FM-ISAMB-Artigos em Revistas Internacionais
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- Persistence of IgG COVID-19 antibodies: a longitudinal analysisPublication . Carvalho, Álvaro; Henriques, Ana Rita; Queirós, Paula; Rodrigues, Joana; Mendonça, Nuno; Rodrigues, Ana Maria; Canhao, Helena; Sousa, Germano de; Antunes, Francisco; Guimarães, MiguelBackground and aim: The kinetics of antibody production in response to coronavirus disease 2019 (COVID-19) infection is not well-defined yet. This study aimed to evaluate the antibody responses to SARS-CoV-2 and its dynamics during 9-months in a cohort of patients infected during the first phase of the pandemic. As a secondary aim, it was intended to evaluate the factors associated with different concentrations of IgG antibodies. Methods: A prospective cohort study was conducted from June 2020 to January 2021. This study recruited a convenience sample of adult individuals who where recently diagnosed with COVID-19 and were living in mainland Portugal. A total of 1,695 blood samples were collected from 585 recovered COVID-19 patients up to 9 months after SARS-CoV-2 acute infection. A blood sample was collected at baseline and three, 6 and 9 months after SARS-CoV-2 acute infection to assess the concentration of IgG antibody against SARS-CoV-2. Results: The positivity rate of IgG reached 77.7% in the first 3 months after symptom onset. The IgG persists at all subsequent follow-up time-points, which was 87.7 and 89.2% in the 6th and 9th months after symptom onset, respectively. Three distinct kinetics of antibody response were found within the 9 months after infection. Kinetic 1 (K1) was characterized by a constant low IgG antibody concentration kinetic (group size: 65.2%); kinetic 2 (K2), composed by constant moderate IgG kinetic (group size: 27.5%) and kinetic 3 (K3) characterized by higher IgG kinetic (group size: 7.3%). People with ≥56 years old (OR: 3.33; CI 95%: [1.64; 6.67]; p-value: 0.001) and symptomatic COVID-19 (OR: 2.08; CI 95%: [1.08; 4.00]; p-value: 0.031) had higher odds of a "Moderate IgG kinetic." No significant association were found regarding the "Higher IgG kinetic." Conclusion: Our results demonstrate a lasting anti-spike (anti-S) IgG antibody response at least 9 months after infection in the majority of patients with COVID-19. Younger participants with asymptomatic disease have lower IgG antibody positivity and possibly more susceptible to reinfection. This information contributes to expanding knowledge of SARS-CoV-2 immune response and has direct implications in the adoption of preventive strategies and public health policies.
- Unveiling the prevalence and antimicrobial resistance landscape of Pantoea genus in veterinary clinical strains: insights from a cohort studyPublication . Holy, Ondrej; Sladecek, Vladimir; Bzdil, Jaroslav; Zouharova, Monika; Parra-Flores, Julio; Caneiras, CatiaThe genus Pantoea, of which Pantoea agglomerans is the most common species, is an emerging Gram-negative facultative anaerobic bacillus that causes a wide range of opportunistic infections. To date, the prevalence, antibiotic resistance, and pathogenic potential of this bacterium in animals remains largely unexplored. The aim of this work was to describe the prevalence of microorganisms of the genus Pantoea in clinical samples obtained from animals during the period 2015–2017 and to define their susceptibility to antimicrobial agents. In the monitored period, a total of 23,739 clinical samples obtained from animals in the Czech Republic with symptoms of disease were tested, from which 151 Pantoea genus were isolated (prevalence 0.63 %). Cultivation and incubation were carried out under aerobic conditions by culture methods using massopeptone blood agar, Endo's agar and xylose lysine deoxycholate agar at 37 ± 1 °C for 24 h. Suspect strains were confirmed by matrix-assisted laser desorption/ionization coupled to time-of-flight mass spectrometry (MALDI-TOF MS). Susceptibility testing was performed by the standard disk diffusion method using Mueller-Hinton agar. Pantoea strains were recovered from domestic horses, carnivores (dogs, cats) and rodents (prevalence of 6.78, 1.64 and 1.12 % respectively). Resistance to beta-lactam antimicrobials was detected in 12 strains. In addition to beta-lactams, resistance to co-trimoxazole was detected in 1 case and to co-trimoxazole and chloramphenicol in 1 case, highlights the need to monitor the emergence of this strain in the context of the One Health approach.
- Barriers and facilitators to older adults' engagement in social prescribing: a qualitative study using focus groupsPublication . Sadio, Rute; Henriques, Adriana; Nogueira, Paulo Jorge; Costa, AndreiaIntroduction: Social prescribing is an innovative approach that connects individuals to community-based activities to promote well-being. This study explores the barriers and facilitators influencing older adults' engagement in social prescribing programmes in Portugal. Methodology: A qualitative study was carried out in October 2024, in Portugal, with 16 participants aged 65 and over. Data was collected through two focus groups, each with eight participants. Data were analysed using the COM-B model (Capability, Opportunity, Motivation) to identify key factors affecting adherence. Results: The main barriers identified were physical limitations, digital exclusion, transport inaccessibility, and the urban-centric location of services. Facilitators comprised tailored activities, digital support and education, accessible venues and transport, and personalised interventions. Ongoing feedback mechanisms and familiar community settings were essential for sustained participation. Conclusions: These findings suggest that co-designed, inclusive, and locally accessible programmes can significantly enhance the involvement and well-being of older adults.
- Sensor based sleep patterns and reported sleep quality in breast cancer patients undergoing neoadjuvant chemotherapyPublication . Malveiro, Carla; Boavida, Sofia; Cargaleiro, Catarina; Bernardino, Ana Vilelas; Correia, Inês; Reis, Cátia; Matos, Leonor; Sardinha, Luís B.; Cardoso, Maria João; Saint-Maurice, Pedro F.Breast cancer is the most diagnosed cancer in women worldwide and its treatment often leads to the onset of sleep disturbances. While much research has focused on chemotherapy's impact on overall sleep quality through subjective measures, less attention has been given to its effects on specific sleep metrics such as duration, timing, continuity, and naps. This preliminary study addresses this gap by assessing sleep duration, timing, and regularity, using the Emfit QS device over 100 consecutive days in 24 breast cancer patients undergoing neoadjuvant chemotherapy. Additionally, we incorporated the Pittsburgh Sleep Quality Index (PSQI) to measure reported sleep quality. Our results suggest that chemotherapy may influence the duration for time spent in bed (ptrend = 0.02) measured by the Emfit QS. Duration in bed decreased over the first seven weeks (e.g., 9.3 h/day at week 1 vs. 8.5 h/day at week 8), and increased thereafter to similar amounts as those recorded in week 1 (9.0 h/day at week 15). Sleep timing and regularity, also measured by the Emfit QS, remained unchanged. Overall sleep quality, as measured by the PSQI, did not change over time. However, our analysis of the individual components of the PSQI revealed that sleep disturbances increased as treatment progressed from week 1 to week 8 (1.3 ± 0.6 to 1.7 ± 0.6; p = 0.01), concurrently with an increase in insomnia symptoms. Approximately, 33%, 63%, and 73% reported having insomnia symptoms at week 1, 8, and 15. These findings highlight critical periods during treatment when patients are vulnerable to disrupted sleep. Future research should focus on interventions to mitigate sleep disturbances, improving patient well-being and overall quality of life.
- TASTY trial: protocol for a study on the triad of nutrition, intestinal microbiota and rheumatoid arthritisPublication . Charneca, Sofia; Hernando, Ana; Almada-Correia, Inês; Polido Pereira, Joaquim; Vieira, Adriana; Sousa, Joana; Almeida, Ana S.; Motta, Carla Motta; Barreto, Gonçalo; Eklund, Kari K.; Alnso‑Pérez, Ana; Gómez, Rodolfo; Cicc, Francesco; Mauro, Daniele; Pinho, Salomé S.; Fonseca, João Eurico; Costa Reis, Patricia; Guerreiro, Catarina SousaBackground: The gut microbiota has been implicated in the onset and progression of Rheumatoid Arthritis (RA). It has been proposed that gut dysbiosis impairs gut barrier function, leading to alterations in mucosal integrity and immunity. This disruption allows bacterial translocation, contributing to the perpetuation of the inflammatory process. Since diet is recognised as a key environmental factor influencing the gut microbiota, nutritional interventions targeting RA activity are currently being explored. This study aims to investigate whether a dietary intervention based on a typical Mediterranean Diet enriched with fermented foods (MedDiet +) can impact the gut microbiota, intestinal permeability, and RA-related outcomes. Methods: One hundred RA patients are being recruited at Unidade Local de Saúde (ULS) Santa Maria in Lisbon, Portugal, and randomly assigned to either the intervention (MedDiet +) or the control group. The 12-week nutritional intervention includes a personalised dietary plan following the MedDiet + pattern, along with educational resources, food basket deliveries, and clinical culinary workshops, all developed and monitored weekly by registered dietitians. The control group receives standardised general healthy diet recommendations at baseline. The intervention's effects will be assessed by evaluating disease activity, functional status, quality of life, intestinal permeability, endotoxemia, inflammatory biomarkers, intestinal and oral microbiota, serum proteomics, and serum glycome profile characterisation. Discussion: We anticipate obtaining integrative insights into the interplay between diet, the gut, and RA, while also exploring the underlying mechanisms driving these changes. This study, conducted by a multidisciplinary research team of registered dietitians, rheumatologists, biologists, and immunologists, aims to bridge the current gap between nutrition-related knowledge and RA. Trial registration: Registered in ClinicalTrials.gov (NCT06758817; date of registry: January 6th 2025).
- Health and social care integration: insights from international implementation casesPublication . Matos, Ricardo Correia de; Nascimento, Generosa do; Campos Fernandes, Adalberto; Matos, CristianoThe integration of health and social care is increasingly recognized as essential to address population ageing, the rise in chronic diseases, and persistent health inequities. Across Europe, diverse models have been developed to improve service coordination, resource efficiency, and person-centered care. This paper aims to explore international experiences in integrating health and social care, identify common strategies and challenges, and provide insights to inform policy development in countries where integration remains incipient, with a focus on Portugal. A qualitative comparative approach was employed. A systematic literature review was conducted across PUBMED, MEDLINE, and Google Scholar, including peer-reviewed articles, policy reports, and government documents. Thematic analysis was used to identify integration models, enablers, and barriers across different countries. Different models reveal that joint governance, pooled funding, strong community involvement, and digital innovation are key enablers of integration. However, common challenges persist, including fragmented governance, inconsistent implementation, and financial sustainability. In Portugal, structural separation between the health and social sectors continues to limit strategic alignment. Successful integration depends on political commitment, shared vision, and active stakeholder collaboration. European models offer adaptable lessons for Portugal and similar systems, especially regarding intersectoral coordination and preventive care. Integrating health and social care is vital for building resilient, equitable systems. Portugal must adopt a cohesive national strategy; strengthen local implementation; and embrace person-centered, sustainable solutions to ensure long-term impact. Integrating the health and social sectors is indispensable in navigating the ever-evolving healthcare landscape and promoting holistic well-being.
- Sleep and circadian rhythms in delayed sleep–wake phase disorder: phenotypic differences between patients with and without comorbid depressionPublication . Reis, Cátia; Pilz, Luísa K.; Paiva, Teresa; Hidalgo, Maria Paz; Wright, Kenneth P.Delayed sleep-wake phase disorder involves chronic difficulty going to bed and waking up at conventional times and often co-occurs with depression. This study compared sleep and circadian rhythms between patients with delayed sleep-wake phase disorder with depression (DSWPD-D) and without (DSWPD-ND) comorbid depression. Clinical records of 162 patients with delayed sleep-wake phase disorder (70 DSWPD-D, 92 DSWPD-ND) were analysed, including a subset of 76 patients with circadian phase determined by the dim light melatonin onset. Variables assessed included sleep behaviour on work and free days, weekly sleep duration, social jet lag, chronotype, and phase relationships between dim light melatonin onset and sleep/wake times. Mean (SD) or median [Q1-Q3] values were compared using t-tests or Mann-Whitney. Patients with DSWPD-D showed longer sleep on workdays (DSWPD-D = 7.63 hr [1.70] versus DSWPD-ND = 6.20 hr [1.59]; p < 0.001), but not on free days. DSWPD-D also showed later sleep onset (DSWPD-D = 03:30 14;hours [02:49 hours-04:23 hours], DSWPD-ND = 02:53 hours [02:00 hours-03:41 hours]; p = 0.02) and wake times (DSWPD-D = 11:30 hours [09:30 hours-13:00 hours], DSWPD-ND = 08:45 hours [07:20 hours-11:00 hours]; p < 0.01) on workdays. Furthermore, DSWPD-D showed less social jet lag (DSWPD-D = 0.38 [0.00-1.75] versus DSWPD-ND = 2.17 [1.25-3.03]; p < 0.01), and reported higher anxiety symptoms (DSWPD-D = 71.4% versus DSWPD-ND = 45.8%; p = 0.03) and medication use (DSWPD-D = 75.0% versus DSWPD-ND = 43.8%; p = 0.01). DSWPD-D also showed wider dim light melatonin onset phase relationships with dim light melatonin onset-mid-sleep (DSWPD-D = -5.77 [1.32] versus DSWPD-ND = -4.86 [1.53]; p = 0.01) and dim light melatonin onset-waketime (DSWPD-D = -9.46 [1.82]; DSWPD-ND = -8.13 [2.08]; p = 0.01). Multivariable Poisson regression, adjusted for age and sex, showed more medication use, less social jet lag, and longer weekly sleep duration as significantly associated with DSWPD-D. These findings suggest potential biopsychosocial protective factors linked to depression in delayed sleep-wake phase disorder. Further research is required to confirm these phenotypic differences and their relevance to delayed sleep-wake phase disorder aetiology and treatment.
- Climate change: nursing leadership in disaster situationsPublication . Pires, Eunice; Henriques, Adriana; Nogueira, Paulo Jorge; Arriaga, Miguel; Costa, AndreiaClimatic conditions are challenging, especially when combined with other factors, such as geographical conditions. Nurses play a vital role in disaster preparedness and response, directly influencing their organization and effectiveness. However, scientific evidence still struggles to define clearly the specific knowledge and skills nurses should possess when leading in disaster situations. The central theme of this editorial aims to contribute to reflection on the recognition of the competencies of nurses who work in these situations. To analyze this topic, we focused on a particular case of an island in the Azores archipelago. Data was collected through a documentary analysis of the Azores Regional Civil Protection Emergency Plan, the Ponta Delgada Municipal Civil Protection Emergency Plan and the Hospital External Emergency Plan, seeking to obtain in-depth knowledge of the available information.
- Host and environmental determinants of in-hospital mortality in community-acquired pneumonia: evidence of seasonality, socioeconomic factors, and hospital differentiation in PortugalPublication . Pessoa, Ezequiel; Bárbara, Cristina; Costa, Andreia; Nogueira, Paulo JorgeBackground: Community-Acquired Pneumonia (CAP) is regarded as a substantial part of the global burden of disease and a public health priority. In addition to host factors, such as demographic characteristics, comorbidities, CAP clinical severity, and in-hospital mortality may also be influenced by factors such as socioeconomic status, seasonal variations, and hospital differentiation. This study aims to analyse trends in hospital mortality among patients hospitalized with CAP in National Health Service (NHS) hospitals in mainland Portugal and the impact of various host and environmental factors on in-hospital mortality. METHODS: This retrospective cross-sectional study analyzed 378,449 hospitalization episodes with CAP as the primary diagnosis (ICD-9-CM and ICD-10-CM/PCS) in mainland Portugal from 2010 to 2018. Data were sourced from the National Hospital Discharge Database and population census records. Variables included host factors (demographic characteristics, secondary diagnoses, CAP clinical severity indicators, Charlson score) as well as environmental factors, such as seasonality, socioeconomic factors and hospital differentiation. Trend analysis of hospitalization episodes and in-hospital mortality due to CAP was performed. Multivariable logistic regression was used to examine associations with in-hospital mortality, with statistical significance set at p < 0.05. Results: A decrease in the number of hospitalization episodes and in-hospital mortality rate over time was observed. The regression model identified advanced age, male gender, secondary diagnoses, CAP clinical severity, high Charlson score, the summer season, early school leaving rate, higher unemployment rate, and lower hospital differentiation as factors associated with an increased probability of death (p < 0.001). CONCLUSIONS: Throughout the nine-year period, a steady decline in in-hospital mortality rates was observed. In-hospital mortality exhibited a dual influence, shaped by host factors (such as age, gender, secondary diagnoses, CAP clinical severity, Charlson score) and environmental factors, including the summer season, socioeconomic vulnerability and hospital capabilities. Therefore, effectively reducing CAP in-hospital mortality requires comprehensive policies that focus on at-risk groups and address a broad range of both host and environmental risk factors. These policies should aim to improve healthcare access, increase vaccination coverage, and enhance thermal housing conditions, with particular attention to socially vulnerable individuals.
- Co-creation and implementation of a healthy snacks policy in primary schools: data from Sintra Grows HealthyPublication . Nogueira, Telma; Ferreira, Raquel J.; Liñan Pinto, Mariana; Silva, Vitória Dias da; Nogueira, Paulo Jorge; Sousa, JoanaPolicy interventions in the school food environment can improve dietary behaviors. However, the literature describing its development and implementation is scarce. This manuscript aims to describe the process of co-creation, implementation, monitoring, and evaluation of a Healthy Snacks Policy, in the scope of Sintra Grows Healthy intervention. Through a community-based participatory research methodology, the co-creation of the Healthy Snacks Policy comprises six stages: snacks evaluation, feedback sessions, class assemblies, school community assemblies, school cluster policy approval, and process evaluation. Within one school year, a Healthy Snacks Policy was co-created, approved, incorporated in the school regulations, implemented, continuously monitored, and evaluated. Regarding snacks evaluation, 1900 snacks were evaluated at the beginning of the school year and 1079 at the end of the school year. There were three feedback sessions, twenty-two class assemblies, and three school community assemblies. Most teachers perceived that children began to consume healthier snacks (72%); 66% of the children were considered to have started eating healthier; and most families said "yes or sometimes" when asked whether their children started requesting healthier snacks (70%), trying new foods (63%), and noticing improvements in their eating habits (74%). The co-creation of a Healthy Snacks Policy establishes an approach to effectively implement existing guidelines for school food supplies, complying with national priority implementation recommendations.