Home collection (ENSP)
URI permanente para esta coleção:
Navegar
Entradas recentes
- Invasive cervical cancer detection after transition to primary human papillomavirus screeningPublication . Sousa, Rita; Fonseca-Moutinho, José Alberto; Gomes, Fábio; Loureiro, Fernanda; Nascimento, Helena; Solheiro, Helena; Saavedra, Isabel; Ponte, Madalena; Barros, Mónica; Pereira, Sofia; Rebelo, Teresa; Caeiro, Vítor; Goes, Ana Rita; Soares, Patrícia; Laboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOMIntroduction: Invasive cervical cancer (ICC) is a key outcome for evaluating cervical cancer screening (CCS) programs. Monitoring ICC trends and distinguishing cancers detected within and outside the organized screening program are essential for assessing program impact, particularly during transitions such as the introduction of human papillomavirus (HPV) based primary screening. Methods: We conducted a retrospective population-based study in Portugal's Central Region (2014 - 2023). Deterministic linkage was performed between the organized CCS database and hospital morbidity records. Invasive cervical cancer cases were classified as screen-detected or non-screen-detected based on prior screening history. Incidence rates were calculated using population denominators. Poisson regression models with log link and log-transformed population offsets were fitted to estimate incidence rate ratios (IRR) comparing cytology-based (2014 - 2019) and HPV-based (2020 - 2023) periods, adjusting for temporal trends. Results: A total of 654 ICC cases were included. Screening participation remained broadly stable over time. The HPV-based period was associated with a significantly higher rate of screen-detected ICC (IRR = 1.94; 95% CI 1.11 - 3.40) compared with the cytology period. In contrast, ICC incidence outside the organized screening program did not differ significantly between periods (IRR = 0.94; 95% CI 0.65 - 1.35). Conclusion: The transition to HPV-based primary screening was associated with a shift in ICC detection towards the organized screening program, without evidence of a corresponding increase in incidence among women diagnosed outside the organized screening program. These findings should, however, be interpreted with caution in light of the early phase of implementation and potential external factors influencing access to diagnosis. Overall, the results support a shift in detection within the screening pathway rather than changes in underlying disease occurrence. Strengthening integration between screening, hospital, and cancer registry data remains essential for robust evaluation of cervical cancer screening policies.
- When less may be enoughPublication . Presume, Márcia; Oliveira, Eduardo Infante de; Escola Nacional de Saúde Pública (ENSP); Sociedade Portuguesa de Cardiologia | Elsevier
- Framing of ultra-processed foods in UK news media (2022–2023) and associations with quoted actors’ interestsPublication . Parnham, Jennie C.; Chang, Kiara; Essman, Michael; Smith, Deb; Etkind, Mike P.; McKenzie, Maisie; Shah, Prisha; Vasiljevic, Milica; Petticrew, Mark; White, Martin; Laverty, Anthony A.; Boyland, Emma; Cummins, Steven; Millett, Christopher; Adams, Jean; Vamos, Eszter P.; Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); Elsevier BVIncreasing attention on “ultra-processed” foods (UPFs) and their health effects has sparked policy debate. News media influences public perceptions yet understanding of UPF framing and industry influence remains limited. This study analysed UPF framing in UK news media and trade press, exploring interests of quoted individuals and organisations. We systematically searched UK media for UPF articles in 2022–23, identifying 188 articles for mixed-methods content analysis. Articles were examined for their position towards classifying food by processing-level (accepted/contested/mixed). Framing Theory guided identification of UPF frames describing problem definitions, causes, and solutions. Actors’ interests were classified using academic journal guidelines. Half the articles (52%) accepted the UPF concept, 19% contested it, and 29% were mixed. Five frames were identified. The ‘Social Justice’, ‘Lifestyle Drift’, and ‘Science Report’ frames accepted the UPF concept, with the ‘Social Justice’ frame positioning UPF consumption as a structural public health problem requiring policy action such as taxes or front-of-package labelling. The ‘UPF Critique’ and ‘Market Justice’ frames contested the scientific basis of the UPF concept, proposing nutrient-based approaches instead. Among 116 named actors, 33% had UPF industry interests, with academics comprising 45% and industry spokespeople 11%. Actors with UPF industry interests were more commonly cited in contesting frames (e.g. ‘Market Justice’: 73%) than accepting frames (e.g. ‘Social Justice’: 10%). These findings highlight that industry influence on UPF media discourse is often obscured behind academic voices. Greater transparency around actor interests is urgently needed to ensure emerging UPF policies are shaped by independent evidence.
- Environmental burden of lead (Pb) and methylmercury (MeHg) exposure on IQ loss in children in EuropePublication . Palmont, Philippe; Bhoonah, Rachna; Caudeville, Julien; Cherfan, Sarah; Benchrih, Rafiqa; Martins, Carla; Mc Vey, Emily; Plass, Dietrich; Purece, Anthony; Thomsen, Sofie Theresa; Sell, Paulina; Buekers, Jurgen; Crépet, Amélie; Sanchez, Margaux; Escola Nacional de Saúde Pública (ENSP); Laboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); ElsevierLead (Pb) and methylmercury (MeHg) are well-established developmental neurotoxicants, associated with adverse effects on cognition in children. This study estimates the environmental burden of disease associated with Pb and MeHg on IQ loss of children. Human biomonitoring surveys from five European countries were used to estimate exposure for children and women of childbearing age, covering all exposure sources and routes. Coupled with exposure–response functions we derived from meta -analyses, IQ points lost attributable to each metal were estimated. Assuming a normal distribution of IQ points, we calculated the resulting IQ score due to exposure and applied disability weights to calculate DALYs. Uncertainty (on model parameters) and intra-populational variability (exposure differences) were propagated through Monte Carlo simulations. The burden due to combined exposure to both substances was estimated for the French dataset, which met data requirements for a mixture assessment. The estimated IQ shift between exposed and theoretically unexposed individuals was higher for Pb than for MeHg. Pb was responsible for a median shift in IQ points of −0.36 (Sweden) to −0.47 (Czech Republic), while MeHg contributed to −0.03 (Czech Republic) to −0.08 (France) IQ points. We estimated a mean attributable burden from 950 to 1173 DALYs per 100,000 individuals for Pb, and 96 to 251 DALYs per 100,000 for MeHg across the studied countries. The burden of combined exposure in the French population was estimated at an average of −0.49 IQ points lost per individual, and 1,367 DALYs per 100,000 births. Our results highlight the necessity to strengthen regulatory measures to reduce lead exposure through key sources such as dust, tap water, and food, despite decreasing blood levels in Europe in the last few decades. Regarding MeHg, our study highlights the importance of maintaining targeted communication towards current and future parents, especially because dietary exposure remains the main exposure source.
- Shifting attitudes from willingness to uptake in COVID-19 and influenza vaccinationPublication . Moura, Sara; Rodrigues, António Teixeira; Romano, Sónia; Rodrigues, Nuno; Guerreiro, José; Paulino, Ema; Peralta-Santos, André; Escola Nacional de Saúde Pública (ENSP); Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; MDPI - Multidisciplinary Digital Publishing InstituteBackground/Objectives: Vaccine hesitancy is a complex and growing phenomenon worldwide, posing a serious threat to public health achievement in disease control and prevention. This study aimed to assess willingness to uptake and factors linked to shifts between different categories of willingness and uptake regarding the COVID-19 and influenza vaccines. Methods: Prospective cohort study with a representative sample of 1400 individuals aged ≥60 years residing in mainland Portugal, randomly selected. Two telephone surveys were conducted: one at the start of the 2023/2024 vaccination campaign, assessing patients’ characteristics and willingness for vaccination (using an 11-point Likert scale), and another at the end, assessing vaccination status and reasons for uptake/non-uptake. Results: Shifts were observed among both acceptance and refusal groups—12.93% of the individuals within these categories shifted to an opposite decision. Hesitancy presents divergent attitudes: for the COVID-19 vaccine, 56.50% declined vaccination, while for the influenza vaccine, non-uptake was only 30.60%. Age, presence of chronic disease, level of education, household dimension, and previous uptake of booster doses are significantly associated with shifting attitudes, playing different roles for each category of willingness and uptake outcome. For the acceptance category, non-uptake relates to confidence factors. For hesitancy, non-uptake is mainly due to complacency. For refusal, the decision is influenced by all domains. Conclusions: Vaccine hesitancy remains an important public health concern in the Portuguese population and appears to differ between COVID-19 and influenza vaccination. Attitudes toward COVID-19 and influenza vaccines can vary in all directions over a short period. Acceptance does not guarantee uptake, and refusal can shift towards uptake. These findings highlight the importance of reinforcing public health strategies and interventions for uptake across a population, taking into consideration the specificities of each willingness group.
- People-centered leadership, organizational commitment and retention in public healthcarePublication . Martins, Patrícia; Nascimento, Generosa; Fernandes, Adalberto Campos; Palma-Moreira, Ana; Vieira, Pedro; Escola Nacional de Saúde Pública (ENSP); MDPI - Multidisciplinary Digital Publishing InstituteBackground: Public healthcare systems face persistent workforce retention challenges that undermine service continuity, organizational resilience, and public value creation. Although leadership is frequently identified as a relevant lever, the literature remains theoretically fragmented and often treats leadership effects as direct and context-free. Methods: This review adopts a PRISMA-guided systematic literature review as a theory-building strategy. Searches were conducted in Web of Science, Scopus, and PubMed using combinations of terms related to leadership, organizational commitment, job satisfaction, turnover intention, and retention in healthcare settings. The review identified 640 records, removed 372 duplicates, screened 268 titles and abstracts, assessed 90 full-text records for eligibility, and retained 30 peer-reviewed studies for configurative synthesis. The analysis combined thematic synthesis with configurative mapping to identify mechanisms, recurring patterns, and contextual contingencies. Results: The review shows three consistent patterns. First, leadership is linked to retention predominantly through organizational commitment, especially affective and normative commitment, rather than through direct effects. Second, institutional and organizational conditions—particularly red tape and working conditions—shape the strength of leadership–commitment relationships. Third, workforce heterogeneity, including generational differences, affects how leadership practices and organizational environments are interpreted, although these dynamics are rarely theorized explicitly in the literature. Conclusions: The article develops a governance-sensitive integrative framework in which people-centered leadership influences turnover intentions indirectly through organizational commitment, while red tape and working conditions operate as contextual moderators. By embedding leadership within Public Administration and governance theory, the review clarifies the literature’s main explanatory gap and provides a foundation for comparative empirical testing and for more sustainable workforce strategies in public healthcare systems.
- Public health diplomacy in an era of complexity, uncertainty, and unpredictabilityPublication . Linares, Lucia; Chen-Xu, José; Medialdea Carrera, Raquel; Pietersz, Danila; Zavattaro, Federica; Otok, Robert; Barros, Henrique; Figueras, Josep; Joshi, Ashish; Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); Frontiers MediaIn an era marked by geopolitical instability and rapidly evolving health threats, public health diplomacy (PHD) can be an essential mechanism for fostering the coordination, collaboration, cooperation, and communication needed to protect public health. PHD helps strengthen trust-building relationships through inclusive communication and cross-sector collaboration. This article synthesizes insights generated during a Young Forum Gastein (YFG) workshop held at the European Health Forum Gastein (EHFG) 2025, hosted by the Association of Schools of Public Health in the European Region (ASPHER) and the Association of Schools and Programs of Public Health (ASPPH). Workshop discussions explored how public health diplomacy is being conceptualized by early-career health professionals working across Europe, positioning youth as critical contributors to inclusive, equitable PHD processes. The outcomes of the workshop provide a way forward for strengthening public health diplomacy and identifying the essential skills that are critical to advancing this field.
- Instruments for dysphonia screening, vocal symptom identification, and self-reported voice perceptionPublication . Gonçalves, Renata da Silva; Leal, Gilberto da Cruz; Simões-Zenari, Marcia; Nemr, Katia; Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); Laboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP); Elsevier Science B.V., Amsterdam.Objective: This study aims to map the instruments used in international literature for dysphonia screening, vocal symptom identification, and self-reported voice perception. Method: A scoping review conducted in accordance with the Joanna Briggs Institute reviewer's manual and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Searches were performed in December 2025 across the Medline, Lilacs, Scopus, Cochrane, and EMBASE databases. Two independent reviewers selected studies addressing dysphonia screening and vocal self-report instruments, with no language or time period restrictions. Results: A total of 190 studies published between 2007 and 2025 were included. Brazil led the publications (n=120; 63.1%), followed by the USA (n=12; 6.3%). Forty-one instruments were identified and categorized into screening (such as the Screening Index for Voice Disorder and Dysphonia Screening Tool), vocal symptom identification and self-reported voice perception (such as the Voice Handicap Index, Voice Symptom Scale, and Voice-Related Quality of Life), and hybrid tools (such as the Dysphonia Risk Screening Protocol and Vocal Tract Discomfort Scale). Most studies focused on working-age adults, revealing a shortage of digital ecological validations and robust sensitivity and specificity studies. Conclusion: Although there is growing development of specific tools for occupational niches, gaps persist regarding pediatric and geriatric populations, as well as the validation of digital formats. The choice of instrument must strictly align its purpose (rapid population screening vs. longitudinal clinical monitoring) with the patient's profile.
- Health literacy of the higher education community in a European countryPublication . RALS; Ferreira, Pedro L.; Morais, Carminda; Pimenta, Rui; Ribeiro, Inês; Alves, Sandra M.; Pedro, Ana R.; Escoval, Ana; Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP); BioMed Central (BMC)BACKGROUND: Health literacy is a dynamic and multidimensional concept. Examining health literacy among higher education students and teachers is crucial for promoting informed health decisions and encouraging healthier behaviors. Our study aimed to measure health literacy among higher education students and teachers, assess the impact of sociodemographic variables, and compare health literacy levels between these groups. METHODS: This study is a Portuguese Academic Health Literacy Network (RALS) project. Data were collected via a questionnaire, including the HLS-EU-Q16 and sociodemographic and health information-seeking behavior items. The statistical analyses involved descriptive statistics and binary logistic regression. The executive boards of the participating universities and polytechnic institutes were initially informed about the objectives of the study and the prior approval obtained from an ethics committee. We then requested that the institutions use their official email databases to distribute invitations to students and teachers to complete the online questionnaire. RESULTS: The sample consisted of 5,798 students and 1,823 teachers. The majority were women, with students predominantly aged 20-30 years and teachers mostly over 40 years. Compared with students, teachers presented higher health literacy levels (p < 0.001). Specifically, 45.0% of the students and 31.5% of the teachers had inadequate or problematic health literacy. Graduate students and PhD-holding teachers had superior literacy scores (p < 0.001). Economic sufficiency (highest OR: students 2.708; teachers 3.310) and self-health perception positively influenced health literacy (highest OR: students 1.974; teachers 2.284), whereas nonhealthy fields decreased the likelihood of positive health literacy (lowest OR: students 0.583; teachers 0.456). For students, age and educational level were significant factors for positive literacy levels, whereas for teachers, professional background in health was key. Sex and chronic disease presence were not significant for either group. CONCLUSIONS: The study highlights a meaningful portion of students with inadequate health literacy (45%). Socioeconomic factors, including education and economic resources, significantly influence health literacy. Additionally, involvement in health-related fields and better self-assessed health correlate with higher health literacy. These findings underscore the need for targeted interventions and training to enhance health literacy across the academic community.
- International differences in the technical qualities of place of death classifications and dataPublication . Delalibera, Mayra; Lopes, Sílvia; Dias da Silva, Inês; Gomes, Barbara; Laboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP); SAGE PublicationsBackground: Place of death is a key population-level indicator for palliative care and health services planning. However, substantial international variation in how it is recorded limits cross-country comparisons and health system evaluations. Aim: Analyse the technical qualities of national place of death classifications and data, and identify strengths and weaknesses from the perspective of researchers using death certificate data. Design: Cross-sectional online survey. The questionnaire design was informed by the United Nations (UN) and World Health Organization (WHO) recommendations for international statistical and health classifications, and included closed- and open-ended questions. Setting/participants: Sixteen researchers identified through published place of death studies participated. Collectively, they had analysed data from 67 countries until 2022, most for over 10 years. Results: Most researchers reported that national classifications were stable, had mutually exclusive categories, and included a category for “home”. However, shortcomings were identified: lack of detailed categories for relevant settings (e.g. hospice, nursing home), ambiguous or inconsistent terminology, and limited use of hierarchical or multi-axial structures. Participants emphasised the need for greater standardisation of categories, clearer definitions, and improved data quality through training on completing death certificates. Conclusions: This is the first study to assess place of death classifications and data from researchers’ perspectives. Findings highlight critical limitations in current classification systems and provide guidance for developing an international classification aligned with UN and WHO recommendations. This will enable more meaningful cross-country comparisons and strengthen evidence to inform palliative care and health services planning worldwide.