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- The effectiveness of NIRS technology to the early diagnosis of lower limb ischemia in patients on peripheral VA ECMO: A systematic review and meta-analysisPublication . Coelho, Raquel; Tavares, Joana; Marinheiro, Catarina; Costa, Carina; Ferreira, Simão; Gregório, Tiago; Ferreira, SimãoAcute lower limb ischemia is a major complication of peripheral venoarterial ECMO, significantly impacting patient outcomes and survival rates. Traditional methods for assessing limb perfusion, such as physical exams and Doppler ultrasound, are often unreliable and do not provide continuous monitoring. Near-infrared spectroscopy (NIRS), a non-invasive technique, shows promise for perfusion monitoring in venoarterial ECMO patients, but its effectiveness in the early detection of limb hypoperfusion remains unreviewed. Evaluate the effectiveness of NIRS technology in the early diagnosis of lower limb ischemia in patients undergoing peripheral VA ECMO. The search strategy covered five databases. Inclusion criteria included studies in Portuguese, English, Spanish, or German involving participants aged 18 or older dependent on peripheral VA ECMO. The intervention assessed was limb perfusion monitoring using NIRS in VA ECMO patients. The primary outcome was the effectiveness of NIRS in the early diagnosis of limb ischemia. Exclusion criteria included review articles, book chapters, books, editorials, conference papers, and studies on pediatric patients, central VA ECMO, or venovenous ECMO. Study quality was evaluated using the ROBINS-I tool. Meta-analysis was performed using R package meta. Narrative synthesis was applied when meta-analysis was unfeasible. Of 180 studies, 164 were excluded after initial screening. Of the remaining 16 studies, eight were removed for irrelevance, high bias risk, or pediatric focus, leaving eight studies. The results revealed a pooled sensitivity of the diagnostic method of 0.71 (95% CI: [0.67, 0.74]) and a pooled specificity of 0.68 (95% CI: [0.61, 0.74]). NIRS technology is an effective diagnostic tool for reliably detecting true positive cases of limb ischemia.
- Military stress management training using virtual reality: A systematic review and delphi methodPublication . Vianez, Ana; Marques, António; Loureiro, Javier; Gomes, Paulo Veloso; Machado Veloso Gomes, Paulo Sérgio; Pereira da Silva Marques, António JoséMilitary personnel encounter stressors that uniquely affect their performance and well-being, necessitating effective stress management interventions. This study investigates the efficacy of VR-based Stress Management Training (SMT) programs in comparison to traditional approaches. Through a systematic review of 13 studies, VR-based SMT programs were found to significantly reduce stress and anxiety symptoms, with various physiological markers used to evaluate the stress response. Additionally, a Delphi study was conducted to gather expert insights on designing VR-based SMT programs specifically for special operations forces. The experts identified key stressors and coping strategies relevant to this group, emphasizing the potential of VR for stress monitoring, simulation training, and real-time feedback. The Delphi study reached a 97 % consensus on the design principles for these programs. Overall, the findings suggest that integrating VR into SMT programs offers a promising strategy for enhancing stress management and resilience in military personnel.
- A scoping review of sustainable strategies adopted in nuclear medicinePublication . Ribeiro, D. F.; Grimab, K. B.; Geao, A.; Andersson, C.; Murphy, S.; Costa, Pedro; Baung, C.; Karangelis, A.; Champendal, M.; Costa, PedroSustainable development is an approach that must be applied to all areas within healthcare, especially those in constant technological development, such as nuclear medicine. The aim of this study was to scope the literature to identify knowledge gaps in the sustainable development of the nuclear medicine field. The Joanna Briggs Institute methodology for scoping reviews was employed. A search strategy was conducted in PubMed, Embase, CINAHL and Web of Science in December 2024 using Mesh terms and keywords related to sustainability development and nuclear medicine. Three independent reviewers screened titles, abstracts, and full text. Four authors performed the data extraction and analysis. A total of 36 studies met the inclusion criteria. The majority originated from Spain, and most were published in 2022 and 2023. Studies were categorised by procedure type: 33.3 % focused on therapy, 9.7 % on PET imaging, 33.3 % on diagnostic and therapeutic procedures, and 18.1 % on SPECT imaging. They were also categorised by location to include research conducted in hospital settings (n = 23), non-hospital settings (n = 8), both (n = 4) or none (n = 1). Reviewed studies implemented sustainability measures across the sustainability pillars: environmental (n = 30), economic (n = 12), and social (n = 9) pillars. This scoping review has highlighted the growing interest in sustainability, within the nuclear medicine field. Findings indicate that there is a strong emphasis on reducing environmental impact, with efforts such as waste minimisation, implementation of alternative discharge methods, and radionuclide extraction systems gaining popularity; however, further evidence is needed to understand the economic and social impact of nuclear medicine procedures. The scoping review identified a range of strategies focused on mitigating the adverse impact on the environment and working towards efficient economic and social resources, to foster sustainable practices in nuclear medicine.
- Prevalence of the use of dosimeters for ionizing radiation from fluoroscopy − a systematic literature review and meta-analysisPublication . Videira, Sara; Rodrigues, Matilde; Santos, Joana; Guedes, Joana; Martins, João; Silva, Manuela Vieira da; Vieira da Silva, Manuela; Rodrigues, MatildeThis study aims to assess the prevalence of individual dosimeter use among workers exposed to ionizing radiation during fluoroscopy-guided procedures. Additionally, factors contributing to its use were identified. Studies were identified through searches in five databases on 13 April 2024. Additionally, snowballing techniques were employed. The review followed PRISMA guidelines and the CoCoPop model. A narrative synthesis, bibliometric analysis, and meta-analysis were performed. Study quality was assessed using the Joanna Briggs Institute checklist for prevalence studies. Fifty studies involving 11,067 individuals were included. Orthopedics/traumatology was the most studied specialty (46 %). Median use rates were: 24 %(IQR = 44 %) for eye lens dosimeters, 15 %(IQR = 13 %) for electronic real-time dosimeters, 27 %(IQR = 42 %) for wrist/finger dosimeters, 25 %(IQR = 23 %) for collar/ thyroid dosimeters and 5 % for ankle dosimeter; 15 %(IQR = 78 %) reported no monitoring device. In 15 studies (30 %) with 4,188 individuals (38 %), the overall prevalence of “always” using whole-body dosimeters was 43 % [95 %CI:24–62]. By continent, the highest prevalence was found in Africa (75 %[95 % CI: 46–95]), while the lowest was in the “Americas” (33 %[95 % CI: 16–52]). Significant moderator effects were found: higher prevalence in “Africa” (p = 0.04), “gastroenterology” (p = 0.04), and “involving radiology” (p = 0.01); lower in “orthopedics” (p = 0.01) and “physicians” (p = 0.03). No significant moderator effects were found: “very high Human Development Index” (p = 0.72) and “high Human Development Index” (p = 0.69). Studies showed moderate risk of bias (6/9), with little evidence of publication bias. Exposure doses may be underestimated due to the low prevalence of dosimeter use. Interventions targeting individual and organizational factors are needed to promote consistent use and improve safety.
- How distinct Autism and Schizotypal trait dimensions influence neural predictive processingPublication . Mazer, Prune; Pasion, Rita; Fontes, Melissa; Pires, Cristiana; Silveira, Celeste; Fernando Ferreira-Santos; Mazer, PruneThe Predictive Processing (PP) framework provides a compelling model for understanding the neural mechanisms underlying autism spectrum disorders (ASD) and schizophrenia spectrum disorders (SSD). In this study, we developed visual and auditory oddball tasks with two levels of target detection difficulty to effectively elicit event-related potential (ERP) components. A total of 122 participants from the community completed these tasks during an EEG recording and self-reports assessing their variations on autistic and schizotypal traits. Results revealed that task difficulty significantly reduced P300 amplitudes across both auditory and visual modalities. Higher Restricted Interests and Detail Orientation autistic traits resulted in enhanced N2 amplitudes in the difficult visual task. Our findings also indicated a trend-level reduction in visual P300 amplitude and modulation of the auditory complex N1-P2 for individuals with higher autistic scores regarding difficulties in communication. For positive schizotypal traits, an unexpected trend-level association with increased auditory P300 amplitude emerged. These findings highlight differential impacts of ASD and SSD dimensions, on predictive processing, with variations observed across sensory modalities, task difficulty, and ERP components. This study advances our understanding of neurophysiological variability in ASD and SSD, supporting dimensional approaches to neurodevelopmental disorders and emphasizing the need for symptom-specific research. Our findings contribute to the growing body of literature on predictive processing in ASD and SSD, suggesting pathways for more refined investigations into the neural variability associated with these traits.
- The effectiveness of Virtual Reality in improving balance and gait in people with Parkinson’s Disease: A Systematic ReviewPublication . Fernandes, Sofia; Oliveira, Bruna; Sacadura, Sofia; Rakasi, Cristina; Furtado, Isabel; Figueiredo, João Paulo; Gonçalves, Rui Soles; Martins, Anabela CorreiaVirtual reality (VR), often used with motion sensors, provides interactive tools for physiotherapy aimed at enhancing motor functions. This systematic review examined the effects of VR-based interventions, alone or combined with conventional physiotherapy (PT), on balance and gait in individuals with Parkinson’s disease (PD). Following PRISMA guidelines, eight randomized controlled trials (RCTs) published between January 2019 and April 2025 were included. Interventions lasted between 5 and 12 weeks and were grouped as VR alone or VR combined with PT. Methodological quality was assessed using the PEDro Scale. Of the 31 comparisons for balance and gait, 30 were favored by the experimental group, with 12 reaching statistical significance. Secondary outcomes (function, cognition, and quality of life) showed mixed results, with 6 comparisons favoring the experimental group (3 statistically significant) and 4 favoring the control group (1 statistically significant). Overall, the studies showed fair to good quality and a moderate risk of bias. VR-based interventions, particularly when combined with PT, show promise for improving balance and gait in PD. However, the evidence is limited by the small number of studies, heterogeneity of protocols, and methodological constraints. More rigorous, long-term trials are needed to clarify their therapeutic potential.
- A preliminary assessment of a stool-based microRNA profile for early colorectal cancer screeningPublication . Santos, Daniela A. R.; Eiras, Mariana; Gonzalez-Santos, Miguel; Santos, Marlene; Pereira, Carina; Santos, Lúcio Lara; Dinis-Ribeiro, Mário; Lima, Luís; Santos, MarleneColorectal cancer screening methods are well established worldwide as a fundamental pilar in CRC management, namely through non-invasive faecal occult blood testing. However, the limited sensitivity of faecal occult blood test for detecting precancerous lesions highlights the need to search for alternative tools, such as microRNAs (miRs). The main aim of this study was to identify stoolbased miR profiles for early colorectal cancer detection. A panel with miR-21-5p, miR-199a-5p, and age showed a moderate performance for colorectal cancer detection (sensitivity: 88%). Additionally, miR-451a, miR-21-5p, miR-199a-5p, age, and gender showed high performance for discriminating high-grade dysplasia lesions (sensitivity: 91%). Moreover, when we obtained a positive result in either panel, we achieved a sensitivity of 96% for high-grade dysplasia lesions identification. Finally, when a negative result was obtained in these panels after a positive faecal occult blood test result, we accurately identified individuals without lesions. These findings demonstrate the potential of miR panels as non-invasive biomarkers for colorectal cancer and high-grade dysplasia lesions detection and could constitute a secondary screening method following a positive faecal occult blood test.
- Smartphone addiction and chronic spinal pain among university students: A cross-sectional studyPublication . Oliosi, Maria Eduarda; Silva, Cláudia; Simões, Daniela; Pinheiro, Ana Rita; Silva, CláudiaCurrent smartphones are highly versatile, and their use is embedded in people’s daily lives, particularly among university students. Their overuse does not seem to be harmless, being associated with adverse effects, including musculoskeletal dysfunction. Moreover, chronic spinal pain (CSP) is increasing among university students. This study aimed to assess the prevalence of self-reported smartphone addiction (SA) and CSP among university students and analyze the association between both. A cross-sectional study was performed. Date were obtained from a sample of university students through an online self-reported questionnaire, which included the Smartphone Addiction Scale Short Version, the Numerical Pain Rating Scale, the Neck Disability Index, and the Oswestry Disability Index. Of 465 students who responded, 31% showed SA, and 26% reported CSP. Students with SA evidenced a greater prevalence of neck, thoracic, and low back pain when compared to university students without addiction. Logistic regression analysis showed a significant association between SA and CSP (OR = 2.48, 95% CI = 1.55–3.98). However, longitudinal studies are needed to establish causal relationships. This study concludes that SA and CSP are both prevalent among university students, and their association should be further analyzed and considered in preventive measures.
- Effects of a reminiscence therapy program on neuropsychiatric symptoms and quality of life in people with dementia: a pilot study comparing immersive virtual reality and non-immersive approachesPublication . Soares, Maria; Quental, Vanessa; Pereira, Miguel; Sanchez, Ana Isabel Corregidor; Costa, Ana; Portugal, Paula; Coelho, Tiago; Coelho, Tiago; Portugal, PaulaThis study compared the impact of an immersive virtual reality (VR)-based reminiscence therapy program with a similar non-immersive intervention on neuropsychiatric symptoms and quality of life of people with dementia. A pilot randomized controlled trial was conducted with 14 individuals with mild to moderately severe dementia, who participated in eight biweekly individual reminiscence sessions conducted by trained researchers, in which 360° videos of locations with personal relevance were displayed. Participants were randomly divided in two groups: one receiving therapy using VR headsets to promote an immersive experience while the other watched the videos on a monitor (non-immersive approach). Assessment was conducted pre- and post-intervention using the Quality of Life in Alzheimer’s Disease Scale to measure quality of life and the Geriatric Depression Scale, Generalized Anxiety Disorder Scale and Neuropsychiatric Inventory to evaluate neuropsychiatric symptoms. Adverse simulation-related symptoms were also assessed with the Simulator Sickness Questionnaire. There were no statistically significant differences between groups at baseline, regarding sociodemographic variables and level of dementia progression. The results indicated significant improvements post-intervention in quality of life from caregivers’ perspectives in the non-immersive group (p < .05) but not in the VR group. Differences in overall neuropsychiatric symptoms, depressive symptoms and anxiety symptoms between assessments were non-significant. However, slight improvements were visible, particularly regarding anxiety. Only a few instances of mild cybersickness symptoms were reported in both groups. In this study, pre- and post-intervention comparisons do not support the added value of using immersive VR in reminiscence therapy for people living with dementia. This raises questions about whether VR is worthwhile compared to traditional approaches, and how to better capture potential benefits of immersion with VR, which may be more evident considering in-session engagement and well-being or longer intervention programs.
- Eco‑friendly cleaning agent applied for ex situ remediation of beach sand contaminated with crude oilPublication . Santos, Adriana Vieira dos; Santos, Verena Filgueiras Borges dos; Fernandes, Virgínia Cruz; Figueiredo, Sónia Adriana; Grosso, Clara; Delerue‑Matos, Cristina; Simonelli, George; Santos, Luiz Carlos Lobato dos; Fernandes, VirgíniaCoastal oil spills cause significant adverse effects, and removing weathered crude oil mixed with sand remains a considerable challenge. To address this, an environmentally friendly cleaning agent was formulated using a vegetable oil-based microemulsion for sediment cleaning. The relationship between microemulsion composition and its efficiency in cleaning oil-contaminated sediments in coastal environments was investigated. Component selection followed criteria of low toxicity and high biodegradability, including pine oil as the oily phase, distilled water as the aqueous phase, saponified coconut oil as the surfactant, and isopropyl alcohol as the cosurfactant. Pseudoternary phase diagrams were constructed using a cosurfactant/surfactant ratio of 10. The microemulsified cleaning agents were characterized and optimized using Scheffé's simplex lattice design, with refractive index, viscosity, conductivity, and specific gravity as response variables. Biodegradable microemulsion systems were successfully applied to remediate oil-contaminated beach sand, where higher proportions of the oily phase, specifically 30% and 60%, demonstrated excellent oil removal performance. The remediation process effectively incorporated the crude oil contaminant into the oily phase of the microemulsion, achieving a maximum removal efficiency of 90%. Additionally, the microemulsion exhibited stability for 30 days and maintained efficiency for up to five reuse cycles. This study highlights the potential of environmentally friendly microemulsions derived from vegetable oils for effective remediation of beach sand contaminated with crude oil, particularly through in situ soil washing or soil flushing, reinforcing the viability and sustainability of these cleaning agents.