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- Plano de Atividades 2025Publication . Instituto Nacional de Saúde Doutor Ricardo Jorge; Rama, PatríciaPlano de Atividades do Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA) para o ano de 2025. O INSA é um organismo público integrado na administração indireta do Estado, sob a tutela do Ministério da Saúde. Enquanto Instituto Público de interesse estratégico nacional, tem por missão contribuir para ganhos em saúde pública, enquanto Laboratório do Estado e Laboratório Nacional de Referência. Tendo por contexto o Plano Estratégico 2024-2026 e os desafios estratégicos identificados, o Plano de Atividades para 2025, reflete as prioridades institucionais e respetivos indicadores, enquanto instrumento orientador para as atividades a desenvolver no corrente ano.
- Harmonização dos valores de anticorpos IgG contra a proteína Spike do vírus SARS-CoV-2Publication . Saraiva, Ana Leonor Fonseca; Afreixo, Vera; Gaio, VâniaO surgimento da COVID-19 conduziu ao rápido desenvolvimento de vacinas e testes de diagnóstico. Para avaliar a resposta de anticorpos IgG contra a proteína Spike do vírus SARS-CoV-2 (IgG anti-S SARS-CoV-2) em profissionais de saúde do meio hospitalar, foi realizado um estudo de coorte entre 2020 e 2022 em três centros hospitalares portugueses: Centro Hospitalar de Lisboa Ocidental (CHLO), Centro Hospitalar Tondela-Viseu (CHTV) e Centro Hospitalar e Universitário de Coimbra (CHUC). Os níveis de anticorpos foram medidos em seis momentos: antes da vacinação, após vacinação completa, aos 3, 6 e 12 meses após a segunda dose, e após a dose de reforço. Cada hospital utilizou um método analítico distinto: CMIA da Abbott, ECLIA Elecsys® da Roche e ADVIA Centaur® da Siemens, o que gerou desafios na comparabilidade dos dados. O presente estudo teve como objetivo harmonizar os anticorpos IgG anti-S SARS-CoV-2 entre os hospitais para permitir uma análise conjunta e uma melhor compreensão da dinâmica da imunidade nos profissionais de saúde em Portugal. Para assegurar uma conversão adequada dos títulos de anticorpos obtidos por métodos laboratoriais diferentes, foram aplicadas e comparadas várias estratégias de harmonização, nomeadamente a conversão internacional proposta pela Organização Mundial da Saúde (WHO) e a interpolação de quantis, seguida da aplicação de regressão de Deming. A interpolação de quantis seguida de regressão revelou-se mais eficaz do que a conversão recomendada pela OMS, ao preservar as características individuais de distribuição dos dados de cada hospital e ao permitir que os valores harmonizados refletissem a escala e a magnitude do método usado como referência (CMIA da Abbott). Após a harmonização, observou-se o padrão esperado de tendência temporal do título de anticorpos, com um aumento acentuado após a vacinação, seguido de um declínio ao longo dos meses e, por fim, um novo aumento mais pronunciado após a dose de reforço. Embora não tenha sido realizada uma validação laboratorial através da análise cruzada das amostras, uma limitação importante para a confirmação definitiva da abordagem, a metodologia demonstrou ser prática, reprodutível e com elevado potencial de aplicação em estudos multicêntricos e multinacionais que requerem a integração de dados serológicos obtidos por diferentes plataformas, nomeadamente no âmbito de colaborações europeias e internacionais. Após a harmonização, a análise estatística recorreu a modelos mistos para avaliar a evolução do título de anticorpos ao longo do tempo e a regressões lineares para analisar separadamente cada fase. Os modelos mistos evidenciaram aumentos significativos após a vacinação e o reforço, destacando diferenças entre os centros hospitalares. Nas análises por fase, além das variações entre os centros hospitalares no período pós-reforço, observou-se que indivíduos acima dos 50 anos apresentaram uma resposta imunitária superior. Estes resultados sugerem que tanto as características individuais como as diferenças institucionais influenciaram a resposta imunitária dos profissionais de saúde.
- Relatório de Atividades 2024Publication . Instituto Nacional de Saúde Doutor Ricardo Jorge; Rama, PatríciaO relatório de atividades do Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA) apresenta uma síntese das principais iniciativas, ações e projetos desenvolvidos ao longo do ano de 2024. O principal objetivo deste documento relaciona-se com a avaliação dos resultados alcançados, a sistematização da informação relevante, bem como a identificação dos principais desafios. Reflete, igualmente, o trabalho colaborativo entre os diferentes departamentos técnico-científicos e outras unidades orgânicas e funcionais do Instituto. Adicionalmente, salientam-se os seguintes objetivos específicos: Avaliar a execução do Quadro de Avaliação e Responsabilização e do Plano de Atividades de 2024, enquadrado nos objetivos estratégicos definidos no Plano Estratégico 2024-2026, através da aferição do grau de concretização dos objetivos operacionais definidos; Disponibilizar informação institucional relativa à execução orçamental, contemplando a alocação de recursos humanos, financeiros e técnicos; Apresentar, de forma quantitativa e qualitativa, os dados referentes às funções essenciais do Instituto, dos Departamentos Técnico-Científicos, do Museu da Saúde, do Laboratório de Análises de Dopagem, das Direções de Serviços e das Áreas de Apoio à Gestão.
- Rapid climate action is needed: comparing heat vs. COVID-19-related mortalityPublication . Batibeniz, Fulden; Seneviratne, Sonia I.; Jha, Srinidhi; Ribeiro, Andreia; Suarez Gutierrez, Laura; Raible, Christoph C.; Malhotra, Avni; Armstrong, Ben; Bell, Michelle L.; Lavigne, Eric; Gasparrini, Antonio; Guo, Yuming; Hashizume, Masahiro; Masselot, Pierre; das Neves Pereira da Silva, Susana; Royé, Dominic; Sera, Francesco; Tong, Shilu; Urban, Aleš; Vicedo-Cabrera, Ana M.The impacts of climate change on human health are often underestimated or perceived to be in a distant future. Here, we present the projected impacts of climate change in the context of COVID-19, a recent human health catastrophe. We compared projected heat mortality with COVID-19 deaths in 38 cities worldwide and found that in half of these cities, heat-related deaths could exceed annual COVID-19 deaths in less than ten years (at + 3.0 °C increase in global warming relative to preindustrial). In seven of these cities, heat mortality could exceed COVID-19 deaths in less than five years. Our results underscore the crucial need for climate action and for the integration of climate change into public health discourse and policy.
- Alternative Splicing at the Crossroad of Inflammatory Bowel Diseases and Colitis-Associated Colon CancerPublication . Matos, Paulo; Jordan, PeterSimple Summary: Patients with ulcerative colitis (UC) face a higher risk of developing colorectal cancer (CRC) due to chronic inflammation, a known promoter of tumour growth. Here, we review the molecular differences between colitis-associated cancer (CAC) and sporadic CRC, with a focus on “alternative splicing”, a mechanism by which the same gene can produce various protein forms. We explore how inflammation triggers changes in this process, increasing cancer risk for UC patients. The revised data emphasize that additional research into these molecular changes could help identify new biomarkers (molecules that indicate disease progression) and pave the way for innovative treatments targeting these alterations. Such advances would improve outcomes and quality of life for patients while contributing to cancer prevention and care.
- Safety assessment of the process NGR LSP used to recycle post‐consumer PET into food contact materialsPublication . EFSA Panel on Food Contact Materials (FCM); Lambré, Claude; Crebelli, Riccardo; Silva, Maria de; Grob, Koni; Milana, Maria Rosaria; Pronk, Marja; Rivière, Gilles; Ščetar, Mario; Theodoridis, Georgios; Van Hoeck, Els; Waegeneers, Nadia; Dudler, Vincent; Papaspyrides, Constantine; Tavares Poças, Maria de Fátima; Comandella, Daniele; Lioupis, Alexandros; Lampi, EvgeniaThe EFSA Panel on Food Contact Materials (FCM) assessed the safety of the recycling process NGR LSP (EU register number RECYC328). The input is hot washed and dried poly(ethylene terephthalate) (PET) flakes mainly originating from collected post‐consumer PET containers, with no more than 5% PET from non‐food consumer applications. The flakes are dried (step 2), melted in an extruder (step 3) and decontaminated during a melt‐state polycondensation step under high temperature and vacuum (step 4). In step 5, the material is granulated. Having examined the challenge test provided, the Panel concluded that the melt‐state polycondensation (step 4) is critical in determining the decontamination efficiency of the process. The operating parameters to control the performance of step 4 are the pressure, the temperature, the residence time and the characteristics of the reactor. It was demonstrated that this recycling process ensures that the level of migration of potential unknown contaminants into food is below the conservatively modelled migration of 0.0481 or 0.0962 μg/kg food, depending on the molar mass of a contaminant substance. Therefore, the Panel concluded that the recycled PET obtained from this process is not of safety concern, when used at up to 100% for the manufacture of materials and articles for contact with all types of foodstuffs, including drinking water, for long‐term storage at room temperature or below, with or without hot‐fill. Articles made of this recycled PET are not intended to be used in microwave and conventional ovens and such uses are not covered by this evaluation.
- Oral health behavior associated with cardiometabolic outcomes: A nationally representative cross-sectional study in PortugalPublication . Santos, Maria; Gaio, Vânia; Matias Dias, CarlosBackground: Oral diseases are associated with the development of cardiometabolic diseases. This study aimed to evaluate the relationship between oral health behaviors (tooth brushing and oral health appointments) with cardiometabolic diseases. Methods: Data from the First National Health Examination Survey were used. Participants aged 25-74 years and diagnosis of acute myocardial infarction (n = 4442), stroke (n = 4441), hypertension (n = 4450) and diabetes (n = 4327) were analyzed. A fifth subsample (n = 2555) included participants aged 40-69 for calculating cardiovascular risk. Poor oral health behavior was defined as brushing once a day or less and having the last oral health appointment at 12 months or more. Poisson regression models assessed the relationship between poor oral health behavior and these cardiometabolic outcomes. Results: Among 4.450 participants, 20.5 % had poor oral health behavior. A statistically significant association was found between poor oral health behavior with diabetes (PR: 1.44 [95 % CI: 1.10-1.98], and high/very high cardiovascular risk (PR: 1.42 [95 % CI: 1.25-1.62]). In the sensitivity analysis the association with diabetes and high/very high cardiovascular risk persisted when considering only brushing behavior but not when considering only oral health appointments at 12 months or more. Conclusions: Individuals with poor oral health behavior had a higher prevalence of diabetes and high/very high cardiovascular risk. Sensitivity analysis suggested that regular tooth brushing may be the main behavior for preventing diabetes and cardiovascular risk. The results suggest that regular tooth brushing may act in prevention for diabetes and cardiovascular risk.
- Re‐evaluation of citric acid esters of mono‐ and diglycerides of fatty acids (E 472c) as a food additive in foods for infants below 16 weeks of age and follow‐up of its re‐evaluationPublication . EFSA Panel on Food Additives and Flavourings (FAF); Castle, Laurence; Andreassen, Monica; Aquilina, Gabriele; Bastos, Maria Lourdes; Boon, Polly; Fallico, Biagio; FitzGerald, Reginald; Frutos-Fernandez, Maria Jose; Grasl-Kraupp, Bettina; Gundert-Remy, Ursula; Gürtler, Rainer; Houdeau, Eric; Kurek, Marcin; Louro, Henriqueta; Passamonti, Sabina; Wölfle, Detlef; Dusemund, Birgit; Turck, Dominique; Barmaz, Stefania; Tard, Alexandra; Rincon, Ana MariaCitric acid esters of mono‐ and diglycerides of fatty acids (E 472c) was re‐evaluated in 2020 by the Food Additives and Flavourings Panel (FAF Panel) along with acetic acid, lactic acid, tartaric acid, mono‐ and diacetyltartaric acid, mixed acetic and tartaric acid esters of mono‐ and diglycerides of fatty acids (E 472a,b,d,e,f). As a follow‐up to this assessment, the FAF Panel was requested to assess the safety of citric acid esters of mono‐ and diglycerides of fatty acids (E 472c) for its use as food additive in food for infants below 16 weeks of age belonging to food categories (FCs) 13.1.1 (Infant formulae as defined by Directive 2006/141/EC) and 13.1.5.1 (Dietary foods for infants for special medical purposes and special formulae for infants). In addition, the FAF Panel was requested to address the recommendation of the re‐evaluation of E 472c as a food additive to update the EU specifications in Commission Regulation (EU) No 231/2012. For this, a call for data was published to allow interested partied to provide the requested information for a risk assessment. The Panel concluded that the technical data provided by the interested business operators support an amendment of the EU specifications for E 472c. Regarding the safety of the use of E 472c in food for infants below 16 weeks of age, the Panel concluded that there is no safety concern from its use at the reported use levels and at the maximum permitted levels in food for infants below 16 weeks of age (FCs 13.1.1 and 13.1.5.1).
- Coffee Pulp from Azores: A Novel Phytochemical-Rich Food with Potential Anti-Diabetic PropertiesPublication . Costa, Anabela S.G.; Peixoto, Juliana A. Barreto; Machado, Susana; Santo, Liliana Espírito; Soares, Thiago F.; Andrade, Nelson; Azevedo, Rui; Almeida, Agostinho; Costa, Helena S.; Oliveira, Maria Beatriz P.P.; Martel, Fátima; Simal-Gandara, Jesus; Alves, Rita C.Coffee pulp, a by-product of wet coffee processing, shows significant potential in the food and health domains, but its real applications remain underexplored. This work investigated the chemical composition and bioactive properties of coffee pulp from São Miguel Island (Azores, Portugal). The studied coffee pulp exhibited high fiber content (52% dw), mostly insoluble; notable mineral levels (10.6%), mainly K, Ca, and Mg; and 6% dw of total amino acids, with hydroxyproline, aspartic acid, glutamic acid, and leucine in higher amounts. Despite containing low fat (1.6% dw), mainly saturated, it also showed considerable amounts of polyunsaturated fatty acids with a favorable n6/n3 ratio (1.40) and vitamin E (α-, β-, and γ-tocopherols). Its antioxidant capacity can be partially explained by the chlorogenic acid content (9.2 mg/g dw), and caffeine (0.98%) was present in similar amounts to those observed in some arabica coffee beans. A decrease in glucose uptake in Caco-2 cells was found, but not in fructose, suggesting selective inhibition of SGLT1 and potential antidiabetic effects. These results show that Azorean coffee pulp has potential as a sustainable and bioactive ingredient for incorporation into functional foods or dietary supplements.
- Assessing the impact of TiO2 nanomaterials on intestinal cells: New evidence for epithelial translocation and potential pro-inflammatory effectsPublication . Rolo, Dora; Pereira, Joana F.S.; Gonçalves, Lídia; Bettencourt, Ana; Jordan, Peter; Silva, Maria João; Matos, Paulo; Louro, HenriquetaUnderstanding the potential impact of nanomaterials (NMs) on human health requires further investigation into the organ-specific nano-bio interplay at the cellular and molecular levels. We showed increased chromosomal damage in intestinal cells exposed to some of in vitro digested Titanium dioxide (TiO2) NMs. The present study aimed to explore possible mechanisms linked to the uptake, epithelial barrier integrity, cellular trafficking, as well as activation of pro-inflammatory pathways, after exposure to three TiO2-NMs (NM-102, NM-103, and NM-105). Using confocal microscopy, we show that all NMs, digested or not, were able to enter different types of intestinal cells. At the physiologically relevant concentration of 14 μg/mL, the digested TiO2-NMs did not compromise the transepithelial resistance, nor the levels of epithelial markers E-cadherin and Zonula occludens protein 1 (ZO-1), of polarized enterocyte monolayers. Nonetheless, all NMs were internalized by intestinal cells and, while NM-102 was retained in lysosomes, NM-103 and NM-105 were able to transverse the epithelial barrier through transcytosis. Moreover, 24 h exposure of 14 and 1.4 μg/mL digested NM-105, promoted interleukin IL-1β expression in activated M1 macrophages, indicating a potential pro-inflammatory action in the gut. Taken together, our findings shed light on the cell-specific nano-bio interplay of TiO2-NMs in the context of the intestinal tract and highlight transcytosis as a potential gateway for their systemic distribution. The potential proinflammatory action of digested NM-105 emphasizes the importance of pursuing research into the potential impact of NMs on human health and contribute to the weight of evidence to limit their use in food.