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- Effects of caffeine on P300: A systematic review and meta-analysisPublication . Pinho, Beatriz B.; Mazer, Prune; Barroso, Beatriz; Pinto, Joana O.; Mazer, PruneCaffeine is a widely consumed psychoactive substance that stimulates the central nervous system, enhancing alertness and concentration. Its effects on brain activity can be examined using neurophysiological techniques such as event-related potentials, with emphasis on the P300 component. Caffeine appears to modulate P300 amplitude and latency, suggesting changes in processing speed and attention, although findings remain inconsistent. The objective of this work was to systematise the literature about the effects of caffeine on the amplitude and latency of the P300. A systematic review and meta-analysis of empirical studies measuring the effect of caffeine on P300 amplitude and latency was conducted, following the Preferred Reporting Items for Systematic Reviews and Meta- Analyses. Statistical analyses were performed using the meta-analysis package for R. Caffeine intake between 201 and 399 mg was associated with a significant increase in P300 amplitude across anterior, central, and posterior regions, whereas higher doses were associated with smaller effect sizes. No significant differences in P300 latency were observed between pre- and post-caffeine intake. Overall, our findings align with previous reviews showing that caffeine, as a stimulant, can modulate brain activity. The main limitation of this work is the high heterogeneity across studies. Future research directions are discussed.
- 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.
- From healthcare system to individuals through stroke rehabilitation pathways. Outcomes, information, and satisfaction along 12 months prospective cohort in PortugalPublication . Barbosa, Pedro Maciel; Machado, João Firmino; Ferreira, Lara Noronha; Cruz, Vitor Tedim; Szrek, Helena; Barbosa, PedroThe nature and quality of stroke survivor rehabilitation varies throughout Europe,including in Portugal, having not been widely monitored or benchmarked. This study analyses the stroke care pathway from three perspectives: healthcare system, process, and patient. The study uses data from a one-year single-center prospective cohort of first stroke patients, assessed at baseline, 3, 6, and 12 months. Care pathways and settings were described interms of organizational model, funding, patient involvement, frequency and intensity and multi-disciplinary team. Patient-level information and satisfaction were evaluated using a 10-point numeric rating scale. Kruskal – Wallis and post-hoc tests were used to compare EQ-5D-3 L, National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Barthel Index, Mini-Mental State Examination scores between pathways and settings. A total of 391 acute stroke patients, with a mean disability of 3.7 (mRS) and severity of 11.7(NIHSS) participated. Six pathways and eight settings were described. A lack of compliance between guidelines and care was identified. There were significant differences in the four outcomes between the six pathways (p-values 0.007 to 0.020) suggesting inefficiency and inequalities, with an inadequate level of information and patient satisfaction. After post-hoc analysis, pathways 1 and 2 showed highest outcomes (p-values 0.001 to 0.002). Within settings, short-term units showed high scores,followed by rehabilitation center, outpatient hospital, and community clinic (p-values 0.001 to 0.040).A multilevel characterization of the post-stroke rehabilitation pathway showed a more complete perspective on stroke management which may contribute to future rehabilitation and stroke policies.
- Factors associated with urinary incontinence in female weightliftersPublication . Lopes, Sofia; Becam, Manon; Pierrot, Carla; Réard, Julie; Carvalhais, Alice; Vieira, Ágata; Brochado, Gabriela; Lopes, SofiaUrinary incontinence (UI) is common among women practicing sports, particularly those involving heavy lifting or high-impact movements that increase intra-abdominal pressure. UI can negatively affect social life, self-confidence, and motivation to remain active. This study aimed to examine the associations of sociodemographic, training-related, obstetric, and surgical factors with UI in female weightlifters. This cross-sectional study included 84 French women who regularly practiced weightlifting. Participants completed a structured questionnaire collecting sociodemographic and gynecological information, as well as the Urinary Symptom Profile (USP). Data were analyzed using appropriate inferential statistical tests, including the Mann–Whitney U test, Student’s t-test, chi-square test, and Fisher’s exact test, as applicable. A 95% confidence level was adopted for all analyses. Among participants (aged 15–49 years), 51 (60.7%) reported involuntary urine leakage, and 31 (36.9%) scored 1–3 on the USP stress incontinence subscale. Most participants were non-smokers (73.8%), with a median of 3.5 years of weightlifting experience, four weekly training sessions, and six–seven competitions per year. No significant associations were found between UI and sociodemographic factors, obstetric history, previous surgeries, or training characteristics. Maximal lifts in Clean & Jerk and Snatch exercises were also similar between participants with and without UI. Slight trends suggested a higher UI prevalence among women with vaginal deliveries, episiotomies, or vaginal lacerations. Regarding athletes with and without UI, no differences were found (p > 0.05) with respect to weightlifting belt use or the breathing phase during load lifting. UI is common among female weightlifters, but in this study, was not associated with sociodemographic factors or weightlifting practices. These findings indicate that UI prevalence cannot be explained by the variables studied and highlight the need for further research into other potential contributing factors.
- Towards a multidimensional Model of Neurocognitive Disorders (MOND Model): Integrating evidence from a critical review into a model for future researchPublication . Pinto, Joana O.; Peixoto, Bruno; Dores, Artemisa R.; Barbosa, Fernando; Dores, ArtemisaThe main purpose of this work is to critically review the literature on neurocognitive disorders (ND) diagnosis. A critical review was conducted in PubMed, Scopus, and EBSCO. Systematic reviews and meta-analyses focusing on ND diagnosis were included. The selected studies were critically analyzed and conceptually integrated to identify relevant dimensions for the diagnosis of ND. The review included 88 studies. Most studies focused on Alzheimer’s disease and mild cognitive impairment. The literature remained predominantly centred on isolated diagnostic domains, and important limitations were consistently identified, including methodological heterogeneity, lack of standardized thresholds, and reduced clinical applicability. Based on the identified conceptual and methodological limitations, a Multidimensional Model of Neurocognitive Disorders (MOND model) for ND diagnosis was proposed. The MOND model was developed as a multidimensional, multilevel, transdiagnostic model integrating biological, neurocognitive, neuropsychiatric, motor, functional, frailty, reserve-related, and socio-environmental dimensions. The model may contribute to research, symptom classification, severity characterization, prognosis, and personalized intervention planning across different ND trajectories. Future studies using the MOND model should focus on refining algorithms to estimate the risk of ND.
- 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.
- Professionals’ perspectives on the role of advanced technologies in responsible gamblingPublication . Barroso, Beatriz C. R.; Cardoso, Leonor G.; Morgado, Pedro; Marques, António; Rocha, Carla; Griffiths, Mark D.; Queirós, Ricardo; Dores, Artemisa R.; Dores, ArtemisaProblematic gambling is associated with substantial individual and societal harms, which may be intensified by the accessibility, anonymity, and captivating design of online gambling products. In this domain, advanced technologies (e.g., artificial intelligence and data analytics) are increasingly recommended for prevention, early detection, and harm reduction. This study aimed to examine the current and potential uses of advanced technologies in gambling. Forty-five semi-structured interviews were conducted with social/legal science (n = 24) and technology (n = 21) experts. Data were analysed using thematic analysis, beginning with a deductive approach followed by an inductive analysis. A total of 182 codes were identified from social/legal science professionals, and 228 from technology experts. Four overarching themes were identified: (i) characterisation of contemporary gambling; (ii) applications and implications of advanced technologies; (iii) regulatory frameworks and challenges; and (iv) recommendations and solutions. Profit-driven design practices, heightened vulnerabilities in online gambling environments, regulatory gaps, and concerns regarding algorithmic opacity and data use were highlighted. Advanced technologies were viewed as having a dual role, with potential both to exacerbate gambling-related harm and to enable earlier identification of risky behaviours and targeted interventions. Findings indicate that responsible gambling cannot rely solely on technological solutions (e.g., behavioural monitoring and limit-setting) and should be instead integrated with community-level strategies, public education, and robust regulatory oversight. Leveraging technological innovation alongside user protection is essential, requiring interdisciplinary collaboration, a public health-oriented approach, and transparent, evidence-based and ethically governed frameworks. Implications, limitations, and future directions are discussed.
- Physical activity during pregnancy: Associations between levels and types of physical activity and low back pain–related disability in Portuguese pregnant womenPublication . Teixeira, Isabel; Santos, Paula Clara; Festas, Clarinda; Bernardo, Diana; Santos, Paula ClaraLow back pain (LBP) is one of the most prevalent musculoskeletal conditions during pregnancy and frequently impairs daily living activities and quality of life. The association between different levels and types of physical activity (PA) and LBP-related functional disability remains insufficiently explored. This study aimed to examine the association between PA levels and types and functional disability among pregnant women with LBP. A cross-sectional analytical study was conducted involving 192 Portuguese pregnant women. Data were collected through an online questionnaire comprising the Pregnancy Physical Activity Questionnaire and the Oswestry Disability Index (ODI). Most participants engaged predominantly in light-intensity or sedentary activity (69.1%), with minimal participation in vigorous activity (0.8%). Functional disability was generally mild (mean ODI = 11.5 ± 7.35); however, 42.2% of participants reported moderate disability and 11.0% severe disability. Advancing gestational age showed weak associations with increased domestic activity (r = 0.146, p = 0.044), decreased occupational activity (r = −0.295, p = 0.001), and higher functional disability scores (r = 0.142, p = 0.049). Parity was associated with differences in total PA levels (p = 0.005) and domestic activity (p = 0.001). Higher ODI scores were weakly associated with light-intensity and sedentary activity (r = 0.144, p = 0.047), whereas severe disability demonstrated a moderate association with sedentary behavior (r = 0.529, p = 0.014). Overall, lower levels of PA, particularly sedentary behavior, were weakly associated with higher LBP-related disability; however, the observed associations were generally weak and should be interpreted with caution considering the cross-sectional design.