atribuicoes de cada um e promovendo atividades de geracao de emprego e renda baseada em principios de sustentabilidade. bem como as interacoes que eles estabelecem entre si por meio das quais se apreende a dinâmica dos ecossistemas. O diagnostico deve caracterizar as potencialidades e vulnerabilidades da area, face as atividades transformadoras previstas. Dessa forma, conclui-se que a pratica do ecoturismo so torna-se viavel se for adotado um modelo de planejamento e gestao adequada com a participacao de todos, sejam os proprietarios, turistas, comunidades e populacao local, respeitando as atribuicoes de cada um e promovendo atividades de geracao de emprego e renda baseada em principios de sustentabilidade. bem como as interacoes que eles estabelecem entre si por meio das quais se apreende a dinâmica dos ecossistemas. O diagnostico deve caracterizar as potencialidades e vulnerabilidades da area, face as atividades transformadoras previstas. Dessa forma, conclui-se que a pratica do ecoturismo so torna-se viavel se for adotado um modelo de planejamento e gestao adequada com a participacao de todos, sejam os proprietarios, turistas, comunidades e populacao local, respeitando as atribuicoes de cada um e promovendo atividades de geracao de emprego e renda baseada em principios de sustentabilidade.

A growing interest in academic entrepreneurship has characterized the past few years. Young university students are increasingly encouraged to create their compa- nies to boost their region's social and economic development. In this regard, women entrepreneurs have been playing a decisive role. They have been increasing in num- ber, becoming of key importance due to their status and significance for the gender impact on entrepreneurship. This research evaluates women's entrepreneurial inten- tion in the Portuguese academy, denoting which entrepreneurial intent is influenced by environmental factors such as closer valuation and social valuation and motiva- tional factors such as attitude toward the behavior, subjective norms, and perceived behavioral control. For this purpose, a quantitative methodology was used. A ques- tionnaire was applied to 731 female students of higher education in Portugal. The analysis of the results allowed us to perceive which variables under study influenced the entrepreneurial intention. The findings will reinforce the literature, thus, contrib- uting to strengthening the theoretical framework on entrepreneurial intentions in women and launching clues for action within public decision-makers, universities, and civil society, allowing to adopt practices that will increase entrepreneurship in women. To our knowledge, this research is one of the few studies on female entre- preneurial intention in academia in a peripheral region of Europe such as Portugal.

Academic entrepreneurship is becoming increasingly important to the field of research as well as to policy makers due to its ability to contribute to the economic, technological, and social development of regions and countries. This research aims to evaluate the determinants that influence the interest of Portuguese higher education students (HEI’s) to become entrepreneurs. The methodology used is quantitative and uses structural model equations. The results obtained demonstrate that the student’s perception of business skills, business growth skills, strategy, and successful business are key factors that students take into account in their entrepreneurial orientation. The research contributes to this theory by adding new knowledge to the literature on the perception of the HEI’s students to become entrepreneurs, specifically the students of Portuguese universities. In practical terms, the contributions offered within this research are based on suggestions for the third mission of universities, explicitly knowledge transfer to the community, business groups, and policy makers, as well as the creation of the essentials within university boundaries to promote entrepreneurship amongst its students. The research is original and innovative, as no research on this field with all the aggregated elements under study has been previously performed in Portugal. Furthermore, the obtained results can translate into ideas that potentially create jobs. info:eu-repo/semantics/publishedVersion

In order to identify risk factors for SARS-CoV-2 infection as well as for severe/critical COVID-19 in rheumatic and musculoskeletal diseases (RMDs) patients, we conducted a multicentre observational nationwide study of adult patients prospectively-followed in the Rheumatic Diseases Portuguese Register – Reuma.pt – during the first 6 months of the pandemic. We further evaluated the development of IgG antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 in patients with RMDs. We used multivariate logistic regression to compare patients with COVID-19 (COVID-19+) with those who did not develop the disease (COVID-19-) and patients with mild/moderate disease with those exhibiting severe/critical COVID-19. COVID-19+ patients were asked to collect a blood sample for IgG testing ≥ 3 months after infection and results were compared with age-, sex- and sampling date-matched controls. Overall, 179 cases of COVID-19 were registered in Reuma.pt in the period of interest (median age 55 (IQR 20); 76.5% females) in a total of 6404 registered appointments. We found that patients treated with TNF inhibitors had reduced odds of infection (OR=0.16, 95%CI 0.10-0.26, p

espanolParentalidad y salud mental infantil durante la pandemia de COVID-19: Un estudio online con familias Portuguesas y Britanicas. COVID-19 y la subsiguiente respuesta de salud publica crearon muchas tensiones adicionales para las familias. Examinamos el comportamiento de los padres durante la pandemia de COVID-19 en dos paises europeos y exploramos la asociacion entre el comportamiento de los padres y la ansiedad y la calidad de vida del nino. Cuidadores de ninos y adolescentes (N = 442; 86.7% madres) entre 6 y 16 anos (M = 10, DT = 2,85) participaran en una online encuesta en Portugal y en el Reino Unido. En los resultados se observa que la mayor ansiedad y una menor calidad de vida de los ninos se asociaron con niveles mas altos de demandas parentales poco realistas, menor autocuidado y mayor desregulacion emocional de los padres. El estimulo a la expresion de las emociones de los ninos y el manejo de la exposicion a la informacion de COVID-19 se asocio negativamente con la ansiedad de los ninos. La promocion de rutinas, el apoyo a la modulacion de las emociones de los ninos y la promocion de estilos de vida saludables de los ninos se asociaron positivamente con la calidad de vida de los ninos. Los predictores difirieron segun el pais y el grupo de edad. Estos resultados resaltan la importancia de comportamientos parentales especificos en la salud mental de los ninos durante el COVID-19. La necesidad de moderar las demandas poco realistas y prestar atencion al autocuidado de los padres para reducir la desregulacion emocional de los padres es importante EnglishCOVID-19 and the subsequent public health response created many additional stresses for families. We examined parental behaviour during the COVID-19 pandemic in two European Countries and explored the association between parents’ behaviour and children’s anxiety and quality of life. Caregivers of children and adolescents (N = 442; 86.7% mothers) between 6 and 16 years old (M = 10, SD = 2.85) participated in an online cross-sectional survey in Portugal and the United Kingdom. Results show that higher children’s anxiety and lower quality of life were associated with higher levels of unrealistic parental demands, lower parental self-care, and higher parental emotional dysregulation. Encouragement of children’s emotion expression and management of exposure to COVID-19 information was negatively associated with children’s anxiety. Promotion of routines, support of children’s emotion modulation and promotion of children’s healthy lifestyles were positively associated with children’s quality of life. The predictors differed according to country and age group. These results highlight the importance of specific parenting behaviours on children’s mental health during COVID-19. The need to moderate unrealistic demands and attend to parental self-care to reduce parental emotional dysregulation is important.

The present research aims to analyze the habits observed in the perception of the general physical health condition of Portuguese food consumers in the COVID-19 pandemic. The investigation is focused on indicators such as weight, physical activity, and consumption habits through the adoption of healthy and not healthy food. Centered on a quantitative approach, the research is based on the application of a questionnaire to a sample of 741 Portuguese consumers, between November 2020 and February 2021, a period during which the most severe measures of social isolation were imposed by the Portuguese government, since the beginning of the pandemic. Moreover, the questionnaire was applied to consumers over 18 years old. According to this population, and considering a 95% confidence level and a margin of error of 4%, the sample has a minimum of 601 responses. Being so, the results of this research are representative for the Portuguese food consumers. The theoretical model was estimated using Partial Least Squares (PLS) in the Smart PLS 3.0 software. The obtained results allowed us to conclude that the Portuguese perception of their weight did not change in the pandemic, despite showing that in general, the pandemic had a negative impact on their physical condition. On the other hand, the results show that the Portuguese associate the practice of physical exercise with physical well-being. Respondents also confirm a positive relationship between “positive eating behaviors (such as consumption of fruits and vegetables, low saturated foods and rich in monounsaturated and polyunsaturated fats” and water consumption) and “the perception of physical health in general”. On the contrary, respondents’ perception of the choice of negative eating behaviors (measured by the consumption of products with a high content of salt and sugar, snacks, and processed frozen and pre-cooked foods) have a negative impact on the “assessment of physical health, in the COVID-19 pandemic”. Hence, it was concluded that the Portuguese consider that an eventual increase in weight does not necessarily correspond to a perception of worse physical health; the practice of physical exercise and good eating habits corresponds to a perception of better physical health; the adoption of bad eating habits corresponds to the perception of bad physical health., This work is supported by national funds, through the FCT-Portuguese Foundation for Science and Technology under the project UIDB/04630/2020.

© 2021 Elsevier Ltd. All rights reserved, Background: The COVID-19 pandemic has raised numerous questions among patients with immune-mediated inflammatory diseases regarding potential reciprocal effects of COVID-19 and their underlying disease, and potential effects of immunomodulatory therapy on outcomes related to COVID-19. The seroprevalence of SARS-CoV-2 and factors associated with symptomatic COVID-19 in patients with immune-mediated inflammatory diseases are still unclear. The Euro-COVIMID study aimed to determine the serological and clinical prevalence of COVID-19 among patients with immune-mediated inflammatory diseases, as well as factors associated with COVID-19 occurrence and the impact of the pandemic in its management. Methods: In this multicentre cross-sectional study, patients aged 18 years or older with a clinical diagnosis of rheumatoid arthritis, axial spondyloarthritis, systemic lupus erythematosus, Sjögren's syndrome, or giant cell arteritis were recruited from six tertiary referral centres in France, Germany, Italy, Portugal, Spain, and the UK. Demographics, comorbidities, treatments, and recent disease flares, as well as information on COVID-19 symptoms, were collected through a questionnaire completed by participants. SARS-CoV-2 serology was systematically tested. The main outcome was the serological and clinical prevalence of COVID-19. Factors associated with symptomatic COVID-19 were assessed by multivariable logistic regression, and incidence of recent disease flares, changes in treatments for underlying disease, and the reasons for treatment changes were also assessed. This study is registered with ClinicalTrials.gov, NCT04397237. Findings: Between June 7 and Dec 8, 2020, 3136 patients with an immune-mediated inflammatory disease answered the questionnaire. 3028 patients (median age 58 years [IQR 46-67]; 2239 [73·9%] women and 789 [26·1%] men) with symptomatic COVID-19, serological data, or both were included in analyses. SARS-CoV-2 antibodies were detected in 166 (5·5% [95% CI 4·7-6·4]) of 3018 patients who had serology tests. Symptomatic COVID-19 occurred in 122 (4·0% [95% CI 3·4-4·8]) of 3028 patients, of whom 24 (19·7%) were admitted to hospital and four (3·3%) died. Factors associated with symptomatic COVID-19 were higher concentrations of C-reactive protein (odds ratio 1·18, 95% CI 1·05-1·33; p=0·0063), and higher numbers of recent disease flares (1·27, 1·02-1·58; p=0·030), whereas use of biological therapy was associated with reduced risk (0·51, 0·32-0·82; p=0·0057). At least one disease flare occurred in 654 (21·6%) of 3028 patients. Over the study period, 519 (20·6%) of 2514 patients had treatment changes, of which 125 (24·1%) were due to the pandemic. Interpretation: This study provides key insights into the epidemiology and risk factors of COVID-19 among patients with immune-mediated inflammatory diseases. Overall, immunosuppressants do not seem to be deleterious in this scenario, and the control of inflammatory activity seems to be key when facing the pandemic., Pfizer, Sanofi, Amgen, Galapagos, and Lilly funded this study through unrestricted grants.

Human resources are seen as an important asset for general associations, particularly for non-profit organizations. In the literature, it is possible to ascertain a set of factors influencing the performance of these resources, in general, in an organizational context. However, given the specificity of their missions, realizing that large management areas in this type of institutions influence their performance would significantly contribute. In practice, it was possible to implement assertive strategies to promote the performance of these employees. Thus, for the present study, and using a quantitative methodology, we started by analysing strategic management, financial management, governance and management of social services promoted by the Holy Houses of Mercy in Portugal. It was possible to ascertain that, among these areas, only financial management does not influence the performance of human resources in this type of institution. Recognizing the importance of the remaining areas, it was possible to present a set of indicators grouped into subdimensions, revealing important contributions to theory and practice. It was possible to conclude that, in a context of significant economic and social instability, such as the one we are currently experiencing, NPOs that seek to improve their level of human resource management should pay special attention to aspects related to strategy, governance and management of the social services they promote, as this is where the key factors for this performance improvement are found. info:eu-repo/semantics/publishedVersion

The financial crises and the pandemic COVID 19 have reinforce the importance of the nonprofit organizations (NPOs) in promoting the social welfare. These institutions face nowadays various challenges related to the new needs required by the populations, and also the deepening of the traditional social problems. In this context, fulfill their social mission implies that NPOs have to take care with their performance and simultaneously maximize the social value generated. The review of the literature allowed to identify factors associated with financial management and governance that may contribute to the definition of the social services offered by NPOs. Thus, in a studied applied to Holy Houses of Mercy in Portugal, this investigation intends to understand the influence of the financial management and the governance on the NPO social services provided. The results obtained show a positive contribution of the finances and the governance on the social services of these institutions, which lead us to conclude that to be more effective in the social services provision, NPOs must emphasize their financial management and governance practices. info:eu-repo/semantics/publishedVersion

The socioeconomic changes that many countries have been experiencing in recent decades, caused by structural factors or by specific circumstances, where the pandemic crisis of COVID-19 is only the most recent example, have posed challenges to organizations, which present themselves more and more and in various forms as threatened by the possibility of fulfilling their mission. Public and private sectors increasingly present themselves as insufficient to respond effectively to day-to-day requests. This context of instability and the resulting impacts for non-profit organizations pose serious problems to the way in which governance is exercised and served as a motivation for carrying out a study that aimed to understand the influence of strategy and human resources on the governance of these organizations. A review of the literature on the variables under study made it possible to identify the sub-dimensions associated with each one of them and the respective indicators. Thus, for a quantitative study, it was possible to apply a questionnaire to 242 Holy Houses of Mercy in Portugal to understand the direct and indirect influences of strategic management and human resources management on the governance of these institutions. The results obtained show the existence of a positive relationship between the variables under analysis, confirming that not only do these variables influence, by themselves and directly, the governance of the institutions studied, but also the strategy influences human resources policies, which in turn have implications for the way the Holy Houses of Mercy deal with aspects associated with governance. It is concluded that, in general, for these organizations to be more effective in efforts to improve their governance processes, they must focus on strategic management and human resources management instruments. info:eu-repo/semantics/publishedVersion

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Objective: Recent studies on immersion (first-person perspective) and distancing (third-person perspective) in psychotherapy have shown the potential of both perspectives in the treatment of depression. High levels of change were associated with transitions between immersion and distancing, suggesting that a dynamic pattern between them may result in a more adaptive view of reality. This study aimed to assess if higher flexibility between these perspectives, during clientś reflection on negative experiences in the intermediate phase, is associated with lower levels of depressive symptoms at the end of treatment. Method: We analyzed the flexibility through frequency and magnitude of transitions between immersion and distancing, in representative sessions of the intermediate phase of therapy in 17 cases with depression. Results: The results showed that the higher frequency and lower magnitude in the intermediate phase predicted lower levels of depressive symptoms at the end of treatment. Conclusion: Immersion and distancing seem to work as dynamic processes, and greater flexibility between them in intermediate phase of therapy, characterized by frequent and fast transitions between the two perspectives, may be an adaptive pattern due to its effect on post treatment depressive symptoms. info:eu-repo/semantics/publishedVersion