Repositório Científico do Instituto Nacional de Saúde

National Institute of Health Dr Ricardo Jorge Scientific Repository

A digital and freely accessible institutional repository in the area of Public Health, which provides the collection of scientific and technical publications produced by the institution.

Its aims to aggregate, preserve and disseminate the technical-scientific literatura and materials produced, increasing their visibility and the sharing of information, in order to increase the impact of their research and contribute to the promotion of study and scientific knowledge. It also aims to preserve the memory of the institution.

Institutional Site insa.min-saude.pt

Email repositorio.cientifico@insa.min-saude.pt

Recent Submissions

Epidemiology of board-related incidents in the Portuguese National Maritime Authority’s Jurisdiction (2020-2023): a cross-sectional study

Publication . Ourique, Matilde; Alves, Tatiana; Aniceto, Carlos; Dias, Carlos Matias; Mendes, Pedro Marques; Fernandes, João Ferraz; Correia, Diana Martins; Gaio, Vânia

Background: Portugal’s favourable conditions for water-based recreational activities (WRA) often lead to incidents requiring intervention by the National Maritime Authority (AMN). Despite being documented in the SEGMAR database, participant profiles and severity factors, particularly for water-board-related incidents (BRIs), remain underexplored. This study aims to profile individuals involved in BRIs, identify determinants of severe incidents, and examine key clusters within the AMN’s jurisdiction from 2020 to 2023. Methods: A cross-sectional observational study analysed 14,456 WRA incidents from the SEGMAR database. BRIs included activities involving water-boards (e.g., surfing, bodyboarding, kitesurfing) and collisions with waterboards. Severe BRIs were defined as incidents causing injuries, fatalities, or disappearances. Sociodemographic, temporal, and spatial factors were analysed using descriptive analysis and Quasi-Poisson regression to estimate frequency ratios (FR). Cluster analysis identified at-risk groups, and the severe to non-severe BRIs ratio was mapped by captaincy and municipality. Statistical significance was set at p<0.05. Results: BRIs made up 11.9% of all incidents, occurring more often among men, individuals aged 15–55, and foreigners, especially outside the bathing season and in unsupervised areas (p<0.001). Severe BRIs were linked to winter (FR 1.92; 95% CI 1.15–3.19), nighttime (FR 2.0; 95% CI 1.6–2.6), dawn (FR 1.6; 95% CI 1.3–2.0), and the bathing season (FR 1.9; 95% CI 1.3–2.7). Clusters revealed at-risk groups: children under 14 at patrolled beaches in summer evenings, men over 55 at unpatrolled areas in autumn, and young females at unpatrolled beaches in winter. Seven captaincies and 20 municipalities had a severe to non-severe BRIs ratio above 1. Conclusion: BRIs predominantly affect men, young adults, and foreigners. Key risk factors include extreme ages, non-summer seasons, unsupervised areas, and low-light conditions. Targeted interventions, such as adjusting lifeguard schedules to cover high-risk times, promoting safety campaigns for children and older adults, and reinforcing safety infrastructure at unpatrolled beaches, might be important to mitigate risks and reduce incident severity.

2025-08-09Journal article

Restricted access

A scoping review of the health effects of fermented foods in specific human populations and their potential role in precision nutrition: current knowledge and gaps

Publication . Humblot, Christèle; Alvanoudi, Panagiota; Alves, Emilia; Assunção, Ricardo; Belovic, Miona; Bulmus-Tuccar, Tugce; Chassard, Christophe; Derrien, Muriel; Fevzi Karagöz, Mustafa; Karakaya, Sibel; Laranjo, Marta; Th Mantzouridou, Fani; Rosado, Catarina; Pracer, Smilja; Saar, Helen; Tap, Julien; Treven, Primož; Vergères, Guy; Pertziger, Eugenia; Savary-Auzeloux, Isabelle

Background: Diets and specific foods have a significant impact on health, and individual responses to nutritional factors vary. This variability among humans can be considered a basis for developing personalized or precision nutrition. Fermented foods (FF) contain a wide range of macro- and micronutrients, bioactive compounds, and live or dead microorganisms. FF represent a diverse range of products and have garnered significant interest due to their potential health benefits. However, consistent evidence remains limited, possibly due to heterogeneity in individual responses. Objectives: The objective of this review is to assess and compile existing evidence on the variable responses of populations to FF and to determine whether FF could be integrated into a precision nutrition strategy. Design: Interventional and observational human studies were systematically collected. The publication identified the main factors likely to contribute to variable responses to FF across all health outcomes. The question was systematically addressed to assess the available evidence and identify knowledge gaps, guiding future research. A pragmatic approach was employed, following EFSA health claim guidelines, which require an assessment of food characteristics and mechanisms of action, as well as conducting a systematic search of human interventional studies. A similar approach was used to analyze data extracted from observational studies. The population included all humans (healthy and non-healthy, of all ages), encompassing both observational and interventional studies. The intervention consisted of the ingestion of any FF, while the control was defined as the absence or lower consumption of FF or consumption of a corresponding non-FF. Outcomes included all markers of the population's health status. Results: The main factors contributing to variable responses to FF across all health outcomes were related to initial phenotypic characteristics (biological sex, geographical origin, hormonal status, and age), baseline health status [metabolic syndrome [MetS], chronic metabolic pathologies, cancer, and psychological disorders], and genetic background. Additionally, since the gut microbiota is person-specific and influences metabolic responses, particular attention was paid to its functions and role in the variability of population responses to FF. Conclusion: Collectively, this review represents a first step toward evaluating the feasibility of using FF in tailored nutritional strategies.

2025-11-13Journal article

Open access

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

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

Global excess deaths associated with heatwaves in 2023 and the contribution of human-induced climate change

Publication . Hundessa, Samuel; Huang, Wenzhong; Xu, Rongbin; Yang, Zhengyu; Zhao, Qi; Gasparrini, Antonio; Armstrong, Ben; Bell, Michelle L.; Huber, Veronika; Urban, Aleš; Coelho, Micheline; Sera, Francesco; Tong, Shilu; Royé, Dominic; Kyselý, Jan; de'Donato, Francesca; Mistry, Malcolm; Tobias, Aurelio; Íñiguez, Carmen; Ragettli, Martina S.; Hales, Simon; Achilleos, Souzana; Klompmaker, Jochem; Li, Shanshan; Guo, Yuming; Multi-Country Multi-City Collaborative Research Network

Abstract: An unprecedented heatwave swept the globe in 2023, marking it one of the hottest years on record and raising concerns about its health impacts. However, a comprehensive assessment of the heatwave-related mortality and its attribution to human-induced climate change remains lacking. We aim to address this gap by analyzing high-resolution climate and mortality data from 2,013 locations across 67 countries/territories using a three-stage modeling approach. First, we estimated historical heatwave-mortality associations using a quasi-Poisson regression model with distributed lag structures, considering lag effects, seasonality, and within-week variations. Second, we pooled the estimates in meta-regression, accounting for spatial heterogeneity and potential changes in heatwave-mortality associations over time. Third, we predicted grid-specific (0.5 0.5) association in 2023 and calculated the heatwave-related excess deaths, death ratio, and death rate per million people. Attribution analysis was conducted by comparing heatwave-related mortality under factual and counterfactual climate scenarios. We estimated 178,486 excess deaths (95% empirical confidence interval [eCI], 159,892≥204,147) related to the 2023 heatwave, accounting for 0.73% of global deaths, corresponding to 23 deaths per million people. The highest mortality rates occurred in Southern (120, 95% eCI, 116≥126), Eastern (107, 95% eCI, 100≥114), and Western Europe (66, 95% eCI, 62≥70), where the excess death ratio was also higher. Notably, 54.29% (95% eCI, 45.71%≥61.36%) of the global heatwave-related deaths were attributable to human-induced climate change. These results underscore the urgent need for adaptive public health interventions and climate mitigation strategies to reduce future mortality burdens in the context of increasing global warming.

2025-09-04Journal article

Open access