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Background: In 2009, Portugal ratified the UN CRPD and a turn to a rights-based approach in disability law and policy has intensified since. It thus becomes important to understand whether these legal changes are furthering the social inclusion of adults with intellectual and complex disabilities. Method: Questionnaires were applied to a stratified sample of 127 adults with intellectual and complex disabilities attending social care and vocational training programmes across the country. Results: Participants reported low rates of social participation, and many (49%) were found to live below the poverty line. High rates of discrimination and violence and feelings of loneliness and sadness were also reported, which can be strong indicators of the oppression that many of them daily endure. Conclusion: Adults with intellectual and complex disabilities in Portugal face exclusion, discrimination, and violence. The poverty and isolation in which many of them live compounds their (de)citizenship status in Portuguese society.

Purpose: The purpose of this paper is to provide an example of best practice towards enhancing employability in the cross-sectoral labour market for doctorate-holders. This was achieved through an Erasmus+ KA2 (Strategic Partnership) skills development project which created a training programme (TRANSPEER) involving a multi-disciplinary cohort of researchers at a range of career stages, drawn from universities in Norway, Portugal, Sweden and the UK. Design/methodology/approach: Research support staff designed and delivered four transnational training events for the cohort, with the overarching theme of enhancing researcher employability. An initial skills awareness survey of the researcher cohort was undertaken prior to the start of the programme; this survey was repeated after each event. An additional aim of the project was the development of the consortium's research support staff through exposure to the facilitation techniques and methodologies of their international colleagues. Findings: The findings indicate that transnational collaboration in researcher development enhances the learning environment for participating researchers and provides significant professional development opportunities for both researchers and researcher developers. The findings further suggest the benefits of mixing cohorts across career stages and engaging researchers with novel and interactive approaches on themes not typically addressed in academic competence development offerings. Originality/value: Transversal skills development cooperation between universities--especially transnational cooperation--is rare. Even more so is the professional development of research support staff in a transnational context. This paper outlines the benefits of such collaborative activities.

The development of an inclusive education system is regarded as a fundamental pillar for the full participation of persons with disabilities in society. To date, research on inclusive education has been mainly focused on students with disabilities, special education teachers and the role of legislation with less attention being paid to another important player in the implementation of a truly inclusive education system: teachers with disabilities. To address this knowledge gap, in this article we present a literature review, analysing the main findings and contributions from research that examines issues pertaining to teachers with disabilities. Drawing from 53 articles published in English in peer-review journals, the paper identifies four main research topics: (1) Teachers' life trajectories, educational practices, and challenges; (2) Teacher's training; (3) Perspectives about teachers with disabilities (among students and school principals), and (4) the under-representation of teachers with disabilities in the literature. We conclude arguing that the research agenda on inclusive education would benefit from including the perspective of teachers with disabilities.

Background: COPD is highly underdiagnosed, thus applying clinical prediction scales such as the COPD Diagnostic Questionnaire (CDQ) helps to address this problem. Objective: To evaluate the criterion validity and in-tra-rater reproducibility of the questionnaire CDQ in a Colombian population. Materials and methods: A prospective cohort study. The reproducibility was assessed with the Kappa sta-tistic and the intraclass correlation coefficient (ICC). Validity was established with the score obtained from the CDQ questionnaire and the spirometry values (FEV1/ FVC 16.5 and < 19.5, and high probability of CDQ COPD ≥ 19.6. The ACOR was 0.68 (95%CI: 0.647-0.712), a sensitivity of 79% and a specificity of 44% were obtained for a score ≥16.5, with a PPV of 26% and a NPV of 86%. Conclusions: The CDQ questionnaire has a regu-lar performance for the diagnosis of COPD with an ACOR similar to other questionnaires, it can be useful in underdiagnosed patients. The optimal cut-off point for this population was 16.5.

Intrapartum asphyxia is responsible for approximately 900 000 deaths per year worldwide. These numbers show the urgency of investing in the quality of fetal health care. The heart rate signal is a complex signal and sometimes behaves unpredictably. Thus, it becomes relevant to study approaches that take into account their complexity, namely non-linear compression-based methods. In this work, feature extraction was based on two approaches: univariate and bivariate. The univariate approach is concerned with the extraction of fetal, maternal and maternal-fetal compression ratios and the bivariate approach aims to extract compression indices from maternal-fetal heart rate simultaneous signals and of each of the signals individually over time. To understand how the features calculated in this work can be useful in distinguishing acidemic and non-acidemic cases, a classifier was applied. Three different classifiers were tested, and the one that proved to be more effective was the Support-Vector Machine. Furthermore, it was also possible to conclude that the input set of variables that provides a better performance (f1-score = 0.793) of the classifier is composed of the variables of maternal-fetal compression ratio, maternal-fetal normalized relative compression and maternal-fetal normalized compression distance, obtained through trend and residual signal, which indicates that slow and fast fluctuations on the heart rate time series are important in acidemia assessment. [ABSTRACT FROM AUTHOR]

This article assesses evidence of and challenges to the development of inclusive education in Portugal, which is built on three pillars: access to, participation in, and achievement in education for all children and young people. It presents an overview of the present policy framework, followed by an analysis of available statistical data on Portuguese students with disabilities in mainstream schools. The article also discusses significant achievements at the policy and practice levels, namely the attempt to align curriculum and pedagogy and the presence of almost 100% of students with disabilities in mainstream schools. It also considers challenges, such as the issue of monitoring achievement (both at the student and system level) and investments in the system and in teacher education.

Background/Objectives: The Mediterranean Diet (MD) is a lifestyle offering numerous health benefits. Nevertheless, the adherence to the MD is moderate even in Mediterranean countries. While sociodemographic factors influence MD adherence, additional impacts occurred due to the COVID-19 pandemic. This cross-sectional longitudinal study with three cohorts of Portuguese adults analyzes MD adherence before, during, and after the COVID-19 pandemic, and explores the effect of sociodemographic variables. Methods: Sociodemographic factors, lifestyle habits, and MD adherence were assessed in the years 2019, 2021, and 2024 with an online self-filled questionnaire. MD adherence was measured with the Mediterranean Diet Adherence Screener (MEDAS). Results: MEDAS score increased significantly (p < 0.05) from 2019 to 2021 (6.2 ± 0.7 to 7.7 ± 0.1), followed by a significant (p < 0.05) decrease in 2024 (7.2 ± 0.1) relative to 2019, which was more pronounced in participants with higher income. Accordingly, a trend in healthier food choices was observed followed by a decline in 2024. Of note is the significant increase in red meat consumption (p < 0.05) in 2024 relative to 2021. Respondents who consumed more red meat were mostly men, employed, or in a stable relationship. Most respondents practiced sport "Never or occasionally" in 2019 and 2021 (59.4 and 55.2%, respectively); in 2024, this category was significantly (p < 0.05) reduced (40.9%); men or higher-income participants were more likely to meet the recommended activity levels. Conclusions: This study reveals that the improvements in MD lifestyle during the pandemic were not sustained in 2024, as healthier habits formed during confinement were not fully integrated into long-term behavior. These findings strengthen the need for targeted public health interventions to promote the MD. [ABSTRACT FROM AUTHOR]

Dietary sodium restriction increases plasma triglycerides (TG) and total cholesterol (TC) concentrations as well as causing insulin resistance and stimulation of the renin-angiotensin-aldosterone system (RAAS) and the sympathetic nervous system. Stimulation of the angiotensin II type-1 receptor (AT1) is associated with insulin resistance, inflammation, and the inhibition of adipogenesis. The current study investigated whether aerobic exercise training (AET) mitigates or inhibits the adverse effects of dietary sodium restriction on adiposity, inflammation, and insulin sensitivity in periepididymal adipose tissue. LDL receptor knockout mice were fed either a normal-sodium (NS; 1.27% NaCl) or a low-sodium (LS; 0.15% NaCl) diet and were either subjected to AET for 90 days or kept sedentary. Body mass, blood pressure (BP), hematocrit, plasma TC, TG, glucose and 24-hour urinary sodium (UNa) concentrations, insulin sensitivity, lipoprotein profile, histopathological analyses, and gene and protein expression were determined. The results were evaluated using two-way ANOVA. Differences were not observed in BP, hematocrit, diet consumption, and TC. The LS diet was found to enhance body mass, insulin resistance, plasma glucose, TG, LDL-C, and VLDL-TG and reduce UNa, HDL-C, and HDL-TG, showing a pro-atherogenic lipid profile. In periepididymal adipose tissue, the LS diet increased tissue mass, TG, TC, AT1 receptor, pro-inflammatory macro-phages contents, and the area of adipocytes; contrarily, the LS diet decreased anti-inflammatory macrophages, protein contents and the transcription of genes related to insulin sensitivity. The AET prevented insulin resistance, but did not protect against dyslipidemia, adipose tissue pro-inflammatory profile, increased tissue mass, AT1 receptor expression, TG, and TC induced by the LS diet. [ABSTRACT FROM AUTHOR]

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Background/Objectives: A comprehensive and up-to-date review on cardiovascular disease (CVD) risk in patients with COPD is needed. Therefore, we aimed to systematically review the risk of a range of CVD in patients with COPD. Methods: We searched three databases (Pubmed, Web of Science, SCOPUS) from inception to September 2023 using terms related to COPD and CVD. Observational studies were included if they (1) were conducted in adults with a diagnosis of COPD based on the GOLD criteria, spirometry, physician diagnosis, or review of electronic health records; (2) reported the risk of CVD, namely of myocardial infarction (MI), ischaemic heart disease (IHD), atrial fibrillation (AF), heart failure, cerebrovascular disease, pulmonary hypertension, and peripheral vascular disease, compared with a control population using a measure of risk. A narrative synthesis was used. Results: Twenty-four studies from 2015 to 2023, mainly from Europe (n = 17), were included. A total of 3,485,392 patients with COPD (43.5–76.0% male; 63.9–73.5 yrs) and 31,480,333 (40.0–55.4% male, 49.3–70.0 yrs) controls were included. A higher risk of CVD in patients with COPD was evident regarding overall CVD, MI, IHD, heart failure, and angina. Higher risks of arrhythmia and AF, stroke, sudden cardiac death/arrest, pulmonary embolism, pulmonary hypertension, and peripheral vascular disease were also found, although based on a small amount of evidence. Conclusions: Patients with COPD have a higher risk of CVD than the general population or matched controls. This review underscores the need for vigilant and close monitoring of cardiovascular risk in individuals with COPD to inform more precise preventive strategies and targeted interventions to enhance their overall management. [ABSTRACT FROM AUTHOR]

Due to the continuous optimization of cutting plans, the cotton scrap size resulting from the cutting of components for clothing production (post-industrial residues) is often considered insufficient to obtain fibres with the proper length to produce a new yarn through mechanical recycling processes; so it is important to search for other applications for these wastes. In this context, small pieces of cotton were submitted to a shredding process to obtain recycled fibres. Cotton small pieces and recycled fibres were then submitted to a refining process to achieve refined fibres. Using these materials alone and in blends with refined and unrefined bleached eucalyptus kraft pulp (BEKP), wet-laid nonwovens were developed and characterized. An analysis of the results revealed that the replacement of unrefined BEKP by 70% cotton waste fibres in wet-laid nonwovens, reducing the use of virgin raw material, enhances the structures' mechanical properties by 80% and 14%, for small pieces or recycled fibres, respectively. Additionally, refining small pieces of cotton seems to be more promising than refining recycled fibres, because less steps are required to obtain wet-laid nonwovens with better mechanical properties. These results highlight the potential of this approach to be explored further for different products and end applications. [ABSTRACT FROM AUTHOR]

There is a consensus that students should be involved in interdisciplinary activities that promote a solid education in STEAM subjects from an early age. The outdoor settings of schools present an advantageous context for STEAM education, allowing for a myriad of learning experiences. To understand how teachers perceive the pedagogical use of the school's outdoor space, a study was carried out in a cluster of schools in a Portuguese city, including one middle school and 10 kindergarten and elementary schools. A mixed methods approach was used, combining a questionnaire for teachers (N = 49) with interviews (N = 8). The results indicate that teachers' perceptions of the characteristics of their school's outdoor spaces either facilitate or hinder the implementation of outdoor pedagogical activities. Most teachers concur that the outdoors provides contact with nature and encourages interdisciplinary and collaborative activities. However, the teachers surveyed admit to using the school's outdoor spaces only occasionally, and this use decreases as the educational level at which they teach increases. The most common use of outdoor spaces is for physical and motor activities, promoting the well-being of children and youth. Although interdisciplinary activities in outdoor spaces are recognised, their implementation is limited and hampered by factors such as the length of curricula and the lack of training for teachers in these approaches. In this sense, there is an urgent need to train teachers in the interdisciplinary use of outdoor spaces to promote a solid education in STEAM subjects. [ABSTRACT FROM AUTHOR]

BackgroundPoor medication adherence is a major challenge in asthma, and objective assessment of inhaler adherence is needed. The InspirerMundi app aims to monitor adherence while providing a positive experience through gamification and social support. ObjectiveThis study aimed to evaluate the feasibility and acceptability of the InspirerMundi app to monitor medication adherence in adolescents and adults with persistent asthma (treated with daily inhaled medication). MethodsA 1-month mixed method multicenter observational study was conducted in 26 secondary care centers from Portugal and Spain. During an initial face-to-face visit, physicians reported patients’ asthma therapeutic plan in a structured questionnaire. During the visits, patients were invited to use the app daily to register their asthma medication intakes. A scheduled intake was considered taken when patients registered the intake (inhaler, blister, or other drug formulation) by using the image-based medication detection tool. At 1 month, patients were interviewed by phone, and app satisfaction was assessed on a 1 (low) to 5 (high) scale. Patients were also asked to point out the most and least preferred app features and make suggestions for future app improvements. ResultsA total of 107 patients (median 27 [P25-P75 14-40] years) were invited, 92.5% (99/107) installed the app, and 73.8% (79/107) completed the 1-month interview. Patients interacted with the app a median of 9 (P25-P75 1-24) days. At least one medication was registered in the app by 78% (77/99) of patients. A total of 53% (52/99) of participants registered all prescribed inhalers, and 34% (34/99) registered the complete asthma therapeutic plan. Median medication adherence was 75% (P25-P75 25%-90%) for inhalers and 82% (P25-P75 50%-94%) for other drug formulations. Patients were globally satisfied with the app, with 75% (59/79) scoring ≥4,; adherence monitoring, symptom monitoring, and gamification features being the most highly scored components; and the medication detection tool among the lowest scored. A total of 53% (42/79) of the patients stated that the app had motivated them to improve adherence to inhaled medication and 77% (61/79) would recommend the app to other patients. Patient feedback was reflected in 4 major themes: medication-related features (67/79, 85%), gamification and social network (33/79, 42%), symptom monitoring and physician communication (21/79, 27%), and other aspects (16/79, 20%). ConclusionsThe InspirerMundi app was feasible and acceptable to monitor medication adherence in patients with asthma. Based on patient feedback and to increase the registering of medications, the therapeutic plan registration and medication detection tool were redesigned. Our results highlight the importance of patient participation to produce a patient-centered and engaging mHealth asthma app.