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- Firefighters' sleep quality: results of a study in The Northeast of PortugalPublication . Alves, Sara; Esteves, Filipa; Silva, Francisca; Queiroga, Felisbina; Costa, Solange; Slezakova, Klara; Alves, Maria José; Pereira, Maria do Carmo; Teixeira, João Paulo; Morais, Simone; Vaz, Josiana; Fernandes, AdíliaThe aim of this study was to evaluate and describe the overall sleep quality of firefighters. Application of the Portuguese version of the Pittsburgh Sleep Quality Index (PSQI) to firefighters, from the Northeast of Portugal, who accepted to participate in the study. Data collected between June 2021 and July 2022. The PSQI global score classified participants as 36,9% of participants as poor sleepers, although 73,9% of firefighters reported a subjective quality of sleep of “very good” or “good”, with 9,1% recording a “bad” quality of sleep. In particular, among the 273 total of participants, 35,8% of firefighter’s assumed sleeping more than 7 hours, whilst 59,7% have a sleep efficiency of 85%. Nevertheless, 7% of individuals stated difficulties staying awake on some occasions, and/or some degree of unwillingness to carry out daily activities, in addition, 26 participants (9,5% of the cohort) stated ever took medicine to help them sleep over the past month. Results revealed a global PSQI score ranged from 0 to 19, being higher scores indicative of worse quality of sleep. The mean score was 4.6 and the median score was 4, being scores >5 considered as a significant sleep disturbance. The analytical results of this study reveal the presence of concerns related to the quality of sleep in firefighters, although they have a contrary perception, which can compromise their health and well-being. Thus, it is necessary to develop more research and appropriate interventions to optimize firefighters' sleep and reduce subsequent risks.
- Characterization of Haemophilus influenzae non-invasive disease in children, in Portugal: 2015-2022Publication . Duarte, Sara; Bajanca Lavado, Maria Paula; Portuguese Group for the Study of Haemophilus influenzae Invasive InfectionBackground: Haemophilus influenzae is a Gram-negative bacterium that colonizes the human upper respiratory tract, where it can remain asymptomatic. It can also progress from colonizer to pathogen and cause acute mucosal infections, such as otitis and conjunctivitis, particularly in children. These infections are frequently associated to NTHi H. influenzae. Empirical treatment with antibiotics is of concern due to possible emergence and dissemina-tion of resistant strains. Aims / Methods: We aim to characterize H. influenzae isolates from two epidemiologically relevant non-invasive diseases, otitis media and conjunctivitis, in Portugal, from 2015 to 2022 and compare this data with results from invasive disease. From January 2015 to December 2022, 134 H. influenzae isolates (78-ear-swab; 56-eye-swab) were collected in the National Reference Laboratory for Haemophilus influenzae, based at the NIH, in Lisbon. Most isolates were from children (99.5%; 132/134). Capsular status was characterized by conventional PCR. Beta-lactamase producers were identified with nitrocefin. Antimicrobial susceptibility was determined by microdilution, according to EUCAST guidelines, for several antibiotics of interest. Genetic diversity was studied by MLST and ST assigned in PubMLST (https://pubmlst.org/organisms/haemophilus-influenzae/). Results: Among 134 H. influenzae isolates, 99.3% were NTHi (133/134), whereas only one encapsulated isolate was found, and characterized as Hia (0.8%, 1/134). Beta- lactamase producers accounted for 6.7% (9/134). Antibiotic susceptibility results (n=113) showed that most isolates were susceptible to the antibiotics tested, with the exception of 34.5% resistance to trimethoprim-sulfamethoxazole (39/113). In the course of this study, we highlight the characterization of a beta-lactamase negative, NTHi isolate, resistant to ampicillin, cefotaxime, cefuroxime, amoxicillin-clavulanic acid, cefepime, and trimethoprim/sulfamethoxazole. This is the first time that we characterized resistance to cefotaxime in H. influenzae, in our country. The isolate, from a 67 years old man with multi-microorganisms corneal ulcer, was characterized as BLNAR group III-like, ST3 (confirmed by WGS). High genetic diversity was observed among NTHi, as expected, with 22 different STs assigned for 31 isolates (71% 22/31), although ST12 and ST34 included three isolates each. When comparing the MLSTs results of isolates from both invasive and non-invasive diseases, we observed that 41% (9/22) of the STs were shared among both diseases: ST-12, ST-34, ST-142, ST-160, ST-262, ST-367, ST-396, ST-1034, and ST-1411.
- Characterization of breakfast habits among Portuguese school-aged children – Missão Continente School Program 2021/2022Publication . Cabral, Mariana; Martins, Fatima; Mendes, Sofia; Figueira, Ines; Rito, AnaIntrodução: O pequeno-almoço (PA) desempenha um papel importante nos hábitos alimentares das crianças, constituindo parte de uma dieta saudável e equilibrada fundamental para o seu crescimento e desenvolvimento. Objetivos: Caracterizar os hábitos de PA de crianças em idade escolar participantes no Programa Escola Missão Continente (EMC), quanto à sua composição, frequência e local, associando estes fatores ao estado nutricional infantil. Metodologia: No âmbito do Programa EMC, decorrido no ano letivo 2021/2022, foi desenvolvida uma análise transversal, contando com uma amostra de 573 crianças (51.5% sexo masculino, idades 6-8 anos) de 35 escolas de todos os distritos de Portugal Continental e Regiões Autónomas dos Açores e da Madeira. Foram recolhidos dados antropométricos (peso e estatura) para avaliar o estado nutricional, utilizando a classificação no Índice de Massa Corporal e o referencial de curvas de crescimento da Organização Mundial de Saúde para crianças dos 5 aos 19 anos. A caracterização dos hábitos alimentares foi realizada através de um questionário aplicado aos Encarregados de Educação com questões relativas ao PA. Para o teste de hipóteses, aplicou-se o teste estatístico Qui-quadrado. Resultados: Verificou-se que a maioria das crianças consumia PA diariamente (94,5%) em casa (95,9%), sendo esta composto por produtos lácteos (24,6%), pão e equivalentes (20,7%) e cereais de pequeno-almoço (17,7%). O grupo de crianças que não consumia PA todos os dias da semana apresentava índices de pré-obesidade (25,8%) e obesidade (22,6%), significativamente superiores (p=0,01) comparativamente ao grupo de crianças que consumia pequeno-almoço diariamente (pré-obesidade = 17,0% e obesidade = 10.4%). Os resultados obtidos para os fatores local e composição não foram estatisticamente significativos. Conclusão: A frequência de PA parece estar associada com o estado nutricional infantil. Deste modo, torna-se fundamental implementar bons hábitos alimentares ao PA, desde a infância, em prol da promoção em saúde como parte de todo o desenvolvimento da criança.
- Infográfico - COSI/COVID-19 Portugal 2022Publication . Departamento de Alimentação e Nutrição. Centro Colaborativo da OMS em Nutrição e Obesidade InfantilO INSA, coordena desde 2008 o sistema de vigilância nutricional infantil – COSI Portugal. Este sistema, integrado na rede europeia da OMS, efetua a vigilância e monitorização do estado nutricional infantil a cada 3 anos. O COSI Portugal 2022 incluiu, excecionalmente, o estudo COSI/COVID-19 para avaliar o impacto da pandemia nos comportamentos associados ao estilo de vida de crianças em idade escolar
- Functional studies of APOB variants the experience of the Portuguese Familial Hypercholesterolemia StudyPublication . Ferreira, Maria Simões; Chora, Joana Rita; Medeiros, Ana Margarida; Bourbon, Mafalda; Alves, Ana CatarinaFamilial hypercholesterolemia (FH) is clinically characterized by increased levels of circulating LDL cholesterol leading to premature coronary heart disease. It can be caused by variants in LDLR, APOB, and PCSK9 genes. APOB variants are responsible for 5-10% of the FH cases, p.(Arg3527Gln) being the most common. Only recently the whole gene has been sequenced due to Next Generation Sequencing, increasing the variant spectrum of APOB and with it the number of variants that need to be functionally assessed. We aimed to characterize novel APOB variants identified in patients included in the Portuguese FH Study to confirm if they are the genetic cause of hypercholesterolemia. To better analyze these variants, we also create a database with all APOB rare variants found up to date in the Portuguese FH Study. The functional study of 5 variants is ongoing. To access if these variants affect apoB:LDL receptor binding, LDL from index cases and relatives with the variants was separated using sequential ultracentrifugation, and proliferation assays were performed with U937 cells. These cells do not synthesize cholesterol and they depend on apoB:LDL receptor binding to grow.
- Develop methodology for quality evaluation data from national FCDBs – Task 1.2, update D1.2Publication . Costa, H.S.; Dias, M.G.; Albuquerque, T.G.; Ravasco, F.; Lopes, A.; Finglas, P.; Roe, M.; Milesević, J.; Kadvan, A.; Westenbrink, S.About TASK 1.2 - To develop an approach to evaluate quality of national FCDBs.
- The disease modelling value of a folklore FAIRYtale: SHEDing light over a special group of genetic disordersPublication . Carvalho, S.; Santos, J.I.; Moreira, L.; Gaspar, P.; Gonçalves, M.; Encarnação, M.; Ribeiro, D.; Duarte, A.; Prata, M.J.; Coutinho, M.F.; Alves, SandraThe problem we are addressing: Despite extensive research, the links between accumulation of glycosaminoglycans (GAGs) and the clinical features seen in patients suffering from various forms of Mucopolysaccharidoses (MPSs) have yet to be further elucidated. These Lysosomal Storage Diseases (LSDs) present symptoms, which may (or may not) include critical musculoskeletal and cardiovascular alterations, respiratory problems, and serious neurological dysfunctions. The skeletal and brain systems are the hardest ones to access and, consequently, those in greatest need of additional knowledge and novel therapeutic solutions.
- Sintomas de COVID-19 durante predominância da variante Delta versus Ómicron: coorte prospetiva de profissionais de saúdePublication . Gaio, Vânia; Ramalhete, Sara; Santos, Ana João; Melo, Aryse; Guiomar, Raquel; Machado, AusendaIntrodução: A apresentação clínica da COVID-19, na maioria dos pacientes infetados, foi considerada como leve sem necessidade de hospitalização. No entanto, ao longo da pandemia, o padrão de sintomatologia variou, nomeadamente pela influência da introdução da vacina, mas também consoante a variante SARS-CoV-2 em circulação. Objetivos: Neste estudo pretende-se comparar a sintomatologia autorreportada pelos profissionais de saúde num período de predominância (>50%) da variante Delta (PVD) comparativamente a um período de predominância da Variante Ómicron (PVO). Metodologia: Foram utilizados os dados de um estudo de coorte realizado entre 1 de junho de 2021 e 26 de janeiro de 2022, no qual foram seguidos 3255 profissionais de saúde (PS) com idades compreendidas entre os 18 e os 70 anos. Foram comparados os sintomas autorreportados pelos PS que manifestaram doença sintomática (teste PCR positivo e autorreporte de sintomas) durante o período de PVD (1.6.2021 a 19.12.2021) comparativamente ao período de PVO (3.1.2022 a 26.1.2022). As diferenças entre os dois grupos foram analisadas usando o teste Qui-quadrado ou o teste exato de Fisher no caso de menos de 5 eventos. Resultados: De entre o total de 3255 PS seguidos, 84 tiveram um teste positivo com reporte de sintomatologia durante o período do estudo (43 durante o período PVD e 41 durante o período PVO). Os sintomas febre, anosmia, e ageusia foram mais reportados durante o período PVD comparativamente ao período PDO (46,2% versus 21,6%, p=0.04; 64,3% versus 11,1%, p<0.001; 56,1% versus 17,1%, p=0.001). O sintoma dor de garganta foi mais reportado durante o período PVO do que no período PVD (9,0% versus 36,7%, p=0.006). As percentagens dos casos sintomáticos que tinham a 1ª dose de reforço da vacina foram de 45,7% e 91,4% nos períodos PVD e PVO, respetivamente. Conclusões: Os resultados obtidos através deste estudo permitiram verificar que houve uma alteração nas frequências dos sintomas reportados pelos PS durante o período PVD comparativamente ao período PVO. É essencial o desenvolvimento e manutenção de estudos de seguimento que permitam monitorizar a evolução desta sintomatologia para reconhecer a apresentação clínica da doença e identificar possíveis causas virológicas e imunológicas para as alterações observadas.
- Obesity dialogues – fostering policy options in Western Balkans and Central AsiaPublication . Spiroksi, I.; Abdrakhmanova, S.; Rito, Ana; Racovak, I.; Heinem, M.; Whiting, S.; Williams, J.; Wickramasinghe, K.Introduction: Obesity has been identified as a serious public health challenge globally and a major determinant of premature death and disability in the WHO European Region. More than 50% of adults and one in three children around the Region are living with overweight or obesity, with prevalence close to 70% in several countries. In 2022, The WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD office) organized two policy dialogues with the objectives to highlight the obesity situation, present possible interventions and prioritize policy actions to tackle this public health issue in the regions of Western Balkans and Central Asia. Methods: Two key professionals and decision makers per country/territory were invited to discuss the current state as well as challenges and opportunities related to prevention and management of obesity in Skopje, North Macedonia (MKD) for the Western Balkans countries/territory and in Bishkek, Kyrgyzstan (KGZ) for the Central Asian countries. Dialogues were kindly supported by the Ministries of Health of the host countries with personal presence of the Ministers of Health and in MKD with the presence of the First Lady of the country. Results: WHO’s representatives presented on the burden of obesity in the countries of the Region by providing comprehensive data collected by the NCD Office through regular surveillance, as well as a summary of possible multisectoral actions listed in the recently published WHO European Obesity Report and other documents like the “Best Buys” to tackle NCDs. Country experiences were shared on implementing policies to reduce obesity burden like the public health tax in Hungary and the SSB tax and food marketing regulation in Portugal and also double duty actions to address the burden of both undernutrition and obesity, particularly important in the Central Asian countries. Participating countries, as final exercise of the one-day event, were asked to prioritize actions, according to the national context, and to assess the feasibility of its implementation over the short, medium, and long term. Conclusions: Participating countries at both events found that this activity was a novelty in their national approaches to tackle obesity in Western Balkans and the double burden of obesity and malnutrition in Central Asia and increased their knowledge on a whole-of government multicomponent approach to address obesity. Both the representatives of the European Region of the WHO and the participating countries concluded that dialogues among stakeholders at national level, as initiated at these meetings, should be stimulated, and executed if any success in tackling rising trends of obesity should be expected. Follow up on countries’ priorities should be performed to assess the progress and to support experts and policy makers in evidence-informed decision making for obesity.
- Synergistic, additive or antagonistic effects evaluation for vitamin C content of mixtures of fruits and vegetablesPublication . Levy, S.; Silva, M.A.; Costa, H.S.; Figueira, M.E.; Albuquerque, T.G.Fruits and vegetables are considered healthy foods because they are a good source of vitamins, minerals and phytochemicals. These groups of foods are the major sources of vitamin C in the diet, especially when they are consumed fresh. Low consumption of fruits and vegetables is among the top ten risk factors that contribute to global mortality. In this study 5 ingredients (spinach, carrot, apple, orange and kiwi) and 19 mixtures, were evaluated concerning vitamin C content, to estimate the potential additive, synergistic or antagonistic effects of their mixture. In 2022, the ingredients were collected from the major supermarket chains in Lisbon. Then, Design Expert software was used to define the composition of the mixtures. Total vitamin C, dehydroascorbic and ascorbic acids contents of the 5 ingredients, plus 19 mixtures, were determined by liquid chromatography coupled to photodiode array detection. Kiwi and orange were the ingredients with the highest vitamin C content, with 51.3 and 24.5 mg/100 g, respectively. These samples were also the ones with the highest ascorbic acid content, representing more than 90% of their vitamin C. For mixtures, total vitamin C ranged from 2.21 and 27.4 mg/100 g. However, 47% of the mixtures only have dehydroascorbic acid. For 79% of the mixtures, antagonistic effects were observed, meaning that the determined value was lower than the predicted value. Our findings suggest that the mixture of the ingredients decreases the ascorbic acid availability in comparison with the ingredients. A portion (160 g) of kiwi can contribute with 91% and 103% of the daily reference intake for vitamin C for adult men and women, respectively. Regarding the mixtures, it would be necessary to ingest more than 300 g to meet the recommended needs, indicating that the mixture of these ingredients should be rethought.