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- Hidden hazards: a literature review on occupational exposure to fungi and mycotoxins in the coffee industryPublication . Oliveira, Filipe da Silva; Andrade, Ednilton Tavares de; Viegas, Carla; Souza, Jéssica Raquel; Rabelo, Giovanni Francisco; Viegas, SusanaSeveral studies have reported the incidence of fungi and mycotoxins in coffee beans; however, there are few reports related to occupational exposure to these agents at coffee dry milling industries. This review aimed to identify and analyze studies assessing occupational exposure to fungi and mycotoxins in coffee industries. Therefore, a systematic literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and focusing on the assessment of occupational exposure to fungi and mycotoxins in the coffee industry. In these papers, different environmental matrices were considered in evaluating occupational exposure, but the most commonly used matrix was airborne dust (four of the five studies). Airborne fungi were sampled using active (four of the five studies) and passive sampling. Only the most recent of the studies (2022) identified microorganisms by their genera and species, and only two groups of mycotoxins were analyzed in the studies considered, namely, Ochratoxin A and Aflatoxins. None of the studies reported data on both fungi and mycotoxins. The fungal genera identified in these occupational environments included Cladosporium, Paecilomyces, Aspergillus, Penicillium, and other genera. Among the mycotoxins, only aflatoxins and ochratoxin A were investigated. Occupational exposure to these biological agents may lead to several health effects. Fungal spores and fragments can cause respiratory diseases such as asthma, allergic rhinitis, bronchitis, and hypersensitivity pneumonitis. Additionally, the mycotoxins studied—particularly Aflatoxins and Ochratoxin A—are associated with serious toxicological effects. Coexposure to both fungi and mycotoxins may enhance health risks and should be carefully considered in occupational risk assessments. Considering the possible effects related to exposure to fungi and mycotoxins and the number of workers involved in this type of industry in the world, more studies should be conducted. This is the first review to systematically consolidate data on occupational exposure to both fungi and mycotoxins specifically within the coffee industry, highlighting existing knowledge gaps and the need for targeted risk assessments in coffee-producing settings.
- From knowledge to action: how Portuguese higher education students engage with circular economy principlesPublication . Pardal, Ana; Moreira, Anabela; Galacho, Cristina; Mateus, Dina; Viegas, Laura; Gaspar, Marcelo; Teixeira, Margarida Ribau; Manteigas, Vítor; Dinis, Maria Alzira PimentaThis study investigates the perceptions and practices of Portuguese higher education students regarding the circular economy (CE), emphasising their knowledge, attitudes, and behaviours toward sustainable resource management. Carried out by the Working Group on Circular Economy and Waste Management of the Portuguese Sustainable Campus Network (RCS), the research used an online survey targeting students from 20 higher education institutions (HEIs), resulting in 400 responses. The findings indicate that while students generally hold positive views of the CE, their understanding of its practical applications, such as waste reduction and resource efficiency, remains limited. Only a small proportion of students reported exposure to CE-related topics in their curriculum, revealing a gap in academic integration. This study also identifies significant demographic variations in CE awareness and practices, influenced by factors such as age, field of study, and employment status. These insights underscore the need for HEIs to strengthen CE education and actively involve students in hands-on sustainability initiatives, fostering a generation equipped to drive the transition toward a circular economy.
- Assessing the quality and reliability of ChatGPT’s responses to radiotherapy-related patient queries: comparative study with GPT-3.5 and GPT-4Publication . Grilo, Ana; Marques, Catarina; Corte-Real, Maria; Carolino, Elisabete; Caetano, MarcoBackground: Patients frequently resort to the internet to access cancer information. However, these websites often lack content accuracy and readability. Recently, ChatGPT, an artificial intelligence-powered chatbot, has signified a potential paradigm shift in how patients with cancer can access vast amounts of medical information, including insights into radiotherapy. However, the quality of the information provided by ChatGPT remains unclear. This is particularly significant given the general public's limited knowledge of this treatment and concerns about its possible side effects. Furthermore, evaluating the quality of responses is crucial, as misinformation can foster a false sense of knowledge and security, lead to noncompliance, and result in delays in receiving appropriate treatment. Objective: This study aims to evaluate the quality and reliability of ChatGPT's responses to common patient queries about radiotherapy, comparing the performance of ChatGPT's two versions: GPT-3.5 and GPT-4. Methods: We selected 40 commonly asked radiotherapy questions and entered the queries in both versions of ChatGPT. Response quality and reliability were evaluated by 16 radiotherapy experts using the General Quality Score (GQS), a 5-point Likert scale, with the median GQS determined based on the experts' ratings. Consistency and similarity of responses were assessed using the cosine similarity score, which ranges from 0 (complete dissimilarity) to 1 (complete similarity). Readability was analyzed using the Flesch Reading Ease Score, ranging from 0 to 100, and the Flesch-Kincaid Grade Level, reflecting the average number of years of education required for comprehension. Statistical analyses were performed using the Mann-Whitney test and effect size, with results deemed significant at a 5% level (P=.05). To assess agreement between experts, Krippendorff α and Fleiss κ were used. Results: GPT-4 demonstrated superior performance, with a higher GQS and a lower number of scores of 1 and 2, compared to GPT-3.5. The Mann-Whitney test revealed statistically significant differences in some questions, with GPT-4 generally receiving higher ratings. The median (IQR) cosine similarity score indicated substantial similarity (0.81, IQR 0.05) and consistency in the responses of both versions (GPT-3.5: 0.85, IQR 0.04; GPT-4: 0.83, IQR 0.04). Readability scores for both versions were considered college level, with GPT-4 scoring slightly better in the Flesch Reading Ease Score (34.61) and Flesch-Kincaid Grade Level (12.32) compared to GPT-3.5 (32.98 and 13.32, respectively). Responses by both versions were deemed challenging for the general public. Conclusions: Both GPT-3.5 and GPT-4 demonstrated the capability to address radiotherapy concepts, with GPT-4 showing superior performance. However, both models present readability challenges for the general population. Although ChatGPT demonstrates potential as a valuable resource for addressing common patient queries related to radiotherapy, it is imperative to acknowledge its limitations, including the risks of misinformation and readability issues. In addition, its implementation should be supported by strategies to enhance accessibility and readability.
- Literacia digital como determinante de acesso à saúde: scoping reviewPublication . Barão, Sónia; Pereira, Catarina; Cunha, Tânia; Rego, João; Eiras , MargaridaO rápido desenvolvimento das tecnologias digitais conduziu a um aumento da sua aplicação nas mais diversas áreas, incluindo na área da saúde. Contudo, para retirar o maior benefício da tecnologia no acesso à saúde é necessário que os utilizadores possuam competências básicas de compreensão, obtenção e avaliação de informações. A literacia digital em saúde surge como a convergência de dois conceitos isolados: literacia em saúde e literacia digital. Através de uma scoping review, sustentada na metodologia de Joanna Briggs Institute, procurou caracterizar-se de que forma a literacia digital em saúde determina o acesso à mesma. A pesquisa dos artigos foi realizada recorrendo às bases de dados PubMed, Scopus e Web of Science utilizando palavras-chave definidas. Foram encontrados 114 artigos, tendo sido incluídos 11, de acordo com os critérios de inclusão e exclusão estabelecidos. No atual contexto de transformação digital dos Sistemas de Saúde, a literacia digital em saúde desempenha um papel crucial como determinante de acesso. Há que avaliar e identificar as necessidades dos utilizadores, promover a literacia digital em saúde e garantir a equidade de acesso quebrando barreiras sistémicas e sociais.
- Cultura de segurança do doente: melhoria contínua de segurança – uma scoping reviewPublication . Silva, Sara Lisete; Dias, Ana Cristina; Carvalho, Ana Catarina; Neto, Sara; Eiras , MargaridaA segurança do doente é essencial na qualidade dos cuidados de saúde. Apesar dos progressos nas últimas décadas, os eventos adversos evitáveis continuam a representar uma carga significativa para os doentes, profissionais e sistemas de saúde. A cultura de segurança do doente é fundamental na prevenção de danos. Este trabalho tem como objetivos sintetizar as principais evidências disponíveis sobre os fatores que influenciam a cultura de segurança do doente e identificar medidas baseadas na literatura que possam contribuir para a sua melhoria nos serviços de saúde. A pesquisa dos artigos foi realizada nas bases de dados PubMed e Scopus utilizando palavras-chave definidas, resultando na inclusão de 22 publicações. A análise demonstrou que os fatores mais frequentemente associados à quebra de segurança são o ambiente de trabalho, a falta de trabalho em equipa e a subnotificação de erros. As medidas mais referidas para mitigar estas fragilidades incluíram a resposta não punitiva ao erro e a abertura na comunicação A segurança do doente continua a ser um dos maiores desafios na área da saúde. Uma cultura de segurança eficaz depende não apenas de sistemas e protocolos, mas também do envolvimento ético, emocional e coletivo dos profissionais. Apesar de o objetivo de “zero dano” parecer inatingível, deve permanecer como orientação ética essencial para a qualidade e a integridade dos cuidados de saúde.
- Portuguese cross-cultural adaptation and validation of the hospital survey on patient safety culture 2.0Publication . Freitas, Elsa; Silva, Carina; Eiras , MargaridaBackground: As patient safety continues to be a global priority, it is crucial to emphasize the assessment and development of Patient Safety Culture [PSC] to advance healthcare quality and safety initiatives worldwide. This study focused on the assessment of PSC in Portuguese hospitals, specifically through the translation and cultural adaptation of the Hospital Survey on Patient Safety Culture 2.0 [HSOPSC 2.0] for the Portuguese context. Methods: The study followed a two-phase design, encompassing the translation, cultural adaptation, and psychometric evaluation of HSOPSC 2.0. A total of 2,604 fully completed questionnaires were collected. The sample consisted of seven public hospitals from different regions of Portugal, ensuring broad representation within the Portuguese National Health System. The translation process includes four stages: forward translation, back translation, expert panel review, and pre-testing. Instrument reliability was assessed using Cronbach’s alpha coefficients and Exploratory Factor Analysis (EFA). Construct validity was evaluated through Confirmatory Factor Analysis (CFA), while convergent and discriminant validity were examined using Average Variance Extracted (AVE) and Pearson’s correlation coefficients, respectively. Results: The Portuguese translated version of the HSOPSC 2.0 [PT-HSOPSC 2.0] demonstrated good internal consistency, with Cronbach’s alpha values ranging from 0.63 to 0.88, and factor loadings above 0.80 indicating strong factor reliability. CFA results supported the adequacy of the model fit: χ²/df = 4.64, p < 0.01; RMSEA = 0.05; CFI = 0.93; GFI = 0.90; TLI = 0.91; PCFI = 0.78; PGFI = 0.71. The instrument demonstrated good convergent validity, with AVE values at or above 0.50. Strengths included “Teamwork” and “Management Support for Patient Safety”, whereas “Open Communication” and “Hospital Management” were identified as areas requiring improvement. Overall, the PT-HSOPSC 2.0 demonstrated robust psychometric properties, confirming its suitability for assessing PSC in Portuguese hospitals. Conclusion: This study contributes to enhancing PSC assessment in Portuguese healthcare settings by providing a translated and validated version of the HSOPSC 2.0 adapted to the Portuguese context. Findings support that PT-HSOPSC 2.0 is a reliable and valid tool for evaluating PSC in Portuguese healthcare settings.
- Boosting knowledge on occupational exposure to microbial contamination in Portuguese carpentriesPublication . Dias, Marta; Gomes, Bianca; Pena, Pedro; Cervantes, Renata; Rodriguez, Margarida; Riesenberger, Bruna; Marques, Liliana; Carolino, Elisabete; Twarużek, Magdalena; Kosicki, Robert; Soszczynska. Ewelina; Caetano, Liliana Aranha; Viegas, Susana; Viegas, CarlaIntroduction: Wood industry workers face health risks due to exposure to microorganisms and their metabolites. This study aimed to characterize seasonal microbial contamination, antifungal resistance, mycotoxins, cytotoxicity, and particulate matter in Portuguese carpentries, to reduce exposure and promote safe working conditions. Methods: Conducted in six carpentries in Lisbon, Portugal, the sampling strategy encompassed active and passive sampling methods to assess microbial contamination. A Handheld Particle Counter HH3016-IAQ was used to monitor particulate matter size, temperature, and humidity. Results: The highest fungal load was in the cold season, with Aspergillus sp. being the predominant species, and the highest bacterial load was in the warm season. Reduced susceptibility to azoles was observed in both seasons, with greater species diversity in the cold season. In the warm season, Nidulantes and Fumigati sections of Aspergillus were detected by RT-PCR, with Fumigati being the most prevalent; in the cold season, only Nidulantes were detected. Mycotoxins, mainly fumonisins, were more prevalent in the warm season; in the cold season, griseofulvin was the most prevalent mycotoxin. Cytotoxicity was more prevalent in A549 cells than in SK cells. Settled dust caused greater cytotoxicity in SK cells, and filters from the vacuumed dust in A549 cells. Higher particulate matter concentrations in the sampled indoor areas suggest a significant contribution of indoor activities to workers’ exposure. Discussion: The study highlights concerns about seasonal variations in microbial contamination, emphasizing the potential for respiratory diseases, invasive infections by azole-resistant fungi, mycotoxin exposure, and cytotoxicity in lung cells due to co-exposure to fungi, particulate matter, and mycotoxins influenced by environmental conditions.
- Sleep and indoor air quality: an exploratory polysomnographic evaluation of potential associationsPublication . Belo, Joana; Meira e Cruz, Miguel; Viegas, Carla; Lage, Joana; Almeida, Susana Marta; Cabo Verde, Sandra; Alves, Célia; Canha, NunoThis exploratory pilot study examines the potential impact of indoor environmental exposures on sleep quality, with a particular focus on a comprehensive characterization of indoor air quality (IAQ) parameters and their association with sleep architecture assessed through polysomnography. The study was conducted during the cold seasons of 2016 and 2017 with a small sample of 10 subjects from the urban area of Lisbon, Portugal. Polysomnography was performed over two consecutive weeknights, while IAQ monitoring took place over three consecutive nights using typical real-time instruments. Additionally, bioburden was assessed in each bedroom before and after the sleep period using active methods. The analysis was based on correlations between the environmental parameters and the sleep data from these 10 subjects. Parametric and non-parametric statistics were employed to examine potential associations, with a significance level set at α = 0.05. The findings showed that higher bedroom temperatures during sleep were associated with a decrease in REM sleep. Both minimum and mean heart rates (HR) increased with higher levels of CO and CO2, while post-sleep bacteria levels were linked to a decrease in maximum HR. Fungal levels in the bedrooms were associated with a reduction in NREM2, and higher formaldehyde exposure was found to increase REM sleep latency. Exposure to PM2.5 negatively impacted NREM1, RDI, and snoring, while PM10 levels were negatively correlated with WASO and RDI. Although these findings provide a preliminary baseline, they are based on a small sample and may not be representative, highlighting the need for future studies to confirm the effects of various IAQ parameters on sleep quality in a larger and more diverse population.
- Prevalence and factors associated with inadequate intake of fruits and vegetables in a population from Northern AngolaPublication . Morais, Humberto; Cupessala, Vizé Preciosa; Pedro, João Mário; Brito, Miguel; Gonçalves, Mauer A. A.Background: The World Health Organization recommends a minimum intake of 400 g or five servings of Fruits and Vegetables (FVs) per day for the prevention of chronic diseases. Objective: The present study aims to describe the prevalence and factors associated with inadequate FV intake in a sample of Angolan adults who participated in the CardioBengo study. Methods: It is a subset analysis of CardioBengo, a community-based cross-sectional observational study conducted in the Dande Municipality, Bengo Province, Angola. Results: The sample included 2161 individuals aged 18 to 84, with 64.1% being women. 57.2% of participants were below high school, and only 3.1% attended higher education. 61.7% were married, and 48.3% had a monthly income below 150 USD. The prevalence of insufficient FV consumption in the sample was 86.2%. It was observed that female gender, low education level, and the age group of 20-29 years were associated with inadequate FV intake (p = 0.010, p = 0.001, and p = 0.006, respectively). Conclusion: There was no association between FV consumption and cardiovascular risk factors. A prevalence of FV consumption well below current recommendations was identified. The identified risk factors can serve as a strategy to increase FV consumption in this population.
- Construct validity of markerless three-dimensional gait biomechanics in healthy older adultsPublication . Carvalho, Andreia; Vanrenterghem, Jos; Cabral, Sílvia; d'Assunção, Ana M.; Carnide, Filomena; Veloso, António P.; Moniz-Pereira, VeraBackground and aim: Gait changes due to aging can result in functional limitations and a higher risk of falls, with older adults showing alterations in joint angles and moments. Marker-based gait analysis is not widely used in clinical settings due to its complexity and discomfort, especially in older adults. Recent advances in markerless motion capture, such as Theia3D, offer a promising alternative. This study aims to assess the construct validity of a markerless motion capture system for gait analysis in healthy older adults. Methods: A cross-sectional study included 30 healthy community-dwelling older adults. Gait data were collected using marker-based and markerless motion capture systems in randomized order, with participants wearing tight-fitting minimal clothes plus 46 reflective markers attached, or their usual clothes, respectively. Joint kinematics (including range of motion) and kinetics were analyzed, and correlations between methods (Rxy) were assessed. Bland-Altman analysis was used to measure agreement. Root-mean-square differences (RMSD) were computed. Acceptable thresholds were set at ≤ 5º for kinematics and at ≤ 10 % of signal amplitude for kinetics. Results: Strong correlations (Rxy≥0.7) were found between the systems for sagittal plane kinematics (except for the pelvis), particularly for knee and ankle joints. A low agreement was detected in sagittal plane hip and pelvis kinematics, along with RMSD exceeding 5º. Weaker correlations and poor agreement were observed for transverse and frontal plane motions. Overall, strong correlations were found for kinetics, except for the joint ankle inversion-eversion moment, and poor agreement for the frontal and transverse planes. Conclusion: Overall, markerless motion capture demonstrated good construct validity for measuring sagittal plane gait lower-limb gait kinematics (excluding pelvis) and kinetics in healthy older adults. However, considering the agreement between methods and the results for the other movement planes, further validation is required before markerless and marker-based systems can be used interchangeably in gait assessments.