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- Neuropeptides neurotensin and substance P accelerate diabetic wound healing by modulating immunity and the skin microbiomePublication . Maranha, Ana; Leal, Ermelindo C.; Alarico, Susana; Tiago, Igor; Pereira, Sónia G.; Empadinhas, Nuno; Carvalho, EugéniaDiabetic foot ulcers (DFUs) are a common and debilitating complication of diabetes mellitus, typified by impaired healing, persistent inflammation, and skin microbiota dysbiosis. Although some neuropeptides are immunomodulatory, their effects on skin microbiota and wound resolution remain largely unexplored. We examined the therapeutic potential of the neuropeptides neurotensin (NT) and substance P (SP) in reshaping inflammatory and microbial dynamics and accelerating wound closure in a healthy and streptozotocin-induced diabetic mice model. Full-thickness cutaneous wounds were induced on both groups, followed by daily topical applications of saline (CT), NT, or SP. Wound closure was monitored and changes in skin bacterial communities characterized using next-generation sequencing. Wound tissue samples were collected for immunohistochemical analysis. Topical application of NT or SP significantly accelerated wound healing, with the most pronounced effects in diabetic animals. Both neuropeptides reduced the number of pro-inflammatory cells, lowering M1 macrophages in diabetic wounds from 16.4 ± 4 to 12.1 ± 3 with NT and 10.9 ± 3 with SP, while increasing M2 macrophages from 11.6 ± 4 to 18.1 ± 4 (NT) and 21.6 ± 5 (SP). SP exerted the most pronounced immunomodulatory effect, normalizing the M1/M2 ratio and reducing the number of CD3⁺ T cells (12.4 ± 3) and neutrophils (12.1 ± 3) to levels comparable to non-diabetic skin. Concurrently, SP treatment induced substantial microbiota remodeling in diabetic wounds, reducing Staphylococcus by circa 34%, Aerococcaceae_unclassified by 6.8%, Aerococcus by 1.5% and nearly eliminating Weissella. These reductions were accompanied by an over twofold increase in commensal genera (Lactobacillus, Micrococcaceae_unclassified, Actinobacteria_unclassified), shifting the microbial community toward a more non-diabetic profile. Our findings suggest that NT and especially SP, enhance diabetic wound healing through dual local immunomodulation and microbiota restructuring.
- Evaluation of Procalcitonin Accuracy for the Distinction Between Gram-Negative and Gram-Positive Bacterial Sepsis in Burn PatientsPublication . Cabral, Luís; Afreixo, Vera; Meireles, Rita; Vaz, Miguel; Frade, João Gonçalo; Chaves, Catarina; Caetano, Marisa; Almeida, Luís; Paiva, José-ArturSepsis is the main cause of death in burns. Early institution of antimicrobial therapy is crucial to optimize outcomes but superfluous therapy increases adverse events, microbial resistance, and costs. Blood cultures are the gold standard for diagnosis but can take 48 to 72 hours. Biomarkers are used to help sepsis diagnosis and distinction between Gram-negative and Gram-positive bacterial cause. The aim of this work is to evaluate procalcitonin (PCT) accuracy for this distinction in burn patients. Retrospective observational study of adult septic burn patients with ≥15% total burn surface area admitted from January 2011 to December 2014 at a Burn Unit in Portugal. A statistical analysis was done, evaluating the correlation between PCT levels on the day of the first positive blood culture and microbiological data for Gram-negative and Grand-positive bacteria. Patients with mixed bacterial and/or fungal blood cultures were excluded. Data were summarized by quartiles statistics. Blood cultures were positive in 189 patients: 75 (39.7%) showed growth for Gram-negative and 114 (60.3%) for Gram-positive bacteria. Patients with Gram-negative bacteria have significantly higher PCT levels. Receiver operating characteristic curve analysis showed accuracy for Gram-negative discrimination with area under the curve = 0.687. Most elevated levels were related to nonfermentative Gram-negative bacteria and by Klebsiella pneumoniae and other Enterobacteriaceae. PCT levels were significantly higher in burn patients with Gram-negative sepsis comparing to patients with Gram-positive sepsis and controls. The determination of PCT levels may help the choice of empirical antimicrobial therapy while microbiological culture results are not available, despite not fully ensuring the desirable degree of precision.
- Assessing the Carbon Footprint of Meals: A Case Study from a Portuguese College CanteenPublication . Guimarães, Carla; Caseiro, B.; Bento, B.; Costa, C.; Moskalenko, D.; Manuel, E.; Neto, I.; Simões, J.; Chinita, M.; Henriques, R.; Ferreira, S.; Barroso de Moura Cipreste Vaz, Daniela; Pereira, Cidália Almeida; Santos Ribeiro, VâniaInstitutional food services, such as school canteens, significantly contribute to the environmental impact of food systems due to the high volume of meals served and their influence on dietary habits, particularly among younger populations. This study assessed the carbon footprint (CF) of all the dishes on the menu offered by a college canteen in central Portugal, including meat, fish/seafood, and vegan options. Nutritional adequacy was also evaluated, defined as the percentage of dishes meeting established nutritional guidelines. The findings revealed that meat-based dishes had the highest CF, followed by fish/seafood options, while vegan dishes exhibited the lowest environmental impact. In terms of nutritional adequacy, meat and fish/seafood dishes frequently exceeded recommended levels of protein and lipids, making them the least nutritionally balanced. These results indicate that reducing animal-based protein sources in institutional menus could effectively lower carbon emissions while enhancing nutritional quality. Promoting plant-based alternatives and adjusting portion sizes of meat and fish can support both environmental sustainability and public health objectives.
- Nursing Practice Environments and Professional and Care-Related Outcomes in Portuguese Emergency Services: A Descriptive Study of 2018 and 2022Publication . Pragosa, Ângela; Roque, Sofia; Araújo, Beatriz; Jesus, ÉlvioBackground/Objectives: Emergency Services (ESs) are highly demanding clinical settings where Nursing Practice Environments (NPEs) play a critical role in shaping professional- and care-related outcomes. International evidence suggests that unfavorable NPEs are associated with reduced job satisfaction, compromised care quality, and increased safety risks. This study aimed to describe NPEs and selected professional and care-related outcomes among ESs nurses in Portugal in 2018 and 2022. Methods: A descriptive, cross-sectional study was conducted using data from two national surveys of ESs nurses collected in 2018 (n = 390) and 2022 (n = 434). Data were collected through an online questionnaire including the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of job satisfaction, intention to leave, perceived quality and safety of care, safety culture, incident occurrence, and missed nursing care. Descriptive statistics were used to summarize results across both samples. Results: NPEs were predominantly classified as unfavorable in both samples, with around 70% of nurses working in unfavorable environments. The most compromised dimensions were staffing and resource adequacy, nurses’ participation in hospital affairs, and nurse manager ability, leadership, and support of nurses. Job satisfaction was low in both samples, and a high proportion of nurses reported an intention to leave the organization. Differences were observed between samples in perceived quality and safety of care, incident occurrence, and missed nursing care, particularly in relational and autonomous interventions. Collegial nurse–physician relations emerged as the only favorable dimension in both samples. Conclusions: The findings indicate that NPEs in Portuguese ESs were predominantly unfavorable in both study periods, reflecting structural and organizational challenges. These findings may be associated with nurses’ professional outcomes and perceived care quality and safety, highlighting the importance of targeted organizational interventions to improve practice environments.
- Fundamentals of Care in a 1997 Azorean Disaster: A Multiple-Case StudyPublication . Pires, Eunice Gatinho; Baixinho, Cristina Lavareda; Henriques, Adriana; Costa, AndreiaBackground/Objectives: Disasters have a substantial impact on health systems and populations worldwide, with increasing frequency, mortality, and economic losses associated with natural hazards. The United Nations emphasises that disasters result from the interaction between hazards, exposure, and vulnerability, requiring integrated, people-centred health responses aligned with the 2030 Agenda. However, empirical evidence describing specific nursing interventions, particularly during response and recovery phases, is limited. This study aims to analyse the fundamental nursing care interventions provided to disaster victims in the Autonomous Region of Azores, Portugal. Methods: A qualitative multiple case study was conducted using documentary analysis of the nursing records from two disaster survivors with different clinical trajectories. Data were collected between August 2023 and May 2024 through complete transcription of nursing documentation contained in the clinical files. Data analysis followed Yin’s case study methodology and was theoretically supported by the Fundamentals of Care Framework. Results: The findings indicated a predominance of interventions addressing physiological needs during the acute phase, which progressively evolved to maintenance, psychosocial support, and adaptation needs during prolonged hospitalizations. Nursing care integrates advanced technical skills with relational and person-centred interventions, including emotional support, therapeutic communication, and promotion of patient autonomy. Conclusions: Nursing practice in disaster situations should be conceptualised as integrative, person-centred care grounded in international nursing frameworks. Strengthening disaster-specific nursing education, developing phase-adapted care protocols, and promoting multicentre longitudinal research appear to play a critical role for advancing nursing care models and informing health policies in disaster-prone regions.
- Cardiovascular pharmacotherapy in 2025Publication . Tamargo, Juan; Agewall, Stefan; Ambrosio, Giuseppe; Borghi, Claudio; Cerbai, Elisabetta; Dan, Gheorghe A; Drexel, Heinz; Ferdinandy, Péter; Grove, Erik Lerkevang; Klingenberg, Roland; Morais, João; Parker, William; Rocca, Bianca; Sulzgruber, Patrick; Semb, Anne Grete; Sossalla, Samuel; Kaski, Juan Carlos; Dobrev, DobromirDespite recent advances in cardiovascular pharmacotherapy, prevention and treatment of many cardiovascular diseases remain limited with a clear need for more effective and safer pharmacological strategies. Here, we summarize the most relevant advances in cardiovascular pharmacotherapy in 2025, including the approval of four new drugs (aficamten, etripamil, lerodalcibep, and plozasiran), the label expansions for five already approved drugs, and the results of major randomized clinical trials with already approved drugs, including those that met the prespecified primary endpoints (positive trials) representing new pharmacological options for cardiovascular diseases, those with neutral or negative results, which did not confirm the primary endpoints and the withdrawal from the US market of Andexanet-alfa for safety concerns. Finally, we present the most promising experimental cardiovascular drugs currently being investigated in ongoing Phase 2 and 3 clinical trials.
- Physiotherapy education and game-based learning: developing the SPINE frameworkPublication . Bernardo, Diana Filipa Salvador; Paquete, Manuel Joaquim da Silva P. G.; Rosa, Marlene Cristina NevesInnovative pedagogical approaches are increasingly essential in physiotherapy education to foster engagement and competency development. This multicenter cross-sectional study explored physiotherapy students’ perceptions of game-based learning (GBL) across six Portuguese higher education institutions. A total of 208 students completed a structured questionnaire assessing attitudes toward GBL in teaching–learning contexts and competency development. Results indicated generally positive perceptions of GBL, emphasizing its value for motivation, engagement, and integration of theoretical and practical learning. Transversal competencies—such as teamwork, communication, and empathy—were consistently recognized across academic years, while perceived benefits for technical skills increased with clinical exposure. Female students and those with prior health-related experience reported more favorable attitudes. However, students also highlighted limited curricular implementation and the need for clearer alignment between game activities and learning objectives, suggesting barriers at the institutional and pedagogical levels. These insights point to a gap between students’ enthusiasm and current educational practices, underlining the importance of structured guidance for integrating GBL effectively. Building on these findings, the student-perceived integration for novel education (SPINE) framework is proposed as a decision-making model to guide the pedagogically grounded GBL in physiotherapy curricula, emphasizing evidence-informed, context-sensitive, and sustainable implementation.
- The Arabic Generalized Anxiety Disorder 2 (GAD-2): Psychometric evaluation among mothers of children with intellectual disabilitiesPublication . Ali, Amira Mohammed; Al-Dossary, Saeed A.; Fekih-Romdhane, Feten; Laranjeira, Carlos; Khatatbeh, Haitham; El-Gazar, Heba Emad; Ayed, Ahmad; Alkhamees, Abdulmajeed A.; Aljaberi, Musheer A.; Alamer, Rasmieh; Pakai, Annamaria; Zoromba, Mohamed AliIntroduction Disruptive behaviours of children with intellectual disabilities predispose mothers to mental and physical morbidities, leading to caregiving burnout, lower childcare quality, and poor child progress. Methods This cross-sectional study investigated the psychometrics of the Arabic version of the Generalised Anxiety Disorder 2-item scale (GAD-2) among 85 Saudi mothers of children with intellectual disabilities through latent variable model and receiver-operating characteristic curve analyses. Results The unidimensional GAD-2 demonstrated good construct validity, invariance at the configural, metric, and scalar levels across age groups, and adequate convergent/divergent validity—It was negatively predicted by high mood and happiness and positively predicted by stress, and it mediated the effect of stress and happiness on depression. Its known-group validity was determined by elevated anxiety levels among mothers using psychotropic drugs. Two cut-offs (≥2.5 and ≥3.5) flagged the best trade-off between sensitivity and specificity for predicting low mood, poor sleep quality, nightmares, high stress, low general physical health, and willingness to join a psychological support program. The positive predictive value for the cut-off ≥3.5 was higher for all outcomes than that of the cut-off ≥2.5. Discussion The GAD-2 is a valid and reliable tool, which at thresholds ≥3.5 can identify anxious mothers, aiding early diagnosis and intervention.
- Psychological Distress and Health-Related Quality of Life in Ménière’s Disease: A Comparative Study in the Portuguese PopulationPublication . Ribeiro, Diogo; Martins, Tânia; Oliveira, André; Dias, Sara Simões; Caroça, CristinaBackground/Objectives: Ménière’s disease (MD) is a chronic inner-ear disorder characterized by vertigo, tinnitus, and fluctuating sensorineural hearing loss (SNHL) that impairs health-related quality of life (HRQoL) and is frequently accompanied by psychological distress. This study aims to quantify psychological distress and generic HRQoL in patients with definite MD compared with age- and sex-matched general-population controls and to examine the associations between hearing loss (HL) severity, symptom-related handicap, and these outcomes within the MD cohort. Methods: In this observational cross-sectional study, 45 adults with definite MD were recruited from an otolaryngology clinic in Portugal and individually matched (1:3) by sex and 10-year age strata to 135 participants from the EpiDoC population cohort. HRQoL was assessed using the SF-36v2 and EQ-5D-3L, psychological distress using the HADS, and tinnitus- and dizziness-related handicap using the THI and DHI. HL severity was staged using the AAO-HNS (1995) criteria. Results: Patients with MD had higher anxiety and depression scores and nearly twice the prevalence of abnormal anxiety compared with controls. SF-36v2 scores were significantly worse in several role and psychosocial domains, with less bodily pain but similar physical functioning and general health. EQ-5D-3L revealed a lower utility index and higher pain/discomfort and anxiety/depression. Within the MD cohort, HL stage was only weakly related to distress and HRQoL. In contrast, higher THI and DHI scores were consistently associated with more severe anxiety and depression and lower SF-36v2 scores. In multivariable analysis, abnormal anxiety was strongly associated with moderate-to-severe tinnitus handicap (OR = 17.5), whereas higher depressive symptoms independently predicted moderate-to-severe dizziness handicap, with abnormal anxiety showing a strong but borderline association with the latter. Conclusions: MD confers clinically meaningful HRQoL decrements and a higher psychological distress burden than in the general population. Tinnitus- and dizziness-related handicap and psychological distress, particularly anxiety, rather than HL severity, are key multidisciplinary management targets. Systematic screening for anxiety and depression, regardless of audiometric stage, should be integrated into MD care pathways.
- L’efficacia dell’istruzione sul riconoscimento dei sintomi in pazienti affetti da insufficienza cardiaca ai fini del self-care: un protocollo di revisione sistematicaPublication . Sousa, Joana Pereira; Neves, Hugo; Lobão, Catarina; Gonçalves, Rui; Santos, MiguelL’insufficienza cardiaca è una malattia cronica caratterizzata da un complesso regime di trattamento. I pazienti devono registrarsi a un programma di gestione del trattamento della patologia anche ai fini del self care. Tuttavia, il riconoscimento dei sintomi è una fase difficilmente gestibile dai pazienti, poiché essi tendono ad attenderne la scomparsa. Lo scopo di questo studio è verificare se i pazienti affetti da insufficienza cardiaca sappiano riconoscere i primi segnali della malattia. METODO: Sarà effettuata una revisione sistematica al fine di analizzare l’efficacia dell’istruzione dei pazienti nel rilevamento dei sintomi legati all’insufficienza cardiaca. RISULTATI: La revisione sistematica fornirà dati atti a comprendere se l’istruzione dei pazienti in materia di insufficienza cardiaca sia efficace nella riduzione dei ricoveri ospedalieri. CONCLUSIONI: I pazienti affetti da insufficienza cardiaca lottano quotidianamente per trovare un equilibrio in merito all’automedicazione. Se non istruiti sui sintomi da attendersi, i pazienti resterebbero a casa ad aspettarli, determinando così ricoveri ospedalieri gravi. Le precedenti revisioni sistematiche e meta-analisi si sono concentrate sulle associazioni tra i sintomi nei pazienti affetti da insufficienza cardiaca o su programmi di gestione dell’insufficienza cardiaca caratterizzati da più componenti, con diversi argomenti didattici. Il presente protocollo di revisione è incentrato sul monitoraggio dei sintomi da parte dei pazienti affetti da insufficienza cardiaca, e lo sviluppo di questa abilità interferirà positivamente con l’automedicazione, evitando più ricoveri ospedalieri.