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- Cultivating global antimicrobial stewardshipPublication . First Portugal-Hospital NAPS Working Group; Palos, Carlos; Ierano, Courtney; James, Rodney; Paiva, José Artur; Thursky, Karin; Sousa, Paulo; Andrade, Paulo; Silveira, Natacha; Rei, Maria José; Duarte, Josiana; Luque, Jesus; Almeida, Francisco; Cunha, Flávia; Pena, Eduarda; Fernandes, Diana; Duran, David; Batista, Clara; Quinaz, Catarina; Fernandes, Ana; Raimundo, Pedro; Rocha-Pereira, Nuno; Duarte, Marta; Pássaro, Leonor; Neves, Isabel; Leitão, Inês; Pascoalinho, Dulce; Vicente, Alcina; 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); BioMed Central (BMC)Background: Assessing the quality of antimicrobial prescribing is critical to combating antimicrobial resistance. The Australian Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) assists in the assessment of antimicrobial prescribing appropriateness using consensus definitions, extending beyond guidelines compliance. Applying the Hospital NAPS in Portugal can address a knowledge gap. Objectives: To assess the quality of antibiotic prescribing in a sample of Portuguese hospitals and evaluate Hospital NAPS implementability. Methods: A point prevalence audit using the translated and culturally validated Hospital NAPS definitions for Portugal and Hospital NAPS methodology was conducted across eight Portuguese hospitals from October 2023 to February 2024. Antimicrobial stewardship teams were surveyed to explore implementability. Results: Among 2178 non-critical adult inpatients, 719 (33%) received antibiotics, resulting in 881 prescriptions (1.2 per patient). Most were male (68%), with a median age of 74 years, admitted to medical wards (46%) and managed by internal medicine (39%). Treatment indications accounted for 86% of prescriptions. High documentation rates were observed for indication (95%) and review/stop dates (91%). Guideline compliance was 68% Unnecessary prescribing occurred in 7%. Overall prescriptions inappropriateness was 42%. Spectrum too broad (41%) or incorrect dose or frequency (29%) were the main reasons for prescriptions being deemed inappropriate. Surgical prophylaxis > 24 h occurred in 26% of surgeries. Participants reported that Hospital NAPS has potential for implementation in Portugal. Conclusions: The First Portugal Hospital NAPS increased knowledge about antibiotic prescribing, identified areas for improvement and demonstrated the potential for Hospital NAPS implementation in Portugal, contributing to global antimicrobial stewardship efforts.
- Childhood circumstances and alcohol consumption in Portuguese people aged 50 and overPublication . Machado, Carolina Martins; Aguiar, Pedro; Escola Nacional de Saúde Pública (ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Biblioteca Nacional de Portugal, Centro de Estudos Históricos, CELOMIntroduction: The aim of this study was to estimate the association between childhood and adolescence circumstances and alcohol consumption in Portuguese adults aged 50 and over, particularly focusing on socioeconomic conditions, physical abuse, family and social integration during childhood and adolescence, and alcohol consumption in adulthood. Methods: We conducted an observational, cross-sectional, and analytical epidemiological study using self-reported data collected face-to-face through computer-assisted interviews in waves 7 (2017) and 9 (2022) of the Survey of Health, Ageing, and Retirement in Europe in Portugal. Participants included all Portuguese individuals who responded to the "Childhood and Adolescence Circumstances" module (wave 7) and "Behavioural Risks" module (wave 9). Associations were assessed using chi-squared or Student's t-tests. Odds ratios (OR) with 95% confidence intervals (95% CI) were estimated through binary and multinomial logistic regressions models. Results: A total of 903 participants were included; 378 (41.9%) were male and 770 (85.3%) were over 65 years old. Higher-risk drinking was identified in 220 participants (50.0%). The optimized binary logistic regression model for the current drinkers revealed significant positive associations between higher-risk alcohol consumption and male sex (OR = 6.444; 95% CI 4.329 - 11.111; p < 0.001), and having been a victim of physical abuse in childhood and adolescence (OR 2.063; 95% CI 1.119 - 3.803; p = 0.020). Living in a house with better conditions (OR = 0.767; CI 0.608 - 0.968; p = 0.025) revealed a significant negative association with higher-risk alcohol consumption. The optimized multinomial logistic regression model considering the non and current drinkers supported that being male (low-risk OR = 2.312; 95% CI: 1.567 - 0.3409; p < 0.001 higher-risk OR = 15.682; 95% CI: 10.041 - 24.491; p < 0.001) and physical abuse in the childhood and adolescence (higher-risk OR = 2.049; 95% CI: 1.200 - 3.497; p = 0.008) were risk factors for higher-risk alcohol consumption. Conclusion: Physical abuse in childhood was associated with higher-risk alcohol consumption, while living in better housing conditions during these periods showed a protective association. Being male was strongly associated with both low- and higher-risk drinking patterns. Further studies, especially longitudinal ones, are needed to clarify the role of early-life circumstances in alcohol consumption.
- Orthoptic treatment after strabismus surgery in child intermittent divergent strabismusPublication . 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); MDPI - Multidisciplinary Digital Publishing InstituteHighlights: What are the main findings? Postoperative orthoptic therapy producedlarge improvements in sensory–motor function, including fusional amplitudes and convergence measures (NPC and convergence amplitudes). Static ocular alignment changed only minimally, showing a small exo-drift consistent with the normal postoperative course rather than a therapeutic effect. What is the implication of the main finding? Orthoptic therapyenhances binocular stability and functional controlafter strabismus surgery, even when ocular alignment itself remains largely unchanged. These sensory–motor gains maysupport long-term binocular function and reduce the risk of postoperative decompensation or recurrencein children with intermittent exotropia. Purpose: To evaluate short-term motor and sensory–motor outcomes following postoperative OT in children with IXT after strabismus surgery. Methods: This prospective before–after observational study included children with IXT who underwent bilateral lateral rectus recession and were referred for postoperative OT based on predefined clinical criteria. A structured 12-week OTplan was initiated approximately six months after surgery. Outcome measures included angle of deviation (prism diopters, PD), near point of convergence (cm), positive fusional vergence amplitudes (PD), and convergence amplitudes at distance and near (PD). Pre- and post-therapy changes were analysed using paired-samples t-tests with effect sizes calculated using Cohen’s d. Final postoperative alignment was additionally compared cross-sectionally between children who underwent OT and those managed without OT. Results: Eighty-eight children had complete paired motor and sensory–motor data and were included in the analyses. Changes in static ocular alignment were small, with mean residual deviation improving from −7.02 ± 6.91 PD to −5.22 ± 6.60 PD after OT (mean change +1.80 PD; p < 0.01; d ≈ 0.30). No significant difference in final postoperative alignment was observed between the OT and non-OT groups (p = 0.827). In contrast, marked improvements were observed in sensory–motor outcomes. Positive fusional vergence amplitude increased from 7.30 ± 8.33 PD to 22.19 ± 9.26 PD (p < 0.001; d ≈ 1.5). Distance convergence amplitude improved from 7.30 ± 8.33 PD to 22.19 ± 9.26 PD, and near convergence amplitude from 10.95 ± 12.50 PD to 33.29 ± 13.89 PD (both p < 0.001; d ≈ 1.5). Near point of convergence showed a modest but significant improvement. Conclusions: Postoperative OT was associated with substantial short-term improvements in sensory–motor function, particularly fusional and convergence capacities, while changes in static ocular alignment were small and of limited clinical relevance. These findings support the role of OT as a functional adjunct to surgery, aimed at enhancing binocular control and postoperative sensory–motor stability in children with IXT.
- Ensuring coherence in occupational biomonitoringPublication . Hopf, Nancy B.; Viegas, Susana; Zare Jeddi, Maryam; Pasanen-Kase, Robert; Santonen, Tiina; Schmid, Kaspar; van Nieuwenhuyse, An; Godderis, Lode; Persoons, Renaud; Ndaw, Sophie; Duca, Radu Corneliu; 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); ElsevierThis commentary addresses a critical and timely issue, namely the continued exclusion of certified occupational hygienists from conducting exposure assessments using the biomonitoring approach, as reflected in the recent EU-OSHA 2025 guidance. Current EU regulations frame biomonitoring within medical surveillance. This regulatory structure limits the use of biomonitoring as a preventive tool and sidelines professionals who are essential to exposure assessment and workplace safety. We are a multidisciplinary team comprising certified occupational hygienists and occupational medical doctors. We believe that the EU OSHA guidance represents a missed opportunity for collaboration. We hope this commentary will reach members of the EU regulatory bodies encouraging them to reconsider the current framing and promote a more integrated approach. By clarifying roles and fostering cooperation between occupational hygienists and physicians, we can ensure that biomonitoring fulfills its full potential in protecting worker health.
- Influenza and COVID-19 vaccination intention in Portuguese adults from at-risk groupsPublication . Godinho, Cristina A.; Francisco, Rita; Gaspar, Rui; Henriques, Joana; Costa, Andreia; António, João; Costa, Diana; Fernandes, Teresa; Arriaga, Miguel; Centro de Investigação em Saúde Pública (CISP/PHRC); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Escola Nacional de Saúde Pública (ENSP); BioMed Central (BMC)Background: Seasonal influenza and COVID-19 vaccines are critical for protecting at-risk populations, yet uptake remains suboptimal in some priority groups. This study aimed to identify psychosocial and structural factors associated with vaccination intention and hesitancy among Portuguese adults from high-risk groups, including older adults, individuals with chronic conditions, healthcare professionals, and pregnant women. Methods: A mixed-methods design was employed. A cross-sectional telephone survey applied to a probabilistic sample (n = 474) assessed sociodemographic, psychological, and logistical predictors of intention to vaccinate against influenza and COVID-19 among older adults and individuals with chronic illnesses. Semi-structured interviews conducted with vaccine-hesitant healthcare professionals (n = 13) and pregnant women (n = 10) explored perceptions and experiences towards vaccination. Results: Survey findings showed moderately high intentions to vaccinate, with higher scores for influenza than COVID-19. Older age, worry, belief in vaccine safety and efficacy, and healthcare provider recommendations were positively associated with vaccination intention. Conversely, concerns about side effects, preference for natural immunity, and work-related barriers were negatively associated with vaccination intention. Interview data revealed ambivalence toward seasonal vaccines, particularly COVID-19, due to perceived rapid development and limited long-term data. Healthcare professionals often distinguished between seasonal and the national vaccination programme vaccines, mentioning low personal risk and side effects as reasons for hesitancy related to seasonal vaccines. Pregnant women emphasized concerns about fetal safety and the importance of clear healthcare providers recommendations. Conclusions: Psychosocial factors, including beliefs about disease severity and vaccine safety, play a central role in vaccination intention. Work-related structural barriers further contribute to hesitancy. These findings underscore the need for targeted communication strategies, healthcare providers engagement and employer-based vaccination programs to address both structural and motivational aspects of vaccination adherence within priority groups.
- Tuberculosis in children under 5 years of age in a low-burden settingPublication . Fronteira, Inês; Pacheco, Matilde; Vilichane, Ivinildo; Ricardo, Edgar; Aguiar, Pedro; Duarte, Raquel; Ferrinho, 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); Global Health and Tropical Medicine (GHTM); Instituto de Higiene e Medicina Tropical (IHMT); Springer VerlagPurpose: To describe the sociodemographic and epidemiological characteristics and healthcare utilization patterns—primary healthcare (PHC) use, emergency department (ED) visits, and hospital admissions—of children under 5 years of age born in Portugal between July 1, 2010, and June 30, 2021, and diagnosed with TB during the same period. Methods: This is a quantitative, observational cohort study of 58 children diagnosed with TB and reported to the National Epidemiological Surveillance System (SINAVE) before age 5. Data were obtained through linkage of five population-based databases. Descriptive statistics and bivariate analyses were conducted. Incidence rates of PHC, ED visits, and hospital admissions were calculated per 1000 person-days. Results: Most TB cases (81.0%) were diagnosed between ages 1 and 5; 55.2% were male, and 72.2% resided in metropolitan areas. Over half (58.6%) were unvaccinated with BCG. Unvaccinated children were diagnosed earlier than vaccinated peers (p < 0.01), though no significant differences were found in the clinical presentation of TB, risk factors, or healthcare utilization. Pulmonary TB was most common (51.7%), and 68.4% of children were hospitalized. PHC services were underutilized (32.7%), while ED visits were more frequent, primarily for infectious and respiratory conditions. One child died, with TB diagnosed post-mortem. Conclusions: TB in young children remains a public health concern in Portugal, especially in unvaccinated populations. Strengthening PHC access and preventive care is essential to improve early detection and outcomes.
- Instruments to assess the digital health competencies of healthcare professionalsPublication . Ferreira, Joana Paias; Magalhães, Teresa; 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); Frontiers MediaBackground: The digital transformation of healthcare is reshaping clinical practice, healthcare management, patient-provider interactions, and traditional public health fields. These digital tools enhance safety, quality of care and efficacy, while also supporting the shift from cure to prevention, empowering patients, and promoting overall efficiency of healthcare management and delivery. In healthcare, digital competence remains inconsistently defined and its assessment is often limited by conflation with narrower constructs such as digital literacy. The aim of this scoping review is to identify instruments that capture multiple dimensions of digital health competencies, analyse their scope and reported psychometric properties. This provides a clear view of the essential digital competencies in healthcare, critical for improving patient care, development of targeted education and workforce strategies, and advancing public health functions, contributing to a more equitable and sustainable healthcare systems in the digital era. Methods: A scoping review was conducted according to the JBI Manual for Evidence Synthesis. Three databases (PubMed, Scopus, Web of Science) were searched for studies published from 2015 to June 2025, using established criteria. Identified instruments were mapped by the digital area they apply, healthcare sample and setting, dimensions of competencies assessed and number of items. Further analysis followed two frameworks for questionnaire development (ESS Handbook) and measurement properties (COSMIN). Results: Of the 441 identified studies, 19 met the inclusion criteria. Included studies predominantly used mixed professional samples; among single-group studies, nurses were most often targeted, and hospital settings dominated, with the public health field rarely represented. Most instruments adopted a generalist scope rather than focusing on a specific digital health area. Psychometric reporting was limited, with only three studies offering comprehensive psychometric validation. One instrument introduced a new perspective by explicitly assessing factors influencing the adoption of competencies. Conclusion: Interest in assessing digital health competencies has grown, and the field is continually evolving; however, psychometrically validated instruments remain scarce. Mapping multidimensional instruments reveals recurring core dimensions and adoption-related factors, providing a clear foundation for more specific, targeted, and practice-aligned education and training, and a generalizable core for a standardized, digital public health competency framework for the multi-professional public health workforce.
- Breast cancer survivor’s sexual health unmet supportive care needsPublication . Ferreira, Diana; Quinta-Gomes, Ana Luísa; Pieramico, Sonia; Weiderpass, Elisabete; Santana, Rui; Andersson, Gerhard; Mendes-Santos, Cristina; Escola Nacional de Saúde Pública (ENSP); Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Springer New YorkPurpose: Breast cancer is one of the most common malignancies affecting women worldwide. Despite advances in early detection and treatment improving long-term survival rates, the sexual health needs of breast cancer survivors (BCS) remain overlooked due to the predominant focus on biomedical outcomes. In Portugal, as in many other countries, these needs are frequently neglected, despite evidence showing their significant impact on the quality of life. This study aims to explore the unmet sexual health needs of BCS in Portugal, identify barriers to addressing these issues in oncological settings, and outline key requirements for developing effective interventions to improve their quality of life. Methods: A mixed-methods design was used, combining quantitative data from 336 BCS, assessed using the Female Sexual Function Index (FSFI) and EORTC QLQ-C30/BR23 questionnaires, with qualitative data from semi-structured interviews with 11 survivors. Interviews explored unmet sexual health needs and satisfaction with oncology support services. Data were analyzed descriptively and thematically. Results: Quantitative findings showed low sexual functioning, particularly in desire and arousal, and high levels of sexual pain. Emotional functioning scored lowest in quality-of-life assessments, with fatigue, insomnia, and pain as prevalent symptoms. Qualitative results highlighted unmet needs, including a lack of sexuality-related information, body image concerns, limited psychosexual support, and insufficient partner involvement. Conclusions: Participants reported poor sexual functioning and quality of life, with critical sexual health needs unaddressed in care. Implications for Cancer Survivors: Integrating tailored sexual health support—including psychoeducational and therapeutic interventions—into oncology services may enhance survivors’ emotional well-being, relational intimacy, and overall quality of life.
- Access of the LGBTQIA+ Population to Brazilian Public Primary Health Care ServicesPublication . Cepas, Lariane Angel; de Carvalho, Isadora Silva; Fernandes, Talita Morais; Sousa, Álvaro Francisco Lopes de; Sorgi, Carlos Arterio; Donadi, Eduardo Antonio; Fernandes, Ana Paula Morais; 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; Wiley-Blackwell Publishing LtdBackground: LGBTQIA+ individuals in Brazil face persistent inequities in accessing Primary Health Care (PHC), largely due to structural barriers, institutional discrimination, and limited professional training. Despite the existence of the National Policy for Integral LGBT Health, significant challenges remain in ensuring inclusive and equitable care. Objective: To map the available scientific evidence regarding the access of the LGBTQIA+ population to Brazilian public PHC services, identifying barriers, facilitators, and research gaps. Method: This scoping review followed the JBI framework and PRISMA-ScR guidelines. Searches were conducted in MEDLINE/PubMed, Embase, Scopus, CINAHL, SciELO, LILACS for studies published between 2018 and 2023. Results: A total of 19 studies were included, predominantly qualitative (84.2%) and concentrated in the Northeast and Southeast regions, with no studies from the Central-West. Most investigations prioritized healthcare professionals’ perspectives, particularly nurses and physicians, while the experiences of LGBTQIA+ users remained underrepresented. Barriers to access included institutional prejudice, lack of professional preparedness, and a narrow biomedical focus on HIV/aids. Facilitators involved social support networks, and the search for inclusive spaces. Research gaps persist, particularly regarding dissident gender identities. Conclusion: Strengthening inclusive policies, diversifying scientific production, and integrating sexual and gender diversity into professional training are essential to promoting equity and improving health outcomes.
- Hand eczema, risk factors and microbial skin contamination in the norwegian waste sorting industryPublication . Alfonso, Jose Hernán; Graff, Pål; Lossius, Astrid Haaskjold; Viegas, Carla; Eriksen, Elke; Comprehensive Health Research Centre (CHRC) - Pólo ENSP; Centro de Investigação em Saúde Pública (CISP/PHRC); Escola Nacional de Saúde Pública (ENSP); Wiley-BlackwellIntroduction: Hand eczema, skin barrier function and skin microbial contamination among waste workers are underexplored. This study aims to assess: (1) the prevalence and risk factors of hand eczema, (2) the levels of transepidermal water loss (TEWL), and (3) skin microbial contamination in waste sorting workers. Methods: Using the Nordic Occupational Skin Questionnaire—2002, data were collected from 69 waste sorting workers and 25 office personnel. TEWL was measured with a Tewameter (TM 300, Courage+ Khazaka Electronic, Köln). Microbial skin samples were collected from the left dorsal hand with sterile swabs (Copan, Italy) and cultured. Analyses included descriptive statistics and multivariate logistic regression. Results: The hand eczema prevalence was 25% among waste workers and 40% in office personnel. The prevalence of hand eczema was significantly lower among exposed workers compared to controls (p = 0.012). TEWL and fungal concentrations were comparable across groups. Atopic dermatitis (AD) and nicotine use were significant predictors of HE. The prevalence of hand eczema experienced during the past week was significantly associated with elevated bacterial concentrations (p value = 0.05) in both groups. Conclusions: Waste sorting workers had up to 2.4 times higher prevalence of hand eczema compared with the general population, but a lower prevalence than office workers in the same industry. These findings may reflect a potential healthy worker effect. The potential role of bacterial concentrations in the occurrence of hand eczema warrants further investigation.