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  • Improved global air quality health index reveals ozone and nitrogen dioxide as main drivers of air-pollution-related acute mortality
    Publication . Huang, Wenzhong; Li, Tiantian; Masselot, Pierre; Xu, Rongbin; Gasparrini, Antonio; Sera, Francesco; Bell, Michelle L.; Hashizume, Masahiro; Breitner, Susanne; Tong, Shilu; Kan, Haidong; Yang, Zhengyu; Zhang, Yiwen; Yu, Wenhua; Yu, Pei; Zhou, Shuang; Sun, Qinghua; Zhang, Jingwei; Lavigne, Eric; Madureira, Joana; Guo, Yue Leon; Gaio, Vânia; Li, Shanshan; Guo, Yuming; MCC Collaborative Research Network
    Ambient air pollutants are leading contributors to global mortality. Despite the well-established risks, most studies have relied on single-pollutant models in limited regions, leaving the combined effects and individual contributions of pollutants unclear, particularly across countries. Here, we integrate daily mortality and air pollutant (nitrogen dioxide [NO], ozone [O], fine particulate matter, and sulfur dioxide) data from 482 cities in 12 countries/territories from 1998 to 2021 to assess the joint mortality risks and identify the main contributing pollutant through an air quality health index of multi-pollutant constrained groupwise additive models (AQHI-Multi). AQHI-Multi outperformed commonly used air quality indices in capturing the overall mortality risks. O and NO were the leading contributors (accounting for over 70% across countries/territories), with O's share increasing slightly to moderately in most countries/territories. These findings highlight the need for developing air quality indices using advanced multi-pollutant models and the emerging global significance of targeted control of O and NO.
    2025-10Journal article Restricted access Show more
  • Infográfico - Envelhecimento e Saúde em Portugal: Quem Somos e Como Envelhecemos
    Publication . Grupo de Trabalho do INSA sobre Envelhecimento e Saúde
    Trata-se do primeiro infográfico de uma série que pretende contribuir para o conhecimento da dinâmica do envelhecimento da população portuguesa através da integração e síntese de informação sobre saúde. Portugal é um dos países mais envelhecidos da União Europeia dos 27 (UE27), contando, desde 2022, com mais de 2 milhões e 500 mil pessoas idosas (idade igual ou superior a 65 anos), correspondendo a cerca de um quarto da população residente em Portugal. A atualização do conhecimento demográfico e social da população idosa e do processo de envelhecimento em Portugal, bem como das respetivas necessidades de saúde e modelos de atuação adequados à sua satisfação, tendo em vista a integração da informação resultante e sua divulgação, são linhas de investigação em desenvolvimento pelo Grupo de Trabalho sobre Envelhecimento e Saúde do Departamento de Epidemiologia do INSA, com a finalidade de disponibilizar evidência de apoio à seleção e implementação de estratégias que promovam o envelhecimento saudável e sustentável.
    2025-10-01Other Open access Show more
  • Rural–urban differences in healthcare utilization across different outcomes in Portugal
    Publication . Martinho, Júlia; Leite, Andreia
    Background: Urbanization influences healthcare access and utilization, contributing to health disparities. This study aims to assess the effect of degree of urbanization on healthcare utilization in Portugal, where urbanization levels are above global average. Methods: Utilizing data from the 2019 National Health Survey, this cross-sectional study analyzed the association between degree of urbanization and outcomes including general and specialist consultations, flu vaccination, colonoscopy, and wait times. Adjusted prevalence ratios (aPR) were estimated using Poisson regression models. Results: Less populated areas had increased wait times (aPR = 1.54; 95% confidence intervals [95% CI]: 1.06-2.24) and lower colonoscopy utilization (aPR = 0.86; 95% CI: 0.78-0.95). Flu vaccination rates were higher in rural (aPR = 1.15; 95% CI: 1.03-1.30) and suburban areas (aPR = 1.16; 95% CI: 1.04-1.30). No significant association was found for general/specialist consultations or excessive wait times. Conclusions: Geographic constraints limit healthcare access in less populated areas. Urban areas showed suboptimal flu vaccination rates, suggesting a need for improved immunization strategies. Addressing geographical disparities is crucial for ensuring equitable healthcare access across Portugal.
    2025-10-02Journal article Restricted access Show more
  • Genetic and Epidemiological Insights Into Respiratory Syncytial Virus Infections: A Comparative Study of Hospitalized Versus Community Cases in Portugal (2021-2023)
    Publication . Lança, Miguel; Gaio, Vânia; Rodrigues, Ana Paula; Henriques, Camila; Gomes, Licínia; Dias, Daniela; Chasqueira, Maria de Jesus; Guiomar, Raquel; Melo, Aryse
    Background: Respiratory syncytial virus (RSV) is the leading cause of acute respiratory infection (ARI) in young children, but its genetic diversity requires ongoing surveillance. Methods: From 2021 to 2023, a total of 619 and 94 RSV-positive samples from the National Respiratory Syncytial Virus Surveillance Network (VigiRSV) and the Sentinel Influenza and other respiratory viruses surveillance network (Sentinel ISN), respectively, were analysed. The RSV A and RSV B typing was assessed by a multiplex real-time RT-PCR. Sanger sequencing was performed on a subset of samples (n = 495). Phylogenetic analysis was carried out on partial glycoprotein G sequences. Clinical and epidemiological data were compared through Pearson Chi-Square tests. Results: RSV Subgroup A was more prevalent (53.5%, 85/159) in the 2021/2022 season, whereas in the 2022/2023 season, it was RSV Subgroup B (82.1%, 435/530) in both networks. RSV A strains in VigiRSV clustered mainly to A.D.1 (39.0%, 39/100), whereas in Sentinel ISN, they clustered in A.D.5 (30.0%, 3/10). RSV Type B clustered mainly to B.D.E.1 (96.6%, 372/385) in both networks. All lineages cocirculated during the study period and in both surveillance networks. Regional clusters were identified for both subgroups. Conclusions: This study provides new insights into RSV genetic variability in Portugal, namely, the cocirculation of lineages and intravariability among lineages within both subgroups during the study period and in all Portuguese regions. However, our study is based on partial sequencing of the G gene, and because of this limitation, our results should be considered with great caution.
    2025-10-13Journal article Open access Show more
  • Probe-based metagenomic pathogen detection: advancing laboratory capacity for complex diagnosis
    Publication . Ferreira, Rita; Coelho, Luís; Santos, João Dourado; Sobral, Daniel; Isidro, Joana; Mixão, Verónica; Pinto, Miguel; Nunes, Alexandra; Borrego, Maria José; Lopo, Sílvia; Oleastro, Mónica; Sousa, Rita; Palminha, Paula; Veríssimo, Cristina; Gargaté, Maria João; Guiomar, Raquel; Cordeiro, Rita; Macedo, Rita; Bajanca-Lavado, Paula; Paixão, Paulo; Duarte, Sílvia; Vieira, Luís; Borges, Vítor; Gomes, João Paulo
    Probe-based pathogen enrichment, followed by NGS, is a promising tool for complex diagnosis, overcoming traditional challenges of shotgun metagenomics, namely small microbial/human genetic material ratio and demanding computational resources. Here, we assessed the combined detection performance of two Illumina probe-based panels, the Respiratory and the Urinary Pathogen ID panels (RPIP and UPIP), using 99 clinical samples of 15 different matrices (e.g., cerebrospinal fluid, plasma, serum, urine, swabs, biopsies, etc.) available from Portuguese National Reference Laboratories. This sample set involved 114 "PCR-positive hits" (Ct values range of 9.7-41.3; median of 28.4) for 52 non-redundant human pathogens. For a more detailed bioinformatics assessment, as a complement of the Illumina turnkey solution (Explify), we applied an extended version of our INSaFLU-TELEVIR(+) metagenomics pipeline. Whereas Explify analyses resulted in an initial detection frequency of 73.7% (84/114), the subsequent application of INSaFLU-TELEVIR(+), including taxonomic classification followed by confirmatory read mapping, enabled an overall detection proportion of 79.8% (91/114) of the PCR-positive hits. This translated into a detection rate increment from 54.3% (19/35) to 65.7% (23/35) for bacteria, and from 85.3% (58/68) to 89.7% (61/68) for viruses. The implemented workflow was also very satisfactory for samples with qPCR Ct values above 30, with an overall detection frequency of 71.8% (28/39) when compared with the 92.0% (46/50) observed for those with Ct ≤ 30. In summary, this study validated and established a pioneering approach at the Portuguese National Institute of Health to support clinicians in complex diagnosis, contributing to advance diagnostic capabilities toward a more informed clinical decision and potential improvement of infectious disease outcomes.
    2025-10-14Journal article Open access Show more
  • HBM4EU e-waste study – Occupational exposure assessment to chromium, cadmium, mercury and lead during e-waste recycling
    Publication . Leese, Elizabeth; Verdonck, Jelle; Porras, Simo P.; Airaksinen, Jaakko; Duca, Radu C.; Galea, Karen S.; Godderis, Lode; Janasik, Beata; Mahiout, Selma; Martins, Carla; Mārtiņsone, Inese; Ani, Maria Mirela; van Nieuwenhuyse, An; Scheepers, Paul T.J.; Silva, Maria João; Viegas, Susana; Santonen, Tiina; HBM4EU E-waste Study Team
    Processing of electronic waste (e-waste) causes the release of toxic substances which may lead to occupational exposure. The study aimed to gather information on potential occupational exposure during e-waste recycling, with a focus on biomonitoring of chromium, cadmium, mercury and lead. In eight European countries, 195 workers involved in the recycling of lead batteries, white goods, brown goods and metals and plastics were studied. These workers were compared to 73 controls with no direct involvement of e-waste recycling or other metal processing activities. The samples collected consisted of urine, blood and hair samples, along with personal air samples, hand wipes, settled dust samples and contextual information. Chromium, cadmium, mercury and lead was measured in urine, hair, air samples, hand wipes and settled dust; cadmium and lead in whole blood and chromium in red blood cells. Results showed that lead exposure is of concern, with workers from all five types of e-waste showing exposure, with elevated measurements in all matrices. Internal exposure markers were positively correlated with markers of external exposure, indicating workers are not adequately protected. Exposure to mercury and cadmium was also observed but to a much lesser extent with raised cadmium concentrations in urine and blood of all workers when compared to controls and raised mercury concentrations were found in brown goods workers when compared to controls. This study has highlighted exposure concerns when processing e-waste, particularly for lead across all waste categories studied, indicating a need for improved control measures in this sector.
    2025-10-15Journal article Open access Show more
  • Boletim Epidemiológico Observações: Vol. 14 (2025), Número Especial 17, Doenças genéticas
    Publication . Instituto Nacional de Saúde Doutor Ricardo Jorge
    2025-10-16Periodical Open access Show more
  • 2025-10-16Journal article Open access Show more
  • 2025-10-16Journal article Open access Show more
  • Diagnóstico pré-natal: história, impacto e perspetivas futuras
    Publication . Marques, Bárbara; Correia, Hildeberto
    2025-10-16Journal article Open access Show more