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- Curriculum Meeting Points: A transcultural and transformative initiative in nursing educationPublication . Cook, Sarah Sheets; Sheerin, Fintan; Bancel, Suzanne; Gomes, José Carlos RodriguesFollowing the Bologna initiative in the 1990s, schools of nursing across Europe began considering ways in which they might collaborate with each other in educating nurses in advanced/post-bachelor programs. There were various levels of success which led the writers to explore if such collaboration was possible with similar programs in the United States.Spearheaded by the Institute of Nursing at the Oslo and Akershus University College of Applied Sciences (HiOA), a consortium was established in 2010 to explore the possibilities of international collaborations in this area. In the process, recognition of subtle and more obvious barriers to such collaborations emerged. Consortium members agreed that there was a need to explore the origins and effects of these barriers and the assumptions which seemed to underpin them.The identified barriers were often caused by assumptions about the content of educational programs and about individual and collective approaches to teaching and learning. Several participants experienced a shift in consciousness about nursing education following the consortium's initial meeting in Oslo. For some, there was a feeling of finding 'like-minded thinkers' and for others it was like viewing a new landscape.This article details the evolution of the consortium and the philosophic underpinnings which guide its continued deliberations.
- Evaluating the Impact of Different Hypercaloric Diets on Weight Gain, Insulin Resistance, Glucose Intolerance, and its Comorbidities in RatsPublication . Melo, Bernardete F.; Sacramento, Joana F.; Ribeiro, Maria J.; Prego, Claudia S.; Correia, Miguel C.; Coelho, Joana C.; Cunha-Guimaraes, Joao P.; Rodrigues, Tiago; Martins, Ines B.; Seiça, Raquel M.; Matafome, Paulo; Conde, Silvia V.; Guarino, Maria PedroAnimal experimentation has a long history in the study of metabolic syndrome-related disorders. However, no consensus exists on the best models to study these syndromes. Knowing that different diets can precipitate different metabolic disease phenotypes, herein we characterized several hypercaloric rat models of obesity and type 2 diabetes, comparing each with a genetic model, with the aim of identifying the most appropriate model of metabolic disease. The effect of hypercaloric diets (high fat (HF), high sucrose (HSu), high fat plus high sucrose (HFHSu) and high fat plus streptozotocin (HF+STZ) during different exposure times (HF 3 weeks, HF 19 weeks, HSu 4 weeks, HSu 16 weeks, HFHSu 25 weeks, HF3 weeks + STZ) were compared with the Zucker fatty rat. Each model was evaluated for weight gain, fat mass, fasting plasma glucose, insulin and C-peptide, insulin sensitivity, glucose tolerance, lipid profile and liver lipid deposition, blood pressure, and autonomic nervous system function. All animal models presented with insulin resistance and dyslipidemia except the HF+STZ and HSu 4 weeks, which argues against the use of these models as metabolic syndrome models. Of the remaining animal models, a higher weight gain was exhibited by the Zucker fatty rat and wild type rats submitted to a HF diet for 19 weeks. We conclude that the latter model presents a phenotype most consistent with that observed in humans with metabolic disease, exhibiting the majority of the phenotypic features and comorbidities associated with type 2 diabetes in humans.
- Psoriatic arthritis and ankylosing spondylitis impact on health-related quality of life and working life: a comparative population-based study.Publication . Rodrigues, Joana; Rodrigues, Ana Maria; Sousa, Rute Dinis; Branco, Jaime Cunha; Canhão, Helena; Dias, SaraPsoriatic arthritis (PsA) and ankylosing spondylitis (AS) are chronic disorders that significantly impact patients' quality of life (QoL), health care systems and society. There is very limited data on the epidemiology and the impact of PsA and AS in Portugal, so in this study we aim to: 1) estimate the prevalence of PsA and AS in the adult Portuguese population; 2) compare health-related quality of life (QoL) of PsA and AS with the one of other rheumatic and musculoskeletal diseases (RMD) and with subjects with no rheuma - tic diseases; 3) compare early retirement and productivity loss among PsA and AS with other RMD. Methods: We used data from EpiReumaPt, a population-based survey, conducted from 2011 to 2013, in which 10661 subjects, over 18 years old, were screened for RMD. Spondyloarthritis (SpA) was defined by a posi tive expert opinion combined with the fulfillment of the Assessment of Spondyloarthritis International Socie ty (ASAS) criteria for axial and peripheral SpA. Estimates were computed as weighted proportions considering the study design. Logistic regressions were used to compare AS/PsA subjects with other RMD and the adult Portuguese population without rheumatic di - seases. Results: Prevalence rate of SpA was of 1.6% (95% CI 1.2% to 2.1%). Subjects with AS or PsA had worse QoL, reflected by EQ5D score when compared with the adult Portuguese population without rheumatic diseases (b=- 0.08; p=0.031). AS and PsA also had worse QoL when compared with participants with other RMD (b=-0.22; p>0.001). AS and in comparison to patients with other RMD, PsA subjects retired early due to their illness (OR=4.95; 95% CI 1.54% to 15.93%). A significant proportion of patients with SpA (13.6%) referred absenteeism in the previous 12 months to the interview. Conclusions: AS and PsA were found to be associated with poor QoL and a high rate of disease-related early retirement, emphasizing the burden of such rheuma tic conditions in Portugal.
- HIV AIDS Length of Stay OutliersPublication . Dias, S. Sara; Martins, Maria F.O.Costs with HIV/AIDS hospitalizations are one of the major financial burdens on healthcare systems worldwide. In Portugal, hospitalizations related to HIV infection are some of the most expensive and the second major diagnosis category, and also accounts for the greatest average length of stay. As a result, it is crucial to understand and identify HIV/AIDS hospital length of stay outliers. The objective of this study is to analyse HIV/AIDS length of stay high outliers during five consecutive years (2009-2013) and to identify its determinants for a specific HIV/AIDS diagnosis related group. To attain these objectives we will use a logistic regression model with random effects.
- Seeking Something Beyond Themselves: A Concept Analysis of Spiritual Awakening Experiences at the End of LifePublication . Monteiro, Manuela; Vitorino, Joel; Marina G. Salvetti; Laranjeira, CarlosBackground/Objectives: End-of-life (EoL) experiences are critically important for everyone involved, giving rise to a set of needs that extend far beyond bio-physiological aspects, to encompass the spiritual dimension as the core of human beings. Understanding the processes of spiritual awakening (SA) assists palliative care professionals in enhancing the quality of care provided to individuals with life-threatening illnesses, as well as to their families. SA is a fundamental occurrence linked to the fulfilment of our spiritual needs when facing an existential crisis, such as the proximity of death. However, its conceptual boundaries need to be clarified to provide qualified and humanized palliative care. Therefore, this study aims to identify the key attributes, antecedents, consequents, and empirical referents of SA at EoL, as well as to clarify the concept’s existing ambiguities. Methods: Walker and Avant’s eight-step concept analysis was used. A literature search was conducted in May 2025 across three databases (PubMed, CINAHL and Scopus). Results: Following the review, 21 articles were included for analysis. The concept analysis revealed four main attribute domains: (1) sensory–perceptual domain; (2) affective/cognitive domain; (3) relational domain; and (4) transcendental domain. Moreover, spiritual consciousness and the existential matrix were antecedents to this concept; revaluation of beliefs, finding spiritual serenity and inner freedom, fostering spiritual growth, and the desire to leave a legacy were its consequences. Conclusions: The concept of SA at the EoL reveals itself to be a complex and multifactorial phenomenon, with a profound impact on a person’s confrontation with finitude. Recognizing and integrating SA into palliative care allows for a more comprehensive understanding of human consciousness. To deal with SA experiences in healthcare settings, a multifaceted approach is needed. This encompasses acknowledging spirituality as a determinant of health, including spiritual care in standard practice, and offering education and training on spiritual care competence for healthcare practitioners. Further transdisciplinary research should be undertaken to explore SA phenomenological variations, guide clinical interventions, and evaluate SA impacts on spiritual well-being and spiritual growth.
- Legacy Building from the Perspective of Palliative Care Professionals in Portugal: A Qualitative Thematic AnalysisPublication . Laranjeira, Carlos; Marques, Andréa; Fernandes, Ana Fátima; Domingos, Maria Aparecida; Moreira, Isabel BorgesBackground/Objectives: Legacy planning should respect te care preferences of people facing serious illness and integrate palliative care (PC). Legacy creation with the guidance of health professionals in PC assumes a therapeutic nature and aims to respond to the psychospiritual needs of patients and their families. To date, research on professional experiences to create legacy in PC remains scarce. Therefore, this study sought to explore the experiences of PC professionals in legacy creation with the ill person and their family during EoL care. Methods: A descriptive qualitative study was performed through in-person semi-structured interviews with PC professionals from Portugal. Data collection was conducted from February to May 2025. Transcripts from the interviews were thematically analyzed with qualitative data management software WebQDA. The study adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines. Results: Sixteen PC professionals participated in the study. Most participants were nurses (n = 8), followed by six physicians and two psychologists. The mean age of participants was 44.93 ± 10.46 years. Data analysis yielded three themes: (1) the worth of legacy in EoL; (2) enablers of legacy-building process; and (3) challenges of legacy-building process. Conclusions: Legacy is a meaningful resource that gives professionals the opportunity to connect with patients and their families, and to enact value-concordant person-centered care. By providing a greater grasp of legacy construction, our findings may help healthcare providers better understand how to provide dying patients and their families with dignity-conserving care.
- Trajetórias precursoras da Enfermagem de Reabilitação na Guerra Colonial PortuguesaPublication . Correia, Nuno Miguel Catela; Bernardes, Rafael Alves; Queirós, Paulo Joaquim Pina; Subtil, Carlos LousadaApós a Segunda Guerra Mundial, a criação da ONU influenciou movimentos de independência colonial. Portugal resistiu, enfrentando a Guerra Colonial, que influenciou o desenvolvimento da enfermagem de reabilitação. Objetivo: Analisar as práticas precursoras de enfermagem de reabilitação na Guerra Colonial Portuguesa. Metodologia: Uso do método histórico para sumula da narrativa histórica. Resultados: O desenvolvimento na saúde tornou necessário uma melhor “preparação técnica” através da criação de “Escolas Técnicas de Enfermagem”. No “curso de enfermagem e acção social colonial” eram abordados a “educação física”, “agentes físicos”. Em 1961, o quadro das tropas pára-quedistas passou a incluir enfermeiras. Também nos comandos navais das colónias, nas Alfandegas do Ultramar e nos navios de guerra da Guarda Fiscal, os enfermeiros desempenharam um papel nas “inspecções sanitárias” e colaboração com as Forças Armadas. Em 1963, o quadro de enfermagem do Hospital do Ultramar previa enfermeiros “de fisioterapia” e “especializados em ortopedia, reabilitação…”. À época, em 1964, a conjuntura sanitária conduziu à regulamentação dos Serviços de Saúde e Assistência do Ultramar, reconhecendo-se a importância da enfermagem especializada no Ultramar. Conclusão: A enfermagem de reabilitação surge em Portugal em 1965 influenciada por todo um contexto prévio a nível social e politico que criou novas necessidades de saúde.
- Prácticas de enfermería en la reeducación profesional de los soldados en la Casa Pía de Lisboa durante la Primera Guerra MundialPublication . Correia, Nuno Miguel Catela; Subtil, Carlos Lousada; Queirós, Paulo Joaquim Pina; Bernardes, Rafael AlvesNo período da Primeira República em Portugal, no decorrer da I Guerra Mundial, implementou-se, com base na experiência de ensino da Casa Pia de Lisboa, a reeducação profissional tendo sido particularmente importante na recuperação de mutilados e estropiados de guerra. Objetivo: Interpretar e analisar quais as práticas das enfermeiras na reeducação profissional de soldados portugueses no Instituto de Reeducação de Mutilados de Guerra de Santa Izabel na Casa Pia de Lisboa durante a I Guerra Mundial. Metodologia: Recurso ao método histórico para a síntese da narrativa histórica. Resultados: Encontram-se referências importantes nos Anuários da Casa Pia de Lisboa a funções exercidas pelas enfermeiras nomeadamente “a propaganda que as sr.as enfermeiras fizeram junto dos feridos sobre as vantagens da reeducação”; o “tratamento massoterápico”; “os tratamentos pela massagem” e ainda ao “papel importantíssimo” das senhoras (enfermeiras) na “pequena enfermaria” chefiada pelo Dr. V. Pontes onde havia um pequeno serviço de “massotherapia”, uma oficina de “prothese provisória” e um laboratório de exame de aptidões. Conclusão: Confirma-se que as enfermeiras desempenharam um papel importante nos serviços de “reeducação preparatória” no Instituto de Reeducação de Mutilados de Santa Izabel da Casa Pia de Lisboa, intervindo de forma diferenciadora e eficaz, obtendo um bom reconhecimento.
- Veggies4myHeart digital game: an educational tool to promote vegetable consumption in preschool children - a multicentre experimental studyPublication . Braga-Pontes, Cátia; Ferreira, Patrícia V.; Barros, Neuza; Vieito, Leonel; Lages, Marlene; Simões-Dias, Sara; Torre, Sophie Bucher Della; Guarino, Maria P.Background Vegetable consumption as part of a balanced and diversified dietary pattern is associated with a lower risk of cardiovascular disease, cancer, and all-cause mortality. Even though the scientific evidence for these benefits is strong, the consumption of vegetables remains far below recommendations, especially in early childhood. Despite existing literature, the evidence on how to increase vegetable consumption in preschool children remains limited and the development and validation of new strategies should be pursued in varied contexts. The study presented herein aimed to compare the impact of educational sessions based on the serious game Veggies4myHeart and repeated exposure to vegetables on preschool children’s willingness to taste them and also their nutrition knowledge, measured at baseline and post-intervention, in Portuguese and Swiss preschool children. Methods The intervention was carried out in preschools with 39 Portuguese and 45 Swiss children, from 3 to 6 years old, in their preschools, between May 2019 and February 2021. Children participated in weekly 20-minute educational sessions for 5 weeks, delivered by trained nutritionists and incorporating the Veggies4myHeart digital game. Willingness to taste was assessed by offering the five raw vegetables in standard portions and recording whether each child tasted them at baseline, throughout the intervention, and post-intervention. Nutrition knowledge was assessed using three questionnaires applied before and after the intervention. Data were analysed using IBM SPSS software and statistical significance was set at p-value < 0.05. Results Comparing the results between the two countries post-intervention, statistically significant differences were found in the willingness to taste lettuce, carrot, and red cabbage, with Portuguese children showing more willingness to taste these vegetables than Swiss children (p < 0,05). Improvements in nutrition knowledge, from baseline to post-intervention, were observed in both countries (p < 0,001), but without statistically significant differences between countries (p = 0.114). Conclusions Despite differences in context and eating habits of Portuguese and Swiss children, the intervention with the Veggies4myHeart digital game increased preschoolers’ willingness to taste vegetables, supporting the value of repeated exposure combined with digital tools. Improvement in nutrition knowledge further reinforces the potential of serious games as comprehensive educational strategies for promoting healthy habits in young children.
- Sequential extraction of oxindole alkaloids from Uncaria tomentosa leaves by green pressurized solventsPublication . Botelho, José Rafael S.; Gaspar, Marisa C.; Sousa, Hermínio J.C. de; Braga, Mara E.M.; Freire, M.Uncaria tomentosa (Cat’s Claw) is a woody climbing vine known for its therapeutic effects, which have been validated in clinical trials. The leaves, often discarded in traditional uses, contain high quantities and a wide variety of oxindole alkaloids, such as rhynchophylline (Rhy), isomytraphylline (Imyt), or mitraphylline (Myt), with Myt typically being the major alkaloid found in extracts of this species. In this study, sequential extraction in two steps was employed to recover oxindole alkaloids. In the first step, pressurized liquid acetone was used, extracting approximately 17 % of the raw material mass, with no detectable alkaloids in the extract. In the second step, CO2-expanded liquid ethanol (25 % w/w) was used under varying temperature, pressure, and solvent density conditions. Extracts enriched with the oxindole alkaloids Rhy, Imyt, and Myt were obtained from the 2nd step extraction, with ratios ranging from 39:61 to 62:38 (Rhy:Myt + Imyt). These extracts demonstrated significant inhibition of lipoxygenase (up to 95 %) and acetylcholinesterase, indicating potential anti-inflammatory and neurological applications. Moreover, these effects were positively correlated with the proportion of Rhy relative to Myt + Imyt. Based on the alkaloid content and the observed potential bioactivities, optimized parameters, robustness and process stability were assessed using deterministic and stochastic statistical methods to maximise Rhy and minimise Imyt and Myt. Finally, this study presents the development and optimization of a robust process to obtain extracts with anti-inflammatory and neurological potential, adding value to U. tomentosa leaves and promoting the sustainable use of this plant as a raw material.