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- Programa Nacional de Vigilância da Gripe: relatório da época 2019/2020Publication . Pechirra, Pedro; Cristóvão, Paula; Costa, Inês; Conde, Patrícia; Silva, Susana; Torres, Ana Rita; Machado, Ausenda; Rodrigues, Ana Paula; Guiomar, Raquel; Direcção-Geral da Saúde (colaboração); Rede Portuguesa de Laboratórios para o Diagnóstico da Gripe e Outros Vírus Respiratórios (colaboração)Relatório anual do Programa Nacional de Vigilância da Gripe (PNVG). A presente publicação descreve a caraterização clínica e laboratorial da atividade gripal na época 2019/2020. O PNVG assegura a vigilância epidemiológica da gripe em Portugal, integrando as componentes de vigilância clínica e laboratorial. A componente clínica possibilita o cálculo de taxas de incidência permitindo descrever a intensidade e evolução da epidemia no tempo. A componente virológica tem por base o diagnóstico laboratorial do vírus da gripe, SARS-CoV-2 e vírus sincicial respiratório (RSV) o que permite detetar e caraterizar os vírus respiratórios em circulação em cada inverno. As atividades do PNVG são desenvolvidas pelo Laboratório Nacional de Referência para o Vírus da Gripe e Outros Vírus Respiratórios do Departamento de Doenças Infeciosas e pelo Departamento de Epidemiologia do Instituto Nacional de Saúde Doutor Ricardo Jorge, em colaboração com a Direção-Geral da Saúde.
- Comparison of series and parallel reactance to identify changes in intracellular water in response to physical training in athletes during a sports seasonPublication . Francisco, Rúben; Jesus, Filipe; Nunes, Catarina L.; Alvim, Marta; Campa, Francesco; Sardinha, Luís B.; Mendonca, Goncalo V.; Lukaski, Henry; Silva, Analiza M.Objective: Cross-sectional evidence has demonstrated that parallel reactance obtained by bioelectrical impedance analysis (BIA) may be an alternative to the regularly used series of measurements to predict intracellular water (ICW) in athletes. However, we are not aware of any studies that have determined the predictive role or compared the effectiveness of both series and parallel reactance for tracking ICW changes during an athletic season. The main aim of this study was to determine the predictive role and compare both series and parallel reactance (Xc) in tracking ICW during an athletic season. Research methods and procedures: This longitudinal study analyzed 108 athletes in the preparatory and competitive periods. Using dilution techniques, total body water (TBW) and extracellular water (ECW) were determined and ICW was calculated. Resistance (R), Xc, and impedance (Z) standardized for height were obtained through BIA spectroscopy using a frequency of 50kHz in a series array and then mathematically transformed in a parallel array. Results: Multiple regression analyses showed that only changes in parallel Xc and capacitance (CAP) (P < 0.05) were predictors of delta ICW during the sports season. In contracts, this was not the case for Xcs. Both changes in R and Z, series and parallel, predicted similarly the changes in ECW and TBW (P < 0.05) in athletes. Conclusion: Our findings highlight the potential of parallel BIA values to detect changes in body water compartments over a competitive season. These data provide preliminary evidence that changes in parallel Xc/H, and ultimately CAP, represent valid markers of alterations in cell volume during a sports season.
- H2OAthletes study protocol: effects of hydration changes on neuromuscular function in athletesPublication . Francisco, Rúben; Jesus, Filipe; Nunes, Catarina L.; Santos, Paulo; Alvim, Marta; Campa, Francesco; Schoeller, Dale A.; Lukaski, Henry; Mendonca, Goncalo V.; Sardinha, Luís FCB; Silva, Analiza MLAWe aim to understand the effects of hydration changes on athletes’ neuromuscular performance, on body water compartments, fat-free mass hydration and hydration biomarkers and to test the effects of the intervention on the response of acute dehydration in the hydration indexes. The H2OAthletes study (clinicaltrials.gov ID: NCT05380089) is a randomised controlled trial in thirty-eight national/international athletes of both sexes with low total water intake (WI) (i.e. < 35·0 ml/kg/d). In the intervention, participants will be randomly assigned to the control (CG, n 19) or experimental group (EG, n 19). During the 4-day intervention, WI will be maintained in the CG and increased in the EG (i.e. > 45·0 ml/kg/d). Exercise-induced dehydration protocols with thermal stress will be performed before and after the intervention. Neuromuscular performance (knee extension/flexion with electromyography and handgrip), hydration indexes (serum, urine and saliva osmolality), body water compartments and water flux (dilution techniques, body composition (four-compartment model) and biochemical parameters (vasopressin and Na) will be valuated. This trial will provide novel evidence about the effects of hydration changes on neuromuscular function and hydration status in athletes with low WI, providing useful information for athletes and sports-related professionals aiming to improve athletic performance.
- Chemometric and multielement techniques for the exploratory analysis of honey quality from different geographical originPublication . Rios, Francisco Teodoro; Lobo, Manuel Oscar; Castanheira, Isabel; Delgado, Inês; Nascimiento , Ana; Sammán, NormaThe proximal and mineral profiles of multi floral honeys from different geographic regions were determined and related to their origin. Moisture, °Brix sugars, ash, pH, free acidity, water activity (aw) and minerals content were determined by AOAC methods. In the exploratory analysis, non-supervised chemometric methods were applied to build classification rules and relate the origin of the samples based on their physicochemical parameters and mineral content. The means of the physicochemical parameters obtained were °Brix-sugars (82.44±1.68%), moisture (16.49±1.19%), pH (3.97±0.22), free acidity (24.07±6.79 meq/kg), aw (0.59±0.02), ash (0.24±0.11%). These values demonstrate the high quality of the honey analyzed. Among the minerals, K was the most abundant in all samples, ranging between 363.26-2034.11 mg/kg followed by P (45.43-115.63 mg/kg), while Cu was the least abundant (0.18-2.02 mg/Kg). The results showed differences in composition and mineral profile between honeys from different regions. The first three factors of the Principal Component Analysis method explained more than 67% of the variance and minerals had the highest discriminatory power, while hierarchical cluster analysis successfully classified the honey samples. The results show that mineral content is a capable geographical indicator to identify the origin of honey and the use of chemometric methods with proximal analysis and mineral content could be applied to determine the quality and authenticity of honey.
- SOP9 Buccal Cells Sampling - Partnership for the Assessment of the Risks from ChemicalsPublication . Louro, Henriqueta; Silva, Maria JoãoSOP9 Buccal Cells Sampling - presentation for PARC Training for Waste Management Survey / Partnership for the Assessment of the Risks from Chemicals. Aim of presentation: Provide the general procedure for the collection, storage, and transfer of buccal cell samples for micronucleus analysis in exfoliated buccal cells. The buccal micronucleus assay is a minimally invasive approach for measuring DNA damage, cell proliferation, cell differentiation and cell death in exfoliated buccal cells (Bolognesi et al., 2015). It offers a great opportunity to evaluate in a clear and precise way the appearance of genetic damage whether it is present as a consequence of occupational or environmental risk, being reliable, fast, relatively simple, cheap, and minimally invasive and causes no pain. This Standard Operating Procedure (SOP) for buccal cells sampling is intended to be used in the PARC waste management survey. The SOP provides the general procedure for the collection, storage, and transfer of buccal cell samples.
- Epidemiological Data and Antimicrobial Resistance of Campylobacter spp. in Portugal from 13 Years of SurveillancePublication . Duarte, Andreia; Pereira, Luísa; Lemos, Maria-Leonor; Pinto, Miguel; Rodrigues, João Carlos; Matias, Rui; Santos, Andrea; PTCampyNet; Oleastro, MónicaThis study extensively analyzed campylobacteriosis surveillance in Portugal from 2009 to 2021, aiming to investigate demographic shifts, seasonal variations, and antimicrobial resistance (AMR) within Campylobacter isolates. Surveillance network and sentinel laboratory-based system data revealed a substantial under-notification of campylobacteriosis cases, suggesting an underestimated disease burden. Notification rates exhibited a paradigm shift, with a notable prevalence among the pediatric population, particularly in children aged 1-4 years, diverging from European reports. Additionally, an emerging trend of Campylobacter infections in younger adults (15-44 years) was observed. The study unveiled a unique seasonal distribution of cases, defying typical summer peaks seen elsewhere. AMR analysis revealed high resistance to ciprofloxacin and tetracycline, in both C. jejuni (93.7% and 79.2%, respectively) and C. coli (96.5% and 93.2%, respectively), stable throughout the studied period (2013-2021). C. coli exhibited significantly higher resistance to erythromycin, gentamicin, ampicillin and ertapenem compared to C. jejuni (p < 0.001). Multilocus Sequence Typing (MLST) data demonstrated the distribution of resistance markers across diverse sequence types, challenging the notion of a clonal origin for multidrug-resistant isolates. In conclusion, the study highlights the need for enhanced surveillance and raises concerns about alarming AMR levels, recommending the implementation of whole-genome sequencing (WGS)-based surveillance for a deeper comprehension of disease patterns and an evolving AMR landscape.
- Global, regional, and national burden of mortality associated with cold spells during 2000–19: a three-stage modelling studyPublication . Gao, Yuan; Huang, Wenzhong; Zhao, Qi; Ryti, Niilo; Armstrong, Ben; Gasparrini, Antonio; Tong, Shilu; Pascal, Mathilde; Urban, Aleš; Zeka, Ariana; Lavigne, Eric; Madureira, Joana; Goodman, Patrick; Huber, Veronika; Forsberg, Bertil; Kyselý, Jan; Sera, Francesco; Guo, Yuming; Li, Shanshan; Gao, Yuan; Huang, Wenzhong; Zhao, Qi; Ryti, Niilo; Armstrong, Ben; Gasparrini, Antonio; Tong, Shilu; Pascal, Mathilde; Urban, Aleš; Zeka, Ariana; Lavigne, Eric; Madureira, Joana; Goodman, Patrick; Huber, Veronika; Forsberg, Bertil; Kyselý, Jan; Sera, Francesco; Bell, Michelle; Simon Hales; Honda, Yasushi; Jaakkola, Jouni J.K.; Tobias, Aurelio; Vicedo-Cabrera, Ana Maria; Abrutzky, Rosana; Coelho, Micheline de Sousa Zanotti Stagliorio; Saldiva, Paulo Hilario Nascimento; Correa, Patricia Matus; Ortega, Nicolás Valdés; Kan, Haidong; Osorio, Samuel; Roye, Dominic; Orru, Hans; Indermitte, Ene; Schneider, Alexandra; Katsouyanni, Klea; Analitis, Antonis; Carlsen, Hanne Krage; Mayvaneh, Fatemeh; Roradeh, Hematollah; Raz, Raanan; Michelozzi, Paola; de'Donato, Francesca; Hashizume, Masahiro; Kim, Yoonhee; Alahmad, Barrak; Cauchy, John Paul; Diaz, Magali Hurtado; Arellano, Eunice Elizabeth Félix; Valencia, César De la Cruz; Overcenco, Ala; Houthuijs, Danny; Ameling, Caroline; Rao, Shilpa; Carrasco, Gabriel; Seposo, Xerxes; Chua, Paul Lester Carlos; Silva, Susana das Neves Pereira da; Nunes, Baltazar; Holobaca, Iulian-Horia; Cvijanovic, Ivana; Mistry, Malcolm; Scovronick, Noah; Acquaotta, Fiorella; Kim, Ho; Lee, Whanhee; Íñiguez, Carmen; Åström, Christofer; Ragettli, Martina S.; Guo, Yue Leon; Pan, Shih-Chun; Colistro, Valentina; Zanobetti, Antonella; Schwartz, Joel; Dang, Tran Ngoc; Dung, Do Van; Guo, Yuming; Li, ShanshanBackground: Exposure to cold spells is associated with mortality. However, little is known about the global mortality burden of cold spells. Methods: A three-stage meta-analytical method was used to estimate the global mortality burden associated with cold spells by means of a time series dataset of 1960 locations across 59 countries (or regions). First, we fitted the location-specific, cold spell-related mortality associations using a quasi-Poisson regression with a distributed lag non-linear model with a lag period of up to 21 days. Second, we built a multivariate meta-regression model between location-specific associations and seven predictors. Finally, we predicted the global grid-specific cold spell-related mortality associations during 2000-19 using the fitted meta-regression model and the yearly grid-specific meta-predictors. We calculated the annual excess deaths, excess death ratio (excess deaths per 1000 deaths), and excess death rate (excess deaths per 100 000 population) due to cold spells for each grid across the world. Findings: Globally, 205 932 (95% empirical CI [eCI] 162 692-250 337) excess deaths, representing 3·81 (95% eCI 2·93-4·71) excess deaths per 1000 deaths (excess death ratio), and 3·03 (2·33-3·75) excess deaths per 100 000 population (excess death rate) were associated with cold spells per year between 2000 and 2019. The annual average global excess death ratio in 2016-19 increased by 0·12 percentage points and the excess death rate in 2016-19 increased by 0·18 percentage points, compared with those in 2000-03. The mortality burden varied geographically. The excess death ratio and rate were highest in Europe, whereas these indicators were lowest in Africa. Temperate climates had higher excess death ratio and rate associated with cold spells than other climate zones. Interpretation: Cold spells are associated with substantial mortality burden around the world with geographically varying patterns. Although the number of cold spells has on average been decreasing since year 2000, the public health threat of cold spells remains substantial. The findings indicate an urgency of taking local and regional measures to protect the public from the mortality burdens of cold spells. Funding: Australian Research Council, Australian National Health and Medical Research Council, EU's Horizon 2020 Project Exhaustion.
- Seasonality of mortality under climate change: a multicountry projection studyPublication . Madaniyazi, Lina; Armstrong, Ben; Tobias, Aurelio; Mistry, Malcolm N.; Bell, Michelle L.; Urban, Aleš; Kyselý, Jan; Ryti, Niilo; Cvijanovic, Ivana; Ng, Chris Fook Sheng; Roye, Dominic; Vicedo-Cabrera, Ana Maria; Tong, Shilu; Lavigne, Eric; Íñiguez, Carmen; das Neves Pereira da Silva, Susana; Madureira, Joana; Jaakkola, Jouni J.K.; Sera, Francesco; Honda, Yasushi; Gasparrini, Antonio; Hashizume, Masahiro; Multi-Country Multi-City Collaborative Research NetworkBackground: Climate change can directly impact temperature-related excess deaths and might subsequently change the seasonal variation in mortality. In this study, we aimed to provide a systematic and comprehensive assessment of potential future changes in the seasonal variation, or seasonality, of mortality across different climate zones. Methods: In this modelling study, we collected daily time series of mean temperature and mortality (all causes or non-external causes only) via the Multi-Country Multi-City Collaborative (MCC) Research Network. These data were collected during overlapping periods, spanning from Jan 1, 1969 to Dec 31, 2020. We projected daily mortality from Jan 1, 2000 to Dec 31, 2099, under four climate change scenarios corresponding to increasing emissions (Shared Socioeconomic Pathways [SSP] scenarios SSP1-2.6, SSP2-4.5, SSP3-7.0, and SSP5-8.5). We compared the seasonality in projected mortality between decades by its shape, timings (the day-of-year) of minimum (trough) and maximum (peak) mortality, and sizes (peak-to-trough ratio and attributable fraction). Attributable fraction was used to measure the burden of seasonality of mortality. The results were summarised by climate zones. Findings: The MCC dataset included 126 809 537 deaths from 707 locations within 43 countries or areas. After excluding the only two polar locations (both high-altitude locations in Peru) from climatic zone assessments, we analysed 126 766 164 deaths in 705 locations aggregated in four climate zones (tropical, arid, temperate, and continental). From the 2000s to the 2090s, our projections showed an increase in mortality during the warm seasons and a decrease in mortality during the cold seasons, albeit with mortality remaining high during the cold seasons, under all four SSP scenarios in the arid, temperate, and continental zones. The magnitude of this changing pattern was more pronounced under the high-emission scenarios (SSP3-7.0 and SSP5-8.5), substantially altering the shape of seasonality of mortality and, under the highest emission scenario (SSP5-8.5), shifting the mortality peak from cold seasons to warm seasons in arid, temperate, and continental zones, and increasing the size of seasonality in all zones except the arid zone by the end of the century. In the 2090s compared with the 2000s, the change in peak-to-trough ratio (relative scale) ranged from 0·96 to 1·11, and the change in attributable fraction ranged from 0·002% to 0·06% under the SSP5-8.5 (highest emission) scenario. Interpretation: A warming climate can substantially change the seasonality of mortality in the future. Our projections suggest that health-care systems should consider preparing for a potentially increased demand during warm seasons and sustained high demand during cold seasons, particularly in regions characterised by arid, temperate, and continental climates.
- Respiratory syncytial virus under 2 years of age: hospitalization trends and risk factors for severe disease – preliminary data from the Portuguese sentinel networkPublication . Torres, Ana Rita; Melo, Aryse; Aniceto, Carlos; Guiomar, Raquel; Gaio, Vânia; Bandeira, Teresa; Azevedo, Inês; Rodrigues, Ana Paula; on behalf of the VigRSV networkIntroduction and Objectives: Respiratory Syncytial Virus (RSV) infection is an important cause of hospitalization in children under five years. A national RSV sentinel network was set up in Portugal in April 2021. We describe the trends in RSV hospitalizations until September 2022 and identify risk factors for severe disease. Methods: Acute respiratory infections in hospitalized children under two years were reported and tested for RSV. RSV disease severity was defined by the need for ventilation or admission to an intensive care unit. Risk ratios were used to assess the association between gender, age group, gestational age, birthweight, chronic conditions, RSV subtype and severity of disease. Results: We detected two RSV off-season epidemics in June 2021 to February 2022 and May to September 2022. 63.3% of RSV-related hospitalizations occurred in children under six months old and 8.0% had chronic conditions. 11.0% had severe disease. Children under six months and with chronic conditions had, respectively, an 18-fold risk and a 2-fold risk of developing severe illness. Discussion: The off-season RSV epidemics were probably triggered by the relaxation of COVID-19 physical distancing measures and immunity debt. In the first epidemic, the proportion of children with severe disease was higher than reported by previous studies, however, this result is probably overestimated due to the high proportion of cases notified by central hospitals. Age < 6 months and chronic conditions predispose to severe disease. As several factors may change the pattern of RSV activity, causing more severe outbreaks at different times, countries should implement year-round RSV surveillance systems.
- Aeromonas spp. in Freshwater Bodies: Antimicrobial Resistance and Biofilm AssemblyPublication . Nascimento, Maria; Rodrigues, João; Matias, Rui; Jordão, LuisaAeromonas spp. are environmental bacteria able to infect animals and humans. Here, we aim to evaluate the role of biofilms in Aeromonas persistence in freshwater. Aeromonas were isolated from water and biofilm samples and identified by Vitek-MS and 16S rRNA sequencing. Antibiotic susceptibility profiles were determined according to EUCAST, and a crystal violet assay was used to assess biofilm assembly. MTT and the enumeration of colony-forming units were used to evaluate biofilm and planktonic Aeromonas susceptibility to chlorination, respectively. Identification at the species level was challenging, suggesting the need to improve the used methodologies. Five different Aeromonas species (A. salmonicida, A. hydrophila, A. media, A. popoffii and A. veronii) were identified from water, and one species was identified from biofilms (A. veronii). A. veronnii and A. salmonicida presented resistance to different antibiotics, whith the highest resistance rate observed for A. salmonicida (multiple antibiotic resistance index of 0.25). Of the 21 isolates, 11 were biofilm producers, and 10 of them were strong biofilm producers (SBPs). The SBPs presented increased tolerance to chlorine disinfection when compared with their planktonic counterparts. In order to elucidate the mechanisms underlying biofilm tolerance to chlorine and support the importance of preventing biofilm assembly in water reservoirs, further research is required.