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- Insulin resistance: a new consequence of altered carotid body chemoreflex?Publication . Conde, Silvia V.; Ribeiro, Maria J.; Melo, Bernardete F.; Guarino, Maria P.; Sacramento, Joana F.Metabolic diseases affect millions of individuals across the world and represent a group of chronic diseases of very high prevalence and relatively low therapeutic success, making them suitable candidates for pathophysiological studies. The sympathetic nervous system (SNS) contributes to the regulation of energy balance and energy expenditure both in physiological and pathological states. For instance, drugs that stimulate sympathetic activity decrease food intake, increase resting metabolic rate and increase the thermogenic response to food, while pharmacological blockade of the SNS has opposite effects. Likewise, dysmetabolic features such as insulin resistance, dyslipidaemia and obesity are characterized by a basal overactivation of the SNS. Recently, a new line of research linking the SNS to metabolic diseases has emerged with the report that the carotid bodies (CBs) are involved in the development of insulin resistance. The CBs are arterial chemoreceptors that classically sense changes in arterial blood O2 , CO2 and pH levels and whose activity is known to be increased in rodent models of insulin resistance. We have shown that selective bilateral resection of the nerve of the CB, the carotid sinus nerve (CSN), totally prevents diet-induced insulin resistance, hyperglycaemia, dyslipidaemia, hypertension and sympathoadrenal overactivity. These results imply that the beneficial effects of CSN resection on insulin action and glucoregulation are modulated by target-related efferent sympathetic nerves through a reflex that is initiated in the CBs. It also highlights modulation of CB activity as a putative future therapeutic intervention for metabolic diseases.
- Effectiveness of Wearable Devices for Posture Correction: A Systematic Review of Evidence from Randomized and Quasi-Experimental StudiesPublication . Caixeiro, Diogo; Cordeiro, Tomás; Constantino, Leandro; Carreira, João; Mendes, Rui; Silva, Cândida G.; Castro, Maria AntónioIntroduction: The increasing development of wearable devices for postural monitoring (provide feedback on posture) or correction (mechanical or biofeedback to promote change) is partly driven by the rising prevalence of poor posture in the general population and its impact on pain perception and functional capacity. Objective: Examine the effects of wearable devices on posture correction or prevention and on related outcomes, including postural alignment, muscle activity, pain and functional performance. Methods: The review followed the PRISMA 2020 guidelines. Searches were performed in PubMed, Scopus, Web of Science, and PEDro for studies published between 2012 and 2025. Eligible studies included randomized controlled trials and quasi-experimental designs involving participants with postural deviations or at risk of developing them, who underwent interventions using wearable devices that provided vibratory, auditory, visual, or tactile biofeedback. Results: Eight studies reported immediate improvements in postural alignment, body awareness, and self-reported pain, particularly with devices providing vibratory or visual biofeedback. Functional task stability improved, and muscle activity during risky postures decreased. However, the strong heterogeneity across devices and protocols, small sample sizes, short intervention durations, and, in some cases, the lack of independent control groups limit the strength and generalizability of these findings. Conclusions: Wearable devices have potential as complementary tools in physiotherapy due to their autonomous and potentially effective nature. Nevertheless, current evidence remains insufficient to support definitive clinical recommendations.
- Functional abolition of carotid body activity restores insulin action and glucose homeostasis in rats: key roles for visceral adipose tissue and the liverPublication . Sacramento, Joana F.; Ribeiro, Maria J.; Rodrigues, Tiago; Olea, Elena; Melo, Bernardete F.; Guarino, Maria P.; Fonseca-Pinto, Rui; Ferreira, Cristiana R.; Coelho, Joana; Obeso, Ana; Seiça, Raquel; Matafome, Paulo; Conde, Silvia V.Aims/hypothesis: We recently described that carotid body (CB) over-activation is involved in the aetiology of insulin resistance and arterial hypertension in animal models of the metabolic syndrome. Additionally, we have demonstrated that CB activity is increased in animal models of insulin resistance, and that carotid sinus nerve (CSN) resection prevents the development of insulin resistance and arterial hypertension induced by high-energy diets. Here, we tested whether the functional abolition of CB by CSN transection would reverse pre-established insulin resistance, dyslipidaemia, obesity, autonomic dysfunction and hypertension in animal models of the metabolic syndrome. The effect of CSN resection on insulin signalling pathways and tissue-specific glucose uptake was evaluated in skeletal muscle, adipose tissue and liver. Methods: Experiments were performed in male Wistar rats submitted to two high-energy diets: a high-fat diet, representing a model of insulin resistance, hypertension and obesity, and a high-sucrose diet, representing a lean model of insulin resistance and hypertension. Half of each group was submitted to chronic bilateral resection of the CSN. Age-matched control rats were also used. Results: CSN resection normalised systemic sympathetic nervous system activity and reversed weight gain induced by high-energy diets. It also normalised plasma glucose and insulin levels, insulin sensitivity lipid profile, arterial pressure and endothelial function by improving glucose uptake by the liver and perienteric adipose tissue. Conclusions/interpretation: We concluded that functional abolition of CB activity restores insulin sensitivity and glucose homeostasis by positively affecting insulin signalling pathways in visceral adipose tissue and liver.
- Fall Risk Management in Nursing Homes: A Scoping ReviewPublication . Gaspar, Cecília; Pedreira, Larissa; Reis, Neuza; Costa, Andreia; Ferreira, Ricardo; Henriques, Maria; Baixinho, Cristina LavaredaBackground: Population aging represents a growing public health challenge, with falls being one of the leading causes of morbidity, mortality, and loss of autonomy among older adults. In nursing homes, the risk is exacerbated by physical, cognitive, and environmental factors, yet which interventions are most actionable in nursing homes remains unclear, requiring effective and evidence-based prevention strategies. Objective: We aimed to map the evidence on interventions in fall risk management among institutionalized older adults, highlighting assessment, exercise, environmental, and educational strategies. Methods: A scoping review was conducted according to JBI guidelines. The search was carried out in MEDLINE, CINAHL, Scopus, Cochrane, and Web of Science. The review included studies, published between 2019 and 2024, involving older adults (≥65 years) in nursing homes, focusing on nursing interventions for fall risk management. Results: The initial search identified 1146 records across electronic databases and gray literature sources. After removing duplicates and screening titles, abstracts, and full texts, 18 studies met the inclusion criteria and were included in this scoping review. The inclusion criteria were as follows: (i) fall risk assessment, using functional and clinical scales such as the Timed Up and Go (TUG), Berg Balance Scale (BBS), Morse Fall Scale, to identify predisposing factors; (ii) exercise programs, such as the Otago Exercise Program and multicomponent training, which demonstrated benefits in strength, balance, and mobility; (iii) environmental modifications, aimed at reducing extrinsic risks and promoting safer surroundings; and (iv) educational programs, targeting professionals, residents, and families, with positive effects on adherence to preventive practices and on strengthening the safety culture. Conclusions: Effective fall risk management in nursing homes requires an integrated, multidisciplinary, and person-centered approach, with nurses playing a central role in assessment, coordination, and implementation of interventions. However, gaps remain regarding standardization, validation of assessment tools specific to the institutional context, and evaluation of long-term outcomes.
- Effects of dignity therapy on dignity and spiritual well-being in people with advanced cancer: study protocol for a randomized controlled trialPublication . Yanez, Romel; Fernandes, Ana; Sousa, Maria de; Abreu, Cinara; Alcantara, Roberta de; Guimarães, Maria; Cunha, Meire da; Magalhães, Luciana; Brito, Amalia de; Gomes, Matheus; Medeiros, Natacha de; Castro, Régia; Sixsmith, Judith; Paiva, Bianca; Torres, Débora; Johnston, Bridget; Laranjeira, CarlosBackground Dignity Therapy is a person-centered psychotherapeutic intervention designed for people approaching the end of life, fostering reflection on meaningful aspects of life and creating a testimonial legacy. Since 2011, randomized trials have demonstrated its value in addressing psychospiritual needs and preserving dignity in palliative care. However, no controlled studies have been conducted in Latin America to assess its effectiveness within local cultural contexts. Methods This is a protocol for an exploratory, randomized, parallel-group clinical trial (1:1 allocation) with an open-label design. A total of 96 hospitalized individuals with advanced cancer will participate, all receiving care from the Palliative Care Service of a university hospital in Fortaleza, Brazil. The control group will receive usual palliative care, while the intervention group will receive the same care along with Dignity Therapy, delivered in three structured sessions. Assessments will be conducted at baseline (T1), at the end of the intervention (T2), and short-term follow-up (T3). The primary outcome will be the perceived dignity impact of the intervention, measured by the Dignity Impact Scale. Secondary outcomes will include spiritual well-being, hope, anxiety, depression, and distress. Perceptions of the intervention experience will also be collected from individuals in the intervention group. The primary analysis will be performed using linear mixed models. Discussion This trial will provide evidence on the feasibility and potential benefits of Dignity Therapy in supporting dignity and spiritual well-being among individuals with advanced cancer, while also examining how the intervention performs within distinct cultural contexts that may shape perceptions of dignity and end-of-life care. Trial registration Registro Brasileiro de Ensaios Clínicos (ReBEC), RBR-8r3vzw5. Registered on 13 October 2025.
- A Low-Cost Head-Controlled and Sip-and-Puff Mouse: System Design and Preliminary FindingsPublication . Duarte, Rodrigo; Lopes, Nuno Vieira; Coelho, Paulo JorgeThis work introduces a low-cost, wearable assistive mouse designed to support digital interaction for individuals with motor impairments. The system combines inertial sensing for head-movement tracking and a pressure-based interface for simulating mouse clicks via “sip-and-puff” actions. The device enables full mouse control (pointer movement, clicks, and double-clicks) without relying on hand mobility. Preliminary evaluations, conducted with input from occupational therapy professionals, demonstrated promising usability and functionality comparable to commercial devices. The proposed solution offers a cost-effective, open-source alternative to existing adaptive technologies, with future development aimed at broader testing and integration in rehabilitation settings. Future work will include usability testing with individuals presenting real motor impairments to validate clinical applicability.
- Self‐reported oral health–related habits, attitudes and knowledge in adults from Portugal, Romania and Sweden—A comparative studyPublication . Cuculescu, Marian; Slusanschi, Oana; Boscaiu, Voicu Radu; Luis, Henrique Pedro Soares; Graça, Sandra Maria Fernandes Ribeiro; Albuquerque, Teresa Maria Beatriz Ramos Esteves Gonçalves dos Santos; Assunção, Victor Abreu; Galuscan, Atena; Podariu, Angela Codruta; Malmqvist, Sebastian; Johannsen, Gunnar; Johannsen, AnnsofiObjective: The aim of the present study was to compare the self-reported oral health knowledge, habits and attitudes of adults in Portugal, Romania and Sweden, each benefitting from a different oral health system. Methods: A cross-sectional study was conducted on 1081 adults in the three countries, using an adapted version of the WHO oral health questionnaire. This survey took place between November 2015 and June 2016. Results: The mean age of the respondents was 46.85 with 95% CI (45.84, 47.86). Over 85% of the Portuguese and the Swedish, but only 55% of the Romanians, reported having 20 or more teeth left (P < 0.001). Most Swedes visit the dental office regularly, but only 50.5% of the Portuguese and 20.6% of the Romanians do so (P < 0.001). Interdental cleaning aids and fluoridated toothpaste were used the most in Sweden and the least in Romania. Daily consumption of sweets was lowest for Portugal and highest for Romania (P < 0.001), and daily intake of fresh fruits and vegetables was lowest for Sweden (P < 0.001). Conclusions: There is a difference between the three countries regarding oral health, diet, dental attendance and oral health–related quality of life, with Romania being in most need of improvement in these areas. The differences could be explained by the distinct healthcare systems adopted by the countries.
- Veggies4myHeart Project: food and nutrition education tools for pre-schoolers – a SWOT analysisPublication . Braga-Pontes, Cátia; Custódio, Susana; Graça, PedroBackground: Nutrition education tools to promote vegetable consumption in the school context appear as enhancers of children's knowledge and eating behaviors. The purpose of this study is to assess the perspective of the different stakeholders of the Veggies4myHeart project regarding the potential of a digital game, child storybook and the Portuguese Food Wheel Guide to promote vegetable consumption in preschool age. Methods: The sample consisted of 26 participants who were involved in Veggies4myHeart project. This is a qualitative study, using thematic content analysis. The answers were analyzed using the WebQDA qualitative analysis software. Results: Considering the SWOT analysis were identified strengths, weaknesses, opportunities and threats for each nutrition education tool. Participants identified a greater number of positive and negative aspects regarding digital game. Conclusions: This study has allowed the perspective of creators and/or users of food education tools to be known in relation to their potential to promote the consumption of vegetables at pre-school age. A SWOT analysis of each food education tool gives the possibility to know the constraints or potentialities that may be associated with the dissemination of these tools in the educational community.
- Teleconsulta de Enfermagem como Estratégia de Follow-up em Utentes com Ferida Traumática: Estudo ComparativoPublication . Rosa, Cátia de Sousa; Bom, Luís Filipe Pereira Todo; Costeira, Cristina Raquel BatistaBackground: Follow-up telenursing is recommended as an effective strategy for reducing hospital admissions and associated costs. A telenursing service was implemented in an outpatient clinic to monitor patients with traumatic wounds. Objective: To compare satisfaction and healthcare utilization among patients with traumatic wounds who received follow-up telenursing and those who did not. Methodology: A descriptive-comparative study was conducted. The experimental group (n = 33) received follow-up telenursing in addition to conventional care, while the control group (n = 35) received conventional care only. The study was conducted between May and July 2022, with data collected via questionnaire and analyzed using SPSS® software. Ethical standards were observed. Results: Males predominated in both groups, with a mean age of 40 years. The experimental group reported higher satisfaction with nursing care and lower use of in-person services (p ≤ 0.05). Conclusion: Telenursing contributed to health improvements, supporting its potential as an effective tool for monitoring patients with traumatic wounds.
- 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.