Repositório Científico do Instituto Nacional de Saúde
Entradas recentes
Relatório REVIVE 2025 - Culicídeos, Ixodídeos e Flebótomos: Rede de Vigilância de Vetores
Publication . Centro de Estudos de Vetores e Doenças Infeciosas Doutor Francisco Cambournac
Relatório REVIVE: Rede de Vigilância de Vetores (Culicídeos, Ixodídeos e Flebótomos) relativo às atividades desenvolvidas em 2025. O programa REVIVE visa monitorizar a atividade de artrópodes hematófagos, caracterizar as espécies e sua ocorrência sazonal, e identificar agentes patogénicos importantes em saúde pública. Das atividades apresentadas no presente relatório, destaca-se o seguinte:
REVIVE – Culicídeos: - Participaram na vigilância REVIVE Culicídeos as cinco Regiões de Saúde do continente e a Direção Regional de Saúde da Madeira, tendo sido realizadas colheitas de mosquitos em 243 concelhos de Portugal; - No total, foram identificados 44 123 mosquitos de 22 espécies, bem como 48 503 ovos de espécies invasoras; - O mosquito invasor Aedes aegypti encontra-se presente na Região Autónoma da Madeira desde 2005. Outra espécie invasora de mosquito, Aedes albopictus, foi identificada pela primeira vez na região Norte em 2017, no Algarve em 2018, no Alentejo em 2022, na região de Lisboa em 2023 e na região Centro em 2024. Em 2025, Aedes albopictus foi identificado em 28 concelhos, representando um alargamento significativo face a 2024. Estas espécies são vetoras de agentes etiológicos como os vírus dengue, Zika e chikungunya e têm vindo a aumentar a sua distribuição geográfica em Portugal; - A pesquisa de flavivírus e alfavírus patogénicos para o Homem foi negativa na maioria das amostras, com exceção da deteção de vírus dengue serótipo 2 (DENV 2) em amostras de Aedes aegypti provenientes da Região Autónoma da Madeira; - No âmbito do REVIVE – Culicídeos, foi realizada vigilância entomológica em cinco aeroportos internacionais, dois aeródromos, 16 portos e nove outros pontos de entrada, de acordo com o Regulamento Sanitário Internacional.
REVIVE – Ixodídeos: - Participaram na vigilância REVIVE Ixodídeos as cinco Regiões de Saúde do continente e a Direção Regional de Saúde da Madeira, entidades responsáveis pela recolha de carraças em 242 concelhos; - Em 2025, foram identificadas 6612 carraças. Para além das 12 espécies da família Ixodidae já descritas em Portugal, foram ainda detetados exemplares exóticos pertencentes à família Argasidae; - Do total de 1766 carraças analisadas para deteção de DNA de Borrelia spp. e Rickettsia spp., 2,3% revelaram-se positivas para Borrelia e 19,7% para Rickettsia; - Destacou se, neste ano, a identificação de oito espécies de Borrelia: Borrelia afzelii, B. bavariensis, B. burgdorferi sensu stricto, B. garinii, B. lusitaniae, B. valaisiana, todas pertencentes ao grupo etiológico da borreliose de Lyme, bem como B. miyamotoi e Borrelia HTRF, associadas a borrélias filogeneticamente relacionadas com o grupo da febre recorrente transmitida por carraça; - Relativamente à deteção de Rickettsia, foram identificadas sete espécies: Rickettsia aeschlimannii, R. conorii (agente da febre escaro nodular), R. helvetica, R. massiliae, R. monacensis, R. raoultii e R. slovaca, sendo estas duas últimas associadas à rickettsiose denominada TIBOLA/DEBONEL; - A pesquisa do vírus da febre hemorrágica da Crimeia Congo (CCHFV) foi realizada em 143 exemplares do género Hyalomma spp., tendo todos apresentado resultado negativo.
REVIVE – Flebótomos: - Participaram na vigilância REVIVE- Flebótomos as cinco Regiões de Saúde do continente, com colheitas dedicadas em 65 concelhos e colheitas acidentais em 43 concelhos; - No total, foram colhidos 1448 flebótomos, tendo sido identificados exemplares pertencentes às cinco espécies conhecidas em Portugal: Phlebotomus ariasi, Ph. papatasi, Ph. perniciosus, Ph. sergenti e Sergentomyia minuta; - Foram analisados 896 flebótomos para deteção de Leishmania spp. e de flebovírus; - A presença do flebovírus Toscana foi detetada na Região Centro, no concelho de Pedrógão Grande, e na Região Norte, no concelho de Resende.
O programa REVIVE resulta da colaboração entre instituições do Ministério da Saúde (Direção-Geral da Saúde, Administrações Regionais de Saúde, Direções Regionais de Saúde e INSA).
Gender-based violence against women and girls aged ≥15 years presenting to European emergency departments: a multinational, cross-sectional analysis
Publication . Carannante, Anna; Pitidis, Alessio; Fondi, Gianni; Fian, Tabea; Alves, Tatiana; Valkenberg, Huib; Nijman, Susanne; Giustini, Marco; IDB group
Background: Gender-based violence (GBV) is an important public health issue in Europe, yet standardised cross-national data remain scarce. Emergency departments (EDs) are often the first point of contact for an individual who has been assaulted. This study aimed to analyse GBV-related ED presentations using data from the European Injury Database (IDB).
Methods: This cross-sectional study analysed IDB data from 16 European countries (Jan 1, 2008, to Dec 14, 2023), defining GBV as intentional injuries inflicted by male perpetrators, involving female individuals aged ≥15 years. Descriptive analyses compared GBV with other female injuries (female victims in whom the perpetrator was recorded as female or was not specified). Multivariable logistic regression assessed GBV-associated injury severity compared with other violence against girls and women, adjusting for age, period, and country.
Findings: Of 5 643 295 injury-related ED attendances, 1 960 096 were other female injuries and 21 048 were violence cases, of which 10 315 were GBV. Mean age was 38·2 years (SD 15·7) for individuals subjected to GBV and 55·3 years (41·5) for those with other female injuries. There were higher rates of head and face injuries, contusions, and asphyxiation-related injuries in cases of GBV than other female injuries, but there were lower rates of fractures. Most GBV events occurred in domestic settings (5802 [56·3%] of 10 315 GBV cases) and during night-time hours (3931 [41·9%]), involving physical force (7340 [73·1%]); perpetrators were most commonly intimate partners (4906 [47·6%]) or strangers (1546 [15·0%]). Hospital admission was more frequent in GBV than in other female injuries (2210 [21·4%] of 10 315 vs 366 765 [18·7%] of 1 960 096; p<0·0001). GBV was associated with higher injury severity compared with other female injuries after adjustment (odds ratio 1·22, 95% CI 1·12-1·34; p<0·0001).
Interpretation: GBV-related ED cases show distinct features that characterise the visible spectrum of violence against girls and women in emergency settings. These patterns highlight the need for improved documentation and greater awareness of less visible presentations. Cross-national variability underscores the need for harmonised surveillance protocols to capture the true burden of GBV in Europe.
Predicted no effect concentrations of antifungals for wastewater management and agricultural use
Publication . Gil, D.; José, S.; Ascenso, A.; Babič, M. Novak; Segal, E.; Meletiadis, J.; Gangneux, J.P.; Weiskerger, C.J.; Solo-Gabriele, H.M.; Valério, E.; Brandão, J.
Antifungal resistance is an on-growing public health concern due to the difficulty in managing or treating medical conditions that often favour fatal fungal infections. The changing climate and globalisation, which increase fungal persistence and propagation, adds to that concern. Wastewater disposal is one potential source to the environment as antifungals are released into it. Considering that most fungal infections originate from the environment and considering the One Health principle, introducing antifungals through wastewater effluents has the potential to promote the emergence and dissemination of antifungal resistance. The objective of this study was to generate knowledge that can assist regulating the release of antifungals in the environment by quantifying predicted no-effect concentrations (PNECs) that would not promote antifungal resistance. For this purpose, a systematic review was performed to consolidate information on antifungals released to the environment and respective concentrations. The systematic literature review followed Preferred Reporting Items for Systematic literature reviews and Meta Analyses extension for Scoping Reviews (PRISMA-SLR). The analysis of 122 reviewed articles using this approach showed high concentrations and dispersion of antifungals in water, wastewater or soil. This highlights their potential dispersion in the environment, thus increasing the potential of fungal antimicrobial resistance. Due to the lack of PNEC values using fungi as model organisms in this review, PNECs for 17 antifungals were calculated using as model, as it is done for clinical purposes. We consider that the antifungal PNECs calculated and consolidated from the literature can be used to prioritise them for regulation and to determine acceptable levels in wastewater effluents.
Trends in delivery hospitalizations and the impact of ICD-9-CM to ICD-10-CM-PCS transition in Portugal between 2010 and 2018
Publication . Camarinha, Catarina de Paraíso; Oliveira, Maria Miguel Gomes; Elias, Cecília; Nobre, Miguel de Araújo; Nicolau, Leonor Bacelar Costa; Furtado, Cristina; Costa, Andreia Silva da; Nogueira, Paulo Jorge da Silva
Background: Hospital discharge data are essential for maternal health surveillance, clinical research, and healthcare resource allocation. In 2017, Portuguese hospitals transitioned from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th edition, Clinical Modification and Procedure Coding System (ICD-10-CM/PCS), impacting the recording of delivery hospitalizations. This study examines trends in delivery hospitalizations from 2010 to 2018 and assesses the impact of the ICD-10-CM/PCS transition.
Methods: We conducted a register-based observational cross-sectional analysis using data from the National Hospital Discharge Database, covering delivery hospitalizations in public hospitals from January 1, 2010, to December 31, 2018. Delivery episodes were identified using diagnosis codes, normal delivery codes, diagnosis-related group (DRG) codes, and procedure codes. Statistical analyses included descriptive statistics, interrupted time series with segmented regression, and Prophet forecasting models to evaluate trends and the impact of the coding transition.
Results: A total of 673,978 delivery hospitalizations were recorded. The transition from ICD-9-CM to ICD-10-CM/PCS in 2017 had minimal overall impact on delivery trends. DRG codes consistently identified the majority of delivery episodes, with outcome of delivery codes and selected procedure codes showing varying trends. An increase in episodes identified by normal delivery codes and a significant decrease in episodes identified by procedure codes was observed immediately after the ICD-10 transition (p < 0.001). The Prophet model indicated improved forecast accuracy for procedure codes when including the ICD-10 transition variable.
Conclusion: The transition to ICD-10-CM/PCS had a limited impact on overall delivery hospitalization trends but significantly affected procedure coding. These findings underscore the importance of considering coding system changes in healthcare data analyses. Further research should incorporate private hospital data and continuously monitor coding practices to ensure reliable health data for research and policy-making.
SCCS Opinion on Benzophenone-1 (CAS No. 131-56-6, EC No. 205-029-4)
Publication . Scientific Committee on Consumer Safety (SCCS)
Conclusion of the opinion: (1) In light of the data provided and taking under consideration the concerns related to potential endocrine disrupting properties of Benzophenone-1, does the SCCS consider Benzophenone-1 safe when used as a light stabilizer in cosmetic products up to a maximum concentration of 2%?
Having considered the data provided (including two new mutagenicity/genotoxicity studies submitted to ECHA as part of the REACH registration dossier), and the concerns relating to genotoxicity and potential endocrine disrupting properties, the SCCS considers Benzophenone-1 not safe when used as a light stabiliser in cosmetic products for the following reasons:
The available data indicate genotoxicity potential of Benzophenone-1.
The evidence assessed by the SCCS also shows that Benzophenone-1 is an endocrine-active substance due to clear demonstration of estrogenic activity and weak anti-androgenic activity both in vitro and in vivo, and potential activity against thyroid modality in vitro.
A new (2023) OECD TG 422 study relating to ED effects submitted to ECHA as part of the REACH registration dossier has not been assessed by the SCCS at this stage because of the remaining concerns over genotoxicity of Benzophenone-1. The SCCS will be ready to assess the evidence in support of the safe use of Benzophenone-1 in cosmetic products when received in a new mandate.
(2) Alternatively, what is according to the SCCS the maximum concentration considered safe for use of Benzophenone-1 in cosmetic products?
/
(3) Does the SCCS have any further scientific concerns with regard to the use of Benzophenone-1 in cosmetic products?
The SCCS mandate does not address environmental aspects. Therefore, this assessment has not covered the safety of BP-1 for the environment.