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- The effect of neck-specific exercise with or without a behavioral approach in chronic whiplash-associated disorders: A systematic review and meta-analysisPublication . Correia, Luís; Carvalho, Paulo; Amaral, Luísa; Esteves, Mário; Vilarinho, Rui; Cervaens, Mariana; Vilarinho, Rui; Carvalho, PauloChronic whiplash-associated disorders describe a cluster of symptoms that result from a sudden neck acceleration/deceleration movement, including pain, musculoskeletal and neurological signs, inducing functional disability. The aim of this study was to compare the effects of physiotherapy treatment based on neck-specific exercises, with or without a behavioral approach, in individuals with whiplash-associated disorders. Computerized research was performed in PubMed, PEDro, National Institute for Health and Care Excellence, and ScienceDirect to identify randomized controlled trials that evaluated the effectiveness of neck-specific exercises, with or without a behavioral approach, for chronic whiplash. For the meta-analysis, the outcomes of pain and disability were assessed. Thirteen studies were included in the systematic review, with a total of 2427 participants of both sexes, with ages between 18 and 63 years. Although interventions with a behavioral approach decreased pain and disability more significantly in 4 and 6 studies when compared to neck-specific exercises without such an approach, respectively, the meta-analysis revealed no differences between them. Although interventions for chronic whiplash-associated disorders based on neck-specific exercises with a behavioral approach seem to be more effective in reducing pain and disability, there is no quantitative difference favoring one over the other.
- 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.
- A systematic review of the health effects of occupational exposure to ultraviolet radiationPublication . Rocha, Ricardo; Guedes, Joana; Santos, Joana; Carvalhais, Carlos; Alberto Alves Carvalhais, Carlos; Santos, JoanaOutdoor workers face significant health risks from prolonged exposure to solar ultraviolet radiation (UVR), which can lead to serious conditions such as skin cancer and cataracts, while also offering some potential benefits like reduced risks of certain cancers. This systematic review synthesizes findings from 16 studies, revealing a clear association between occupational solar UVR exposure and adverse health effects, underscoring the urgent need for improved sun protection policies and further research to enhance risk assessment and prevention strategies.
- Hippocampal volume loss in mesial temporal lobe epilepsy: Magnitude and laterality in a meta-analysis of MRI volumetry studiesPublication . Carvalho, Ruben Lopes; Borges, Daniel Filipe; Casalta-Lopes, João; Soares, Joana Isabel; Borges, Daniel FilipeHippocampal atrophy is a defining structural feature of mesial temporal lobe epilepsy (mTLE), yet the magnitude of volume loss and the extent of contralateral involvement vary across magnetic resonance imaging (MRI) studies, limiting quantitative interpretation in clinical practice. We conducted a systematic review and meta-analysis to quantify hippocampal volume reduction in adults with mTLE and assess the consistency of contralateral changes. Following PRISMA 2020 guidelines, we searched six bibliographic databases and different trial registries. Eligible studies included adults with unilateral mTLE who underwent pre-surgical structural MRI with quantitative hippocampal volumetry, as well as healthy controls. Two reviewers independently assessed risk of bias using ROBINS-E. Random-effects meta-analyses pooled mean differences in absolute hippocampal volume (mm ; controls minus patients) for hippocampi ipsilateral and contralateral to the seizure focus. Twenty-eight studies met the inclusion criteria; 23 contributed to the meta-analysis (803 patients, 613 controls). Ipsilateral hippocampal volume was significantly reduced (mean difference 985.2 mm 759.7–1210.7; p < 0.001; I 2 3 , 95% CI =98%). Contralateral volume was also reduced (22 studies; mean difference 198.8 mm 3 , 95% CI 124.4–273.3; p < 0.001; I 2 =85%). Funnel plot inspection and Egger testing showed no evidence of small-study effects. ROBINS-E indicated low to moderate risk of bias overall. Adult mTLE shows marked ipsilateral hippocampal atrophy with a smaller, consistent contralateral reduction, consistent with partial bilateral structural involvement. Pooled estimates provide clinically interpretable reference values for quantitative MRI in presurgical evaluation, though substantial heterogeneity warrants caution.
- Cross-cultural adaptation, validity and reliability of the European Portuguese Version of the Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow Score (KJOC)Publication . Almeida, Gonçalo; Amaral, Luísa; Vilarinho, Rui; Magalhães, Bárbara; Silva, Fátima; Abreu, Verónica; Magalhães, André; Esteves, Mário; Cervaens, Mariana; Vilarinho, RuiThe Kerlan-Jobe Orthopaedic Clinic Shoulder & Elbow Score (KJOC) is used to identify dysfunctions and estimate injury risk in overhead sports athletes. Although it has been validated in several countries, a European Portuguese version is currently unavailable. This study aimed to translate, culturally adapt and assess psychometric properties (validity and reliability) of the European Portuguese KJOC (KJOC-PT). The KJOC-PT was translated and culturally adapted according to international guidelines. One hundred athletes were selected (median age 24 [IQR 17] years, 72% male) and divided into two groups: asymptomatic and symptomatic athletes. The convergent validity was assessed by correlating the KJOC-PT with the Disabilities of the Arm, Shoulder and Hand (DASH) and DASH-Sports. 31 athletes from the initial sample were considered to assess between-day reliability and agreement (Bland-Altman analysis). Floor and ceiling effects were also calculated. Sampling adequacy was assessed using the Kaiser Meyer-Olkin (KMO) test. Minor cultural and linguistic changes were made in the KJOC-PT. This version demonstrated excellent internal consistency (Cronbach’s α = 0.91 to 0.97) and moderate negative correlations for validity (KJOC-PT with DASH, rho = −0.595; with DASH-Sports, rho = −0.533, both p < 0.001). Good reliability (ICC2,1 = 0.77 to 0.89 [95%CI 0.36 to 0.96]), measurement error (SEM = 4.11 to 6.90; MDC = 11.39 to 19.13) and mean difference ranging from −0.08 ± 6.14 to 3 ± 9.17 were found. No floor effect (0%) and ceiling effects of 24.2% for the total sample (50% for asymptomatic and 5.1% for symptomatic athletes) were found. KJOC-PT is now available and is a valid and reliable instrument for use by athletes in overhead sports.
- The impact of war on asthma, a systematic review and meta-analysis: An EAACI task force reportPublication . Rufo, João Cavaleiro; Paciência, Inês; Jutel, Marek; Moreira, André; Annesi-Maesano, Isabella; Suojalehto, Hille; Zemelka-Wiącek, Magdalena; Trikamjee, Thulja; Demir, Semra; Eguíluz-Gracia, Ibon; Carvalho, Daniela; Backland, Anaïs; Lawson, Josh; Cavaleiro Rufo, JoãoWartime events have been followed by an increase in asthma prevalence, which is believed to result from a combination of environmental hazards and psychological trauma. This systematic review and meta-analysis aimed to investigate this relationship by pooling available data on various wartime exposures, such as occupational, environmental, and psychological factors. MEDLINE, Scopus, and Cochrane databases were searched for articles that measure the effect of war-related exposures on asthma. Risk of bias was assessed using the Effective Public Health Practice Project tool. The retrieved effects were then used to fit meta-analytical models. A total of 48 studies, corresponding to 90 effect measures, were included. War-related post-traumatic stress disorder showed the strongest association with asthma outcomes (OR [95% CI]=2.25 [1.04, 4.89]), followed by experiencing at least one life-threatening event (1.96 [1.18, 3.26]) and depression (1.56 [1.02, 2.37]). Although environmental exposures were also associated with an increased asthma risk in subgroup analysis (1.64 [1.32, 2.04]), this effect was mitigated when psychological variables were included in the models. The study's results show that wartime events and conflicts may increase asthma prevalence and outcomes associated with asthma. The management of asthma symptoms, lung function, and mental health seems fundamental in individuals who have experienced psychological trauma in war zones.
- Occupational exposure to solar ultraviolet radiation: A systematic review of protective measuresPublication . Rocha, Ricardo; Santos, Joana; Baptista, João Santos; Guedes, Joana; Carvalhais, Carlos; Alberto Alves Carvalhais, Carlos; Santos, JoanaSolar ultraviolet radiation (UVR) is classified as a Group 1 carcinogen and poses a significant occupational hazard to outdoor workers. Despite preventive guidelines, adherence to protective measures remains inconsistent. This systematic review identified the protective measures adopted by healthy outdoor workers and assessed their adherence to and the effectiveness of these measures. Following the PRISMA 2020 statement, the review searched Scopus, Web of Science, and PubMed for peer-reviewed studies published between 2015 and 2025. Eligible studies included at least 100 healthy participants and evaluated preventive or protective measures against solar UVR. Independent reviewers extracted data and assessed risk of bias using the McMaster Critical Review Form. From 17,756 records, 51 studies met the inclusion criteria after screening and a subsequent snowballing process. The identified protective strategies clustered into physical, behavioural, and organisational categories. Adherence ranged from low to moderate, with structured interventions and employer support improving compliance. Sunscreen use remained low due to perceived inconvenience and lack of provision. Overall, the evidence revealed substantial variability in implementation and effectiveness across occupations. Strengthened regulations and integrated interventions combining education, personal protective equipment, and organisational measures are essential. Future research should prioritise longitudinal designs and objective indicators such as biomarkers and dosimetry.
- Assessing resilience potentials in management of occupational safety and health in hospitals: Development and validation of a toolPublication . Fernandes, Joana Afonso; Barbosa, Judite Lopes; Arezes, Pedro; Ferreira, María del Carmen Pardo; Rubio-Romero, Juan Carlos; Rodrigues, Matilde A.; Rodrigues, Matilde; Afonso Fernandes, JoanaA resilient Occupational Safety and Health (OSH) management system is crucial for effectively addressing potential future public emergencies, ensuring the continuous protection of workers’ safety and health. Therefore, it is essential for organizations, particularly hospitals, to assess their resilient performance and employ tools that are appropriate and tailored to their specific context. This study aims to enhance the understanding of resilience potentials in OSH management within hospital settings. To this end, an assessment tool was developed based on the Resilience Assessment Grid (RAG). A Delphi study involving subject matter experts was conducted to refine the tailored RAG tool. Following this, a pilot test was administered to 404 healthcare professionals across three public hospitals, with subsequent psychometric analysis. Exploratory Factor Analysis (EFA) identified a four- dimensional structure. Goodness-of-fit indices demonstrated acceptable values, confirming the adequacy of the measurement model. Reliability testing indicated that the 29 item assessment tool is both valid and reliable. The tailored RAG tool was successfully validated, enabling the identification of strengths and weaknesses in OSH management.
- Deciphering the potential of orange peel polysaccharides for modulating black tea astringencyPublication . Vieira, Joana; Silva, Inês E.; Guerreiro, Carlos; Bravo, Carlo; Rinaldi, Alessandra; Ramos, Rui M.; Fernandes, Pedro A. R.; Coimbra, Manuel A.; Fernandes, Virgínia Cruz; Freitas, Victor de; Brandão, Elsa; Soares, Susana; Fernandes, VirgíniaAstringency: a complex oral sensation described as dryness, puckering, or tightening - limit consumer acceptance of polyphenol-rich products like black tea, with recognized health benefits. Traditional strategies, such as sugar addition or polyphenol removal, often compromise nutritional quality, highlighting the need for alternative approaches to modulate astringency. One promising strategy involves the use of pectic polysaccharides as modulators of polyphenol-oral constituents interactions. This study explored two pectic polysaccharides fractions (PPFs) from orange peels with different composition on the interactions between black tea polyphenols and oral constituents, using an advanced oral cell-based quaternary model and trained sensory panel. PPF1 had a high degree of methylesterification (88 %) and high molecular weight (1.004 kDa), while PPF2 had a low degree of methylesterification and low molecular weight (226 kDa). Both fractions exhibited high uronic acid content, 72–80 mol%, respectively. Results: showed that PPFs decreased black tea polyphenols-oral constituents interactions, particularly in the HSC- 3-Mu-SP model (HSC-3 tongue-derived cell line, mucosal pellicle, salivary proteins). Notably, PPF2 showed a greater effect (53 % reduction) of total polyphenols adsorbed (UV–Vis colorimetric assay) and decreased the adsorption of all individual polyphenols, with the stronger effect on theasinensin C (56 % reduction) (HPLC analysis). PPF2 also decreased cystatins–oral component interactions (64 % reduction). Conversely, PPF1 showed a reducing effect on theaflavin-3,3′-digallate adsorption (24 %) and on gRPPs/aPRPs precipitation (33–38 %). Sensory analysis corroborated that both PPFs reduced astringency perception of black tea and contributed to positive astringency subqualities: silkiness associated with high molecular weight and mouthcoating associated with high uronic acid content.
- StressMatic: Bridging innovation and reliability in animal models of stressPublication . Martins-Macedo, Joana; Gomes, Eduardo D.; Oliveira, João F.; Patrício, Patrícia; Pinto, Luísa; Gomes, EduardoPreclinical research involving animal models of stress exposure typically rely on traditional manual protocols, which are laborious and time-consuming and may compromise reproducibility and the effective translation of f indings into clinical applications. StressMatic is an automated stress exposure system (auCMS), designed to improve the standardization and reproducibility of stress-induction methodologies. The auCMS demonstrated consistent efficacy, with animals subjected to automated stressors displaying similar responses to those exposed to conventional manual methods, thus confirming its validity as a reliable tool. While some stressors still require human involvement, the automation of key processes has markedly enhanced efficiency and minimized operational time. This innovative approach reduces the introduction of human error, increases precision, and standardizes experimental workflows, resulting in a more robust preclinical research platform. By streamlining repetitive tasks, the auCMS promotes adaptability in experimental design, particularly in the study of mood disorders. Ultimately, this automated protocol not only enhances the reliability of pharmaceutical screening processes but also strengthens the drug discovery pipeline, facilitating deeper insights into behavioral outcomes and informing therapeutic strategies.