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- Adaptação Cultural e Validação do Maastricht Upper Extremity Questionnaire (MUEQ) para o Português EuropeuPublication . Valente, Ana Filipa de Sousa; Basílio, Andreia Teixeira Marques Dionísio; Silva, Paulo César LopesEste estudo teve como objetivo adaptar culturalmente e validar o Maastricht Upper Extre-mity Questionnaire (MUEQ) para a população portuguesa, tornando-o num instrumento confiável para avaliar riscos físicos e psicossociais em trabalhadores que utilizam Equipa-mentos Dotados de Visor (EDV). Seguiram-se as recomendações de Beaton et al. (2000) e as diretrizes constantes no Consensus-Based Standart for the Selection of Health Mesu-rement Instruments (COSMIN), realizando tradução, retroversão e pré-teste. Este estudo envolveu 450 participantes de uma Unidade Local de Saúde (ULS) do Serviço Nacional de Saúde (SNS). O MUEQ-Pt demonstrou elevada concordância entre especialistas (AC1 > 0,81), boa consistência interna (ICC = 0,811) e alfa de Cronbach aceitável (0,725). A vali-dade de construto foi confirmada por análise fatorial exploratória (AFE), com variância acu-mulada dos domínios obtidos, entre 10% e 80%. Os resultados indicam que o MUEQ-Pt é uma ferramenta válida e confiável para avaliar riscos ocupacionais na população portuguesa.
- Diagnosis of Stable Coronary Disease by Computed Tomography Angiography as a first-line test:Cost Analysis in an Integrated Responsibility CenterPublication . Russo, Cláudia Sofia Mendes Magro; Patrício, Lino; Oliveira, SandraA melhoria da eficiência no setor da saúde é essencial para reduzir falhas nos serviços e assegurar cuidados de qualidade aos utentes do Serviço Nacional de Saúde (SNS), otimizando os recursos limitados. Em Portugal, a incidência de enfarte agudo do miocárdio (EAM) tem aumentado devido à prevalência de fatores de risco cardiovascular, muitos dos quais poderiam ser prevenidos com uma gestão adequada, adoção de hábitos saudáveis e um diagnóstico precoce por imagem. A angiografia por tomografia computorizada cardíaca (Angio TC) tem-se revelado uma ferramenta eficaz no diagnóstico da doença coronária (DC), permitindo calcular o score de cálcio das artérias coronárias e identificar outras patologias importantes. Este exame não invasivo pode substituir métodos convencionais, avaliando o fluxo arterial em tempo real. Este projeto avalia a viabilidade económica de implementar a Angio TC como exame de primeira linha para diagnóstico de DC estável na Unidade Local de Saúde do Alentejo Central (ULSAC), com uma poupança anual estimada de 344 991,16 €/ano.
- Differential Response to Cognitive Stimulation in Moderate Versus Moderately Severe Alzheimer’s DiseasePublication . Justo-Henriques, Susana; Silva, Rosa C. Gomes; Carvalho, Janessa O.; Pérez-Sáez, Enrique; São João, Ricardo; Ribeiro, OscarAlzheimer’s disease (AD) is characterized by impairments across several neurocognitive domains, particularly memory and executive function. The study explored the effectiveness of an individual cognitive stimulation (iCS) program on cognitive outcomes in older adults with moderate to moderately severe AD. A multicentre randomized controlled trial was conducted with 80 Portuguese older adults (Mage : 83.0 ± 7.1 years) with AD. Participants were randomly assigned to either iCS (n = 39; 49%) or treatment as usual (n = 41; 51%). Alzheimer’s Disease Severity (ADS) categorized two groups based on Mini-Mental State Examination score: 10–14 in the ADS moderately severe group and 15–20 in the ADS moderate group. In participants with moderate AD, iCS led to significant improvements in memory- related outcomes (particularly Memory Assessment Test) and a trend toward improvement in global cognition. In contrast, no significant effects were observed in participants with moderately severe AD. Meta-analytic comparisons and meta-regression confirmed a significant difference in intervention effectiveness between severity levels. iCS was significantly more effective in individuals with moderate AD than in those with moderately severe AD. This difference in responsiveness between severity levels was statistically confirmed (Q = 11.29, p < .001). iCS was effective in enhancing memory in individuals with moderate AD, with additional indications of global cognitive benefit. However, no meaningful effects were observed in participants with moderately severe impairment, suggesting diminished responsiveness to iCS as disease severity increases.
- Digital and Analogical Cognitive Stimulation in Older Adults with Alzheimer’s Disease: A Multicenter Randomized Controlled Trial Study ProtocolPublication . Henriques, Susana I. Justo; Padeiro, Miguel; Silva, Rosa C. G.; Macedo, Joana; Machado, Flávia Borges; São João, Ricardo M. V. de; Ribeiro, OscarThe growing incidence of neurodegenerative diseases in older adults, with the prevalence of Alzheimer’s disease, progressively affects their quality of life. Cognitive stimulation is a psychosocial intervention that has shown consistent benefits in the lives of people with dementia from mild to moderate stages. The present study aims to evaluate the effectiveness of digital and analogical cognitive stimulation, when compared with usual care, on overall cognitive function, emotional state, and quality of life. It also aims to investigate whether institutional and territorial characteristics of social care services moderate these effects. This is a three-arm multicenter randomized controlled trial with repeated measures (pre-intervention, post-intervention, and follow-up). The intervention consists of 24 individually applied (digital and analogical) cognitive stimulation sessions, twice a week, for 12 weeks, in two intervention groups. The control group receives usual care. The study follows the recommendations of the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT 2025), including the extension for non-pharmacological interventions. The sample size is estimated at 222 older adults with a probable diagnosis of mild to moderate Alzheimer’s disease. Sociodemographic, social, health and clinical data, as well as information on care provider institutions, will be collected and analyzed. Outcomes include cognition (global cognition, memory, and executive function), emotional state (anxiety and depression), and quality of life. All outcomes will be assessed at baseline, endpoint, and follow-up, with comparisons between the interven tion groups and the control group.
- A predictive model for arthrogenous temporomandibular disorders based on clinical signs and symptomsPublication . Angelo, David Faustino; Cardoso, Henrique José; Geraldes, Carlos; São João, Ricardo; Maffia, Francesco; Sanz, David; Salvado, FranciscoThis study aimed to develop and internally evaluate a multivariable statistical model to identify arthrogenous temporomandibular disorders (TMD) using routinely collected clinical data. The model's performance was compared with the Fonseca Anamnestic Index (FAI) alone, using an imaging-based classification as the reference standard. This cross-sectional observational study included 1170 consecutive patients attending their first consultation at a tertiary TMD center between August 2019 and August 2024. Arthrogenous TMD was deter mined using combined clinical and imaging assessment according to the Dimitroulis classification. Clinical variables, including age, maximum mouth opening (MMO), individual FAI items, and joint-related complaints, were extracted from the EUROTMJ database. Generalized additive models (GAMs) were used to develop pre dictive models. Performance was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, and specificity in training (60%) and test (40%) datasets. The final Fonseca–Dimitroulis (FD-Class) model incorporated age, MMO, selected FAI items (Q2, Q6, Q7), crepitus, and temporomandibular joint (TMJ) locking. The model achieved an AUC of 0.761 in the training dataset and 0.742 in the test dataset, outperforming the FAI alone (AUC = 0.662). This model may support the early identification of arthrogenous TMJ disease and improve decision-making regarding referral for advanced imaging in maxillofacial practice.This study aimed to develop and internally evaluate a multivariable statistical model to identify arthrogenous temporomandibular disorders (TMD) using routinely collected clinical data. The model's performance was compared with the Fonseca Anamnestic Index (FAI) alone, using an imaging-based classification as the reference standard. This cross-sectional observational study included 1170 consecutive patients attending their first consultation at a tertiary TMD center between August 2019 and August 2024. Arthrogenous TMD was deter mined using combined clinical and imaging assessment according to the Dimitroulis classification. Clinical variables, including age, maximum mouth opening (MMO), individual FAI items, and joint-related complaints, were extracted from the EUROTMJ database. Generalized additive models (GAMs) were used to develop pre dictive models. Performance was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, and specificity in training (60%) and test (40%) datasets. The final Fonseca–Dimitroulis (FD-Class) model incorporated age, MMO, selected FAI items (Q2, Q6, Q7), crepitus, and temporomandibular joint (TMJ) locking. The model achieved an AUC of 0.761 in the training dataset and 0.742 in the test dataset, outperforming the FAI alone (AUC = 0.662). This model may support the early identification of arthrogenous TMJ disease and improve decision-making regarding referral for advanced imaging in maxillofacial practice.
- Tumor Location and Referral Sources as Determinants of Late-Stage Oral Cancer Diagnosis in a Portuguese CohortPublication . Coutinho, José Cunha; Silva, Leonor Cruz e; São João, Ricardo; Coutinho, Gonçalo Cunha; Domingues, Tiago; Nobre, Miguel Araújo; Caldas, Cecília; Salvado, FranciscoBackground: Most cases of oral cancer at the time of diagnosis are already locally advanced, which is associated with a worse prognosis. This study aimed (1) to identify tumor characteristics and risk factors associated with late-stage oral cancer diagnosis in the Portuguese population and (2) to develop population- and provider-oriented early detection strategies, particularly focused on recognizing potentially malignant disorders, to enhance timely diagnosis and improve patient outcomes. Methods: A retrospective study of 151 patients with oral cancer treated in a Portuguese tertiary hospital between January 2015 and April 2023 was conducted. Information regarding sociodemographic variables, habits, tumor location and form of presentation, referral sources, and stage of the disease at initial diagnosis was analyzed. Results: The majority of patients were male, and the mean age at diagnosis was 65 years. Most were diagnosed at stage IV (51.7%, n = 75), and most of these were referred by the emergency department (46.7%, n = 35). Family physicians made the earliest referrals. Patients referred by dentists were diagnosed at more advanced stages of disease by comparison. The anatomical sites with the highest percentage of locally advanced disease were the lower gingiva, retromolar trigone, and upper gingiva. Conclusions: Late-stage oral squamous cell carcinoma was the most common diagnosis, particularly for lesions in the gingiva and retromolar trigone, and was more frequent among cases referred through emergency departments, reflecting gaps in early detection. Targeted surveillance, improved professional training, and public awareness are essential to promote earlier diagnosis.