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- Deep technologies for responsible gambling: a narrative review of policies and implementation strategiesPublication . Cardoso, Leonor G.; Barroso, Beatriz C. R.; Rocha, Eduardo; Morgado, Pedro; Marques, António; Rocha, Carla; Griffiths, Mark D.; Corazza, Ornella; Queirós, Ricardo; Dores, Artemisa R.; Dores, Artemisa; Pereira da Silva Marques, António JoséDeep technologies, such as artificial intelligence, blockchain, and behavioural analytics, have emerged as promising tools to address complex social challenges. However, their integration into leisure activities, particularly online gambling, has raised concerns over the enhancement of user engagement, which might promote problem gambling behaviours. This review aimed to map how deep technologies intersect with responsible gambling regulations across jurisdictions. A qualitative scoping review was conducted to synthesise evidence from academic literature, legal and regulatory frameworks, and relevant grey literature. A comparative analysis was performed across key jurisdictions, including the European Union, the United Kingdom, Malta, and selected non-European countries. The review identified very few formal legal instruments that explicitly regulate the use of deep technologies in responsible gambling. The European Union Artificial Intelligence Act introduces binding requirements for high-risk AI systems, including those deployed in gambling, representing a pioneering step toward technology-specific regulation. In contrast, regulatory frameworks beyond Europe were generally non-binding or largely absent, with innovation primarily driven by operators acting voluntarily in the absence of legal mandates. This analysis underscores persistent gaps in legal oversight and advocates for a shift toward proactive, ethics-based governance models that integrate technological accountability and robust consumer protections. Overall, the findings suggest that regulatory frameworks must not only keep pace with rapid technological innovation but also prioritise prevention through enforceable, transparent, and harmonised policies across jurisdictions.
- The impact of virtual reality-based forest therapy in psychiatric inpatient care: a pilot studyPublication . Martins, Rafael; Sousa, Sara de; Viana, João; Fortuna, Rita; Henriques, André; Silva, Alzira; Almeida, Raquel Simões de; Simões de Almeida, Raquel; de Sousa, SaraThis study evaluated the effectiveness of a Virtual Reality (VR)-based Forest Therapy program in reducing depressive symptoms, anxiety, stress, and physiological distress among psychiatric inpatients. A quasi-experimental study was conducted with 16 inpatients (mean age: 38) in a clinical setting. Participants engaged in four immersive VR sessions simulating forest environments. Psychometric assessments included the DASS-21 and WHO-5, administered pre- and post-intervention. Autonomic responses were monitored via Heart Rate Variability (HRV) and Electrodermal Activity (EDA). Following the intervention, participants showed statistically significant improvements in depression, anxiety, stress, and well-being scores (p < .001). While changes in physiological indicators (HRV and EDA) were not statistically significant, observed trends suggested increased autonomic stability and relaxation. The findings suggest that VR-based Forest Therapy appears to be a promising, accessible intervention for promoting well being in psychiatric settings with limited nature access. While the results are encouraging, the lack of a control group and follow-up data limits conclusions regarding long-term durability. Further research with larger samples is required to validate these findings.
- Linking critical thinking dispositions to well-being in higher education: A cross-sectional studyPublication . Valentim, Olga; Almeida, Raquel Simões de; Marques, Rita; Lucas, Isabel; Sales, Leila; Payan-Carreira, Rita; Lopes, José; Simões de Almeida, RaquelMental health challenges are increasingly prevalent among higher education students, with significant implications for academic success and personal development. Emerging research suggests that critical thinking dispositions may support psychological well-being by enhancing resilience and adaptive coping. This study aimed to investigate the relationship between critical thinking dispositions and psychological wellbeing and to identify key sociodemographic predictors in this context. A crosssectional design was employed from December 2024 to May 2025, recruiting 429 students from Portuguese higher education institutions via convenience sampling. Participants completed validated self-report measures: the Critical Thinking Dispositions Scale (CTDS) and the Psychological Well-Being Scale (PWBS), assessing seven critical thinking dispositions and six well-being dimensions, respectively. Sociodemographic data were also collected. Descriptive statistics, independent t-tests, one-way ANOVA, Pearson correlations, and hierarchical multiple regression were used for data analysis. Students demonstrated moderate to high levels of critical thinking and psychological well-being, with higher scores associated with increased age and academic progression. Significant positive correlations were identified between critical thinking dispositions and all wellbeing dimensions; personal growth, purpose in life, and autonomy exhibited the strongest associations. Regression analysis revealed that confidence in reasoning, cognitive maturity, and open-mindedness were significant predictors of psychological well-being, explaining 28.7% of the variance. Conversely, inquisitiveness showed a negative association with psychological well-being in the multivariate model, an unexpected finding that warrants cautious interpretation and further investigation. Critical thinking dispositions reflect affective tendencies and habitual ways of engaging with thinking. These dispositions appear to protect psychological well-being in higher education students. Integrating the development of emotional awareness and reflective thinking into curricula may therefore foster resilience and academic success. Further longitudinal research is needed to explore causal mechanisms and intervention efficacy in broader academic contexts.
- Impact of shoulder pain on upper limb function: An observational study in post-stroke individualsPublication . Lopes, Sofia; Fernandes, Ângela; Lopes, Sofia; Fernandes, ÂngelaShoulder pain is a frequent complication after stroke, often associated with reduced arm function, decreased independence, and poorer quality of life. This study aimed to investigate the relationship between post-stroke shoulder pain, motor performance, functional outcomes, and spasticity to provide clinically relevant evidence for rehabilitation. We conducted an observational study including individuals who had experienced a stroke and were undergoing neurorehabilitation. Pain severity and its interference with daily activities were measured through structured clinical evaluation. Motor outcomes were assessed with standardized functional and strength tests, and spasticity was measured using a validated clinical scale. Sociodemographic and clinical variables, including time since stroke and stroke type, were also collected. The mean pain severity score was 4.82 (standard deviation 1.72). Pain severity correlated strongly with pain interference, although neither was significantly associated with motor or functional performance. Motor and functional variables were interrelated: motor recovery scores correlated positively with functional independence and grip strength, and negatively with spasticity. Time since stroke influenced outcomes, with poorer motor and functional results in participants more than two years post-event. Stroke type influenced pain, with greater interference reported in patients with ischemic stroke. No significant differences were observed between sexes. These findings highlight the multifactorial nature of shoulder pain after stroke and emphasize the importance of early and individualized rehabilitation strategies. Addressing pain, spasticity, and functional limitations together may improve long-term outcomes and quality of life for individuals living with the consequences of stroke.
- Digital delivery of dialectical behavior therapy for Borderline Personality Disorder: A Scoping ReviewPublication . Alferes, Filipa; Lárez, Estefânia; Almeida, Raquel Simões de; Simões de Almeida, RaquelThis scoping review aims to identify technological modalities for remote Dialectical Behavior Therapy (DBT) delivery for Borderline Personality Disorder (BPD), assess their effectiveness and engagement, examine associated advantages and challenges, and offer insights for future research and clinical practice. A literature search was performed across PubMed, Web of Science, EBSCO, B-ON, and IEEE Xplore, including studies from the last 10 years. Fourteen studies with diverse methodological designs met the inclusion criteria for analysis. Digital DBT emerged as a promising intervention, demonstrating positive efficacy and engagement, suggesting it as a viable alternative to conventional therapy. Common modalities include videoconferencing and mobile applications. Challenges identified include technical issues, potential impact on the therapeutic relationship, and data security concerns requiring attention for clinical feasibility. Digital DBT offers a promising, cost-effective alternative to traditional therapy. While initial evidence supports its effectiveness and engagement, further research, particularly randomized clinical trials, is crucial to evaluate long-term outcomes and optimize implementation.
- The association between exposure to blue spaces and multidimensional frailty in community-dwelling older adults: A cross-sectional studyPublication . Coelho, Tiago; Leite, Diana; Maciel, Daniela; Ribeiro, Ana Isabel; Rocha, Nuno Barbosa; Rocha, Nuno; Coelho, TiagoContact with blue spaces appears to benefit older adults’ health and well-being, but evidence on its relationship with frailty is scarce. This cross-sectional study investigated associations between exposure to blue spaces and multidimensional frailty in 189 community-dwelling people aged ≥65 years (Portugal). Measurements included the Tilburg Frailty Indicator, questionnaire regarding exposure, and Geographic Information System data for proximity. Purposeful visits once or twice a month were associated with lower physical frailty, as were visits with pets, engaging in physical activity, and spending 1–2 hours or >2 hours in these environments. Visiting with others was associated with lower social frailty. Incidental exposure—passing by visible blue spaces during daily commutes—was linked to lower total and physical frailty. Walking travel times <20 minutes were associated with lower total, physical, and social frailty, with different distances within this range showing domain-specific associations. Results suggest blue spaces may promote healthy aging.
- A systematic review of chest-worn sensors in cardiac assessment: technologies, advantages, and limitationsPublication . Machado, Ana; Ferreira, Filipa; Ferreira, Simão; Almeida-Antunes, Natália; Carvalho, Paulo; Melo, Pedro; Rocha, Nuno; Rodrigues, Matilde A.; Rodrigues, Matilde; Martins de Almeida Melo, Pedro MiguelThis study reviews the scientific use of chest-strap wearables, analyzing their advantages and limitations, following PRISMA guidelines. Eligible studies assessed chest-strap devices in adults and reported physiological outcomes such as heart rate, heart rate variability, R–R intervals, or electrocardiographic waveform morphology. Studies involving implanted devices, wrist-worn wearables, or lacking validation against reference standards were excluded. Searches were conducted in PubMed, Scopus, Web of Science, and ScienceDirect for studies published in the last 10 years. The quality of the studies was assessed using the Mixed Methods Appraisal Tool, and results were synthesized narratively. Thirty-two studies were included. The most frequently evaluated devices were the Polar H10 and Zephyr BioHarness 3.0, which showed strong correlations with electrocardiography at rest and during light-to-moderate activity. Reported limitations included motion artefacts, poor strap placement, sweating, and degradation of the skin–electrode interface. None of the devices had CE or FDA approval for clinical use, and most studies were conducted in controlled settings, limiting generalizability. Ergonomic concerns such as discomfort during prolonged wear and restricted mobility were also noted. Overall, chest-strap sensors showed good validity and were widely used in validation studies. However, technical refinements and large-scale field trials are needed for broader clinical and occupational application. This review is registered in PROSPERO and is part of the SIREN project.
- Deep technologies and safer gambling: A systematic reviewPublication . Cardoso, Leonor G.; Barroso, Beatriz C. R.; Piccoli, Gloria; Peixoto, Miguel; Morgado, Pedro; Marques, António; Rocha, Carla; Griffiths, Mark D.; Queirós, Ricardo; Dores, Artemisa; Pereira da Silva Marques, António José; de Faria Távora Moreira Peixoto, MiguelDeep technologies combine engineering innovation and scientific findings to solve complex problems and are becoming particularly relevant to the gambling industry. With the global rise of gambling practices and the subsequent increase of gambling-related problems and disorders, deep technologies have emerged as a way to create safer online gambling environments. However, there is still limited knowledge regarding their applica bility and consequences. The present study systematically reviewed the existing literature on deep technologies in gambling environments, such as online casinos and betting platforms, and explored their potential benefits, risks, and effectiveness in promoting safer gambling experiences. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. Searches were conducted in Web of Sci ence, PubMed, Scopus, EBSCO, and IEEE databases, and manually. A total of sixty-eight studies were included in the review. In general, four primary applications of deep technologies in online settings were found: (i) behavioural monitoring and feedback; (ii) predictive risk modelling; (iii) decision support and AI classifiers; and (iv) limit-setting/self-exclusion tools. They were primarily used to identify and classify problematic gambling, prompt individual action, regulate gambling behaviours, raise awareness of risk levels, promote responsible gambling practices, support research, interventions, and evaluate player protection initiatives. Together, the findings suggest that deep technologies offer ample opportunities to enhance gambler safety and reduce potential risks, although challenges may arise from their implementation, such as privacy and ethical concerns, malicious data use, misclassification of risk levels, and difficulties in large-scale application. Limitations and directions for future studies are discussed
- The use of heart rate variability-biofeedback (HRV-BF) as an adjunctive intervention in chronic fatigue syndrome (CSF/ME) in long COVID: Results of a phase II controlled feasibility trialPublication . Cossu, Giulia; Kalcev, Goce; Primavera, Diego; Lorrai, Stefano; Perra, Alessandra; Galetti, Alessia; Demontis, Roberto; Tramontano, Enzo; Bert, Fabrizio; Montisci, Roberta; Maleci, Alberto; Castilla, Pedro José Fragoso; Jaramillo, Shellsyn Giraldo; Kurotschka, Peter K.; Rocha, Nuno Barbosa; Carta, Mauro Giovanni; Rocha, NunoEmerging evidence indicates that some individuals recovering from COVID-19 develop persistent symptoms, including fatigue, pain, cognitive difficulties, and psychological distress, commonly known as Long COVID. These symptoms often overlap with those seen in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME), underscoring the need for integrative, non-pharmacological interventions. This Phase II controlled trial aimed to evaluate the feasibility and preliminary efficacy of Heart Rate Variability Biofeedback (HRVBF) in individuals with Long COVID who meet the diagnostic criteria for CFS/ME. Specific objectives included assessing feasibility indicators (drop-out rates, side effects, participant satisfaction) and changes in fatigue, depression, anxiety, pain, and health-related quality of life. Participants were assigned alternately and consecutively to the HRV-BF intervention or Treatment-as-usual (TAU), in a predefined 1:1 sequence (quasirandom assignment). The intervention consisted of 10 HRV-BF sessions, held twice weekly over 5 weeks, with each session including a 10 min respiratory preparation and 40 min of active training. The overall drop-out rate was low (5.56%), and participants reported a generally high level of satisfaction. Regarding side effects, the mean total Simulator Sickness Questionnaire score was 24.31 (SD = 35.42), decreasing to 12.82 (SD = 15.24) after excluding an outlier. A significantly greater improvement in severe fatigue was observed in the experimental group (H = 4.083, p = 0.043). When considering all outcomes collectively, a tendency toward improvement was detected in the experimental group (binomial test, p < 0.0001). HRV-BF appears feasible and well tolerated. Findings support the need for Phase III trials to confirm its potential in mitigating fatigue in Long COVID.
- Rural rehabilitation disparities and strengthening strategies: umbrella reviewPublication . Ayres, Stephanie Nicole; Monteiro, Pedro C.; Doyle, Nancy; Morrow, Corey; Jesus, Tiago S.; Costa Monteiro, Pedro"Rural residents with disabilities often experience healthcare disparities versus urban counterparts. To meta-synthesize the rural rehabilitation disparities, including access barriers, and the strategies for improving rehabilitation access for rural underserved populations. Methods: Umbrella review of the contemporary (2015-2024), English-language reviews focused on rural rehabilitation service-delivery gaps or strategies for adults or children with disabilities, with no country restrictions. Six scientific databases (Medline/PubMed, Scopus, CINAHL, Cochrane Library, PDQ-Evidence, REHABdata) were searched, supplemented by snowballing. Two independent reviewers performed full-text assessments and quality appraisals of the systematic reviews on intervention effects, using the Measurement Tool to Assess Systematic Reviews-2. Of the 530 records identified, 366 were unique references and 16 reviews were finally included, including 8 systematic reviews, two of them with meta-analyses. The 16 reviews included collectively synthesized information from 484 studies. Rural rehabilitation-access disparities were identified. For instance, those derived from supply shortages in low-density markets, workforce recruiting and retention issues, long travel requirements and costs, waiting times or low intervention intensity, and generalist versus specialist skills of the therapist workforce. Rural rehabilitation strengthening strategies were also identified. These include telehealth service options – benefits and challenges; outreach, home and community-centered approaches; navigator programs; and finally, task-sharing with (remote) specialist support. This umbrella review provides a meta-synthesis of the issues affecting equitable access to rehabilitation by rural populations and of the strengthening strategies to address those disparities. Alone or combined, these strategies might be tailored to and with local communities and interested parties for effective co-implementation."