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- Game-based balance training in older adults: systematic review and meta-analysisPublication . Tome, Ana Maria; Castro, Sílvia; Rosa, Marlene; Tomás, Maria Teresa; de Almeida Fontes, Ana Paula; 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
- Conventional, specific, and robotic instrumentation in total knee arthroplasty. How are we progressing in functional outcomes and patient satisfaction?Publication . de Almeida Fontes, Ana Paula; Sousa, João PauloIn recent years, technological advances in total knee arthroplasty (TKA) have made procedures more precise, reducing complications and accelerating recovery. Although the latest techniques offer several advantages, there are still doubts regarding their true functional efficacy and the level of patient satisfaction they provide. Methods: A retrospective study involving 1,076 patients, distributed as follows: 366 (34.0%) conventional instrumentation (CI), 591 (54.9%) Patient-Specific Instrumentation (PSI), and 119 (11.1%) robotics. All functional outcomes were assessed preoperatively and 90 days postoperatively. Bivariate analyses were performed using ANOVA and the Kruskal- Wallis test, with a significance level of p < 0.05. Results: At 90 days, the robotics maintained the greatest flexion range (p = 0.001) and outperformed the PSI and IC in the walking test (350.3 ± 102.1 vs. 312.5 ± 92.9 and 283.8 ± 84.8, respectively; p < 0.001). On the WOMAC test, PSI performed best (14.5 ± 10.6; p = 0.001), with IC and robotics showing similar results (p = 0.974). There was no difference between the groups in absolute gains. In terms of percentage gains, PSI was higher in WOMAC compared to IC (p=0.041) and robotics (p<0.001). Satisfaction was identical between the instrumentation methods (p=0.199). Conclusion: Absolute gains in functional evolution and satisfaction appear to be independent of the surgical technique, although PSI appears to offer improvements in functional activities. Given the still-limited experience with robotic surgery, the functional benefits and long-term satisfaction remain inconclusive.
- Prevalência de lesões músculo-esqueléticas nos membros inferiores e cinemática da marcha: um estudo exploratório em trabalhadores de restaurantes.Publication . de Almeida Fontes, Ana Paula; Jesus, Cláudia; Cavaco, AdrianaIntrodução: As lesões músculo-esqueléticas relacionadas com o trabalho são um problema relevante e prevalente mundialmente. São poucas as investigações que se têm dedicado ao estudo destas na área da restauração, sobretudo ao nível dos membros inferiores, facto que se deve fundamentalmente à dificuldade no recrutamento de trabalhadores do setor e à elevada rotatividade dos mesmos. Por outro lado, sendo a marcha uma atividade determinante para a atividade destes trabalhadores, não foram encontrados estudos que relacionem a prevalência destas lesões nesta área corporal e o desempenho motor da marcha. Objetivos: Conhecer a prevalência destas patologias e a sua correlação com a cinemática da marcha, em trabalhadores do setor da restauração, com funções na Cozinha/Copa e na Sala de Refeições. Metodologia: Trata-se de um estudo observacional, do tipo analítico e transversal. A recolha de dados foi efetuada através de um questionário sociodemográfico e de saúde, pelo Questionário Nórdico Músculo-Esquelético e por passadeira barométrica. Resultados: A amostra incluiu 50 trabalhadores, com idade média de 30,4±11,1 anos, sendo 24 (48%) mulheres. De forma global a prevalência mais elevada de sintomatologia observou-se na coluna lombar, joelhos e pés. A intensidade da dor nestes segmentos foi superior nos trabalhadores da Cozinha/Copa (p=0,032; p=0,014; p=0,041). A pressão plantar e o comprimento do passo foi superior nos trabalhadores da Sala (p=0,026; p=0,009). A correlação entre as variáveis sociodemográficas e de saúde e a prevalência de sintomas compatíveis com eventuais lesões músculo-esqueléticas variaram de acordo com o posto de trabalho, ocorrendo a mesma observação relativamente às variáveis cinemáticas da marcha. Conclusão: A presença da sintomatologia nos trabalhadores da restauração, recolhida pelo questionário de saúde e pelo Questionário Nórdico Músculo-Esquelético foi elevada na coluna lombar, joelhos e pés. A intensidade da dor e os padrões da marcha variaram entre os postos de trabalho, cuja associação se prende com as caraterísticas dos indivíduos e as especificidades do desempenho laboral.
- 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