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- Bioengineered 3D microvessels and complementary animal models reveal mechanisms of Trypanosoma congolense sequestrationPublication . Porqueddu, Teresa; Zorrinho-Almeida, Maria; Niz, Mariana De; Casas-Sánchez, Aitor; Introini, Viola; Sender, Silvia Sanz; Carrasqueira, Diana; Figueiredo, Luísa M.; Bernabeu, Maria; Pereira, Sara SilvaIn the mammalian host, Trypanosoma congolense cytoadheres, or sequesters, to the vascular endothelium. Although sequestration influences clinical outcome, disease severity and organ pathology, its determinants and mediators remain unknown. Challenges such as the variability of animal models, the only-recently developed tools to genetically manipulate the parasite, and the lack of physiologically-relevant in vitro models have hindered progress. Here, we engineered brain and cardiac 3D bovine endothelial microvessel models that mimic the bovine brain microvasculature and the bovine aorta, respectively. By perfusing these models with two T. congolense strains, we investigated the roles of flow for parasite sequestration and tropism for different endothelial beds. We discovered that sequestration is dependent on cyclic adenosine monophosphate (cAMP) signalling, closely linked to parasite proliferation, but not associated with parasite transmission to the tsetse fly vector. Finally, by comparing the expression profiles of sequestered and non-sequestered parasites collected from a rodent model, we showed gene expression changes in sequestered parasites, including of surface variant antigens. This work presents a physiologically-relevant platform to study trypanosome interactions with the vasculature and provides a deeper understanding of the molecular and biophysical mechanisms underlying T. congolense sequestration.
- Patients’ perception of medical care in the hospital environment: the reasons of non-hospitalityPublication . Castelhano, Laura Marques; Guimarães, Gilberto de Araújo; Baptista, IsabelBackground: The medical care provided by the physician is an important part of the hospital scene and the action of caring. Assessments of the physician-patient meeting are based on welcome and the physician’s ability to be perceived as hospitable by the patient. By definition, to be hospitable is to have the ability to welcome, care for, reassure, and be courteous, respectful, and trustworthy. This article aims to understand patients’ perceptions of medical care perceived as not hospitable, characterized by a lack of care and welcome, in a hospital environment, based on a complaint’s website. Method: The research method used was qualitative analysis and the research strategy was documentary research. The data were collected on a complaints registration platform. The theoretical framework used was the theory of Hospitality. The study selected, coded, and categorized the complaints of 127 patients at the 09 most renowned private hospitals in Brazil. The Voyant tools assisted in the textual analysis of complaints while coding classified them into categories. Results: After evaluating the reasons and elements of the complaint, the following was analyzed the encounter characterized as hostile and inhospitable and the attitudes perceived by the patients were grouped into what was defined as “the 4 D’s of non-hospitality”: dehumanization, disregard, dereliction of duty, and disability. Each of the attitudes was characterized by the physician’s behavior and the sensations, emotions, and feelings triggered in the patient. Conclusions: Patients’ perception of the not hospitable encounter may be hostile or inhospitable. The physician’s attitude is an important criterion for evaluating the encounter. The physician’s attitude and the form of care are key factors in a culture focused on hospitality in the hospital environment. Hostile and inhospitable attitudes affect the physician-patient relationship and may compromise the patient’s well-being.
- Understanding the effect of the caring dimension of PYD on depression: the role of positive and negative affect regulation strategies in Spanish emerging adultsPublication . Gomez-Baya, Diego; Matos, Margarida Gaspar de; Wiium, NoraBackground: Positive Youth Development (PYD) has been associated with positive results in the transition to adulthood. Within the 5Cs model of PYD, the Caring dimension has been defined as the ability to feel sympathy and empathy towards others. However, the literature has shown some controversial results on the role of Caring in the psychological adjustment of young people. The aim of this study was to analyze the mediating role of strategies for coping with negative affect (i.e., distraction and depressive rumination) and strategies for coping with positive affect (i.e., dampening and positive rumination) in the relationship between Caring and depressive symptoms. We examined gender differences as well. Methods: A cross-sectional self-report study was carried out in 2021, with a sample of 1,040 young people (75.5% females; Age range = 18–28; Mage = 20.47, SD = 3.08), enrolled at 11 universities in Spain. Multiple partial mediation analysis was performed to examine the mediation of responses to positive and negative affect in the relationship between Caring and depression, and a path analysis was developed to integrate gender effects. Results: The results indicated that Caring was positively associated with more depressive symptoms through maladaptive affect responses, i.e., more depressive rumination, more inhibition of positive affect, less distraction and less positive rumination. On the contrary, a more adaptive regulation of the affect was associated with less depression. Gender differences were observed, where women scored higher in Caring, depressive rumination and dampening. Discussion: Some practical implications may be derived from these results. The role of Caring as an expression of sympathy and empathy can have a protective effect on psychological adjustment through the use adaptive skills to manage positive and negative affect. Programs integrating Caring dimension of PYD and emotional regulation skills training should be designed in university context, so that psychological adjustment can be maximized among university students and that the students, especially, females can be able to care for others as well as themselves.
- Comparison between tooth-derived matrix and DBBM granules on an enhanced bone healingPublication . Cifreda, Victor; Fidalgo-Pereira, Rita; Henriques, Bruno; Teughels, Wim; Özcan, Mutlu; Souza, Júlio C. M.Purpose of the Review: The purpose of this study was to perform a scoping review on the comparison between tooth-derived matrix and demineralized bovine bone mineral (DBBM) granules for enhanced bone healing. Recent Findings: Previous studies reported micro-scale pores in dentin-matrix granules due to the remnant dentin that promote the adsorption of proteins and bioactive molecules. It should be highlighted the remnant dentin is an intrinsic source of collagen and growth factors such as TGF-1, BMP-2, VEGF, and PDGF. The DBBM showed macro-scale interconnected pores which enhances the adhesion of cells and formation of new blood vessels. DBBM also revealed a porosity of around 80% and a lower resorption rate when compared to tooth-derived granules. On in vivo models, dentin-matrix granules induced quite similar results for bone growth when compared to grafting with DBBM as confirmed by histological analyses. Summary: The dentin-derived matrix granules showed morphological aspects and chemical composition suitable for enhancing bone repair comparable to the effects of deproteinized bovine bone mineral granules. The adequate space among particles and size of pores plays a key role in the events of bone formation since the protein adsorption towards the bone growth. Also, a well-adjusted content of DBBM and dentin-derived granules in the mixture maintains the bone volume over the bone healing. Thus, autologous dentin-derived granules are alternative materials for bone healing without any adverse inflammatory reactions.
- Oral health in inflammatory bowel disease: the overlooked impact and the potential role of salivary calprotectinPublication . Rodrigues, Cláudio; Gomes, Ana T. P. C.; Leal, Joana; Pereira, Pedro; Lopes, Pedro C.; Mendes, Karina; Correia, Maria J.; Veiga, Nélio; Rosa, Nuno; Soares, Caroline; Ministro, PaulaBackground: Inflammatory Bowel Disease (IBD), a chronic condition characterized by gastrointestinal inflammation, is influenced by genetic and environmental factors. Emerging evidence suggests a “mouth-gut axis,” with the oral cavity reflecting extra-intestinal manifestations of IBD. This study evaluated the oral health status of IBD patients and the potential of salivary calprotectin (SCP) as a biomarker for assessing IBD activity and oral health. Methods: Oral health was assessed in 100 IBD patients [60 with Crohn’s disease (CD) and 40 with ulcerative colitis (UC)] and 14 controls. Evaluations included the Decayed, Missing, and Filled Teeth (DMFT) Score, Periodontal Diagnosis and the need for dental or prosthetic treatment. Saliva and stool samples were collected to measure SCP and faecal calprotectin (FCP) levels using the Elia Calprotectin 2 Test. IBD activity was evaluated with FCP, the Harvey-Bradshaw Index for CD, and the Partial Mayo Score for UC. Results: The DMFT index mean was comparable between IBD patients (mean 7.99, SD 7.73) and controls (mean 10.00, SD 6.49). However, periodontal disease was significantly more prevalent in IBD patients (57% in CD, 70% in UC) than in controls (29%), with severe cases (stages III/IV) more frequent in IBD. Additionally, 89% of IBD patients required dental treatment, and 39% needed prosthetic rehabilitation. SCP levels showed no significant correlation with disease activity or oral health status, while FCP correlated with C-reactive protein and erythrocyte sedimentation rate. Conclusions: This study underscores the need for improved oral health management in IBD patients and suggests that SCP may not be a reliable biomarker for monitoring IBD or periodontal disease.
- Development and validation of a comfort-measuring scale for elderly individuals with chronic conditionsPublication . Marques, Rita; Veludo, Filipa; Sousa, Patrícia Pontífice; Dixe, Maria dos AnjosBackground: Ageing is associated with chronic diseases and successive losses, which affect the comfort experienced by the elderly. Hence, in that population, comfort must be viewed as a need, and health care professionals (particularly nurses) should promote it through their interventions. This work aimed at developing a scale to assess comfort in elderly individuals with chronic conditions and determining the aforesaid scale’s psychometric characteristics (validity and reliability), while ascertaining the comfort levels experienced by the participants. Methods: Our sample comprised 454 chronically ill elderly individuals, either hospitalized, or in residential care/at home. As regards descriptive statistics, we calculated various summary measures. Validity was appraised via exploratory factor analysis, considering the main components. We performed varimax rotation and factor extraction (in which factors with eigenvalues > 1 were extracted). Reliability was established by calculating internal consistency, using Cronbach’s alpha. For each scale item, we examined the corrected item-test correlation. Additionally, we calculated skewness and kurtosis, also carrying out a confirmatory factor analysis. Results: The exploratory factor analysis produced a scale with 38 items and five factors, which fitted the data and explained a variance of 61.355%. The values of the Kaiser-Meyer-Olkin test and the Bartlett’s test (sphericity) were 0.943 and 12055.962, respectively (both with p < 0.001). Our model was substantiated by the confirmatory factor analysis (χ² = 2884.242; df = 660; RMSEA = 0.086; CFI = 0.811; TLI = 0.798; SRMR = 0.066) and the Cronbach’s alpha coefficient was 0.959. The summary measures showed that, overall, the participants experienced good comfort levels (Mean = 3.64; SD = ±0.676), revealing higher comfort levels in the “Spirituality and meaning of life” dimension (Mean = 3.79; SD = ±0.742) and lower comfort levels in the “Normality of life” dimension (Mean = 3.39; SD = ±0.922). Conclusion: The scale demonstrated suitable psychometric properties, ensuring its validity and reliability in assessing comfort in elderly individuals with chronic conditions. Its five-factor structure enables a comprehensive evaluation, highlighting key comfort dimensions. These findings support targeted interventions, aiding healthcare professionals in improving care and informing evidence-based practices and health policies to enhance well-being. Implications for nursing and health policy: By measuring comfort levels in chronically ill elderly individuals, it is possible to plan/improve the comforting care provided by the involved professionals (namely nurses). Clinical trial number: Not applicable.
- The role of community pharmacists in managing common headache disorders, and their integration within structured headache services: position statement on behalf of the European Headache Federation (EHF) and Lifting The Burden (LTB: the Global Campaign against Headache), with the formal endorsement of the International Pharmaceutical FederationPublication . BaniHani, Heba; Lampl, Christian; MaassenvandenBrink, Antoinette; Amin, Faisal Mohammad; Carlsen, Louise Ninett; Coppola, Gianluca; Deligianni, Christina; Gil-Gouveia, Raquel; Holland, Philip R.; Husøy, Andreas K.; Jensen, Rigmor; Plácido, Madalena; Reuter, Uwe; Ryliškienė, Kristina; Río, Margarita Sanchez del; Schytz, Henrik Winther; Tronvik, Erling; Versijpt, Jan; Steiner, Timothy J.In the sustainable development goals (SDG) context of seeking universal health coverage, the expanding gap between the supply of specialized and primary health-care providers of headache-related health care and the care needs of the very large number of people affected by headache is a formidable but not insoluble public-health challenge. Structured headache services provide a cost-effective framework wherein controlled patient flows enable the care needs of people with headache to be met at appropriate levels, but these services may still be overwhelmed by inappropriate demand. Community pharmacists are an underutilized resource, potentially well able to provide the solution. To do so, they must, as a profession, be integrated into structured headache services. What remains to be determined is how to achieve this integration in an encouraging climate for change, which recognises the potential for relieving strained health-care systems and meeting a range of health-care needs by expanding pharmacists’ scope of practice. This position statement on behalf of the European Headache Federation (EHF) and Lifting The Burden (LTB) is formally endorsed by the International Pharmaceutical Federation (FIP).
- Assessing the psychometric properties and validating the Portuguese version of the INSPIRE measure of staff support for personal recovery in PortugalPublication . Silva, Manuela; Aluh, Deborah Oyine; Lourenço, Ana; Resende, Beatriz; Agostinho, Francisco; Rodrigues, João Bessa; Azenha, João Pedro; Lopes, João Revez; Ribeiro, Marta; Heitor, Maria João; Gago, Joaquim; Cardoso, GraçaBackground: The importance of mental health services that support a recovery-oriented approach is increasingly recognized, and measures that evaluate this practice and promote change over time are needed. The INSPIRE measure is a 27-item questionnaire designed to assess service users’ perceptions of the support received from health professionals in their personal recovery. This study aimed to validate the Portuguese version of INSPIRE and assess its psychometric properties as a measure of staff support for personal recovery. Methods: The questionnaire survey was conducted from October 2023 to February 2024. Service users completed the Portuguese version of INSPIRE, the Client Satisfaction Questionnaire (CSQ-8), and a demographic and clinical questionnaire. Internal consistency was assessed using Cronbach’s alpha and McDonald’s model-based Omega. Test-retest reliability was assessed through the intraclass correlation coefficient (ICC) and weighted kappa. Convergent validity was examined by assessing correlation with CSQ-8. Factor validity was evaluated using exploratory factor analysis (EFA), with confirmatory factor analysis (CFA) performed to test the fit of factor structures derived from the EFA. Results: The study included 165 participants from seven psychosocial rehabilitation units which primarily target persons with a severe mental illness. For test–retest evaluation, 52 participants completed the questionnaire a second time. Internal consistency was satisfactory across all subscales and dimensions of the Support subscale, except for the Identity domain, which had marginally acceptable values. INSPIRE demonstrated significant positive correlations with CSQ-8 scores, supporting its convergent validity. EFA identified five factors for the Support scale and one factor for the Relationship scale, explaining 62% and 59% of the cumulative variance, respectively. CFA confirmed a good model fit for the Relationship scale and all Support subscales, except for the Identity and Empowerment subscales. Conclusions: The Portuguese version of INSPIRE showed strong internal consistency, as well as convergent and factor validity. This validated instrument can be applied in research and clinical settings to assess staff support for personal recovery and promote recovery-oriented mental health practices. Clinical trial number: Not applicable.
- Evaluation of inhibitory control and attentional bias through eye-tracking: a modified emotional stop-signal taskPublication . Barros, Gonçalo; Ribeiro, FilipaObsessive-compulsive disorder (OCD) is characterized by deficits in inhibitory control and attentional processes. The emotional nature of stimuli can significantly influence these cognitive processes, yet traditional paradigms assessing inhibitory responses, such as the Stop-Signal Task, typically neglect emotional stimuli. This limitation reduces their capacity to capture the cognitive impairments associated with OCD fully. To address this gap, we introduce the Modified Emotional Stop-Signal Task (MESST), a novel paradigm designed to concurrently evaluate inhibitory control and attentional biases through eye-tracking technology. MESST integrates emotionally evocative stimuli into a standard stop-signal framework, allowing simultaneous measurement of Stop-Signal Reaction Time (SSRT) and attentional metrics such as latency to first fixation and total dwell time. Additionally, participants complete validated psychological scales—the State-Trait Anxiety Inventory (STAI), Barratt Impulsiveness Scale (BIS-11), and Obsessive-Compulsive Inventory–Revised (OCI-R)—providing detailed characterization of impulsivity and anxiety traits. Suitable for normative and clinical populations, MESST facilitates the investigation of interactions between emotional processing, cognitive control, and attentional biases, thereby advancing our understanding of the cognitive-emotional mechanisms underlying OCD and related disorders. • Integrates emotional stimuli into a standard inhibitory control paradigm. • Measures attentional processes concurrently via high-frequency eye-tracking. • Applicable to both clinical and non-clinical populations.
- Longitudinal assessment of migraine burden in resistant and refractory migraine – data from the prospective REFINE studyPublication . Pensato, Umberto; Ornello, Raffaele; Rosignoli, Chiara; Caponnetto, Valeria; Onofri, Agnese; Braschinsky, Mark; Sved, Olga; Gil-Gouveia, Raquel; Oliveira, Renato; Lampl, Christian; Paungarttner, Jakob; Martelletti, Paolo; Wells-Gatnik, William David; Martins, Isabel Pavao; Mitsikostas, Dimos D.; Apostolakopoulou, Loukia; Ozge, Aynur; Narin, Dilan Bayar; Pozo-Rosich, Patricia; Munoz-Vendrell, Albert; Prudenzano, Maria Pia; Gentile, Martino; Ryliskiene, Kristina; Vainauskiene, Jurgita; Sanchez-del-Rio, Margarita; Vernieri, Fabrizio; Iaccarino, Gianmarco; Waliszewska-Prosół, Marta; Budrewicz, Sławomir; Carnovali, Marta; Katsarava, Zaza; Sacco, SimonaBackground: Some individuals with migraine fail to respond adequately to preventive treatments, bearing most of migraine burden. The European Headache Federation (EHF) classifies these individuals into resistant migraine (ResM) or refractory migraine (RefM) according to treatment failures, debilitating headache days, and disease duration. We investigated the evolution of these categories over six months in patients treated at tertiary headache centers and whether they accurately reflect disability and burden. Methods: Participants from the multicenter, prospective REFINE study were classified into three categories of treatment responsiveness, namely RefM, ResM, and non-refractory non-resistant migraine (NRNRM). The primary objective was to determine the trajectories of category changes over six months. Secondary outcomes included changes in the 6-item Headache Impact Test (HIT-6), Headache-Attributed Lost Time (HALT), and Hospital Anxiety and Depression Scale (HADS-A and HADS-D) scores. Results: Overall, 489 participants were included with a median age of 45 years (IQR = 36–53); 389 participants (79.7%) were female; 256 (52.4%) had NRNRM, 178 (36.4%) ResM, and 55 (11.2%) RefM. At follow-up, 200/256 (78.1%) NRNRM remained stable, while 56/256 (21.9%) progressed to ResM. Among those with ResM, 98/178 (55.1%) remained stable, 72/178 (40.5%) improved to NRNRM, and 8/178 (4.5%) worsened to RefM. Among participants with RefM, 37/55 (67.3%) remained stable, while 18/55 (32.7%) improved to NRNRM. Participants with RefM and ResM presented significantly higher scores at baseline than those with NRNRM. Over time, HIT-6, HALT, and HADS-A scores improved substantially in the overall cohort (p < 0.001, p < 0.001, and p = 0.006, respectively). Improvements were observed in participants with ResM across all scores and HIT-6 and HALT for NRNRM, but no improvement was noted in participants with RefM. Conclusions: Over six months, ~ 40% of ResM and ~ 30% of RefM individuals improved to NRNRM, while ~ 20% of NRNRM developed treatment resistance after receiving care in tertiary headache centers. Participants with ResM had a better prognosis than those with RefM. While both ResM and RefM reflect high migraine disability burden, they might present relevant differences in their management and prognosis.