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- Early identification of bladder diverticula in pre-hospital settings using screening sonography: a case reportPublication . Miravent, Sérgio; Gomes, Carla; Basescu, Andrea; Martins, Ana; Lobo, Manuel Duarte; Almeida, RuiObjective: Bladder diverticula, while not exceptionally rare in clinical practice, presents a significant diagnostic challenge, particularly in remote pre-hospital emergencies where technological limitations and the absence of specialized medical expertise prevail. This report aims to emphasize the role of screening ultrasound in the pre-hospital setting, Case Presentation: A patient experiencing severe lower abdominal pain presented at a basic emergency service (BES) for the third time presenting the same symptoms. Renal and pelvic ultrasound screening was performed, revealing suspected bladder distention and adjacent fluidfilled cavities, consistent with multiple bladder diverticula. Subsequently, the patient was referred to a referral central hospital for management by medical experts. Comprehensive evaluation confirmed the findings of the BES. Conclusion: The results of the screening ultrasound enabled the BES team to initiate clinical interventions to mitigate the patient’s discomfort. Screening ultrasound was crucial in identifying imaging markers that provided the physician with clinical data for correct and prompt patient orientation.
- Stress level of nursing students at the clinical practicum in the University of Aguascalientes (Mexico)Publication . De-Lira-Padilla, Griselda-Paulina; Vallín-López, Karen-Alondra; Compeán-Padilla, Violeta; Gago-Valiente, Francisco-Javier; Costa, Emília Isabel; Merino-Godoy, María-de-los-ÁngelesIntroduction: Coping with stress is a process that involves a particular relationship between the individual and his/her environment. Nursing students are exposed to stressful situations during their practical training, due to the responsibilities they take, which increase as they pass the semesters. The aim of this study was to identify the stress level in the clinical practicum of nursing students at the Autonomous University of Aguascalientes (UAA) (Mexico) in each semester, taking into account a series of sociodemographic variables. Methods: This study employs a quantitative, correlational, and comparative design with a non-experimental, cross-sectional approach. The sample consisted of 190 nursing students belonging to different semesters of the clinical practicum of the UAA. The KEZKAK instrument was used to gather data. Results: Moderate to high stress levels were reported by 70.2% of the participants, indicating a considerable prevalence of stress among the sample. With regard to the association of stress levels with each semester, it was observed that the seventh semester obtained the highest percentage of stress, with statistically significant differences (p < 0.001). Female students also reported higher stress levels than male students, although this difference was not statistically significant (p = 0.428). Discussion: Nursing students in the clinical practicum have moderate stress levels. The clinical practicum represents a transmission of knowledge that will help students to become professionals. Therefore, in order to fulfill their main goal of providing care to others, nursing students must take care of their own health.
- The Impact of Yoga practice on health, strength, and respiratory capacity in portuguese Airforce pilots: an applied psychophysiology and biofeedback approachPublication . Santos, Sara; Villafaina, Santos; Parraca, José Alberto; Orlando, Fernandes; Melo, FilipeTop performance in military aviation relies on strong health. Handgrip strength is key, showing overall strength and work capacity. Since rarefied air affects focus and mission success, respiratory training is essential. The impact of Ashtanga Vinyasa Yoga on Portuguese Air Force Academy pilots from the 2021 and 2022 classes was assessed, aiming to enhance health, lung capacity, and strength. A randomized controlled trial involved 18 individuals from the "Masters in Military Aeronautics: aviator pilot specialist". Participants were randomly assigned to yoga classes (intervention n=10) or a waiting list (control n=8). General health, strength, and respiratory capacity were measured using SF-36 questionnaire, a hand-grip dynamometer, and a spirometer, respectively, before and after a 12-week yoga program. Parametric and non-parametric tests were conducted using Jamovi (version 2.3.26). ClinicalTrials.gov identifier NCT05821270, registered on April 19, 2023.Revealed significant within-group differences pre- vs post-intervention for general health, handgrip strength, and FEV1%. There was a significant difference between groups for lung capacity.Yoga participants showcased superior results versus controls, suggesting yoga's positive impact. The yoga protocol, in conjunction with military training, positively affected health, strength, and lung performance, highlighting its operational benefits even in highly trained individuals.
- Yoga practice in mental health – An innovative lowcost solution for the portuguese airforcePublication . Melo, Filipe; Cabo, Carolina Alexandra; Espada, Mário C.; Fernandes, Orlando; Parraca, Jose A.; Santos, SaraBackground: Military aviation demands cognitive performance, emotional stability, and resilience under pressure (1). Yoga’s capacity to reduce stress and enhance mindfulness makes it a promising intervention for aviation pilots (2). Despite these potential benefits, research on yoga’s impact in military aviation re-mains limited. Purpose: This study investigates the incorporation of yoga into the training regimen of Portuguese military pilots for enhancing mindfulness, reducing stress and improving mental health. Methods: A randomized controlled trial with Portuguese Airforce pilots had the Control Group (n = 8), follow standard military aviation training, and the Intervention Group (n = 10), receive additional yoga training twice a week for 12 weeks. Cognitive/performance assessments included: Five Facet Mindfulness Questionnaire (3); Multidimensional Assessment of Interoceptive Awareness (4); Aviation Safety Attitude Scale (5); Risk Perception To Self (6); Trail Making Test (7). Data analysis used Jamovi v2.6.13. Results: Significant changes were found in FFMQ (Aware Actions and Non-Judgmental Inner Critic), MA-IA (Noticing, Attention Regulation, and Body Listening), ASAS (Self-Confidence, Risk Orientation, and Safety Orientation) and TMT (B) within the yoga group. Discussion: Significant improvements in mindfulness (FFMQ) and interoceptive awareness (MAIA) sug-gest that yoga fosters better self-regulation and stress management (8). Enhanced cognitive flexibility (TMTB) performance, highlights yoga’s potential to bolster decision-making under pressure. Gains in safe-ty-related attitudes paired with risk-related attitudes (ASAS) underscore yoga’s role in promoting calculat-ed-risk confident behaviour, critical for operational safety. Implementing yoga programs could yield wide-spread benefits, including better mental health among aviation pilots. Conclusion: This research offers a unique contribution: studying the hard-to-access population of military aviation pilots, due to security and workload constraints. Results could influence policymakers to imple-ment mandatory exercise programs, enhancing work safety, with low cost and minimally time-consuming interventions. These insights are also applicable to Airforce teams in other nations, commercial and civil aviation sectors, as well as high stress/high-performance sports.
- Does a 12-week yoga program influence the decision-making capacity of military aviation pilots?Publication . Santos, Sara; Fernandes, Orlando; Cabo, Carolina A.; Parraca, José A.; Melo, FilipeDoes a 12-week yoga program influence the decision-making capacity of military aviation pilots? Rationale and aims: This study investigates whether the incorporation of yoga practice into the training regimen of Portuguese Airforce Aviation Pilots can enhance their decision-making capacity, in order to promote better occupational health safety. Methods: A randomized controlled trial with Portuguese Airforce pilots had the Control Group (n = 8), follow standard military aviation training, and the Intervention Group (n = 10), receive additional yoga training twice a week for 12 weeks. Cognitive/performance assessments included the Aviation Safety Attitude Scale (ASAS). The procedures were approved by the Évora University research ethics committee (approval number: 21050), and participants gave written informed consent per the Helsinki declaration. The study was registered on April 19, 2023, on ClinicalTrials.gov (identifier NCT05821270). Analysis: Data analysis used Jamovi (version 2.3.16). Normality was assessed with the Shapiro-Wilk test, non-parametric data analysis used Wilcoxon rank test and Rank Biserial Correlation for effect sizes. Statistical significance was generally determined with a threshold of 0.05. Findings: Results showed significant differences in ASAS: it indicated significant increases in Self-Confidence (p = 0.021), Risk Orientation (p = 0.024), and Safety Orientation (p = 0.021) within the yoga group. Conclusions: This research offers a unique contribution: studying the hard-to-access population of military aviation pilots, due to security and workload constraints. Portuguese Airforce pilots, facing high stress and lacking a structured training regimen, will benefit from the findings of this study. Results could influence policymakers to implement mandatory exercise programs, enhancing work safety. These insights are also applicable to Airforce teams in other nations, commercial and civil aviation sectors.
- Yoga como ferramenta de otimização psicofisiológica no treino de pilotos – contributos e perspetivas futurasPublication . Santos, Sara; Melo, Filipe; Cabo, Carolina; Espada, Mário; Fernandes, Orlando; Parraça, JoséA profissão de piloto de aviação militar exige um sistema vestibular eficiente para a manutenção do equilíbrio e respostas rápidas ao stress (Yang et al., 2015; Wittels et al., 2024). • Fatores como fadiga, hipóxia, forças G, exposição ambiental e aumento do stress psicofisiológico afetam a tomada de decisão (Whitley, 1997; Koskelo et al., 2024). • A transformação tecnológica no setor da aviação intensificou as exigências sobre os pilotos, impondo desafios às capacidades de autorregulação, atenção e tomada de decisão (Koskelo et al., 2024).
- Otimizando a adaptação e performance de pilotos militares na Era TecnológicaPublication . Santos, Sara; Fernandes, Orlando; Parraça, José; Melo, FilipeA profissão de piloto militar é altamente especializada, exigindo um sistema vestibular eficiente e uma resposta rápida a situações de stress (Yang et al., 2015; Wittels et al., 2024). Fatores como stress fisiológico, fadiga e desorientação espacial são intensificados pela evolução tecnológica das aeronaves e simuladores de voo, que, embora cruciais para o treino, podem induzir efeitos colaterais (Whitley, 1997; Koskelo et al., 2024). Estes desafios sublinham a necessidade de novas abordagens para otimizar a adaptação e a performance humana face à transformação tecnológica. Objetivo: Este estudo investigou se uma intervenção de 12 semanas de Ashtanga-Vinyasa Yoga Supta (AVYS) pode melhorar o desempenho e a segurança em voo de pilotos da Força Aérea Portuguesa, com o intuito de aprimorar a sua adaptação e performance num ambiente tecnologicamente exigente. Método: Foi realizado um Ensaio Clínico Randomizado com pilotos da Força Aérea Portuguesa. O grupo de intervenção praticou AVYS (com olhos fechados) duas vezes por semana. A avaliação do desempenho e adaptação incluiu a resposta a uma emergência em simulador de voo, biossensores para variabilidade da frequência cardíaca (Polar H10), além de questionários validados. Figura 1. Abstract gráfico do artigo de Metodologia do protocolo entre a Força Aérea Portuguesa e a Universidade de Évora já publicado na Frontiers in Public Health e Metodologia da intervenção AVYS. Resultados: O AVYS levou à redução significativa no número de erros em simulação de voo, melhorou a resiliência ao stress através da variabilidade da frequência cardíaca, e otimizou a flexibilidade cognitiva. Estes resultados indicam que o AVYS aprimora a performance e a segurança em ambientes de alta pressão, mesmo em indivíduos já altamente treinados. Figura 2. Abstract gráfico do artigo de Ensaio
- Telehealth for integrated cardiovascular and diabetes management: a scoping reviewPublication . Estêvão, Maria Dulce da Mota Antunes de Oliveira ; Teotónio Fernandes, Mónica Alexandra; De Sousa-Coelho, Ana Luísa; Neto Espírito-Santo, Margarida de Fátima; Nascimento, Tânia; Alfredo CaturanoCardiovascular disease (CVD) and diabetes mellitus represent major global health challenges, frequently co-occurring and mutually exacerbating. Telehealth interventions offer a promising approach for their management, with potential to improve patient outcomes, enhance access to care, and increase cost-effectiveness. This review synthesized existing evidence from randomized controlled trials (RCTs) and observational studies to evaluate the effectiveness of telehealth interventions for the management of diabetes, focusing on CVD risk, and to identify critical research gaps. A systematic literature search was conducted across major databases (PubMed, Web of Science, and Scopus) to identify studies meeting predefined eligibility criteria, considering digital tools for remote monitoring, consultation, education, and medication management. After the screening of 3041 articles, six studies met the inclusion criteria. Telehealth interventions utilized a range of digital health tools, including mobile applications, artificial intelligence–powered clinical decision aids, electronic consultations, and integrated remote monitoring platforms. Although direct assessment of composite cardiovascular risk was largely absent, the included studies reported several clinical parameters associated with cardiovascular health, namely, blood pressure, lipid profile, and glycated hemoglobin. Telehealth interventions implemented for individuals with Type 2 diabetes mellitus demonstrated promising potential in improving glycemic control and supporting self-management. However, their effectiveness in managing broader cardiovascular risk factors remains less clear due to inconsistent reporting and heterogeneous intervention designs.
- The effect of nutritional intervention in nutritional risk screening on hospitalised lung cancer patientsPublication . de Oliveira, Raquel; Cabrita, Bruno; Cunha, Ângela; Silva, Sónia; Lima, João P. M.; Martins, Diana; Mendes, FernandoBackground: Lung cancer (LC) patients are prone to suffer from malnutrition. Malnutrition negatively affects patients’ response to therapy, increases the incidence of treatment-related side effects, and decreases survival. Early identification of LC patients who are malnourished or at risk of malnutrition can promote recovery and improve prognosis. Objective: This study aimed to assess the risk and nutritional status of lung cancer patients who are hospitalised, as well as to evaluate the impact of nutritional intervention on the risk of malnutrition. Methods: From January 2022 to December 2023, 53 LC patients hospitalised in a pulmonology department had their nutritional risk (initial and final) and nutritional status (initial) assessed. All were selected for nutritional intervention. Nutrition counselling was the first intervention option, along with dietary changes with/without oral nutritional supplements. Results: At the time of hospitalisation, 90.6% of the patients were at nutritional risk, 45.3% were classified as moderately malnourished, and 35.8% were classified as severely underweight. After the hospitalisation, 73.6% were at nutritional risk at the time of discharge, suggesting a statistically significant decrease in the number of patients with nutritional risk. Conclusions: Most LC patients hospitalised presented an altered nutritional status. Our study suggests that a nutritional intervention must be implemented to reduce malnutrition risk, which may impact prognosis. The comprehensive nutritional problems experienced by LC patients require nutritional assessment and improved individually tailored nutritional support.
- High vs low protein intake in chronic critical illness: a systematic review and meta-analysisPublication . Castro, Sílvia; Tome, Ana Maria; Granja, C.; Macedo, A.; Binnie, AlexandraBackground & aims: Patients with persistent organ dysfunction after the first week of intensive care unit (ICU) admission are considered to have chronic critical illness (CCI). Acquired muscle weakness is a common feature of CCI that is accompanied by loss of muscle mass and electromyographic features of myopathy. Optimizing protein intake may help prevent acquired muscle weakness and/or promote muscle recovery, however, the optimal level of protein intake in CCI is uncertain and there is a lack of consensus in published nutritional guidelines. This systematic review focuses on the impact of high versus low protein intake as part of a nutritional strategy for patients with CCI. Methods: The terms “protein intake” and “critically ill” were systematically searched in PUBMED, CENTRAL (Cochrane Central Register of Controlled Trials), and WEB OF SCIENCE on 06/01/2023. We included studies that (1) enrolled critically ill adults (aged 18 years or over) who were in the ICU for more than 7 days and that compared (2) protein intake above and below 1.3 gr/kg administered by any route (enteral and/or parenteral), (3) had an intervention period that occurred primarily after the first 7 days of critical illness and (4) reported clinical outcomes including length of ICU and hospital stay, duration of invasive mechanical ventilation (IMV), mortality, ICU acquired infections, muscle mass and physical function. Studies pertaining to elective surgery, those with intervention periods shorter than 7 days or occurring primarily within the first 7 days of critical illness, those measuring only laboratory parameters as outcomes, and safety and feasibility studies were excluded. Results: Four studies were included (N ¼ 1730) in the meta-analysis and systematic review. Higher (>1.3 g/kg/d) versus lower protein intake was associated with a decrease in early mortality (defined as ICU or 28-day mortality) hazard ratio (HR) 0.42 (95 % confidence interval (CI): 0.26e0.70, P < 0.001), but had no impact on late mortality (defined as the latest mortality timepoint in each study): HR 0.93 (95 % CI 0.76e1.15, P ¼ 0.51). There was no significant difference between intervention and control groups with respect to duration of IMV, duration of ICU or hospital stay, muscle mass, or the incidence of ICUacquired infections. One study reported improvements in physical function at 3 and 6 months in the intervention group. Conclusion: After the first week of critical illness, increasing protein intake to >1.3 g/kg/d may improve early mortality but not late mortality or other clinical outcomes. The small number of relevant studies and the heterogeneity of outcomes assessed, weaken these conclusions. Further studies are warranted to discern whether higher protein intake is beneficial in chronic critical illness. PROSPERO registration number: CRD42023403554; PROSPERO registration name: “The effect of higher than 1,3 g/kg of protein versus lower intake in chronic critically ill patients”