Bruno de Sousa

Clinical prediction models play a crucial role in advancing personalized care for mental health disorders, providing essential insights for diagnosis, prognosis and intervention planning. This work examines the current methodological approaches used to develop such models, emphasizing their application to mental health problems, including depression. To illustrate these concepts, we used data on prenatal depression from a multinational observational study of 5,372 pregnant women. The goal is to develop an individual prognostic model for depressive symptoms that can be used already at the beginning of pregnancy. Our analysis explores variable selection strategies, validation methodologies and the integration of clinical expertise with data-driven approaches. Particular attention is given to addressing challenges such as population heterogeneity, overfitting and the importance of external validation for generalizability across diverse settings. We distinguish between statistical regression models and machine learning techniques, discussing their respective strengths and limitations in terms of interpretability, predictive accuracy and clinical usability. This work offers practical guidance for researchers and clinicians, focusing on the critical steps for model development and implementation. We highlight best practices to avoid common pitfalls, advocate for interdisciplinary collaboration and address challenges of integrating advanced statistical and machine learning tools into clinical practice. By providing practical guidance and addressing these issues, our aim is to support the development of robust and clinically relevant prediction models.

Playgroups are gatherings for young children and their caregivers to engage in play-based and social activities. Evidence shows significant positive impacts for playgroup participants, including diverse families and families in socioeconomically disadvantaged circumstances. Still, weaknesses in the design of previous studies limit the validity of findings. This paper describes the impacts of a playgroups intervention between 2015–2017 targeting families with children up to 4 years old not participating in any of the available Early Childhood, Education and Care (ECEC) services in Portugal on standardized international measures of child development, home environment and caregiving practices, and socialization goals. Participants included 257 children (M age at pretest = 17.74 months, s.d. 11.51 months) and caregiver dyads in five districts. After a pretest assessment, all families were randomly assigned to one of two groups: an intervention group which included 10 months of playgroup intervention; and a control group who after the 10 month post-test assessment point, received 3 months of the playgroup intervention. Children in the intervention group scored significantly higher on average on a measure of developing ability to reason through manual and visuospatial problems. Caregivers in the intervention group were, on average, more likely to endorse their children's ability to maintain positive and harmonious relationships with others. Subgroup benefits on caregiver involvement were found for employed caregivers, and receptive and expressive language for diverse ethnic children. These results are aligned with intervention foci on the promotion of learning though play and positive relationships.

This study examines how Empowering (EL), Responsible (RL), and Ethical Leadership (EtL) relate to employees’ perceptions of Decent Work (DW) in a Portuguese public university, using the Job Demands–Resources (JD-R) framework. DW, defined by dignity, equity, and security, was assessed across seven dimensions. A total of 226 faculty, researchers, and staff completed validated measures of EL, RL, EtL, and DW. Results showed moderate to strong positive correlations between leadership styles and DW, especially for Fundamental Principles and Values at Work (DW1), Fulfilling and Productive Work (DW3), and Health and Safety (DW7). EL displayed the strongest associations with fairness, inclusion, and psychological safety, while RL and EtL were more closely linked to accountability and ethical climate. Analyses by role and education revealed systematic asymmetries, with leaders and highly educated employees reporting more favorable experiences. High intercorrelations among leadership styles (r ≈ 0.87–0.90) suggest an integrated values-based leadership pattern. In contrast, weaker associations with structural dimensions such as workload and social protection highlight the limits of leadership influence on DW. These findings advance research on DW in higher education and underscore leadership development as a lever for institutional justice and well-being.

The military serves as a vital bridge between strategic goals and societal values. This study aims to comprehensively analyze the potential and limitations of Empowering Leadership (EL) in the armed forces. Considering the current post-pandemic context and the geopolitical shifts in a volatile, uncertain, fragile, and complex world, we look at how EL can boost adaptability. We started by addressing military organization structure and evolution, followed by the EL concept and its impact on organizational performance. We discussed its benefits, progress, and role in modern military environments. The analysis points out EL benefits, despite the challenges posed by the military’s strict hierarchy, which can limit EL’s effectiveness, but concluded that this style can be effective when aligned with Mission Command. We analyze EL’s nuances in military settings, presenting three propositions and stating their potential, challenges, and limitations. This study offers insights into leadership dynamics in the military, highlighting the delicate balance between empowerment and traditional structures.

The Covid-19 pandemic forced the educational community to adopt distance learning, causing us all to reflect on teaching practices and find new ways to reach out to our students. The internationalization of educational programs has redefined concepts such as inclusion, one that is no longer restricted to special needs students, but expanded to embrace a much broader concept where different cultures, languages, and sexual orientation and gender expressions need to be considered and integrated. But, with the enforcement of distance learning due to pandemics, are we truly creating a more inclusive learning environment or are we just enabling existing inequalities? The seven principals of Universal Design proposed by architect Ronald Mace (1985) provide the guidelines of the present case study, with the roadmap created here offering a reflection on the teaching practices and approaches used in order to include a wide range of students.

Young people and their families around the world are especially vulnerable to macroeconomic hard times. This study sought to provide a more comprehensive view on how families with emerging adult children can successfully overcome economic distress. Specifically, we examined the links between economic strain—that is, the subjective perceptions of one's current and future financial situation—family ritual meaning, family problem‐solving communication, and quality of life, as reported by emerging adults and their parents. Data were collected from 1017 individuals nested in 334 families living in Portugal in 2016/2017. Results from multilevel modeling provided evidence for a negative impact of economic strain on family members' quality of life (β = −0.30, p < 0.001); and for the role of family ritual meaning (β = 0.01, p = 0.022), but not family problem‐solving communication, as a buffer against the negative effect of economic strain on quality of life. Findings also suggested that the subjective evaluations that family members formulated about their financial situations played a greater role than objective economic conditions (e.g., income) in establishing a deeper understanding on the impact of economic demands on individuals and families' lives in today's complex financial world. This study provides a significant contribution to family economic stress research, advancing family ritual meaning as a key family dynamic contributing to positive adaptation to economic distress. The implications of these findings for clinical interventions include the potential benefits of symbolic forms of family communication in the work carried out with economically stressed family members.

Objective: Considering the lack of studies exploring the psychological impact of COVID-19 on patients living with and beyond cancer, this study aimed to explore the levels of emotional distress, anxiety, and depression in patients with cancer and survivors during the COVID-19 pandemic and to identify psychological risk factors. Methods: Data for this cross-sectional study were collected through an online questionnaire comprised a self-report questionnaire and the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics and linear regression models were used to characterize the sample and identify the determinants of emotional distress, depression, and anxiety. Statistical analyses were performed using R, version 4.1.1. Results: The sample included 940 patients with cancer and survivors, mostly female (87.1%), with a mean age of 49.7 years. More than half of the patients were survivors (55.1%); 56.7% were diagnosed with breast cancer, and 35.0% had other chronic diseases. Most participants believed that they were more likely to be infected with COVID-19 (53.9%) and that they may have more complications if they were infected (76.7%). Approximately half of the participants revealed significant emotional distress (49.3%), 18.1% revealed significant depression, and 29.2% revealed significant anxiety. Female patients, participants with lower education levels, unemployed/lay-off, or in a medical leave with a chronic disease, taking care of someone with a chronic disease, or perceiving a higher risk of being infected with COVID-19 had higher levels of emotional distress, depression, and anxiety. Conclusions: This study provides useful information regarding the impact of the COVID-19 pandemic on the mental health of patients with cancer and survivors, showing that an increased number of patients experienced significant emotional distress during the pandemic.