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- Promoting Nerve Regeneration in a Neurotmesis Rat Model Using Poly(DL-lactide-ε-caprolactone) Membranes and Mesenchymal Stem Cells from the Wharton’s Jelly: In Vitro and In Vivo AnalysisPublication . Pereira, T.; Gärtner, A.; Amorim, I.; Almeida, A.; Caseiro, A.R.; Armada-da-Silva, Paulo A. S.; Amado, Sandra; Fregnan, Federica; Varejão, A. S. P.; Santos, J. D.; Bártolo, P. J.; Geuna, S.; Luís, A. L.; Maurício, A. C.In peripheral nerves MSCs can modulate Wallerian degeneration and the overall regenerative response by acting through paracrine mechanisms directly on regenerating axons or upon the nerve-supporting Schwann cells. In the present study, the effect of human MSCs from Wharton’s jelly (HMSCs), differentiated into neuroglial-like cells associated to poly (DL-lactide-ε-caprolactone) membrane, on nerve regeneration, was evaluated in the neurotmesis injury rat sciatic nerve model. Resultsin vitroshowed successful differentiation of HMSCs into neuroglial-like cells, characterized by expression of specific neuroglial markers confirmed by immunocytochemistry and by RT-PCR and qPCR targeting specific genes expressed.In vivotesting evaluated during the healing period of 20 weeks, showed no evident positive effect of HMSCs or neuroglial-like cell enrichment at the sciatic nerve repair site on most of the functional and nerve morphometric predictors of nerve regeneration although the nociception function was almost normal. EPT on the other hand, recovered significantly better after HMSCs enriched membrane employment, to values of residual functional impairment compared to other treated groups. When the neurotmesis injury can be surgically reconstructed with an end-to-end suture or by grafting, the addition of a PLC membrane associated with HMSCs seems to bring significant advantage, especially concerning the motor function recovery.
- The Burden of Imported Malaria in Portugal 2003 to 2012Publication . Fonseca, Ana Glória; Dias, Sara S.; Baptista, Joao Luis; Torgal, JorgeIncreasing international travel and expatriation to sub-Saharan countries where malaria is endemic has raised public health concerns about the burden of imported malaria cases in Portugal. From 2009 to 2012, there was a 60% increase in malaria hospitalizations, contradicting the declining trend observed since 2003. Older age was associated with longer length of stay in hospital and higher lethality.
- Carotid body, insulin, and metabolic diseases: unraveling the linksPublication . Conde, Sílvia V.; Sacramento, Joana F.; Guarino, Maria P.; Gonzalez, Constancio; Obeso, Ana; Diogo, Lucília N.; Monteiro, Emília C.; Ribeiro, Maria J.The carotid bodies (CB) are peripheral chemoreceptors that sense changes in arterial blood O2, CO2 and pH levels. Hypoxia, hypercapnia and acidosis activate the CB, which respond by increasing the action potential frequency in their sensory nerve, the carotid sinus nerve (CSN). CSN activity is integrated in the brain stem to induce a panoply of cardiorespiratory reflexes aimed, primarily, to normalize the altered blood gases, via hyperventilation, and to regulate blood pressure and cardiac performance, via sympathetic nervous system (SNS) activation. Besides its role in the cardiorespiratory control the CB has been proposed as a metabolic sensor implicated in the control of energy homeostasis and, more recently, in the regulation of whole body insulin sensitivity. Hypercaloric diets cause CB overactivation in rats, which seems to be at the origin of the development of insulin resistance and hypertension, core features of metabolic syndrome and type 2 diabetes. Consistent with this notion, CB sensory denervation prevents metabolic and hemodynamic alterations in hypercaloric feed animal. Obstructive sleep apnoea (OSA) is another chronic disorder characterized by increased CB activity and intimately related with several metabolic and cardiovascular abnormalities. In this manuscript we review in a concise manner the putative pathways linking CB chemoreceptors deregulation with the pathogenesis of insulin resistance and arterial hypertension. Also, the link between chronic intermittent hypoxia (CIH) and insulin resistance is discussed. Then, a final section is devoted to debate strategies to reduce CB activity and its use for prevention and therapeutics of metabolic diseases with an emphasis on new exciting research in the modulation of bioelectronic signals, likely to be central in the future.
- Validity of the de Jong Gierveld loneliness scale in Portugal population: psychometrics studiesPublication . Areosa, Timóteo; Lima, Margarida Pedroso; Custódio, Susana; Caetano, Tânia; Gierveld, J. De Jong; Dixe, Maria dos AnjosAgeing is a life-span complex process. In current cohorts, the final years of life are often marked by increased cognitive, functional, and relational decline due to a range of socioeconomic, biological, and personal factors. As a result, individuals are more susceptible to social isolation and loneliness. The emergence of the COVID-19 pandemic has further intensified the need to assess feelings of loneliness and to develop appropriate interventions. Given the strong association between loneliness and both physical and psychological health and well-being, this area has become a research priority. The aim of this study is to adapt the De Jong Gierveld Loneliness Scale for the Portuguese population and to gather evidence of its validity and reliability. A study was conducted with 191 participants aged between 54 and 99 years old. Results from the exploratory factor analysis revealed a two-factor structure (social and emotional), with Cronbach's alpha values ranging from 0.719 to 0.734. Confirmatory factor analysis indicated good model fit (CFI = 0.996, GFI = 0.931, RMSEA = 0.093) and satisfactory reliability (0.73–0.76). In conclusion, the instrument demonstrates sound psychometric properties and represents a suitable tool for researchers and practitioners. However, further studies with more representative samples of the Portuguese population are recommended.
- Psychometric validation of the food and nutrition literacy scale (Escala de Literacia da Alimentação e Nutrição – E-LAN) among Portuguese youthPublication . Batalha, Maria; Rosinha, Camila; Amaro, Catarina; Couto, Mariana; Fidalgo, Mariana; Dias, Sara; Borrel, Luisa N.Objectives: Psychometric Validation of the Escala de Literacia da Alimentaç˜ ao e Nutriç˜ ao (E-LAN), addressing the current lack of validated instruments for assessing food and nutrition literacy among portuguese youth. Study design: Cross-sectional. Methods: The study was conducted in a school setting in the western region of central Portugal between April 10 and 12, 2024, using a convenience sample of children aged 10–12 years. The E-LAN comprises 49 items (42 Likert-scale and 7 multiple-choice) across seven subscales assessing cognitive and skills domains. Reliability was examined using Cronbach's α , and confirmatory factor analysis (CFA) was performed to evaluate the internal structure, using χ 2 /df, AGFI, CFI, TLI, and RMSEA as fit indices. Results: The initial scale showed good internal consistency (Cronbach's α α =0.875). Four items were removed due to low item-total correlations and factor loadings. The revised 38-item version demonstrated improved reliability (Cronbach's =0.889), acceptable inter-item correlations, and good model fit ( χ 2 /df = 1.45; AGFI = 0.91; CFI = 0.93; TLI = 0.91; RMSEA = 0.06). Conclusions: The E-LAN is a concise, reliable, and valid tool for assessing food and nutrition literacy among portuguese youth, supporting its use in public health research and interventions.
- Person-centered practice in the Portuguese healthcare system: A documentary studyPublication . Vareta, Diana; Santana, Elaine; Oliveira, Célia; Baixinho, Cristina Lavareda; Ventura, Filipa; Prazeres, FilipeBackground Person-centered practice has increasingly become a key structural component of health systems, driving the progressive reformulation of public health policies internationally. Despite broad consensus regarding its importance, its integration into clinical practice continues to face significant challenges. The Person-Centred Practice Framework identifies the macro context as a critical domain for sustainable implementation, as it encompasses the structural and strategic factors that shape healthcare delivery. Objective To characterize the person-centered practice framing within the macro context of the Portuguese healthcare system. Methodology Qualitative, descriptive, and retrospective documentary study. A systematic literature search was conducted on the websites of entities responsible for defining, guiding, and regulating healthcare in Portugal. Using predefined eligibility criteria, 40 documents were selected. Textual analysis was performed using IRAMUTEQ® software and guided by the constructs of the macro context domain of the Person-Centred Practice Framework. Results The lexicometric analysis identified five classes, grouped into two thematic fields: i) Structural and organizational determinants of person-centered practice, comprising the classes Systemic vision and integrated response, Organizational culture and participation, Digital transformation and information management, and Political vision and governance structures; and ii) Operationalization of person-centered practice, represented solely by the class Care approach, reflecting its thematic specificity. Factorial analysis revealed distinct and poorly connected discursive patterns associated with different action levels within the healthcare system. Similarity analysis highlighted a discourse centered on the health-care-person nucleus, showing relations with service organization, care integration, and person participation, albeit with word dispersion suggesting misalignment between organizational and practice levels. Conclusion The macrocontextual framing of person-centered practice in the Portuguese healthcare system demonstrates significant political and strategic advances, as seen in the emphasis on humanized care, investment in health literacy and digitalization, and the introduction of Integrated Care Pathways. However, implementation remains limited due to the absence of clear formative guidelines, biomedical paradigm persistence, and lack of evaluation mechanisms sensitive to care experience.
- Evidence synthesis methodology for questions relating to barriers and enablers in health care: a scoping reviewPublication . Stern, Cindy; Valenzuela, Chelsea; Whitehorn, Ashley; Pollock, Danielle; Minooee, Sonia; Gohil, Dilan; Zhu, Zheng; Kirkpatrick, Pamela; Loureiro, Ricardo; Davies, Ellen; Cardoso, Daniela; Munn, Zachary; Carrier, Judith; Pieper, Dawid; Cooper, Kay; Jia, Romy; Loveday, Heather; Martin, Priya; Salmond, Susan; dos Santos, Kelli; Habibi, Nahal; Lizarondo, Lucylynn; Aromataris, EdoardoObjective: The objective of this scoping review was to map the range of methodologies and methods used to undertake evidence synthesis aimed at determining barriers and/or enablers in health care, and to inform further research relevant to synthesis methodology in this area. Introduction: Questions related to identifying and exploring barriers and/or enablers within health care are becoming increasingly popular. Currently, there are multiple approaches to synthesizing this evidence, and it is unclear whether a more consistent approach is warranted. Eligibility criteria: Evidence synthesis on barriers and/or enablers (facilitators) that included interest-holders at different levels of the health system were considered. Evidence synthesis projects had to include primary research studies and were published from 2010 to 2021. Literature reviews, narrative reviews, and umbrella reviews were excluded, as were reviews published in languages other than English. Methods: This scoping review followed JBI methodology and was based on a published a priori protocol and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A 3-step search strategy using a combination of key terms and index headings was undertaken in October 2021 via the following databases/resources: PubMed, Embase, CINAHL (EBSCOhost), PsycINFO (Ovid), Cochrane Database of Systematic Reviews, JBI Evidence Synthesis, and EPPI-Centre Systematic Reviews. An extensive piloting process for screening and selection, and data extraction was undertaken due to the large number of reviewers involved. All records were screened independently by 2 reviewers, and any disagreements were resolved through either a third reviewer or discussion with a panel of reviewers. Extraction was undertaken using a customized form, and data were analyzed using descriptive statistics. Data are presented via tables, figures, a word cloud, and an infographic, supplemented with a narrative synthesis. Results: Following completion of the search, 24,823 records were screened and 774 reviews were included in the scoping review. Systematic reviews were the most commonly used methodology (68%) to synthesize barrier and/or enabler questions. Reviews often included diverse types of evidence and involved an assessment of methodological quality (70%). Findings related to barriers and/or enablers were usually grouped and organized into categories, often by thematic methods (33%) or a narrative approach (20%). Incongruencies related to nomenclature, missing information, and methods used were evident across the large dataset. Conclusions: A variety of methodological approaches are being followed to undertake reviews focused on barriers and/or enablers in health care. The current state of the literature indicates that most authors answer these questions via the conduct of a systematic review and include diverse types of evidence. Further work is needed to determine whether authors are unclear when deciding on methodology and whether guidance is required.
- The family caregiver of the older person with hip fracture: perceptions about the transition to homePublication . Rocha, Paula; Albuquerque, Carlos; Batista, Susana; Henriques, Maria Adriana; Baixinho, Cristina Lavareda; Jester, RebeccaBackground Fractures resulting from falls constitute a problem of great magnitude for the older person, as they cause functional decline and difficulty in returning to the state prior to the fracture, and for the family caregiver, as they require care support to face the compromised ability to perform daily life activities that these people experience. Objective To characterize the perception of difficulties and needs felt by family caregivers in supporting older person with hip fractures in the transition home. Methods A descriptive, exploratory, qualitative study was developed, based on semi-structured interviews with family caregivers of patients with hip fractures undergoing surgical treatment, belonging to a hospital in the central region of Portugal. To analyze the data obtained, Bardin's content analysis was used, with the support of the MAXQDA Analytic pro 2022 software. Results From the analysis of the 15 interviews carried out, two categories emerged related to the difficulties perceived by family caregivers in supporting older person with hip fractures in the transition home: Care Support and Responsiveness. In relation to felt needs, the following categories emerged: Continuity of care and Training to provide care. Conclusions The family caregiver perceives multiple needs and difficulties experienced in the support provided to older person with hip fractures in the transition home. As this phenomenon is somewhat complex due to the involvement of numerous factors, the analysis of the aspects associated with this care process is essential, contributing to a favorable evolution and a safe transition.
- Intention to Use Digital Health Among COPD Patients in Europe: A Cluster AnalysisPublication . Alem, Solomon Getachew; Nguyen, Le; Hipólito, Nádia; Spiller, Maelle; Metting, EstherBackground: Chronic obstructive pulmonary disease (COPD) increasingly strains European health systems amid population ageing. Digital health interventions (DHIs) can reduce hospitalizations and support self-management, yet older patients hesitate to adopt them. Tailored interventions require understanding patient profiles. This study aimed to identify clusters by intention to use DHIs. Methods: Between July 2024 and February 2025, 232 COPD patients (mean age 65; 61% female) across seven European countries completed surveys covering sociodemographic and Unified Theory of Technology Acceptance (UTAUT) constructs. Intention to use DHIs was categorized as positive, neutral, or negative. Weighted UTAUT scores were clustered using Gower distance and Partitioning Around Medoids. Associations were visualized with multiple correspondence analysis and heat maps; differences were tested with the chi-square test. Results: Intention to adopt DHIs varied across countries, with the highest in the Netherlands. Two clusters emerged. Cluster 1, the ‘balanced hesitant’ group (n = 104), showed mixed intentions (38% positive, 40% neutral, 21% negative). Barriers included low performance expectancy and limited digital skills (both p < 0.05). Cluster 2, the ‘enthusiastic’ group (n = 128), demonstrated strong adoption intentions, with 84% positive intention. Enablers included low effort expectancy and complex disease (p < 0.01). Across both clusters, performance expectancy predicted intention. Conclusions: Digital health adoption among COPD patients is shaped by psychosocial and digital skill profiles. Hesitant users benefit from expectation-based information about DHIs, digital literacy training and peer support. Enthusiasts require ease of integration. Performance expectancy is a consistent driver of adoption, whereas country-specific factors should guide strategies.
- Shallow and deep learning approaches to classify melanoma and non-melanocytic skin lesionsPublication . Spolaôr, Newton; Lee, Huei Diana; Takaki, Weber Shoity Resende; Mendes, Ana Isabel Gonçalves; Fonseca-Pinto, Rui; Nogueira, Conceição Veloso; Coy, Claudio Saddy Rodrigues; Wu, Feng ChungSeveral image processing methods in Dermatology are grounded in shallow and deep learning approaches. These solutions are relevant to assist health experts in decision-making processes related to harmful melanoma—a malignant melanocytic condition—and other skin lesions. This work aims to compare these approaches in a specific classification problem: malignant melanocytic lesions versus non-melanocytic ones. We developed 39 learning method configurations, including three original ones based on fine-tuned deep neural networks. Some implemented settings incorporate auxiliary procedures, such as oversampling, feature selection and data augmentation. An experimental evaluation in the public Derm7pt dermoscopic database suggests that the best original setting performance was competitive against the leading results reported by recent literature alternatives. In particular, the proposal reached average accuracy and sensitivity of 0.9909 and 0.9976, respectively. These results were averaged across three runs of the stratified nested cross-validation strategy. Moreover, our 39 configurations outperformed an experimental baseline derived from the majority class error. Thus, this work can be helpful in inspiring computational systems that could act as preliminary filters to support the detection of a harmful form of skin cancer and its separation from other lesions.