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- Sand quality on Portuguese blue flagged beachesPublication . Silva, Ana Margarida; Sarioglou, Konstantina; Silva, Susana; Viegas, Carla; Ribeiro, Edna; Rebelo, Maria Teresa; Brandão, João; 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); MDPI AGThere is growing concern about the quality of sand on beaches, as users tend to spend most of their time on the sand rather than in the water. Numerous pathogenic agents have reportedly been isolated from sand, including bacteria, nematodes and opportunistic fungi. The ability of sand to retain pollutants and facilitate the transmission of pathogens raises public health concerns. We analysed sand-monitoring data from the 2024 and 2025 bathing seasons on Blue Flag beaches to find trends and patterns in total fungal counts, enterococci, and E. coli. The values recorded for microorganisms showed considerable variability, which may reflect the possible combined influence of multiple climatic, environmental, and anthropogenic factors contributing to their presence in beach sand. Our findings suggest that the total fungal count on coastal beaches may be influenced by periods of rainfall, which increases the fungal load in the sand. Values recorded from inland beaches vary considerably between beaches which may reflect the influence of local environmental characteristics, particularly vegetation and beach morphology, although the smaller number of inland samples also makes it difficult to define clear patterns and consistent reference values for this parameter. Bacterial indicators may be particularly influenced by occasional anthropogenic disturbances and contamination events. This study adds significantly to the understanding of the microbiological quality of beach sand, encouraging the integration of sand monitoring into environmental surveillance and management programmes.
- Progress in identifying the preventable causes of human cancerPublication . Schubauer-Berigan, Mary K.; Madia, Federica; Kunzmann, Andrew T.; Benbrahim-Tallaa, Lamia; de Conti, Aline; Facchin, Caterina; Pasqual, Elisa; Wedekind, Roland; Deng, Xiaobei; Suonio, Eero; Viegas, Susana; Mattock, Heidi; Weiderpass, Elisabete; Escola Nacional de Saúde Pública (ENSP); Oxford University PressFor 54 years, the Monographs program of the International Agency for Research on Cancer has evaluated the carcinogenicity of agents suspected of causing cancer in humans, classifying them into categories according to strength of the scientific evidence. More than 15 years ago, all Group 1 agents (carcinogenic to humans, the highest strength-of-evidence category) were re-evaluated. Since then, 24 additional agents have been classified for the first time in Group 1. Here, we summarize the evidence for the 135 Group 1 agents, emphasizing those recently classified and providing a synthetic overview of the evidence that contributed to the classification. All but two of these newly identified Group 1 agents were found to have sufficient evidence for one or more cancer types in humans, most commonly cancers of lung, hematolymphoid tissue, skin, and urinary bladder. Perfluorooctanoic acid and “dioxin-like” polychlorinated biphenyls were classified in Group 1 with less than sufficient evidence for cancer in humans. For nearly all Group 1 agents, there was also sufficient evidence for cancer in experimental animals, strong mechanistic evidence, or both, illustrating the robust biological plausibility of Group 1 classifications. This survey of the known human carcinogens confirms that there are few established preventable causes for 3 of the 4 most common cancer types (breast, prostate, and colorectum) and for reproductive cancers in both women and men. Over the last 15 years, the number of known human carcinogens has increased by >20%, reflecting the continued advancement of evidence and implying the existence of as yet unrecognized, preventable causes of cancer.
- Determinants for health decentralisation in PortugalPublication . Oliveira, Rafaela Choupeiro de; Santinha, Gonçalo Alves De Sousa; Perelman, Julian Alejandro; Sá Marques, Teresa; Escola Nacional de Saúde Pública (ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Centro de Estudos Geográficos (CEG), Universidade de LisboaThe decentralisation of health competences in Portugal was launched with the aim of bringing decision-making closer to local realities and strengthening municipalities’ role in promoting population well-being. A regulatory framework introduced between 2018-2019 enabled the transfer of specific responsibilities from central government to local governments. However, by 2022, only around a quarter of eligible municipalities had accepted these competences, highlighting the existence of structural, political, and financial barriers to reform. While the effects of decentralisation on health system have been widely studied, there remains limited empirical evidence on the factors that influence local jurisdictions’ willingness to assume new responsibilities. Addressing this gap, the present study analyses 201 eligible Portuguese mainland municipalities over the 2020-2022 period, modelling acceptance decisions based on demographic, political, financial, and health-related variables through binary logistic regression. Findings reveal that acceptance was more likely in municipalities politically aligned with the central government, with greater per capita financial resources, and with younger population profiles. In addition, regional dynamics emerged as an important contextual factor. These results highlight the need for decentralisation processes to account for territorial diversity, funding adequacy, and local capacity-building in order to ensure equitable and effective implementation.
- Risk factors and outcomes of healthcare-associated infections in a Brazilian intensive care unitPublication . Moura, Andressa Maria de Sousa; Sousa, Álvaro Francisco Lopes de; de Carvalho, Herica Emilia Félix; Madeira, Maria Zélia de Araújo; Freitas, Daniela Reis Joaquim; Lima, Ana Carolina de Macedo; Carneiro, Liliane Moretti; Valim, Marilia Duarte; Junior, Aires Garcia Dos Santos; Batista, Odinéa Maria Amorim; 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; Belitung Raya Publisher - Belitung Raya FoundationBackground: Healthcare-associated infections (HAIs) in intensive care units (ICUs) are frequent and are associated with sepsis, antimicrobial resistance, and high mortality, reinforcing the need for early risk stratification at admission. Objective: To analyze risk factors and clinical outcomes associated with HAIs in ICU patients. Methods: This cross-sectional study was conducted in the ICU of a public hospital with 141 patients (182 HAI cases). Medical records covered ICU admissions from August 1, 2022, to August 31, 2024, and data collection occurred from November 2024 to February 2025. Data were extracted from medical records and the Hospital Infection Control Committee database. Risk factors were assessed at admission using the Rodríguez-Almeida-Cañon (RAC) Scale, which stratifies HAI risk using intrinsic and extrinsic factors and classifies patients as low, moderate, or high risk. Clinical outcomes monitored during hospitalization included hospital discharge, sepsis, septic shock, and death. Results: By RAC, 53.9% were moderate risk and 45.4% high risk; lower educational level was associated with higher risk (p = 0.016). Ventilator-associated pneumonia predominated (44.4%). Predominant pathogens were Pseudomonas (28.1%), Acinetobacter (19.1%), and Klebsiella (17.4%), with 34.3% showing carbapenem resistance. Sepsis occurred in 18.5% and septic shock in 30.2%; mortality was 62.9%. Compared with the reference group, odds of discharge were higher among patients aged 20–39 years (OR = 12.48; 95% CI: 4.89–102.90; p = 0.002) and 40– 59 years (OR = 4.33; 95% CI: 3.89–35.78; p = 0.019). Conclusion: RAC screening revealed a high burden of predisposing factors at ICU admission, particularly among patients with lower educational levels, which was associated with worse outcomes. RAC-guided admission screening can support risk-proportional nursing surveillance and targeted prevention bundles, while institutional policies should reinforce microbiological surveillance and antimicrobial stewardship tailored to social vulnerability.
- Grieving process during the COVID-19 pandemicPublication . Marques, Inês; Godinho, Cristina A.; Francisco, Rita; 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 InstituteThe COVID-19 pandemic has been associated with a substantial number of deaths, exposing many individuals to bereavement under particularly adverse circumstances, as public health restrictions often prevented individuals from engaging in customary farewell and mourning practices. In this context, the development of interventions capable of mitigating the psychological impact of grief is of critical importance. This mixed-methods study, with a predominantly qualitative design, aimed to develop and pilot-test a group intervention grounded in cognitive-narrative theory for individuals experiencing bereavement during the COVID-19 pandemic, in Portugal. Four patients aged between 18 and 65 years (M = 49.25; SD = 21.24) participated in the 6-week intervention, between July and August 2022. Quantitative data were collected using the Grief and Meaning Reconstruction Inventory, the Prolonged Grief Assessment Instrument, and the Hospital Anxiety and Depression Scale, with pre- and post-intervention comparisons. To assess the intervention process, participants completed an individual evaluation form, and a group interview was conducted at the end of the intervention. The results indicated a clinically significant reduction in feelings of emptiness and loss of meaning in most participants, with improved meaning-making related to the loss. The thematic analysis performed on the qualitative data highlighted the strengths of the intervention (e.g., adjustment to grief and sharing) and some areas for improvement (e.g., more regular feedback and group composition). Despite limitations, particularly the small sample size, the findings are promising and support further evaluation of this intervention in larger samples of individuals diagnosed with prolonged grief.
- Self-care needs in an aged population living with a chronic condition or multimorbidityPublication . Marques, Maria; Nicolau, Vanessa; Mendonça, Susana; Moreira, José; Pires, Rute; Pedrosa, Miguel; Fonseca, César; Pinho, Lara; Escoval, Ana; Goes, Margarida; Oliveira, Henrique; Mendes, Claúdia; Bico, Isabel; Escola Nacional de Saúde Pública (ENSP); Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; BioMed Central (BMC)Background: A increase in average life expectancy leads us to an older population with multimorbidity. Understanding their self-care needs is essential for a response that promotes self-care with better health outcomes. Methods: A systematic review was performed to identify the self-care needs of an aged population living in their own residency with a chronic condition or multiple chronic conditions, in high income countries. Any approach designed and implemented to assess self-care needs was considered, with no restrictions applied to study designs. Two electronic databases were searched, MEDLINE (PubMed) and Web of Science, between the 1st of January 2017, and the 28th of April 2023, and structured according to the guidelines of the Joanna Briggs Institute (JBI). A narrative synthesis approach was adopted to extract, synthesize, and analyse the data. Results: In the included studies (n = 14), which identified self-care needs in older people with multimorbidity, they considered three dimensions: Self-maintenance; Self-monitoring and Self-management. The methods and tools that researchers used most frequently to identify and analyse self-care needs were questionnaires and interviews. All the participants with self-care needs had two or more chronic pathologies (diabetes, cardiovascular disease, arthritis, kidney disease, among others), although some didn’t mention them specifically. Conclusions: Self-care for older people with multimorbidity who are not institutionalized is fundamental, with an integrated approach to their health process, with healthcare aimed at their individual needs. Trial registration: PROSPERO, number CRD42023429034.
- A call for preregistration of in vitro researchPublication . Heinl, Céline; Franco, Nuno H.; Bert, Bettina; Siewert, Katherina; Movia, Dania; Aruçi, Edlira; Ladeira, Carina; Sanin, Ahmed Y.; Neuhaus, Winfried; Kahlert, Ulf D.; Ghosh, Manosij; Thomas, Aurélie; Sotiropoulos, Athanassia; Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP); Nature Publishing Group
- Management of myopiaPublication . Grzybowski, Andrzej; Lanca, Carla; Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP); International Virtual Ophthalmic Research CenterBackground: Myopia is becoming more common in many populations worldwide, particularly in East Asia. It is primarily driven by axial elongation, a structural change associated with increased risks of myopic maculopathy, retinal detachment, glaucoma, and cataracts. The expanding range of myopia-control options can make treatment selection and management decisions more challenging in routine pediatric care. This narrative review synthesizes contemporary evidence and guidance for delaying myopia onset and slowing progression in children. Methods: A targeted, non-systematic search was conducted in PubMed/MEDLINE, Embase, and the Cochrane Library for English-language records published between January 2015 and July 2025, supplemented by the inclusion of seminal pre-2015 trials. Eligible records included randomized or comparative clinical studies, systematic reviews/meta-analyses, and professional consensus/guideline statements in participants < 18 years reporting spherical equivalent refraction and/or axial length (AL). Non-comparative studies were included to provide additional information on safety, including adverse events. Findings were synthesized and presented using a narrative approach. Results: The evidence reviewed indicated that increased outdoor time consistently reduced incident myopia and modestly slowed progression, supporting the adoption of low-cost prevention strategies. Associations between near work and digital exposure and myopia were less consistent, though moderation in these activities remains advisable. Optical interventions showed consistent efficacy compared to single-vision correction, with strong evidence for defocus incorporated multiple segments (DIMS) lens with highly aspherical lenslet technology spectacles, and dual-focus/high-add soft contact lenses. Safety was generally favorable, although contact lens wear requires infection-risk mitigation. Orthokeratology was effective in slowing AL but requires specialist fitting and structured follow-up, and may be followed by rebound after cessation. Atropine showed a concentration-dependent effect; 0.01% atropine produced inconsistent AL benefit in several non-Asian trials, but longer-term European data suggest a cumulative advantage with continued 0.01% treatment versus placebo. Repeated low-level red-light therapy reduced axial elongation in early trials but was limited by protocol heterogeneity, rebound, and uncertainty regarding long-term safety. Combination regimens (notably orthokeratology plus low-dose atropine and DIMS plus atropine) may provide additional slowing of AL, particularly in children with faster progression. Conclusions: Evidence supports a risk-stratified pathway integrating outdoor time with effective optical and/or pharmacological therapy. Future research should prioritize head-to-head comparative trials with standardized AL endpoints, longer follow-up, inclusion of more diverse populations, validated treatment cessation strategies, and independent safety and performance standards for light-based devices.
- The suppression of moral engagement in consumer responses to animal slaughterPublication . Fonseca, Rui Pedro; De Groeve, Ben; Camilleri, Lauren; Godinho, Cristina; Prada, Marília; Escola Nacional de Saúde Pública (ENSP); ElsevierDespite growing research on meat-animal reminders, the psychological impact of slaughter exposure on consumers remains underexplored. In this preregistered experiment, we examined whether exposing consumers to animal slaughter increases their willingness to substitute meat by activating a moral engagement process involving perceived harm, prevention beliefs, and personal norms. A sample of 392 UK meat-eating participants were recruited and randomly assigned to view one of four images: an image of animal slaughter (i.e., chicken or pig) or a control image (i.e., chicken or pork meat prepared for consumption). Mediation analyses revealed that slaughter exposure did not directly affect willingness to substitute meat but had an indirect effect through the moral engagement process, activated through increased perceived harm, prevention beliefs, and personal norms. This indirect effect was stronger upon exposure to pig slaughter than to chicken slaughter. Higher meat consumption and especially higher meat attachment suppressed the moral engagement process, reducing the impact of animal slaughter on willingness to substitute meat. In both slaughter conditions, indirect effects were stronger when personal norms were bypassed, suggesting that perceived harm and prevention beliefs alone can shift meat-eating intentions. While subject to methodological limitations, our study informs the design of interventions to promote moral engagement towards animals and encourage meat substitution and highlights the importance of strengthening prevention beliefs and addressing meat attachment.
- Evolution of mortality attributable to passive smoking in the 27 Brazilian capitals, 2009–2021Publication . Flores, Bibiana Wanderlei; Rey-Brandariz, Julia; Corrêa, Paulo César Rodrigues Pinto; Ravara, Sofia; Martinez, Agustín Montes; Pérez-Ríos, Mónica; Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP); Assocaicao Brasileira de Pos, Gradacao em Saude ColetivaObjective: To estimate the mortality attributable to passive smoking in the population aged 35 years old and older, by gender, in the 27 Brazilian state capitals, from 2009 to 2021. Methods: A prevalence-dependent method was used, based on the calculation of population attributable fractions (PAF). Deaths from diseases causally related to passive smoking were obtained from the Mortality Information System of the Brazilian Unified Health System (SIM/SUS); prevalence data were taken on SHS exposure were obtained from Vigitel surveys (2009–2021); and relative risks were obtained from a meta-analysis. Mortality attributable to passive smoking and mortality rates were estimated by capital city, year, gender, and cause of death. Trends in crude mortality rates attributable to passive smoking were analyzed using joinpoint regression models. Results: Passive smoking accounted for 64,913 deaths in all Brazilian state capitals between 2009 and 2021. Cardiovascular diseases were the main cause of death in both genders. The mortality rate attributed to passive smoking decreased from 33.1/100,000 deaths in 2009 to 15.4/100,000 deaths in 2021. This reduction was observed in all 27 Brazilian state capitals, both overall and by gender. Conclusion: Passive smoking was responsible for 1.4 of all deaths in Brazil during the period 2009-2021 and showed a favorable trend, with rates decreasing by half during the period.