https://hdl.handle.net/10216/111510 2026-04-17T16:33:07Z https://hdl.handle.net/10216/170120 Title: Pressing Issues for Oral Health Care Access and Quality Improvement During Pregnancyin Portugal - A Qualitative Study 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168479 Title: Dietary intake according to different patterns of food preparation in children and adults: results from the Portuguese National Food, Nutrition and Physical Activity Survey (IAN-AF 2015/2016) Abstract: Objective: To investigate associations between dietary intake and patterns of food preparation, by age group. Design: This cross-sectional study analysed dietary intake data from the most recent Portuguese National Food, Nutrition and Physical Activity Survey. Cluster analysis categorized dietary intake based on the source of food preparation. Regression models were used to study the association between dietary daily intake, Healthy Eating Score (HES), and patterns of food preparation. Setting: Portugal, using data representative of the Portuguese population. Participants: A total of 5005 Portuguese residents aged 3 to 84 years were included in the analysis. Dietary intake and food preparation patterns were examined by age group. Results: The predominant pattern of food preparation was food prepared by restaurants, canteens, and other away-from-home establishments (45.9%, 95%CI = 43.8, 48.1%). Children and adolescents in this pattern had significantly higher intakes of energy and carbohydrates but lower protein intake compared to those consuming predominantly home-prepared foods. Among adults and the elderly, this pattern was associated with higher intakes of energy, saturated fats, trans fats, and free sugars, and lower fibre intake. Additionally, children and adolescents whose diets predominantly included food prepared away-from-home showed a decrease in HES (ß = -0.7, 95% CI = -1.3, -0.2), and adults experienced a greater reduction (ß = -1.2, 95% CI = -1.5, -0.9). Conclusions: In Portugal, consuming food prepared away-from-home is associated with poorer dietary quality, with higher energy and unhealthy nutrient intake and lower HES, suggesting a need for interventions focused on promoting healthier food preparation practices. (c) 2025 Cambridge University Press. All rights reserved. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168475 Title: Dietary exposure to heterocyclic amines by the Portuguese population: comparison of different exposure assessment methods Abstract: To estimate dietary exposure to heterocyclic amines (HAs) in the Portuguese population, three methods of attributing HAs occurrence data to consumed food items were compared. Participants are part of the National Food, Nutrition and Physical Activity Survey (n = 5005, 3-84y). Food consumption was collected through two non-consecutive 24 h dietary recalls or food diaries. HAs occurrence was extracted from the literature. Margins of exposure (MOE) were estimated for different cancer types. Three methods were considered: 1.FoodEx2 Hierarchy model (FH) - random HAs values were attributed to missing data, considering the closest item in the occurrence dataset according to the FoodEx2 hierarchy; 2.FoodEx2 Hierarchy Median model (FHM) - median HAs values of the closest items in the dataset were attributed to missing data; 3.Regression Tree model (RTM) - an RTM was used to predict mean occurrence values of homogeneous food groups based on the FoodEx2 hierarchy. The FH method presents higher dietary exposure for the 95th percentile and lower MOE values, appearing to estimate better. Red and white meat were the main contributors to HAs intake. The Portuguese population's dietary exposure to HAs seems to be safe. However, MOE values for prostate cancer in children may raise concern about potential future adult risk from early-life exposures. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168474 Title: Health and environmental impacts of shifting to plant-based analogues: a risk-benefit assessment Abstract: PurposePlant-based analogues (PBAs) simulate animal-based foods' attributes and can facilitate adherence to flexitarian and vegetarian dietary patterns, which have been associated with health benefits. However, possibly classifying PBAs as ultra-processed (UPF) and excluding healthy animal-based foods (e.g., fish) can result in unintended health risks. This study aims to quantify the health and environmental impact of replacing animal-based foods with PBAs.MethodsUsing data from the Portuguese National Dietary Survey (n = 3852 adults; 2015-2016), three substitution scenarios of animal-based foods with PBAs were modelled: vegan (replacing all animal-based foods with PBAs), ovolactovegetarian (replacing meat and fish with PBA), and pescatarian (replacing meat with PBA). Varying degrees of substitution (33%, 50%, 67%, 100%) and two classification approaches for PBAs were explored: UPF or non-UPF. The overall health impact was estimated considering several health outcomes (cancer, cardiovascular diseases and metabolic outcomes) combined through Disability-Adjusted Life Years (DALYs). The environmental impact was measured through greenhouse gas emissions and land use.ResultsEnvironmental benefits were evident, especially for the vegan scenario. Regarding health impact, the 100% substitution of all animal-based foods (vegan scenario) might represent a risk if PBAs are classified as UPF (triangle DALY average = 72,109 years). The highest overall benefit was found for 100% substitution of meat only (pescatarian scenario) independently of considering PBAs as UPF or not (UPF: triangle DALY average = - 40,202 years; non-UPF: triangle DALY average = - 88,827 years).ConclusionPBAs can be considered feasible alternatives to animal-based foods, and the results emphasise meat substitution as a crucial factor for health and environmental benefits. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168469 Title: Adherence to the EAT-Lancet Planetary Health Diet in Portugal and its associations with socioeconomic and lifestyle factors Abstract: PurposeThe Planetary Health Diet (PHDiet) proposed by the EAT-Lancet Commission is expected to bear health and environmental benefits. This study assesses adherence to the PHDiet in Portuguese adults and its associations with socioeconomic and lifestyle factors. For that, an adapted PHDiet score was computed, and its construct validated.MethodsData from the National Food and Physical Activity Survey 2015-2016 were used for this analysis, covering a representative sample of 3852 adults with two non-consecutive dietary interviews (8-15 days apart). Adherence to the PHDiet was measured through a score (ranging from 0 to 140), afterwards divided into terciles (T1-T3). Multinomial regression models were used (i) to assess the construct validity through associations with diet quality based on WHO recommendations and diet environmental impact using greenhouse gas emissions (GHGE) and land use (LU); (ii) to investigate associations between adherence to the PHDiet and socioeconomic and lifestyle characteristics. The prevalence of consumption of PHDiet components above/below the recommendations was estimated.ResultsAdherence to the PHDiet was generally low (36.0, 95% CI 35.4-36.6), with high consumption of meat and added sugars and low consumption of pulses, nuts, and whole grains. Higher PHDiet scores were found for diets with lower environmental impact (GHGE: ORT1vsT3:1.31; 95% CI 1.26; 1.37; LU: ORT1vsT3:1.25; 95% CI 1.21; 1.29), lower animal protein intake levels (ORT1vsT3:1.11; 95% CI 1.06; 1.16) and higher diet quality (ORT1vsT3:0.70; 95% CI 0.68; 0.72), verifying the construct validity. Men (ORT1vsT3:1.32; 95% CI 1.12; 1.55), intermediate-educated individuals (ORT1vsT3:1.43; 95% CI 1.16; 1.75), and those facing food insecurity (ORT1vsT3:1.79; 95% CI 1.36; 2.38) had higher odds of having lower scores.ConclusionLow adherence to the PHDiet is associated with several socioeconomic and lifestyle factors. This highlights the need to implement targeted public health policies that encourage shifts towards a healthier and more sustainable dietary pattern. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168464 Title: Impact of the Creche com Sabor e Saúde (C2S) project on the food provided by Portuguese daycare centers Abstract: Introduction and Objectives: To assess the impact of implementing a community intervention project on the food offered at lunch in Portuguese daycare centers. Methods: A study was conducted in a nonprobabilistic, convenience sample of 18 Portuguese daycare centers that welcome children from six to 36 months old. The characterization of the institutions was developed using a self-administered online questionnaire. To evaluate the menu, a qualitative analysis tool was created. After an initial assessment of 12 weeks of menus in each institution, the intervention lasted for nine months. This entailed the preparation of individualized technical reports and the close monitoring of the daycare centers. A further application of the menu analysis tool was subsequently conducted for the final 12 weeks of the project. The impact of the intervention was estimated by the difference between the results obtained before and after the intervention. Results: Following the intervention, there was an improvement in the description of meal components and the overall quality of the menus, which was improved by 16%. Throughout the study, the number of facilities with a lunch menu for the six to eight months age group increased from 13 to 16, while the number of times cooked fruit was offered decreased by a median of 100% in the institutions. In the nine to 11 months age group, there was a median of 100% of institutions beginning to offer only one type of pureed fruit. In the 12 to 36 months age group, the number of times that oily fish was offered, as well as vegetables, in addition to the carbohydrate source increased in a median of 8.3% of the institutions. Discussion: Despite the simplicity and duration of this intervention, there was an improvement with compliance with recommendations, including a decrease in the number of times cooked fruit was offered in the six to eight months age group and an increase in the number of times oily fish was offered in the 12 to 36 months age group. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168444 Title: Reply to Prof. Tiejuan Shao et al. Abstract: [No abstract available] 2025-01-01T00:00:00Z https://hdl.handle.net/10216/168262 Title: Cooking Skills and Mediterranean Diet Adherence: Societal Insights from the iMC SALT Trial Abstract: Background: Cooking skills represent an important yet often overlooked form of social and cultural capital, influencing dietary quality and health outcomes. As modern societies face growing challenges related to unhealthy eating patterns and a loss of traditional food practices, understanding the societal role of culinary competence becomes critical. This study explored the association between culinary skills, adherence to the Mediterranean diet, and nutritional intake. Methods: Baseline data from 111 adults (60 women; mean age 47.6 +/- 10.5 years) participating in the iMC SALT randomized controlled trial (Portugal) were analyzed. Culinary skills were assessed using the Cooking Skills Score, while the dietary intake was evaluated with a Food Frequency Questionnaire and adherence to the Mediterranean diet through the alternative Mediterranean Diet (aMED) Score. Food and beverage processing levels were categorized using the NOVA classification, and the sodium/potassium intake was measured via 24 h urinary excretion. Results: Women demonstrated better culinary skills (5.1 +/- 0.9 vs. 4.0 +/- 1.1, p < 0.001) and greater adherence to the Mediterranean diet (5.1 +/- 1.9 vs. 3.8 +/- 1.8, p = 0.001) than men. Better culinary skills were associated with younger age, larger households, and increased adherence to the Mediterranean diet. Culinary skills significantly explained 27.2% of the variance in the Mediterranean diet adherence. Better culinary skills were linked to a greater energy and protein intake; but a lower sodium and potassium intake. Conclusion: These findings highlight culinary skills as a key societal factor shaping dietary behavior and nutritional intake. Promoting culinary education may offer a powerful strategy to address dietary inequalities, support cultural food heritage, and foster healthier, more resilient societies. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/167672 Title: Becoming experts: life changes, adaptation, and learning of stroke survivors' informal caregivers 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166752 Title: Validation of the academic misconduct questionnaire: exploring predictors of student misconduct 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166728 Title: "Are we still at this point?:" persistent misconceptions about the adequacy, rigor and quality of qualitative health research 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166493 Title: European guidelines for the management of tuberculosis screening procedures in migrants: A systematic review Abstract: "Background: This systematic review assesses the current available evidence across the WHO European region on the effectiveness and cost-effectiveness of the different approaches used for TB screening and also explores the facilitators and barriers that migrants face during screening programmes. Methods: We conducted an extensive, comprehensive, and systematic literature search across multiple databases, including MEDLINE, Cochrane, Scopus, and ISI Web of Knowledge, without any restrictions on publication date or language. In addition, we reviewed grey literature and reports. The data were meticulously analysed with a focus on screening of TB active disease and infection effectiveness indicators, and cost-effectiveness economic analyses as a primary objective and the comprehension of barriers and facilitators of screening as a secondary objective. Findings: Our review included 43 studies covering over 8 million migrants from 11 countries. The findings demonstrate that while screening uptake was high, coverage varied, and completion rates for preventive treatments were low. Economic analyses supported the high cost-effectiveness of the screening programmes, particularly when integrating both active TB and TBI screening strategies. Interpretation: This review underscores the cost-effectiveness and public health importance of TB screening in migrant populations within Europe. However, the disparities in screening practices highlight the urgent need for standardisation at the European level." 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166088 Title: History of mental health problems moderates the association between partner support during childbirth and women's mental health in the postpartum period Abstract: " Background: Partner support during childbirth is an important protective factor for women's perinatal mental health. However, its protective role in women experiencing vulnerabilities is largely unknown, namely in those with history of mental health problems. Aim: This study analysed (1) the association between partner support during childbirth and depressive, anxiety, and childbirth-related post-traumatic stress disorder symptoms in the postpartum period; and (2) the moderating role of previous diagnosis of mental health problems in those associations. Design: Cross-sectional study with 284 women. Methods: At 2 months postpartum, participants reported on sociodemographic, obstetric, and mental health-related data, partner support during childbirth, and depressive (Edinburgh Postnatal Depression Scale), anxiety (State Anxiety Inventory), and childbirth-related post-traumatic stress disorder (City Birth Trauma Scale) symptoms. Findings: More partner support during childbirth was associated with lower depressive, anxiety, and childbirth-related post-traumatic stress disorder symptoms. Previous diagnosis of mental health problems was associated with higher depressive, anxiety, and childbirth-related post-traumatic stress disorder symptoms and moderated the association between partner support during childbirth and depressive and anxiety symptoms. Higher partner support during childbirth was associated with lower depressive and anxiety symptoms, only in women without a previous diagnosis of mental health problems. Discussion: Findings suggest that partner support during childbirth can be a protective factor for women's postpartum mental health, particularly for women without a previous diagnosis of mental health problems. However, for those with a previous diagnosis of mental health problems, this support was not associated with symptoms. Conclusion: Women with a history of mental health problems may require additional support beyond that provided by their partners to prevent or mitigate postpartum mental health problems." 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166087 Title: Fetal exposure to phthalates and body mass index from infancy to adolescence. The Generation R study Abstract: Prenatal exposure to phthalates might influence the development of childhood obesity. Most previous studies used body mass index (BMI) at a specific age instead of BMI development, which might be a better indicator of later health. We aimed to assess the association of prenatal phthalate exposure with longitudinal BMI development from infancy to adolescence. Among 1,379 mother-child pairs from a population-based cohort study, phthalate concentrations were measured in maternal spot urine samples, collected during first, second and third trimester. We estimated age- and sex-adjusted BMI standard deviation scores (SDS) at 6 months and 1, 2, 3, 4, 6, 10 and 13 years. We examined the associations of maternal phthalate urine concentrations during pregnancy with repeated measures of BMI using linear mixed effects models. An interquartile range higher natural log-transformed maternal first trimester high-molecular weight phthalate and di-2-ethylhexylphthalate (DEHP) urine concentrations were associated with a −0.10 (95% confidence interval (CI) −0.15 to −0.04), and −0.09 (95% CI -0.15 to −0.04) lower age- and sex-adjusted BMI at 6 months. An interquartile range higher natural log-transformed maternal first trimester phthalic acid and low-molecular weight phthalate urine concentrations were associated with a 0.11 (95% CI 0.03 to 0.18) and 0.13 (95% CI 0.04 to 0.21) higher age- and sex-adjusted BMI at 13 years old. No significant associations were observed for maternal second and third trimester phthalate urine concentrations with BMI. Thus, higher maternal phthalate metabolites urine concentrations appear to be related to lower BMI at early ages but with higher BMI at later ages. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166086 Title: Methodological Choices on 24-h Movement Behavior Assessment by Accelerometry: A Scoping Review Abstract: " Background: There are no reviews describing current measurement protocols and accelerometer processing decisions that are being used in 24-h MovBeh studies, across the lifespan. We aim to synthesise information on methods for assessing 24-h movement behaviors using accelerometry across all age groups. Main body: PubMed, PsycINFO, SPORTDiscus, and EMBASE were searched until December 2022. Observational or intervention reports describing accelerometry methods in studies on combinations of movement behaviors, with a 24-h protocol across all ages, were included. This review included 102 studies: three studies in toddlers, 15 in preschoolers, 17 in children, 23 in adolescents and 44 in adults and older adults. The Actigraph GT3X was the most commonly used device; the majority of the included reports collected data for seven days, including three weekdays and one weekend day, with a ≥ 16 h/day per 24-h period for valid data. The criteria for non-wear time varied between ≥ 20 and ≥ 90 min of consecutive zero counts, depending on the age group. The most common epoch used was 15 or 60 s for youth and adults, respectively. The choice of sleep algorithms and SB/PA cut-points, of the included reports, depended on age and the original validation/calibration study. To deal with non-compliant participants, exclusion of non-compliant participants from the analysis was most frequently used. Most studies used diaries/logs to complement the accelerometer data. Conclusions: Accelerometer protocols and methodological decisions varied considerably between reports. Therefore, consensus on methodological decisions is needed to improve precision and comparability between studies, which is challenging given the complexity of the procedures, the number of available brands and types of accelerometers, and the plethora of programming options." 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166085 Title: Exposure to per-and poly-fluoroalkyl substances and respiratory and skin effects in children and adolescents: A systematic review and meta-analysis Abstract: Despite being previously banned due to long-term health effects, Per- and polyfluoroalkyl substances (PFAS) remain widespread in the environment, accumulating in animals and humans. This systematic review and meta-analysis explores associations between exposure to PFAS and asthma onset, wheezing, atopic dermatitis, and eczema in children and adolescents while addressing exposure timing and sex-specific differences. After comprehensive search conducted in several databases, including risk of bias, study heterogeneity, and quality of evidence evaluation, the review included 28 observational studies, most with low risk of bias in all domains. PFAS exposure was not significantly associated with asthma onset (OR:1.03, CI:0.99;1.07), but revealed significantly lower association in the prenatal period (OR:0.97, CI:0.94;0.99), higher in the postnatal period (OR:1.20, CI:1.07;1.35), and no differences among sexes. PFAS exposure (mainly prenatal) was associated with 4 % significantly lower odds of wheezing (OR:0.96, CI:0.94;0.98), higher in girls (OR:0.94, CI:0.91;0.98) than in boys (OR:0.97, CI:0.94;1.00). No significant impact was noted on atopic dermatitis (OR:1.04, CI:0.94;1.16), while PFAS exposure was associated with 8 % significantly lower eczema odds (OR:0.92, CI:0.89;0.96). Evidence was insufficient to perform sensitivity analyses on atopic dermatitis and eczema. Additional research is needed on the impact of synergistic and co-exposure to other pollutants on children and adolescents' health. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166084 Title: Assessing the impact of Lithuania's 2018 alcohol marketing ban on adolescent alcohol use by comparing trends with five EU control countries: a study protocol for a secondary data analysis Abstract: "Introduction Alcohol consumption poses a significant health risk, contributing to 10% of deaths in the WHO European Region. To combat this, the WHO recommends the implementation of its ‘best buy’ policies—three cost-effective alcohol policies that include higher taxes, restricted availability and marketing bans. While evidence links alcohol marketing to increased consumption, the effectiveness of marketing bans in decreasing alcohol use remains inconclusive. Lithuania’s 2018 comprehensive alcohol marketing ban offers a unique opportunity to measure the impact of this particular ‘best buy’ control policy. Methods and analysis We will analyse repeated cross-sectional measures of alcohol use among 15-year-old and 16-year-old adolescents from Lithuania and other five European Union countries (Estonia, France, Italy, Latvia and Poland). Data from the European School Survey Project on Alcohol and Other Drugs collected between 2003 and 2019 will be used, as well as longitudinal alcohol policy data meticulously gathered through official records, supplemented by relevant literature and consultations with national authorities. Although all six countries introduced best buy alcohol policies—primarily via excise tax increases implemented at different times—only Lithuania implemented a full marketing ban. Generalised linear mixed models will be employed to assess the impact of national alcohol marketing restrictions on alcohol consumption, controlling for participant characteristics, social behaviours and country-level variables such as other alcohol control policies evaluated through a partial Bridging the Gap (BtG) scale. Sensitivity analyses will explore different outcome time periods and model specifications. Ethics and dissemination The Research Ethics Board of the primary recipient of the grant has approved the secondary data analyses as outlined in the grant proposal (CAMH REB 050/2020 delegated review, renewed annually). The study results will be published in a peer-reviewed journal, presented at conferences, and shared with policymakers." 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166083 Title: National survey of the rat hepatitis E virus in rodents in Spain, 2022 to 2023 Abstract: BackgroundRat hepatitis E virus (ratHEV) is an emerging virus causing acute and chronic hepatitis in humans. Rats are the main natural reservoir of this pathogen. Large-scale studies assessing ratHEV circulation in rodents in Spain are lacking.AimWe aimed to determine the prevalence of ratHEV in rats in Spain and evaluate potential transmission risk to humans.MethodsWe designed a cross-sectional nationwide study where black (Rattus rattus) and Norway (R. norvegicus) rats were collected and analysed between 2022 and 2023 for ratHEV infection using real-time (RT)-qPCR testing of liver tissue. Sequencing and analysis of ratHEV shedding in faeces were carried out in positive animals.ResultsRatHEV was detected in 125 of the 481 rats analysed, supposing a prevalence of 26.0% (95 CI%: 22.3-30.1). Positive rats were found in urban (25.6%), and farm (29.8%) settings. Black rats (31.3%) had 1.5 times higher odds of being infected by the virus than Norway rats (22.5%) (p = 0.049). Significantly higher prevalence of ratHEV was detected in rodents sampled from southern (31.9%) than northern (17.8%) Spain (p = 0.003). Viral RNA was detected in faeces from 45.5% of infected rats. Phylogenetic analysis evidenced a wide genetic diversity of ratHEV sequences, some showing high homology with ratHEV strains found in patients from Spain.ConclusionsCirculation of ratHEV appears to be heterogeneous and the virus appears to be endemic among rat populations in Spain, highlighting the possible risk of zoonotic transmission of this emerging virus in this country. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166082 Title: Hazard characterization of the mycotoxins enniatins and beauvericin to identify data gaps and improve risk assessment for human health Abstract: Enniatins (ENNs) and beauvericin (BEA) are cyclic hexadepsipeptide fungal metabolites which have demonstrated antibiotic, antimycotic, and insecticidal activities. The substantial toxic potentials of these mycotoxins are associated with their ionophoric molecular properties and relatively high lipophilicities. ENNs occur extensively in grain and grain-derived products and are considered a food safety issue by the European Food Safety Authority (EFSA). The tolerable daily intake and maximum levels for ENNs in humans and animals remain unestablished due to key toxicological and toxicokinetic data gaps, preventing full risk assessment. Aiming to find critical data gaps impeding hazard characterization and risk evaluation, this review presents a comprehensive summary of the existing information from in vitro and in vivo studies on toxicokinetic characteristics and cytotoxic, genotoxic, immunotoxic, endocrine, reproductive and developmental effects of the most prevalent ENN analogues (ENN A, A1, B, B1) and BEA. The missing information identified showed that additional studies on ENNs and BEA have to be performed before sufficient data for an in-depth hazard characterisation of these mycotoxins become available. 2025-01-01T00:00:00Z https://hdl.handle.net/10216/166081 Title: Urgent request for pretomanid label expansion to align with WHO guidelines and improve treatment accessibility and efficacy Abstract: Pretomanid is a key anti-TB drug included in the WHO list of essential medications. The current EMA-approved label for pretomanid restricts its use to the regimen comprising bedaquiline, pretomanid and linezolid (BPaL) and only for extensively drug-resistant-TB or multidrug-resistant TB, “when antibiotics used for the latter form of TB do not work or cause unacceptable side effects.” This restricted use implies that the older, prolonged and poorly tolerated regimens remain the recommended treatment for most cases of drug-resistant TB. The authors, representing many respiratory groups and societies, call for the label expansion of pretomanid to align with global guidelines, allowing for broader use. 2025-01-01T00:00:00Z