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- The need of a one health approach to tackle microbiological contamination in animal and dairy productionPublication . Viegas, Carla; Gouveia, Ana Filipa; Cervantes, Renata; Pena, Pedro; Carolino, Elisabete; Twarużek, Magdalena; Viegas, Susana; 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); Elsevier BVWith the global population rising, there is increasing demand for agricultural productivity, particularly for animal-derived proteins and products. This trend places additional pressure on natural resources and the workforce in the animal production sector. This study aims to address environmental and health factors influenced by animal production within the One Health framework, encompassing animal welfare, food security, food safety, worker´s health and climate change. In this context, three feedlots' farms and two dairies from the North of Portugal, representing the worst-case exposure scenario, were engaged in this study. Samples were collected using Electrostatic Dust Cloths (EDC) placed on farm surfaces and attached to work clothing (EDCT). Additional samples were obtained from feed, used bedding material, and surface swabs from feeders, drinkers, milking parlors, and frequently touched areas in social spaces (e.g., offices and changing rooms). Microbial characterization and azole-resistance screening were performed using diverse culture media, complemented by molecular assays (qPCR) targeting toxigenic fungal species. Thirty-eight mycotoxins were analyzed across the sampled matrices. This comprehensive approach identified critical sources of microbial and mycotoxin contamination: bedding material showed the highest bacterial contamination (TSA; 5.40 X 103 CFU.g-1), while swabs (MEA; 2.5 X 104 CFU.m-2 to 9.00 X 104 CFU.m-2) and feed (MEA; ranged from 1.33 X 102 CFU.g-1 to 8.00 X 102 CFU.g-1) exhibited the greatest fungal contamination. Feed was identified as the main source of mycotoxin exposure for both animals and workers, since all 16 feed samples tested positive for mycotoxin contamination. Results revealed widespread distribution of Aspergillus sp. across environmental matrices, highlighting the need for targeted interventions. Azole-resistance screening and mycotoxin profiling further emphasize the importance of implement targeted interventions to prevent, monitor, and remediate environmental contamination by fungi and mycotoxins across different contexts (food safety, animal health, public and occupational health) underscoring the value of a One Health approach.
- EditorialPublication . Stufano, Angela; Paulo, Marília Silva; Laboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP); Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Frontiers Media
- A digital toolkit for weight loss maintenance in European adults (nohow)Publication . Stubbs, R. James; Duarte, Cristiana; Dakin, Clarissa; Palmeira, António L.; Sniehotta, Falko F.; Horgan, Graham W.; Larsen, Sofus C.; Marques, Marta M.; Encantado, Jorge; Evans, Elizabeth H.; Turicchi, Jake; O'Driscoll, Ruari; Scott, Sarah E.; Pearson, Beth; Ramsey, Lauren; Mikkelsen, Marie Louise; Santos, Inês; Matos, Marcela; Teixeira, Pedro J.; Heitmann, Berit L.; Laboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP); Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); JMIR PublicationsBackground: Digital approaches to weight management have the potential to produce cost-effective and scalable weight management solutions. Effective behavior change interventions typically promote self-regulation of energy balance behaviors, which may be enhanced by incorporating emotion regulation strategies. Objective: This study aimed to evaluate the effectiveness of a digital behavior change toolkit for weight loss maintenance in European adults who had achieved ≥5% weight loss in the previous 12 months. We hypothesized that a combined intervention targeting self-regulation or motivation and emotion regulation would be more effective than either component alone, and that each would outperform an active control. Methods: The Navigating to a Healthier Weight (NoHoW) trial was a 2×2 factorial randomized, single-blind, controlled trial involving 1627 adults who had achieved ≥5% weight loss in the previous 12 months (initial BMI ≥25 kg/m2) across 3 European centers (the United Kingdom, Denmark, and Portugal). The trial evaluated a digital toolkit for weight management subsequent to an initial ≥5% weight loss in the prior 12 months. Participants were assigned using adaptive stratified sampling to one of four groups: (1) self-regulation or motivation (n=403), (2) emotion regulation (n=416), (3) combined motivation and emotion (n=408), or (4) active control (generic content, regular self-weighing, and Fitbit use, n=400). The primary outcome was weight change from baseline to 12 months. Prespecified secondary outcomes included cardiometabolic markers. Linear models adjusted for recruitment center, sex, age group, BMI group, and pretrial weight loss. Subgroup analyses were conducted by sex. Results: At 12 months, 76% (364/1627) of participants remained in the study. In the primary ITT analysis in all participants, none of the intervention arms (motivation, emotion, or combined) differed significantly from the active control for weight change at 12 months. Completer and per-protocol analyses produced similar patterns and did not change the overall interpretation. In the per-protocol sample, men regained 0.14 kg, and women regained 0.54 kg of their pretrial weight loss. Subgroup analyses indicated a small effect of the motivation intervention in men, but this was not clinically meaningful and did not alter the primary null findings. Nearly half of ITT participants regained weight, and no significant intervention effects were observed for cardiometabolic secondary outcomes. Conclusions: The NoHoW trial was the first large-scale, multicountry 2×2 factorial randomized controlled trial to evaluate a digital-only toolkit based on self-regulation or motivation and emotion regulation techniques for weight loss maintenance. NoHoW found no evidence in the primary ITT analysis that digital interventions targeting self-regulation or emotion regulation improved weight loss maintenance compared with the active control. A small subgroup effect in men should be interpreted cautiously and does not change this conclusion. The trial provides evidence on both the limitations and potential of digital behavior change interventions for long-term weight outcomes. Future digital interventions may benefit from enhanced engagement and tailored content to improve long-term weight outcomes.
- Economic burden of overall and advanced light chain amyloidosisPublication . Thompson, Jeffrey A.; Gupta, Ankita; Catini, Julia; Laires, Pedro A.; Escola Nacional de Saúde Pública (ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC)Background: Real-world data on healthcare resource utilization (HCRU) and costs in light chain amyloidosis (AL) by disease severity are limited. This study evaluates HCRU and costs among patients with AL, particularly those with advanced stages. Methods: A retrospective analysis of deidentified patient records (January 2016 to March 2022) from Optum’s clinical electronic health record (EHR) database was conducted. Adult patients with ≥2 AL diagnoses or positive mentions of the disease in the physician’s notes (≥30 days apart) were included. Patients with a Mayo disease stage, including those with advanced disease (stages IIIa/IIIb), based on cardiac biomarkers (N-terminal pro-brain natriuretic peptide and troponin T), were identified most proximal to the index date (first-identified AL diagnosis date). Patient records were then linked to payer-agnostic claims. Data, including HCRU and costs, were assessed from the index date until the end of continuous enrollment or death (minimum 30-day follow-up) during the 12-month postindex period. Results: Among the 85 patients (75% aged ≥60 years; 65% males) included in the study, 60% had at least one condition-related inpatient hospitalization (66.7% with advanced cardiac involvement), 92.9% had an outpatient visit (54.4% with advanced cardiac involvement), 74.1% had an office visit (53.9% with advanced cardiac involvement), and 22.4% had an emergency room visit (68.4% with advanced cardiac involvement) within 12 months after diagnosis. The median (range) per-patient per-month (PPPM) condition-related total, medical, and drug costs for patients with advanced cardiac involvement (n = 47) were $7532 ($3336–$15,097), $2107 ($1079–$4618), and $4613 ($1664–$9488), respectively. The median (range) PPPM condition-related inpatient hospitalization costs for patients with advanced cardiac involvement (n = 34) was $462 ($77–$1839). Conclusion: This EHR-claims linked database study showed that patients with advanced disease face high economic burden, supporting the continued need for therapeutic advances to help manage this population.
- The impact of climate change on the emergence and reemergence of diseases transmitted by mosquitoes in temperate regionsPublication . Silva, Raquel Rosado e; Dittrich, Sabine; Donato, Helena; Millett, Christopher; Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); KargerAbstract – Introduction: Mosquito-borne diseases (MBD) represent a global public health concern. Many mosquito species have rapidly expanded globally due to climate change and are expected to continue spreading beyond their current range into temperate regions. To support policy action, an umbrella review was conducted to summarize the growing literature on the impact of climate change indicators on MBD patterns in temperate zones. Methods: Studies published until December 31, 2023, were searched in PubMed, EMBASE, Cochrane, Epistemonikos, and Web of Science Core Collection. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Problem/Population, Intervention, Comparison, and Outcome (PICO) guidelines were used. The quality of the methodology and evidence of the included reviews was assessed using “A Measurement Tool to Assess Systematic Reviews 2” (AMSTAR 2). Results: The initial search yielded 6, 518 studies, with 78 undergoing full-text assessment. Ten studies met the inclusion criteria. Key findings include a significant association between climate factors (specifically temperature, rainfall and humidity) and MBD in temperate regions, mostly malaria and dengue, with temperature consistently showing a strong predictive value. Our findings are likely to be robust as we employed strict quality criteria to ensure the quality of included primary studies and systematic reviews. Conclusion: This umbrella review identifies concerning impacts of climate change on MBD in temperate regions, highlighting significant correlations between climate variables and diseases such as dengue, malaria, and the Ross River virus. The review underscores the importance of targeted public health strategies that integrate climatic data for effective management of MBD in temperate regions and calls for further research on extreme weather events and less-studied diseases.
- Interregional outbreak of Salmonella Typhimurium linked to fresh cheesePublication . von Schreeb, Sebastian; Silveira, Leonor; Pista, Ângela; Gomes, João Paulo; Oleastro, Mónica; Raposo, Sara Gomes; Lutsiv, Valentyna; Rachadell, Juan; Pinto, Helder; Rico, Patrícia Correia; Pestana, Luísa; Pessoa, Vera Leal; Silva, António Carlos; Dinis, Ana; Almeida, Maria Helena; Danis, Kostas; Vasconcelos, Paula; Leite, Pedro Pinto; Peixoto, Vasco Ricoca; 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); Cambridge University PressIn 2024, an outbreak of Salmonella typhimurium affected two regions in Portugal. To identify the vehicle, we conducted a case–case study using a ‘same disease, different time period’ design. We compared S. typhimurium cases linked by whole-genome sequencing (WGS) (cluster cases) with salmonellosis cases notified in 2023 (historical cases) and calculated odds ratios (OR) for food exposures in surveillance data using logistic regression. We performed WGS on 58 isolates from the outbreak period (11/03/2024–2118/06/2024), and all belonged to a single cgMLST cluster (HierCC HC5_410,410). Compared with the 552 historical cases, cluster cases more frequently reported fresh cheese consumption (OR 18; 95% CI: 8.5–38). We visited the implicated cheese production site, identified food safety non-conformities, and enforced hygiene measures. Environmental and product specimens collected at the visit tested negative for Salmonella spp. Taken together, the most plausible vehicle in this outbreak was fresh cheese. The case–case design enabled a rapid, low-cost analysis to support targeted investigation using surveillance data. Using WGS cluster cases as the case definition, rather than all S. typhimurium cases during the outbreak period, yielded a higher OR in the case–case study, increasing confidence in the findings. We recommend this combined approach as part of the toolkit for foodborne outbreak investigations in Portugal in similar contexts.
- HelloAgainPublication . Pombo, Carolina; Lopes, Diana; Gomes, Inês; Santos, Carolina; Escola Nacional de Saúde Pública (ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); ElsevierSocial isolation is a growing public health concern that affects individuals of all ages, from children to the elderly. It´s associated with various physical, mental, and cognitive health risks, as well as reduced quality of life. In response to this challenge, this project proposes the development of an inclusive and personalized digital application designed to promote physical activity, social engagement, and intergenerational interaction. The app leverages artificial intelligence to recommend activities based on users' profiles, preferences, and needs, offering tailored experiences supported by healthcare professionals. The user-friendly interface and adaptive features improve digital accessibility for diverse populations, including people with special needs and caregivers. This article presents the conceptual framework, design strategy, expected benefits, and pilot implementation plan for the solution, highlighting its potential to promote healthy aging, autonomy, and community integration across the life course.
- HeartBracePublication . Coelho, Beatriz; Lopes, Diana; Martins, Inês; Passinhas, Rita; Santos, Carolina; Escola Nacional de Saúde Pública (ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); ElsevierCardiovascular diseases (CVDs) are the leading cause of death worldwide, with arrhythmias representing a significant clinical challenge due to their often asymptomatic nature and potential for severe complications. Early detection and effective monitoring are crucial for reducing morbidity and mortality associated with these conditions. The HeartBrace project proposes an innovative digital health solution: a wearable wristband device capable of continuously monitoring vital signs, detecting arrhythmias, and activating emergency protocols in real time. Through integrated GPS, photoplethysmographic sensors, and user interaction, the device aims to enhance patient autonomy, reduce emergency room visits, and improve outcomes by enabling timely medical intervention. The project includes pilot testing in cardiology outpatient settings, involving healthcare professionals and patients through structured training and feedback loops. HeartBrace aspires to contribute to a more efficient and proactive healthcare system, combining clinical reliability with user-centered design to support chronic disease management.
- Metacognitive interventions for adolescents with mental disordersPublication . Espírito Santo, Andreia C.J.; Marques, João P.R.; Silva, Rosa C.G.; Balzan, Ryan P.; Sampaio, Francisco M.C.; Guedes de Pinho, Lara M.; Laboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP); Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); Springer NatureIntroduction: Mental disorders among adolescents are increasing globally, yet access to tailored, evidence-based treatments remains limited. Metacognitive interventions, which target thinking processes influencing emotional regulation and behaviour, have shown promise in adults but remain underexplored in adolescents. This scoping review aimed to map and summarise metacognitive interventions for adolescents (aged 10–19) with mental disorders, examining intervention types, targeted disorders, delivery methods, and reported outcomes. Methods: Following JBI methodology for scoping reviews, comprehensive searches of published and grey literature were conducted across multiple databases. Reference lists of included full-text articles and relevant reviews were also screened. Results: Twenty-three studies published between 2004 and 2024 were included, most from Europe. Interventions identified included Metacognitive Therapy, Metacognitive Training, Metacognitive Interpersonal Therapy, Metacognitive Reflection and Insight Therapy, Virtual Environment Training with metacognitive components, and the Teen Cognitive-Functional Intervention. These were primarily applied to anxiety, depressive, psychotic, and personality disorders. Delivery formats varied (individual, group, family-inclusive), with most interventions delivered face-to-face in outpatient settings. Conclusions: Findings demonstrate the acceptability and feasibility of metacognitive interventions for adolescents, but also highlight gaps, including limited research on certain disorders, inconsistent outcome measures, scare exploration of digital formats and underexamined contextual factors such as family and school involvement. Impact: This is the first scoping review to map metacognitive interventions for adolescents with mental disorders, addressing a gap in literature predominantly focused on adults. It synthesizes evidence on metacognitive intervention types, delivery formats, clinical contexts, and outcomes, indicating that these interventions are feasible, acceptable, and safe for adolescents. The review identifies important research gaps, including under-studied disorders, methodological limitations, limited investigation of digital delivery formats, and insufficient examination of contextual factors such as family and school involvement, guiding future research and practice.
- Midwives/nurse midwives’ autonomy experience in caring for labouring women in health facilitiesPublication . Salgueiro, Elsa; Afonso, Catarina; Sim-Sim, Margarida; Janeiro, Claúdia; Zangão, Maria Otília; Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); BMJ Publishing GroupIntroduction: Midwives/nurse midwives are the healthcare professionals most often present on the birth scene. However, they have been the professionals who are most justified to defend their legally established position by arguing their competence and autonomy. Thus, it is important to show their reality through experiences, particularly when autonomy does notalign with regulations. This meta-synthesis aims to bring together scientific evidence regarding midwife/nurse midwife’s autonomy experience in caring for labouring women in health facilities. Methods and analysis: The meta-aggregation will be used to conduct a systematic review of qualitative studies. In January 2025, a search was carried out in scientific databases: EBSCOhost (CINAHL Ultimate, MEDLINE Ultimate and Academic Search Complete), LILACS, PubMed, Wiley Online Library, Scopus and Web of Science. The articles will be independently reviewed by two authors who will assess data quality, extraction and synthesis. Studies will be assessed for rigour using critical appraisal tools provided by the Joanna Briggs Institute. Data extraction and synthesis will be carried out using software, and results will be presented in tables. The results of the qualitative research will, where possible, be grouped according to the meta-aggregation approach proposed by the Joanna Briggs Institute. Ethics and dissemination: Ethical approval to analyse secondary data is not required. The results will be published in peer-reviewed journals and presented at international and national conferences.