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- The indoor microbiomePublication . Šunić, Iva; Šarac, Jelena; Havaš Auguštin, Dubravka; Pozdniakova, Sofya; Ferguson, Robert M.W.; Jergović, Matijana; Visentin, David; Borràs, Sílvia; Archer, Elizabeth; Henderson, Drew K.; Vitko, Sandra; Ašić, Adna; Bošnjaković, Anja; Maglica, Željka; Viegas, Carla; Novokmet, Natalija; Karlović, Nina; Marjanović, Damir; Muszyński, Adam; Liu, Yuxi; Karisola, Piia; Alenius, Harri; Krych, Lukasz; Lovrić, Mario; 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); John Wiley and Sons Inc.Indoor spaces contain diverse microbial communities that shape human health. These microorganisms are particularly relevant to respiratory diseases, including asthma and allergies. Despite growing recognition of the importance of indoor microbial exposures, research in this field is slowed by differences in methods. These inconsistencies make it difficult to compare results and draw conclusions. This systematic review analyses 106 studies published between 2000 and 2025 that investigated indoor microbiomes in dust, air, and other matrices across homes, schools, and other built environments. We assessed sampling strategies, DNA extraction protocols, sequencing technologies, and bioinformatic pipelines, identifying trends, inconsistencies, and areas requiring harmonisation. Passive sampling, particularly dust collection, was the most common approach, while Illumina-based 16S rRNA and ITS amplicon sequencing dominated molecular analyses. However, variations in targeted gene regions, extraction kits, and analytical tools limited cross-study comparability. Ecological findings revealed consistent detection of bacterial taxa such as Staphylococcus, Streptococcus, and Corynebacterium, and fungal taxa including Cladosporium, Aspergillus, and Penicillium, with diversity shaped by building characteristics, ventilation, humidity, occupancy, and presence of pets. This review highlights the need for standardised protocols in indoor microbiome research to facilitate reproducibility, enable meta-analyses, and inform health-related guidelines for indoor environments.
- Harmonization of IgG antibody values against the SARS-CoV-2 Spike proteinPublication . Saraiva, Ana Leonor; Afreixo, Vera; Amaral, Palmira; Viana, João Faro; Antunes, Isabel; Paiva, Artur; Gonçalves, Lígia Antunes; Araújo, Lucília; Machado, Ausenda; Gaio, Vânia; 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); Nature Publishing GroupThe COVID-19 pandemic led to the rapid development of vaccines and diagnostic tests. To evaluate the response of IgG antibodies against the SARS-CoV-2 Spike protein in healthcare workers, a cohort study (2020–2022) was conducted in three Portuguese hospitals. Each hospital used a different assay (Abbott CMIA, Roche Elecsys ECLIA, Siemens ADVIA Centaur), which presents challenges to comparability. This study aimed to harmonize anti-S IgG levels across hospitals using a mathematical approach for combined analysis, and to estimate anti-S IgG levels over time, thus better understanding immunity dynamics. Antibody levels were measured at six time points: before vaccination, after full vaccination, 3, 6, and 12 months after the second dose, and after booster. Various harmonization strategies were tested, including WHO international conversion and quantile interpolation, followed by Deming regression. Quantile interpolation plus regression proved to be more effective than WHO conversion, preserving each hospital’s data distribution and aligning the harmonized values with the Abbott CMIA used as the reference scale. After harmonization, antibody titers followed the expected trend: a sharp rise post-vaccination, a gradual decline over 12 months (659.32 BAU/mL before booster), and a notable increase after the booster (25,919.89 BAU/mL). Although cross-laboratory validation was lacking, this approach proved practical, reproducible, and promising for multicenter studies that integrate serological data from diverse platforms, at the European and global levels.
- Health literacy among adults with inflammatory bowel disease in a day-hospital settingPublication . Raposo, Tânia; Mendonça, Susana; Queiroz, Sandra; Fronteira, Inês; Fonseca, César; Alves, Elisabete; 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); MDPI - Multidisciplinary Digital Publishing InstituteInflammatory bowel disease (IBD) requires sustained patient engagement in complex therapeutic and self-management processes, making health literacy (HL) a key determinant of effective care. This cross-sectional study assessed HL levels among adults with IBD attending a public day-hospital service in Lisbon, Portugal, and examined associations with sociodemographic, lifestyle, and selected clinical variables. A convenience sample of 280 participants completed a self-administered questionnaire, including the Portuguese version of the European Health Literacy Survey Questionnaire (HLS-EU-PT-Q16). Descriptive statistics, bivariate analyses, and multiple linear regression were used. HL indices were computed and categorized into proficiency levels; domain- and competency-specific indices were also analyzed. Overall, 48.3% of participants had inadequate or problematic HL, whereas 42.5% had sufficient HL. Healthcare-related HL showed the most favourable profile, whereas health promotion emerged as the weakest domain, with domain-specific mean indices ranging from 31.8 ± 8.3 to 34.4 ± 7.4 on a 0–50 scale. Competency-specific indices indicated that appraisal and, particularly in disease prevention, application were the lowest, and item-level analyses highlighted difficulties with mental health information-seeking and evaluating or acting on media-based health information. In multivariable linear regression analysis, higher educational attainment was positively associated with HL (B = 0.89; 95% CI: 0.05 to 1.73; p = 0.039), whereas female sex was independently associated with slightly lower HL scores (B = −1.72; 95% CI: −3.33 to −0.11; p = 0.036). These findings indicate that nearly half of patients with IBD in a day-hospital setting experience HL-related vulnerabilities, especially beyond clinician-mediated care. Targeted, HL-sensitive interventions focusing on critical appraisal and decision-to-action support may enhance self-management and equity in IBD care.
- Occupational exposure to cadmiumPublication . Paulo, Marilia Silva; Martins, Carla; Riesenberger, Bruna; Cordeiro, João; Cervantes, Renata; Palmont, Philippe; Bhoonah, Rachna; Ndaw, Sophie; Viegas, Susana; 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); BMJ Publishing GroupINTRODUCTION: Cadmium is a metal that poses significant health risks, particularly in occupational environments where exposure can happen. The main objective of this scoping review is to review the cadmium exposure levels in the different occupational settings in the European Union (EU), considering the regulatory measures currently in place. The secondary objectives, depending on the availability of data, are (a) to identify the occupational settings where higher exposure levels occur, (b) to identify any geographical and temporal differences and trends within the EU and (c) to identify the most relevant co-exposures reported. METHODS AND ANALYSIS: A scoping review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines. Studies reporting quantitative occupational data on cadmium exposure obtained through human biomonitoring and/or air monitoring will be included. A descriptive analysis of the findings will be performed. ETHICS AND DISSEMINATION: This protocol for a scoping review does not require ethical approval as it is based on secondary data. The dissemination plan of the scoping review includes its publication in a scientific journal of reference, as it is expected that it will provide important knowledge to support ongoing and future occupational health interventions in the EU, at the technical and regulatory levels. REGISTRATION: This study is registered at the Open Science Framework (OSF), 7 April osf.f2w3h.
- Multigene Germline Panel Testing in gastric cancer patients in a Portuguese populationPublication . Mourato, B.; Cordeiro, B.; Costa Pinto, F.; Pratas, N.; Fronteira, I.; Areia, M.; Dinis, R.; 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); John Wiley and Sons Inc.Background: Gastric cancer is a heterogeneous disease with both environmental and genetic determinants. While Multigene Germline Panel Testing (MGPT) increasingly reveals hereditary predisposition, the prevalence and clinical significance of germline variants in Portuguese gastric cancer patients tested through institutional MGPT programs remain insufficiently characterised. The main objective of this study was to determine the prevalence and spectrum of germline pathogenic variants and likely pathogenic variants in gastric cancer patients from Portugal, and to explore their clinicopathological correlations. Methods: We conducted a pilot retrospective observational study including 51 patients with histologically confirmed gastric cancer who underwent MGPT between 2020 and 2025. Genetic testing was performed using validated 15 or 30 gene panels. Clinical, pathological, and survival data were retrieved from medical records. Results: Germline pathogenic or likely pathogenic variants were detected in 6 patients (11.8%), involving MLH1, MSH6, PMS2, CHEK2, and BLM. Variants of uncertain significance (VUS) were identified in 11.8%. No CDH1 alterations were observed. Compared with MGPT-negative cases, MGPT-positive patients were significantly younger at diagnosis (median 48 vs. 76 years, p = 0.00) and more frequently presented with mixed-type gastric cancer (33.3% vs. 4.4%, p = 0.05). No significant associations were found with tumour stage or treatment. Conclusions: In this Portuguese cohort, nearly 12% of consecutive real-world MGPT-tested gastric cancer patients had germline pathogenic or likely pathogenic variants, predominantly in mismatch repair genes but also in CHEK2 and BLM. These findings further illustrate the heterogeneity of hereditary gastric cancer beyond classical CDH1 mutations and support the integration of MGPT into clinical care to identify at-risk individuals not captured by current criteria. Larger multicentre studies are warranted to validate these results and clarify the role of emerging susceptibility genes. Trial Registration: Study Registration Number: NCT07387237.
- Understanding discrepancies in perceived importance of patient safety measures between patients and healthcare professionals in perioperative carePublication . Machado, Maria de Lacerda; Nunes, Ana Beatriz; Carvalho, Dimey; Gama, Ana; Orrego, Carola; Sousa, Paulo; Escola Nacional de Saúde Pública (ENSP); 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; PLOS - Public Library of ScienceBackground Patient safety is a critical concern in perioperative care. This study explores the discrepancies in how patients and healthcare professionals perceive the importance of perioperative patient safety outcome measures, aiming to improve the development of future Core Outcome Sets (COS). Methods Qualitative exploratory study using focus groups with healthcare professionals and patients involved in the Core Outcome Set for Patient Safety in Perioperative Care. Data were collected through online mini-focus groups and analysed using thematic qualitative text analysis. Results Communication failure emerged as the predominant cross-cutting issue across discussions, particularly in relation to discrepancies in expectations, information exchange, and understanding between healthcare professionals and patients. Three primary reasons for discrepancies in attributed importance of indicators were identified: different targets/focus; knowledge gaps; and varying importance placed on the sense of safety. Patients often emphasized subjective experiences, fears, and emotional impacts, leading them to prioritize quality of life indicators and long-term effects. In contrast, healthcare professionals focused on system-level factors and resource limitations, giving greater weight to technical and physiological outcomes. Discussion/conclusion The study findings underscore the need for a more holistic approach in developing COS, balancing technical medical outcomes with patient-centered quality of life measures.
- Characterizing the substance use prevention funding landscape in the United StatesPublication . Liu, Shirley S.; Elek, Elvira; Blackburn, Natalie; Wondimagegnehu, Feker; Ballard, Parissa J.; Graham, Phillip W.; Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); SpringerYouth and adolescent substance use remains a persistent public health challenge in the United States; the delivery of evidence-based interventions (EBIs) is critical to improving related negative consequences. The Substance Abuse and Mental Health Services Administration funds a large portion of the implemented substance use prevention interventions in the United States by supporting a funding infrastructure that plays an important role in the adoption and scaling of interventions. Prevention intervention developers and researchers need to understand this infrastructure and its influence on local practitioners to increase the adoption of their EBIs. This study sought to identify which agencies in each state and jurisdiction are involved in funding allocation, how they prioritize and distribute funding to intervention implementers, and, subsequently, how they guide the selection of EBIs. This study used a mixed-methods, cross-sectional design to understand the infrastructure of prevention funding that underlies EBI decision-making. In 2023, we conducted surveys with 40 National Prevention Network representatives (NPNs) and 222 community-level practitioners; in early 2024, we conducted qualitative interviews with a subset of 16 NPNs. NPNs’ priorities were shaped by the agencies in which they were housed and the partners with whom they collaborated. Most were located within their state’s or jurisdiction’s department of health or behavioral health, and many engaged in partnerships with departments of public health or education. Most NPNs reported that they prioritized school and health settings and youth populations for prevention intervention delivery. Almost all NPNs directly distributed funding to intervention implementers (community, regional, or state entities); about half distributed some funds through an intermediary that then subcontracted another entity to implement interventions. More NPNs required or recommended that funded recipients select EBIs from lists or registries (75%) than required or recommended a specific strategy for at least some of their programs (53%). Many practitioners (47%) reported that they selected a recent strategy from a list of interventions provided by their funder, but 27% received no funder guidance on intervention selection. Prevention developers and researchers could increase the adoption of EBIs by focusing them on the priority areas for NPNs, including the health, behavioral health, and education sectors. Developers need to get their EBIs onto registries or intervention lists and increase the EBIs’ wide-scale dissemination. Audiences for information about specific EBIs should include NPNs, regional entities, and their funded community practitioner recipients.
- Factors associated with the recurrence of intermittent exotropia and reoperations in the long termPublication . Lino, Pedro; Aguiar, Pedro; Cunha, João Paulo; 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); Taylor & FrancisPurpose: To evaluate long-term reoperation risk after bilateral lateral rectus (BLR) recession for intermittent exotropia (IXT) in a paediatric cohort, and to identify the perioperative factors associated with recurrence and reoperation. Methods: A retrospective observational cohort of 258 children with basic or divergence-excess IXT who underwent BLR recession at CUF Cascais Hospital between 2010 and 2020 was analysed. Clinical variables included age, age at surgery, pre- and immediate postoperative deviation angles, preoperative occlusion therapy, orthoptic treatment, binocular function, and initial surgical success (residual deviation <10 prism dioptres with fusion). Bivariate analyses were performed using t-tests or χ2 tests, and variables with p < 0.10 were entered into multivariable binary logistic regression to identify the independent predictors of reoperation. Model diagnostics included variance inflation factors (VIF), Hosmer–Lemeshow test, and area under the receiver operating characteristic curve (AUC). Significance was set at p < 0.05. Results: Reoperation was required in 11% of cases. Failed initial surgery (adjusted OR = 34.7; p < 0.001), larger preoperative deviation (adjusted OR per PD = 1.143; 95% CI 1.062–1.231; p < 0.001), larger immediate postoperative deviation (adjusted OR per PD = 0.822; 95% CI 0.766–0.881; p < 0.001), and older patient age (adjusted OR per year = 1.261; 95% CI 1.032–1.542; p = 0.024) were independently associated with reoperation. Orthoptic and occlusion therapies showed non-significant trends. Conclusion: In children undergoing BLR for IXT, initial surgical failure and deviation magnitude (pre- and immediate postoperative) are the strongest predictors of reoperation, with age having the modest additional effect. These findings emphasize precise surgical planning and the need for long-term follow-up.
- The comet assay as a tool in human biomonitoring exposure to antineoplastic drugsPublication . Ladeira, Carina; Azqueta, Amaya; Giovannelli, Lisa; Gajski, Goran; Gerić, Marko; Haveric, Anja; Stopper, Helga; Bankoglu, Ezgi Eyluel; Collins, Andrew; Møller, Peter; Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP); ElsevierAntineoplastic agents are toxic compounds, generally used in the treatment of cancers, which are recognized as carrying a cancer development risk. In this systematic review and meta-analysis of human biomonitoring studies, we have assessed the effects of exposure to antineoplastic drugs on levels of DNA strand breaks in leukocytes, measured by the comet assay. Focusing on the application of the comet assay in human biomonitoring of occupational exposure to antineoplastic agents, we have analyzed 458 original research studies which used this assay, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-ScR). The systematic review led to 23 studies, of which 20 studies met the criteria for inclusion in the meta-analysis. Using standardized mean difference and 95% confidence interval (CI), the meta-analyses show increased levels of DNA strand breaks in subjects exposed to antineoplastic drugs (1.26, 95% CI: 0.78, 1.73). Results originate mainly from studies on healthcare workers, with only one study in an industrial setting. Subgroup analysis indicates that all studies combined from middle-income countries have a higher effect size (1.77, 95% CI: 1.00, 2.55) than studies from high-income countries (0.49, 95% CI: 0.09, 0.90). This difference between middle- and high-income countries may be attributable in part to differences in exposure levels or exposure assessment. Additionally, sensitivity analysis indicates that studies with moderate/high risk of comet assay measurement bias have higher effect size (2.07, 95% CI: 0.82, 3.31) than studies with low risk of bias (0.73, 95% CI: 0.34, 1.13); and that studies with high risk of exposure misclassification have higher effect size (1.47, 95% CI: 0.89, 2.06) than studies with low/moderate risk (0.13, 955 CI: −0.08, 0.33). Most studies have low/moderate risk of bias related to the comet assay procedure (15 out of 20 studies), absence of reporting the use of assay controls (1 out of 20 studies), blinded analysis of samples (7 out 20 studies); exposure assessment (16 out of 20 studies). In conclusion, this systematic review and meta-analysis shows that exposure to antineoplastic drugs is associated with increased levels of DNA strand breaks in human leukocytes.
- Clinical efficacy and cost-effectiveness of four myopia control interventions in childrenPublication . Kang, Daohuan; Yuan, Lu; Lança, Carla; Feng, Jia; Grzybowski, Andrzej; Jin, Kai; Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP); Nature Publishing GroupTo compare the one-year clinical efficacy and cost-effectiveness of single vision lenses (SVL), Myopia-control spectacle lenses (MCSL), Orthokeratology (Ortho-K), and Repeated Low-Level Red-Light (RLRL) therapy in children within a real-world setting. This retrospective observational cohort study analyzed data from 206 myopic children aged 8–14 years, who had already received one of four myopia control interventions: SVL (n = 50), MCSL (n = 60), Ortho-K (n = 44), or RLRL (n = 52). The primary outcomes were the change in axial length (AL) and spherical equivalent refraction (SER) after one year of intervention. The secondary outcome was the Incremental Cost-Effectiveness Ratio (ICER), calculated as the additional cost per 0.1 mm of AL elongation saved compared to the SVL group. All active interventions significantly outperformed SVL in controlling AL elongation (SVL mean: 0.42 mm/year). RLRL exhibited the greatest efficacy (mean AL change: 0.06 mm; 86.0% relative to SVL), with 31% of participants showing axial shortening. Ortho-K (0.18 mm; 57.5% efficacy) and MCSL (0.23 mm; 45.2% efficacy) also demonstrated substantial benefits. Mean annual direct medical costs were $140.93 (SVL), $429.44 (MCSL), $1,108.08 (Ortho-K), and $806.29 (RLRL). ICER analysis identified MCSL as the most cost-effective active intervention ($151.69 per 0.1 mm AL saved), followed by RLRL ($184.13), while Ortho-K yielded the highest ICER ($400.42). In this one-year study, RLRL therapy was observed to have the highest efficacy. However, the finding of axial shortening warrants validation in long-term randomized controlled trials (RCTs) to elucidate its mechanism and long-term safety. MCSL spectacle lenses were identified as the most cost-effective option, representing a well-balanced profile of efficacy and economic feasibility. Ortho-K, while a highly effective intervention, was associated with a greater financial burden.