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- Translation and cross-cultural validation of the technological competence as caring in nursing instrument for the portuguese cultural contextPublication . Cachata, Dulce; Gaspar, Filomena; Magalhães, Teresa; Lucas, Pedro; Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP)Aim: To translate, culturally and linguistically adapt and validate the psychometric properties of the Technological Competency as Caring in Nursing Instrument, for the Portuguese cultural context. Background: The integration of caring practices with technological and informatics knowledge is central to advancing nursing and requires a refined understanding of the interaction between human care and technology-enabled practice. In this context, the importance of an instrument capable of assessing technological competence in nursing care becomes evident. The Technological Competency as Caring in Nursing Instrument (TCCNI-RePract), evaluates this competence across two dimensions: perception and practice. Design: The study followed a two-phase design consisting of qualitative translation and quantitative psychometric validation phases. Methods: This methodological, exploratory, cross-sectional study evaluated the psychometric properties of the TCCNI-RePract in a Portuguese sample (n = 257, non-random). Transcultural adaptation followed established guidelines to assess the instrument's validity, reliability and sensitivity. Descriptive statistics, Cronbach's alpha and factor analysis were performed. Results: The Portuguese version of the TCCNI_RePract instrument consists of two scales: an 18-item Perception dimension and a 21-item Practice dimension, both organized within a three-factor model that explains 54% and 62% of the total variance, respectively. The Perception and Practice dimensions demonstrated high internal consistency, with Cronbach's alpha values of 0.89 and 0.94. Conclusion: The instrument demonstrates strong psychometric properties to assess technological competence as caring in nursing and can be used as a reliable and effective measure in the Portuguese health system.
- Determinants and interventions influencing quality of life following trauma in adultsPublication . Barros, João Paulo de Melo; João, Ana Lúcia da Silva; Fonseca, César; Lopes, Mauro; Dias, Ana Maria Guégués da Silva; Sousa, Luís; Escola Nacional de Saúde Pública (ENSP)Background: Trauma is commonly defined as a sudden injury to human tissues or organs resulting from violence or accidents, with potential outcomes including death or long-term disability. Among adults, traumatic injuries represent a major public health concern, frequently leading to persistent physical, psychological, and social impairments that substantially affect the quality of life (QoL) and impose a significant socioeconomic burden. Objective: To identify and synthesize the determinants and interventions associated with QoL in adults with trauma. Methods: This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. The literature search was carried out across multiple electronic databases, including CINAHL Plus with Full Text, MEDLINE Ultimate, MedicLatina, Scopus, and Web of Science. The search strategy employed combinations of keywords derived from the Medical Subject Headings (MeSH) thesaurus. Results: Of the 25 included studies, most demonstrated that structured and multidimensional interventions had a significant positive impact on the QoL of individuals with trauma. The most effective interventions included psychological approaches (such as psychotherapeutic support and self-efficacy-focused interventions), rehabilitative interventions (physical rehabilitation programs, functional training, and therapeutic exercise), educational strategies directed at patients and caregivers, and coordinated and integrated care models, including transitional care and postdischarge follow-up. The main determinants associated with QoL were the level of social support, the presence of chronic pain and depressive symptoms, physical functioning, independence in activities of daily living, and recovery time, which differentially influenced the physical, psychological, and social domains of QoL. Conclusion: The findings highlight that post-trauma QoL is a multidimensional construct shaped by a range of personal and contextual factors. Person-centered interventions tailored to individual needs showed a positive impact and are essential for effective rehabilitation and adaptation following trauma. The study underscores the need for greater investment in longitudinal research and the practical implementation of integrated care strategies focused on holistic well-being.
- National and subnational analysis of self-reported diabetes mellitus and health inequalities in EuropePublication . Andrade, Carlos Alexandre Soares; Mahrouseh, Nour; Kovács, Nóra; Cuschieri, Sarah; Chen-Xu, José; Varga, Orsolya; 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); Nature Publishing GroupDiabetes mellitus (DM) has been a major public health concern with increased epidemiologic and economic burden in Europe. We aimed to estimate self-reported national and subnational DM prevalence and inequalities in individuals aged 50 years and over in 13 European countries between 2010 and 2019. Microdata were extracted from waves 4 (2010/2011), 5 (2013), 6 (2015), 7 (2017/2018) and 8 (2019) of the Survey of Health, Ageing and Retirement in Europe (SHARE) database. The analysis was conducted at both national and subnational levels, comprising 13 European countries. Health inequalities were assessed using the gini coefficient (GC) and concentration index (CI). Socioeconomic risk factors were included in the inequality analysis (urbanization, income, and educational level) in addition to multilevel regression model. The prevalence of DM decreased from 11% in wave 4 to 10.6% in wave 8, with the lowest recorded in Switzerland at 5.9% in wave 5 and the highest observed in Czechia at 16.7% in wave 8. DM prevalence varied widely subnationally, ranging from 2.1% in wave 8 Zentralschweiz (Switzerland) to 28.5% in wave 8 in Střední Čechy in Czechia. The GC demonstrated an increase from 21.9% (95% CI 17.0, 24.5) in wave 4 to 22.5% (95% CI 19.4,25.2) in wave 8, with Switzerland exhibiting the highest coefficient in wave 8 [30.1% (95% CI 7.9, 41.7)]. The CIs for income and educational level at national level were consistently low and mostly negative. The education and income CI ranged from [− 0.0182 (95% CI – 0.0242, − 0.0122) to − 0.0010 (95% CI − 0.0021, − 0.0001)] and [− 0.0278 (95% CI − 0.0411, −0.0166) to − 0.0018 (95% CI – 0.0032, – 0.0005)] across waves 4 and 8, respectively. The CI for urbanization displayed both negative and positive values, but most were not statistically significant (p > 0.05). Inequalities exist in the self-reported prevalence of DM both nationally and subnationally, with elevated rates observed among individuals with lower educational and income levels. Addressing these significant health inequalities calls for the development of prevention programs and policies by the European countries and subnational regions, specifically tailored to prioritize and support vulnerable groups.
- STEMI-CRPublication . Candjondjo, Pinheiro; Vaz, Elisabete; Marques, Sara; Moreira, José; Escola Nacional de Saúde Pública (ENSP); ElsevierSTEMI - CR (ST Elevation Myocardial Infarction - Cardiac Rehabilitation) is a program based on a model of home monitoring through digital tools (mobile application and website) in patients who have suffered acute myocardial infarction. This solution found in information technology will be used to address the delivery of services with remote operation between patients and health professionals and allows the delivery of home services through a cardiac recovery program in post-myocardial infarction patients through the automation of PROM's (Patient Reported Outcomes Measures) and biometric/electrocardiographic data monitored in real time, which can be incorporated into the hospital clinical record. The platform brings together several resources, such as exercise prescription, diet and medication, monitoring exercise plan, prescription history and recording the symptom. It will also be possible to have an avatar, gamification challenges and a communication area (social network), so that patients included in the program can enhance interaction and share their experiences about the various recommended activities and their impact on quality of life. It is based on this conception that any pharmacological and non-pharmacological guidelines can be based, with the expectation of greater patient adherence to CR programs and a significantly impact on the respective prognosis.
- NAMs for closing knowledge gaps in assessment of respiratory uptakePublication . Billat, Pierre André; Hansen, Tanja; De Bruijn, Véronique; Boufalaas, Rayane; Stefano, Simone; Sosnowska, Anita; Kohl, Yvonne; Verstraelen, Sandra; Camassa, Laura Maria Azzurra; Spänig, Max; Gabriel, Catherine; Sarigiannis, Dimosthenis; Krätschmer, Kerstin; Raitano, Giuseppa; Bulawska, Natalia; Ratier, Aude; Zienolddiny-Narui, Shan; Chary, Aline; Serchi, Tommaso; Viegas, Susana; Mollerup, Steen; Escher, Sylvia E.; Staal, Yvonne C.M.; Laboratório Associado de Translacção e Inovação para a Saúde Global - LA Real (Pólo ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); Centro de Investigação em Saúde Pública (CISP/PHRC); Frontiers MediaInhalation is a major route of chemical exposure for both consumers and workers. Physiologically-based kinetic (PBK) modeling is a promising tool to understand the absorption, distribution, metabolism, and excretion (ADME) of inhaled chemicals and to predict systemic concentrations of chemicals in humans. New Approach Methodologies (NAMs) can help generate essential input parameters for PBK models. However, validated NAM-based test methods to assess uptake of inhaled chemicals are currently lacking. Reliable information on respiratory uptake is required to determine relevant exposure concentrations for evaluation of systemic effects using NAMs. This manuscript describes a project that aims to apply robust and reliable in vitro models to study cellular uptake, intracellular accumulation, absorption and systemic exposure of chemicals following inhalation. To evaluate the robustness and predictivity of different NAM-based barrier models, to examine appropriate in vitro to in vivo scaling strategies, and to assess sensitivity and uncertainty in the resulting PBK models, the project will focus on relatively data-rich chemicals, specifically per- and polyfluoroalkyl substances (PFAS). While some have been widely explored and others remain data-poor, the entire chemical family is of interest due to its health hazards. Therefore, the work combines experimental and modeling approaches by generating in vitro data on the respiratory uptake and benchmark this to existing human in vivo data, developing biokinetic models to better understand chemical fate within the test systems, and refining inhalation PBK models to improve estimates of systemic uptake. Read-Across (RAx) will be employed as data gap filling technique to infer on the apparent permeability of non-tested PFAS. Together, the in vitro and in silico results will inform and parameterize PBK models, ultimately enabling more reliable predictions of systemic availability. The project will deliver a workflow to combine in vitro and in silico methods to assess the uptake of inhaled substances, that could be modified and applied to other inhaled substances. Standardized in vitro models for respiratory uptake will improve the evaluation of inhalation as a route of exposure contributing to systemic effects, which is a key requirement for quantitative in vitro to in vivo extrapolation (qIVIVE) and supports the implementation of next-generation risk assessment (NGRA).
- Physical impact and health-related quality of life of SCD in adultsPublication . Saunders, Christopher J.; Martins, Madalena; Major, Marinela; Favas, Catarina; Tomé, Ana; Vargas, Fernanda; Rosa Martins, Joana; Costa, Ryan Silva; Deveza, Maria Manuel; Pires, Filipa; Maia, Tabita Magalhães; Santos, João Gaião; Bento, Celeste; Fonseca, Inês; Moital, Inês; Brás, Daniel; Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); Oxford University PressObjectives: SCD negatively impacts patient’s health-related quality of life (HRQoL). The ASCEND study investigated how SCD impacts the HRQoL of adults in Portugal, focusing on its physical, emotional, and social burdens. Methods: This non-interventional, cross-sectional study included two cohorts of adult SCD patients from seven Portuguese Reference Centers (Cohort 1) and the Portuguese Patient Association (Cohort 2). Sociodemographic and patient-reported outcomes were collected for both cohorts, along with clinical data for Cohort 1, between February and September/2022. Results: 211 adult SCD patients (Cohort 1: 200; Cohort 2: 11) were included (median age of 33.0 years, 58.8% male). Nearly 90% reported complications. Patients were diagnosed at a median age of 2.0 years, mainly with the HbSS variant (89.0%), and 86.0% were under treatment (73.5% on hydroxyurea, 45.0% on chronic transfusion). All had lifetime pain episodes, with 72.6% experiencing at least one in the previous year. Most (91.9%) adopted daily strategies to prevent pain episodes, 67.1% had pain management plans, and 46.7% self-managed crises at home. Pain/discomfort (60.6%) and anxiety/depression (51.0%) were major problems (median EQ-5D-5L score = 0.91), affecting emotional well-being (53.8%) and/or social life (49.0%). Indeed, less frequent pain significantly correlated with improved HRQoL (P = .001). While 40.0% felt neglected, 70.5% rarely or never experienced solitude, and 84.6% reported a sense of support. Conclusion: The ASCEND study reveals the multifaceted impact of SCD on adults in Portugal and its influence on HRQoL, emphasizing the need for a multidisciplinary care approach and effective self-management education to improve patient outcomes.
- The impact of socioeconomic inequities and small-area deprivation on child inpatient carePublication . Russo, Tânia; Pereira, João; 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); Molecular Diversity Preservation International (MDPI)Socioeconomic inequities are associated with longer length of hospital stay (LOS) and clinical severity in children. This retrospective cross-sectional study analyzes health inequalities and area-level deprivation, focusing on hospitalization indicators, in a suburban pediatric population in Portugal. Pediatric admissions to a local general hospital were analyzed for LOS and admission to intensive care unit (ICU), as well as their relation to socioeconomic factors, over an 8-year period (2014 to 2021), using population-averaged models. Area-level inequalities were measured for the population ranked by civil parishes’ European Deprivation Index. 8016 admissions were included. Health inequalities associated with socioeconomic deprivation were observed, with concentration curves above the diagonal for LOS and admission to ICU and located in urban and densely populated civil parishes. Neonatal age showed the highest mean LOS ratio (MR = 2.29, 95% CI 1.96; 2.67, p < 0.001) and ICU admission odds (OR = 9.25, 95% CI 4.84; 17.68, p < 0.001). Mean LOS ratio was significantly higher for Black ethnicity (MR = 1.19; 95% CI 1.10; 1.28, p < 0.001) and lower maternal education. Odds of admission to ICU was significantly higher for male gender (OR = 1.25, 95% CI 1.01; 1.55, p = 0.048) and mother’s unskilled occupation (OR = 1.66, 95% CI 1.09; 2.53, p = 0.019). Paternal manual skilled occupation demonstrated 17% higher mean LOS ratio (p < 0.001) and 51% higher odds of admission to ICU (p = 0.019). Public policies must be culturally competent and target socioeconomic and geographical deprivation.
- “It's peanuts?”Publication . Paulo-Fernandes, J.; Cabral; Escola Nacional de Saúde Pública (ENSP); Elsevier BVPeanut allergy is usually framed as a clinical problem of diagnosis, avoidance and emergency management, but its consequences extend into everyday eating, restaurants, events, travel, commensality and culinary promotion. This thematic narrative review uses Palforzia, an oral immunotherapy based on peanut allergen powder-dnfp, as an analytical case to examine the intersection between peanut allergy, public health, food regulation, gastronomy and allergen-aware food environments. It synthesises literature and regulatory sources across six domains: 1) peanut allergy as a public health and gastronomic problem; 2) food allergy in restaurants, events and commensality; 3) Palforzia as peanut oral immunotherapy; 4) evidence, safety and adverse drug reactions; 5) regulatory and commercial fragility; and 6) implications for gastronomic and international promotion of national cuisines through gastrodiplomacy. Peanut occupies a boundary position as food ingredient, mandatory declarable allergen, source of severe reactions, medicinal substance and gastronomic identitarian element. Palforzia may increase tolerance thresholds in selected patients, but it does not resolve peanut allergy, remove avoidance or replace emergency preparedness. Its commercial discontinuation also shows that pharmaceutical inclusion may remain fragile despite regulatory approval. The review argues that transforming peanuts into a medicinal product does not remove the need to transform food environments. Peanut allergy requires a combined approach including clinical tools that may reduce vulnerability to reactions after accidental exposure and gastronomic infrastructures that support safer and more inclusive gastronomic participation.
- Measuring antimicrobial prescribing quality and driving behavioral changePublication . Palos, Carlos; Sousa, Paulo; Paiva, José Artur; Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOM
- Associated factors of myopia in a Portuguese sample of adolescentsPublication . Nunes, Amélia Fernandes; Cunha, Mariana; Ferreira, Dário; Sousa, Miguel Castelo Branco; Godinho, Cristina; Escola Nacional de Saúde Pública (ENSP); Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; PLOS - Public Library of SciencePURPOSE: This study aimed to investigate the interaction between parental myopia and school-related lifestyle patterns, and myopia in a sample of Portuguese adolescents. Based on previously reported data, we examined whether environmental and behavioural correlates traditionally associated with myopia, such as outdoor time, physical activity practice, screen time, and academic load, maintain their significance in a non-metropolitan European context. METHODS: This analysis involved a sample of 874 adolescents (10-18 years). Myopia was measured using non-cycloplegic open-field autorefraction and defined as a spherical equivalent ≤ -0.50D in the worse eye. Potential factors correlated with myopia were collected through supervised questionnaires completed by students and parents. Data were analysed using univariate and multivariable logistic regression to identify independent associations adjusting for demographic and behavioural covariates. RESULTS: The prevalence rate of myopia was 22.5%. The multivariable model identified family history of myopia as the strongest association (OR up to 3.75; CI:2.03-6.95; p < 0.001). Attending a higher school level (OR=2.20; CI:1.07-4.52; p = 0.032) and schools in urban locations (OR=1.59; CI:1.00-2.50; p = 0.048) showed a significant association. Regarding lifestyle, regular physical activity (≥ 2 times per week) was associated with odds of myopia (OR=0.47; CI:0.29-0.77; p = 0.003) even after adjustment for parental history of myopia. Although included in the fully adjusted model, factors such as smartphone use and breastfeeding did not reach statistical significance (p > 0.05). CONCLUSIONS: Despite the low population-density environment in this region, myopia prevalence was comparable to that reported in other European studies. The identified associations suggest that both parental history and school-related lifestyle factors should be considered when interpreting myopia patterns in adolescence. These findings may help inform school-based strategies aimed at promoting healthier visual and behavioural habits.