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Percorrer IPC-ESTeSC - Artigos em revistas por Objetivos de Desenvolvimento Sustentável (ODS) "03:Saúde de Qualidade"
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- An update on the role of immune checkpoint inhibitors in lung cancer: a narrative systematic reviewPublication . Sousa, Inês; Martins, Diana; Mendes, FernandoIntroduction: Lung cancer (LC) remains the leading cause of cancer-related mortality worldwide, and its aggressive nature necessitates the development of alternative therapeutic strategies. Immune checkpoint inhibitors (ICIs) have shown remarkable success in LC treatment. Despite advances with programmed cell death protein-1/programmed cell death ligand-1 inhibitors, many patients experience limited or short-lived responses, prompting interest in novel ICIs such as T-cell immunoreceptor with immunoglobulin and tyrosine-based inhibitory motif domain (TIGIT), lymphocyte-activation gene 3 (LAG-3), and indoleamine 2,3-dioxygenase 1 (IDO-1). Objectives: This narrative systematic review aimed to assess the clinical efficacy and safety of these novel ICIs compared to standard ICI therapy in LC. Methods: A systematic literature search was conducted across PubMed, Web of Science, and ClinicalTrials.gov. The search covered studies published from January 2020 to January 2025, to identify randomized controlled trials (RCTs) evaluating novel ICIs in LC. Due to substantial heterogeneity in study design, intervention targets, and outcome reporting, findings were synthesized narratively in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Risk of bias was assessed using RoB 2. Results: Five RCTs involving a total of 825 patients were included. TIGIT inhibition demonstrated benefit in progression-free survival and response rate. LAG-3 inhibitors showed mixed efficacy, with potential dose-related differences. IDO-1 inhibitors failed to improve outcomes compared with standard ICI. Reporting quality varied, with concerns regarding incomplete outcome data in some trials. Conclusion: These findings suggest promise for novel ICIs but are limited by small study numbers, methodological bias, and clinical heterogeneity. Larger, well-designed Phase III trials are required to validate these results.
- Association between dietary intake and the expression of clock genes in adults: a brief reportPublication . Lages, Marlene; Correia, Joana; Caseiro, Armando; Carmo-Silva, Sara; Barros, Renata; Ferreira-Marques, Marisa; Guarino, Maria P.Background: The circadian system regulates several physiological processes, including energy metabolism, through the expression of core clock genes. Animal studies suggest that dietary composition can influence circadian gene expression; however, evidence in humans remains limited. Objective: This study aimed to explore the association between dietary macronutrient intake and the expression of circadian clock genes in the whole blood of adults with distinct metabolic profiles. Methods: Nineteen adults (94.7% female; 43.4 ± 16.05 years) were categorized into healthy-weight and overweight/obesity groups based on BMI. Dietary intake was assessed using a 3-day food diary, and clock gene expression (CLOCK, BMAL1, PER2, CRY) was evaluated in whole blood samples collected between 08:00 a.m. and 04:00 p.m. Statistical analyses included group comparisons and correlation analyses between macronutrient intake and gene expression. Results: No statistically significant differences were observed in the clock gene expression between BMI groups, although group-level trends were noted, particularly in PER2 and CRY expression. The overweight/obesity group exhibited a significantly higher percentage of energy intake from protein. Correlation analyses revealed several time-dependent associations between macronutrient intake and clock gene expression. Notably, in the healthy BMI group, BMAL1 and CRY expression correlated with lipid and protein intake, while in the overweight/obesity group, CLOCK expression was strongly associated with both lipid and carbohydrate intake. Conclusion: These findings suggest that macronutrient composition may influence peripheral circadian gene expression in a time- and BMI-dependent manner. Further research is necessary to confirm these associations in larger and more diverse populations and to investigate the potential for chrononutrition strategies to support metabolic health
- Association between shift work and auditory–cognitive processing in middle-aged healthcare workersPublication . Roque, Margarida; Marques, Tatiana; Serrano, MargaridaBackground/Objectives: Shift work in healthcare professionals affects performance in high cognitive processing, especially in complex environments. However, the beneficial effects that working in complex environments may have on auditory–cognitive processing remain unknown. These professionals face increased challenges in decision-making due to factors such as noise exposure and sleep disturbances, which may lead to the development of enhanced auditory–cognitive resources. This study aims to investigate the associations between shift work and auditory–cognitive processing in middle-aged healthcare workers. Methods: Thirty middle-aged healthcare workers were equally allocated to a shift worker(SW) or a fixed-schedule worker (FSW) group. Performance on a cognitive test, and in pure-tone audiometry, speech in quiet and noise, and listening effort were used to explore whether correlations were specific to shift work. Results: Exploratory analyses indicated that shift workers tended to perform better in visuospatial/executive function, memory recall, memory index, orientation, and total MoCA score domains compared to fixed schedule workers. In the SW group, hearing thresholds correlated with memory recall and memory index. In the FSW group, hearing thresholds correlated with orientation, memory index, and total MoCA score, while listening effort correlated with naming, and speech intelligibility in quiet correlated with total MoCA scores. Conclusions: These exploratory findings suggest that shift work may be linked to distinct auditory–cognitive patterns, with potential compensatory mechanisms in visuospatial/executive functions and memory among middle-aged healthcare workers. Larger, longitudinal studies are warranted to confirm whether these patterns reflect true adaptive mechanisms.
- Auditory attention in primary school-aged childPublication . Soares, Constança; Serrano, MargaridaIntrodução: A atenção auditiva é um processo multimodal complexo, essencial para o desenvolvimento cognitivo, académico e socioeducativo das crianças. Défices nesta competência podem comprometer a comunicação e a aprendizagem. A evidência proveniente das neurociências indica que o tálamo, bem como os córtices pré-frontal, parietal e auditivo, desempenham papéis fundamentais na sua regulação. Do ponto de vista funcional, a atenção auditiva é classificada em seletiva, sustentada, alternada e dividida — todas cruciais para o funcionamento quotidiano. Objetivo: Avaliar o desempenho da atenção auditiva em crianças do 1.º ao 4.º ano do ensino básico. Materiais e Métodos: Participaram no estudo 35 crianças (com idades entre 6 e 9 anos), de ambos os sexos, com audição normal e matriculadas no ensino básico. A avaliação recorreu a dois instrumentos: um objetivo — o Teste de Habilidade de Atenção Auditiva Sustentada (P-THAAS) — aplicado às crianças, e um subjetivo — a subescala de atenção auditiva do Pediatric Children’s Auditory Performance Scale (P-CHAPPS) — preenchida pelos professores. Resultados: O progresso no nível de escolaridade esteve associado a um menor número de erros e a uma maior estabilidade na vigilância auditiva, conforme avaliado pelo P-THAAS. Por outro lado, os resultados da subescala do P-CHAPPS apresentaram maior variabilidade entre os diferentes anos de escolaridade. Conclusões: Os resultados sugerem um desenvolvimento gradual da atenção auditiva ao longo dos primeiros anos de escolaridade. A combinação de instrumentos objetivos (P-THAAS) e subjetivos (P-CHAPPS) revela-se fundamental para uma avaliação abrangente e contextualizada desta função no ambiente escolar.
- Curcumins-Loaded ZIF-8 Nanoparticles-Embedded Transdermal Polymeric Patches Increase Apoptosis and Reduce Necrosis in a Dose-Dependent Manner in MCF-7 CellsPublication . Kiyak-Kirmaci, Humeysa; Aydin, Saliha; Yekeler, Humeyra Betul; Guler, Ece; Kayaci, Ayse Beyza; Gurer, Zeynep; Yilmaz-Goler, Ayse Mine; Erkmen, Ziya Engin; Duygulu, Ozgur; Bostan, Muge Sennaroglu; Martins, Diana; Mendes, Fernando; Eroglu, Mehmet Sayip; Edirisinghe, Mohan; Cam, Muhammet EminCurcumin(Cur)-loaded zeolitic imidazolate framework-8 (ZIF-8) nanoparticles (Cur@ZIF-8 NPs) were produced to increase the anticancer activity of Cur. Cur@ZIF-8 NPs were embedded in polycaprolactone (PCL) fibers as transdermal polymeric patches via a pressured gyration (PG) method to provide controlled release. Cur@ZIF-8 NPs and Cur@ZIF-8 NPs-embedded PCL fibers were characterized for physical, chemical, mechanical, and thermal properties, also biological activities were examined with in vitro tests. Cur@ZIF-8 NPs were produced homogeneously with a size of ∼200 nm and a zeta potential of ∼−19 mV. Cur had better stability inside Cur@ZIF-8 NPs than its powder form. Cur@ZIF-8 NPs were successfully loaded in PCL fibers with a size of∼7 µm, and Cur@ZIF-8 NPs were dispersed amorphously in fibers. Cur was released in a controlled manner, and its efficiency was increased in the acidic microenvironment that is characteristic of cancer. Cur@ZIF-8 NPs have more bioavailability than powdered Cur and can penetrate the cells to deliver their anticancer effects on MCF-7 human breast cancer cells. Cur@ZIF-8 NPs-embedded transdermal polymeric patches promote apoptosis in MCF-7 cells by reducing necrosis, particularly under acidic conditions. This work presents a release system with synergistic anticancer effects, offering a novel approach for Cur’s clinical application in breast cancer through enhanced targeting.
- Current practices and perceptions on diagnostic reference levels: a EuroSafe Imaging Survey AnalysisPublication . Damilakis, John; Brkljacic, Boris; Frija, Guy; De Bondt, Timo; Paulo, Graciano; Tsapak, Virginia; Vano, Eliseo; European Society of RadiologyDespite progress in implementing diagnostic reference levels (DRLs) across Europe, clinical practices remain variable. This prompts the EuroSafe Imaging campaign to conduct a survey assessing current practices, perceptions, and challenges related to DRLs. A total of 146 responses were collected from radiology departments in 38 countries, predominantly in the EU/EEA region. While 52.4% reported established local DRLs, significant gaps were identified, with 34.5% lacking local DRLs and 13.1% unaware of their existence. DRLs were primarily established for computed tomography (CT) (88.7%) and conventional radiography (77.5%), with lower implementation in interventional radiology (36.6%). Key challenges included time constraints, data collection difficulties, and limited standardization across institutions. Education gaps were notable, with less than half of the respondents reporting DRL-related training for radiology residents. Respondents emphasized the need for dose management systems, personalized DRLs based on clinical indications, and enhanced education and policy support. Addressing barriers through targeted training, policy enhancements, and technological innovations can improve DRL implementation. Future efforts should focus on promoting standardized clinical protocols, increasing awareness, and fostering European and international collaboration to ensure the consistent use and optimization of DRLs in clinical practice. Critical relevance statement. The article critically examines the variability and challenges in implementing diagnostic reference levels (DRLs) across European radiology departments, providing actionable recommendations on policy, education, and technological advancements to optimize radiation protection and improve clinical radiology practices. Patient summary. Diagnostic reference levels (DRLs) help healthcare providers ensure that radiation doses from medical imaging, like CT scans and X-rays, are not higher than necessary. This study looked at how DRLs are used across Europe. It found that while many hospitals have established and follow DRLs, others do not, which may affect patient safety. Challenges like time constraints and lack of training prevent better use of DRLs. Improving education for medical staff and updating protocols can help protect patients by reducing unnecessary radiation exposure while still ensuring accurate diagnoses. Key Points. ● Variability persists in diagnostic reference level (DRL) practices across Europe. ● Over half of radiology departments have established local DRLs. ● Less than half of radiology residents receive structured DRL training. ● Improved DRL adoption can optimize radiation protection and patient safety. ● Collaboration, training, and standardized protocols are essential for better DRL practices.
- Development of a speech-in-noise test in european portuguese based on QuickSIN: a pilot studyPublication . Serrano, Margarida; Simões, Jéssica; Vicente, Joana; Ferreira, Maria; Murta, Ana; Ferrão, João TiagoBackground and Objectives: Speech-in-noise testing is essential for evaluating functional hearing abilities in clinical practice. Although the Quick Speech-in-Noise test (QuickSIN) is widely used, no equivalent tool existed for European Portuguese. This study aimed to develop a Speech-in-Noise Test for European Portuguese (SiN-EP), linguistically adapted and calibrated for native speakers, to support clinical assessment of speech perception in realistic listening environments. Materials and Methods: The SiN-EP was developed through a multi-stage process. Sentences were drafted to reflect natural speech patterns and reviewed by native speakers for clarity and grammatical accuracy. Selected sentences were recorded by a female native speaker in a controlled acoustic environment and mixed with multi-talker babble at signal-to-noise ratios (SNR (dB)) from 25 to 0 SNR (dB). A pre-test in a free-field setting at 65 dB SPL was conducted with fifteen normal-hearing young adults. Participants repeated each sentence, and their responses were analyzed to refine list composition, adjust difficulty, and ensure phonetic balance. Results: Intelligibility decreased systematically as SNR (dB) worsened, with ceiling effects at 25 and 20 SNR (dB). At 5 SNR (dB), high variability was observed, with set 5 showing disproportionate difficulty and set 14 containing an incomplete sentence; both were removed. At 0 SNR (dB), all sets demonstrated expected low intelligibility. The final test comprises thirteen lists of six sentences, each maintaining stable intelligibility, phonetic representativeness, and consistent difficulty across SNRs (dB). Conclusions: The SiN-EP provides a linguistically appropriate, phonetically balanced, and SNR (dB) calibrated instrument for assessing speech-in-noise perception in European Portuguese. The refinement process improved reliability and list equivalence, supporting the test’s clinical and research applicability. The SiN-EP fills a critical gap in assessing speech-in-noise perception in European Portuguese speakers, providing a reliable tool for both clinical and research applications.
- Effects of audiovisual presentations on visual localization errors: one or several multisensory mechanisms?Publication . Nazaré, Cristina Jordão; Oliveira, Armando Mónica deThe present study examines the extent to which temporal and spatial properties of sound modulate visual motion processing in spatial localization tasks. Participants were asked to locate the place at which a moving visual target unexpectedly vanished. Across different tasks, accompanying sounds were factorially varied within subjects as to their onset and offset times and/or positions relative to visual motion. Sound onset had no effect on the localization error. Sound offset was shown to modulate the perceived visual offset location, both for temporal and spatial disparities. This modulation did not conform to attraction toward the timing or location of the sounds but, demonstrably in the case of temporal disparities, to bimodal enhancement instead. Favorable indications to a contextual effect of audiovisual presentations on interspersed visual-only trials were also found. The short sound-leading offset asynchrony had equivalent benefits to audiovisual offset synchrony, suggestive of the involvement of early-level mechanisms, constrained by a temporal window, at these conditions. Yet, we tentatively hypothesize that the whole of the results and how they compare with previous studies requires the contribution of additional mechanisms, including learning detection of auditory-visual associations and cross-sensory spread of endogenous attention.
- Effects of time-restricted eating on body composition, biomarkers of metabolism, inflammation, circadian system and oxidative stress in overweight and obesity: an exploratory reviewPublication . Lages, Marlene; Carmo-Silva, Sara; Barros, Renata; Guarino, Maria PedroObesity is a chronic, complex and multi-factorial condition with an increasing prevalence worldwide. Irregular eating schedules might be a contributing factor to these numbers through the dysregulation of the circadian system. Time-restricted eating (TRE), an approach that limits eating windows, has been studied as a strategy to treat obesity, aligning eating occasions with metabolic circadian rhythms. This review aims to provide an overview of the impact of TRE protocols on metabolic, inflammatory, oxidative stress and circadian rhythm biomarkers in people with overweight or obesity. Most studies report significant weight loss following TRE protocols. While glucose levels decreased in nearly all TRE interventions, only a few studies demonstrated statistically significant differences when compared to the control groups. The findings for c-reactive protein and TNF-α were inconsistent, with limited significant differences. Changes in lipid profile changes were variable and generally did not reach statistical significance. Both 4-hour and 6-hour TRE interventions significantly reduced 8-isoprostane levels. Additionally, TRE significantly altered clock gene expression, as well as that of genes associated with metabolic regulation in subcutaneous adipose tissue. While the evidence is still inconsistent, limiting eating to a consistent daily window of 8 to 12 h can improve insulin sensitivity, reduce blood glucose, cholesterol and triglyceride levels and promote weight loss.These effects are likely attributable to both direct metabolic impacts and indirect benefits from weight loss and improved dietary habits. However, data on circadian, inflammatory and specific metabolic biomarkers remain scarce and occasionally contradictory, highlighting the need for further research on these interventions.
- Exploring the link between stress and working memory in adultsPublication . Carvalho, Constança; Reis, Cláudia; Serrano, MargaridaBackground: Working memory (WM) is essential for reasoning, learning, and everyday cognitive tasks and can be influenced by stress. This study investigated the relationship between perceived stress and auditory working memory in 24 adults (16 women, 8 men; median age = 22). Methods: Participants completed the Perceived Stress Scale (PSS-10) and a pseudoword span task assessing auditory memory under phonologically demanding conditions. Results: Participants with higher stress levels exhibited greater variability and a decline in performance across pseudowords sets, particularly in the final set. Correlational analyses revealed that higher PSS-10 scores were significantly associated with lower accuracy on the most demanding memory set (r = −0.467, p = 0.021) and with younger age (r = −0.489, p = 0.015). These findings suggest that elevated stress may impair auditory working memory, with younger adults reporting higher perceived stress. Conclusions: This study highlights the importance of considering stress levels in cognitive assessments and supports the hypothesis that stress negatively affects working memory efficiency, particularly in tasks requiring phonological processing.