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- Optimization of heart failure with reduced ejection fraction prognosis-modifying drugs: A 2021 heart failure expert consensus paperPublication . Silva-Cardoso, José; Fonseca, Cândida; Franco Fátima; Morais, João; Ferreira, Jorge; Brito, DulceHeart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients’ functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members’ clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks.
- Literacia em saúde dos cuidadores informais sobre a doença de alzheimerPublication . Sarmento, Beatriz; Caetano, Liliana; Serra, Maria João; Costa, MônicaIntrodução: Considerando o envelhecimento populacional e as projeções demográficas para Portugal é esperado um aumento do desenvolvimento de doenças crónico e degenerativas, como é o caso da doença de Alzheimer (DA). Deste modo os Cuidadores Informais (CI) têm um papel fundamental na prestação de cuidados, sendo este influenciado pelo nível de literacia desta população. Objetivo: Explorar o nível de literacia dos Cuidadores Informais sobre a doença de Alzheimer. Métodos: Estudo descritivo, exploratório e quantitativo, com uma amostra de 28 participantes. A recolha de dados decorreu através de um questionário e da Escala do Conhecimento sobre a Doença de Alzheimer, no Google Forms, após o consentimento informado. Resultados: A maioria dos CI era do sexo feminino (75%), com uma média de 54,04 anos de idade (±12,46), um elevado nível de habilitações literárias e uma relação próxima com a pessoa cuidada. Prestam cuidados em média 4,18 anos (±2,41), aproximadamente 12 horas por dia, sete dias por semana. Sobre as dificuldades sentidas, a maioria referiu alterações neurocomportamentais na DA, gestão da vida pessoal e profissional, falta de apoio e incertezas de capacitação pessoal para cuidar. Considera-se que 57,14% dos CI têm um nível intermédio (3 numa escala de 1-5) na forma como prestam cuidados. Conclusão: Devido às dificuldades e necessidades referidas pelos CI revela-se essencial a criação de novos programas de literacia em saúde na comunidade. Em estudos futuros importa avaliar a eficácia destes programas a fim de promover estratégias de cuidados para os CI de pessoas com DA.
- Fructose Malabsorption, Gut Microbiota and Clinical Consequences: A Narrative Review of the Current EvidencePublication . Simões, Catarina D.; Sousa, Ana Sofia; Fernandes, Sofia; Sarmento, AméliaFructose malabsorption is characterized as the incomplete absorption of fructose in the small intestine. Fructose is one of the most common monosaccharides in the human diet. The purpose of this review is to provide an updated overview of insights into the relationship between high-fructose diet, fructose malabsorption, gut microbiota and clinical consequences. Incomplete absorption of fructose causes accumulation in the colon, which leads to fermentation by gut microbiota and abdominal symptoms such as bloating and excessive gas production. Malabsorption mayresult from exceeding theabsorptive capacity of GLUT5orinsufficient upregulation, with incidence increasing with age and higher dietary fructose concentrations. High-fructose diets generally promote an increase in inflammatory bacterial groups such as Desulfovibrio and Deferribacteraceae, while reducing beneficial Bacteroidetes. These microbial alterations may impair intestinal barrier function, modify short-chain fatty acid profiles, and contribute to systemic inflammation, metabolic disorAcademic Editors: Edyta Juszczuk-Kubiak and Katarzyna Góralska Received: 19 October 2025 Revised: 5 November 2025 Accepted: 5 November 2025 Published: 6 November 2025 Citation: Simões, C.D.; Sousa, A.S.; Fernandes, S.; Sarmento, A. Fructose Malabsorption, Gut Microbiota and Clinical Consequences: A Narrative Review of the Current Evidence. Life 2025, 15, 1720. https://doi.org/ 10.3390/life15111720 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/). ders, and potentially mental health issues. Animal studies using fructose malabsorption models present inconclusive results regarding the impact of fructose on the composition of gut microbiota. Additional research is essential to fully comprehend the complex relationship between diet, fructose malabsorption and gut microbiota, to develop personalized, effective dietary approaches for managing symptoms of fructose malabsorption.
- Validation of the Dysmorphic Concern Questionnaire (DCQ) in First- Episode SchizophreniaPublication . Fekih‐Romdhane, Feten; Bouallègue, Nour; Ali, Amira Mohammed; Laranjeira, Carlos; Cheour, Majda; Harb, Frederic; Souheil, Hallit; McGorry, Patrick DBackground: There is evidence that suggests that body dysmorphia represents a risk factor that may occur at the prodromal phase of schizophrenia, affecting ongoing developmental processes and conferring vulnerability to the disease. This study examined the psychometric properties of the Arabic Dysmorphic Concern Questionnaire (DCQ) among patients with a first- episode schizophrenia in a Tunisian, Arabic- speaking context. Method: A cross- sectional study was conducted. Data collection was performed using a traditional paper- and- pencil approach by a single interviewer, who was one of the study's authors. Results: Our findings showed that the unidimensional factor structure of the DCQ holds up in patients with schizophrenia from a Tunisian culture and at an early stage of their disease, and shows excellent reliability (Cronbach's α of 0.91) in this specific population. Measurement invariance was supported in terms of three levels (configural, scalar and metric). Convergent validity of the DCQ was evidenced through significant positive correlations of the scale with abnormal bodily phenomena, muscle dysmorphia and body dissatisfaction. Besides, concurrent validity was demonstrated via significant positive correlations between the DCQ and four other measures: psychological distress, disordered eating, insight and psychotic symptoms severity. Conclusion: The DCQ showed good validity and reliability for measuring dysmorphic concerns in patients with schizophrenia from a Tunisian culture and at an early stage of their disease. The sound psychometric performance of the DCQ, its short administration time, as well as easy scoring and interpretability make it an excellent instrument for use in future clinical and research endeavours.
- Prevalence and Predictors of Long Covid in a Cohort of Brazilian Adults 12 Months After Acute Infection: A Cross‐Sectional StudyPublication . Covre, Eduardo Rocha; Laranjeira, Carlos; Carreira, Lígia; Höring, Carla Franciele; Góes, Herbert Leopoldo de Freitas; Baldissera, Vanessa Denardi Antoniassi; Marques, Priscila Garcia; Meireles, Viviane Camboin; Tostes, Maria Fernanda do Prado; Oliveira, Rosana Rosseto de; Paiano, Marcelle; Ageno, Rosella Santoro; Moroskoski, Márcia; Alcaraz, Jesús Puente; Vissoci, João Nickenig; Facchini, Luiz Augusto; Salci, Maria; Chew-Graham, CarolynIntroduction: Since the onset of the pandemic in early 2020, various reports have emerged regarding persistent symptoms associated with Covid‐19. Nevertheless, there is insufficient data on the persistence of symptoms over time. This study sought to estimate the prevalence of persistent symptoms 12 months after Covid‐19 infection and identify predictors of long Covid in adults living in the State of Paraná, southern Brazil, according to the level of severity of Covid‐19 infection. Method: An observational and cross‐sectional survey was conducted with Brazilian adults diagnosed with Covid‐19, as assessed from data available in two official Covid‐19 notification databases in Brazil, using telephone interviews. Descriptive statistics, tests of associations and simple and multiple binary logistic regression analysis were used to identify predictors of long Covid. Results: In total, 1033 adults participated in the study. The overall prevalence of long Covid was 60.3% (n = 623). Prevalence was higher in women (67.7%), people aged between 50 and 59 years (65.8%) and in individuals who received treatment in an Intensive Care Unit (ICU) during the acute phase of Covid‐19 infection (74.4%, n = 241). The risk factors associated with a greater chance of developing long Covid were: female (OR 2.38; 95% CI 1.55; 3.66), living in the Brazilian northwest health macro‐region (OR 2.20; 95% CI 1.21; 4.00), presenting multimorbidity (OR 1.86; 95% CI 1.06; 3.28), having an average of six symptoms in the acute phase of Covid‐19 (OR 1.22; 95% CI 1.17; 1.28) and having received treatment in an ICU (OR 4.86; 95% CI 2.83; 8.35) and inpatient ward (OR 2.45; 95% CI 1.47; 4.09). Conclusions: The results highlight the high prevalence of long Covid and support the formulation of health policies capable of minimising the consequences on the population, on the services offered by professionals and on health systems. Patient or Public Contribution: The study topic's importance was based on the patients' experiences in the author's previous research and the need to develop patient‐centred care.
- Prevalence of Avoidant/Restrictive Food Intake Disorder in Portuguese children aged 2–10 years: a cross-sectional studyPublication . Novo, Rita; Vieito, Leonel; Dias, Sara; Braga-Pontes, Cátia; Hay, Phillipa; Touyz, StephenBackground Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating disorder characterised by the avoidance or restriction of food intake, associated with high sensory sensitivity, disinterest in eating, or fear of adverse consequences. It can lead to nutritional deficiencies, impaired growth, or psychosocial difficulties. Although recognition of ARFID has increased internationally, prevalence data in Portugal remain scarce. Methods This cross-sectional, descriptive observational study assessed the prevalence of ARFID in children aged 2–10 years attending a private outpatient clinic. Paediatricians applied DSM-5-TR diagnostic criteria during routine consultations. Parents completed online questionnaires, including the Children’s Eating Behaviour Questionnaire (CEBQ) and the Child Feeding Questionnaire (CFQ). Results Of the 163 children assessed, ARFID was diagnosed in 3.1% of cases. Four of the five identified children were male (80%), with a mean age of 5.8 years (SD = 2.17). On the CEBQ, children with ARFID showed the highest mean scores on the food fussiness and satiety responsiveness subscales, indicating greater selectivity and heightened sensitivity to fullness. The lowest mean scores were observed in emotional overeating and desire to drink. On the CFQ, perceived responsibility and monitoring were the subscales with the highest mean values. Conclusions This study provides the first prevalence estimate of ARFID in Portuguese clinical practice. Although the small sample limits generalisability, the findings emphasise the need to raise awareness among both clinicians and parents to promote earlier recognition, thereby improving support for children and families and helping to reduce the long-term impact of ARFID.
- Gamification to Enhance University Students' Resilience: Transforming Challenges into OpportunitiesPublication . Pérez-López, Isaac José; Navarro-Mateos, Carmen; Rosa, MarleneThis study investigates the impact of a gamification-based intervention on the resilience of university students, comparing it to a traditional lecture-based approach. In recent years, resilience has become a key factor in student well-being, helping them overcome academic challenges and personal difficulties. A quasiexperimental design was employed, involving 88 participants divided into an experimental group (EG) and a control group (CG). The intervention, inspired by the popular TV show Time Zone, integrated elements such as time management, emotional regulation, and problem-solving, all of which are essential for developing resilience. The resilience of participants was assessed using the CD-RISC 10 scale both before and after the intervention. Results revealed that the EG demonstrated significant improvements in resilience, particularly in managing adversity, achieving goals, and maintaining a positive self-concept. Conversely, the CG showed minimal changes, suggesting the impact of the gamification-based intervention. The findings highlight that students in the EG were better able to cope with stress, recover from setbacks, and achieve goals despite obstacles. This demonstrates that gamification can be an effective tool for enhancing emotional resilience and well-being, offering a compelling alternative to traditional educational methods. The results also suggest that future interventions incorporating gamification could lead to sustained improvements in student resilience. Furthermore, this study contributes to the expanding body of literature on gamification in higher education, emphasizing its potential to foster personal competencies and enhance learning outcomes.
- Pseudophakic macular edema: Review and new insights on treatment and prophylaxisPublication . Campos, António; Mota, Carolina; Cruz, Henrique; Sousa, João Paulo; Gittinger Jr., JohnPseudophakic cystoid macular edema (PCME) is a common complication of cataract surgery that may rarely result in vision loss. In most cases PCME resolves spontaneously, which makes it challenging to establish the efficacy of therapeutic and prophylactic interventions. Although no consensus exists regarding management or prevention, most surgeons advocate prophylaxis primarily for high-risk eyes. Nevertheless, the costs associated with preventive measures have risen substantially in recent years. In this review, we summarize the current evidence on the epidemiology, pathogenesis, diagnosis, risk factors, treatment, and prophylaxis of PCME, to provide a comprehensive understanding of its clinical indications and the cost-effectiveness of available strategies.
- Learning to assess the fall risk in clinical nursing education: an interpretative studyPublication . Pedrosa, Ana Rita; Dixe, Maria dos Anjos; Sousa, Luís; Ferreira, Rogério; Marques-Vieira, Cristina; Marques, Andréa; Lavareda Baixinho, CristinaBackground Falls are a complex problem for the health and quality of life of older persons. Risk assessment is important for identifying people at risk and planning preventive measures. Few studies have focused on how health professionals learn to assess this risk. Objective The aim of this study was to explore how nursing undergraduate students learn to assess fall risk in older adults/people during their hospital-based clinical practice. Methods This qualitative study was conducted within an interpretive paradigm. The focus group was selected as the method to address the research question: How do nursing students learn to assess of fall risk in the older population during clinical practice? The participants were students enrolled in a Bachelor of Nursing program. To support data organization and enhance analytic rigor, qualitative data analysis software (WebQDA®) was employed. Results Fifteen students participated in two focus groups. The analysis identified three main categories: (i) risk factors assessed; (ii) risk assessment; and (iii) learning to manage fall risk in clinical practice. Students reported that nursing supervisors primarily emphasized physical factors, mobility, and cognitive status. The findings also highlighted a gap between the assessment and the implementation of individualized interventions, as well as the difficulty in converting records into preventive actions and risk management. Conclusions Nursing students learn to assess fall risk primarily through observation of clinical practices and the influence of supervisors, although they do not always understand the instrumental basis or the correlation between risk and intervention. The results indicate the need to strengthen the training of professionals and students.
- Avaliação da dor na pessoa não comunicante em contexto de cuidados pós-anestésicosPublication . Oliveira, João Pedro; Costeira, CristinaIntrodução: No processo de heteroavaliação de dor em contexto de cuidados pós-anestésicos, os enfermeiros deparam-se com diversas dificuldades. Acresce a este desafio a falta de uniformização e treino neste processo. Objetivos: Identificar as dificuldades dos enfermeiros na avaliação de dor em pessoas não comunicantes; implementar a utilização de instrumentos de heteroavaliação; comparar a satisfação dos enfermeiros na avaliação de dor após implementação de medidas. Métodos: Projeto de melhoria contínua da qualidade realizado num serviço de cuidados pós anestésicos de uma instituição de Saúde de Portugal. Desenvolvido em 3 fases: I: identificação do problema e avaliação; II: implementação de medidas; III: avaliação após implementação de medidas. Participaram 37 enfermeiros. Dados colhidos nas fases I e III através de aplicação de questionários eletrónicos, analisados por estatística descritiva e inferencial. Cumpridos pressupostos éticos. Resultados: Principais dificuldades identificadas na heteroavaliação: défice de conhecimento (32,87%), défice de treino (26,03%) e recursos materiais/logísticos desadequados (23,29%). Correlação positiva de 97% entre o tempo de experiência profissional e a satisfação na utilização de instrumentos de heteroavaliação. Após implementação de medidas verifica-se diferença estatisticamente significativa (p = 0,002) na satisfação dos enfermeiros na heteroavaliação de dor. Conclusões: A avaliação de dor é afetada por diversos fatores (profissionais, organizacionais e mistos). A heteroavaliação de dor exige formação contínua, melhorando o conhecimento, treino e satisfação dos profissionais, suportada por políticas institucionais que uniformizem práticas clínicas.