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- Digital delivery of dialectical behavior therapy for Borderline Personality Disorder: A Scoping ReviewPublication . Alferes, Filipa; Lárez, Estefânia; Almeida, Raquel Simões de; Simões de Almeida, RaquelThis scoping review aims to identify technological modalities for remote Dialectical Behavior Therapy (DBT) delivery for Borderline Personality Disorder (BPD), assess their effectiveness and engagement, examine associated advantages and challenges, and offer insights for future research and clinical practice. A literature search was performed across PubMed, Web of Science, EBSCO, B-ON, and IEEE Xplore, including studies from the last 10 years. Fourteen studies with diverse methodological designs met the inclusion criteria for analysis. Digital DBT emerged as a promising intervention, demonstrating positive efficacy and engagement, suggesting it as a viable alternative to conventional therapy. Common modalities include videoconferencing and mobile applications. Challenges identified include technical issues, potential impact on the therapeutic relationship, and data security concerns requiring attention for clinical feasibility. Digital DBT offers a promising, cost-effective alternative to traditional therapy. While initial evidence supports its effectiveness and engagement, further research, particularly randomized clinical trials, is crucial to evaluate long-term outcomes and optimize implementation.
- 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.
- 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.
- Effects of a reminiscence therapy program on neuropsychiatric symptoms and quality of life in people with dementia: a pilot study comparing immersive virtual reality and non-immersive approachesPublication . Soares, Maria; Quental, Vanessa; Pereira, Miguel; Sanchez, Ana Isabel Corregidor; Costa, Ana; Portugal, Paula; Coelho, Tiago; Coelho, Tiago; Portugal, PaulaThis study compared the impact of an immersive virtual reality (VR)-based reminiscence therapy program with a similar non-immersive intervention on neuropsychiatric symptoms and quality of life of people with dementia. A pilot randomized controlled trial was conducted with 14 individuals with mild to moderately severe dementia, who participated in eight biweekly individual reminiscence sessions conducted by trained researchers, in which 360° videos of locations with personal relevance were displayed. Participants were randomly divided in two groups: one receiving therapy using VR headsets to promote an immersive experience while the other watched the videos on a monitor (non-immersive approach). Assessment was conducted pre- and post-intervention using the Quality of Life in Alzheimer’s Disease Scale to measure quality of life and the Geriatric Depression Scale, Generalized Anxiety Disorder Scale and Neuropsychiatric Inventory to evaluate neuropsychiatric symptoms. Adverse simulation-related symptoms were also assessed with the Simulator Sickness Questionnaire. There were no statistically significant differences between groups at baseline, regarding sociodemographic variables and level of dementia progression. The results indicated significant improvements post-intervention in quality of life from caregivers’ perspectives in the non-immersive group (p < .05) but not in the VR group. Differences in overall neuropsychiatric symptoms, depressive symptoms and anxiety symptoms between assessments were non-significant. However, slight improvements were visible, particularly regarding anxiety. Only a few instances of mild cybersickness symptoms were reported in both groups. In this study, pre- and post-intervention comparisons do not support the added value of using immersive VR in reminiscence therapy for people living with dementia. This raises questions about whether VR is worthwhile compared to traditional approaches, and how to better capture potential benefits of immersion with VR, which may be more evident considering in-session engagement and well-being or longer intervention programs.
- Effects of an immersive virtual reality reminiscence intervention on engagement, behavioral and psychological symptoms, and well-being of people with dementia: A randomized crossover trialPublication . Pereira, Miguel; Leite, Cláudia; Campos, Carlos; Coelho, Tiago; Coelho, Tiago; Campos, CarlosVirtual reality (VR) is a novel technology that can facilitate reminiscence in people with dementia. However, few studies have explored the role of VR’s immersiveness in enhancing therapeutic outcomes. This study aimed to analyze the effects of an immersive VR reminiscence session compared to a non-immersive session, focusing on engagement, behavioral and psychological symptoms (BPSD), and well-being, using behavioral observation and physiological metrics. A randomized crossover trial with a seven-day washout period was conducted. Engagement, BPSD and well-being were assessed before, during and after each intervention using both observational scales and heart rate variability analysis. 20 participants (average age 80.55 years, 90% women) were recruited. Significant pre-post differences were found in behavioral engagement (z=−2.67, p=0.008) and facial expression of apathy (z=−2.12, p=0.034) during the immersive intervention. Additionally, lower apathy in terms of purposeful activity was observed during the immersive intervention (z=−2.24, p=0.025). These results are particularly noteworthy given the sample size, which, although small, highlights a clear trend of behavioral and apathy change. The results suggest that VR’s immersiveness can enhance engagement in dementia intervention programs. As VR technology becomes more accessible and safer, continued research is needed to explore its therapeutic potential.
- A gamified virtual reality exposure therapy for individuals with Arachnophobia: a pilot studyPublication . Lopes, Inês; Almeida, Raquel Simões de; Gomes, Paulo Veloso; Marques, António; Simões de Almeida, Raquel; Machado Veloso Gomes, Paulo Sérgio; Pereira da Silva Marques, António JoséArachnophobia is a specific phobia characterized by an intense and persistent fear of spiders, often leading to avoidance behaviors that can significantly impact daily life. Virtual Reality Exposure Therapy (VRET) offers a controlled, adaptable, and immersive therapeutic environment, allowing for greater personalization, flexibility, and the real-time modulation of exposure parameters. This pilot study employed a quasi-experimental design without a control group to evaluate the efficacy of a gamified VRET intervention for treating arachnophobia. A sample of 25 participants underwent the intervention, with outcomes assessed through a Behavioral Approach Test (BAT) and self-report measures, including the Fear of Spiders Questionnaire (FSQ) and the Spider Phobia Questionnaire (SPQ-15), administered pre-intervention, post-intervention, and at a two-week follow-up. Findings indicate that gamified VRET led to significant reductions in self-reported fear and avoidance behaviors, suggesting its potential as an effective therapeutic tool for arachnophobia. Although some results were not entirely conclusive, the overall improvements observed support further investigation in larger, controlled trials.
- Usefulness of mixed reality in surgical treatment: Delphi studyPublication . Magalhães, Renato; Lima, Ana Carolina; Marques, António; Pereira, Javier; Santos. Lúcio Lara; Pereira da Silva Marques, António José; Magalhães, RenatoMixed reality (MR) combines real and virtual elements and has shown promise in diverse fields, including surgical procedures. MR headsets may support surgical navigation, planning, and training. It is crucial to determine whether medical professionals consider this technology indispensable. This study uses the Delphi method, facilitated by the Welphi web-based platform, to assess the utility of MR in surgical settings and analyzes the results of the first round using a systematic approach modeled on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework. This study aims to examine the feasibility and advantages of MR technology in surgical contexts. The findings are intended to inform and direct health care professionals, researchers, and developers in advancing MR integration into surgical environments to optimize treatment quality and safety. A 3-round Delphi approach was implemented to ascertain consensus on the utility of MR in surgical treatment. Participants (n=22) were purposefully selected from among experts with professional experience in technologies such as virtual reality, augmented reality, 3D laparoscopy, and robotics. In the first round, participants provided insights into the potential applications of MR in surgical procedures through open-ended questions structured across 5 distinct sections. Responses were analyzed to develop the second-round questionnaire, which was hierarchically organized into main topics and subtopics. In the third round, the questions were identical to those in the second round, including the percentage results, allowing participants to reconsider their responses. A consensus round was subsequently conducted. The majority consensus level was defined as agreement by ≥70% of the participants in a given round. The study was conducted from January to May 2024. All 22 invited experts provided responses in both the first and second rounds (100% response rate). In the third and consensus rounds, 20 (91%) of the 22 experts participated. The consensus round, conducted to present the results, yielded a majority consensus (19/20, 95%) on the usefulness of MR in surgical treatment. The primary benefits of MR in surgery were identified as surgical navigation (15/20, 75%), planning (15/20, 75%), and teaching and training (14/20, 70%). In addition, 75% (15/20) of the experts identified cost and investments as primary constraints. We used the Kendall tau-b coefficient for correlation analysis, and significant correlations were identified between distinct aspects. MR technology is most beneficial in surgical navigation, planning, and training. However, the costs and investments required for implementation may present a potential limitation for the integration of this technology into surgical procedures. Moreover, it is of crucial importance to consider the ethical implications associated with MR use, particularly regarding patient safety and privacy.
- Military stress management training using virtual reality: A systematic review and delphi methodPublication . Vianez, Ana; Marques, António; Loureiro, Javier; Gomes, Paulo Veloso; Machado Veloso Gomes, Paulo Sérgio; Pereira da Silva Marques, António JoséMilitary personnel encounter stressors that uniquely affect their performance and well-being, necessitating effective stress management interventions. This study investigates the efficacy of VR-based Stress Management Training (SMT) programs in comparison to traditional approaches. Through a systematic review of 13 studies, VR-based SMT programs were found to significantly reduce stress and anxiety symptoms, with various physiological markers used to evaluate the stress response. Additionally, a Delphi study was conducted to gather expert insights on designing VR-based SMT programs specifically for special operations forces. The experts identified key stressors and coping strategies relevant to this group, emphasizing the potential of VR for stress monitoring, simulation training, and real-time feedback. The Delphi study reached a 97 % consensus on the design principles for these programs. Overall, the findings suggest that integrating VR into SMT programs offers a promising strategy for enhancing stress management and resilience in military personnel.