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- Desempenho dos participantes no programa PNAEQ/Labquality VIH POCT em 2024 e primeiro semestre de 2025Publication . Mendes, Inês; Correia, Helena; Cardoso, Ana; Faria, Ana PaulaIntrodução: Para o rastreio da infeção pelo Vírus de Imunodeficiência Humana (VIH) podem ser utilizados testes rápidos, Point-of-care test (POCT) que permitem o encaminhamento precoce de casos positivos. Estes testes podem ser realizados por profissionais de saúde qualificados (laboratórios ou farmácias) ou por profissionais sem formação laboratorial específica, como agentes comunitários de organizações não governamentais (ONGs). A participação em programas de avaliação externa da qualidade (AEQ) permite avaliar a fiabilidade dos resultados obtidos e identificar oportunidades de melhoria. Este estudo analisa os resultados dos participantes nos ensaios de AEQ VIH POCT, realizados em 2024 e primeiro semestre de 2025, pelo Programa Nacional de Avaliação Externa da Qualidade (PNAEQ). Objetivo: Avaliar o desempenho dos participantes do PNAEQ, nos ensaios AEQ VIH POCT, comparando os resultados obtidos com os valores de referência. Metodologia: O programa do PNAEQ VIH POCT é organizado pela entidade congénere Labquality EQAS by Aurevia e contempla 4 ensaios por ano, sendo cada ensaio constituído por 3 amostras controlo de plasma ou soro humano, de um dador único. Foram avaliadas 4 amostras VIH-1 anticorpo (Ac) positivo e antigénio (Ag) positivo fraco, 7 VIH-1 Ac positivo e Ag negativo, 6 VIH-1 Ac e Ag negativo e 1 VIH-2 Ac positivo e Ag negativo, utilizando os testes POCT VIHAc (1/2) e VIHAcAg (combo). Os resultados foram submetidos pelos participantes na plataforma online da Labquality (Labscala). A avaliação foi realizada com base nos resultados pré-testes e comentários de peritos. Resultados: Em 2024, participaram 18 ONGs, 11 farmácias, 5 instituições hospitalares e 3 unidades de ambulatório. Em 2025, participaram 20 ONGs, 1 unidade de ambulatório e 2 instituições hospitalares, não havendo registo de farmácias. O desempenho global das farmácias foi de 100%, nas instituições hospitalares foi de 96,2%, nas unidades de ambulatório 66,7%, nas ONGs foi de 90,2%. A taxa de desempenho global foi superior em 2025 (97,5%) face a 2024 (88,1%). Vinte e nove participantes utilizaram POCT VIHAc (1/2), e destes apenas um participante utilizou um POCT que permite distinguir entre VIH-1 e VIH-2. Dois participantes utilizaram testes combo e três participantes recorreram simultaneamente a testes de anticorpos e testes combo. Nos Ensaios 2 de 2024 e 2025, com maior número de participantes, 47 (27 e 20 respetivamente) obteve-se as seguintes taxas de acerto: nas duas amostras negativas-92,9%, na amostra VIH-1 positiva com antigénio p24 fraco-93,8% e nas três amostras VIH-1 positivas com antigénio negativo-91,3%. Conclusões: Os resultados evidenciam um bom desempenho global dos POCT VIH no programa de AEQ, com melhor desempenho em 2025 face a 2024. As ONGs foram os participantes maioritários em ambos os anos, e as farmácias, com desempenho de 100% em 2024 não participaram em 2025. A maioria dos testes utilizados não distingue entre VIH-1 e VIH-2. Estes resultados reforçam a importância da participação regular em programas de AEQ permitindo avaliar a execução do procedimento e desempenho dos testes VIH POCT, contribuindo para uma resposta segura no rastreio da infeção VIH.
- HbA1c laboratory quality performance of National External Quality Assessment Program (PNAEQ) in the EurA1c project: 2017–2024Publication . Correia, Helena; das Neves Pereira da Silva, Susana; Miranda, Armandina; Faria, Ana; Weykamp, Cas; Siebelder, CarlaIntroduction: The determination of glycated hemoglobin (HbA1c) is used in patients with diabetes mellitus as a key to monitoring the long-term blood glucose control (1). The Portuguese National External Quality Assessment Program (PNAEQ), organizes since 2003 the Hemoglobin glycated (HbA1c) program for External Quality Assessment Laboratory and integrated the IFCC EurA1c project in 2017. External Quality Assessment (EQA) is a powerful education tool to monitor quality that, by identifying poor performing laboratories and test systems, can be used as a tool to improve quality (2). Objective: Monitor the analytical performance of HbA1c determination, performed by PNAEQ participants, based on results of their participation in EurA1c project (bias (%) and coefficient of variation (CV%). Methods: From 2017 to 2024, PNAEQ laboratory participants (mean=41), from public and private sectors of ambulatory and hospital care, analysed in first round, two control samples per year, (n=16), with different concentrations (samples below and above 48mmol/mol). The samples sent from EurA1c project were lyophilized hemolysate specimens manufactured from the same pool. Participants HbA1c results, in IFCC units, were evaluated by comparison with target values assessed by EurA1c project. Usually, values were assigned by five laboratories using the IFCC Reference Measurement Procedure. The statistical analysis followed the EurA1c project´s methodology. Outliers- defined as results differing by more than 25% from the target value- were excluded prior to calculating the mean, CV% and bias%. Performance comparisons between different concentration samples were performed with Wilcoxon test considering a significance of 5%. Results: During the study period, an average of 41 laboratories participated (range: 26–49). A total of 17 different types of equipment and 9 distinct methodologies were used. From 2022 onwards, a noticeable shift in equipment and/or methodology was observed among several participants. Notably, five laboratories consistently submitted results for all samples throughout the study. There was no significant difference in the mean CV% between pathological samples (CV% = 5.1) and non-pathological samples (CV% = 5.7), with a p-value of 0.151. Similarly, no significant difference was observed in Bias% between pathological samples (Bias% = 1.0) and non-pathological samples (Bias% = 1.6), with a p-value of 0.069. Before pandemic period (2017-2019), the mean bias% was 0.02, in the pandemic period (2020-2021) was 3.18, and after pandemic 1.43. Based on the minimum EFLM quality specifications for HbA1c bias (2,7%), the mean bias of participants meets the established criteria in 13 samples. Regarding the desirable specification (1.8%), 10 samples and regarding the optimal specification (0.9%), 5 samples were compliant. During the pandemic period, 3 samples did not meet the minimum specifications. Conclusion: During the study period, the laboratories changed equipment without showing performance improvements. There is clear sign of a decline in performance in the pandemic period (2020-2022) with no improvement to the level of pre pandemic period. Most samples met the minimum quality specifications for HbA1c bias established by the EFLM, with a substantial proportion also meeting desirable and optimal targets. These findings highlight the effectiveness of the EurA1c external quality assessment framework in supporting continuous quality improvement in HbA1c testing across Portuguese laboratories.
- Exposure to mycotoxins in the Portuguese adult populationPublication . Maris, Elias; Namorado, Sónia; Chen, A.; Pero-Gason, Roger; De Boevre, Marthe; De Saeger, Sarah; Silva, Maria João; Alvito, PaulaMycotoxins are toxic fungal metabolites commonly found in food, posing health risks such as immunosuppression, carcinogenicity, and endocrine disruption. Despite regulatory limits, chronic low-level exposure remains a concern. Understanding real-life exposure in populations is essential for effective risk assessment. This study aims to investigate mycotoxin exposure among young adults in Portugal, contributing to evidence-based public health interventions. This study leveraged data and biospecimens from the INSEF-ExpoQuim survey, a cross-sectional study nested within thPortuguese National Health Examination Survey (INSEF). Data was collected via REDCap-assisted telephone interviews, covering sociodemographic and exposure-relevant variables. A subset of 295 first morning urine samples was collected from adults aged 28–39 years between May 2019 and March 2020. Urine samples were analyzed by a newly optimized and validated LC-MS/MS method targeting 40 mycotoxins and/or their corresponding metabolites in urine. Urinary creatinine was measured using a validated colorimetric method to allow adjustment and standardization of mycotoxin concentrations, ensuring accurate exposure assessment and comparability. This methodological approach enabled a robust characterization of mycotoxin exposure in a representative Portuguese population cohort.The study included 58% females and 42% males. Most participants had medium to high education, and urbanization was nearly evenly split between towns/suburbs (36.9%) and rural areas (35.9%), with fewer living in cities (27.1%). The majority were employed, and sampling was primarily conducted in summer and autumn. The number of mycotoxin co-exposures in the Portuguese population ranged from 0 to 5, with two simultaneous exposures being most common (n = 160). Among the 40 mycotoxins analysed, deoxynivalenol and tenuazonic acid were most frequently detected, with frequency of detection of 85% and 96%, respectively. This study offers robust biomonitoring data on mycotoxin exposure in Portuguese young adults using a validated LC-MS/MS method. The high prevalence of deoxynivalenol and tenuazonic acid suggests low level dietary contamination. These findings support the need for continued monitoring and the integration ofhuman biomonitoring into national food safety strategies. Detailed sociodemographic analyses are planned to further clarify exposure patterns and enable targeted public health interventions.
- Modelling Mobility Data during COVID-19 in Portugal with R-INLAPublication . Brito, André; Machado, Ausenda; Rodrigues, Ana Paula; Patrício, Paula; Bispo, ReginaThe COVID-19 pandemic underscored the vital role of mathematical modelling in epidemiology, supporting the forecasting of disease trends and informing public health strategies. In Portugal, modelling efforts highlighted the effectiveness of physical distancing in reducing transmission and offered important insights into the impacts of deconfinement and vaccination on disease burden. The period also saw an increased use of non-traditional data sources, particularly human mobility data, which acted as a proxy for contact patterns and helped refine models of disease spread. In this context, we aim to model mobility patterns across districts in Portugal during the COVID-19 pandemic using Google Mobility Reports. Our objective is to identify which covariates are most relevant for predicting mobility dynamics during this period within a spatiotemporal modelling framework.
- Psychosocial factors of vaccine confidence: an exploratory study among Portuguese healthcare workersPublication . Gaio, Vânia; Saraiva, Ana Leonor; Santos, Ana João; Amaral, Palmira; Machado, AusendaBackground: Healthcare workers (HCWs) play a critical role in vaccination uptake, both through personal adherence and by promoting immunisation among patients. Low vaccine confidence among HCWs can undermine public health efforts by reducing personal vaccination rates, but also impacting vaccine recommendations. This study aimed to assess psychosocial determinants influencing vaccine confidence among HCWs in Portugal. Methods: A cross-sectional study was conducted between October and November 2024 among doctors and nurses from a Portuguese healthcare unit. An online questionnaire incorporating an adapted short version of the Professionals Vaccine Confidence and Behaviors (Pro-VC-Be) scale was applied. Exploratory factor analysis (EFA) was conducted to assess the scale’s unidimensionality. Descriptive statistics, bivariate analyses (vaccinated vs. non-vaccinated) using Fisher’s exact and Pearson’s Chi-squared tests were performed to identify key psychosocial dimensions of vaccine confidence. Results: Among 112 HCWs (82% female; 71% nurses), 67% were vaccinated against COVID-19 in the 2024/25 season. EFA suggested an unidimensional structure, with one dominant factor (eigenvalue=1.90) explaining 56% of the variance. Vaccinated HCWs showed significantly higher confidence scores (mean=42.9 vs. 40.8; p=0.003). Trust in vaccine safety (p=0.027), belief in vaccine benefits (p=0.011), and complacency (p=0.048) were positively associated with COVID-19 vaccination status. Conclusions: This exploratory study highlights key psychosocial determinants of vaccine confidence among Portuguese HCWs, notably perceived safety and effectiveness. Given the small sample size, results should be interpreted with caution. Applying the scale to a larger and more diverse population of HCWs is essential to validate these findings and support the development of targeted strategies focusing on building trust and combating misinformation to enhance vaccine uptake.
- Unavoided cerebral palsy after induced hypothermiaPublication . Moreira , Tânia; Folha, Teresa; Virella, Daniel; Programa de Vigilância Nacional da Paralisia CerebralInduced hypothermia (IH) reduces the risk of death or cerebral palsy (CP) among term neonates with moderate-to-severe hypoxic-ischemic encephalopathy (HIE). It is now accepted as the standard of care. The aim of the study is intend to access if the severity of CP among survivors of HIE after IH is similar to their counterparts not submitted to IH or otherwise. Data from Portuguese Surveillance of Cerebral Palsy registers 5 to 8-year-old children with CP, born in Portugal between 2010-2016 ≥ 36 weeks gestation and andmitted into the neonatal care unit. From 2967 registered children with CP, 790 were identified as been born in Portugal between 2010 and 2016. From 86 eligible children (42 born 2010-12, 44 born 2013-16), 35 (42%) had been on IH. Overall, children with CP, if had been on IH had higher prevalence of Dyskinetic CP 57% vs 35%; p 0.04; GMFCS III-V 80% vs 56.5%; p 0.03; MACS II-V 85% vs 62%; p 0.04. Increased CP complexity: 0 indicators 10% vs 16%; 1-2 indicators 33% vs 51%; 3-4 indicators 57% vs 32%; p 0.057 No differences were found on the prevalences of epilepsy, higher grade affection on Viking SS or cognition and schooling. Children of the 2013-2016 cohort, compared with the 2010-2012 cohort did not reveal significant improvement in any of the clinical or functionality parameters. Instead, a tendency for a higher prevalence of GMFCS III-V was found (p 0.066). Children with CP, if having been on IH, seem to be more likely to have high complexity CP. Surveillance data provide useful information on the effectiveness IH to prevent CP after HIE.
- Uma amostra, três avaliações: Análise dos resultados em Química Clínica do PNAEQPublication . Batista, Ana; Correia, Helena; Cardoso, Ana; das Neves Pereira da Silva, Susana; Faria, Ana PaulaIntrodução: O laboratório clínico desempenha um papel fundamental na prestação de cuidados de saúde, ao fornecer informação analítica fiável e clinicamente relevante. Para garantir a qualidade dos resultados, a participação em programas de Avaliação Externa da Qualidade (AEQ) é essencial, permitindo aos laboratórios monitorizar continuamente o seu desempenho através da comparação interlaboratorial. Objetivo: Este estudo teve como objetivo avaliar o desempenho dos laboratórios participantes do Programa Nacional de Avaliação Externa da Qualidade (PNAEQ) em Química Clínica, de uma amostra controlo, em três avaliações diferentes, na determinação dos parâmetros: albumina, creatinina, glucose, potássio e sódio. Metodologia: Uma mesma amostra controlo integrada no programa de Química Clínica do PNAEQ, foi enviada duas vezes, em 2024 no mês de abril (ensaio 3 e 5) e em 2025, em fevereiro (ensaio 1), para a determinação de vários parâmetros, dos quais foram selecionados para este estudo a albumina, creatinina, glucose, potássio e sódio. A análise estatística dos resultados foi efetuada com recurso ao MS Excel, com o cálculo da média e do desvio padrão (DP), para identificação e exclusão dos resultados outliers (valores superiores à média ± 2 DP). Foram recalculados os indicadores, média e DP, e determinado o coeficiente de variação (CV%), para cada um dos parâmetros em estudo. A análise do índice de desvio (ID/z-score) apenas foi efetuada para os laboratórios que participaram nas 3 avaliações. Resultados: A percentagem de participação média para todos os parâmetros foi de 90%, variando entre 73 a 100% nas três avaliações, tendo sido a menor percentagem (73%) verificada na segunda avaliação para o parâmetro albumina. Após a exclusão dos outliers, a creatinina foi o parâmetro que apresentou maior percentagem de exclusão (média 8%) e que um CV% maior (6,88-7,04-7,08) seguida da albumina (4,20-4,71-5,21), glucose (2,94-3,11-3,53), potássio (2,23-2,83-3,49) e por último do sódio (1,67-2,55-1,81). No cálculo do ID foram considerados 24 resultados para a albumina, 26 para a creatinina e para o sódio, 29 para a glucose e 27 para o potássio. Os participantes não obtiveram valores insatisfatórios (ID >3) para a albumina, a creatinina e o sódio, apresentando a glucose e o potássio um valor de ID insatisfatório na 3ª avaliação, em diferentes participantes. Os parâmetros que obtiveram a percentagem mais elevada de ID excelente (0 < ID ≤ 0,5) e bom (0,5 < ID ≤ 2) foram a creatinina e a glucose (média de 44,87% e 52,56% (97%)); média de 42,53% e 54,02% (97%) respetivamente), seguidos do potássio (média de 43,21% e 51.85% (95%)) da albumina (média de 40,28% e 54,17% (94,44%)) e do sódio (média de 43,59% e 50,00% (94%)). Conclusões: Dos parâmetros avaliados, a creatinina apresentou o CV% maior, e todos os parâmetros, com a exceção do sódio, apresentaram uma tendência de aumento do CV% nas três avaliações. Os laboratórios que participaram nas três avaliações obtiveram um bom desempenho, embora a glucose e o potássio tenham apresentado o maior número de ID insatisfatórios. Prevê-se a repetição deste estudo, numa mesma amostra com concentrações diferentes às do presente estudo, analisada em três ou mais avaliações.
- Reasons for non-uptake of Influenza Vaccination: comparison between high-risk and non-high risk groups in the Portuguese populationPublication . Santos, Ana João; Kislaya, Irina; Machado, Ausenda; Matias, Carlos Matias; Neto, MarianaBackground & objective: In Portugal, the Influenza Vaccine (IV) coverage remains bellow the coverage goals proposed by the European Union. Understanding motives for IV non-uptake, particularly for high-risk groups is essential for intervention purposes. The Health Belief Model (HBM) has been one of the most used theoretical frameworks to understand vaccination. This study aims to describe the Portuguese non-uptake and differences between HBM dimensions (susceptibility, severity, benefits, barriers and cues for action) frequency for high-risk and non-high-risk groups. Methods: A cross-sectional study was developed using the panel of families, a probabilistic dual-sampling frame telephone household panel of Portugal. The survey was conducted between June and September 2021-2013, with data collected by questionnaire applied to one element of each household unit with 18+ years (n=1050). Content thematic analysis was conducted in one open question about the reasons for IV non-uptake and included in HBM dimensions. Statistical analysis focused on estimating non-adherence to IV and frequency of the HBM categories stratified by target group recommended for vaccination. Results were weighted by age group and region Results: The response rate was 68%. Of the total sample (n=1050), 671 individuals did not uptake the IV (69.3%, CI95%:64.8-73.5). For the population recommended for the IV, non-uptake was 49.8 (CI95%:43.6-55.9). The perception of low Susceptibility was more common in individuals who did not belong to the target group (74%, CI95%:63.4-82.3 vs. 26%, CI95%:17.7-36.6). By contrast, the Barriers dimension was more frequently mentioned by the target population (45%, CI95%:32.4-58.2 vs. 55%, CI95%:41.8-67.6), namely due to unavailability of stock. Conclusion: IV non-uptake was lower for high-risk group of the Portuguese population, compared to the general population. Differences between the reasons not to take the IV, suggest that the group to whom the IV is recommended, due to increased risk of complications, is aware of increased susceptibility. Overall, these results indicate that vaccination campaign seem to be successfully targeting high-risk group, even then efforts need to be maintained to decrease non-uptake.
- Impact of influenza vaccination strategy on medically attended influenza in Portugal in five pre-pandemic seasons (2015/16 to 2019/20)Publication . Machado, Ausenda; Kislaya, IrinaBackground: There is limited research on the impact of the yearly influenza vaccination programs in the eligible population. This study aimed to estimate the number of primary care medically attended influenza-confirmed cases (MAICC) among the population aged ≥65 years averted by influenza vaccination programme in Portugal during five seasons in the pre-COVID pandemic period (2015/16 to 2019/20). Methods: We compared the number of observed MAICC to the estimated number that would have occurred in a population without seasonal influenza vaccination (N). To estimate N, we used: i) number of MAICC estimated from national influenza surveillance systems, ii) vaccine coverage (VC) collected in a national telephone survey, iii) influenza vaccine effectiveness (IVE) estimates weighted by the proportion of virus circulation each season in Portugal. We estimated the number of MAICC averted (NAE) by the influenza vaccination programme per 100.000 inhabitants and number needed to vaccinate to prevent one MAICC. We used Monte-Carlo simulations to estimate 95% uncertainty intervals (UI). Results: Comparing with results from 2015/16 to 2017/18 (NAE ranged 24 to 44 per 100.000 inhab) the season 2018/19 showed the highest NAE (62.3 per 100.000 inhab) attributed to the influenza vaccination programme. In 2019/20 season the vaccination strategy averted approximately 11.7 per 100.000 inhab (95%UI: 6.0 to 20.9) events and it was necessary to vaccinate 549 (95%UI: 436 to 742) to prevent one MAICC in primary care. Conclusion: The influenza vaccination strategy had consistent and positive benefit, with more pronounced impact in 2018/19 season. This results were mainly due to a combination of a higher vaccination coverage assumed for 2018/19 (60.8%) and one of the highest vaccine effectiveness (34.8% vs. previous study range 8.5% to 40.6%). To maximize its impact, efforts should be conducted to increase the vaccine coverage. In addition, the surge for more effective vaccines should be maintained.
- Mark-Release-Recapture of Aedes albopictus in Portugal: the influence of climatic factorsPublication . Soares, Patricia; Carvalho, Danilo O.; Silva, Susana Pereira; Gomez Pacheco, Maylen; Amaro, Fátima; Amaro F.; Osório, HugoAedes albopictus mosquitoes spread diseases like dengue, Zika, yellow fever, and chikungunya. The Sterile Insect Technique (SIT), which is based on production of male sterile mosquitoes through radiation and in the release in target areas, can be used as a prevention and control tool against Ae. albopictus native populations. Mark-Release-Recapture trials (MRR) estimate the number of mosquitoes to release during the SIT, but weather conditions can affect results. Thus, we aimed to understand the influence of climatic factors on mosquito collection. MRRs were conducted in October 2022 in Faro, Southern Portugal. Mosquito sterilisation, marking and transport followed protocols from the International Atomic Energy Agency. Releases occurred weekly for three consecutive weeks at two different sites, and mosquitoes were collected using Human Landing Collections (HLC) one, two, four and six days after release. Climatic data, such as temperature, humidity, wind intensity (moderate 15-35 km/h vs weak <15 km/h) and precipitation, were obtained from the Portuguese Institute of the Sea and the Atmosphere. We used generalised linear models with a negative binomial family and log function to estimate factors associated with the number of captured mosquitoes, estimated prevalence ratios (PRs), and the 95% confidence intervals (CI). We released 84 000 marked sterile male mosquitoes and recaptured 528 marked males (0.7%) by HLC. The prevalence of captured mosquitoes was 23% lower when the wind intensity was moderate compared with a weak wind intensity (PR: 0.77, 95% CI: 0.61−0.98). We did not find a statistically significant association between the number of captured mosquitoes and humidity (PR: 0.98, 95% CI: 0.96−1.00), temperature (PR: 1.03, 95% CI: 0.83−1.28) and precipitation (PR: 1.07, 95% CI: 0.60−2.03). Conclusion: It is crucial to plan MRRs carefully and consider weather conditions during their execution to avoid underestimating the population needed for the SIT and compromising the effectiveness of this control method.