Cristina Nogueira-Silva

This paper demonstrates how a principle-based interpretation of the Project Management Body of Knowledge (PMBoK) 8th Edition can enhance the initiating and planning phases of complex research projects, using a multicenter maternal health initiative—Active Pregnancy—as an illustrative case. Building on PMBoK’s emphasis on value delivery, adaptability, and tailoring, the project is framed as a health-focused endeavor that must balance scientific rigor with stakeholder needs, ethical constraints, and organizational strategy across multiple sites. The paper adopts a qualitative, document-based approach to map project charters, management plans, and governance structures onto PMBoK’s performance domains and value delivery system. It shows how explicit definition of scope, schedule, cost, quality, communication, and risk management in the early phases provides a coherent architecture for later execution, monitoring, and closure. Particular attention is given to the translation of PMBoK principles into practical mechanisms, including a detailed stakeholder matrix, an organizational breakdown structure, and a work breakdown structure that covers management, intervention, resource development, digital product design, and dissemination. Another contribution is the illustration of a hybrid lifecycle tailored to a research-intensive, ethically sensitive environment. Predictive elements are used for ethics approval, protocol development, and trial logistics, while adaptive, agile components guide iterative co-creation of educational materials, digital tools, and communication strategies responsive to participant feedback and contextual changes. The paper also discusses how success criteria, key performance indicators, risk registers, and sustainability plans can be aligned with both project-level objectives and broader organizational and societal goals, including health equity and the Sustainable Development Goals. By abstracting from the specific maternal health context, the case study offers a transferable model for project managers seeking to operationalize PMBoK in other complex, multi-stakeholder research and innovation projects, demonstrating how a principle-based framework can improve planning effectiveness, coordination, and value realization beyond traditional commercial settings.

Introduction: Portuguese is the fifth most spoken language worldwide. However, no validated patient-reported outcome measure (PROM) is available to assess the impact of vulvovaginal atrophy (VVA) symptoms in Portuguese-speaking women. This study aimed to culturally adapt and psychometrically validate the European Portuguese version of the Day-to-Day Impact of Vaginal Ageing questionnaire (DIVA), herein renamed DIVAS-Q (Day-to-Day Impact of Vulvovaginal Atrophy Symptoms Questionnaire), to reflect vulvovaginal atrophy Symptoms across different age groups. Also, deliberately broadened the conceptual scope for symptomatic adult women across reproductive stages in Portugal. Design and methods: A multicentre observational study was conducted in Portugal, including pre- and post-menopausal women reporting at least one symptom of vulvovaginal atrophy. Participants were recruited from four clinical settings (public and private hospitals, private practice, and primary health care). Translation followed a standardised, multistep forward-backwards cultural adaptation protocol. Psychometric evaluation comprised descriptive analysis, confirmatory factor analysis (CFA) with WLSMV/DWLS estimation for ordinal indicators, internal consistency (Cronbach’s alpha and McDonald’s omega), item-total correlations, test-retest reliability using intraclass correlation coefficients (ICCs), convergent and discriminant validity, and known-groups validity based on the Vulvovaginal Symptom Questionnaire (VSQ) symptom-burden groups. Results: A total of 291 women completed the short version (19 items), and 243 sexually active women completed the long version (23 items) of the DIVAS-Q. CFA with WLSMV/DWLS estimation supported the original four-factor structure (daily activities, emotional well-being, sexual function, and self-concept/body image) for both versions, with good model fit (scaled CFI/TLI = 0.981/0.978 and RMSEA = 0.027 for the short version; scaled CFI/TLI = 0.973/0.970 and RMSEA = 0.033 for the long version; SRMR = 0.035-0.040). Internal consistency was excellent across all domains (Cronbach’s alpha = 0.856-0.960), with strong item-total correlations and average variance extracted values above recommended thresholds. Test-retest reliability was excellent (ICC = 0.982-0.994; 95% CIs consistently above 0.95). Known-groups validity was supported by significantly higher DIVAS-Q scores among women with higher VSQ symptom burden, with large effect sizes across domains. Conclusions: The European Portuguese DIVAS-Q demonstrated good psychometric properties for assessing the day-to-day impact of vulvovaginal atrophy-related symptoms among symptomatic adult women in Portugal. The findings support its use in clinical and research contexts in Portugal, but further studies are needed before extending its use to other Portuguese-speaking populations or using it to monitor clinically meaningful change over time.

Endometriosis is a chronic gynecological disease affecting approximately 10% of women of reproductive age and up to 40% of women with infertility, with a significant impact on quality of life due to pain and reproductive impairment. Its etiology remains unclear, although several mechanisms have been proposed, including retrograde menstruation and immune dysfunction. Increasing evidence highlights similarities between endometriosis and cancer, particularly regarding selected hallmarks such as sustained cell proliferation, angiogenesis, inflammation, invasion, and immune dysregulation. Notably, alterations in glucose metabolism have been identified, suggesting a metabolic reprogramming resembling the Warburg effect in cancer. This review examines clinical aspects, therapeutic challenges, and emerging evidence for Warburg-like glycolytic metabolism in endometriotic lesions, which favors aerobic glycolysis over oxidative phosphorylation to evade apoptosis and promote survival in hypoxic microenvironments. These cancer-like hallmarks—shared with malignancies—suggest repurposing glycolytic inhibitors as targeted therapies to disrupt disease progression beyond symptom palliation. However, most evidence remains preclinical, and important challenges regarding disease heterogeneity, target validation, and safety still need to be addressed.

Endometriosis is a chronic inflammatory condition, characterized by the presence of endometrial tissue outside the uterus, affecting 5–10% of women of reproductive age [1–4]. Its clinical spectrum ...

Purpose Advances in assisted reproductive technologies (ART) have led to an increasing number of surplus embryos being cryopreserved. Deciding the fate of these embryos poses complex emotional, ethical, and practical challenges. Understanding the factors that influence these decisions is critical in improving patient counseling and ART policy. This study aimed to analyze patterns in embryo disposition decisions across 6 years in a Portuguese ART center, focusing on differences by family type, patient age, and temporal trends. Methods We conducted a retrospective quantitative analysis of embryo disposition forms completed between 2017 and 2022, covering 3494 patients. Data were categorized by year, relationship group (different-sex couples, female couples, and single women), and final decision. Results Disposition decisions vary significantly by relationship group. Female couples were more likely to donate embryos to others (31.8%, p = 0.007) and less likely to discard them (15.9%, p = 0.03) than different-sex couples, who had the highest discard rate (26.5%). Single women showed intermediate behaviors. Age was a significant factor: those who donated embryos, particularly to others, were older (mean = 40.6 years) than those who kept or discarded them. No significant differences were found in relation to the number of embryos stored. Temporal analysis showed variation across years, with a notable increase in donations to research in recent years. Conclusions Family type and age are important factors influencing embryo disposition decisions, while the number of embryos appears to have a limited impact.

Many studies have supported the positive effects of an active lifestyle on the prevention and treatment of pregnancy-related complications, as well as maintaining fitness and functionality. The COVID-19 pandemic has underscored the need for virtual approaches to health interventions; however, few studies have examined the effectiveness of these interventions. The Standard Protocol Items: Recommendations for Interventional Trials 2025 guidelines were followed to describe the protocol of the ACTIVE PREGNANCY trial, an intervention study that delivers a physical exercise programme in-person (IN) and online (ON) to improve maternal physical activity (PA), fitness and healthy lifestyle parameters in pregnant women. Pregnant women will be invited to participate in a multisite, multicomponent exercise programme delivered either IN or ON by qualified exercise physiologists. Both groups will receive an exercise intervention delivered in different real-life environments. Participants will undergo basic fitness field tests and complete questionnaires assessing PA, fitness and lifestyle parameters before starting the exercise programme and after completing 12 weeks of the intervention. Researchers will test whether the intervention is beneficial in maintaining or improving maternal parameters after 12 weeks and will compare the effectiveness of different exercise modes. Subgroups of maternal age and weekly volume of PA will also be analysed. Primary outcomes: PA volume and health-related and functional fitness. Secondary outcomes: healthy lifestyle parameters. Additional outcomes: satisfaction with the exercise interventions and resources. This study was approved by the Ethics Committee of Santarém Polytechnic University and registered on ClinicalTrials.gov (NCT06954454). Findings will be disseminated via publications, conferences and training programmes.

Background: Patch repair of congenital diaphragmatic hernia (CDH) using Gore-Tex^® is associated with infection, adhesions, hernia recurrence, long-term musculoskeletal sequels and poor tissue regeneration. To overcome these limitations, the performance of two novel biodegradable membranes was tested to repair CDH in a growing pig model. Methods: Twelve male pigs were randomly assigned to 3 different groups of 4 animals each, determined by the type of patch used during thoracoscopic diaphragmatic hernia repair (Gore-Tex^®, polycaprolactone electrospun membrane-PCLem, and decellularized human chorion membrane-dHCM). After 7 weeks, all animals were euthanized, followed by necropsy for diaphragmatic evaluation and histological analysis. Results: Thoracoscopic defect creation and diaphragmatic repair were performed without any technical difficulty in all groups. However, hernia recurrence rate was 0% in Gore-Tex^®, 50% in PCLem and 100% in dHCM groups. At euthanasia, Gore-Tex^® patches appeared virtually unchanged and covered with a fibrotic capsule, while PCLem and dHCM patches were replaced by either floppy connective tissue or vascularized and floppy regenerated membranous tissue, respectively. Conclusion: Gore-Tex^® was associated with a higher survival rate and lower recurrence. Nevertheless, the proposed biodegradable membranes were associated with better tissue integration when compared with Gore-Tex^®.

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Foetal heart rate (FHR) variability is considered a marker of foetal neurobehavioral development associated with infant self-regulation and thus may be an early precursor of the adverse impact of mother's prenatal depressive symptoms on infant self-regulation. This study analysed the mediator role of FHR variability in the association between mother's prenatal depressive symptoms and infant self-regulation at three months. The sample comprised 86 first-born infants and their mothers. Mothers reported on depressive symptoms at the first trimester of pregnancy and on depressive symptoms and infant self-regulation at three months postpartum. FHR variability was recorded during routine cardiotocography at the third trimester of pregnancy. A mediation model was tested, adjusting for mother's postnatal depressive symptoms. Higher levels of mother's prenatal depressive symptoms were associated with both lower FHR variability and lower infant self-regulation at three months. FHR variability was associated with infant self-regulation and mediated the association between mother's prenatal depressive symptoms and infant self-regulation at three months. Findings suggested FHR variability as an early precursor of infant self-regulation that underlies the association between mother's prenatal depressive symptoms and infant self-regulation. Infants of mothers with higher levels of prenatal depressive symptoms could be at risk of self-regulation problems, partially due to their lower FHR variability.