Paulo Teles

Abstract
BackgroundDialysis recovery time (DRT) refers to the period during which fatigue and weakness subside following hemodialysis treatment, allowing patients to resume their daily routines. This study aimed to identify the factors influencing DRT in hemodialysis patients in Turkey and Portugal, where the prevalence of chronic kidney disease is notably high.MethodsA cross-sectional observational study was conducted in a private dialysis center in Turkey and three dialysis centers in Portugal. The study included hemodialysis patients aged 18 years or older who had been undergoing four-hour hemodialysis sessions three times a week for at least six months. Participants had no communication barriers and voluntarily agreed to take part in the study. Data were collected using a semi-structured questionnaire to gather descriptive characteristics and the Hospital Anxiety and Depression Scale. Logistic regression analysis was employed to identify independent variables influencing DRT.ResultsA total of 294 patients participated in the study, including 187 from Turkey and 107 from Portugal. In Turkey, increased interdialytic weight gain (P = 0.043) was associated with prolonged recovery time, while the use of high-flux dialyzers (P = 0.026) was linked to shorter recovery times. In Portugal, older age (P = 0.020) was found to extend recovery time.ConclusionRecovery time after dialysis is influenced by varying factors across different countries. Further research with larger sample sizes is needed to deepen understanding of these factors and their implications.Clinical trial numberNCT04667741.

Abstract
Contemporary transformations in the world of work, together with the growing emotional and physical demands in nursing, have led to the emergence of new labor phenomena such as quiet quitting, which reflects changes in professional engagement and in the management of nurses’ well-being. Objective: To translate, culturally adapt, and validate the Quiet Quitting Scale for European Portuguese, evaluating its psychometric properties among the nursing population. Methods: A cross-sectional validation study was conducted following COSMIN guidelines. The process included forward and back translation, expert panel review, and pretesting with 30 nurses. The psychometric evaluation was carried out with 347 nurses from Northern Portugal. Data were analyzed using descriptive and inferential statistics, internal consistency measures (Cronbach’s a and McDonald’s ?), and confirmatory factor analysis (CFA) with maximum likelihood estimation to assess construct validity. Results: The Portuguese version (QQS-PT) maintained the original three-factor structure (Detachment/Disinterest, Lack of Initiative, and Lack of Motivation). The model showed satisfactory fit indices (CFI = 0.936; GFI = 0.901; AGFI = 0.814; TLI = 0.905; RMSEA = 0.133). The overall internal consistency was excellent (a = 0.918; ? = 0.922), with subscale a ranging from 0.788 to 0.924. Composite reliability (CR) ranged from 0.815 to 0.924, and average variance extracted (AVE) from 0.606 to 0.859, confirming convergent and discriminant validity. Conclusions: The QQS-PT demonstrated a stable factorial structure, strong reliability, and solid validity evidence. It is a brief and psychometrically sound instrument for assessing quiet quitting among nurses, providing valuable insights for research and management of professional engagement and well-being in healthcare contexts.

Abstract
Purpose: To evaluate the outcomes and durability of drug -eluting stents (DESs) for the treatment of hemodialysis access outflow stenosis. Material and Methods: A single -center retrospective analysis was conducted of all patients with hemodialysis vascular access outflow stenosis treated with a paclitaxel-coated DES (Eluvia; Boston Scientific, Marlborough, Massachusetts) between January 2020 and July 2022. A total of 34 DESs were implanted to treat outflow stenosis in 32 patients. Primary target lesion patency after stent deployment was the main outcome. Comparison between the time interval free from target lesion reintervention (TLR) after previous plain balloon angioplasty (PBA) and that after stent deployment for the same target lesion was considered a secondary outcome. Results: The primary patency at 6, 12, and 18 months was 63.1%, 47.6%, and 41.7%, respectively. The secondary patency rate was 100% at 18 months. The median time interval free from TLR increased from 4.1 to 11.9 months (P < .001). No adverse events were observed during the median follow-up period of 387 days. Conclusions: The patency rates after use of DES for hemodialysis access outflow stenosis were comparable with results for drug -coated balloons and stent grafts, addressing recoil and minimizing the risk of jailing by a covered stent.

Abstract
PurposeExergames, which combine digital games and physical exercise, have become increasingly popular for rehabilitation in the health domain. This study aimed to assess the effectiveness of exergame rehabilitation on the quality of life of cancer patients undergoing abdominal surgery.MethodsThis randomized controlled trial evaluated the effectiveness of exergame rehabilitation on the quality of life of cancer patients who had undergone abdominal surgery. Seventy postoperative patients were included, and data collection took place between January 2023 and May 2023. The patients were randomly assigned to either an exergame rehabilitation program (n = 35) or a traditional rehabilitation program (n = 35). The assessed outcome was the quality of life, and data collection occurred at three different time points: upon admission, 48 h postoperatively, and on the 7th day after surgery.ResultsQuality of life was evaluated using the WHOQOL-BREF Scale. At the third assessment, a statistically significant difference was observed between the two groups (p = 0.016), indicating that the intervention group had a higher quality of life than the control group.ConclusionsThe study showed a positive effect of exergames on the population under investigation. By the 7th day after surgery, the intervention group demonstrated an improvement in their quality of life compared to the control group.Clinical trial registrationCenter of Open Science OSF https://osf.io/286zb/, registered in July, 2023.

Abstract
We investigate the fuzzy clustering of interval time series using wavelet variances and covariances; in particular, we use a fuzzy c-medoids clustering algorithm. Traditional hierarchical and non-hierarchical clustering methods lead to the identification of mutually exclusive clusters whereas fuzzy clustering methods enable the identification of overlapping clusters, implying that one or more series could belong to more than one cluster simultaneously. An interval time series (ITS) which arises when interval-valued observa-tions are recorded over time is able to capture the variability of values within each interval at each time point. This is in contrast to single-point information available in a classical time series. Our main contribution is that by combining wavelet analysis, interval data analysis and fuzzy clustering, we are able to capture information which would otherwise have not been contemplated by the use of traditional crisp clustering methods on classical time series for which just a single value is recorded at each time point. Through simulation studies, we show that under some circumstances fuzzy c-medoids clustering performs better when applied to ITS than when it is applied to the corresponding traditional time series. Applications to exchange rates ITS and sea-level ITS show that the fuzzy clustering method reveals different and more meaningful results than when applied to associated single-point time series.