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- HBM4EU E-waste study – An untargeted metabolomics approach to characterize metabolic changes during E-waste recyclingPublication . Kozlowska, Lucyna; Viegas, Susana; Scheepers, Paul T.J.; Duca, Radu C.; Godderis, Lode; Martins, Carla; Krzesimir, Ciura; Jagiello, Karolina; Silva, Maria João; Mahiout, Selma; Mārtiņsone, Inese; Matisāne, Linda; van Nieuwenhuyse, An; Puzyn, Tomasz; Sijko-Szpanska, Monika; Verdonck, Jelle; Santonen, Tiina; HBM4EU E-waste Study TeamE-waste contains hazardous chemicals that may be a direct health risk for workers involved in recycling. We conducted an untargeted metabolomics analysis of urine samples collected from male e-waste processing workers to explore metabolic changes associated with chemical exposures in e-waste recycling in Belgium, Finland, Latvia, Luxembourg, the Netherlands, Poland, and Portugal. Questionnaire data and urine samples were obtained from workers involved in the processing of e-waste (sorting, dismantling, shredding, pre-processing, metal, and non-metal processing), as well as from controls with no known occupational exposure. Pre- and post-shift urine samples were collected and analysed using ultrahigh-performance liquid chromatography-mass spectrometry (UPLC-MS). A total of 32 endogenous urinary metabolites were annotated with a Variable Importance in Projection (VIP) above 2, indicating that e-waste recycling is mainly associated with changes in steroid hormone and neurotransmitter metabolism, energy metabolism, bile acid biosynthesis, and inflammation. The highest VIP was observed for dopamine-o-quinone, which is linked to Parkinson’s disease. These and other changes in metabolism in workers employed in the processing of e-waste need further verification in targeted studies.
- A atividade do Instituto Nacional de Saúde Doutor Ricardo Jorge à luz dos Objetivos do Desenvolvimento Sustentável [Editorial]Publication . Dias, Carlos Matias; Almeida, Fernando deAo percorrer os 15 artigos incluídos neste trigésimo oitavo número do Boletim Epidemiológico Observações do Instituto Nacional de Saúde Doutor Ricardo Jorge (INSA), podemos, adotando uma interpretação lata da Agenda 2030 preconizada pela Organização Mundial da Saúde (OMS), associar, diretamente ou indiretamente, dez daqueles artigos ao terceiro Objetivo do Desenvolvimento Sustentável (ODS 3: Garantir o acesso à saúde de qualidade e promover o bem-estar para todos, em todas as idades), constatação natural num Instituto público do sector da saúde como INSA. (...)
- 4P-CAN: Deliverable 2.2 – Paper on countries’ stakeholder profiles for CPPPublication . Roxo, Luis; Carvalho da Silva Santos, Ana João; Girvalaki, Charis; Geantă, Marius; 4P-CAN WP2 study team; Sousa Uva, MafaldaOver the last decades, cancer incidence has been increasing in Europe, being cancer one the leading causes of death. Meaningful differences persist in cancer incidence and mortality between Western and Eastern European countries, highlighting regional differences regarding risk factors (e.g., smoking habits). Cancer Primary Prevention (CPP) aims to tackle these modifiable factors and to decrease individual risk of cancer. Yet, implementing CPP goes beyond the actions of the governments, and involves a complexity of actions from different stakeholders in society. In this study, we use mixed methods to characterize CPP stakeholders of public sector, academia/research, private sector, media and civil society. We also aim to get a deeper understanding on the regional differences in cancer incidence and mortality. Descriptive statistics were performed to analyze survey results - relative frequencies (%) were computed for each variable, and are presented for the total sample and stratified by country group (Western and Eastern). Data from interviews were analyzed by thematic analysis
- Anti-corrosion and cytotoxicity properties of inorganic surface treatments on Mg1Ca biodegradable alloyPublication . Neves, C.S.; Sousa, I.; Freitas, M.A.; Moreira, L.; Costa, C.; Teixeira, J.P.; Fraga, S.; Silva, R.M.; Silva, R.F.; Starykevich, M.; Scharnagl, N.; Zheludkevich, M.L.; Ferreira, M.G.S.; Tedim, J.In this work biodegradable Mg1Ca alloy underwent surface modification using hydroxyapatite (HAp), aluminium oxide (Al2O3), and treatments with phosphoric (H3PO4), hydrofluoric (HF), and acetic (CH3COOH) acids. The resulting surface-treated Mg substrates were assessed in terms of phase content and chemical composition through X-ray diffraction (XRD) and glow discharge optical emission spectrometry (GDOES). Additionally, atomic force microscopy (AFM) and scanning electron microscopy (SEM) were employed to examine the surface's topography and structure, while the corrosion behavior and cytotoxicity were surveyed using electrochemical impedance spectroscopy (EIS), alongside WST-1 reduction and lactate dehydrogenase (LDH) release assays on L929 mouse fibroblasts. The findings indicated that the surfaces of all samples were uniformly structured, while chemical analysis of the treated surfaces suggested the presence of mostly thin films. Furthermore, EIS results highlighted that the HAp-treated Mg1Ca alloy exhibited superior corrosion resistance, and the cytotoxicity assessment of Mg1Ca-HAp and Mg1Ca-H3PO4 alloys showed minimal cytotoxic effects on mouse fibroblasts, compared to other treated surfaces, suggesting enhanced biocompatibility of those two surface treatments. Overall, this constitutes the first comparative study of different surface treatments developed on biodegradable Mg1Ca alloy, aiming to identify optimal modification strategies for biomedical applications.
- Classification of microcytic anemias using machine learning methodsPublication . Neves Leitão, Beatriz; Vinga, Susana; Faustino, PaulaA prevalência mundial da anemia é estimada em 24,8% e de entre as suas possíveis causas sobressaem a carência nutricional em ferro (anemia ferropénica) e algumas doenças genéticas (hemoglobinopatias como, por exemplo, beta-talassémia e alfa-talassémia). O diagnóstico da etiologia das anemias microcíticas requer métodos laboratoriais caros e morosos, mas é fundamental para a decisão clínica referente ao tratamento e, quando apropriado, para o aconselhamento genético. Neste trabalho aplicaram-se algoritmos de aprendizagem automática (machine learning) para diferenciação das referidas anemias microcíticas usando apenas as informações obtidas no hemograma, um dos exames laboratoriais mais comuns em medicina. Os resultados destacaram o excelente desempenho dos classificadores desenvolvidos com o algoritmo de florestas aleatórias (random forests), tanto na classificação binária quanto na multiclasse, demonstrando o potencial da inteligência artificial na identificação da etiologia dessas anemias.
- Adesão à definição de caso na vigilância da gripe e outros vírus respiratórios: grupo focalPublication . Santos, Ana João; Santos, João Almeida; Rodrigues, Ana PaulaO sistema de vigilância da gripe e outras infeções respiratórias em Portugal integra diversas redes, como a Rede Médicos-Sentinela (MS), serviços hospitalares e laboratórios especializados. Este estudo analisou o alargamento da vigilância para incluir outros vírus respiratórios e a transição da definição de caso de Síndrome Gripal (SG) para Infeção Respiratória Aguda (IRA), explorando o impacto na prática clínica dos médicos e nos processos da Rede Sentinela. Os métodos utilizados incluíram um grupo focal online, com a participação de nove profissionais da Rede Sentinela. A sessão teve a duração de uma hora e 31 minutos e a discussão foi gravada e transcrita para análise de conteúdo, utilizando codificação temática indutiva e dedutiva, permitindo a identificação de categorias e subcategorias relevantes ao tema. Os resultados da análise de conteúdo temática são apresentados em seis grandes temáticas, parcialmente alinhadas com as perguntas abertas que orientaram a discussão: (1) Alargamento da vigilância a outros vírus respiratórios – Explora as perceções dos profissionais sobre os impactos na prática clínica e os benefícios epidemiológicos associados à inclusão de novos vírus na vigilância; (2) Alargamento da vigilância para todo o ano – Avalia os benefícios e desafios da monitorização contínua, incluindo o impacto da sazonalidade das infeções e dificuldades operacionais; (3) Definição e seleção de casos – Infeção Respiratória Aguda (IRA) vs. Síndrome Gripal (SG) – Analisa a transição da definição de caso, destacando facilidade de adoção, vantagens e dificuldades na aplicação dos critérios; (4) Desafios na inclusão de crianças – Identifica as barreiras técnicas e éticas associadas à colheita de amostras em idades pediátricas; (5) Questões organizacionais – Discute as barreiras estruturais e operacionais na implementação da vigilância, incluindo sobrecarga de trabalho, papel do ponto focal e adesão das equipas; (6) Procedimentos e registos – Aborda as estratégias adotadas pelos profissionais, os desafios na notificação de casos e a variabilidade da codificação nos registos clínicos. As temáticas com maior consenso foram aquelas relacionadas com os benefícios do alargamento da vigilância (para outros vírus e para todo o ano) e com a clareza da nova definição de caso (IRA). As questões organizacionais e operacionais, por outro lado, refletiram maior variabilidade nas perceções, com soluções e barreiras específicas para cada contexto. Os resultados mostram perceções positivas sobre o alargamento da vigilância para outros vírus respiratórios, reconhecendo-se benefícios epidemiológicos significativos. A transição para a definição de SG para IRA foi amplamente aceite pelos médicos que a consideraram mais clara e abrangente, permitindo a inclusão de casos mais diversificados. Foram identificados desafios operacionais, incluindo dificuldades na interpretação de critérios como início súbito dos sintomas e a inclusão de subgrupos. O alargamento da vigilância para todo o ano foi visto como vantajoso, mas com ressalvas devido à sazonalidade das infeções e desafios operacionais, como esquecimentos fora do período gripal e sobrecarga de trabalho. A centralização do trabalho em pontos focais mostrou-se essencial para garantir a continuidade e eficácia do sistema. As dificuldades organizacionais continuam a ser uma barreira crítica, com carga de trabalho elevada, falta de adesão da equipa e necessidade de um ponto focal forte para garantir a continuidade da vigilância. A integração de médicos internos e de elementos da equipa da enfermagem mostrou-se uma estratégia promissora para reduzir o impacto destas barreiras. Por fim, o estudo destaca a necessidade de reforçar estratégias organizacionais e fornecer suporte contínuo aos profissionais, promovendo a adesão às mudanças e garantindo a qualidade e representatividade dos dados de vigilância.
- Source attribution of human Campylobacter infection: a multi-country model in the European UnionPublication . Thystrup, Cecilie; Brinch, Maja Lykke; Henri, Clementine; Mughini-Gras, Lapo; Franz, Eelco; Wieczorek, Kinga; Gutierrez, Montserrat; Prendergast, Deirdre M.; Duffy, Geraldine; Burgess, Catherine M.; Bolton, Declan; Alvarez, Julio; Lopez-Chavarrias, Vicent; Rosendal, Thomas; Clemente, Lurdes; Amaro, Ana; Aldert L. Zomer; Joensen, Katrine Grimstrup; Nielsen, Eva Møller; Scavia, Gaia; Skarżyńska, Magdalena; Pinto, Miguel; Oleastro, Mónica; Cha, Wonhee; Thépault, Amandine; Rivoal, Katell; Denis, Martine; Chemaly, Marianne; Hald, TineIntroduction: Infections caused by Campylobacter spp. represent a severe threat to public health worldwide. National action plans have included source attribution studies as a way to quantify the contribution of specific sources and understand the dynamic of transmission of foodborne pathogens like Salmonella and Campylobacter. Such information is crucial for implementing targeted intervention. The aim of this study was to predict the sources of human campylobacteriosis cases across multiple countries using available whole-genome sequencing (WGS) data and explore the impact of data availability and sample size distribution in a multi-country source attribution model. Methods: We constructed a machine-learning model using k-mer frequency patterns as input data to predict human campylobacteriosis cases per source. We then constructed a multi-country model based on data from all countries. Results using different sampling strategies were compared to assess the impact of unbalanced datasets on the prediction of the cases. Results: The results showed that the variety of sources sampled and the quantity of samples from each source impacted the performance of the model. Most cases were attributed to broilers or cattle for the individual and multi-country models. The proportion of cases that could be attributed with 70% probability to a source decreased when using the down-sampled data set (535 vs. 273 of 2627 cases). The baseline model showed a higher sensitivity compared to the down-sampled model, where samples per source were more evenly distributed. The proportion of cases attributed to non-domestic source was higher but varied depending on the sampling strategy. Both models showed that most cases could be attributed to domestic sources in each country (baseline: 248/273 cases, 91%; down-sampled: 361/535 cases, 67%;). Discussion: The sample sizes per source and the variety of sources included in the model influence the accuracy of the model and consequently the uncertainty of the predicted estimates. The attribution estimates for sources with a high number of samples available tend to be overestimated, whereas the estimates for source with only a few samples tend to be underestimated. Reccomendations for future sampling strategies include to aim for a more balanced sample distribution to improve the overall accuracy and utility of source attribution efforts.
- SOLARIS project: a portable 3D-printed bioaerosol sampler for environmental bacterial collectionPublication . Dobroes Fonseca, Pedro Henrique; Duarte, Filipe Miguel Borgas Henriques; Alves, Frederico Silva de Sousa; Borges, Jose Alberto de Jesus; Cardoso, Susana Isabel Pinheiro; Silverio, Vania Cristina Henriques; Antunes, Wilson David TalhaoBioaerosols, a subset of aerosols released from the biosphere, can carry pathogens, and include particles with diameters from nanometres to a few micrometres. They can remain suspended indoors and travel significant distances. Bioaerosol studies play a vital role in public health, as bioaerosols are an effective route for human and animal pathogen transmission, especially in animal production and handling facilities, which are considered hotspots for the emergence of zoonotic pathogens. The 'One Health' approach, which interconnects human, animal and environmental health, underscores the need for robust biomonitoring and biosurveillance systems. We introduce the SOLARIS project, a novel bioaerosol sampler manufactured through three-dimensional printing with a biocompatible material. Our sampler is compact, portable and uses a liquid collection medium, increasing bioefficiency. Our sampler's laboratory testing demonstrated the successful separation of viable bacteria from artificially generated bioaerosols. Collected samples were found suitable for downstream analysis methods such as culturing, mass spectrometry, molecular detection and electron microscopy. A field trial at a swine facility was performed, in which spores were successfully collected from bioaerosols and identified using microbiological and molecular methods, reinforcing our sampler's utility and emphasizing the significance of incorporating aerosol samples in research studies within the One Health approach.
- From health impact to green choices: The dual impact of fermented foodsPublication . Assunção, Ricardo; Laranjo, MartaFermented foods (FF) have been an essential part of human diets across cultures, cherished for their distinctive flavors and preservation capabilities. Beyond their culinary value, FF have shown significant potential health benefits (1). Studies link fermented foods to antioxidation, lower blood lipid levels, enhanced immunity, tumor inhibition, delayed aging, and prevention of gastrointestinal disorders (2). However, their consumption needs caution regarding potential risks, such as pathogenic contamination or the formation of harmful by-products during fermentation. The safety of fermented foods is currently being systematically revised within the PIMENTO CA20128 under WG3-Health benefits and risks of fermented foods. To navigate these complexities, risk-benefit assessment methodologies provide a robust scientific framework to evaluate the trade-offs, enabling evidence-based dietary recommendations (3). Sustainability is another pivotal aspect of fermented foods. In the face of global challenges like food waste and climate change, fermentation emerges as a key strategy (4). For instance, kimchi and sauerkraut help preserve surplus vegetables, while yogurt and kefir optimize dairy utilization. Nonetheless, the production of certain products, such as fermented meats, underscores the need for strategies to mitigate their environmental impacts while maintaining their benefits. This communication highlights the dual role of fermented foods in promoting health and enhancing sustainability. By bridging tradition and innovation, fermented foods hold the potential to support the transition towards sustainable food systems, paving the way for future diets that address pressing public health and environmental priorities.
- Lymphogranuloma venereum (LGV) ompA-subvariants of the Portuguese collection of Chlamydia trachomatis, 2007–2023Publication . Lodhia, Zohra; Cordeiro, Dora; Correia, Cristina; João, Inês; Carreira, Teresa; Nunes, Alexandra; Ferreira, Rita; Schäfer, Sandra; Aliyeva, Elzara; Portugal, Clara; Monge, Isabel; Gonçalves, Elsa; Matos, Susana; Dias, Ana Paula; Corte-Real, Rita; Vieira, Luís; Gomes, Joao Paulo; Borges, Vítor; Jose Borrego, MariaBackground: Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis ompA-genotypes L1–L3, with increasing numbers of detected cases across Europe. Here, we analysed diversity and temporal distribution of the LGV ompA-subvariants detected in Portugal between 2007 and 2023, in order to better understand the dissemination and diversification landscape of LGV strains. Methods: The collection of the Portuguese National Reference Laboratory includes 1188 LGV ompA-genotyped samples between 2007 and 2023. In-depth analysis of the diversity of LGV ompA-subvariants circulating in Portugal across the years was performed, identifying newly described subvariants and integrating this data in a comprehensive compilation with all representative LGV ompA-subvariants described globally. Results: L2 ompA-variant (L2/434/Bu) was consistently the most frequently detected in our collection, with annual proportions ranging from 34.0% to 82.9%, between 2016 and 2023. L2bV5 was the second most frequent followed by L2b, ranging from 5.0% to 27.9% and 2.6% to 23.7% across the years, respectively, from 2017 to 2023. We highlighted the emergence and considerable increase in circulation of L1-like ompA-subvariants in recent years, representing 13.7% of LGV sequences in 2023. We also identified 13 novel LGV ompA-subvariants that had not been described before, differing by up to three mutations from the respective genotype reference sequences. Conclusions: This study contributes to the worldwide picture of the LGV molecular epidemiology, highlighting the importance of long-term molecular surveillance to monitor the circulation and geographical spread of LGV and to timely identify and track new strains, such as the recently emerging L1-like ompA-subvariants.