Female genital mutilation (FGM) comprises non-medical procedures involving partial or total removal of the external female genitalia and remains a public health concern in Europe, including Portugal, due to migration from high-prevalence countries. This study aimed to assess the perceptions and experiences of Portuguese gynaecologists and obstetricians regarding FGM. A nationwide cross-sectional survey was conducted using a 13-item anonymous electronic questionnaire distributed via email and WhatsApp® to Portuguese gynaecologists and obstetricians residents and specialists through professional societies. Data were analysed using descriptive statistics, chi-square tests, and logistic regression (p < 0.05). A total of 172 Portuguese gynaecologists and obstetricians completed the survey. Overall, 43.0% reported previous clinical contact with women affected by FGM. Previous contact with FGM was significantly associated with knowledge of FGM classification (OR = 3.66, 95% CI 1.89-7.11; p < 0.001), having sought information or training on FGM (OR = 11.58, 95% CI 5.64-23.80; p < 0.001), awareness of countries where FGM is practiced (OR = 6.07, 95% CI 1.73-21.29; p = 0.005), and reporting cases to authorities (OR = 18.77, 95% CI 2.38-148.00; p = 0.005). Despite clinical exposure, important knowledge and preparedness gaps persist, highlighting the need for targeted training and national guidance to improve FGM-related care in Portugal. A national survey of Portuguese gynaecologists and obstetricians assessing knowledge, perceptions, and clinical practices regarding female genital mutilation, highlighting training gaps and the need to strengthen identification, management, and referral pathways.
To reconstruct the identity of an individual, sex assessment is an essential step in the estimation of the biological profile of a skeleton. For that purpose, forensic anthropologists apply both morphological and metric methods based in skeletal elements. In 2000, Wasterlain used a sample from the Identified Skeletal Collection of the University of Coimbra (19th -20th centuries) to develop a method to estimate sex on the basis of the limb bones metrics. In the present study, a sample of 202 individuals (92 males and 110 females) from the 21st Century Identified Skeletal Collection (University of Coimbra) was used to revise the Wasterlain method to better suit the contemporary Portuguese population. In all, 22 measurements were performed in the femur, tibia, calcaneus, and talus. Although the Wasterlain method has shown satisfactory results, new cut-off points and discriminant functions were developed to promote accurate sex classifications in the contemporary Portuguese population. Regarding the cut-off points, the femoral vertical head diameter, the bilateral width of the tibia, the length of the calcaneus, and the maximum length of the talus presented the best results for sex estimation (89.8%, 88.0%, 85.6%, 85.9%, respectively). Discriminant functions presented correct classification percentages varying between 78.7% and 91.5% for femur, 83.7% and 93.0% for tibia, 84.9% and 86.6% for calcaneus, and 86.6% and 88.5% for talus. In sum, the new cut-off points and discriminant functions presented an overall good performance, constituting reliable methods to be applied in forensic cases involving individuals of Portuguese origin.
Assessing loneliness is essential to better understand older adults' mental health needs and to inform timely and appropriate interventions. The De Jong Gierveld Loneliness Scale (DJGLS) is one of the most widely used measures of loneliness worldwide. However, there is no evidence regarding its psychometric adequacy for older adults in Portugal. This study analysed the psychometric properties (validity and reliability) of the Portuguese version of the DJGLS (both the 11-item and 6-item versions) for community-dwelling older adults. A cross-sectional study was conducted with 466 participants. Construct, convergent and divergent validity were evaluated, and test-retest reliability was assessed using intraclass correlation coefficients (ICC) and Bland-Altman plots. The 11-item DJGLS showed a bifactor structure with a general loneliness factor and two specific factors (social and emotional loneliness), with good model fi, whereas the 6-item DJGLS demonstrated excellent fit. Both versions showed a significant correlation with ULCA-16 (r ≥ 0.6), adequate internal consistency (Cronbach's alpha = 0.8 (11 item) and 0.67 (6 item)), excellent test-retest (two-weeks) reliability (ICC ≥ 0.9) and acceptable agreement on the Bland-Altman plots, without evidence of proportional biases. The Portuguese versions of the DJGLS-11 and DJGLS-6 are valid and reliable instruments for assessing loneliness in Portuguese community-dwelling older adults, supporting their use in research and screening contexts. The validated version of the DJGLS enable the assessment of social and emotional loneliness, expanding the range of loneliness measures currently available in Portugal.
To translate, culturally adapt, and semantically validate the Brazilian Portuguese version of the Spine Oncology Study Group Outcomes Questionnaire 2.0 (SOSGOQ 2.0) through cognitive interviews with patients with spinal metastases. Following the guidelines of Beaton et al., the translation process included forward translation by two independent Brazilian translators, back translation by two native English speakers, expert committee review, and reconciliation. The final version underwent semantic validation through cognitive interviews with five patients with spinal metastases at a Brazilian public cancer center. Following Consolidated Criteria for Reporting Qualitative Research guidelines, semi-structured interviews assessed comprehensibility, relevance, and cultural appropriateness. All interviews were recorded, transcribed, and analyzed using thematic content analysis. All participants (mean age 58±12 years, 60% male) completed the questionnaire successfully. Thematic analysis identified three main themes. High comprehensibility was observed, as all items were clearly understood without ambiguity. Cultural relevance emerged because the questions reflected the Brazilian healthcare context appropriately. Clinical applicability was also evident, as participants recognized the relevance of the symptoms addressed in the questionnaire to their condition. The mean completion time was 12±3 min, and no linguistic modifications were required. Participant feedback demonstrated semantic equivalence and acceptability of the translated instrument. The Brazilian Portuguese SOSGOQ 2.0 demonstrated strong semantic validity and cultural appropriateness in this qualitative validation study. The instrument is ready for large-scale psychometric validation studies in Brazilian oncology settings.
Family environments play a critical role in shaping children's lifestyle behaviours that influence obesity risk. However, culturally validated instruments to assess these behaviours are lacking in Portuguese primary care. This study aims to translate and culturally adapt the Family Nutrition and Physical Activity (FNPA) screening tool for use in Portugal (FNPA-PT) and to evaluate its face and content validity through cognitive interviews with parents attending well-child visits. An exploratory, descriptive study followed internationally endorsed guidelines (Beaton; MAPI) for translation and cross-cultural adaptation. The process comprised seven stages: forward translations, synthesis, back translations, comparisons of back translations, expert committee review, cognitive debriefing and final proofreading. Ten parents of five-year-old children attending a public primary care centre in Lisbon completed the FNPA-PT while participating in individual cognitive interviews. Data were analysed using Content Analysis, guided by Tourangeau's four-stage response model. Semantic equivalence between forward and back translations was high (85% of items with satisfactory or perfect equivalence). Minor linguistic and cultural adaptations were introduced to improve clarity and contextual relevance. Cognitive interviews indicated that the FNPA-PT was well understood, acceptable to parents, and feasible to complete during well-child visits. Parents valued the questionnaire's comprehensiveness and its potential to enhance awareness and stimulate discussion about family health behaviours. Minor revisions addressed comprehension issues in three items related to milk consumption, screen time and sleep. The FNPA-PT demonstrated strong face and content validity and high acceptability among Portuguese parents. It provides a culturally appropriate, family-centred tool for health professionals to support early identification of obesogenic environments and to guide preventive counselling in primary care. The study also offers a transparent methodological pathway for translating and adapting behavioural measures across languages and settings.
To analyze the performance of the Montreal Cognitive Assessment Hearing Impairment (MoCA-H) in Brazilian Portuguese in neurologically healthy older adults, comparing those with normal hearing and those with hearing loss who use hearing aids. Observational, cross-sectional, and quantitative study involving 20 neurologically healthy older adults (with no signs of cognitive decline), matched by age and education, divided into two groups: one with a quadritonal average within normal limits, and the other with bilateral moderate or greater hearing loss, all users of bilateral Hearing Aids (HA). Participants were assessed through anamnesis, pure-tone audiometry, speech audiometry, tympanometry, Mini-Mental State Examination (MMSE), and MoCA-H. Comparisons between groups were conducted using Student's t-test, with a significance level of 5%. Similar performance was observed between groups in seven of the eight cognitive domains assessed by the MoCA-H. The only statistically significant difference was found in the visuo-spatial/executive domain, with lower performance in the group with hearing loss. No significant difference was found in the total MoCA-H score between the groups. Neurologically healthy older adults with and without treated hearing loss showed similar performance on the MoCA-H tasks. Only the visuospatial/executive task distinguished the groups evaluated. The MoCA-H proved to be an effective and sensitive tool in the cognitive assessment of older adults with moderate to severe hearing loss, at least in the sample studied. Analisar o desempenho do Montreal Cognitive Assessment Hearing Impairment (MoCA-H) em português brasileiro em idosos neurologicamente saudáveis, comparando aqueles com audição normal e com perda auditiva usuários de próteses auditivas. Estudo observacional, transversal e quantitativo, com 20 idosos neurologicamente saudáveis (sem sinais de declínio cognitivo), pareados por idade e escolaridade, divididos em dois grupos: um com média quadritonal dentro da normalidade e outro com perda auditiva bilateral de grau moderado ou superior, usuários de Aparelhos de Amplificação Sonora Individual (AASI). Os participantes foram avaliados por meio de anamnese, audiometria tonal liminar, logoaudiometria, imitanciometria, Mini Exame do Estado Mental (MEEM) e MoCA-H. As comparações entre os grupos foram realizadas com o teste t de Student e Mann Whitney com nível de significância de 5%. Observou-se desempenho semelhante entre os grupos em sete das oito habilidades avaliadas pelo MoCA-H. A única diferença estatisticamente significativa foi identificada no domínio visuo-espacial/executivo, com desempenho inferior no grupo com perda auditiva. A pontuação total do MoCA-H não apresentou diferença significativa entre os grupos. Os idosos neurologicamente saudáveis sem e com perda auditiva tratada apresentaram desempenho semelhante nas tarefas do MoCA-H. Apenas a tarefa visuo-espacial/executivo distinguiu os grupos avaliados. O MoCA-H mostrou-se uma ferramenta eficaz e sensível na avaliação cognitiva de idosos com perda auditiva moderada à severa, ao menos na amostra estudada. Analisar o desempenho do Montreal Cognitive Assessment Hearing Impairment (MoCA-H) em português brasileiro em idosos neurologicamente saudáveis, comparando aqueles com audição normal e com perda auditiva usuários de próteses auditivas. Estudo observacional, transversal e quantitativo, com 20 idosos neurologicamente saudáveis (sem sinais de declínio cognitivo), pareados por idade e escolaridade, divididos em dois grupos: um com média quadritonal dentro da normalidade e outro com perda auditiva bilateral de grau moderado ou superior, usuários de Aparelhos de Amplificação Sonora Individual (AASI). Os participantes foram avaliados por meio de anamnese, audiometria tonal liminar, logoaudiometria, imitanciometria, Mini Exame do Estado Mental (MEEM) e MoCA-H. As comparações entre os grupos foram realizadas com o teste t de Student e Mann Whitney com nível de significância de 5%. Observou-se desempenho semelhante entre os grupos em sete das oito habilidades avaliadas pelo MoCA-H. A única diferença estatisticamente significativa foi identificada no domínio visuo-espacial/executivo, com desempenho inferior no grupo com perda auditiva. A pontuação total do MoCA-H não apresentou diferença significativa entre os grupos. Os idosos neurologicamente saudáveis sem e com perda auditiva tratada apresentaram desempenho semelhante nas tarefas do MoCA-H. Apenas a tarefa visuo-espacial/executivo distinguiu os grupos avaliados. O MoCA-H mostrou-se uma ferramenta eficaz e sensível na avaliação cognitiva de idosos com perda auditiva moderada à severa, ao menos na amostra estudada.
Pain is common in people living with dementia (PLWD), yet frequently remains unrecognized and undertreated. Traditional observational tools are limited by subjectivity and suboptimal psychometric properties. The PainChek® mobile application (app) is a medical device that enables objective assessment in non-verbal people, such as those with more advanced dementia, using artificial intelligence (AI)-driven recognition of facial muscle movements. This study evaluated the usability of the Portuguese (PT) version of the PainChek® app among formal caregivers in residential care. Usability was evaluated in a controlled environment, guided by ISO 9241-11:2018 and ISO 25062:2025. After training, 19 participants performed nine tasks using the PainChek®-PT app while undertaking concurrent think-aloud; performance was screen and audio-recorded and supplemented with observation notes. Participants completed the Post-Study System Usability Questionnaire (PSSUQ-PT). Metrics included effectiveness (success rates, errors), efficiency (task completion time, attempts), satisfaction, usability problems and likely defects. Descriptive statistics were performed and confidence intervals (CI) computed, using 95% CIs for success rates and task times. PSSUQ scores were interpreted using 99% CIs against normative datasets. Eight tasks achieved over 95% success rate. Task 5 (interrupted assessment of an existing resident) represented an outlier at 42% success (95% CI: 23.1-63.7). Seventeen distinct error types were recorded across tasks. Completion times varied considerably; Task 3 (assessing an existing resident's pain via video) had the longest geometric mean (335 s, 95% CI: 269.6-417.2), while log-out (Task 9) had the shortest (11 s, 95% CI: 6.6-18.4). Resident archiving (Task 7) recorded the highest number of attempts (17). The mean overall PSSUQ-PT score was 1.9 (SD: 1.06; 99% CI: 1.20-2.60), outperforming the normative mean of 2.82, with no overlap in 99% CIs. Seven usability problems were identified and linked with likely underlying usability defects. PainChek®-PT demonstrated effectiveness, efficiency and satisfaction in this context of use, supporting its intended use for conducting pain assessments in non-verbal PLWD. The robustness of the overall PSSUQ score indicates high perceived usability. The errors and usability problems identified in the simulated environment may be addressed through training and minor design refinements.
Multiple factors contribute to cognitive maintenance and the development of cognitive reserve in aging, including life experiences and behaviors. Among these, education plays a key role, particularly through language-related activities such as reading and writing. This study investigates the impact of Reading and Writing Habits (RWH), alongside educational level and socioeconomic status (SES), on word and pseudoword naming across the lifespan in Brazilian Portuguese. Using a stepwise linear regression model, we analyzed the predictive value of age, SES, education, and RWH on naming performance in young and older adults, utilizing response time and accuracy as dependent variables. Results indicate that age, SES, education, and RWH significantly influence naming latencies and accuracy. While education showed the strongest effect on response time, RWH also contributed meaningfully, particularly in populations with limited formal education and low SES. These findings suggest that RWH may serve as an important compensatory factor in cognitive processing. Overall, the study highlights the combined role of formal education and lifelong reading and writing habits in supporting language-related cognitive performance and maintaining cognitive reserve, especially in socioeconomically disadvantaged populations.
Hospital morbidity data are used for hospital reimbursement in many countries and are also critical for epidemiological profiling and health planning, both of which depend on data quality. Exploring the clinical coders' perspective is crucial for implementing targeted interventions in this field. To identify the main factors influencing the quality of health registries, the coding process and data quality, from the perspective of clinical coders in Portugal. We conducted a nationwide online survey of clinical coders, informed by prior focus groups and a literature review, to assess their perspectives on the quality of health records, the clinical coding process, and coded data. A total of 162 responses were obtained. Respondents primarily used electronic health records, including discharge notes, clinical diaries, and surgical reports. Common problems in health records included "copy-paste" practices (67%) and the use of unspecified acronyms (52%). Incomplete records, inconsistent information, and the lack of support affected coding quality. Half agreed that a reduction in the number of coders contributed to delays. Financial incentives for quality, software availability, and frequent internal audits were identified as priority measures to improve data quality. This study highlights the importance of clinical documentation for coding accuracy. Despite the use of electronic health records and the transition to ICD-10-CM/PCS, difficulties such as "copy-paste" practices and the use of unspecified acronyms persist. Continuous training, standardisation of documentation practices, and collaboration between clinical coders and other health professionals are essential to ensure coding accuracy. These problems and potential improvements may affect national policymaking and initiatives such as the European Health Data Space and international health prioritisation.
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Critical thinking is widely recognised as essential for occupational therapy education and practice, yet its conceptualisation, teaching, and assessment remain inconsistent across international contexts. Existing literature highlights a lack of clarity regarding effective pedagogical approaches and a limited understanding of how educators make sense of critical thinking within occupational therapy curricula. This study examined how occupational therapy educators across different countries conceptualise critical thinking and how it features in the programmes they teach. A convergent mixed-methods design was used. Occupational therapy educators completed an online survey (available in Spanish, Portuguese, and English) containing 28 quantitative items and six open-ended qualitative questions. Quantitative data were analysed using descriptive statistics, and group comparisons were made using the Kruskal-Wallis and Dunn tests. Qualitative data underwent inductive content analysis within language groups and were later synthesised across datasets through reflexive, collaborative analysis. No consumers were involved in the study conceptualisation or analysis. Responses revealed a spectrum of conceptualisations of critical thinking, ranging from concrete, pragmatic, and clinically focused understandings to abstract, socially oriented, and transformative perspectives. English-language responses tended to emphasise clinical reasoning, evidence use, and decision-making, whereas Portuguese and Spanish responses more strongly foregrounded reflection on knowledge, sociopolitical structures, and critical action. Teaching practices mirrored this spectrum: Critical thinking was taught unevenly across curricula, most commonly within clinical reasoning or foundational occupational therapy subjects, with fewer programmes explicitly addressing broader sociocultural or transformative dimensions. Findings highlight significant epistemological variation shaping how critical thinking is conceptualised and enacted in occupational therapy education. Recognising these epistemological foundations, rather than seeking a universal definition, may support more intentional, inclusive, and socially responsive curriculum design. Critical thinking is an important skill for occupational therapists, helping them question assumptions and understand how social, cultural, and political factors influence people's everyday lives. However, occupational therapy educators around the world may not always agree on what critical thinking means or how it should be taught to students. This study explored how occupational therapy educators from different countries understand critical thinking and how it features in their university programmes. Educators completed an online survey with multiple‐choice questions and open‐ended questions. We analysed the numerical answers using statistics and the written answers using qualitative content analysis, comparing similarities and differences across language groups. We found that educators think about critical thinking in two main ways. Some described it as a practical, concrete process linked to clinical reasoning, evidence evaluation, and intervention decision‐making. These views were most common in English‐language responses. Others described critical thinking as more abstract or as part of a social process. This included questioning how knowledge is created, considering social and political influences on occupation and everyday life, and taking action to address injustices. These views were more common in Portuguese and Spanish responses. Educators also differed in perceptions of how and where critical thinking featured in their programmes. For many, it featured most often in clinical or professional reasoning subjects. A smaller number reported that it featured in courses about society, culture, or social justice. The study shows that critical thinking is shaped by different cultural, epistemological, and educational traditions. Becoming more aware of these differences can help occupational therapy educators design more inclusive and socially responsive curricula.
Cardiac surgery is an effective treatment for cardiovascular diseases but is associated with significant risks. Limited patient knowledge during the perioperative period may negatively affect outcomes. To map the knowledge gaps among patients with heart diseases in the perioperative context of cardiac surgery. Scoping review developed based on the guidelines of the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist (PRISMA-ScR). Evidence selection was conducted between August and September 2025 through searches in the MEDLINE, CINAHL, BDENF, Web of Science, Scopus, LILACS, CAPES Theses and Dissertations Portal, Theses Canada, RCAAP, BDTD, and Trove. The inclusion criteria comprised studies in Portuguese, English, and Spanish involving individuals aged 18 years or older, with no time restriction, addressing patients' knowledge about their health condition in the perioperative period of cardiac surgery. Studies unavailable in full text, restricted-access documents, and opinion articles were excluded. Data extraction was based on predefined variables, and the information was analyzed using descriptive statistics. Six studies were included in the final sample, predominantly journal articles with a quantitative approach, originating from Brazil, published in Portuguese, and covering the period from 2012 to 2024. Patients' knowledge was found to be deficient mainly regarding the risks and potential complications of cardiac surgery, how the surgical procedure is performed, the specific type of cardiac surgery to be undertaken, the possibility of engaging in physical activity after surgery, and care related to the surgical wound. Patients' knowledge presents gaps in several aspects related to the perioperative period of cardiac surgery, and that health education interventions are essential to address this issue. This scoping review identifies critical knowledge gaps among cardiac surgery patients in the perioperative period, underscoring the need for targeted nursing-led health education to improve patient safety, recovery, and evidence-based cardiovascular care. Heart diseases are common and often require cardiac surgery. Before and after surgery, people frequently feel fear, anxiety, and uncertainty, especially when they do not clearly understand their condition, the procedure, the risks, or what recovery will be like. For this reason, knowing what patients still do not understand helps improve health care. This review gathered studies about the knowledge of adults with heart disease during the surgical period. The results show that many patients have difficulty understanding important parts of their treatment. The main concerns involve the risks and complications of surgery, how the procedure is performed, which operation will be done, lifestyle changes after surgery, physical activity, and care of the surgical wound. These findings show how important it is for nurses and other health professionals to explain information in a clear, simple, and timely way. When patients better understand what is happening, they feel safer, recover better, experience less anxiety, and may achieve better health outcomes. This study also helps guide future research and the development of educational strategies that place patients’ needs and understanding at the center of cardiac surgical care.
Peritoneal Carcinomatosis (PC) has a negative impact on patients' physical and mental health, decreasing quality of life (QoL). Cytoreductive Surgery and HIPEC (CRS + HIPEC) is the only potentially curative option for PC. However, it can be an aggressive procedure requiring multivisceral resection, particularly involving the gastrointestinal (GI) tract. Its impact on long-term QoL remains poorly established. To evaluate the long-term impact of CRS + HIPEC on both generic and GI QoL in our Centre and to compare generic QoL results with standard values for the Portuguese Population (PtP). A single-center retrospective analysis was performed including all patients who underwent CRS + HIPEC with curative intent between 2016 and 2020. All selected patients completed three QoL questionnaires: the SF-36, the Gastrointestinal QoL Index (GIQLI), and the EORTC QLQ-C30. Mean time between CRS + HIPEC and the QoL survey was 66 ± 19 months. The median SF-36 scores, evaluating generic QoL, were very high, and no differences were found when compared with standard values for the Portuguese population. Furthermore, patients who underwent CRS + HIPEC showed better QoL outcomes in Emotional Performance (EP), Mental Health (MH), Social Function (SF), and Pain (P) (p < 0.005). When evaluating GI-specific QoL, both the GIQLI and EORTC QLQ-C30 reflected few or no GI symptoms (GIQLI ≥3; EORTC QLQ-C30 0-33). When specifically analysing patients who underwent GI resection, some GI symptoms were more prevalent, although infrequent, with no significant differences between groups. CRS + HIPEC does not appear to have a significant long-term negative impact on either generic QoL or specific GI parameters.
Autosomal dominant polycystic kidney disease (ADPKD) is the most common monogenic kidney disease, accounting for 5-10% of incident patients requiring kidney replacement therapy (KRT). Although most cases result from pathogenic variants in PKD1 (≈75%) or PKD2 (≈15%), clinical experience at a major academic hospital in Porto (ULSSJ), suggested a higher regional prevalence of ADPKD-PKD2, particularly involving the truncating variant PKD2 p.(Gln61*). This study aimed to characterize the clinical and genetic epidemiology of ADPKD in patients initiating KRT at ULSSJ, compare ADPKD-PKD1 with ADPKD-PKD2, and contrast local and national ADPKD prevalence among incident KRT patients. Nephrology reports for KRT initiation (NR-KRT) issued at ULSSJ from 1990 to 2023 were reviewed to identify ADPKD cases and extract demographic and clinical data. Genotypes were obtained from the Genetics Laboratory, Faculty of Medicine, University of Porto, or inferred through pedigree analysis. Next-generation sequencing was the first-tier genotyping test, with Sanger sequencing and multiplex ligation-dependent probe amplification for unresolved cases. National prevalence figures for ADPKD among incident KRT were retrieved from the Portuguese Society of Nephrology registry. Among 6791 NR-KRT reviewed, 426 ADPKD patients were identified. Genotyping information was available for 168 individuals (39.4%), including 101 (60.1%) with inferred genotypes. Among genetically resolved cases, 70.2% had ADPKD-PKD1 and 29.8% had ADPKD-PKD2. Mean age at KRT initiation was 54.5 years in ADPKD-PKD1 and 66.9 years in ADPKD-PKD2. The PKD2 p.(Gln61*) variant was present in 39 patients (23.2%). Between 2010 and 2023, ADPKD prevalence among incident KRT patients was 7.48% at ULSSJ versus 5.19% nationwide (p<0.0001). The prevalence of ADPKD among incident KRT patients at ULSSJ exceeded national rates. ADPKD-PKD1 was associated with earlier kidney failure compared to ADPKD-PKD2. PKD2 p.(Gln61*) variant was the most frequent pathogenic allele identified. Given historical patterns of Portuguese emigration, these findings likely have broader international clinical relevance.
Arts-based interventions create meaningful opportunities for emotional expression, strengthening personal competencies that can enhance prison social climate and support reintegration. This study examined the perceived feasibility and acceptability of RadioACTIVITY, a co-creative arts-based program combining radio theatre production with participatory practices (RadioLAB, RadioSTUDIO, RadioDIFFUSION), implemented across three 10-month editions in a Portuguese prison. Twenty-eight incarcerated individuals (53.6% female; 46.4% male) participated in focus groups. Thematic analysis indicated that feasibility was supported by sustained engagement facilitated through non-judgmental facilitation, collaborative processes, and dynamic sessions. Acceptability was reflected in positive evaluations of the program as meaningful and appropriate, alongside interest in its continuation. Participants also reported intrapersonal (e.g., self-regulation, language skills) and interpersonal (e.g., empathy) gains, as well as perceived social impacts, including reduced stigma. Findings highlight the potential of arts-based approaches to foster rehabilitation and more constructive prison environments. A Participant-Led Radio Program in Prison: What Worked and WhyCreative arts programs can help people in prison express their thoughts and emotions, build personal skills, and improve relationships with others. These benefits may also contribute to a more positive prison environment and support successful reintegration into society. This study explored how people in prison experienced RadioACTIVITY, an innovative arts-based program that uses radio theatre and collaborative creative activities. RadioACTIVITY was implemented over three editions (i.e., three groups of participants), each lasting 10 months, in a Portuguese prison. The program involved three main stages: experimenting with ideas and voices (RadioLAB), creating radio productions together (RadioSTUDIO), and sharing the final content with others (RadioDIFFUSION). A total of 28 incarcerated participants (men and women) took part in group discussions to share their views about the program. Overall, participants found the program easy to engage with and highly meaningful. They highlighted the importance of facilitators who showed respect, listened without judgment, and worked collaboratively with the group. The creative and varied structure of the sessions also helped maintain motivation and interest. Participants reported several personal benefits. On an individual level, they described improvements in emotional control, self-discipline, and language skills. On a social level, they noted better understanding of others, increased empathy, and more positive interactions. Beyond personal change, participants felt the program had a wider impact by helping to challenge negative stereotypes about people in prison and by creating content that could be shared with other prisons. These findings suggest that arts-based programs like RadioACTIVITY can play an important role in rehabilitation by fostering personal growth, improving relationships, and contributing to healthier and more constructive prison environments.
Methicillin-resistant Staphylococcus aureus is a pathogen transmitted both in hospital and community settings. Although carriage among medical and nursing personnel has been widely studied, information regarding its presence among dental healthcare workers is limited. To estimate the prevalence of healthy methicillin-resistant S. aureus carriers among dental personnel. We searched for articles in PubMed, ScienceDirect, Scopus, BVS, and Google Scholar in English, Portuguese, and Spanish. Three reviewers selected and extracted data from cross-sectional studies published up to December 2024. We assessed risk of bias using the Joanna Briggs Institute tool. We calculated pooled prevalence and conducted subgroup analyses using a random-effects model with maximum likelihood estimation in Stata 18.0™. The protocol was registered in PROSPERO (CRD42024563164). We included 17 articles in the systematic review and six in the meta-analysis. The overall prevalence of nasal methicillin-resistant S. aureus carriage among dental personnel was 2.28% (95% CI: 0.78-6.4) in a combined sample of 1256 participants. Among dentists, prevalence was 3.63% (95% CI: 0.98-10.57); among dental assistants, 1.45% (95% CI: 0.11-11), and among dental students in clinical training, 2.0% (95% CI: 0.36-8.0). Differences between groups were not statistically significant (p = 0.87). Evidence on methicillin-resistant S. aureus carriage among dental personnel is scarce and lacks population representativeness. Although prevalence appears low, continued surveillance among all dental healthcare providers is recommended to monitor epidemiological transmission and associated risk factors. Staphylococcus aureus resistente a la meticilina es un agente patógeno transmitido en hospitales y comunidades. Aunque la presencia en personal médico y de enfermería ha sido ampliamente estudiada, existe poca información sobre su presencia en personal odontológico. Estimar la prevalencia de portadores sanos de este agente patógeno en el personal odontológico. Se buscaron artículos en PubMed, ScienceDirect, Scopus, BVS y Google Scholar, en inglés, portugués y español. Tres revisores extrajeron los datos de los estudios transversales publicados hasta diciembre del 2024. El riesgo de sesgo se evaluó con la herramienta Joanna Briggs Institute. La prevalencia agrupada y los subanálisis se calcularon mediante un modelo de efectos aleatorios con estimación de máxima verosimilitud, utilizando Stata 18.0™. El protocolo fue registrado en PROSPERO (CRD42024563164). Se incluyeron 17 artículos en la revisión sistemática y 6 en el metaanálisis. La prevalencia general de presencia nasal de S. aureus resistente a la meticilina en personal odontológico fue del 2,28 % (IC95%: 0,78-6,4), de un total de 1256 participantes. En odontólogos, la prevalencia fue del 3,63 % (IC95%: 0,98-10,57); en asistentes dentales, del 1,45 % (IC95%: 0,11-11); y en estudiantes en prácticas clínicas, del 2,0 % (IC95%: 0,36-8,0). No se observaron diferencias significativas entre los grupos (p = 0,87). Los estudios de prevalencia de portadores sanos de S. aureus resistente a la meticilina en personal odontológico son escasos y sin representatividad poblacional. A pesar de una baja prevalencia, la vigilancia rigurosa de todos los proveedores de atención médica permite el monitoreo de su transmisión epidemiológica y los factores de riesgo predisponentes.
To map existing scientific evidence on the relationship between clinical supervision and burnout and burnout-related outcomes among nurses in clinical practice. Scoping review. The review followed the Joanna Briggs Institute methodology for scoping reviews. A total of 1396 records were identified and imported into Rayyan for screening. Data were synthesised descriptively using absolute and relative frequencies and presented in narrative and tabular form. Searches were conducted in February 2025 in CINAHL Complete, Nursing & Allied Health Collection: Comprehensive, MedicLatina, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PubMed, and Web of Science Core Collection. Grey literature was searched in OpenGrey and the Portuguese Open Access Scientific Repository (RCAAP). No time or language restrictions were applied. Twenty studies were included. The evidence base was heterogeneous and predominantly cross-sectional. Clinical supervision in Nursing (CSN) was mainly delivered face-to-face and most frequently in group formats, with considerable variability in frequency, duration and theoretical grounding. Burnout was primarily assessed using validated instruments, particularly the Maslach Burnout Inventory. Nine studies reported inverse statistical associations between CSN and burnout or burnout-related outcomes. Clinical supervision is frequently associated with burnout and burnout-related indicators among nurses. Clearer intervention reporting, stronger theoretical grounding, and research designs capable of exploring temporal and contextual dynamics are needed to advance the field. Clinical supervision may represent a context-sensitive organisational support strategy within broader workforce well-being frameworks, particularly when structurally defined and supported by leadership. This review clarifies how clinical supervision has been conceptualised and evaluated, identifying reporting gaps and priorities for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. No stakeholder consultation was undertaken. Future research should consider involving practising nurses and supervisors to define core CSN components. The protocol was registered in the Open Science Framework.
Maintaining meaningful access to the surrounding community is increasingly recognised as a key component of well-being, quality of life, independence, identity, and social citizenship for people living with dementia. Institutions often act as gatekeepers, mediating residents' access to the surrounding neighbourhood. Yet little empirical evidence exists on how residential care facilities act as institutional mediators of of residents' access to the neighbourhood beyond the institution's premises. This cross-sectional study draws on survey data from 423 directors of Portuguese care homes to examine: (i) the extent to which residents with dementia are permitted to go outside and under what conditions; (ii) how frequently they engage in individual and institution-organised outings; and (iii) the organisational and environmental determinants associated with these practices. Three logistic and one ordinal regression models were conducted, reflecting different conceptualisations of "going outside", from independent mobility to the frequency of structured outings. Overall, the findings indicate that outing opportunities are strongly shaped by organisational culture, staffing structures, staff training and awareness, facility ownership, and the local environment. For-profit facilities were consistently more restrictive across several models. Higher person-centred care scores, the availability of facility-owned transport and dementia-relevant staff training were associated with greater freedom or more frequent outings. Environmental perceptions also played an important role: directors who considered the surrounding area to be quiet or green tended to permit more liberal access and reported higher frequencies of outings. These results highlight the multilayered nature of community access in dementia care and underscore the need for integrated policy approaches that address organisational resources, workforce capacity and capability, and neighbourhood environments to support the independence and social participation of residents living with dementia.
Diagnosing COPD in primary care remains challenging, with significant international evidence of underdiagnosis, misdiagnosis and miscoding. How reliably COPD diagnoses in real-world practice reflect objective diagnostic criteria is less well understood. To evaluate the compatibility between recorded COPD diagnoses and key diagnostic criteria - spirometry and risk-factor documentation - and to identify patient and contextual factors associated with diagnostic adequacy. A population-based, cross-sectional study including all patients with a recorded diagnosis of COPD across a large Portuguese primary care cluster (17 Family Health Units; 182,947 patients). Electronic Health Records data were extracted for demographics, comorbidities, symptoms, exposures, spirometry and clinical follow-up. Spirometry and risk-factor records were independently classified according to their compatibility with a diagnosis of COPD (compatible, uncertain or not compatible) and combined to derive diagnostic-certainty categories. Associations were analysed using non-parametric tests and multinomial logistic regression. Among 1817 included patients, only 3.63% had both spirometry and exposure records fully compatible with COPD at diagnosis; 24.05% had incompatible records. Using the most recent spirometry, compatibility improved only marginally (4.4%), while incompatible cases remained high (21.57%). Spirometry was absent or non-confirmatory in nearly 80% of patients, and smoking or other exposures documentation was missing or incomplete in almost 50%. Diagnostic incompatibility was strongly associated with older age, female sex, diagnosis made outside primary care, multimorbidity, and especially psychological comorbidities (OR 11.6; 95% CI 7.7-17.4). Asthma was the only respiratory comorbidity significantly associated with incompatible diagnoses. Records of symptoms, exacerbations and GOLD classification were infrequently documented. COPD diagnoses recorded in routine primary care frequently lack spirometric confirmation and adequate documentation of risk factors, resulting in high rates of incompatible diagnoses. Diagnostic adequacy reflects demographic, social and clinical determinants, revealing important inequities. These findings highlight an urgent need to strengthen diagnostic pathways through systematic use of spirometry, structured recording of risk factors and symptoms, and enhanced electronic health records documentation. Improving these core elements is essential to ensure accurate, consistent and equitable COPD diagnosis in primary care.
Artworks, such as paintings, are frequently utilized as stimuli in research and interventions. However, the complexity of their perceptual, emotional, and cognitive properties necessitates rigorous validation to ensure the reliability of research outcomes and the efficacy of their application in real-world contexts. A few studies have already established norms for paintings. Still, the type of stimuli (e.g., artificial intelligence [AI]-generated) and the comprehensiveness of the assessed dimensions may not entirely capture the complexity of human-made ecological artworks. The current study establishes norms for a diverse set of 144 human-made paintings retrieved from the publicly accessible WikiArt database and thematically clustered into four categories: objects (n = 36), places (n = 36), people (n = 36), and abstract (n = 36) works. European Portuguese native speakers (N = 361) rated the paintings in 11 perceptual, cognitive, and emotional dimensions. Participants also provided qualitative descriptions of the paintings, detailing their content and recognized elements. Descriptive data for each painting are provided by dimension and category. Correlations among the dimensions and between individual variables (e.g., personality traits, prior experience with the arts) and the evaluative ratings are also reported. The results indicate that this painting set is diverse, allowing for the selection of artworks that represent different levels of the evaluated dimensions across stimulus categories. These norms fill a critical gap in the standardized evaluation of paintings, facilitating a more precise and controlled use of these stimuli in experimental, clinical, and creative expression applications.