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- 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 comprehensive profile of volunteer firefighters: sociodemographic and occupational dimensionsPublication . Teixeira, Tatiana; Carvalho, Eduardo; Santos, Joana; Vaz, Mário; Guedes, Joana; Santos, JoanaThe European Union prioritizes occupational health and safety, with firefighters—particularly volunteers—facing significant risks. In Portugal, 94% of firefighters are volunteers, often balancing multiple jobs, which increases their exposure to hazards. This study investigates Portuguese firefighters’ occupational risks and identifies tasks with the highest accident incidence to build a comprehensive profile of their health and work conditions. Firefighters are exposed to extreme environments, long shifts, and high-stress situations, especially during wildfires. These conditions contribute to physical and mental health issues, including cardiovascular disease and sleep disturbances. Training and experience are key to improving risk perception and preventing accidents. Understanding firefighters’ main characteristics is essential for risk reduction and improving their quality of life. A sociodemographic questionnaire was developed and administered to firefighters, covering three sections: General Information, Lifestyle and Clinical History, and Firefighting Activity. This enabled the collection of sociodemographic and occupational data. A total of 220 responses were collected from Portuguese volunteer firefighters. Cardiovascular and respiratory diseases were the most commonly reported diagnoses. Wildland and urban/industrial fires were the main operational contexts linked to accidents, with 84 individuals reporting accident history in these scenarios. The study revealed a lack of data on the profile of volunteer firefighters, a group at heightened risk due to cumulative exposures and existing health conditions. Further research is needed to support the development of regulations and health monitoring strategies that protect this workforce without compromising their operational capacity.
- A systematic review of indoor air quality in schools settings: Focus on microbiome and their relation to particulate matter and chemical pollutantsPublication . Ferraz, Mariana; Santos, Joana; Silva, Manuela Vieira da; Santos, Joana; Vieira da Silva, Manuela; Ferraz, MarianaIndoor air quality (IAQ) in schools is a growing concern due to its impact on children's health. Continuous exposure to indoor air pollutants, such as particulate matter (PM), carbon dioxide (CO 2 ), and microorganisms, such as bacteria and fungi, can affect school performance, increase absenteeism, and trigger respiratory problems. This systematic review aimed to analyze the potential correlation between the presence of microorganisms and PM and chemical pollutants in school indoor environments. Study design: A systematic literature review was conducted using the methodology PRISMA and 25 articles were selected. The current systematic review follow the steps: definition of research objectives; selection of the science databases; definition of keywords; establishment of the inclusion and exclusion criteria, evaluation process and evaluation and management of selected studies. The findings highlight the significant presence of airborne microorganisms, including bacteria and fungi, often associated with PM and chemical pollutants such as CO 2 correlations between CO 2 and volatile organic compounds (VOCs). Positive and bacteria were observed in ten studies and were statistically significant in six of them. Both positive and negative correlations between fungi and CO 2 were reported. Fungal genera such as Aspergillus spp. And Cladosporium spp. Were associated with particulate matter (PM). In general, the concentrations of bacteria and fungi were often correlated with PM levels, with larger particles (PM 10 adhesion and transport of microorganisms, while smaller particles (PM 2 . 5 ) favoring the ) remain suspended in the air for longer periods, increasing exposure. Despite the methodological variations among the various studies, the results reinforce the need to create effective interventions to reduce pollutant concentrations to minimize health risks for occupants.
- Chemical safety in academic laboratories: awareness, attitudes, and practices among higher education studentsPublication . Ribeiro, Inês; Ramos, Catarina; Santos, Joana; Carvalhais, Carlos; Santos, Joana; Alberto Alves Carvalhais, CarlosHigher education institutions, particularly those with teaching and research laboratories, play an important role in transmitting knowledge and attitudes regarding chemical safety to their students. As such, this study aims to assess the knowledge and attitudes of higher education students across different study programs regarding laboratory chemical safety. A cross-sectional study was conducted using a questionnaire adapted and translated into Portuguese. The instrument comprised twenty-seven questions and was distributed to students enrolled in undergraduate and graduate programs that include laboratory practices in their curricula in March and July of 2025. A total of 284 students participated in the study, divided among the different study programs (CTeSP = 4.2%; Bachelor’s = 70.4%; Master’s = 21%; Doctorate = 4.2%). The results showed that, although a large percentage of students have a high level of knowledge, their attitudes are not always the most appropriate, which could jeopardize their safety and that of those around them. Our findings revealed that there is room for curriculum adjustments. Early exposure to chemical and laboratory safety concepts can promote the development of students’ awareness and future professionals’ competence. Integrating safety modules into education may enhance knowledge and skills for making informed decisions that reduce accidents/incidents in laboratory environments.
- Consensus on covert awareness: a Delphi studyPublication . Schnakers, Caroline; Overbeek, Berno; Fullmer, Niko; Teixeira, Liliana; Zandalasini, Matteo; Yatsko, Kseniia; Morrissey, Ann-Marie; Zasler, Nathan; Estraneo, AnnaIdentifying wilful brain activity in patients with disorders of consciousness is critical, as some patients fail to exhibit behavioural signs of consciousness at the bedside but respond to active tasks via neuroimaging or electrophysiological measures. Standardized terminology for this subgroup is absent while it is essential for advancing research and clinical care. The objective of this study was to determine the level of consensus among a large group of international experts on terminology and definitions for this clinical entity, as described by terms such as covert awareness, cognitive motor dissociation, functional locked-in syndrome, and non-behavioural minimally conscious state. A Delphi study was conducted using REDCap to evaluate expert agreement on terminology and definitions. The study was conducted among international experts, primarily from Europe/UK, the USA and other regions. Ninety-six experts participated. Among these, 75 (78%) completed both rounds. Participants were predominantly clinical scientists (71%) working in rehabilitation settings (63%). A Delphi method was followed. Consensus on terminology and related definitions was defined as a median score of 5, an interquartile range ≤1 and ≥75% agreement (scores of 4 or 5). Within two rounds, consensus was achieved for over two- thirds of the statements. The term ‘Covert Awareness’ and its associated definition were identified as the preferred terminology by an international expert panel. We recommend the use of ‘Covert Awareness’ since our large group of international experts consistently agreed on such preferred term for this subgroup of patients with disorders of consciousness. This consensus (>75% agreement) establishes a foundation both for future research and clinical standardization. The findings have implications for improving diagnostic accuracy and advancing understanding of covert awareness, although further study is needed to refine and apply the agreed-upon definition in clinical practice.
- Movement behaviours, air pollution and health in school-aged children: a cross-sectional study to guide the co-creation of healthier environments – the MOVE-AIR projectPublication . Martins, Clarice; Rufo, João Cavaleiro; Fonseca, Hélder; Padrão, Ana; Baptista, Liliana C.; Santos, Maria Paula; Sousa, Miguel; Zacca, Rodrigo; Silva, José Pedro; Ribeiro, Ana Isabel; Cavaleiro Rufo, JoãoThe MOVE-AIR study was designed to explore the moderating role of movement behaviours on the association between air pollutants and health outcomes in Portuguese children. Secondarily, it aims to characterise the settings (both indoor and outdoor) where children are exposed to air pollutants and to co-create solutions with participants to mitigate the exposure to air pollutants in children’s daily life. This study aims to describe the MOVE-AIR study protocol in detail. Data from 52 primary school children aged 9–11 years will be assessed for indoor and outdoor air pollutants (particulate matter (PM)2.5 and PM10, and carbon dioxide), geo-tracked for distinct settings (ie, home/school, indoor/outdoor) along the day, through an optical monitoring sensor with Global Positioning System incorporated. Health-related biological outcomes, such as interleukin-6, tumour necrosis factor alpha and oxidative parameters, including total antioxidant status and total oxidant status, will be evaluated and the Oxidative Stress Index will be calculated. Children’s cardiopulmonary fitness will be assessed through the shuttle run test, and movement behaviours will be evaluated through accelerometers (wGT3X). Children’s sex, age and parental socioeconomic status will be provided by parents through a questionnaire. The influence of movement behaviours in the link between pollution and health will be analysed through moderating regression models using process for SPSS R software (V.30.0.0). A subsample of class teachers, school leaders, parents and children will be invited to a co-creation process to create solutions to mitigate their daily exposure to air pollutants. The results will contribute to further understanding the moderating role of movement behaviours in the association between air pollution and health, adding a biological layer to the mechanistic links underlying these potential relationships that have not been explored in this target population. Finally, enhancing our comprehension of the living environments and contexts where children are more exposed to air pollution can help to cooperatively create solutions to mitigate their daily exposure to those harmful pollutants.
- Optimizing neurobehavioral assessment for patients with disorders of consciousness: Proposal of a comprehensive pre-assessment checklist for cliniciansPublication . Keech, Kristen; Schnakers, Caroline; Murtaugh, Brooke; O’Brien, Katherine; Slomine, Beth; Briand, Marie-Michèle; Formisano, Rita; Thibaut, Aurore; Estraneo, Anna; Noé, Enrique; Gosseries, Olivia; Teixeira, Liliana da Conceição; da Conceição Teixeira, LilianaClinicians are challenged by the ambiguity and uncertainty in assessing level of consciousness in individuals with disorder of consciousness (DoC). There are numerous challenges to valid and reliable neurobehavioral assessment and classification of DoC due to multiple environmental and patient-related biases including behavioral fluctuation and confounding or co-occurring medical conditions. Addressing these biases could impact accuracy of assessment and is an important aspect of the DoC assessment process. A pre-assessment checklist was developed by a group of interdisciplinary DoC clinical experts and researchers based on the existing literature, current validated tools, and expert opinions. Once finalized, the checklist was electronically distributed to clinicians with a range of experience in neurobehavioral assessment with DoC. Respondents were asked to use the checklist prior to completing a neurobehavioral assessment. A survey was also provided to respondents to obtain feedback regarding checklist feasibility and utility in optimizing the behavioral assessments. Thirty-three clinicians completed the survey after using the checklist. Over half of the respondents were a combination of physicians, neuropsychologists, and physical therapists. All respondents served the adult DoC population and 42% percent had over ten years of clinical experience. Eighty percent reported they found the format of the checklist useful and easy to use. All respondents reported the checklist was relevant to preparing for behavioral assessment in the DoC population. Eighty-four percent reported they would recommend the use of the tool to other clinicians. The use of a pre-assessment checklist was found to be feasible and efficacious in increasing interdisciplinary clinician’s ability to optimize the patient and environment in preparation for neurobehavioral assessment. Initial results of clinicians’ perception of the utility of a pre-assessment checklist were positive. However, further validation of the tool is needed with larger sample sizes to improve representation of clinical use across disciplines and care settings.
- Are wearable sleep-tracking devices reliable alternatives to Polysomnography? A Systematic Review and Meta-AnalysisPublication . Agostinho, Margarida; Borges, Maria; Pereira, Telmo; Borges, Daniel Filipe; Soares, Joana Isabel; Borges, Daniel FilipePolysomnography (PSG) is the reference method for characterizing sleep architecture, but it is resource-intensive and difficult to scale for large cohort assess ments. This has increased interest in wearable devices for naturalistic sleep monitoring. This systematic review and meta-analysis evaluated how wearable sleep-tracking devices compare with laboratory PSG in healthy adults across standard sleep metrics and sleep stage durations. PubMed, Scopus, Scielo, Web of Science, and the Cochrane Library were searched following PRISMA guidelines. Eligible studies included healthy adults under going simultaneous wearable and PSG recordings. Mean differences were synthesized for total sleep time, sleep latency, sleep efficiency, wake after sleep onset, and time spent in light (N1+N2), deep (N3), and REM sleep using fixed or random effects models based on heterogeneity, with significance set at p < .01. Risk of bias and applicability were assessed using QUADAS-2. Sixteen studies met the inclusion criteria, and ten contributed to the meta- analysis. Wearable devices overestimated total sleep time and sleep efficiency and underestimated wake after sleep onset, with substantial variability between devices. No device demonstrated consistently superior performance. In individual studies, the closest agreement with PSG was observed for the Oura Ring (third generation) for sleep latency and sleep efficiency, and for selected Fitbit models for deep and REM sleep. Wearable devices provide reasonable estimates of global sleep metrics and may complement PSG for population monitoring and longitudinal self-tracking. However, variable performance, methodological heterogeneity, and risk-of-bias consid erations currently limit their use as stand-alone diagnostic tools or for detailed sleep- stage characterization.
- Patient doses in image-guided radiotherapy: status in Europe for cone-beam CT imaging in the pelvic regionPublication . Kansanoja, Toni; Brovchuk, Serhii; Vezirovic, Milana; Petrovic, Borislava; Amico, Antonio Giuseppe; Sapignoli, Sonia; Paiusco, Marta; Ferrari, Paolo; Sá, Ana Cravo; Dias, Anabela G.; Teles, Pedro; Siiskonen, TeemuOrgan absorbed doses in cone-beam CT (CBCT) imaging are often neglected in image-guided radiation therapy (IGRT). However, frequent imaging for patient positioning can result in significant and unrecorded additional radiation exposure. This study aims to evaluate organ doses from kV-CBCT and assess if they are optimized and how, in prostate and pelvic patient positioning protocols across Europe. Status of quality assurance in IGRT CBCT imaging is assessed in general. Data collected from a survey distributed across Europe on IGRT practices were compiled and analysed. A representative set of imaging protocols were simulated using Monte Carlo based ImpactMC software to assess mean absorbed doses in various organs in the International Commission on Radiological Protection (ICRP) standard phantom. Absorbed doses to red bone marrow were estimated with a three-parameter mass-energy absorption coefficient method. The simulations were validated against measurements with MOSFET detectors and radiochromic film. Simulated prostate absorbed doses ranged from 12 mGy to 34 mGy per imaged fraction for pelvic protocols, and 4 mGy to 26 mGy for prostate protocols. The selected length of the imaging region influenced doses to the femur and sacral red bone marrow. Overall, 74% of treatments involved positioning imaging at every fraction, indicating substantial cumulative doses from kV-CBCT imaging. Quality assurance was performed by 90% of responders, but good practice guides and national protocols do not exist. The results of this study suggest that clear guidelines and standardized protocols for CBCT imaging in IGRT are lacking. There is significant potential to optimize the patient doses resulting from imaging. Given that most clinics already perform regular quality assurance for imaging equipment, including dosimetry and positioning accuracy verification, establishing diagnostic reference levels for CBCT imaging in IGRT could help promote further dose optimization.
- Real-time dosimetry, organs dose and risk assessment for CBCT thorax protocols in IGRT proceduresPublication . Campos, A.; Sá, Ana Cravo; Romanets, Y.; Vaz, P.; Di Maria, S.Cone Beam Computed Tomography (CBCT) is essential in Image-Guided Radiation Therapy (IGRT), enabling more accurate treatments but increasing patients exposure to radiation. Despite advancements in dose reduction acquisition methods, routine daily CBCT imaging can still result in a considerable cumulative radiation dose to the patient, which should be considered and assessed. This study aimed at estimating the radiation doses absorbed with MOSFET detectors of some radiosensitive organs (e.g. lung, stomach, liver) during thoracic CBCT examination and calculates the risk of cancer incidence and mortality with adult thorax physical phantom. The absorbed doses in the aforementioned organs ranged between 3 mGy and 8 mGy per fraction, close to the isocenter. Over 33 fractions, the cumulative absorbed dose reached approximately 260 mGy. The analysis of cancer incidence and mortality risk through BEIR VII model revealed that the lungs have the highest number of cases for each age considered (20–80 years interval). Comparing dose assessment obtained using several methods (Monte Carlo, TLDs and MOSFETs), with the same irradiation protocol, lung dose varies among 2.08 mGy and 7.60 mGy, whereas the heart varies among 4.9 Gy and 10 mGy. Although surrogate dose-index methods are often used, organ absorbed doses assessment should be the preferred method to assess the magnitude of realistic organ radiation risk of populations undergoing examinations with ionizing radiation. Implications for practice: Promoting experimental dosimetry phantom studies in a more harmonized way would increase the accuracy of organ absorbed dose assessment and consequently would improve the risk communication and decision-making for better CBCT protocols choice in clinical settings.