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- Community surveillance of Staphylococcus aureus and presumptive MRSA nasal colonization in rural Portugal: The BI-STAPH Project—Phase 2: FundãoPublication . Costa, Rodrigo; Cordero, Ainhoa Ferreira; Ferreira, Francisco; Metello, João; Santos, Carina; Belo, João; Coelho, Patricia; Mateus, Sónia; Castelo Branco, Miguel; Rodrigues, FranciscoStaphylococcus aureus is one of the leading causes of both community- and healthcareassociated infections. Nasal colonization constitutes the primary reservoir for subsequent infection and transmission, while methicillin-resistant Staphylococcus aureus (MRSA) remains a major public health concern because of its resistance to multiple antimicrobial agents. However, data regarding community nasal colonization in rural Portuguese populations remain scarce. The BI-STAPH Project was established to address this knowledge gap through systematic surveillance of rural communities in inland Portugal. To estimate the prevalence of presumptive nasal colonization by Staphylococcus aureus and MRSA among adults living in the municipality of Fundão, Portugal, and to explore potential associations between colonization and demographic, behavioural, occupational, and environmental characteristics. A prospective community-based cross-sectional study was conducted as the second phase of the BI-STAPH Project. A total of 200 adults were recruited from different parishes of the municipality of Fundão. Bilateral nasal swabs were collected and processed using standardized microbiological methods for the presumptive identification of S. aureus. Presumptive MRSA isolates were investigated using a PBP2′ latex agglutination assay. Sociodemographic and exposure-related information was obtained through structured questionnaires. Associations between presumptive colonization and participant characteristics were evaluated using Pearson’s chi-square or Fisher’s exact tests, as appropriate. Presumptive S. aureus nasal colonization was identified in 56 of 200 participants, corresponding to a prevalence of 28.0% (95% CI: 21.8–34.2%). No presumptive MRSA-positive isolates were identified, corresponding to an observed prevalence of 0% (95% CI: 0.0–1.8%). Colonization prevalence was 29.5% among females and 26.8% among males, and ranged from 25.8% to 31.1% across age groups; neither sex nor age was significantly associated with colonization. Participants reporting daily animal cont act had a colonization prevalenceof 32.3%, compared with 20.5% among those without animal contact, but this difference was not statistically significant (p = 0.075). Overall, no statistically significant associations were identified between presumptive S. aureus colonization and the demographic, behavioural, occupational, or environmental variables evaluated. Presumptive S. aureus nasal colonization was common among adults living in the rural municipality of Fundão, Portugal, whereas no presumptive MRSA-positive isolates were identified in this study population. No statistically significant associations were observed between colonization and the characteristics evaluated. These findings expand the epidemiological evidence generated by the BI-STAPH Project and support continued community-based surveillance of S. aureus in rural Portugal. Future multicentre studies incorporating molecular confirmation, antimicrobial susceptibility testing, and larger populations will be important to better characterize circulating strains and transmission patterns within a One Health framework.
- Effects of multicomponent exercise on immunity, antibodies, and physical activity in older adults after COVID-19 vaccination: An RCT-feasibility studyPublication . Ferreira, Bruna Maria Palotino; Furtado, Guilherme Eustáquio; Gomes, Antonio Felipe Souza; Amaral, Jônatas Bussador do; Rodrigues, Francisco; Silva, Albená Nunes; RossiMarcelo; Bachi, André Luís Lacerda; Oliveira, Juliana da Silva; Santos, Clarice Alves dos; Vasconcelos, SauloBackground Immunosenescence contributes to reduced vaccine responsiveness and chronic low-grade inflammation in olderadults. Although regular physical exercise has been associated with improved immune function, evidence regarding thefeasibility and immunological effects of multicomponent exercise training (MET) following COVID-19 vaccinationremains limited. This pilot randomized feasibility trial aimed to assess the feasibility of implementing a 10-week METprogram and to explore its effects on functional fitness, physical activity, anthropometric measures, lipid profile, andimmuno-inflammatory markers in community-dwelling older adults after COVID-19 vaccination. Methods Twenty-three community-dwelling older adults (≥60 years) completed this randomized pilot feasibility trial and wereallocated to either a MET group (n = 10) or a Behavior Change Program (BCP) group (n = 13). Both interventions lasted10 weeks. Pre- and post-intervention assessments included functional fitness (Short Physical Performance Battery),physical activity levels, anthropometric measures, lipid and protein profiles, immunoglobulins (IgA, IgM, IgG), andcytokines (IL-2, IL-6, IL-10, TNF-α, and IFN-γ). Results The intervention proved feasible, with satisfactory adherence among participants completing the program and noexercise-related adverse events. The MET group demonstrated significant improvements in functional fitness (p =0.002; d = 1.90). Although physical activity levels showed a positive trend, changes did not reach statistical significance.Significant reductions in IL-2, IL-6, and TNF-α were observed following MET (all p ≤ 0.05), whereas the BCP groupexhibited increased IL-6 concentrations together with higher IL-2/IL-10 and IL-6/IL-10 ratios, suggesting a shift towarda more pro-inflammatory profile. Moderate-to-large effect sizes were also observed for improvements in selected lipidparameters, although most biochemical changes were not statistically significant. Conclusions This pilot feasibility trial demonstrated that a 10-week multicomponent exercise program can be safely implementedin community-dwelling older adults following COVID-19 vaccination and provides preliminary evidence of beneficialeffects on functional fitness and selected immuno-inflammatory markers. Given the small sample size, these findingsshould be interpreted cautiously and confirmed in adequately powered randomized controlled trials.
- Determinants of multidrug resistance among gram-positive uropathogens in Central Portugal: A 5 year retrospective studyPublication . Adnan, Muhammad; Patricia Coelho; Mateus, Sónia; Castelo Branco, Miguel; Rodrigues, FranciscoUrinary tract infections (UTIs) are among the most common bacterial infections worldwide. Although Gram-negative bacteria predominate, Gram-positive cocci (GPC) are increasingly recognized as significant uropathogens. This retrospective study analyzed 655 patients with culture-confirmed GPC UTIs in a hospital in Central Portugal (2018–2022) to identify predictors of multidrug resistance (MDR). MDR was defined as resistance to three or more antimicrobial classes. The overall MDR prevalence was 83.7%, with Enterococcus spp. showing the highest MDR prevalence (98.2%). Multivariate analysis identified older age as na independent predictor of MDR, whereas Staphylococcus and Streptococcus species were associated with significantly lower odds compared to Enterococcus. A temporal increase in MDR risk was observed in 2021 and 2022. Despite the high overall resistance rates observed, oxazolidinones and cyclic lipopeptides retained near-complete activity against all GPC isolates, reinforcing their role as last-line therapeutic options.
- From food systems to gut microbiota: Dietary substrates, microbial exposure and one healthPublication . Barreto, Inês R.; Eugénio, Ana; Cristóvão, Mário; Rodrigues, Francisco; Espírito Santo, Christophe; Brandão, InêsFood systems are usually discussed in terms of nutrition, food safety, productivity, sustainability or emissions. Less attention is given to the microbial dimension of the farm-to-fork pathway and to the way food systems shape the dietary substrates, food matrices and microbial exposures that reach the gut. Soils, plants, foods, processing environments, animals and the human gut all host microbial communities that influence nutrient cycling, plant performance, food characteristics, metabolism, immune regulation and ecological resilience. This review examines how food systems may modulate gut microbiota and microbiome resilience within a One Health framework. Evidence from soil, crop and food microbiome studies suggests that local conditions and farming practices can leave detectable microbial signatures on plants and edible tissues. However, the soil–food–gut continuum should not be understood as a simple transfer route. Microorganisms and microbial products are repeatedly filtered by plant traits, farming systems, animal-production interfaces, harvesting, processing, storage, preparation and host physiology. The review also considers how this continuity may be weakened or redirected. Agricultural intensification, pollutants, postharvest processing, antimicrobial use, ultra-processed foods, additive mixtures, low-fibre diets, early-life microbial disruption and reduced contact with environmental biodiversity may alter microbial communities at different points of the food system. Antimicrobial resistance is also discussed as a functional microbial trait that can circulate across human, animal, food and environmental interfaces. One Health approaches to food systems should therefore combine microbial risk control with microbial stewardship: protecting useful microbial diversity and function while preserving food safety. The aim is not to maximise microbial exposure, but to understand which microbial functions matter and how food systems can support gut microbiota resilience across environments, foods and hosts.
- Urinary tract infections in Portugal: A decade of evidence on uropathogens and antimicrobial resistance — A systematic reviewPublication . Rodrigues, Francisco; Coelho, Patricia; Mateus, Sónia; Eideh, Hatem; Castelo-Branco, MiguelBackground: Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and represent a significant public health concern due to their high prevalence and increasing antimicrobial resistance. This study aimed to systematically review the epidemiology, uropathogens, and resistance patterns of UTIs in Portugal over the last decade. Methods: A systematic review was conducted in accordance with PRISMA 2020 guidelines. A literature search was performed in April 2026. A total of 425 records were identified. After removal of duplicates and preliminary exclusions, 121 records were screened by title and abstract. Following application of eligibility criteria, 41 full-text articles were assessed, of which 13 met the criteria for detailed eligibility assessment. Six studies met the inclusion criteria and were included in the final qualitative synthesis. Results: The included studies consistently reported a higher prevalence of UTIs in females and, in some cases, in older populations. Escherichia coli was identified as the predominant uropathogen across all studies, followed by Klebsiella pneumoniae, Proteus spp., and Enterococcus spp. A consistently high prevalence of antimicrobial resistance was observed, particularly against commonly used antibiotics such as ampicillin and trimethoprim–sulfamethoxazole. The presence of extended-spectrum β-lactamase (ESBL)-producing strains was also reported, especially in healthcare-associated infections, which exhibited higher resistance profiles compared to community-acquired infections. Conclusions: The available evidence suggests that UTIs in Portugal are predominantly caused by enterobacteria, particularly Escherichia coli. However, the limited number and heterogeneity of studies highlight the need for cautious interpretation. Further multicenter and methodologically robust studies are required to better characterize national epidemiological patterns and antimicrobial resistance trends.
- Impact of cognitive distraction on driving performance and safety in older adults: A cluster analysis of age, gender, and functional mobilityPublication . Ayama, Sérgio; Greve, Júlia Maria D'Andréa; Silva, Vanderlei Carneiro da; Canonica, Alexandra Carolina; Lino, Matheus Henrique dos Santos; Guiotto, Alisson de Lima; Davis, Catherine L.; Soares, André Luiz de Seixas; Rodrigues, Francisco; Furtado, Guilherme Eustáquio; Brech, Guilherme Carlos; Castilho Alonso, AngelicaAny activity that diverts a driver's attention during vehicle operation may compromise driving performance and road safety. This study aimed to analyze the effect of conversational distraction on driving performance, examine the association of age and gender with braking time, and identify driver profiles potentially associated with increased traffic vulnerability. A total of 101 drivers participated: 51 older adults (mean age: 69.5 ± 5.9 years) and 50 younger adults (mean age: 33.4 ± 8.8 years). Driving performance was assessed using a simulator, with braking time and driving speed as primary outcomes. Cognitive function was evaluated using the Mini-Mental State Examination (MMSE), and mobility and balance were assessed using the Timed-Up and Go Test (TUGT), both with and without a cognitive task. Older adults exhibited significantly longer braking times compared to younger adults (p = 0.046). However, they also demonstrated lower driving speeds, both with distraction (p = 0.01) and without distraction (p = 0.003). Conversation did not increase braking time but reduced speed in older adults (p = 0.01), suggesting a compensatory driving strategy. Women, regardless of age group, showed significantly longer braking times both with (p < 0.001) and without distraction (p = 0.03). Cluster analysis identified two groups: Cluster 1 (n = 64, 63%) and Cluster 2 (n = 37, 37%). Cluster 2, characterized by a higher proportion of older adults, lower education levels, slower TUGT performance, longer braking times, and reduced driving speeds, accounted for 24.7% of the variance explained by the multivariate clustering solution. Age and female sex were associated with longer braking times. Although conversation did not increase braking time, it reduced speed among older adults, suggesting a compensatory strategy. Drivers who were older, less educated, and presented reduced functional mobility exhibited a performance profile associated with increased vulnerability in traffic contexts.
- Early cardiovascular risk indicators in school-aged children from inland Portugal: Elevated blood pressure at screening and the coexistence of underweight and excess weightPublication . Coelho, Patricia; Figueiredo, Ana; Mateus, Sónia; Furtado, Guilherme Eustáquio; Rodrigues, FranciscoBackground: Cardiovascular risk factors may emerge early in life and track into adulthood. Local data from inland and socioeconomically vulnerable regions remain limited. This study aimed to describe cardiovascular risk indicators in school-aged children from inland Portugal, focusing on body mass index (BMI), blood pressure (BP), and physical activity patterns. Methods: A cross-sectional school-based screening study was conducted in 101 children and adolescents aged 10–15 years. Anthropometric measurements and BP were obtained using standardized procedures. BMI categories were classified according to age- and sex-specific WHO references. BP was classified using European pediatric percentiles. Because measurements were obtained during a single visit, results were interpreted as elevated BP at screening. Associations between variables were explored using chi-square or Fisher’s exact tests and Spearman’s correlation. Results: The prevalence of underweight, normal weight, and overweight/obesity was 25.7%, 67.3%, and 6.9%, respectively. Overall, 24.8% of participants presented elevated BP at screening. The BMI category was significantly associated with BP classification (p = 0.003), and BMI correlated positively with systolic BP (ρ = 0.32; p = 0.001). Most children reported only school-based physical education. Conclusions: This school-based screening suggests a high proportion of elevated BP measurements and an unexpectedly high prevalence of underweight children, indicating the coexistence of different nutritional vulnerabilities. Findings should be interpreted cautiously due to the small, single-school sample and single-occasion BP assessment but support the importance of early cardiovascular risk monitoring in vulnerable settings.
- Prevalence, determinants, and temporal dynamics of multidrug-resistant Gram-negative bacilli in urinary tract infection patients from Central Portugal (2018–2022)Publication . Adnan, Muhammad; Coelho, Patricia; Castelo-Branco, Miguel; Rodrigues, FranciscoBackground: Multidrug-resistant (MDR) Gram-negative bacilli (GNBs) significantly compromisse the effective management of urinary tract infections (UTIs) worldwide. As antimicrobial resistance varies across regions, locally tailored data are essential to guide empirical therapy. This study investigated the prevalence, determinants, and temporal dynamics of MDR GNBs in UTI patients from Central Portugal between 2018 and 2022. Methods:We conducted a retrospective observational study at a hospital center in Central Portugal, analyzing data from 2018 to 2022. Data from 5194 UTI patients with GNB-positive cultures were analyzed. Binary logistic regression was used to identify determinants of MDR GNBs, defined as resistance to ≥1 agent in ≥3 antibiotic classes. Results: The study population had a mean age of 64.5 ± 25.3 years, and females represented two-thirds of the sample (67.0%). The overall prevalence of MDR GNBs was 35.8%. Advanced age (≥75 years), male sex, and specific treatment contexts—particularly day treatment and laboratory-only cases—were independently associated with MDR. SBL-producing Enterobacterales and non-fermenting GNBs showed the highest risk levels. Conclusions: MDR GNBs are highly prevalent among UTI patients in Central Portugal, and their increasing trend—particularly in 2022—highlights an urgent need for strengthened surveillance and updated empirical treatment strategies. The observed temporal increase highlights the urgent need for strengthened regional surveillance and updated empirical treatment guidelines.
- The influence of structured physical activity on vaccination response from adults to older individuals: a systematic review on the Immunoinflammatory crosstalk of COVID-19Publication . Ferreira, Bruna Maria Palotino; Rocha, Saulo Vasconcelos; Silva, Albená Nunes; Gomes, Antonio Felipe Souza; Rodrigues, Francisco; Coelho, Patricia; Bachi, André Luís Lacerda; Oliveira, Rodrigo Assunção de; Barros, Marcelo Paes de; Furtado, Guilherme EustáquioBackground: Amidst the ongoing COVID-19 pandemic, understanding factors that influence vaccine efficacy is crucial, particularly in older adults. Regular physical exercise and/or structured physical activity (SPA) has emerged as a potential modulator of immune responses, enhancing vaccine effectiveness. This systematic review aims to consolidate current evidence on the impact of SPA/exercise on both immune and inflammatory responses to COVID-19 vaccination in adults and older individuals. Methods: Most relevant studies were extracted from indexed databases using health subject terms in English, Portuguese, and Spanish. Studies that examined the impact of regular exercise or SPA on inflammatory and/or immunological responses in relation to COVID-19 immunization were selected. In particular, all chosen studies included individuals who received vaccinations either prior to or following the exercise regimen or SPA, and the main goal was to evaluate these effects on immunological and/or inflammatory reactions induced by vaccination. Results: Among the 7 studies included (n = 1149), the effects of regular exercise or PA on vaccine-induced imune responses while concurrently assessing inflammatory markers were examined. The findings suggest that moderate to high-intensity structured physical activity (50–70% of maximum heart rate for aerobic exercise and 60–80% of 1RM for resistance training), performed 3–5 times per week, was able to enhance immune responses to COVID-19 vaccination, particularly by mitigating chronic low-grade inflammation. Acute exercise can transiently boost immunity, whilst engagement in moderate SPA over a period of six months may contribute to sustained improvements in imune function, especially in older adults. However, these findings should be interpreted with caution due to variability in study design, sample characteristics, and potential confounding factors. Conclusion: Regular exercise and SPA play a significant role in improving immune/inflammatory responses to COVID-19 vaccination. Older adults, in particular, may benefit from regular SPA and exercise as a strategy to counteract immunosenescence and optimize vaccine efficacy. However, further research is needed to better refine exerciseprotocols and determine long-term benefits in different populations.
- Community surveillance of MRSA and Staphylococcus aureus in rural Portugal: The BI-STAPH Project—Phase 1: SertãPublication . Cordero, Ainhoa; Ferreira, Francisco; Coelho, Patricia; Belo, João; Metello, João; Santos, Carina; Mateus, Sónia; Miguel Castelo-Branco; Rodrigues, FranciscoIntroduction: Colonization by Staphylococcus aureus—including methicillin-resistant strains (MRSA)—represents a growing public health concern, particularly in community and rural settings. In Portugal, limited data are available regarding its prevalence in populations with agricultural or animal-related exposures. Objectives: To determine the prevalence of S. aureus and MRSA nasal colonization among adults residing in the municipality of Sertã, Portugal, and to explore potential sociodemographic and behavioral factors associated with colonization. Methods: A cross-sectional study was conducted with 292 adult participants from multiple parishes of Sertã. Nasal swabs were collected for microbiological identification of S. aureus and MRSA. Data on sociodemographic characteristics, occupational exposure, animal contact, and recent antibiotic use were collected via structured questionnaires. Descriptive statistics and inferential analyses (chi-square and Fisher’s exact tests) were performed, and odds ratios were estimated. Results: The overall prevalence of S. aureus colonization was 19.9% (58/292), with MRSA detected in 4.8% (14/292) of participants, representing 24.1% of all S. aureus carriers. Colonization by S. aureus was slightly more frequent among females (51.7%) and predominantly observed in individuals aged 35–59 years. MRSA was more frequent in participants aged ≥ 60 years and was equally distributed between sexes. 57% of MRSA cases reported recent antibiotic use and all MRSA cases reported daily contact with animals—primarily domestic species. No statistically significant associations were identified between colonization and the analyzed variables, although trends suggested increased risk among individuals with animal contact and moderate to high-risk occupations. Conclusions: This study revealed a notable prevalence of S. aureus and MRSA colonization in a rural Portuguese population. Although no statistically significant associations were found, with animal contact, occupational exposure, and recent antibiotic use emerged as relevant epidemiological factors. These findings highlight the need for strengthened surveillance and further investigation into zoonotic transmission and occupational risk in rural environments.