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- Programas de educação dirigidos ao utente com diabetes mellitus tipo 2: revisão sistemática da literaturaPublication . Menino, Eva; Dixe, Maria dos Anjos; Martins Louro, Maria Clarisse; Roque, SofiaO aumento da longevidade e as problemáticas de saúde associadas ao aumento da incidência da doença crónica, concretamente a diabetes que apresenta implicações documentadas ao nível económico, social e familiar, justificam a necessidade de uma resposta dos serviços de saúde consertada e de qualidade. Esta revisão sistemática tem como objetivo analisar os programas de educação dirigidos ao utente diabético, metodologias de avaliação assim como os respetivos resultados. Os cinco estudos incluídos resultaram duma pesquisa realizada na EBSCOhost e na ISI Web of Knowledge. Os programas de intervenção apresentam metodologias e estruturas distintas, embora todos tenham tido por base teórica a educação para a autogestão. As metodologias de avaliação da eficácia dos programas incidiram essencialmente em parâmetros fisiológicos, embora em alguns estudos tenham sido avaliados parâmetros psicológicos. Os resultados mostram melhorias nos valores da Hemoglobina glicada; da pressão arterial, colesterol, na vigilância oftálmica, autovigilância dos pés e vigilância nefropática, autoeficácia, qualidade de vida, dieta, peso corporal, perímetro abdominal, indicadores de atitude e indicadores de comportamento. Parece haver uma resposta positiva aos programas de intervenção, traduzida em resultados relacionados com parâmetros fisiológicos e parâmetros psicológicos.
- Attitude Towards Pressure Ulcers Instrument: validação e adaptação transcultural para a população portuguesa de enfermeirosPublication . Batista, Margarida; Dixe, Maria dos Anjos; Alves, PauloContexto/objetivos: A investigação e a prática têm evidenciado a importância das atitudes dos enfermeiros na prevenção das úlceras de pressão e a necessidade da elaboração de instrumentos de medida válidos e fiáveis para a sua avaliação. Respondendo a esta necessidade, procedemos à validação transcultural do Attitude Towards Pressure Ulcers Instrument (APU) para a população portuguesa. Metodologia: Realizou-se um estudo metodológico numa amostra não-probabilística de estudantes de enfermagem (n=147) e enfermeiros (n=155). Foi utilizada a metodologia usada no estudo de validação original. Resultados: A tradução-retrotradução com a participação de um painel de peritos garantiu a equivalência semântica e conceptual. A análise fatorial determinou que os 22 itens se organizam em 5 fatores (importância, responsabilidade, obstáculos/barreiras, confiança na eficácia e competências pessoais), explicando 53,6% da variância total. Obteve-se um poder descriminante da escala em alguns dos grupos comparados. O coeficiente a Cronbach total=0,847 garantiu a consistência interna da escala e a confiabilidade teste-reteste revelou coeficientes de correlação r=0,883 comprovando a sua estabilidade temporal. Enfermeiros e estudantes revelaram uma atitude positiva acerca dos itens da escala, sem diferença estatisticamente significativa entre estes (t=0,567; p>0,05). Conclusão: A escala APu-PT evidenciou ser fiável e válida para a prática, ensino e investigação.
- ASA classification – What is the real impact of the introduction of the new clinical examples?Publication . Godinho, Pedro; Gonçalves, Lúcia; Muendane, Paulo; Dixe, Maria dos Anjos; Valente, ElisabeteAim The American Society of Anesthesiologists scale is used worldwide for the assessment of the physical status of patients proposed for anaesthesia interventions. This study aims to assess the level of agreement of the last updated American Society of Anesthesiologists classification version, with the introduction of examples for each class, and search for variables that could promote inconsistency. Methods An online questionnaire was sent to anaesthesiology specialists and residents in Portugal, describing 10 fictitious clinical cases. Sociodemographic and labour data were also correlated. Results/findings: A total of 243 anaesthesiology physicians participated. There was a high diversity in responses. Years of practice influence this diversity (P < 0.05). Discussion and conclusions: The need for a universal scale for classification of patients proposed for anaesthesia is consensual. Despite the last update in 2014, the American Society of Anesthesiologists classification continues to present limitations regarding consistency and objectivity. Efforts should be made to reduce their interpersonal variability.
- Does Symptom Recognition Improve Self-Care in Patients with Heart Failure? A Pilot Study Randomised Controlled TrialPublication . Sousa, Joana Pereira; Neves, Hugo; Pais-Vieira, MiguelPatients with heart failure have difficulty in self-care management, as daily monitoring and recognition of symptoms do not readily trigger an action to avoid hospital admissions. The purpose of this study was to understand the impact of a nurse-led complex intervention on symptom recognition and fluid restriction. A latent growth model was designed to estimate the longitudinal effect of a nursing-led complex intervention on self-care management and quality-of-life changes in patients with heart failure and assessed by a pilot study performed on sixty-three patients (33 control, 30 intervention). Patients in the control group had a higher risk of hospitalisation (IRR 11.36; p < 0.001) and emergency admission (IRR 4.24; p < 0.001) at three-months follow-up. Analysis of the time scores demonstrated that the intervention group had a clear improvement in self-care behaviours (βSlope. Assignment_group = −0.881; p < 0.001) and in the quality of life (βSlope. Assignment_group = 1.739; p < 0.001). This study supports that a nurse-led programme on symptom recognition and fluid restriction can positively impact self-care behaviours and quality of life in patients with heart failure. This randomised controlled trial was retrospectively registered (NCT04892004).
- Practices and Challenges in Portuguese Early Childhood Intervention: A Descriptive StudyPublication . Costeira , Cristina; Lopes, Inês; Lopes, Saudade; Pedrosa, Vanda Varela; Custódio, Susana; Cioga, Elisabete; Silva, Cândida G.Background/Objectives: Early Childhood Intervention (ECI) services are critical for supporting children with developmental needs and their families. Despite an established legislative framework, challenges related to accessibility, equity, resources, and standardization of practices persist. This study aimed to describe the perspectives of early intervention professionals in Portugal regarding current barriers, facilitators, and priority areas for improvement within the system. Methods: A descriptive study was conducted involving 82 professionals working in early intervention in Portugal. Data were collected using a survey specifically developed by the research team, grounded in a comprehensive literature review and professional expertise. The instrument was validated through a Delphi Panel with two rounds involving six experts in ECI. Data from open-ended questions were analyzed using content analysis, identifying categories and sub-categories to describe the responses, and descriptive statistics for the closed-ended questions. Results: Professionals highlighted the need to update the National ECI System (SNIPI), improve accessibility, and ensure equitable access to early intervention services. Participants reported limited resources, a lack of standardization in practices, and emphasized the importance of professional training and continuous professional development. The findings also pointed to the urgent need for investment and functional and structural restructuring of early intervention services. Various barriers and facilitators were identified. Conclusions: The study provides valuable insights into the perspectives of early intervention professionals, identifying critical areas for policy improvement, resource allocation, and practice standardization.
- Mapping the Second Victim Experience Among Western Nurses: A Scoping ReviewPublication . Costeira, Cristina; Junqueira, Helena; Quintas, Pedro; Pragosa, Ângela; Mata, Ema; Duarte, Hugo; Bom, Luís; Pais, NelsonBackground/Objectives: The second victim phenomenon is increasingly recognized as a significant issue affecting nurses involved in adverse events resulting from clinical decisions or interventions. Although patients and families, considered the first victims, are directly impacted, nurses often undergo challenges as second victims. With the growing awareness of these effects, this study aimed to map recent evidence on the second victim phenomenon among nurses in Western countries. Methodology: A Scoping Review was conducted following the Joanna Briggs Institute methodology in September 2024 and updated in November 2025. Eligibility criteria were defined using the PCC (Population, Concept, Context) framework. Searches were performed in PubMed, CINAHL, SciELO, and Scopus. Two independent reviewers carried out study selection, data extraction, and synthesis. Rayyan® supported screening, performed in two phases: title/abstract review and full-text analysis. Data extraction was conducted in Excel®, and data were analyzed using descriptive statistics and categorized into thematic areas. The review followed PRISMA-ScR guidelines and was registered in the Open Science Framework. Results: Of the 111 articles retrieved, 39 met the inclusion criteria. Evidence shows that although several support programs exist for nurses as second victims, they are often perceived as inadequate or inconsistently implemented. Second victim experience is associated with physical (e.g., sleep disturbances), emotional (e.g., fear), and psychological (e.g., distress) symptoms, with consequences such as absenteeism, professional dissatisfaction, loss of meaning in life, and even suicide. Conclusion: Findings highlight the need for more comprehensive, accessible, and consistently implemented support strategies to meet the complex needs of nurses affected by the second victim phenomenon.
- Gait Kinematics Analysis of Flatfoot AdultsPublication . Marouvo, Joel; Sousa, Filipa; Fernandes, Orlando; Castro, Maria António; Paszkiel, SzczepanBackground: Foot postural alignment has been associated with altered gait pattern. This study aims to investigate gait kinematic differences in flatfoot subjects’ regarding all lower limb segments compared to neutral foot subjects. Methods: A total of 31 participants were recruited (age: 23.26 yo ± 4.43; height: 1.70 m ± 0.98; weight: 75.14 kg ± 14.94). A total of 15 subjects were integrated into the flatfoot group, and the remaining 16 were placed in the neutral foot group. All of the particpants were screened using the Navicular Drop Test and Resting Calcaneal Stance Position test to characterize each group, and results were submitted to gait analysis using a MOCAP system. Results: Significant kinematic differences between groups were found for the ankle joint dorsiflexion, abduction, and internal and external rotation (p < 0.05). Additionally, significant differences were found for the knee flexion, extension, abduction, and external rotation peak values (p < 0.001). Significant differences were also found for the hip flexion, extension, external rotation, pelvis rotation values (p < 0.02). Several amplitude differences were found concerning ankle abduction/adduction, knee flexion/extension and abduction/adduction, hip flexion/extension and rotation, and pelvis rotation (p < 0.01). Conclusion: Flatfooted subjects showed kinematic changes in their gait patterns. The impact on this condition on locomotion biomechanical aspects is clinically essential, and 3D gait biomechanical analysis use could be advantageous in the early detection of health impairments related to foot posture.
- Low-Protein Diets, Malnutrition, and Bone Metabolism in Chronic Kidney DiseasePublication . Pereira, Cidália D.; Guimarães, Carla; Ribeiro, Vânia S.; Vaz, Daniela C.; Martins, Maria JoãoChronic kidney disease (CKD) has a high prevalence worldwide, with increasing incidence in low- and middle-income countries, and is associated with high morbidity and mortality, particularly from cardiovascular disease. Protein-restricted diets are one of the most widely used non-pharmacological approaches to slow the progression of CKD and prevent associated metabolic abnormalities. However, some concerns have been raised about the long-term safety of these diets, particularly with regard to patients’ nutritional status and bone and mineral disorders. Therefore, the aim of this article is to review the most recent scientific evidence on the relevance of using protein-restricted diets (with or without keto-analogue supplementation) and, in particular, their relationships with malnutrition and mineral and bone disorders in people with CKD without kidney replacement therapies. Although protein-restricted diets, especially when supplemented with keto-analogues and highly personalized and monitored, do not appear to be associated with malnutrition, research on their effects on bone and mineral disorders is scarce, deserving further investigation.
- Should Children Drink Water with Very Low Mineral Content? Implications of the Global Expansion of Water Filtration Systems and Relevance of Consumption of Water with Higher Mineralization LevelsPublication . Pereira, Cidália D.; Martins, Maria JoãoThe consumption of water with very low mineral content (W-VLMC; water with total dissolved solids below 50 mg/L), despite limited and inconsistent evidence and the resulting knowledge gaps, has not been associated with health risks for the general population. However, certain population subgroups (those eating very unbalanced diets or avoiding certain foods, engaged in prolonged periods of fasting, and/or doing prolonged or strenuous exercise as well as pregnant or breastfeeding women) should be mindful of maintaining sufficient intake of all essential minerals through their food if regularly using this type of water as their main beverage. The rapid expansion of water filtration systems—often producing W-VLMC—creates a timely and valuable opportunity to advance research on the health implications of W-VLMC intake. As these systems become increasingly common in educational settings and homes, children represent a subgroup experiencing rising exposure to W-VLMC. Additional studies are needed to assess the health effects of such exposure from early childhood. A complementary yet contrasting perspective is that the use of water intended for human consumption—with stringent quality control standards—and natural mineral waters—inherently pure, thus eliminating the need for filtration—with higher mineralization in both types of water, may provide an additional dietary source of essential minerals, especially for all the population subgroups mentioned above.
- ¿Cuáles son las prácticas y comportamientos de los mayores institucionalizados para prevenir las caídas?Publication . Baixinho, Cristina Lavareda; Dixe, Maria dos AnjosObjetivos: describir las prácticas y los comportamientos de los mayores para prevenir las caídas;; identificar prácticas de comunicación de los mayores para la prevención de caídas y asociar las prácticas y comportamientos de prevención de caídas con la edad, sexo, tiempo de institucionalización, grado de dependencia y utilización de medios auxiliares de marcha. Metodología: La muestra fue de 156 personas mayores de ambos sexos de seis residencias de ancianos que autorizaron la realización del estudio. El instrumento utilizado fue la Escala de prácticas y comportamientos de los ancianos para prevenir las caídas (α=0,881). Resultados: los ancianos son poco perseverantes en la elección de los zapatos cerrados y con suelas antideslizantes. Los hombres valoran más las prácticas y comportamientos seguros (p=0,045) que las mujeres. Los ancianos más dependientes revelan peores prácticas y comportamientos de prevención. Los mayores que utilizan auxiliares de marcha revelan mejores prácticas de comunicación (p=0,019) y mejores prácticas y comportamientos relacionados con la accesibilidad al espacio físico (p=0,012). Conclusiones: Estudios futuros deben asociar el predominio de caídas a las prácticas y comportamientos de los ancianos.