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- Results of the Portuguese EQA program for molecular detection of SARS-CoV-2, 2020-2022Publication . Correia, Helena; Silva, Susana; Ventura, Catarina; Melo, Aryse; Guiomar, Raquel; Faria, Ana PaulaThe initial strategy for containing the spread of SARS CoV 2 was the prompt identification of COVID 19 cases. National Reference laboratory implemented the biomolecular assays to detect SARS-CoV-2. In June 2020 the Portuguese National External Quality Assessment Program (PNAEQ) in collaboration with National Reference Laboratory for Influenza and Other Respiratory Viruses (NRL) organized the first National External Quality Assessment Program (EQA) for detection of SARS CoV 2 virus by molecular methods. The majority of the rounds included extra analytical questions The aim of EQA programs is to evaluate the participant’s performance and also estimate the overall detection rate of multiple national laboratories. We aimed to evaluate the results of implementation of a national external quality assessment program for the molecular detection of SARS-CoV-2 virus during 2020-2022.
- Avaliação da sensibilidade aos fármacos em tuberculose (método molecular e fenotípico), resultados do PNAEQ (2018-2022)Publication . Pereira, Edna; Correia, Helena; Silva, Anabela; Faria, Ana PaulaA deteção das resistências permite adotar um esquema terapêutico adequado contribuindo desta forma para o aumento do sucesso terapêutico e para a diminuição da mortalidade e das taxas de recidiva. Os métodos moleculares permitem a rápida deteção das mutações mais frequentes que conferem resistências e por isso a sua utilização é recomendada pela Organização Mundial de Saúde (OMS) e pela Direção Geral da Saúde (DGS). O método fenotípico permite confirmar os resultados dos testes moleculares e testar outros fármacos importantes para definir o esquema terapêutico adequado a cada caso. A participação em programas de avaliação externa da qualidade permite aos laboratórios que determinam a sensibilidade aos fármacos em tuberculose avaliarem os seus resultados e, se necessário, corrigirem procedimentos. O objetivo deste trabalho é avaliar o desempenho dos participantes do Programa Nacional de Avaliação Externa da Qualidade PNAEQ) nos 2 programas Micobacteriologia, deteção molecular de multirresistência (DMMR) e Micobacteriologia, avaliação da sensibilidade aos fármacos de 1 ª linha (TSA) no período 2018-2022.
- How to use human biomonitoring in chemical risk assessment: Methodological aspects, recommendations, and lessons learned from HBM4EUPublication . Santonen, Tiina; Mahiout, Selma; Alvito, Paula; Apel, Petra; Bessems, Jos; Bil, Wieneke; Borges, Teresa; Bose-O'Reilly, Stephan; Buekers, Jurgen; Cañas Portilla, Ana Isabel; Calvo, Argelia Castaño; de Alba González, Mercedes; Domínguez-Morueco, Noelia; López, Marta Esteban; Falnoga, Ingrid; Gerofke, Antje; Caballero, María del Carmen González; Horvat, Milena; Huuskonen, Pasi; Kadikis, Normunds; Kolossa-Gehring, Marike; Lange, Rosa; Louro, Henriqueta; Martins, Carla; Meslin, Matthieu; Niemann, Lars; Díaz, Susana Pedraza; Plichta, Veronika; Porras, Simo P.; Rousselle, Christophe; Scholten, Bernice; Silva, Maria João; Šlejkovec, Zdenka; Tratnik, Janja Snoj; Joksić, Agnes Šömen; Tarazona, Jose V.; Uhl, Maria; Van Nieuwenhuyse, An; Viegas, Susana; Vinggaard, Anne Marie; Woutersen, Marjolijn; Schoeters, GreetThe need for such information is pressing, as previous research has indicated that regulatory risk assessors generally lack knowledge and experience of the use of HBM data in RA. By recognising this gap in expertise, as well as the added value of incorporating HBM data into RA, this paper aims to support the integration of HBM into regulatory RA. Based on the work of the HBM4EU, we provide examples of different approaches to including HBM in RA and in estimations of the environmental burden of disease (EBoD), the benefits and pitfalls involved, information on the important methodological aspects to consider, and recommendations on how to overcome obstacles. The examples are derived from RAs or EBoD estimations made under the HBM4EU for the following HBM4EU priority substances: acrylamide, o-toluidine of the aniline family, aprotic solvents, arsenic, bisphenols, cadmium, diisocyanates, flame retardants, hexavalent chromium [Cr(VI)], lead, mercury, mixture of per-/polyfluorinated compounds, mixture of pesticides, mixture of phthalates, mycotoxins, polycyclic aromatic hydrocarbons (PAHs), and the UV-filter benzophenone-3. Although the RA and EBoD work presented here is not intended to have direct regulatory implications, the results can be useful for raising awareness of possibly needed policy actions, as newly generated HBM data from HBM4EU on the current exposure of the EU population has been used in many RAs and EBoD estimations.
- Participação de Adolescentes com Paralisia Cerebral no DesportoPublication . Vila-Nova, Fabio; Folha, Teresa; Virella, DanielA participação no desporto propicia o desenvolvimento de competências motoras, cognitivas e socioemocionais, impactando positivamente na saúde, na qualidade de vida e na participação de crianças e jovens. Para os adolescentes com paralisia cerebral (PC), o envolvimento nestas atividades pode promover interações positivas com pares, com e sem deficiência, em contexto desportivo. OBJETIVO Analisar a participação no desporto de adolescentes com PC na coorte nacional de nascimento 2001-2003, residentes da Área Metropolitana de Lisboa e do Alto Minho, avaliados pelo Programa de Vigilância Nacional da Paralisia Cerebral (PVNPC). RESULTADOS 51 (44,3%) reportaram participação em atividades desportivas. Identificamos correlação significativa entre a participação no desporto e uma maior funcionalidade motora global (r=.244; p=0.002), motricidade fina (r=.249; p=0.009), nível cognitivo (r=.222; p=0.02) e de expressão (r=.240; p=0.01). CONCLUSÃO No intuito de potenciar a inclusão e participação de adolescentes com PC, professores de educação física e treinadores devem considerar a adaptação das atividades no planeamento e promoção da prática desportiva. Embora não incluídos neste estudo, as atitudes e condicionantes físicas do contexto devem ser monitorizadas, por forma a minimizar barreiras à participação desta população em atividades desportivas.
- Fighting occupational risks among Portuguese wildland firefighters: looking at cytogenetic effectsPublication . Esteves, Filipa; Slezakova, Klara; Madureira, Joana; Vaz, Josiana; Fernandes, Adília; Pereira, Maria do Carmo; Morais, Simone; Teixeira, João Paulo; Costa, SolangeBackground:Evidence linking wildland firefighters’ occupational exposure and health outcomes is still limited. Cytogenetic endpoints have long been applied in the surveillance of human genotoxic exposures and early effects of genotoxic carcinogens. Therefore, it is of utmost importance to clarify the exposure-induced cytogenetic effects concerning wildland firefighters’ occupational exposure at different time points (Pre-fire season and fire season). Objective:Here, we aim to evaluate the cytogenetic levels in buccal cells among a group of wildland firefighters during a Pre-fire season, considering both the i) influence of self-reported variables (e.g., lifestyle) on buccal micronucleus cytome assay (BMCyt) outcomes and ii) the cytogenetic damage in exfoliated buccal cells considering the estimated inhalation doses to particulate matter (PM) in non-fire work settings. Methods:A total of 176 northern Portuguese wildland firefighters (82% males; mean age of 37.5 ± 10.9) were recruited during the pre-fire season of 2021. Relevant information was obtained through a self-administered questionnaire. Genomic instability was assessed for 172 northern Portuguese wildland firefighters by BMCyt. PM10 and PM2.5 inhalation doses (indoor/outdoor) were estimated for a group of 80 firefighters based on methods described elsewhere [1]. Results:Some lifestyle variables (e.g., daily consumption of vegetables) shown to have a protective role on some BMCyt endpoints (p<0.05), whereas others such coffee consumption or being partof Permanent Intervention Teams (full-time firefighters) presented a negative impact (p<0.05). No significant association was found between estimated inhaled doses of PM10and PM2.5 (mean 1.73 ± 0.43 μg kg-1and 0.53 ± 0.21 μg kg-1, correspondingly) and BMCyt endpoints. Conclusions:The characterization of a population is a very important step to have a broad perspective of the potential risk factors that may influence the studied endpoints in further analysis. Surveillance based on (bio)monitoring programs may be a crucial tool to identify firefighters at high risk for developing adverse health outcomes.
- New perspectives on respiratory syncytial virus surveillance at the national level: lessons from the COVID-19 pandemicPublication . Teirlinck, Anne C.; Johannesen, Caroline K.; Broberg, Eeva K.; Penttinen, Pasi; Campbell, Harry; Nair, Harish; Reeves, Rachel M.; Bøås, Håkon; Brytting, Mia; Cai, Wei; Carnahan, AnnaSara; Casalegno, Jean-Sebastien; Danis, Kostas; De Gascun, Cillian; Ellis, Joanna; Emborg, Hanne-Dorthe; Gijon, Manuel; Guiomar, Raquel; Hirve, Siddhivinayak S.; Jiřincová, Helena; Nohynek, Hanna; Oliva, Jesus Angel; Osei-Yeboah, Richard; Paget, John; Pakarna, Gatis; Pebody, Richard; Presser, Lance; Rapp, Marie; Reiche, Janine; Rodrigues, Ana Paula; Seppälä, Elina; Socan, Maja; Szymanski, Karol; Trebbien, Ramona; Večeřová, Jaromíra; van der Werf, Sylvie; Zambon, Maria; Meijer, Adam; Fischer, Thea K.Learning from the COVID-19 pandemic and considering the effects of this pandemic, we provide recommendations that can guide towards sustainable RSV surveillance with the potential to be integrated into the broader perspective of respiratory surveillance.
- Evidence for an association of prenatal exposure to particulate matter with clinical severity of Autism Spectrum DisorderPublication . Santos, João Xavier; Sampaio, Pedro; Rasga, Célia; Martiniano, Hugo; Faria, Clarissa; Café, Cátia; Oliveira, Alexandra; Duque, Frederico; Oliveira, Guiomar; Sousa, Lisete; Nunes, Ana; Moura Vicente, AstridEarly-life exposure to air pollutants, including ozone (O3), particulate matter (PM2.5 or PM10, depending on diameter of particles), nitrogen dioxide (NO2) and sulfur dioxide (SO2) has been suggested to contribute to the etiology of Autism Spectrum Disorder (ASD). In this study, we used air quality monitoring data to examine whether mothers of children with ASD were exposed to high levels of air pollutants during critical periods of pregnancy, and if higher exposure levels may lead to a higher clinical severity in their offspring. We used public data from the Portuguese Environment Agency to estimate exposure to these pollutants during the first, second and third trimesters of pregnancy, full pregnancy and first year of life of the child, for 217 subjects with ASD born between 2003 and 2016. These subjects were stratified in two subgroups according to clinical severity, as defined by the Autism Diagnostic Observational Schedule (ADOS). For all time periods, the average levels of PM2.5, PM10 and NO2 to which the subjects were exposed were within the admissible levels defined by the European Union. However, a fraction of these subjects showed exposure to levels of PM2.5 and PM10 above the admissible threshold. A higher clinical severity was associated with higher exposure to PM2.5 (p = 0.001), NO2 (p = 0.011) and PM10 (p = 0.041) during the first trimester of pregnancy, when compared with milder clinical severity. After logistic regression, associations with higher clinical severity were identified for PM2.5 exposure during the first trimester (p = 0.002; OR = 1.14, 95%CI: 1.05–1.23) and full pregnancy (p = 0.04; OR = 1.07, 95%CI: 1.00–1.15) and for PM10 (p = 0.02; OR = 1.07, 95%CI: 1.01–1.14) exposure during the third trimester. Exposure to PM is known to elicit neuropathological mechanisms associated with ASD, including neuroinflammation, mitochondrial disruptions, oxidative stress and epigenetic changes. These results offer new insights on the impact of earlylife exposure to PM in ASD clinical severity.
- Distribution and Clinical Significance of HPV16 Variants in Head and Neck Squamous Cell Carcinomas: Data from a Portuguese Cohort and Systematic ReviewPublication . Cochicho, Daniela; Nunes, Alexandra; Sobral, Daniel; Gomes, João P.; Esteves, Susana; Mendonça, Joana; Vieira, Luis; Martins, Luís; Cunha, Mario; Montalvão, Pedro; Magalhães, Miguel; Gil da Costa, Rui M.; Félix, AnaIntroduction: Genomic variants of the human papillomavirus type 16 (HPV16) are thought to play differential roles in the susceptibility to head and neck squamous cell carcinomas (HNSCC) and its biological behaviour. This study aimed to establish the prevalence of HPV16 variants in an HNSCC cohort and associate them with clinical pathological characteristics and patient survival. Methods: We retrieved samples and clinical data from 68 HNSCC patients. DNA samples were available from tumour biopsy at the time of the primary diagnosis. Targeted next-generation sequencing was used to obtain whole-genome sequences, and variants were established based on phylogenetic classification. Results: 74% of samples clustered in lineage A, 5.7% in lineage B, 2.9% in lineage C, and 17.1% in lineage D. Comparative genome analysis revealed 243 single nucleotide variations. Of these, one hundred were previously reported, according to our systematic review. No significant associations with clinical pathological variables or patient survival were observed. The E6 amino acid variations E31G, L83V, and D25E and E7 N29S, associated with cervical cancer, were not observed, except for N29S in a single patient. Conclusion: These results provide a comprehensive genomic map of HPV16 in HSNCC, highlighting tissue-specific characteristics which will help design tailored therapies for cancer patients.
- Nutritional quality of foods consumed by the Portuguese population according to the Nutri-Score and consistency with nutritional recommendationsPublication . Santos, Mariana; Matias, Filipa; Fontes, Tânia; Bento, Ana Cristina; Pires, Maria João; Nascimento, Ana; Santiago, Susana; Castanheira, Isabel; Rito, Ana Isabel; Loureiro, Isabel; Assunção, RicardoIn the last few years, public health authorities have shown interest in introducing front-of-pack labelling (FOPL), as one of the main policies to combat diet-related non-communicable diseases (NCDs). Nutri-Score is a FOPL that categorizes a food product into five categories according to its nutritional value. This study aimed to investigate the ability of Nutri-Score to discriminate the nutritional quality of foods consumed by the Portuguese population and the consistency with the food-based dietary guidelines. The applicability of Nutri-Score was assessed by applying it to 165 food products that were considered under the PT-Total Diet Study (PT-TDS). At least three categories (colours/letters) of the Nutri-Score were observed for most of the food groups and for sub-groups a minimum of two categories were identified. The Nutri-Score showed moderate agreement with the Portuguese Nutrient Profile Model (PT-NPM) (k = 0.416). The food classification according to the Nutri-Score was consistent with the nutritional recommendations. Food groups in which consumption is encouraged were more favourably classified than those in which consumption should be limited (i.e., Vegetables and Pastries were classified as A (93.0%) and E (57.1%), respectively). Appropriate food labelling with a system such as Nutri-Score can be relevant to health-promoting purchasing choices, improving diet quality and consequently public health.
- Relatório REVIVE 2022 - Culicídeos e Ixodídeos: Rede de Vigilância de VetoresPublication . Centro de Estudos de Vetores e Doenças Infeciosas Doutor Francisco CambournacRelatório Culicídeos e Ixodídeos relativo às atividades desenvolvidas em 2022 no âmbito da Rede de Vigilância de Vetores (REVIVE). 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 as cinco Administrações Regionais de Saúde e a Direção Regional de Saúde da Madeira, entidades que realizaram colheitas de mosquitos em 236 concelhos de Portugal; · No total foram identificados 40.293 mosquitos. Nas amostras em que foi pesquisada a presença de flavivírus patogénicos para o Homem, os resultados foram negativos; · O mosquito invasor Aedes aegypti está presente na Região Autónoma da Madeira desde 2005. Outra espécie de mosquitos invasor, nomeadamente Aedes albopictus, foi identificado, pela primeira vez, na região Norte de Portugal em 2017, no Algarve em 2018 e no Alentejo em 2022. Estas espécies são vetoras de vírus como dengue, zika e chikungunya, e têm vindo a aumentar a sua distribuição geográfica naquelas regiões; · No âmbito do REVIVE – Culicídeos foi feita a vigilância em seis aeroportos internacionais, dois aeródromos, catorze portos e seis outros pontos de entrada de acordo com o Regulamento Sanitário Internacional. REVIVE – Ixodídeos · Participaram as cinco Administrações Regionais de Saúde e a Direção Regional de Saúde da Madeira, entidades que realizaram colheitas de carraças em 169 concelhos; · No total foram identificados 1810 ixodídeos. Foi identificada uma espécie exótica – Argas spp. · Foi detetada a presença de duas espécies de Borrelias e quatro espécies de Rickettsias patogénicas para o Homem tendo sido observada a prevalência média de 3,0% e 20,7%, respetivamente, sobretudo em carraças colhidas quando parasitavam seres humanos. A pesquisa do vírus da febre hemorrágica Crimeia-Congo (CCHFV) foi realizada em exemplares de carraças do género Hyalomma com resultados negativos. 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), tendo como objetivos i) monitorizar a atividade de artrópodes hematófagos; ii) caracterizar as espécies e sua ocorrência sazonal; iii) identificar agentes patogénicos importantes em saúde pública, dependendo da densidade dos vetores, o nível de infeção ou a introdução de espécies exóticas para alertar para as medidas de controlo. O REVIVE contribui para um conhecimento sistemático da fauna de culicídeos e de ixodídeos de Portugal, e do seu potencial papel de vetor, constituindo uma componente dos programas de vigilância epidemiológica indispensável à avaliação do risco de transmissão de doenças potencialmente graves.
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