NOVA University Lisbon
Publications
29 844
Citations
775 418
h-index
272
Top-3 journals
Lecture Notes in Computer Science
(728 publications)
IFIP Advances in Information and Communication Technology
(440 publications)
SSRN Electronic Journal
(367 publications)
Top-3 organizations
University of Lisbon
(5100 publications)
University of Porto
(1416 publications)
University of Coimbra
(975 publications)
Top-3 foreign organizations
Harvard University
(333 publications)
Katholieke Universiteit Leuven
(322 publications)
University of Oxford
(304 publications)
Most cited in 5 years
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Publications found: 27961
Stillbirth rate trends across 25 European countries between 2010 and 2021: the contribution of maternal age and multiplicity
Kniffka M.S., Schöley J., Lee S., Bertens L.C., Been J.V., Gunnarsdóttir J., Farr A., Klimont J., Alexander S., Zhang W., Vandervelpen G., Kolarova R., Yordanova E., Draušnik Ž., Kyprianou T., et. al.
Abstract
Stillbirth rates have stalled or increased in some European countries during the last decade. We investigate to what extent time-trends and between-country differences in stillbirth rates are explained by the changing prevalence of advanced maternal age and teenage pregnancies or multiple births. We analysed data on stillbirths and live births by maternal age and multiplicity from 2010 to 2021 in 25 European countries using Kitagawa decomposition to separate rate differences into compositional and rate components. Rates significantly decreased in six countries, but increased in two. Changes in maternal age structure reduced national stillbirth rates by a maximum of 0.04 per 1000 in the Netherlands and increased rates by up to 0.85 in Cyprus. Changes in the prevalence of multiple births decreased rates by up to 0.19 in the Netherlands and increased rates by up to 0.01 across multiple countries. Maternal age differences explained between 0.11 of the below-European average stillbirth rate in Belgium and 0.13 of the above-average rate in Ireland. Excluding Cyprus, differences in multiple births explained between 0.05 of the below-average rate in Malta and 0.03 of the above-average rate in Ireland. For most countries, the increase in advanced-age pregnancies contributed to rising stillbirth rates over time, while reductions in multiples led to decreases in rates. However, large parts of the trends remain unexplained by those factors. By 2021, neither factor explained the differences between countries, due to increased compositional uniformity and declining stillbirth risk for advanced maternal age.
Effectiveness of the AZD1222 vaccine against COVID-19 hospitalization in Europe: final results from the COVIDRIVE test-negative case–control study
de Munter L., Meeraus W., Dwivedi A., Mitratza M., Wyndham-Thomas C., Carty L., Ouwens M., Hartig-Merkel W., Drikite L., Rebry G., Casas I., Mira-Iglesias A., Icardi G., Otero-Romero S., Baumgartner S., et. al.
Abstract
Marketing authorization holders of vaccines typically need to report brand-specific vaccine effectiveness (VE) to the regulatory authorities as part of their regulatory obligations. COVIDRIVE (now id. DRIVE) is a European public–private partnership for respiratory pathogen surveillance and studies of brand-specific VE with long-term follow-up. We report the final VE results from a two-dose primary series AZD1222 (ChAdOx1 nCoV-19) vaccine schedule in ≥18-year-old individuals not receiving boosters. Patients (N = 1,333) hospitalized with severe acute respiratory infection at 14 hospitals in Austria, Belgium, Italy, and Spain were included in the test-negative case–control study in 2021–2023. Absolute VE was calculated using generalized additive model (GAM), generalized estimating equation (GEE), and spline-based area under the curve (AUC, measuring VE up to 6 months after the last dose of AZD1222). Overall VE (against coronavirus disease 2019 [COVID-19] hospitalization) of an AZD1222 primary series was estimated as 65% using GEE (95% confidence interval [CI]: 52.9–74.5), and 69% using GAM (95% CI: 50.1–80.9) over the 22-month study period (comparator group: unvaccinated patients). The AUC of the spline-based VE estimate was 74.1% (95% CI: 60.0–88.3). VE against hospitalization in study participants who received their second AZD1222 dose 2 months or less before hospitalization was 86% using GEE (95% CI: 77.8–91.4), 93% using GAM (95% CI: 67.2–98.6). During this study period, where mainly the severe acute respiratory syndrome coronavirus 2 Omicron variant was circulating, a two-dose primary series AZD1222 vaccination conferred protection against COVID-19 hospitalization up to at least 6 months after the last dose.
Public knowledge, attitudes, and practices regarding antibiotics use and resistance in Montenegro
Raicevic M., Labovic Barjaktarovic S., Milic D., Nedovic Vukovic M., Bajceta N.
Abstract
A drug consumption monitoring revealed that Montenegro is one of the major consumers of antimicrobial drugs in Europe. The aim of this study is to obtain the first data on the knowledge, attitudes, and practices of the general population in Montenegro regarding antibiotics use. This cross-sectional study was designed according to the methodology of Eurobarometer survey on antimicrobial resistance, created by the European Commission. The standardized questionnaire was conducted in Podgorica, in October–November 2022. A total of 532 participants completed the questionnaire. More than a half of responders (60.9%) have received antibiotics within the last 12 months and among them 33.4% was missing a medical prescription, nor the antibiotic was administered by a medical practitioner. The rest of the responders mostly had some antibiotics left over from a previous course (13.0%), had taken it from a pharmacy (11.4%), or elsewhere without a prescription. The most frequent reasons for antimicrobial therapy were “cold” (22.5%), “sore throat” (21.0%), “cough” (19.4%), and “COVID-19” (coronavirus disease 2019) (17.9%). Throat swab, blood test, urine test, or other test that could identify the cause of the illness preceded antimicrobial therapy in 46.3% participants. Only one-half of the participants were convinced that antibiotics are ineffective in viral infection treatment. This study is the first report on public knowledge, attitudes and practices regarding antibiotics use and resistance in Montenegro and it highlights the need for the knowledge improvement among general population, better regulations for antibiotics procurement and a campaign regarding appropriate antibiotics use among youth.
Increasing incidence and prevalence of Hodgkin’s lymphoma in Finland: a population-based registry study
Antikainen T., Hannuksela N., Anttalainen A., Partanen A., Rönkä A., Kuitunen H., Ukkola-Vuoti L., Toppila I., Miettinen T., Kuittinen O.
Abstract
Hodgkin’s lymphoma (HL) is a lymphoid malignancy with an emphasized incidence in developed countries. This study aimed to assess the changes in the epidemiology of HL in Finland at the population level by utilizing data from six nationwide healthcare registries. A total of 2912 patients with HL, diagnosed and treated between 2000 and 2019 were matched by controls and divided into younger (<50 years) and older cohorts (≥50 years) for analysis. A slightly increasing trend in incidence per age group was observed. For the younger patients, the mean annual incidence was 3.19 for males and 2.89 for females. For the older patients, it was 3.07 and 1.59, respectively. Finland has higher incidence rates than other Scandinavian countries possibly due to unique human leucocyte antigen allele distribution. There was a notable increase in prevalence. For females, this was particularly emphasized between the ages of 30–50 years, while among males, it was more evenly distributed across all ages. As a result of improved disease management, the proportion of HL survivors is increasing.
Advancing personalized medicine: key priorities for clinical studies and funding systems based on a Europe–China collaborative Delphi survey
Osti T., Savoia C., Farina S., Beccia F., Causio F.A., Wang L., Wang W., Fotino C., Cadeddu C., Ricciardi W., Boccia S.
Abstract
Personalized medicine (PM) has the potential to revolutionize healthcare by delivering treatments tailored to individual patients based on their unique characteristics. However, ensuring its effective implementation presents complex challenges, particularly in terms of long-term sustainability. To address these challenges, the IC2PerMed project fosters collaboration between the European Union and China. This study, building on insights from the project, aims to identify key priorities for advancing PM, focusing on Clinical Studies and Funding Systems, with special attention to optimizing resource management, distribution, and protection to support sustainable development. A two-round Delphi survey was conducted to achieve consensus on common priorities among China and Europe related to Clinical Studies and Funding Systems. Consensus was measured using the Content Validity Index, requiring an agreement level of 80% or higher for item inclusion. The survey identified 20 key priorities in PM research, split evenly between research initiatives and funding mechanisms. Notable priorities include developing technology for deep phenotyping, standardizing methodological approaches, and fostering public–private collaborations. In funding, the emphasis was placed on involving patient voices in research design and establishing synergies among funders to support larger projects. The findings underscore the importance of structured collaboration between Europe and China in advancing personalised medicine. By addressing identified priorities in research and funding, this initiative can significantly enhance the efficacy of PM, ultimately improving healthcare outcomes globally. The study sets a precedent for future international partnerships aimed at fostering innovation in health sciences.
Using Rasch analysis to assess the latent construct of the Capacity to Work Index in a Swedish working population sample
Blomberg A., Hensing G., Bertilsson M., Hadžibajramović E.
Abstract
Measurements of capacity to work (CTW) in relation to common mental disorders (CMD) are needed to improve research on determinants for maintained work participation (WP). The aim of this study was to assess the construct validity of the Capacity to Work Index (C2WI) in a heterogenous sample of the Swedish working population. Cross-sectional web survey data among Swedish employees (n = 8201) was used. The construct validity was assessed in terms of the unidimensionality of the scale, response categories appropriateness, and the differential item functioning with respect to gender and age. Rasch analysis was used in both the full sample and randomly selected subsets. The Rasch model (RM) was fitted using two versions of the C2WI construct: the original 17-item scale and a 7-item scale. The 17-item scale did not discriminate as required, whereas the 7-item scale demonstrated a better fit to the RM. However, statistically significant χ2 statistics indicated non-invariant item performance across the latent continuum. A third attempt assessed both scales on a subgroup, yielding improved results, but an overall fit to the RM was not achieved. CTW in relation to CMD assessed by the C2WI did not fulfil the requirements for construct validity outlined by the RM. Real-world experiences of CTW are complex and reflect expressions of mental health in diverse work environments. Further studies are required to determine the predictive capacity of C2WI and its individual items in relation to relevant outcomes, such as maintained WP in the working population.
Preventing common mental health problems by increasing neighbourhood socioeconomic status: a mental health impact assessment in Rotterdam, the Netherlands
Kosīte D., van Lenthe F.J., Nieuwenhuijsen M.J., Beenackers M.A.
Abstract
Neighbourhood socioeconomic status (NSES) has been identified as a determinant of mental health. In this study, we aimed to quantify how many cases of common mental health problems could be prevented by increasing NSES in the most socioeconomically deprived neighbourhoods in Rotterdam, the Netherlands, and how the increases in NSES would affect mental health inequalities. We used publicly available data for conducting a quantitative Health Impact Assessment (HIA) of two counterfactual policy scenarios. In Scenario 1, we set the NSES to the Rotterdam median score for all neighbourhoods which were below the Rotterdam median. In Scenario 2, we set the NSES score to the Dutch national average socioeconomic status score for the neighbourhoods that were below the national average. We estimated that Scenario 1 could prevent 5847 (95% CI, 2700–7999) or 10.7% of annual cases of common mental health problems, and Scenario 2 could prevent 10 713 (95% CI, 4875–14 799) or 19.6% of annual cases in Rotterdam while also reducing mental health inequalities between neighbourhoods in both scenarios. Given the substantial improvements in population mental health that enhanced neighbourhood socioeconomic conditions would bring, policy implementation is urgently needed.
Parental impact on adherence of young children to 24-h movement behaviour guidelines: the Czech FAMIly Physical Activity, Sedentary behaviour and Sleep study
Sigmundová D., Vorlíček M., Voráčová J., Dygrýn J., Sigmund E.
Abstract
Human movement behaviour typically unfolds in 24-h cycles, with children being additionally influenced by their parents. Therefore, the aim of this study was to investigate the adherence of 3–10-year-old children to the World Health Organization’s (WHO) 24-h movement behaviour guidelines in relation to the behaviours of their mothers/fathers. Data from the Czech cross-sectional FAMIly Physical Activity, Sedentary behaviour and Sleep study included 381 families (with at least one child aged 3–10 years) from urban and rural areas across all three regions of Czechia. Twenty four-hour movement behaviour (sleep, sedentary behaviour, and physical activity) was monitored using ActiGraph accelerometers placed on the non-dominant wrists of children and their parents for seven consecutive days. Children's adherence to the WHO guidelines was analysed using logistic regression analysis. 25.9% of girls and 26.7% of boys simultaneously met all three 24-h movement behaviour guidelines (sleep + sedentary + physical activity), and 44.7% of girls and 46.1% of boys met any combination of two of the three guidelines, regardless of the children’s gender, weight, or calendar age. Maternal overweight/obesity significantly (P = .05) decreased the odds of children achieving at least two of the three guidelines, while parental university education and maternal adherence to at least two of the three guidelines significantly (P = .05) increased the odds of children complying with these guidelines. Parents, especially mothers, play an important role in influencing their children in meeting 24-h movement behaviour guidelines and in shaping a healthy lifestyle.
The contribution of common mental disorders and alcohol-related morbidity to educational differences in early labour market exit among older workers: a register-based cohort study
Carlsson E., Hemmingsson T., Landberg J., Burström B., Thern E.
Abstract
Previous studies have identified educational differences in early labour market exits, yet the mechanisms behind these disparities remain unclear. This study aims to examine to what extent common mental disorders (CMD) and alcohol-related morbidity can explain educational differences in early labour market exit. This cohort study included all men born 1951–53 who underwent conscription examination for military service in Sweden at age 18–20 (n = 136 466). The highest level of educational attainment and early labour market exit, using five different exit routes, was obtained from nationwide registers. Mediation analysis was used to examine the contribution of CMD and alcohol-related morbidity to the educational differences in early labour market exit. Factors measured in childhood, late adolescence, and early adulthood were included as confounders. Lower-educated men were at higher risk of leaving the labour market early. CMD contributed marginally to the educational differences in early exit due to disability pension, long-term sickness absence, and long-term unemployment, explaining up to 4%. Alcohol-related morbidity explained up to 12% of the educational differences in disability pension, long-term sickness absence, and long-term unemployment. Neither CMD nor alcohol-related morbidity were associated with early old-age retirement with and without income. Alcohol-related morbidity appears to be of importance when trying to understand educational differences in some but not all early labour market exit routes. Thus, reducing the negative effects of alcohol consumption could reduce educational inequalities in early exits from the labour market and prolong working life for all individuals regardless of socioeconomic position.
Trends in smoking-attributable cardiovascular mortality in Germany
Mons U., Lohner V., Seuthe K.
Abstract
We quantified the fraction of cardiovascular deaths attributable to smoking in Germany over time, accounting for population ageing. We calculated population-attributable fractions to quantify cardiovascular deaths attributable to smoking for 1992 to 2021, and compared actual with age-standardized figures. We found a significant decline in the number of cardiovascular deaths attributable to smoking: from about 71 900 cases in 1992 to around 42 000 cases in 2021, with a steeper decline in men. Age-standardized figures suggest that population ageing partially offset this trend. Forward projections indicate increasing trends over the next decade. The results highlight the need for targeted smoking cessation programmes.
Effectiveness of targeted social and behavior change communication on maternal health knowledge, attitudes, and institutional childbirth: a cluster-randomized trial in Jimma Zone, Ethiopia
Gebretsadik L.A., Mamo A., Koricha Z.B., Morankar S.
Abstract
Maternal mortality remains a critical global health challenge, with 95% of deaths occurring in low-income countries. While progress was made from 2000 to 2015, regions such as Ethiopia continue to experience high maternal mortality rates, impeding the achievement of the sustainable development goal to reduce maternal deaths to 70 per 100 000 live births by 2030. This study evaluated the effectiveness of a Social and Behavior Change Communication (SBCC) intervention to improve maternal health behaviors. A community-randomized trial was conducted in three districts of Jimma Zone, rural Ethiopia, involving 5057 women. Sixteen primary healthcare units were randomly assigned to either the intervention (SBCC) or control (standard care) group. Data on socio-demographics, antenatal care (ANC) visits, maternal health knowledge, attitudes, and institutional childbirth rates were collected at baseline and endline. Statistical analyses included t-tests, effect sizes, and generalized estimating equations. The intervention group demonstrated significant improvements. Maternal health knowledge increased from 5.68 to 7.70 (P < .001, effect size = 0.34), attitudes improved from 37.49 to 39.73 (P < .001, effect size = 0.29), and ANC visits rose from 3.27 to 4.21 (P < .001, effect size = 0.50). Institutional childbirth rates increased from 0.52 to 0.71 (P < .001, effect size = 0.18). ANC attendance (B = 0.082, P = .002) and positive attitudes (B = 0.055, P < .001) were significant predictors of institutional childbirth. The SBCC intervention significantly enhanced maternal health knowledge, attitudes, ANC utilization, and institutional childbirth rates, highlighting the value of community-based strategies in improving maternal health behaviors.
Telemedicine in cancer care: lessons from COVID-19 and solutions for Europe
Gottlob A., Schmitt T., Frydensberg M.S., Rosińska M., Leclercq V., Habimana K.
Abstract
The COVID-19 pandemic challenged healthcare delivery, especially cancer care. Telemedicine emerged as an important tool to reduce disease transmission risks, maintain continuity of care, and improve accessibility. This study explores temporary measures during the pandemic as well as challenges and facilitators for integrating telemedicine into the European healthcare landscape in five case countries, focusing on cancer care. Expert interviews were conducted in five EU countries with diverse health systems: Austria, Belgium, Denmark, Italy, and Poland. A thematic analysis was performed. Themes were further explored related to regulatory changes during COVID-19 as well as barriers and facilitators to telemedicine implementation. COVID-19 accelerated telemedicine uptake and processes (i.e. regulations, reimbursement) in all case countries. Acceptance of telemedicine increased among healthcare professionals and patients. Post-pandemic telemedicine use and acceptance declined to pre-pandemic levels in some countries and was attributed to several factors including preferences for in-person visits. Overall, persistent barriers were identified by all country experts including lack of standardized policies, data privacy concerns, technological infrastructure issues, and digital literacy gaps. Telemedicine was validated by all country experts as an important tool to enhance cancer care access and efficiency and to help maintaining continuity of cancer care during crises. Our findings highlight some overlapping barriers and suggest solutions to overcome these barriers across the selected countries. Recommendations for policymakers are listed, emphasizing the importance of telemedicine services in improving healthcare access, efficiency, and resilience. Future research should incorporate diverse population studies, patient perspectives, cost-effectiveness, and policy impacts.
Physical activity partially mediates the association between health literacy and mild cognitive impairment in older adults: cross-sectional evidence from Switzerland
Meier C., Wieczorek M., Aschwanden D., Ihle A., Kliegel M., Maurer J.
Abstract
Individuals’ health literacy (HL) is positively associated with healthy behaviors and global cognitive functioning. Current evidence also suggests that physical activity may prevent or delay cognitive decline and dementia. This study examines the potential mediating role of physical activity in the association between HL and cognition in a population-based sample of adults aged 58+ in Switzerland. We used data from 1645 respondents to Wave 8 (2019/2020) of the Survey on Health, Ageing, and Retirement in Europe in Switzerland. HL was assessed using the HLS-EU-Q16 questionnaire. Mild cognitive impairment (MCI) was defined as a 1.5 SD below the mean of age- and education-specific global cognition score. The frequency of moderate and vigorous physical activity was self-reported. The associations were assessed using probit regression models, controlling for social, health, and regional characteristics. Structural equation modeling was used to test the mediation hypothesis. Higher HL was associated with a higher likelihood of being engaged in moderate (P < .001) and vigorous (P < .01) physical activity and with a lower likelihood of having MCI (P < .05). In addition, both moderate (P < .05) and vigorous (P < .01) physical activity were associated with a lower probability of having MCI. Mediation analysis indicated that the association between HL and MCI was partially mediated by both moderate (12.9%) and vigorous (6.7%) physical activity. Given that physical activity may partially mediate the association between HL and MCI, improving HL in older adults could potentially foster engagement in physical activity, which could, in turn, act as a protective factor against MCI.
Opinion of Polish doctors on the use of futile therapy
Damps M., Gajda M., Wiktor Ł., Byrska-Maciejasz E., Rybojad B., Kowalska M., Bartkowska-Śniatkowska A., Paprocka-Lipińska A., Kucewicz-Czech E.
Abstract
The discontinuation of futile therapy is increasingly discussed in Polish clinical practice. Given the need to ensure patient well-being, it is essential to consider whether all clinical options resulting from medical progress should be used for every patient and on what grounds decisions to limit therapy should be based. The aim of our study was to determine the opinions of Polish medical doctors on this topic. We anonymously surveyed physicians across various specialties. An analysis of the collected data was carried out using descriptive and analytical methods. A total of 323 physicians participated in the study; 93% of them were aware of the problem of futile therapy in adults, with intensivists being significantly more aware (P = 0.002). Additionally, 95% of respondents supported the idea of discontinuing futile therapy, and over 68% used the therapy discontinuation protocol. Among the most common reasons for undertaking futile therapy, respondents cited fear of legal liability (93.5%), as well as fear of being accused of unethical behavior (62.2%) and fear before talking to the patient/patient’s family and their reactions (57.9%). Respondents also identified factors that would facilitate making decisions about limiting futile therapy, including precise qualification criteria for limiting therapy and education in this area (95.3%), the patient’s declaration of will (87.5%), and a clear legal act (81.3%). The majority of study participants supported the idea of limiting futile therapy, and this issue is well known among Polish physicians.