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- 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.
- Prevalence, characteristics, and impact of spinal and lower limb recurrent pain at age 13Publication . Rodrigues, Elisa; Bessa, Isabel Moura; Brochado, Gabriela; Carvalho, Paulo; Talih, Makram; Pires, Catarina; Lucas, Raquel; Rodrigues, Elisa; Moura Bessa, IsabelTo compare spinal and lower limb pain in adolescents regarding prevalence, characteristics, causes, and impact. Methods: A descriptive cross-sectional study was conducted in 13-year-old adolescents (female n=2210; male n=2353) from the Portuguese Generation XXI birth cohort. Data were collected between 2018 and 2020 through personal interviews by applying the Luebeck Pain Questionnaire. The pain features examined in each anatomical location (back and lower limb) were recurrence, duration, frequency, intensity, perceived causes, and impact on school and leisure activities. Frequencies and the Chi-square test were used. Results: Questionnaires from 4563 adolescents were analysed, 57.9% had pain in the last three months (main pain in the spine: 11.6%; main pain in the lower limb: 29.0%). Of those, 69.4% and 62.4% reported recurrent pain in the spine and lower limb, respectively. Recurrent pain was more frequent in girls than in boys (spine: 80.0%; 57.0%; lower limb: 70.4%; 58.1% respectively). Pain lasted more than three months in most adolescents (spine: about 60%; lower limb: above 50%); frequency was similarly high in both regions and both sexes (girls: 47.0%; boys: 45.7% in the spine; girls: 45.7%; boys: 40.3% in the lower limb); intensity was rated as high by girls (spine: 45.5%; lower limb: 47.3%) and moderate by boys (spine: 42.0%; lower limb: 41.0%). The leading causes of pain were daily living activities, both for the spine (girls: 65.9%; boys: 76.5%) and the lower limb (girls: 62.2%; boys: 72.1%). Psychosocial causes were the second most common cause of spinal pain (girls: 25.0%; boys: 21.0%). Other causes of lower limb pain were traumatic (girls: 25.5%; boys: 16.6%) and physical factors (girls: 20.7%; boys: 23.8%). Absences from school (girls: 11.7%; boys: 4.8%) and restrictions of leisure activities (girls: 20.7%; boys: 25.2%) were more related to pain in the lower limb. Conclusion: More than half of the adolescents reported spinal or lower limb recurrent pain, which presents a higher frequency, higher intensity, and longer duration in the spine. However, lower limb pain led to more concurrent limitations.
- Optimized extraction protocols for bioactive antioxidants from commercial seaweeds in Portugal: A comparative study of techniquesPublication . Santos, Francisca; Soares, Cristina; Morais, Stephanie L.; Neves, Cátia; Grosso, Clara; Ramalhosa, Maria João; Vieira, Mónica; Delerue-Matos, Cristina; Domingues, Valentina F.; Vieira, MónicaThis study aimed to optimize the extraction conditions for a valuable source of antioxidants: seaweed. Therefore, ten seaweed samples were subjected to a solid–liquid extraction (SLE), where the extraction conditions (biomass (g): solvent (mL) ratio, temperature, and time) were optimized using response surface methodology (RSM). The seaweeds were also subjected to subcritical water extraction (SWE) (140 and 190 ◦C) and ultrasound-assisted extraction (UAE) (10 and 20 min). The antioxidant capacity of the extracts was determined through the ferric-reducing antioxidant power and the 2,2′ -azino-bis(3-ethylbenzothiazoline-6-sulfonic acid). The total phenolic content revealed the significance of temperature and biomass; solvent ratio parameters in the extraction process with higher conditions generally promoting the release of phenolic compounds. Furthermore, applying RSM allowed for the identification of optimal conditions and the establishment of predictive models that can be valuable in industrial-scale extraction processes. The antioxidant potency composite index (APCI) shows that SWE at 190 ◦C stands out, with E. bicyclis reaching an APCI score of 46.27%. The AGREEprep evaluation showed that UAE is the most sustainable method, achieving the highest score (0.69). The results of this study contribute to the development of efficient and standardized extraction protocols for each seaweed species, allowing for the maximum yield of antioxidants.
- Editorial comments on “Multiarray screening identifies plasma proteins associated with Th17 cell differentiation and viral defense in coincident asthma and obesity”Publication . Rufo, João Cavaleiro; Chauhan, Jitesh; Kalayci, Ömer; Eigenmann, Philippe; Cavaleiro Rufo, JoãoThe clinical associations between asthma and obesity remain poorly understood. The increasing prevalence ofboth conditions occurring may represent a modern clinical paradox. It is unclear whether reduced physical activ-ity in children with asthma leads to obesity, or if asthma-like symptoms in obese children result directly from theassociated excessive abdominal fat, impaired lung function, and heightened Th2 inflammation. Determining theetiology of both diseases and their interconnection is therefore an important research avenue.A recent study has sought to investigate this through a cross-sectional analysis of Australian children, bothwith and without asthma, examining their levels of physical activity. Interestingly, the study found no evidencethat asthma hindered physical activity.1 On the other hand, although most studies have shown obesity is linkedto a higher risk of asthma, the exact mechanism remains unclear. Many studies refer to obesity as an exacerbationfactor for asthma symptoms rather than a direct contributor to the underlying pathophysiological mechanisms ofasthma. 2 This highlights the need for continued research to untangle the complex interplay between these twoconditions.In 2019, a study investigating the associations between exposure to endocrine-disrupting chemicals andchildhood asthma identified a specific pattern of volatile organic compounds that were significantly linked to theearly onset “obese-asthma” phenotype, but not to asthma or obesity independently. 3 This suggests that asthmaand obesity may share common risk factors that trigger disease onset of both conditions during early childhood.Supporting this hypothesis, subsequent research has identified 29 genes associated with the obese-asthma phe-notypes, including GBP5 and SOCS, which further highlights the genetic underpinnings of this dual condition. 4In this issue, Manell et al. offer valuable insights by investigating novel plasma protein biomarkers specificallyassociated with the coexistence of asthma and obesity in an adolescent population. 5 The cross-sectional studyinvolved 390 children and adolescents, aged 10 to 19, who were categorized into four groups: healthy controls,individuals with asthma, individuals with obesity, and those with both obesity and asthma (OA).A proximity extension assay was used to assess the relative plasma concentrations of 113 proteins associatedwith inflammation and immune response. The study identified five plasma proteins—CCL8, IL-33, IL-17C, FGF-23,and CLEC7A—that were significantly and specifically elevated in the OA group compared to controls. However,after adjusting for age, sex, and sIgE levels, only CCL8 and CLEC7A remained significantly elevated. This suggeststhat the high levels observed for IL-33, IL-17C, and FGF-23 in the OA group may be partially attributable to atopy.Drawing on previously published evidence and considering the role of CCL8 in mucosal chemotaxis and Th2inflammation, Manell et al. propose that viral defense at mucosal barriers may play an important role in obesity-related asthma in children and adolescents. 5 While the exact pathophysiological mechanism behind CCL8 over-expression remains unclear, it is noteworthy that prior studies have confirmed no association between CCL8and atopy. 6 This, along with the evidence that CCL8 levels are regulated in obese individuals without asthma,strengthens the argument for this chemokine as a promising biomarker for obese-asthma phenotypes.Additionally, FGF-23, IL-17C, and IL-33, which are linked to mucosal host defense against viral infections andTh17 cell activation, were also regarded as potential biomarkers for concomitant asthma and obesity, though toa lesser extent. 5 Conversely, the elevated levels of CLEC7A in the OA group appear to be additive, reflecting thecombined effects of asthma and obese observed separately.
- Unlocking the functional potential of Mesembryanthemum nodiflorum: Insights into digestibility, safety and intestinal uptakePublication . Pinto, Diana; Vieira, Raquel; Teixeira, Filipa; Sut, Stefania; Vieira, Mónica; Salazar, Miguel; Delerue-Matos, Cristina; Dall’Acqua, Stefano; Rodrigues, Francisca; Vieira, MónicaMesembryanthemum nodiflorum, commonly known as slenderleaf iceplant, is an undervalued edible halophyte. The nutraceutical potential of M. nodiflorum was investigated in the current study by extracting bioactive compounds using ultrasound-assisted extraction (UAE) and assessing the influence of gastrointestinal digestion and intestinal permeability on their bioactive composition. The phenolic and flavonoid contents were the highest in the alcoholic extract, along with exceptional antioxidant/antiradical effects. The gastrointestinal digestion enhances the release and detectability of phenolic compounds and antioxidant activity, with bioaccessibility exceeding 100 %. Additionally, the extracts stimulated antioxidant enzymes and inhibited acetylcholinesterase (AChE), with alcoholic extract showing the highest inhibition (38 %). UPLC-QTOF-MS unveiled high concentrations of glycerophospholipids, tryptophan, and 5,5 ′-dihydroferulic acid. Ethanol was the most effective solvent for extracting bioactive compounds. Through an intestinal co-culture model, the intestinal digest from the alcoholic extract demonstrated notable permeation (66 % for rosmanol, 30 % for Lys-Asp-Tyr, and 15 % for tryptophan). These results highlight the bioactivity and intestinal absorption of M. nodiflorum extracts, repurposing this halophyte as a nutraceutical.