Lusíada University of Porto

To provide an ESSKA-ESA formal Consensus to help general practitioners in their daily clinical decisions regarding the diagnosis and treatment of traumatic anterior shoulder instability (TASI) according to age and timing after injury. Part 1 is dedicated to the history-taking, physical examination and imaging studies. Patients were categorised into three age groups: adolescents (<20 years), young adults (20-40 years) and older adults (>40 years). Two clinical scenarios were addressed: first-time and recurrent dislocations. A formal consensus process was followed, including a steering group (15 experts from 9 countries), a rating group (18 experts from 18 countries) and a reader group (28 experts from 13 countries). The steering group formulated 35 clinical questions, 12 of which related to Part 1. Each question was answered with a statement and grade of recommendation (A-D), based on literature and expert opinion. The rating group reviewed and refined the statements, followed by validation from the reader group for cultural adaptability. Consensus was reached with high agreement: median (range) 9 (8-9). One question received a grade A recommendation, nine were B, and two were C. Most debated topics included imaging to guide treatment decisions in first-time dislocations, assessment of glenoid bone loss, and soft tissue quality. Each age group presents unique diagnostic considerations: younger patients have higher recurrence risk and activity levels; older patients more often present with associated soft-tissue injuries. While physical exam findings were consistent across ages, associated injuries gain importance with age. The distinction between first-time and recurrent dislocations significantly impacts imaging needs. The ESSKA-ESA Consensus highlights that age and timing (first-time versus recurrent) influence the decision-making when managing TASI. All parameters related to history taking, physical exam and imaging studies should be considered according to the patient's age and the number of dislocation episodes. Level II.

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent and highly impacting neurodevelopmental disorders worldwide. Beyond its complexity, it’s a childhood-onset condition influenced by both genetic and environmental factors. Among these, nutrition has emerged as a relevant modifiable factor, yet most studies have focused on isolated nutrients, overlooking dietary complex interplay. This study addresses that gap using a data-driven nutrient pattern approach. To identify nutrient patterns in children with ADHD and explore their association with behavioural symptoms. In this case–control study, 76 children aged 6–10 years (ADHD: n = 43, Neurotypical, n = 33) were included. Nutritional intake was assessed using 3-day food diaries and Principal Component Analysis (PCA) was applied to 24 total energy intakeadjusted dietary nutrients. Multivariable regression models assessed associations between nutrient patterns, individual nutrients, and ADHD-related symptoms measured by Child Behaviour Questionnaire (CBCL) and Conners’ Parent Rating Scale-Revised: Short Form (CPRS-R:S). Seven major nutrient patterns were identified, explaining 76.7% of the total variance. Although no group-level differences in overall patterns reached statistical significance, the Antioxidant–Mineral factor showed a near-significant lower score in the ADHD group (p = 0.077). Children with ADHD consumed significantly less Monounsaturated fats (MUFAs) (p = 0.003), Polyunsaturated fats (PUFAs) (p = 0.010), and vitamin C (p = 0.014). Vitamin A and selenium emerged as key nutrients associated with behavioral and emotional symptoms, and ADHD severity. Our findings suggest that children with ADHD may have lower intake of antioxidant-rich micronutrients and healthy fats, with implications for symptom severity. These results underscore the potential role for nutrition-based strategies in the clinical management of ADHD.

Social media has fundamentally altered how information is created, disseminated, and consumed, with growing impact on spine surgeons and professional societies. Traditional academic publishing remains the standard for research validation, but digital platforms now shape much of the real-time dialogue in spine care. To explore strategies for integrating spine surgeons' social media presence with traditional publishing channels to enhance knowledge dissemination, support clinical innovation, and improve member engagement within spine societies. This perspective reviews current patterns of social media use among spine surgeons, focusing on platforms such as X (formerly Twitter), Instagram, and LinkedIn. It analyzes benefits (reach, speed, interactivity) and challenges (variable quality, lack of peer review, potential bias), and proposes a conceptual hybrid model in which social media and peer-reviewed journals function in a complementary rather than competitive manner. Social media enables rapid sharing of clinical insights, techniques, and innovations, and facilitates engagement with both peers and patients. However, it often privileges observational data, lower-level evidence, and real-world experiences that do not easily fit into traditional high-level evidence frameworks. A hybrid approach is proposed in which professional societies (1) formally recognize curated social media content as a feeder for peer-reviewed work; (2) create more inclusive forums for lower-level evidence and case-based discussions; and (3) intentionally link digital dialogues to structured academic outputs. By aligning the dynamic, interactive nature of social media with the rigor and credibility of traditional publishing, spine societies can foster greater member engagement, accelerate innovation, and reinforce their role as thought leaders. A deliberate, hybrid communication strategy can bridge the gap between digital and print, creating a more collaborative and inclusive platform for advancing spine surgery. Integrating social media with traditional publishing can accelerate the dissemination of practical, real-world clinical insights, ultimately enhancing surgeon education and improving patient care in spine surgery.

Background Autologous cancellous bone, the “gold standard” for bone grafting, is limited by donor site morbidity, restricted availability, and procedural complications. Synthetic bone graft substitutes, particularly calcium phosphate ceramics (CaPs) with submicron topography, offer a promising alternative due to their osteoconductive and osteoinductive properties. MagnetOs Putty, a synthetic CaP-based graft with advanced submicron surface topography, has demonstrated equivalence to autograft in preclinical and human clinical studies. This study evaluates the clinical performance of MagnetOs Putty as a standalone bone graft in hindfoot fusion Objectives This study aims to (1) evaluate the clinical and radiological outcomes of MagnetOs Putty in hindfoot fusion, (2) compare these outcomes to autograft, and (3) assess patient-reported outcomes, complications, and reoperation rates. Study Design and Methods A retrospective medical chart review identifiedof 72 patients undergoing hindfoot fusion that met the inclusion criteriawas conducted. Data was collected from Patients receiving either MagnetOS Putty (36) or were divided into two groups: 36 treated with MagnetOs Putty and 36 with autologous bone graft. Inclusion criteria required degenerative hindfoot disease, treatment with either graft type, and follow-up data availability. Primary outcomes included radiographic fusion assessed by independent, blinded radiological analysis. Secondary outcomes included changes in outcome scores, complication rates, and reoperation rates. Descriptive statistics and appropriate statistical tests will used to analyze the results. Results Data collection is ongoing Results are forthcoming and will describe fusion rates, clinical outcomes, and complication rates associated with MagnetOs Putty compared to autograft. Preliminary analysis suggests that MagnetOs Putty offers a viable alternative to autograft for hindfoot fusion. Conclusions This study aims to provide evidence supporting the use of MagnetOs Putty as a standalone bone graft in foot and ankle surgery, addressing limitations and avoiding complications associated with of traditional grafting materials. The findings could inform clinical decision-making and promote the adoption of advanced synthetic bone graft substitutes.

EP1.4, e-Poster Terminal 1, September 4, 2025, 11:35 - 13:00AimsIn 2022 migrants comprised 48% of all new HIV diagnoses in the EU/EEA and only four countries provided data across the care continuum for migrants. We sought to implement a HIV screening strategy for migrants in 10 European countries.MethodsBetween April 2022 – March 2023, we conducted the Mi-Health HIV Partnership, a study of migrants in 10 European countries (Belgium, Cyprus, England, France, Germany, Greece, Italy, Netherlands, Portugal, Sweden). HIV infection was determined by combined antibody/antigen, point-of-care, rapid blood or rapid oral test. Additional study variables were collected through a survey of all participants.ResultsWe screened 2402 migrants and diagnosed 154 with HIV, a prevalence rate of 6.41%. Amongst the subset of migrants self-identifying as MSM (n = 413), 74 were diagnosed with HIV, a prevalence rate of 17.92%. Of the HIV-positive MSM, 64.86% identified as South/Central American, compared to 47.46% of all MSM sampled. Higher levels (90.54%) of HIV-positive MSM were linked into healthcare compared to all MSM (48.43%). Additionally, 10.82% of HIV-positive MSM reported no/limited access to healthcare as compared to 19.73% of all MSM with no/limited access. Substantially higher levels of HIV-positive MSM (47.30%) reported stigma/racism/discrimination as their primary barrier to healthcare access as compared to all MSM in our sample (34.14%). Markedly higher levels of HIV-positive MSM identified engaging in sex work or sex with a sex worker as their primary behavioural vulnerability as compared to all MSM (64.86% versus 35.59%, respectfully). Finally, HIV-positive MSM reported lower levels of both PrEP awareness (43.24%) and using PrEP at least once in the previous year (4.05%) as compared to all MSM (68.28% and 13.08%, respectfully).ConclusionsHIV infection rates are higher amongst key population migrants. There is a need to implement community-led, targeted, culturally-sensitive screening, engagement and treatment strategies to address the multilevel barriers faced by migrants.

There are few certainties in the field of migration. From the factors that drive migrants to flee their countries and the conditions they expect to find in the destination country to migrants’ flows, routes and methods, migration policy is constantly functioning within a field of uncertainty. Yet, the importance of better managing migration processes is becoming increasingly relevant due to the multiple factors that stimulate the international movement of people, such as conflict, political or economic instability or climate change. The uncertainty surrounding the European Union’s (EU) ability to manage migration has spurred a twofold approach: the criminalisation of migrant smuggling (in an all-encompassing way) and the externalisation of migration policy through agreements with third countries. However, are these approaches effective, or should the EU consider alternative strategies to address the challenges posed by irregular migration? The purpose of this article is to evaluate the effectiveness of the EU’s policies on irregular migration, by exploring firstly the effectiveness of criminal law in deterring migrant smuggling and secondly the EU’s recent emphasis on externalisation. The consequences of both are examined in an effort to determine their effectiveness towards the objective. The article concludes with some suggestions for the way forward.

Abstract Objectives This study sought to contribute to an ongoing debate over the dimensionality of the Self-Compassion Scales. Specifically, we aimed to (1) test the factorial structure of the Portuguese-language Self-Compassion Scale-Youth (SCS-Y); (2) evaluate whether total scores are sufficiently unidimensional to be interpretable; and (3) assess construct validity. Method The sample comprised 1467 Portuguese 8th graders ( M age = 14.1 years, 48.8% girls). We tested the factorial structure of the SCS-Y using exploratory structural equation modeling (ESEM) and confirmatory factor analysis (CFA). The network alignment between self-compassion subcomponents was tested with exploratory graph analysis (EGA). Scale unidimensionality was evaluated using bifactor indices. Construct validity was evaluated by estimating correlations between SCS-Y scales and indicators of subjective well-being (SWB). Results A correlated six-factor CFA model and a two-bifactor CFA model fit the data well. Bifactor indices indicated that scores tapping into uncompassionate self-responding (i.e., self-criticism) were essentially unidimensional (ECV = 0.63, ω H = 0.78). In contrast, there was greater multidimensionality in compassionate self-responding (i.e., self-compassion; ECV = 0.42, ω H = 0.54), with the mindfulness and common humanity subscales explaining a sizeable amount of variance. The EGA revealed a two-dimensional structure (self-compassion and self-criticism communities). As evidence of construct validity, self-compassion was correlated with positive affect ( r = 0.33) and self-criticism with negative affect ( r = 0.43). Conclusions The Portuguese SCS-Y is a psychometrically adequate tool for assessing the six theorized subcomponents of self-compassion. While self-criticism is a well-defined unidimensional construct, caution is needed when interpreting a total score of compassionate self-responding. Preregistration This study was not preregistered.

Human papillomavirus (HPV) is causally related to neoplasia in multiple anogenital zones including anal, vulval, vaginal, and cervical areas in women. Care for anogenital neoplasia involves multiple specialist fields. Women with a history of cervical neoplasia are at increased risk of multiple anogenital neoplasias and second cancers occur in the anogenital zones. Results of a survey on current management practices across Europe are presented. A questionnaire was developed by iterative process and circulated amongst specialists in all fields associated with anogenital neoplasia. Data was recorded and analysed using Microsoft Excel/Stata. 316/430 (73.5%) respondents collaborated with colleagues to provide care, but only 27.0% were engaged in full multidisciplinary team meetings (MDT).Second cancers were observed both in the same anatomical zone (56.5%) as well as in different anatomical zones (45.3%) by the respondents.The survey identifies significant variability in clinician workload, experience and screening practices.Low utilisation of high-resolution anoscopy (HRA) by specialists (14.9%) indicate lack of standardisation of practices, though some (12.7%) expressed interest in training in HRA. 24.4% did not offer treatment for anogenital neoplasia, while those who treated utilised multiple modes of treatment. Recognition of multizonal anogenital neoplasia and the risk of second cancers, and new data on successful treatment of anal neoplasia have led to the assessment of expertise amongst Europe's specialists. Enhanced HRA training, improved guidelines and robust follow-up protocols are essential to optimising care. A concerted effort is needed to align professional development, workload standards and clinical practices across Europe.

The current study investigated prevalence rates of sexual difficulties and sexual dissatisfaction, comorbidities, and its sociodemographic correlates in a Portuguese community-based sample. A total of 2475 adults (896 men) completed a web-survey and fulfil a sociodemographic questionnaire, and the International Index of Erectile Function/Female Sexual Functioning Index. According to prevalence rates, the most frequent sexual difficulty for men was erectile difficulties, whereas for women was orgasmic difficulties. For men, age was a significant predictor for ejaculation and desire difficulties, whereas for women, age, marital status and educational level were significant predictors of sexual dissatisfaction, and lubrication and sexual arousal difficulties.