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- Patterns and predictors of the transition between minimally adequate treatment and effective treatment coverage for mental disordersPublication . World Mental Health Survey collaborators; Comprehensive Health Research Centre (CHRC) - pólo NMS; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); BioMed Central (BMC)Background: The quality of mental disorder treatment varies widely, with many patients not receiving treatments based on evidence-based guidelines. We examine data from the World Mental Health (WMH) surveys to investigate prevalence and correlates of receiving effective treatment coverage (ETC) among patients receiving minimally adequate treatment (MAT) in the 12 months before interview. Methods: Data come from 25 WMH surveys carried out in 21 countries that included n = 1,119 participants who met the criteria for at least one of nine 12-month disorders considered here who received MAT for n = 2,313 disorders. MAT was defined as either (i) medication with 4 + healthcare visits or (ii) 8 + counseling sessions. ETC was defined as a subset of MAT that additionally required (i) medication appropriate for the disorder (e.g., mood stabilizers, anticonvulsant, or antipsychotic for bipolar disorder) taken with adequate control and adherence; and/or (ii) 8 + counseling sessions with a mental healthcare provider. Multivariable regression analysis with person-disorder treated as the case was used to examine associations of socio-demographic, disorder-related, and treatment-related factors with receiving ETC given MAT. Results: Fewer than half (47.1%) the cases with MAT received treatment qualifying as ETC. The strongest predictors of ETC given MAT were high patient education, mild/moderate disorder severity, treatment by a mental health specialist rather than primary care provider, and receipt of combined treatment with both medication and counseling rather than only one of these types of treatment. Importantly, combined treatment was associated with a significantly higher relative-risk of ETC if it was provided by a psychiatrist rather than a combination of a general medical provider and a non-psychiatrist mental health provider. Conclusions: Noteworthy limitations include the data being cross-sectional, the predictor set being restricted, and the outcome being defined in terms of structural characteristics rather than fidelity of implementation. Within the context of these limitations, results suggest that fewer than half of cases with minimally adequate treatment receive treatment meeting published guidelines for effective treatment coverage. This finding underscores the importance of improving treatment. Future research should focus on targets to improve each stage of the help-seeking process beginning with entry into treatment through receipt of ETC.
- Mismatch negativity in patients with bipolar affective disorderPublication . Caulfield, Alice; Moura, Rita; Brugger, Stefan; Young, Allan H; Mehta, Mitul A; Adams, Rick A; Beck, Katherine; Comprehensive Health Research Centre (CHRC) - pólo NMS; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); iNOVA4Health - pólo NMS; SAGE PublicationsINTRODUCTION: Mismatch negativity (MMN) is a neural response to unexpected deviations from a regular sequence of stimuli. A diminished MMN is highly replicated in schizophrenia; however, whether this is observed in bipolar disorder (BD) is less clear. AIM: To conduct a meta-analysis of MMN alterations in people with BD compared to healthy controls. METHODS: Electronic databases were searched until 20/10/2025, for between-subjects studies examining MMN amplitudes and or latencies in BD patients compared with controls. 15 studies consisting of 437 BD patients and 815 controls were included in this analysis. RESULTS: The primary outcome was the difference in MMN amplitude between the BD and control groups, from studies using standard MMN paradigms. Meta-analysis revealed diminished MMN amplitudes (n = 14) in BD versus controls (standardised mean difference = 0.47, 95% confidence interval [0.28, 0.66], p < 0.0001). Exploratory secondary meta-regressions revealed no significant relationship between MMN amplitude and age, sex, symptoms, or illness duration. Subgroup analyses revealed MMN amplitude group difference for paradigms using duration versus frequency deviants. CONCLUSION: MMN amplitude deficits are observed in bipolar disorder. As MMN deficits are consistently observed in schizophrenia, whether the MMN deficits observed in BD relate to psychotic symptoms or specific BD subtypes remains unclear. Limitations of this meta-analysis include low study numbers for some of the meta-regressions. Most included studies did not separate bipolar subtypes; therefore, it was not possible to determine whether the observed effects relate to affective or psychotic symptoms. Future research should distinguish putative BD subtypes and include measures of symptoms to clarify the potential of MMN as a clinical marker to guide treatment decisions.
- Recurrent pregnancy lossPublication . Carvalho, Tiago; Ângelo-Dias, Miguel; Moutinho, Filipa; Serra, Sofia Silvério; Costa, Teresa; Martins, João Paulo; Duarte, Gonçalo S; Lima, Jorge; Comprehensive Health Research Centre (CHRC) - pólo NMS; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Frontiers MediaBACKGROUND: Recurrent pregnancy loss (RPL) is a clinically and emotionally significant reproductive condition, yet its reported prevalence and etiological distribution vary widely across studies. This systematic review and meta-analysis aimed to synthesize available evidence on the prevalence of RPL and the pooled proportions of its major etiological categories. METHODS: We conducted a systematic review and meta-analysis of observational studies identified through searches of PubMed/Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. Random-effects meta-analyses were performed to pool prevalence estimates and etiological proportions using inverse-variance weighting and a restricted maximum likelihood estimator. For prevalence analyses, the denominator corresponded to the total number of individuals screened, as reported by each study. Freeman-Tukey transformations were applied where appropriate. Heterogeneity was assessed using I 2 and τ 2. RESULTS: A total of 105 studies were included, comprising 47,907 women with RPL for etiological analyses. Only two studies provided population-based prevalence estimates of RPL, yielding an estimated prevalence of approximately 1% (95% CI, 1-1%), although the small number of studies limits interpretation. Among women with RPL, the pooled proportion of idiopathic or unexplained RPL was highest (37, 95% CI, 30-44%; I 2 = 94.3%), followed by acquired thrombophilia (12, 95% CI, 9-15%), endocrine factors (8, 95% CI, 6-10%), and anatomical factors and hereditary thrombophilia (6, 95% CI, 5-8%). Subgroup and meta-regression analyses suggested that geographic region and selected demographic and temporal study characteristics may contribute to between-study variability in etiological distributions. CONCLUSION: Reported prevalence and etiological proportions of RPL vary substantially across studies, and a large proportion of cases remain unexplained. The observed heterogeneity, partly associated with regional, demographic, and temporal factors, highlights the need for standardized definitions, diagnostic workups, and reporting practices to improve comparability across studies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO Registry Number: CRD42024517675.
- Capturing what people with COPD wantPublication . Souto-Miranda, Sara; Rodrigues, Guilherme; Spruit, Martijn A.; Marques, Alda; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Comprehensive Health Research Centre (CHRC) - pólo NMS; Elsevier Science B.V., Amsterdam.Background: A core outcome set (COS) for chronic obstructive pulmonary disease (COPD) recommends measuring personal goal attainment following PR. However, the optimal method for this assessment remains unclear. This article provides a perspective on a review of existing patient-reported outcome measures (PROMs) and their measurement properties, in an attempt to identify the best PROM for assessing personal goals in individuals with COPD. Methods: The review followed a two-phase approach. In the first phase, a systematic search of PubMed, ScienceDirect and Scopus was conducted to identify PROMs used to assess goal attainment in individuals with COPD after any intervention. In the second phase, measurement properties of the identified PROMs were reviewed using the Consensus-based Standards for the selection of health Measurement INstruments guidelines and search filter. Results: Only one article, reporting on Goal Attainment Scaling, was included after full-text assessment. The Goal Attainment Scaling was used to measure the personal goals of individuals with COPD following a community pharmacist intervention. No studies on the measurement properties of Goal Attainment Scaling were found. Conclusion: This review highlights the lack of PROMs specifically developed and evaluated for assessing personal goals in COPD. Future research should focus on validating the use of Goal Attainment Scaling in the COPD and PR contexts or developing a new PROM to integrate into the COS. Prospero registration id: CRD42022313344.
- Idiopathic Central Precocious Puberty in BoysPublication . Galo, Elisa; Castro, Sofia; Amaral, Daniela; Espada, Filipa; Brandão, Carla Maria Dos Santos Silva; Leite, Ana Luísa; Ferreira, Sofia; Caetano, Francisco; Robalo, Brígida; Cerqueira, Rita; Limbert, Catarina; Comprehensive Health Research Centre (CHRC) - pólo NMS; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); S. Karger AGINTRODUCTION: Central Precocious Puberty (CPP) is rare in boys, and idiopathic forms are particularly uncommon. This study characterizes the genetic architecture of idiopathic CPP (ICPP) in a national cohort of boys. DESIGN AND METHODS: We conducted a retrospective and prospective study of boys with ICPP recorded in the Portuguese national registry over the past 2 decades. Clinical, laboratory and demographic characteristics of the patients were reviewed. Whole exome sequencing (WES) was performed to identify pathogenic variants. RESULTS: Of 736 children with CPP, 8.2% were males. Total CPP cases in boys increased significantly over time (p<0.001), particularly during COVID-19. While secondary CPP remained stable (p=0.198), idiopathic forms increased by 19.1%/year (p<0.001), with change points in 2011 and 2021. WES identified pathogenic MKRN3 variants in 13.3% (2/15) boys, including a novel variant (p.Asp267Asn). MKRN3-positive patients presented with later-onset puberty, though sample size limits definitive conclusions. WES also detected a clinically significant TP53 variant as an incidental finding. CONCLUSIONS: ICPP incidence in Portuguese boys increased significantly over two decades, with acceleration during the pandemic. While genetic causes (primarily MKRN3 variants) were identified in 13.3% of cases, the substantial proportion of unexplained cases and temporal clustering indicate important roles for environmental and epigenetic factors.
- Cow's milk oral immunotherapy in real-lifePublication . Gaspar, Â; Piedade, S; Monteiro-Marques, C; Mota, I; Borrego, L; Comprehensive Health Research Centre (CHRC) - pólo NMS; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); EDRA SpABackground. Oral immunotherapy (OIT) is a promising strategy for severe and persistent cow's milk (CM) allergy. However, clinical experience concerning long-term follow-up is scarce. The objective is to assess long-term efficacy and safety of maintenance phase of OIT in real-life. Methods. Prospective study of children with severe IgE-mediated CM allergy that underwent CM-OIT, and were followed-up by the authors, up to 15 years. Complete desensitisation was defined when maintenance dose of 200 mL daily was achieved. Characterization (clinical and laboratory) was performed before and after OIT during follow-up. Results. Thirty-three patients enrolled: 58% male, 70% asthmatics and 67% with previous history of CM-anaphylaxis. Mean age at onset of CM-OIT was 7±2.8 years. Complete desensitisation was ensured in 94% (free diet with dairy 200mL of CM or equivalent). During maintenance phase 79% developed allergic reactions, with anaphylaxis in 33%, including exercise-induced anaphylaxis in 15% and with cheese intake in 15%. We stress that eosinophilic esophagitis appeared in 12%. Specific IgE levels and skin prick tests (SPT) to CM and casein have significantly decreased, and in most patients (61%) SPT became negative. When available, specific IgG4 levels have significantly increased. Conclusions. This real-life study supports long-term efficacy and safety of CM-OIT. CM-OIT had a high success rate, allowing diet without restrictions with persistence of the effect up to 15 years. However, one-third of patients experienced anaphylaxis during maintenance phase. CM-OIT should always be performed by allergy experts and only motivated families should be enrolled, since long-term follow-up is required, and daily intake of CM is needed to ensure desensitization.
- Lung Stereotactic Body Radiotherapy (SBRT) on Metastatic SarcomasPublication . Ferreira, Pedro; Esteves, Susana; Fonseca, João G; Netto, Eduardo; Comprehensive Health Research Centre (CHRC) - pólo NMS; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); SpringerINTRODUCTION AND PURPOSE: Lung metastases are common in sarcoma patients, often necessitating systemic therapy or local therapies. Stereotactic body radiotherapy (SBRT) offers a targeted approach, achieving low local failure (LF) and delaying systemic therapy. This study evaluates the outcomes of SBRT for sarcoma lung metastases, focusing on LF, systemic therapy-free survival (STFS), and overall survival (OS). METHODS AND MATERIALS: Retrospective study of patients with metastatic pulmonary lesions treated with SBRT between September 2015 and December 2022. STFS was defined as the time from the end of the first RT course to the start of any systemic therapy, if no previous systemic therapy was given or if a pause of at least one month was achieved with RT. STFS was depicted as a Kaplan-Meier curve. LF was analyzed using a competing risks framework. The response assessment was evaluated based on pre- and post-treatment chest CT or PET-CT. Toxicities were classified according to the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0. RESULTS: A total of 17 patients and 53 lesions were treated in 31 courses of treatment. Median follow-up was 96 months. Median number of lesions treated per treatment course was 2 (range: 1-4). In 94.1% of the treatment courses, the target was the only active site of active disease. In 79.2% of the lesions treated, the biologically effective dose (BED) was equal to or superior to 100Gy with a median BED of treated lesions of 105.6Gy (range: 67.2-180Gy). No SBRT-related toxicities were reported. LF rates at one-, two-, and three-years were 32.0%, 45.3% and 47.2%, respectively. Median STFS was 26 months. STFS rates at one- and two-years were 62% (CI95% 40-95) and 54% (CI95% 33-89), respectively. Median OS was 34 months. OS rates at one- and two-years were both 71% (CI95% 53.3-85.6). CONCLUSION: SBRT is a promising strategy for managing lung metastases in sarcoma, offering acceptable local control (LC) rates and significant systemic therapy-free survival without accrued toxicities. Further research should focus on optimizing dose schedules and patient selection to enhance outcomes.
- How do novice physiotherapists practice patient education? A video elicitation interview study in musculoskeletal clinical practice in PortugalPublication . Fernandes, Isabel; Forbes, Roma; Caeiro, Carmen; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Comprehensive Health Research Centre (CHRC) - pólo NMS; Taylor & FrancisBackground and purpose: Musculoskeletal disorders are a leading cause of disability worldwide, for which person-centred education is recommended as a first-line approach. However, novice physiotherapists often face greater challenges in delivering patient education, and limited understanding exists regarding how it is enacted in everyday clinical practice. This study aimed to explore how Portuguese novice physiotherapists enact patient education during musculoskeletal sessions and how they rationalise their educational practices. Methods: An ethnographic study was conducted, involving video-based observations of musculoskeletal treatment sessions delivered by novice physiotherapists, followed by video-elicitation interviews. Data were analysed using a deductive, data-driven content analysis approach. Results: Eight novice physiotherapists (≤5 years of professional experience) participated. Educational practices were categorised into three types of therapeutic relationship: activity-passivity, guidance-cooperation, and mutual participation. Most participants demonstrated characteristics of more than one type across interactions; although, a dominant type could be identified for each physiotherapist. Overall, practices tended to cluster towards activity–passivity and guidance–cooperation, with fewer instances of mutual participation. Conclusion: The findings suggest that patient education delivered by Portuguese novice physiotherapists remains largely physiotherapist-centred, with limited enactment of shared decision-making and patient autonomy. These results highlight the need for educational and mentorship strategies that better support novice physiotherapists in translating person-centred principles into routine musculoskeletal practice.
- DNA/RNA Hybrid Hairpin Gold Nanobeacons Targeting miR-31 Reprogram Invasion in Lung Cancer and Remodel Tumor Histo-Architecture In VivoPublication . Sousa, Diana P.; Oliveira, Jhenifer; Martins, Catarina F.; Conde, João; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Comprehensive Health Research Centre (CHRC) - pólo NMS; ACS - American Chemical Society
- One-pot synthesis of Mn/Fe bimetal-doped metal-organic framework as multifunctional nanocarriers for esophageal cancer targeted therapyPublication . Ma, Jia; Zhang, Xin; Meng, Xiangpeng; Dai, Yuhang; Wang, Huaiyong; Ashrafizadeh, Milad; Conde, João; Li, Zhenggang; Yao, Enyang; He, Wei; NOVA Medical School|Faculdade de Ciências Médicas (NMS|FCM); Comprehensive Health Research Centre (CHRC) - pólo NMS; Xi'an Jiaotong University