National Institute of Health Dr. Ricardo Jorge
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Fatal Case of Crimean-Congo Hemorrhagic Fever, Portugal, 2024
No full textCase ReportsWe report a fatal case of Crimean-Congo hemorrhagic fever in Portugal. An 83-year-old man, initially suspected of having Mediterranean spotted fever, was later confirmed to have Crimean-Congo hemorrhagic fever by the detection of viral genome in the patient's serum and the presence of specific IgM antibodies.This work was partially supported by the Portuguese Foundation for Science and Technology (grant nos. FCT/MCTES UIB/00211/2020, DOI 10.54499/UIDB/00211; FCT/MCTES UIP/00211/2020, DOI 10.54499/UIDP/00211; UIDB/04295/2020; and UIDP/04295/2020)
Mercury exposure assessment from the first harmonised Total Diet Study in Portugal
No full textThe aim of this study was to estimate the Portuguese population’s baseline exposure to methyl and inorganic mercury by a harmonised total diet study (TDS) methodology and the risk of exceeding the Tolerable Weekly Intake (TWI). TDS food samples representative of the whole diet of the population were prepared as consumed, and analysed for total mercury. European Food Safety Authority’s (EFSA) conservative approach was used to estimate methylmercury and inorganic mercury and exposure was estimated using Monte Carlo Risk Assessment (MCRA) software. Mean, median and P95 exposure of the overall population (18 to 74 years old) to methylmercury and to inorganic mercury were 1.25, 0.01 and 5.45 µg/kg bw/week, and 0.37, 0.15 and 1.27 µg/kg bw/week, respectively. The percentage of individuals exceeding TWI was 27.6 for methylmercury and 3.5 for inorganic mercury. Regarding childbearing age women (18 to 45 years old), methylmercury mean exposure was 1.13 µg/kg bw/week with 25% of women exceeding the TWI. Cod and hake were the main contributors to mercury intake.Open access funding provided by FCT|FCCN (b-on). This research was partially funded by the European Commission’s Seventh Framework Programme [FP7/2012–2016] as a part of TDS-Exposure project [grant agreement number 289108]
Regional variation in the role of humidity on city-level heat-related mortality
No full textMCC Collaborative Research Network Authors - INSA: Joana Madureira (Environmental Health Department, National Institute of Health, Porto, Portugal); Susana das Neves Pereira da Silva (Department of Epidemiology, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal).The rising humid heat is regarded as a severe threat to human survivability, but the proper integration of humid heat into heat-health alerts is still being explored. Using state-of-the-art epidemiological and climatological datasets, we examined the association between multiple heat stress indicators (HSIs) and daily human mortality in 739 cities worldwide. Notable differences were observed in the long-term trends and timing of heat events detected by HSIs. Air temperature (Tair) predicts heat-related mortality well in cities with a robust negative Tair-relative humidity correlation (CT-RH). However, in cities with near-zero or weak positive CT-RH, HSIs considering humidity provide enhanced predictive power compared to Tair. Furthermore, the magnitude and timing of heat-related mortality measured by HSIs could differ largely from those associated with Tair in many cities. Our findings provide important insights into specific regions where humans are vulnerable to humid heat and can facilitate the further enhancement of heat-health alert systems.Significance Statement: Climate change has intensified the frequency, duration, and severity of lethal heat stress in recent years, a trend expected to exacerbate further. Despite the increasing focus on humid heat, there remains a gap in understanding how to effectively integrate humid heat into heat-health alert systems across regions with diverse climatic conditions. Addressing this gap, our study utilizes extensive epidemiological and climatological datasets to discern locations where incorporating humidity largely improves the predictive capacity for heat-related mortality compared to relying solely on air temperature. These findings offer crucial insights for enhancing heat-health alert systems in the face of ongoing climate change.Q.G., M.H., and T.O. were supported by the Environment Research and Technology Development Fund (JPMEERF23S21120) of the Environmental Restoration and Conservation Agency provided by the Ministry of the Environment of Japan. Q.G. was supported by the Musha Shugyo international travel grants from the School of Engineering, The University of Tokyo. T.O. was supported by the Japan Society for the Promotion of Science (KAKENHI: 21H05002), and the Environment Research and Technology Development Fund of the Environmental Restoration and Conservation Agency of Japan (JPMEERF23S21100). M.N.M. was supported by the European Commission (H2020-MSCA-IF-2020) under REA grant agreement no. 101022870. A.G. was supported by the Medical Research Council-UK (Grant ID: MR/V034162/1) and European Union’s Horizon 2020 Project Exhaustion (Grant ID: 820655). J.K. was supported by the Czech Science Foundation, project 23-06749S. A.M.V.-C. supported by the Swiss National Science Foundation (TMSGI3_211626). V.H. was supported by the European Union’s Horizon 2020 research and innovation program (H2020-MSCA-IF-2020, Grant No.: 101032087). Y.S. was supported by Brain Pool Plus program funded by the Ministry of Science and ICT through the National Research Foundation of Korea (NRF-2021H1D3A2A03097768), and the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (NRF-2023R1A2C1004754).info:eu-repo/semantics/publishedVersio
Biomonitoring of polycyclic aromatic hydrocarbons exposure and short-time health effects in wildland firefighters during real-life fire events
No full textHuman biomonitoring data retrieved from real-life wildland firefighting in Europe and, also, worldwide are scarce. Thus, in this study, 176 Portuguese firefighters were biomonitored pre- and post- unsimulated wildfire combating (average:12-13 h; maximum: 55 h) to evaluate the impact on the levels of urinary polycyclic aromatic hydrocarbons hydroxylated metabolites (OHPAH; quantified by high-performance liquid chromatography with fluorescence detection) and the associated short-term health effects (symptoms, and total and differentiated white blood cells). Correlations between these variables and data retrieved from the self-reported questionnaires were also investigated. Firefighters were organized into four groups according to their exposure to wildfire emissions and their smoking habits: non-smoking non-exposed (NSNExp), non-smoking exposed (NSExp), smoking non-exposed (SNExp), and smoking and exposed (SExp). The most abundant metabolites were 1-hydroxynaphthalene and 1-hydroxyacenaphthene (1OHNaph + 1OHAce) (98-99 %), followed by 2-hydroxyfluorene (2OHFlu) (0.2-1.1 %), 1-hydroxyphenanthrene (1OHPhen) (0.2-0.4 %), and 1-hydroxypyrene (1OHPy) (0.1-0.2 %); urinary 3-hydroxybenzo(a)pyrene was not detected. The exposure to wildfire emissions significantly elevated the median concentrations of each individual and total OHPAH compounds in all groups, but this effect was more pronounced in non-smoking (1.7-4.2 times; p ≤ 0.006) than in smoking firefighters (1.3-1.6 times; p ≤ 0.03). The greatest discriminant of exposure to wildfire emissions was 1OHNaph + 1OHAce (increase of 4.2 times), while for tobacco smoke it was 2OHFlu (increase of 10 times). Post-exposure, white blood cells count significantly increased ranging from 1.4 (smokers, p = 0.025) to 3.7-fold (non-smokers, p monocytes > neutrophils in non-smokers), evidencing the impact of PAH released from wildfire on immune cells. This study identifies Portuguese firefighters with high levels of biomarkers of exposure to PAH and points out the importance of adopting biomonitoring schemes, that include multiple biomarkers of exposure and biomarkers of effect, and implementing mitigations strategies.Highlights: - PAH metabolites (OHPAH) were analysed pre- and post- real-life wildfire combating; - Exposure to wildfire emissions significantly elevated the levels of all OHPAH; -
The greatest discriminant of exposure to wildfire emissions was 1OHNaph + 1OHAce; - 2OHFlu and 1OHPy correlated positively with the daily number of smoked cigarettes; -
OHPAH were associated with total white blood cells and differential count.This work was financially supported by the project PCIF/SSO/0017/2018 (doi:10.54499/PCIF/SSO/0017/2018) by the Fundação para a Ciência e a Tecnologia (FCT), Ministério da Ciência, Tecnologia e Ensino Superior (MCTES) through national funds.
This work received support by UIDB/50006/2020 (DOI:10.54499/UIDB/50006/2020), UIDP/50006/2020 (DOI:10.54499/UIDP/50006/2020), LA/P/0008/2020 (DOI:10.54499/LA/P/0008/2020) and through the project PCIF/SSO/0090/2019 (doi:10.54499/PCIF/SSO/0090/2019) by the Fundação para a Ciência e a Tecnologia (FCT), Ministério da Ciência, Tecnologia e Ensino Superior (MCTES) through national funds. The authors would also like to thank to FCT and European Union through Fundo Social Europeu (FSE) which supported the scientific contract CEEC- Individual 2017 Program Contract CEECIND/03666/2017 (DOI:10.54499/CEECIND/03666/2017/CP1427/CT0007) and the PhD grant 2020.07394.BD, respectively
Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults
No full textNCD Risk Factor Collaboration (NCD-RisC): Ana Rito, Departamento de Alimentação e Nutrição, INSABackground: Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories.
Methods: We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI 2 SD above the median).
Findings: From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness.
Interpretation: The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.Research in context - Evidence before this study: We searched MEDLINE (via PubMed) for articles published from database inception up to Sept 25, 2023, with no language restrictions, using the following search terms: (((“obesity”[mh:noexp] OR “overweight”[mh:noexp] OR “overnutrition”[mh:noexp]) AND (“thinness”[mh:noexp] OR “malnutrition”[mh:noexp])) OR (“double burden” AND “malnutrition”)) AND (“Health Surveys”[mh] OR “Epidemiological Monitoring”[mh] OR “Prevalence”[mh]) AND (“global*” OR “worldwide”) NOT “patient*”[Title] NOT Comment[ptyp] NOT Case Reports[ptyp]. Articles were screened to include measured data on height and weight, collected from probabilistic samples of national, subnational, or community populations aged 5 years and older. We found two studies that reported the prevalence of underweight and obesity in adults, one of which also reported the prevalence of thinness and obesity in school-aged children and adolescents, for all countries in the world. These outcomes were reported separately, and neither their combination nor their relative sizes were evaluated. The most recent data for both age groups were from 2016. We found eight studies on the double burden of malnutrition in low-income and middle-income countries, using data mostly from Demographic and Health Surveys or Global School-based Student Health Surveys. These studies covered only women of reproductive age or school-aged children and adolescents, and few assessed change over time. We found two other studies that covered multiple world regions but they did not report country-level prevalence or assess change over time. These studies defined double burden of malnutrition at the level of the individual (eg, combination of stunting and obesity), household (eg, presence of underweight and obesity in different members of the same household), or country, depending on the study. None reported for all countries in the world.
- Added value of this study: - This study uses thousands of high-quality population-based studies, and presents consistent and up-to-date estimates of underweight, thinness, and obesity from late childhood through to adulthood, separately and in combination, for all countries in the world. It also analyses how the two components have contributed to the change in their combined burden over a period of more than three decades, 1990–2022, during which major changes occurred in food policies and programmes and nutrition.
- Implications of all the available evidence: The combined prevalence of underweight and obesity has increased in most countries since 1990, due to the rise in obesity surpassing the decline in underweight. Exceptions were most countries in south Asia, and some in southeast Asia and sub-Saharan Africa, where a decrease in the prevalence of underweight led to a decrease in the combined burden. This transition to obesity dominance was already apparent in adults in 1990 in much of the world, and has followed in school-aged children and adolescents. There is a need throughout the world for social and agricultural policies and food programmes that address the remaining burden of underweight while curbing and reversing the rise in obesity by enhancing access to healthy and nutritious foods.This study was funded by the UK Medical Research Council (grant
number MR/V034057/1), the UK Research and Innovation (Research
England Policy Support Fund), UK Research and Innovation (Innovate
UK grant number 10103595, for participation in the OBCT consortium
funded by the European Union grant agreement 101080250), and
European Union (STOP Project grant agreement 774548). BZ is
supported by a fellowship from the Abdul Latif Jameel Institute for
Disease and Emergency Analytics at Imperial College London, funded
by a donation from Community Jameel
HBM4EU chromates study: the Portuguese integrated and harmonized study on exposure to hexavalent chromium and related early effects.
No full textIn the scope of the European Union (EU) human biomonitoring initiative, a multicentric study on different occupational settings from several European countries was performed, to provide information on occupational exposure to hexavalent chromium [Cr(VI)], a known lung carcinogen. Biomonitoring approaches were used to obtain exposure data to support the implementation of new risk management measures and policy actions at the national and European levels. This work describes the Portuguese contribution to the study, which aimed to assess workers' exposure to Cr, by using exposure biomarkers (urinary chromium [U-Cr]), and industrial hygiene samples (air and hand wipes) and to link exposure to potential long-term health effects by using effect biomarkers. Exposure determinants influencing exposure were explored from the contextual information and human biomonitoring data. The ultimate goal of the study was to appraise the risk management measures contributing to minimize exposure and protect workers' health. Several occupational settings and activities were considered, including plating, welding, and painting. A control group from the Portuguese general population was also included. Data on age, sex, and smoking habits from both groups were considered in the statistical analysis. Information on the risk management measures available for workers was collected and used to identify the ones that mainly contributed to reduce exposure. Environmental monitoring and human biomonitoring revealed that painters were the highest exposed group. The use of respiratory protection equipment showed an influence on total U-Cr levels for workers involved in painting activities. Concerning early health effects, the painters presented also a significantly higher level of DNA and chromosomal damage in peripheral blood cells, as compared to the control group, suggesting a plausible association between exposure to Cr(VI) and early genotoxic effects. The results showed that workers are exposed to Cr(VI) in those occupational settings. These findings point to the need to improve the prevention and risk management measures and the implementation and enforcement of new regulatory actions at the national level.What’s Important About This Paper? This study provides human biomonitoring information regarding occupational exposure to hexavalent chromium in Portugal that can be used to support the implementation of new and effective risk management measures and policy actions at both national and international levels. The results also highlight the need to update the hexavalent chromium occupational limit value as it is being discussed at the European level.This project received funding from the European Union’s Horizon 2020 Research and Innovation Programme under grant agreement no. 733032 (Human Biomonitoring for European Union, HBM4EU) and received co-funding from the authors’ organizations and/ or Ministries
Characterization of a cohort of Angolan children with sickle cell anemia treated with hydroxyurea
Get PDFBackground: Sickle Cell Anemia (SCA) is a monogenic disease, although its severity and response to treatment are very heterogeneous.
Objectives: This study aims to characterize a cohort of Angolan children with SCA and evaluate their response to hydroxyurea (HU) treatment and the potential side effects and toxicity.
Methods: The study enrolled 215 patients between 3 and 12 years old before and after the administration of HU, at a fix dose of 20 mg/kg/day for 12 months.
Results: A total of 157 patients started HU medication and 141 of them completed the 12-month treatment. After initiating HU treatment, the frequency of clinical events decreased (transfusions 53.4 %, hospitalizations 47.1 %). The response to HU medication varied among patients, with some experiencing an increase in fetal hemoglobin (HbF) of <5 %. The mean increase in HbF was 11.9 %, ranging from 1.8 % to 31 %. Responders to HU treatment were 57 %, inadequate responders 38.7 % and non-adherent 4.2 %. No clinical side effects related to HU were reported. Hematological toxicities were transient and reversible. Children naïve to HU and with lower HbF reported higher number of hospitalizations caused by malaria infection. During HU treatment, the frequency of malaria episodes did not appear to be affected by HbF levels.
Conclusions: the present study provided a valuable contribution to the understanding of the clinical and laboratory profiles of Angolan children with SCA. These findings support the evidence that the implementation of prophylactic measures and treatment with HU is associated with increased survival in children with SCA.This research was funded by Fundação para a Ciência e Tecnologia
Ministério da Ciência, Tecnologia e Ensino Superior (FCT-MCTES) and
Aga Khan Foundation (FCT/MCTES/Aga Khan, project n◦ 330842553),
by FCT/MCTES funding to H&TRC (UIDB/05608/2020, UIDP/05608/2020) and to GHTM IHMT NOVA (UIBD/04413/2020) and LA-REAL –LA/P/0117/2020.info:eu-repo/semantics/publishedVersio
Hospitalizações por Hepatite A em Portugal – Análise da tendência entre 2013-2022
Get PDFIntrodução: A Hepatite A é uma doença infeciosa provocada pelo vírus da Hepatite A (VHA). A principal via de transmissão é fecal-oral, embora a transmissão sexual tenha vindo a desempenhar um papel mais preponderante na disseminação deste agente. Existe uma associação entre a incidência de Hepatite A com o acesso à água potável e indicadores socioeconómicos. Regiões globais de alta renda têm um reduzido número de novos casos de doença, no entanto a maioria dos diagnósticos é realizado em adultos, faixa etária em que a doença tende a apresentar maior gravidade, com consequências na morbilidade e mortalidade. A infeção por VHA pode ser assintomática, subclínica ou provocar insuficiência hepática aguda. O diagnóstico precoce da infeção é essencial, a hidratação adequada e controlo dos sintomas integram o processo terapêutico. É fundamental a prestação de cuidados intensivos, multidisciplinares para o reconhecimento de fatores de mau prognóstico, como complicações hepáticas ou extra-hepáticas.
Objetivo: Caraterizar a tendência de hospitalizações por Hepatite A ocorridas em Portugal entre 2013 e 2022.
Material e métodos: Estudo observacional retrospetivo, que analisou a tendência de hospitalizações por hepatite A identificadas na Base de Dados de Morbilidade Hospitalar (BDMH/ACSS), utilizando os códigos 070.0 e 070.1 (ICD-09) e B15 e B15.9 (ICD-10), entre 2013 e 2022. Estatística descritiva foi realizada através SPSS® ver.25 e a tendência das hospitalizações foi estimada através do Joinpoint Regression Program 5.0.2.
Resultados: Entre 2013 e 2022, ocorreram 546 hospitalizações por Hepatite A com uma mediana de duração de 5 dias (0-133 dias). A maioria das hospitalizações corresponderam a indivíduos do sexo masculino (n=391; 71,6%), com idades entre 25 e 44 anos (n=231; 42.3%). Apenas 5.5% das hospitalizações envolverem crianças com idade 65 anos foram as únicas a apresentar uma tendência crescente estatisticamente significativa (+39.2, p=0.01; +46.8, p=0.004).
Discussão e Conclusão: Em Portugal, o número de novos casos de doença reportados é baixo. A diminuição dos casos, apesar de ser um bom indicador da melhoria das condições higieno-sanitárias, aumenta a possibilidade da ocorrência de surtos pois a população tenderá a ver reduzida a sua imunidade natural contra a doença. A maioria dos diagnósticos ocorre em indivíduos de idade adulta, traduzindo-se no aumento da gravidade da doença e consequentemente no aumento das hospitalizações. Nas regiões urbanas, Lisboa e Porto, a disseminação da infeção foi associada maioritariamente a transmissão sexual. A monitorização da doença é fundamental para a implementação precoce de medidas de prevenção, de forma a mitigar danos que um surto possa ter na população e auxiliar no desenvolvimento de estratégias de saúde pública no controlo da Hepatite A.info:eu-repo/semantics/publishedVersio
Ongoing outbreak of hepatitis A associated with sexual transmission among men who have sex with men, Portugal, October 2023 to April 2024
No full textRapid communicationAn outbreak of hepatitis A is ongoing in Portugal, with 71 confirmed cases from 7 October 2023 to 24 April 2024. Most cases are male, aged 18-44 years, with many identifying as men who have sex with men (MSM) and reported as suspected sexual transmission. Phylogenetic analysis identified the subgenotype IA, VRD 521-2016 strain, last observed in an MSM-associated multi-country outbreak in 2016 to 2018. We wish to alert colleagues in other countries to investigate potential similar spread.info:eu-repo/semantics/publishedVersio
Communicating and disseminating One Health: successes of the One Health European Joint Programme
No full textThe application of a One Health approach recognizes that human health, animal health, plant health and ecosystem health are intrinsically connected. Tackling complex challenges associated with foodborne zoonoses, antimicrobial resistance, and emerging threats is imperative. Therefore, the One Health European Joint Programme was established within the European Union research programme Horizon 2020. The One Health European Joint Programme activities were based on the development and harmonization of a One Health science-based framework in the European Union (EU) and involved public health, animal health and food safety institutes from almost all EU Member States, the UK and Norway, thus strengthening the cooperation between public, medical and veterinary organizations in Europe. Activities including 24 joint research projects, 6 joint integrative projects and 17 PhD projects, and a multicountry simulation exercise facilitated harmonization of laboratory methods and surveillance, and improved tools for risk assessment. The provision of sustainable solutions is integral to a One Health approach. To ensure the legacy of the work of the One Health European Joint Programme, focus was on strategic communication and dissemination of the outputs and engagement of stakeholders at the national, European and international levels.One Health EJP received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 773830