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- Validation of the Demand Control Support Questionnaire for European PortuguesePublication . Kraus, Teresa; Dixe, Maria dos Anjos; Pais, Ricardo; Theorell, Töres; Gaspar, Pedro; Lopes, Maria da SaudadeBackground: The Demand Control Support model is useful for studying work-related stress. The combination of high demand and a low level of control generates "job strain"("job iso-strain"if poor support is added), with implications for the worker's health and well-being. The aims of this study were to adapt, examine the factor structure of, and determine the reliability of, the Demand Control Support Questionnaire (DCSQ) short version for European Portuguese (DCSQ-PT). Methods: The scale was translated into Portuguese following a rigorous process and then applied to 501 workers from various professional sectors. An online survey was used to collect sociodemographic, professional, and Demand Control Support data. Validation was based on reliability and validity tests. Results: The mean age of the sample was 41.8 ± 10.3 years, and 50.1% of the participants were female. The results reveal good reliability (Cronbach's alpha = 0.807) and validity. Confirmatory factor analyses demonstrated that a four-factor solution of the DCSQ-PT scale had a good fit to the data, as was the case for the original scale. The DCSQ-PT© with 16 items is composed of the following factors: social support at work; psychological demands; skill discretion; and decision authority. Conclusions: This validation allows an instrument to be obtained with 16 items for studying work-related stress in Portuguese workers.
- Factors Associated With Transition of Care in Patients With Chronic Non‐Communicable Diseases: Cross‐Sectional StudyPublication . Seidler, Mardhjorie dos Santos; Trindade, Letícia Flores; Berghetti, Larissa; Castro, Letícia Y.; Rodrigues, Francini de Oliveira; Baixinho, Cristina Lavareda; Romero, Manuel Portela; Rosa, Amanda Caroline Mélo da; Kolankiewicz, Adriane Cristina BernatAim: To assess the relationship between sociodemographic and clinical characteristics and the quality of care transitions among individuals with chronic non- communicable diseases after hospital discharge. Design: Cross- sectional, single- centre study. Method: Participants were people with chronic diseases who underwent clinical or surgical treatment and were discharged from a hospital in southern Brazil. Data were collected from March to July 2021. The study used clinical and sociodemographic characterisation instruments at the bedside; after hospital discharge, the care transitions measure- 15 (CTM- 15) was conducted by telephone. Descriptive and inferential statistical analyses were applied. Results: A total of 487 participants were included, with a mean age of 60.6 years; 67.4% were classified as having satisfactory care transitions. In the adjusted model, a higher likelihood of satisfactory transitions was observed among individuals who underwent surgical treatment (OR = 2.974; p < 0.001), those without family income (OR = 2.546; p < 0.001), White individuals (OR = 1.705; p = 0.027), and women (OR = 1.589; p = 0.042). Discharge with clinical devices was also associated with satisfactory transitions (OR = 1.245; p = 0.043). Conversely, individuals with family income between R$1100 and R$3299 showed a lower likelihood of satisfactory transitions, although this association was not statistically significant (OR = 0.724; p = 0.066). Conclusion: Clinical and sociodemographic characteristics significantly influence the quality of care transitions. The results highlight social and contextual factors and show that effective transitions require strategies that integrate clinical needs with the social determinants shaping the care experience. Transition practices that are sensitive to patients' social, cultural and economic contexts may help strengthen equity and safety in post- discharge continuity of care. Implications for the Profession and/or Patient Care: These findings reinforce the need for individualised discharge planning, clear interprofessional communication and health education adapted to patients' literacy levels and social conditions. Such measures can improve safety, autonomy and treatment continuity for patients with chronic conditions and support professionals in developing context- responsive care transition strategies. Reporting Method: This study followed the STROBE checklist for cross- sectional studies. Patient or Public Contribution: Patients participated in the data collection by answering the care transitions measure- 15 after hospital discharge, directly contributing to the interpretation of the care transitions data.
- Game-based balance training in older adults: systematic review and meta-analysisPublication . Tomé, Ana; Castro, Silvia; Rosa, Marlene; Tomás, Maria Teresa; Fontes, Ana Paula Fontes; Pais, SandraFunctional decline in older adults is a major contributor to both falls and increased fall risk. Nevertheless, such decline may be mitigated through multidimensional interventions. Game-based and gamified interventions have emerged as promising alternative strategies. This study aimed to evaluate the effectiveness of these approaches in improving balance and reducing fall risk among community-dwelling adults aged 65 years and over. The research question was: Do serious games and gamification improve balance and reduce fall risk in community-dwelling older adults, compared with exercise programmes, non-gamified interventions, or control conditions? A systematic search of randomised controlled trials was conducted in accordance with PRISMA guidelines, resulting in the inclusion of nine studies from 634 records screened. Meta-analysis demonstrated significant improvements in the Functional Reach Test and the Berg Balance Scale. However, no significant overall effects were observed for the Timed Up and Go Test or the Single-Leg Stance Test. Although game-based interventions may improve specific dimensions of balance in community-dwelling older adults, the findings should be interpreted with caution. The limited number of studies, small sample sizes, heterogeneity of interventions, and reliance on balance-related surrogate outcomes rather than direct measures of fall incidence highlight the need for further high-quality research.
- Food literacy among Portuguese adults with skeletal dysplasia: insights from a cross-sectional studyPublication . Guerra, Beatriz; Alves, Inês; Costa, Ricardo; Dias, Valter; Jesus, Pedro; Pereira, Cidália D.; Soliman, NeveenPurpose Skeletal dysplasias are a heterogeneous group of 771 rare diagnoses, that present short stature as a common feature. Despite the importance of nutrition in health management, food literacy in this population remains largely unexplored. This study aimed to assess the level of food literacy among Portuguese adults with skeletal dysplasia. Methods A cross-sectional observational study was conducted among adults (> 18 years) with skeletal dysplasia (n = 43, 30 female). Data were collected through an online questionnaire comprising two sections: sociodemographic and clinical information and the Portuguese version of the Food Literacy Scale (FLS). The FLS covers three dimensions: literacy about the nutritional composition of food, literacy about labelling and food choices, and literacy about healthy eating practices. Food literacy scores were calculated as percentage indices. Descriptive statistics with 95% confidence intervals and subgroup comparison by sex and age were performed. Results Mean overall food literacy score was 60.8% (CI 95%: 54.7–66.9). Among the three dimensions, the highest mean score was observed for healthy eating practices, 62.0% (CI 95%: 56.4–67.6), and the lowest for labelling and food choices, 59.0% (CI 95%: 51.1–66.9). No statistically significant differences were found in overall food literacy or in any of its dimensions according to sex or age. Participants reported greater difficulty with recommended protein amounts, interpreting and using food labels, adhering to the Mediterranean diet, and recommended portion sizes. Conclusions Adults with skeletal dysplasia in Portugal showed modest food literacy scores, mainly in domains related to food labelling and food choices. Tailored nutrition education strategies and more easily accessible food-related guidance may help address the specific literacy gaps identified in this population.
- Effectiveness of nursing interventions on preventing the risk of infection in hospitalized adults: a systematic reviewPublication . Bom, Luís Filipe Pereira Todo; Mata, Ema Soraia Fazenda; Cunha, Helena Margarida Pereira; Santos, Ana Rita Melo; Pereira, Ana Sofia Ferreira; Castanheira, Joana Antunes; Dixe, Maria dos Anjos Coelho Rodrigues; Marquês, Maria do CéuBackground Healthcare-associated infections (HAIs) remain a global challenge for patient safety and quality of care, affecting millions of individuals each year and resulting in substantial morbidity, mortality, and financial burden. In Europe alone, over 4.2 million episodes of HAI occur annually. Nurses play a pivotal role in infection prevention through the implementation of evidence-based interventions aimed at disrupting transmission chains and reducing infection risk. Despite the widespread dissemination of preventive strategies, marked heterogeneity persists in their implementation and effectiveness, influenced by institutional, behavioural, and contextual factors. Objective To critically evaluate the effectiveness of nursing interventions in preventing infection risk among hospitalised adults through a systematic review of the literature. Methods A systematic review of Randomised Controlled Trials (RCTs) was conducted following the Joanna Briggs Institute (JBI) methodology and PRISMA 2020 guidelines, with prior registration in PROSPERO (CRD42024582820). Searches were performed across MEDLINE, CINAHL, Scopus, Web of Science, and the Cochrane Library up to January 2025. Methodological quality was assessed using JBI critical appraisal tools, and the certainty of the evidence was rated using the GRADE approach. Given the heterogeneity of the included studies, a narrative synthesis was undertaken. Results Out of 8,123 records identified, 22 RCTs (1979–2024) met the inclusion criteria. Nursing interventions, including daily body bathing with chlorhexidine, prevention bundles for catheters and other devices, promotion of hand hygiene, educational strategies, and environmental disinfection (e.g. ultraviolet-C light) demonstrated a significant reduction in HAI incidence compared with usual care. Multimodal and integrated interventions proved more effective than isolated measures. The overall certainty of evidence was moderate for infection reduction and adherence improvement, but inconsistent for patient mortality and satisfaction outcomes. Conclusions Evidence-based nursing interventions, particularly when applied in a coordinated and multimodal manner, substantially reduce infection risk among hospitalised adults. These findings support the integration of such interventions into institutional programmes and infection control policies. Further multicentre RCTs are recommended to assess implementation fidelity, cost-effectiveness, and patient-centred outcomes.
- Neuropeptides neurotensin and substance P accelerate diabetic wound healing by modulating immunity and the skin microbiomePublication . Maranha, Ana; Leal, Ermelindo C.; Alarico, Susana; Tiago, Igor; Pereira, Sónia G.; Empadinhas, Nuno; Carvalho, EugéniaDiabetic foot ulcers (DFUs) are a common and debilitating complication of diabetes mellitus, typified by impaired healing, persistent inflammation, and skin microbiota dysbiosis. Although some neuropeptides are immunomodulatory, their effects on skin microbiota and wound resolution remain largely unexplored. We examined the therapeutic potential of the neuropeptides neurotensin (NT) and substance P (SP) in reshaping inflammatory and microbial dynamics and accelerating wound closure in a healthy and streptozotocin-induced diabetic mice model. Full-thickness cutaneous wounds were induced on both groups, followed by daily topical applications of saline (CT), NT, or SP. Wound closure was monitored and changes in skin bacterial communities characterized using next-generation sequencing. Wound tissue samples were collected for immunohistochemical analysis. Topical application of NT or SP significantly accelerated wound healing, with the most pronounced effects in diabetic animals. Both neuropeptides reduced the number of pro-inflammatory cells, lowering M1 macrophages in diabetic wounds from 16.4 ± 4 to 12.1 ± 3 with NT and 10.9 ± 3 with SP, while increasing M2 macrophages from 11.6 ± 4 to 18.1 ± 4 (NT) and 21.6 ± 5 (SP). SP exerted the most pronounced immunomodulatory effect, normalizing the M1/M2 ratio and reducing the number of CD3⁺ T cells (12.4 ± 3) and neutrophils (12.1 ± 3) to levels comparable to non-diabetic skin. Concurrently, SP treatment induced substantial microbiota remodeling in diabetic wounds, reducing Staphylococcus by circa 34%, Aerococcaceae_unclassified by 6.8%, Aerococcus by 1.5% and nearly eliminating Weissella. These reductions were accompanied by an over twofold increase in commensal genera (Lactobacillus, Micrococcaceae_unclassified, Actinobacteria_unclassified), shifting the microbial community toward a more non-diabetic profile. Our findings suggest that NT and especially SP, enhance diabetic wound healing through dual local immunomodulation and microbiota restructuring.
- Evaluation of Procalcitonin Accuracy for the Distinction Between Gram-Negative and Gram-Positive Bacterial Sepsis in Burn PatientsPublication . Cabral, Luís; Afreixo, Vera; Meireles, Rita; Vaz, Miguel; Frade, João Gonçalo; Chaves, Catarina; Caetano, Marisa; Almeida, Luís; Paiva, José-ArturSepsis is the main cause of death in burns. Early institution of antimicrobial therapy is crucial to optimize outcomes but superfluous therapy increases adverse events, microbial resistance, and costs. Blood cultures are the gold standard for diagnosis but can take 48 to 72 hours. Biomarkers are used to help sepsis diagnosis and distinction between Gram-negative and Gram-positive bacterial cause. The aim of this work is to evaluate procalcitonin (PCT) accuracy for this distinction in burn patients. Retrospective observational study of adult septic burn patients with ≥15% total burn surface area admitted from January 2011 to December 2014 at a Burn Unit in Portugal. A statistical analysis was done, evaluating the correlation between PCT levels on the day of the first positive blood culture and microbiological data for Gram-negative and Grand-positive bacteria. Patients with mixed bacterial and/or fungal blood cultures were excluded. Data were summarized by quartiles statistics. Blood cultures were positive in 189 patients: 75 (39.7%) showed growth for Gram-negative and 114 (60.3%) for Gram-positive bacteria. Patients with Gram-negative bacteria have significantly higher PCT levels. Receiver operating characteristic curve analysis showed accuracy for Gram-negative discrimination with area under the curve = 0.687. Most elevated levels were related to nonfermentative Gram-negative bacteria and by Klebsiella pneumoniae and other Enterobacteriaceae. PCT levels were significantly higher in burn patients with Gram-negative sepsis comparing to patients with Gram-positive sepsis and controls. The determination of PCT levels may help the choice of empirical antimicrobial therapy while microbiological culture results are not available, despite not fully ensuring the desirable degree of precision.
- Assessing the Carbon Footprint of Meals: A Case Study from a Portuguese College CanteenPublication . Guimarães, Carla; Caseiro, B.; Bento, B.; Costa, C.; Moskalenko, D.; Manuel, E.; Neto, I.; Simões, J.; Chinita, M.; Henriques, R.; Ferreira, S.; Barroso de Moura Cipreste Vaz, Daniela; Pereira, Cidália Almeida; Santos Ribeiro, VâniaInstitutional food services, such as school canteens, significantly contribute to the environmental impact of food systems due to the high volume of meals served and their influence on dietary habits, particularly among younger populations. This study assessed the carbon footprint (CF) of all the dishes on the menu offered by a college canteen in central Portugal, including meat, fish/seafood, and vegan options. Nutritional adequacy was also evaluated, defined as the percentage of dishes meeting established nutritional guidelines. The findings revealed that meat-based dishes had the highest CF, followed by fish/seafood options, while vegan dishes exhibited the lowest environmental impact. In terms of nutritional adequacy, meat and fish/seafood dishes frequently exceeded recommended levels of protein and lipids, making them the least nutritionally balanced. These results indicate that reducing animal-based protein sources in institutional menus could effectively lower carbon emissions while enhancing nutritional quality. Promoting plant-based alternatives and adjusting portion sizes of meat and fish can support both environmental sustainability and public health objectives.
- Nursing Practice Environments and Professional and Care-Related Outcomes in Portuguese Emergency Services: A Descriptive Study of 2018 and 2022Publication . Pragosa, Ângela; Roque, Sofia; Araújo, Beatriz; Jesus, ÉlvioBackground/Objectives: Emergency Services (ESs) are highly demanding clinical settings where Nursing Practice Environments (NPEs) play a critical role in shaping professional- and care-related outcomes. International evidence suggests that unfavorable NPEs are associated with reduced job satisfaction, compromised care quality, and increased safety risks. This study aimed to describe NPEs and selected professional and care-related outcomes among ESs nurses in Portugal in 2018 and 2022. Methods: A descriptive, cross-sectional study was conducted using data from two national surveys of ESs nurses collected in 2018 (n = 390) and 2022 (n = 434). Data were collected through an online questionnaire including the Practice Environment Scale of the Nursing Work Index (PES-NWI), measures of job satisfaction, intention to leave, perceived quality and safety of care, safety culture, incident occurrence, and missed nursing care. Descriptive statistics were used to summarize results across both samples. Results: NPEs were predominantly classified as unfavorable in both samples, with around 70% of nurses working in unfavorable environments. The most compromised dimensions were staffing and resource adequacy, nurses’ participation in hospital affairs, and nurse manager ability, leadership, and support of nurses. Job satisfaction was low in both samples, and a high proportion of nurses reported an intention to leave the organization. Differences were observed between samples in perceived quality and safety of care, incident occurrence, and missed nursing care, particularly in relational and autonomous interventions. Collegial nurse–physician relations emerged as the only favorable dimension in both samples. Conclusions: The findings indicate that NPEs in Portuguese ESs were predominantly unfavorable in both study periods, reflecting structural and organizational challenges. These findings may be associated with nurses’ professional outcomes and perceived care quality and safety, highlighting the importance of targeted organizational interventions to improve practice environments.
- Fundamentals of Care in a 1997 Azorean Disaster: A Multiple-Case StudyPublication . Pires, Eunice Gatinho; Baixinho, Cristina Lavareda; Henriques, Adriana; Costa, AndreiaBackground/Objectives: Disasters have a substantial impact on health systems and populations worldwide, with increasing frequency, mortality, and economic losses associated with natural hazards. The United Nations emphasises that disasters result from the interaction between hazards, exposure, and vulnerability, requiring integrated, people-centred health responses aligned with the 2030 Agenda. However, empirical evidence describing specific nursing interventions, particularly during response and recovery phases, is limited. This study aims to analyse the fundamental nursing care interventions provided to disaster victims in the Autonomous Region of Azores, Portugal. Methods: A qualitative multiple case study was conducted using documentary analysis of the nursing records from two disaster survivors with different clinical trajectories. Data were collected between August 2023 and May 2024 through complete transcription of nursing documentation contained in the clinical files. Data analysis followed Yin’s case study methodology and was theoretically supported by the Fundamentals of Care Framework. Results: The findings indicated a predominance of interventions addressing physiological needs during the acute phase, which progressively evolved to maintenance, psychosocial support, and adaptation needs during prolonged hospitalizations. Nursing care integrates advanced technical skills with relational and person-centred interventions, including emotional support, therapeutic communication, and promotion of patient autonomy. Conclusions: Nursing practice in disaster situations should be conceptualised as integrative, person-centred care grounded in international nursing frameworks. Strengthening disaster-specific nursing education, developing phase-adapted care protocols, and promoting multicentre longitudinal research appear to play a critical role for advancing nursing care models and informing health policies in disaster-prone regions.