Instituto de Investigação e Inovação em Saúde

Cancer literacy is currently one of the most important dimensions of cancer continuum. Objective assessment of cancer knowledge in populations remains a challenging field to public health entities. Different evaluation tools are currently available; still, some groups remain disregarded due to the absence of validated instruments. Cancer literacy in adolescents and young adults has been clearly overlooked being a subject that requires new tools to be properly studied. To address this topic, we developed a new instrument and field tested it in a classroom environment for internal reliability, construct, and face validity. BStudents Knowledge and Perceptions about Cancer questionnaire^ was designed in Portuguese language and adapted to the Portuguese context by a multidisciplinary team. The final version of the questionnaire includes 35 items organized in three sections, encompassing knowledge and perceptions about cancer and socio-biographic data. Cancer experts ensured content validity, while tailoring of contents was refined with high school teachers. Test and retest of the instrument showed a good reliability of the scale and construct validity. Also, the clarity of the questionnaire and suitability to proper evaluate cancer knowledge was consistent between test and retest. The Students' Knowledge and Perceptions About Cancer Questionnaire (SKPaC) showed to be a valid tool to assess adolescents' knowledge and perceptions about cancer that can be used in the educational context.

Cancer is one of the leading causes of death worldwide, and thus represents a priority for national public health programs. Prevention has been assumed as the best strategy to reduce cancer burden, however most cancer prevention programs are implemented by healthcare professionals, which constrain range and educational impacts. We developed an innovative approach for cancer prevention education focused on high-school biology teachers, considered privileged mediators in the socialization processes. A training program, ''Cancer, Educate to Prevent'' was applied, so that the teachers were able to independently develop and implement prevention campaigns focused on students and school-related communities. The program encompassed different educational modules, ranging from cancer biology to prevention campaigns design. Fifty-four teachers were empowered to develop and implement their own cancer prevention campaigns in a population up to five thousands students. The success of the training program was assessed through quantitative evaluation-questionnaires focused on teachers' cancer knowledge and perceptions, before the intervention (pre-test) and immediately after (post-test). The projects developed and implemented by teachers were also evaluated regarding the intervention design, educational contents and impact on the students' knowledge about cancer. This study presents and discusses the results concerning the training program ''Cancer, Educate to Prevent'' and clearly shows a significant increase in teacher's cancer literacy (knowledge and perceptions) and teachers' acquired proficiency to develop and deliver cancer prevention campaigns with direct impact on students' knowledge about cancer. This pilot study reinforces the potential of high-school teachers and schools as cancer prevention promoters and opens a new perspective for the development and validation of cancer prevention education strategies, based upon focused interventions in restricted targets (students) through non-health professionals (teachers).

Cancer represents one of the main causes of death worldwide; consequently, preventive interventions are of utmost importance in public health education. The leading model of cancer prevention campaigns is based on general and undifferentiated actions mediated by health professionals, fo-cusing on the technical and scientific information but rather ineffective in changing the symbolic, cognitive and practical relationship with the disease. New intervention models are thus required to address cancer literacy, being early interventions targeted to specific groups an elective counterpoint to contribute to positive and durable changes in cancer prevention. Our aim is to evaluate the feasibility and impact of cancer prevention programmes planned as focused interventions in restricted targets and mediated by non-healthcare professionals to increase cancer literacy and promote preventive behaviours. This pilot study evaluates schools' potential as a vehicle for cancer prevention education in a reality shaped by traditional health prevention campaigns. We developed a protocol of systematic surveying in order to review and, in the future, optimize and replicate this ecological model of intervention to other groups and contexts. The implementation of this model has been successful in which concerns to the effectiveness of the training programme for teachers. This led to the development of impactful cancer prevention education projects by trainees targeted to their students, allowing us to argue that it contributes to knowledge and practice in this complex as consensual priority area of intervention.

Neste artigo tenta-se explorar as estratégias de integração do mainstreaming de género e das ações específicas de apoio à igualdade de mulheres e homens nos programas operacionais (PO) do Fundo Social Europeu (FSE) e do Fundo Europeu de Desenvolvimento Regional (FEDER). Perspetiva-se a integração das questões de género na programação, dando-se a conhecer a forma como a igualdade de género foi pensada em sede de planeamento do Quadro de Referência Estratégico Nacional e em sede de regulamentação da execução do FSE e do FEDER. Os resultados apresentados derivam das análises produzidas sobre os documentos estratégicos disponíveis de cada PO.

Background: Estimates predict that more than half of all cancers are due to inadequate lifestyle choices. Smartphones can be successfully used to support the behaviour change needed to prevent cancer.
Objective: The purpose of this study was to field-test Happy, a smartphone app designed to promote cancer prevention behaviours, based on tailored-messages.
Methods: Thirty-two participants downloaded and used the app for 28 consecutive days (4 weeks). At the end of this period, they all answered an online questionnaire and ten of them were interviewed. Usability, feasibility, message receptivity, and perceived impact of the app were assessed.
Results: Compliance with cancer prevention guidelines was lower than expected. Happy was considered simple, intuitive and easy to use. Messages sent by the app were considered easy to understand, providing good advice and meaningful information that catch reader’s attention. Participants also considered that Happy might be an effective way to promote cancer prevention. Collected data showed an increased frequency in several cancer prevention related behaviours and an increase in the overall putative cancer prevention level.
Conclusions: This study showed the viability of designing and implementing smartphone-based interventions to promote cancer prevention behaviours. The results suggest that Happy is usable and might help users change their behaviour towards healthier choices and thus reduce their personal cancer risk.

Objectives: This study sought to explore the views and experiences of healthy young adults concerning the fundamental features of a cancer prevention smartphone app that seeks behaviour change.
Methods: Three focus groups were conducted with 16 healthy young adults that explored prior experiences, points of view and opinions about currently available health-related smartphone apps. Then, an online questionnaire was designed and applied to a larger sample of healthy young adults. Focus group and online questionnaire data were analysed and confronted.
Results: Study results identified behaviour tracking, goal setting, tailored information and use of reminders as the most desired features in a cancer prevention app. Participants highlighted the importance of privacy and were reluctant to share personal health information with other users. The results also point out important dimensions to be considered for long-term use of health promotion apps related with usability and perceived usefulness. Participants didn’t consider gamification features as important dimensions for long-term use of apps.
Conclusions: This study allowed the definition of a guideline set for the development of a cancer prevention app.

This chapter explores the potential of smartphones on cancer prevention. The acceptability of mobile health (mhealth) technologies as promoters of behavior change and the identification of desired features necessary to prototype a cancer prevention app were assessed in a target population.
It is estimated that, by the year 2030, cancer will affect more than 26 million people worldwide and over 17 million will die from this disease (IARC, 2008; Jemal, Bray, Ferlay, Ward, & Forman, 2011). More than half of cancer cases are due to unhealthy behavioral options (Colditz & Wei, 2012); if every- one adopt a healthier lifestyle, cancer incidence would fall dramatically (Colditz & Wei, 2012; Colditz, Wolin, & Gehlert, 2012). Research has shown that there is a link between knowledge and the adoption of healthy behaviors (Hawkins, Berkowitz, & Peipins, 2010; Keeney, McKenna, Fleming, & McIlfat- rick, 2010; Niederdeppe & Levy, 2007). Still, exceptions remain, being smokers the most paradigmatic example: despite all the warnings and campaigns designed to promote smoking cessation, many people continue to smoke (International Union Against Cancer, 2004). Information campaigns are needed to increase cancer awareness but they simply are not enough to promote behavior change.

Tobacco and alcohol consumption, excessive sun exposure and lack of physical exercise are important risk factors for cancer. In fact, more than half of cancer cases are due to wrong behavioural options; if everyone adopted a healthier lifestyle, cancer incidence would fall dramatically. Information campaigns are critical to raise cancer awareness but they simply are not enough to promote behaviour change.

The main purpose of the work presented in this paper is to develop a smartphone app, capable of inducing behaviour changes on individuals. A cancer prevention app called Happy was designed and is currently being tested. Preliminary results from a feasibility study show that Happy might be an effective health promotion app, capable of persuading users to change their behaviour towards cancer prevention.

Mobile seamless learning provides the foundation for new digital solutions capable of adapting the contents to the learner needs and contexts. Studies have shown that cancer prevention knowledge remains reduced in modern societies. Given the worldwide burden of cancer, there is a need to increase cancer literacy in the populations, namely through the development of innovative strategies. This paper describes a 3 months two-arm quasi-experimental effectiveness study of a new mobile seamless learning tool for cancer education. Results showed that this application significantly increased cancer prevention knowledge of the users when compared to a control population (p < 0.001). This study provides evidence that a mobile seamless education tool can merge into the users’ daily routine increasing users’ knowledge by providing relevant cancer prevention information through messages delivered over an extended period of time. These innovative health education solutions will further expand the context of a smart learning ecosystem.

Carbapenems are the most potent β-lactam antibiotics and key drugs for treating infections by Gram-negative bacteria. In such organisms, β-lactam resistance arises principally from β-lactamase production. Although carbapenems escape the activity of most β-lactamases, due in the class A enzymes to slow deacylation of the covalent acylenzyme intermediate, carbapenem-hydrolyzing class A β-lactamases are now disseminating in clinically relevant bacteria. The reasons why carbapenems are substrates for these enzymes, but inhibit other class A β-lactamases, remain to be fully established. Here, we present crystal structures of the class A carbapenemase SFC-1 from Serratia fonticola and of complexes of its Ser70 Ala (Michaelis) and Glu166 Ala (acylenzyme) mutants with the carbapenem meropenem. These are the first crystal structures of carbapenem complexes of a class A carbapenemase. Our data reveal that, in the SFC-1 acylenzyme complex, the meropenem 6α-1R-hydroxyethyl group interacts with Asn132, but not with the deacylating water molecule. Molecular dynamics simulations indicate that this mode of binding occurs in both the Michaelis and acylenzyme complexes of wild-type SFC-1. In carbapenem-inhibited class A β-lactamases, it is proposed that the deacylating water molecule is deactivated by interaction with the carbapenem 6α-1R-hydroxyethyl substituent. Structural comparisons with such enzymes suggest that in SFC-1 subtle repositioning of key residues (Ser70, Ser130, Asn132 and Asn170) enlarges the active site, permitting rotation of the carbapenem 6α-1R-hydroxyethyl group and abolishing this contact. Our data show that SFC-1, and by implication other such carbapenem-hydrolyzing enzymes, uses Asn132 to orient bound carbapenems for efficient deacylation and prevent their interaction with the deacylating water molecule.