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- Challenges of ICT use for nurse-patient communication in Portugal: a mixed methods researchPublication . Peres, Marlene; Almeida, Raquel Simões de; Moreira, António; Simões de Almeida, RaquelThe future of digital health holds enormous potential to improve communication with patients and optimize the delivery of care. The current study aims to answer the central question of which knowledge, skills, and competencies in the use of Information and Communication Technologies (ICT), health professionals should develop to promote efficient remote communication processes with patients. A mixed-method approach was used for data collection, combining an online survey with semi-structured interviews. The study was structured into four key phases/question groups: professional context, practices related to the use of ICT in patient communication, training needs, and other relevant information. Qualitative data from open-ended responses were analysed using thematic analysis and triangulated with quantitative findings where applicable. The target population consisted of nursing professionals with patient care experience. The survey was distributed electronically, with 194 nurses fully or partially completing the questionnaire. Additionally, 24 interviews were conducted. The data shows that around 25.85% of professionals do not establish distance communication and 95.4% do not use telehealth. Telephone and cellular contact are the most used means of communication with patients (62.60%). Despite the predominance of face-to-face care, 62.5% stated that they do not experience difficulties or concerns, recognizing ICT as an increasingly integrated and advantageous tool for remote communication. Most professionals (80.1%) believe that there should be more training and courses in digital communication with patients and the use of ICT in healthcare, to address gaps in academic training. The growth of telemedicine and the digitalization of healthcare services reinforce the need for continuous professional training in this area. Most professionals have a positive perception of the opportunities created by emerging technologies, but they also express concerns about the ethical, social, safety and technical challenges that need to be addressed. The introduction of mandatory ICT courses in academic education and the implementation of continuous training are essential to prepare professionals for the challenges of telehealth and digital communication in healthcare. They emphasize the need for a well-structured digital transition, ensuring that technologies complement healthcare rather than replace human care.
- Development of a pandemic resilience competence model for healthcare professionals—individual and organisational aspectsPublication . Lorenzoni, Nina; Almeida, Raquel Simões de; Wimmer, Daniela; Simbrig, Ines; Simbrig, Ines; Moscon, Veronica; Carnelli, Fabio; Sulkowski, Nadine; Malaka, Elohor Pamela; Schober, Paul; Michel, Katharina; Sá, Vítor J.; Raich, Margit; Sá, Vítor J.; Simões de Almeida, RaquelThe COVID-19 pandemic highlighted the critical importance of resilience and adaptability at both individual and organisational levels in navigating unprecedented challenges. This study introduces a novel Pandemic Resilience Competence Model, a framework that articulates eight key competences each for individuals and organisations to enhance preparedness and response in pandemic scenarios. Employing a qualitative approach, the research identifies the essential skills and organisational capacities required to mitigate the impacts of pandemics. Using 50 semi-structured interviews with professionals and managers working in healthcare services in Austria, Germany, Italy, Portugal and the United Kingdom, the model provides actionable insights for implementing processes to improve preparedness and response in pandemic scenarios for stakeholders, including policymakers, educators, and organisational leaders. Findings highlight the interdependence of individual and organisational competences, reinforcing the need for integrated strategies to build pandemic resilience. The conclusions advocate for embedding the competences within training and development initiatives, aiming to enhance collective readiness for future global health crises.
- EEG signatures during pregnancy and their role on parenting-related measures: scoping reviewPublication . Braga, Patrícia Vilela; Amaoui, Sofia; Lamela, Diogo; Jongenelen, Inês; Costa, Raquel; Oliveira, Jorge; Pasion, Rita; Pinto, Tiago Miguel; Paiva, Tiago Oliveira; Campos, Carlos; Campos, CarlosThis scoping review aims to map and synthesise the current research evidence targeting the electroencephalography (EEG) neural correlates during pregnancy and its association with parenting-related measures during pregnancy and postpartum period. Pregnancy is characterised by a wide range of biological changes associated with adaptation to parenthood. A growing body of literature has examined the neural correlates of pregnancy using EEG, revealing distinct patterns in pregnant females, with these EEG metrics changing throughout gestation and postpartum. Due to the heterogeneity of the evidence, the current literature lacks an organised synthesis, making it difficult to understand the neural correlates during pregnancy and their association with parentingrelated measures during pregnancy and postpartum period. Studies will be included if they contain a quantitative EEG metric in their assessment in pregnant women. Studies will be included if they involve clinical or community samples. No sociodemographic, obstetric, or health exclusion criteria will be applied. The scoping review will be conducted following the Joanna Briggs Institute’s (JBI) guidelines and will be reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches will be conducted in 7 databases (Cochrane for Trials and Reviews, PsycInfo, PubMed, Psychological and Behavioural Science Collection, Scopus and Web of Science Core Collection) for articles published in English, Portuguese, or Spanish with no limitation on the region or publication time frame. Two independent reviewers will screen each record following a standardised flowchart using asreview lab. Data extraction will be performed by the two reviewers using charting tables in Excel. Disagreements at any step will be resolved via consensus or by a third reviewer. Results will be reported using tables and graphs along with a descriptive analysis, according to the research questions.
- Auditory N1, N2, and MMN to pure-tone and consonant–vowel stimuli in developmental dyslexia and benign rolandic epilepsy: A progressive insight into the underlying disruptive neurophysiologyPublication . Tomé, David; Pereira, Ilídio; Vieira, Maria Celeste; Soares, Ana Paula; Barbosa, FernandoBenign rolandic epilepsy or benign epilepsy in childhood with centrotemporal spikes (BECTS) and developmental dyslexia (DD) are two of the most studied disorders in childhood. Despite decades of research, the neurophysiological mechanisms underpinning these disorders are largely unknown. Here, we use auditory event-related potentials (AERPs) to shed light on these issues, since several authors have reported the existence of language and learning impairments. AERPs reflect the activation of different neuronal populations and are suggested to contribute to the evaluation of auditory discrimination (N1), attention allocation and phonological categorization (N2), and echoic memory (mismatch negativity (MMN]). This study aims to investigate and document AERP changes in a group of children with BECTS and another group with DD. AERPs were recorded to pure-tones and consonant–vowel (CV) stimuli in an auditory oddball paradigm in eight children with BECTS, seven with DD, and 11 gender- and age-matched controls. The results revealed perceptual deficits for pure-tone and CV stimuli (pre-attentional and auditory discrimination) in DD, related to N1 reduced amplitude (p< 0.05; Fz: 2.57 μV, Cz: 2.75 μV). The BECTS group revealed no significant results for N1; however, there was an increase in N2b latency. The findings in the DD group support the anchor-deficit hypothesis as an explanation for neurolinguistic deficits. The increased N2b latency in the BECTS group could be related to a potential lack of inhibitory mechanisms of pyramidal neurons, as justified by the process of epileptogenesis.
- Association between the history of fall and the fear of falling on stair descent and gait transition spatiotemporal parameters and lower-limb kinematics in older adultsPublication . Teles, Ivone; Moreira, Juliana; Sousa, Andreia S. P.; Santos Moreira, Juliana; Pinheiro de Sousa, Andreia SofiaAmong older adults, there is a high incidence of history of fall (HoF), fear of falling (FoF), and falls on stair descent during gait transitions. We aim to evaluate the association between HoF and FoF on spatiotemporal and lower-limb kinematic parameters in older adults during stair descents and gait transitions. Sixty older adults (>60 years) were evaluated through an optoelectrical motion capture system during stair descents and gait transitions, using the mean value of the task velocity and time; single- and double-support time; peak downward center of mass (CoM) velocity; hip, knee, and ankle positions of ipsi and the contralateral limb; and foot clearance and foot placement, assessed through multivariate analysis of variance. FOF exhibited longer time to complete (p = 0.009) and double-support (p = 0.047) and single-support (p = 0.009) times and a reduced peak downward CoM velocity (p = 0.043). In the gait transition cycle, HOF exhibited reduced ipsi ankle angles at toe-off (p = 0.015), and FOF presented reduced ipsi ankle angles at heel-strike (p = 0.041) and toe-off (p = 0.026) and reduced contralateral ankle angles at toe-off (p = 0.022).Older adults with HoF and FoF exhibit biomechanical changes during stair descents and gait transitions, in line with the use of more conservative strategies to avoid falling.
- Association between gait lower limb intra and interlimb coordination and fear of falling and falling history in older adultsPublication . Castro, Márcia; Moreira, Juliana; Sousa, Andreia S. P.; Santos Moreira, Juliana; Pinheiro de Sousa, Andreia SofiaAging often leads to a decline in intersegmental coordination, particularly in the lower limbs, which can negatively impact gait stability and symmetry. While fear of falling (FoF) and a history of falls (HoF) increase fall risk in older adults, their relationship with intra- and intersegmental coordination during gait remains understudied. This cross-sectional observational study involved 60 participants aged 60 and older. The three-dimensional range of motion of lower limb joints during gait was assessed using an optoelectronic system. Intra- and intersegmental coordination were evaluated via the Continuous Relative Phase (CRP) variable, including its mean, standard deviation, and coefficient of variation. The results showed that the HoF and FoF groups had higher mean CRP values in the left hip-knee (HOF, p = 0.004) and hip-ankle (FOF, p = 0.030) in the sagittal plane, as well as higher standard deviation values in the left knee-ankle (HOF, p = 0.006) and right hip-ankle (HOF, p = 0.004). Inter-segmental coordination differences were also observed, with higher mean CRP values between the knee joints in the sagittal plane (HOF, p = 0.046) and lower mean and standard deviation values between the ankle joints (FOF, p = 0.048 and p = 0.038, respectively). This study concludes that fear of falling and history of falling are significantly associated with altered intra- and intersegmental coordination in older adults, which may contribute to fall risk. Understanding these altered coordination patterns is crucial, as it underscores the therapeutic significance of targeting these changes, which could lead to interventions aimed at improving gait stability and reducing fall risk in elderly individuals.
- A comprehensive understanding of postural tone biomechanics: intrinsic stiffness, functional stiffness, antagonist coactivation, and COP Dynamics in post-stroke adultsPublication . Pinho, Liliana; Freitas, Marta; Pinho, Francisco; Silva, Sandra; Figueira, Vânia; Ribeiro, Edgar; Sousa, Andreia S. P.; Sousa, Filipa; Silva, Augusta; Pinheiro de Sousa, Andreia Sofia; Ferreira Silva, Maria Augusta; Oliveira e Pinho, Liliana; Nicolau Gonçalves de Freitas, Marta SofiaTo analyse the relationship between traditional stiffness and muscle antagonist coactivation in both stroke and healthy participants, using linear and nonlinear measures of coactivation and COP during standing, stand-to-sit, and gait initiation. Participants were evaluated through a cross-sectional design. Electromyography, isokinetic dynamometer, and force plate were used to calculate coactivation, intrinsic and functional stiffness, and COP displacement, with both linear and non-linear metrics. Spearman’s correlations and Mann–Whitney tests were applied (p < 0.05). Poststroke participants showed higher contralesional intrinsic stiffness (p = 0.041) and higher functional stiffness (p = 0.047). Coactivation was higher on the ipsilesional side during standing (p = 0.012) and reduced on the contralesional side during standing and transitions (p < 0.01). Moderate correlations were found between intrinsic and functional stiffness (p = 0.030) and between coactivation and intrinsic stiffness (standing and stand-to-sit: p = 0.048) and functional stiffness (gait initiation: p = 0.045). COP displacement was reduced in post-stroke participants during standing (p < 0.001) and increased during gait initiation (p = 0.001). Post-stroke participants exhibited increased gastrocnemius/tibialis anterior coactivation during gait initiation (p = 0.038) and higher entropy and stability across tasks (p < 0.001). Post-stroke participants showed higher contralesional intrinsic and functional stiffness, reduced coactivation in static tasks, and increased coactivation in dynamic tasks. COP and coactivation analyses revealed impaired stability and random control, highlighting the importance of multidimensional evaluations of postural tone.
- Shoulder and scapular function before and after a scapular therapeutic exercise program for chronic shoulder pain and scapular dyskinesis: A pre–post single-group studyPublication . Melo, Ana S. C.; Soares, Ana L.; Castro, Catarina; Matias, Ricardo; Cruz, Eduardo B.; Vilas-Boas, J. Paulo; Sousa, Andreia S. P.; Pinheiro de Sousa, Andreia SofiaScapular adaptations have been associated with shoulder pain. However, conflicting findings have been reported after scapular-focused interventions. The present study aims to evaluate scapula-related outcomes before and after a scapular therapeutic exercise program. Eighteen adult volunteers with chronic shoulder pain participated in an 8-week scapular therapeutic exercise program that was personalized according to their pain condition and the presence of scapular dyskinesis. This program included preparation and warm-up, scapular neuromotor control, and strengthening and stretching exercises. Both self-reported (shoulder pain and function, psychosocial factors, and self-impression of change) and performance-based outcomes (scapular muscular stiffness and activity level, tridimensional motion, rhythm, and movement quality, measured while participants drank a bottle of water) were used for analysis. After the intervention, participants presented reduced shoulder pain (p < 0.0001) and pain catastrophizing (p = 0.004) and increased shoulder function (p < 0.0001). Additionally, the participants presented changes in scapular winging (p < 0.0001 to p = 0.043), increased scapular downward rotation (p < 0.0001) and depression (p = 0.038), and decreased global movement smoothness (p = 0.003). These were associated with changes in serratus anterior activity (p = 0.016 to p = 0.035), decreased middle (p < 0.0001 to p = 0.002) and lower trapezius (p < 0.0001) and levator scapulae (p = 0.048) activity levels, and decreased middle trapezius muscle stiffness (p = 0.014). Patients’ self-perception of change was rated favorably. After a scapular therapeutic exercise program, changes were observed in both self-reported and performance-based outcomes. These results need to be confirmed by a randomized controlled trial.
- Total sacrectomy rehabilitation: Implementation of the international classification of functioning, disability, and health model – A case reportPublication . Lopes, Alfredo A.; Mesquita, Inês; Torres, Rui; Torres, Rui; Lopes, Alfredo; Mesquita, InêsThis study aims to outline an evaluative diagnostic process and intervention for a patient who underwent total sacrectomy based on the International Classification of Functioning, Disability, and Health (ICF) model. A 70-year-old male with a history of an aggressive sacral chordoma experiencing intense pain, constipation, and polyuria without the sensation of bladder filling, underwent a total sacrectomy. Two evaluations at two-time points were conducted 12 weeks apart. The patient then underwent an individualized rehabilitation program tailored to address impairments, activity limitations, and participation restrictions. The care plan was adjusted based on the patient’s health status and relevant personal and environmental factors. The Barthel Scale scores improved from 60 to 80. Motor scores on the American Spinal Injury Association scale increased from 62 to 66, while sensory scores for light touch improved from 86 to 96. However, pain scores remained stable at 86. Functional reach tests showed notable enhancements, with anterior reach increasing from 16.4 cm to 23.7 cm and lateral reach from 9.6 cm to 15.2 cm. The patient also showed progress in mobility, increasing the number of steps taken from 0 to 10. This case report highlights the positive therapeutic outcomes achieved, illustrating improvements in functional activities and patient independence, thereby underscoring the effectiveness of the ICF model in managing patients undergoing total sacrectomy.
- Home-based rehabilitation maintenance with or without an exercise-based pilates program in COPD patientsPublication . Barbosa, Marisela; Melo, Cristina Argel de; Torres, Rui; Melo, Cristina; Torres, RuiPilates exercise may complement pulmonary rehabilitation of Chronic Obstructive Pulmonary Disease (COPD) to improve Patient-Reported Outcome Measures (PROMs). To investigate the effects on PROMs after incorporating a six-month Pilates exercise maintenance program compared to a home-only exercise program. A total of 32 participants with COPD (GOLD B) were assigned to either the intervention group (n = 14) or the control group (n = 18). Both groups participated in a three-month pulmonary rehabilitation program. For the next six months, the intervention group engaged in a Pilates exercise program and home-based exercises, while the control group continued with home-based exercises only. Primary outcomes were evaluated at baseline, three, six, and nine months. At the nine-month follow-up, the intervention group exhibited significantly fewer activity-related impairments in the St George’s Respiratory Questionnaire Activity domain (p = 0.029) and experienced less symptoms of anxiety (p = 0.002) and depression (p = 0.014) according to the Hospital Anxiety and Depression Scale scores. Other PROMs did not show statistically significant differences between the groups. Incorporating a six-month Pilates exercise maintenance program resulted in fewer activity-related impairments and reduced anxiety and depression symptoms compared to those who followed a home-based exercise maintenance program alone.