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- Anthropometric and Body Composition Changes After Bariatric Surgery—The Effect of Sex, Age, and Type of SurgeryPublication . Guerra, Rita Soares; Pinho-Reis, Cíntia; Sousa, Ana Sofia; Mendes, Joana; Silva, CláudiaThe rise in obesity and its associated health problems increases the need for therapeutic approaches such as bariatric surgery. Therefore, this study aims to explore the changes in the anthropometric and body composition characteristics of patients undergoing bariatric surgery. A retrospective longitudinal study was conducted in subjects ≥ 18 y who underwent bariatric surgery and attended one nutrition appointment before and after surgery. Information on their sex, age, weight, fat mass (kg and %), fat-free mass (kg and %), and skeletal muscle mass, obtained using bioelectrical impedance, and on their waist circumferences was collected. Their BMIs and skeletal muscle mass indexes were calculated. The differences in the anthropometric and body composition parameters between pre- and post-surgery were also calculated. The participants were grouped by sex, age groups (18–44 y and 45–69), and type of surgery (Roux-en-Y gastric bypass and gastric sleeve). The variables are presented as n (%) and as means (SDs) or medians (interquartile ranges). Student’s t-test and the Mann–Whitney test were employed (p < 0.05). The sample consisted of 57 subjects (aged 18–69 years; 75% women). Between the pre- and post-surgical periods (63 (42) days), their weight (mean: 103.0 (SD: 16.3) kg vs. 91.2 (14.2) kg, p < 0.001); BMIs (37.9 (4.2) kg/m2 vs. 33.6 (4.1) kg/m2, p < 0.001); waist circumferences (116.2 (12.4) cm vs. 105.7 (12.3) cm, p < 0.001); % fat mass (45.5 (6.0) vs. 41.0 (8.0), p < 0.001); skeletal muscle mass (32.8 (7.4) kg vs. 30.3 (6.5) kg, p < 0.001); and skeletal muscle mass indexes (12.0 (1.8) kg/m2 vs. 11.1 (1.7) kg/m2, p < 0.001) decreased; meanwhile, their % fat-free mass increased (54.7 (6.0) vs. 59.0 (8.0), p < 0.001). Most of these changes occurred regardless of sex, age, or type of surgery. Shortly after bariatric surgery, patients show a better nutritional status and body composition.
- Antithrombotic treatment following revascularization for chronic limb-threatening ischaemia: a scientific statement of the European Society of Cardiology Working Group on Aorta and Peripheral Vascular Diseases and the European Society of Cardiology Working Group on Cardiovascular PharmacotherapyPublication . Schlager, Oliver; De Carlo, Marco; Mazzolai, Lucia; Bura-Riviere, Alessandra; Heiss, Christian; Palomares, Jose Rodriguez; Morais, João C. A.; Steiner, Sabine; Brodmann, Marianne; Aboyans, Victor; Caterina, Raffaele DeChronic limb-threatening ischaemia (CLTI) is defined as ischaemic rest pain, or non-healing ulceration, requiring endovascular or surgical lower limb revascularization (LLR). Lower limb revascularization in CLTI entails a high risk of major adverse limb events (MALE) and major adverse cardiovascular events (MACE). This scientific statement addresses this risk based on a systematic review. A structured literature search was performed, and articles were independently evaluated by two investigators. In total, 1678 articles were identified, of which 34 were included in the final analysis. Only three randomized controlled trials (RCTs) addressed antithrombotic therapy in CLTI following LLR. None of these demonstrated superiority of any antithrombotic regimen over the other. Eight RCTs investigated antithrombotic therapy following LLR in populations with peripheral arterial disease including CLTI subgroups and suggest a benefit of dual antiplatelet therapy on limb events. One large RCT demonstrated that dual pathway inhibition with aspirin and vascular-dose rivaroxaban reduced the risk of MALE, MACE, and unplanned target limb revascularization. Data from 22 observational studies suggest a benefit of dual antiplatelet therapy on overall survival and amputation-free survival after LLR as compared with single antiplatelet therapy. Intensified antithrombotic treatment should be proposed in patients with CLTI following LLR to reduce the risk of MALE and MACE. Randomized controlled trials on antithrombotic therapy in patients with CLTI following LLR are scarce. Dual pathway inhibition is the only regimen for which an RCT demonstrated a reduction of MALE and MACE following LLR. Dual antiplatelet therapy appears to be associated with a reduced risk of MALE in CLTI following LLR.
- The Arabic Version of the Patient Health Questionnaire‐2 (PHQ‐2): Psychometric Evaluation Among Mothers of Children With Intellectual DisabilitiesPublication . Ali, Amira Mohammed; Al-Dossary, Saeed A; Aljaberi, Musheer A.; El-Gazar, Heba Emad; Laranjeira, Carlos; Khatatbeh, Haitham; Zoromba, Mohamed Ali; Alamer, Rasmieh; Amer, Faten; Pakai, Annamaria; Fekih-Romdhane, Feten; Lidoriki, EiriniAim: Mothers of children with intellectual disabilities are particularly vulnerable to mental distress due to demanding and exhausting caregiving. However, in the Arab world, they are seldom screened for depression because of limited diagnostic resources. Addressing the urgent need for brief and reliable screening tools, this study evaluated the psychometric properties of the Arabic version of the Patient Health Questionnaire-2 (PHQ-2) among 85 Saudi mothers. Design: A cross-sectional study. Methods: The construct, convergent, and divergent validity of the PHQ-2 was examined through a latent variable model (LVM), while its cutoff score was examined through receiver-operating characteristic (ROC) curve analysis. Results: The unidimensional PHQ-2 (item loadings > 0.7) was positively predicted by stress and negatively predicted by high mood and happiness, supporting its convergent and divergent validity. The PHQ-2 effectively predicted low mood, poor sleep quality, nightmares, high stress, low general physical health, and willingness to join a psychological support program (area under the curve [AUC] range = 0.72–0.84, p values < 0.001). The best balance between sensitivity and specificity was achieved at the PHQ-2 threshold ≥ 2.5, while the cutoff ≥ 3.5 demonstrated a higher positive predictive value (PPV) for all outcomes (range = 30.0–78.8 vs. 23.0–70.8). Conclusions: The PHQ-2 is a brief, valid tool, which at cutoffs ≥ 2.5 and ≥ 3.5 can reliably detect clinically significant depression and related psychological and physical adverse effects. Mothers scoring ≥ 3.5 may require a clinician-based examination for depression, and they may benefit from specific mental health literacy interventions. However, the results should be interpreted with caution given convenience sampling, a small sample size, and elevated distress levels in the current population. These limitations highlight the need to replicate the study with larger, randomly selected samples from more diverse populations. Implications for Practice: Nurses can efficiently screen for depression and its mental/physical sequelae, as well as monitor response to treatment using only two items. The study provided two well-interpreted cutoffs of the PHQ-2, with real-world implications for mental health screening in under-resourced settings. Reporting Method: The study adhered to STROBE guidelines. Patient or Public Contribution: No patient or public contribution. Copyright © 2025 Amira Mohammed Ali et al. Nursing Research and Practice published by John Wiley & Sons Ltd.
- Burnout protective patterns among oncology nurses: a cross-sectional study using machine learning analysisPublication . Rocha, Ana; Costeira, Cristina; Barbosa, Raul; Gonçalves, Florbela; Castelo-Branco, Miguel; Viana, Joaquim; Gaudêncio, Margarida; Ventura, FilipaBackground Oncology nurses face unique and intense demands due to the nature of their work, caring for patients with life-threatening illnesses. The emergence of professional burnout among these nurses is influenced by several factors, highlighting the importance of identifying protective and risk factors to mitigate its impact. This study aims to identify burnout profiles and protective socio-demographic and work-related patterns associated with reduced burnout among oncology nurses. Methods A cross-sectional study was conducted with 150 oncology nurses at a specialized hospital exclusively dedicated to adult oncology treatment in Portugal. Data collection included a self-administered questionnaire incorporating the validated Portuguese version of Maslach Burnout Inventory (MBI). Statistical analyses were performed using SPSS and machine learning tools, specifically KMeans clustering and Random Forest algorithms. Results Six protective patterns against burnout were identified, characterized by conditions of permanent contracts, work-life balance, and supportive work environments. Moreover, factors such as holding management roles and being a parent of two or more children might even be protective in some circumstances, suggesting a nuanced relation between personal and professional factors. Machine learning analyses made apparent the unpredictability of burnout and highlighted the critical role of protective factors in mitigating its impact. Conclusions This study underscores the importance of resilience-building strategies and promoting protective factors, such as job stability, learned experience, and adequate rest, to reduce burnout risk among oncology nurses. Future research should validate these findings through hypothesis-driven analyses to inform targeted and context-specific burnout prevention programs.
- Characteristics of respiratory rehabilitation programs for people with Parkinson’s disease: a scoping reviewPublication . Loureiro, Ricardo Filipe de Moura; Santana, Elaine dos Santos; Duque, Filipa Margarida Gonçalves; Bernardes, Rafael Alves; Ventura, Filipa Isabel Quaresma; Silva, Rosa Carla Gomes da; Oliveira, Albertina Lima de; Lima, Margarida Pedroso de; Almeida, Maria de Lurdes Ferreira de; Cardoso, Daniela Filipa Batista; Cardoso, Ana Filipa dos Reis Marques; Aromataris, EdoardoObjective: The objective of this review was to map the characteristics of respiratory rehabilitation programs for people with Parkinson's disease. Introduction: Parkinson's disease is a progressive and heterogeneous neurodegenerative disease. Respiratory dysfunction is highly prevalent in people with Parkinson's disease and is a major contributor to morbidity and mortality. People with Parkinson's disease may experience respiratory dysfunction such as ineffective coughing and dyspnea. Complications, such as atelectasis and respiratory infections, significantly impact their self-care and quality of life. To mitigate its impact on people's lives, various respiratory rehabilitation programs have been developed and implemented. Many studies have examined this topic, yet respiratory rehabilitation programs vary significantly in structure and evaluated outcomes. Eligibility criteria: We considered studies focused on respiratory rehabilitation programs implemented to prevent or target one or more symptoms for adults (18 years and older) with Parkinson's disease, regardless of the disease stage. The programs could be provided by any health professional in any health care setting. Methods: We followed JBI methodology for conducting the scoping review, and the results were reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). A literature search was conducted across PubMed, CINAHL Complete (EBSCOhost), Cochrane Central Register of Controlled Trials (EBSCOhost), the Cochrane Database of Systematic Reviews (EBSCOhost), Scielo, Scopus, PEDro, and ClinicalTrials.gov. Unpublished studies were identified via Google Scholar, DART-Europe, and MedNar. All search strategies were conducted on April 24, 2023. Sources published in English, Spanish, and Portuguese were included and no date restrictions were applied. Study selection and data extraction were conducted independently by 2 reviewers using a standardized extraction tool. Results: Thirty-three studies published between 2001 and 2023 were included. Studies were conducted in the USA, Brazil, Turkey, Chile, Australia, Taiwan, Czechia, Italy, Republic of Korea, Germany, India, and Israel. The sample sizes ranged from 1 participant to 75 participants. The combined sample size of all studies was 1007 participants. Most programs integrated respiratory muscle strength training using devices, targeting people with Parkinson´s disease in Hoehn and Yahr scale stages 1-3. Speech-language pathologists, physiotherapists, and medical doctors were the health professionals responsible for delivering these programs in home-based or clinical settings. A broad spectrum of outcomes related to respiratory function was reported. Additionally, the studies assessed other outcomes such as quality of life, functional capacity, motor symptoms, and fatigue. Conclusions: Respiratory rehabilitation programs for people with Parkinson's disease have predominantly targeted respiratory muscle strength training, without a multidisciplinary approach. More research is needed emphasizing inclusive studies in terms of exercises/interventions in respiratory rehabilitation programs, stages of disease progression, and with the adoption of a multidisciplinary approach. Review registration: OSF https://osf.io/hgajt. Supplemental digital content: A translation of the abstract of this review is available in Portuguese at http://links.lww.com/SRX/A107 .
- Cold atmospheric plasma activation of human gingival fibroblasts for improved wound healingPublication . Silva, Neusa; Marques, Joana; Brito da Cruz, Mariana; Luis, Henrique; Mata, António; Sério, SusanaSoft tissue regeneration plays a crucial role after oral surgery, as the successful healing of the soft tissue is a primary indicator of an efficacious intervention. Cold atmospheric plasma (CAP) has recently emerged as a promising therapeutic modality, exhibiting notable effects on cell migration and proliferation. Despite its potential, the dental application of CAP remains underexplored. This in vitro study aims to elucidate the impact of CAP activated medium on human gingival fibroblast responses, for future wound healing strategies. The study was divided into four parts: initial characterization of the plasma Jet, assessment of cell concentration, exploration of treatment distance effects, and treatment time dynamics. Human gingival fibroblasts were exposed to complete DMEM medium (without sodium pyruvate) activated with CAP at treatment distances of 2, 5, 7, and 9 mm, and treatment times of 15, 60, 120, 180, and 300 s for 1, 2 and 3 d of culture. The cell viability was evaluated using resazurin-based method, while wound healing dynamics was assessed via the scratch assay technique using phase-contrast microscopy. The cell morphology was characterised through fluorescence microscopy using propidium iodide and phalloidin staining, complemented by scanning electron microscopy. The results revealed that treatment distances and exposure times can influence the cell behaviour depending on the cell concentration. For the selected concentration of 1 × 104 cells ml−1, a treatment distance of 9 mm appeared to enhance human gingival fibroblast viability compared to a treatment distance of 2 mm and the control group. The images revealed adherent cells with a pattern typical of fibroblasts. However, no differences were observed for exposure times of 15 s and 180 s. The observed results further evidence that the exposure of the medium to the CAP device promoted an increase in cell viability, proliferation, and attachment in human gingival fibroblasts.
- Collaborative Practices in Mental Health Care: A Concept AnalysisPublication . Pinheiro, Eslia; Laranjeira, Carlos; Harmuch, Camila; Graça, José Mateus Bezerra; Ali, Amira Mohammed; Fekih-Romdhane, Feten; Yıldırım, Murat; Severo, Ana Kalliny; Franco, ElisângelaBackground/Objectives: Collaboration in mental health care is essential for implementing a model oriented towards the psychosocial rehabilitation of people based on multifaceted interventions involving different actors and sectors of society to respond to demands. Despite the benefits presented by the scientific evidence, there are still many barriers to collaborative care, and professionals continue to struggle in reorienting their conduct. The current situation demands organization and the framing of well-founded action plans to overcome challenges, which in turn requires a detailed understanding of collaborative practices in mental health care and their conceptual boundaries. A concept analysis was undertaken to propose a working definition of collaborative practices in mental health care (CPMHC). Methods: This paper used the Walker and Avant concept analysis method. This includes identifying the defining concept attributes, antecedents, consequences, and empirical referents. A literature search was carried out from November 2024 to February 2025 in three databases (Medline, CINAHL, and LILACS), considering studies published between 2010 and 2024. Results: The final sample of literature investigated consisted of 30 studies. The key attributes were effective communication, building bonds, co-responsibility for care, hierarchical flexibility, articulation between services, providers and community, monitoring and evaluating of care processes, and attention to the plurality of sociocultural contexts. Conclusions: This comprehensive analysis contributes to guiding future research and policy development of collaborative practices in mental health, considering the individual, relational, institutional, and social levels. Further research is possible to deepen the understanding of the production of collaborative practices in mental health in the face of the complexity of social relations and structural inequities.
- A Complex Intervention to Minimize Medication Error by Nurses in Intensive Care: A Case StudyPublication . Coelho, Fábio; Furtado, Luís; Tavares, Márcio; Pereira, Joana SousaBackground/Objectives: Medication errors are the most frequent and critical issues in healthcare settings, often leading to worsened clinical outcomes, increased treatment costs, extended hospital stays, and heightened mortality and morbidity rates. These errors are particularly prevalent in intensive care units (ICUs), where the complexity and critical nature of the care elevate the risks. Nurses play a pivotal role in preventing medication errors and require strategies and methods to enhance patient safety. This study aims to develop a comprehensive and evidence-based intervention to minimize medication errors by nurses in ICUs. Methods: This qualitative case study forms a part of a broader research project that commenced with a scoping review. Building on the review findings, a complex intervention was designed to address nurses’ medication errors. A focus group of experts was conducted to validate the intervention designed, evaluating its contextual feasibility and relevance. Results: This study led to the development of a complex intervention whose relevance lies in its potential implementation within the studied context. The resulting intervention was structured around four main components—educational interventions, verification and safety methods, organizational and functional modifications, and an error reporting system—meticulously designed to leverage the ICU’s existing resources. Conclusions: In conclusion, the proposed intervention has the potential to positively impact healthcare quality by reducing errors and promoting a culture of safety. Furthermore, this study’s findings provide a relevant foundation for future research and practical applications, driving advancements in healthcare service excellence.
- Compreensão Leitora em Pessoas com Trissomia 21 – Revisão de EscopoPublication . Barradas, Beatriz; Correia, Maria Rodrigues; Taveira, Luísa; Rodrigues, Inês TelloO objetivo deste trabalho foi analisar os fatores que influenciam a compreensão leitora nas pessoas com Trissomia 21. Revisão de escopo elaborada de acordo com as diretrizes da Prefered Reporting Items for Systematic Reviews and Meta-Analyses. A pesquisa foi realizada nas bases de dados PubMed Central, LILACS, SciELO e via EBSCOHost. Os registos foram analisados por dois investigadores independentes. Os descritores utilizados foram: síndrome de Down e Reading combinados com termos de linguagem natural e operadores booleanos. O nível de evidência foi realizado segundo a classificação de Oxford Centre for EvidenceBased Medicine, e a qualidade metodológica através do Methodological Index for Non-Randomized Studies. A pesquisa resultou em um total de 637 estudos, dos quais sete foram incluídos. A qualidade metodológica dos estudos não comparativos variou entre baixa e média, enquanto a dos estudos comparativos, variou entre médio e alto risco de viés. A compreensão leitora encontra-se alterada nas pessoas com Trissomia 21. A compreensão auditiva foi o fator com mais impacto, existindo outros como a consciência fonológica, a memória de trabalho, a leitura isolada e o vocabulário. Os fatores que demonstram influência na compreensão leitora são heterogéneos, mas devem ser considerados para uma intervenção adequada.
- Contributions of mindfulness in high-risk pregnancy: a mixed methods systematic reviewPublication . Dutra, Irina Neves; Seixinho, Sandra; Baixinho, Cristina; Presado, Maria Helena; García-Fernández, RubénIntroduction Experiencing a high-risk pregnancy entails pathological situations with repercussions that can interfere with maternal-fetal well-being and increase maternal anxiety. Mindfulness emerges as one of the techniques used to improve the quality of care in the transition period resulting from pregnancy, which, through meditative practice, seeks to understand observation and the nature of the lived experience, resulting in a progressive state of clarity and awareness. Objective This review assessed the contributions of applying mindfulness in high-risk pregnancies. The review considered experimental, quasi-experimental studies, randomized controlled trials and non-randomized controlled trials. Observational studies were also considered. Evidence published in the last 5 years was considered. Methods This systematic review was conducted in accordance with the Joanna Briggs Institute methodology for systematic reviews of mixed methods using a convergent integrated approach to synthesis and integration. We searched for published and unpublished English, Portuguese and Spanish-language studies and grey literature. CINAHL Ultimate, MEDLINE (via Pubmed), Web of Science, Academic Search Complete, EBSCO Host Open Dissertations and Open Access Theses and Dissertations were searched in April–May 2024. Two authors screened titles and abstracts before full-text screening and data extraction. Two authors reviewed the extracted data. Results Ten articles were included in the review: 5 randomized controlled trials, 3 quasi-experimental studies and 2 mixed-methods studies. 9 studies measured the effectiveness of the application of mindfulness-based interventions on high-risk pregnant women and 1 assessed the acceptance of mindfulness intervention. Six studies measured the effects of the application of mindfulness in high-risk pregnant women in depressive symptoms, two reported the outcomes in stress, five on anxiety, two on psychological well-being, one on gestational weight gain, one in prenatal attachment and another in sleep quality. Conclusions Long term reduction of depressive symptoms, anxiety and stress and increased psychological well-being are contributions of mindfulness on high-risk pregnant women. The existing evidence on other contributions of the application of mindfulness is limited, further research being necessary.