Cause-Specific Excess Mortality During the COVID-19 Pandemic (2020-2021) in 12 Countries of the C-MOR Consortium.

BACKGROUND: This study investigated cause-specific mortality rates in 12 countries during the COVID-19 pandemic in 2020 and 2021. METHODS: We collected weekly cause-specific mortality data from respiratory disease, pneumonia, cardiovascular disease (CVD) and cancer from national vital statistic databases. We calculated excess mortality for respiratory disease (excluding COVID-19 codes), pneumonia, and CVD in 2020 and 2021 by comparing observed weekly against expected mortality based on historical data (2015-2019), accounting for seasonal trends. We used multilevel regression models to investigate the association between country-level pandemic-related variables and cause-specific mortality. RESULTS: Significant reductions in cumulative mortality from respiratory disease and pneumonia were observed in 2020 and/or 2021, except for Georgia, Northern Ireland, Kazakhstan, and Ukraine, which exhibited excess mortality for one or both causes. Australia, Austria, Cyprus, Georgia, and Northern Ireland experienced excess cumulative CVD mortality in 2020 and/or 2021. Australia, Austria, Brazil, Cyprus, Georgia, Northern Ireland, Scotland and Slovenia, experienced increased crude cumulative cancer mortality during 2020 and/or 2021 compared to previous years. Among pandemic-related variables, reported COVID-19 incidence was negatively associated with increased cancer mortality, excess respiratory, (2020) and pneumonia (2021) mortality, and positively associated with respiratory and CVD mortality (2021). Stringency of control measures were negatively associated with excess respiratory disease, CVD, and increased cancer mortality (2021). CONCLUSIONS: This study provides evidence of substantial excess mortality from CVD, and notable reductions in respiratory disease and pneumonia in both years across most countries investigated. Our study also highlights the beneficial impact of stringent control measures in mitigating excess mortality from most causes in 2021.

Polycyclic aromatic hydrocarbons (PAHs) in men and lactating women in Slovenia: Results of the first national human biomonitoring.

In the first national human biomonitoring study in the Slovenian population of adults (18-49 years), including men (n = 297) and lactating primiparous women (n = 304), exposure to polycyclic aromatic hydrocarbons (PAHs) was evaluated. Nine urinary metabolites of four parent PAHs were determined. These included 1-hydroxypyrene (1-OHPYR), 2-hydroxynaphthalene (2-OHNAP), 2-hydroxyphenanthrene (2-OHPHE), 3-hydroxyphenanthrene (3-OHPHE), 4-hydroxyphenanthrene (4-OHPHE), a combination of 2-hydroxyfluorene and 3-hydroxyfluorene (2/3-OHFLU) and a combination of 1-hydroxyphenanthrene and 9-hydroxyphenanthrene (1/9-OHPHE). For comparison, the analysed phenanthrene metabolites were reported as a sum (ΣOHPHE = 1/9-OHPHE + 2-OHPHE + 3-OHPHE + 4-OHPHE) and all the analysed PAH metabolites were reported as a sum (ΣOHPAH = 1-OHPYR + 2/3-OHFLU + 2-OHNAP + ΣOHPHE). All metabolites or their combinations were determined in more than 91% of the samples, except 4-OHPHE, which was determined in only 5% of the samples. The highest concentration was found for 2-OHNAP. This was followed by 2/3-OHFLU and the phenanthrene metabolites, while the lowest concentration was determined for 1-OHPYR. Among the phenanthrene metabolites, the highest concentration was determined for 2-OHPHE, followed by 1/9-OHPHE and then by 3-OHPHE. Values in units of volume and values adjusted for specific gravity were significantly higher in men than in lactating primiparous women for all metabolites, whereas values in units adjusted for creatinine were generally higher in lactating primiparous women than in men. The difference between the two study groups, men and lactating primiparous women, was no longer significant in statistical models adjusted for specific gravity, suggesting that smoking, wood-burning exposure, and/or education largely explained the difference in PAH exposure in both study groups. For most metabolites, predictors of exposure were less significant in lactating primiparous women than in men. Also, site-specific patterns of exposure were observed, with additional predictors identified in certain areas, namely, proximity to roads and release of particulate matter (PM10) from industry. The time of year in which sampling took place appeared to be an important determinant in urban areas and in the case of participants who used wood for heating. Specific dietary factors could not be identified, as the study questionnaire did not include information on PAH-related diet. Despite the low number of paired partners (women and men living in the same household, n = 84), significant positive correlations for all metabolites were observed. This indicated that 31%-56% of variability in exposure could be explained by shared exposure to sources within the households (such as diet and wood-burning-related determinants).

Seasonal glyphosate and AMPA levels in urine of children and adolescents living in rural regions of Northeastern Slovenia.

There are extensive data on the toxicity of glyphosate (GLY) based herbicides (GBH), however the interpretation of some data (e.g. carcinogenic effect) are subject to controversy. For the appropriate health risk assessment more data on exposure levels in the general population, especially in susceptible groups such as pregnant women, the elderly and children are needed. The aims of the present study were to estimate the exposure to GLY and its major metabolite aminomethylphosphonic acid (AMPA) in children and adolescents living in agricultural areas, to identify possible determinants of the exposure, and to assess co-exposure with elements. In total, 149 children (aged 7-10 years, 55% girls) and 97 adolescents (aged 12-15 years; 44% girls) were recruited in 2018 from rural areas of Northeastern Slovenia. The effect of seasonal GLY application on the exposure was estimated using GLY and AMPA levels determined by GC-MS/MS in first morning urine in winter (n = 246) and in late-spring/early-summer seasons (n = 225). Levels of elements were determined by ICP-MS in urine in both samplings and in blood or plasma in the first sampling. Questionnaire data on basic characteristics, dietary habits, living environments and use of pesticides were obtained for all participants. GLY and AMPA were detected in 27% and 50% of urine samples from the first sampling period, respectively; and in 22% and 56% from the second sampling period, respectively. Geometric means and medians of both AMPA and GLY were below or at the limit of quantification (≤LOQ; 0.1 µg/L). Children rather than adolescents tended to have higher exposure, as did, boys rather than girls among adolescents. The exposure did not significantly differ between both sampling periods. Except for one individual, exposure was not higher among participants who reported use of GLY or herbicides in the vicinity of child's home or live in close vicinity of agriculture, orchards, vineyards, gardens, sport courts or cemeteries. The extensive food consumption frequency data revealed higher exposure to GLY and AMPA only among individuals with higher consumption of nuts and wholegrain rice. Levels of AMPA and GLY were significantly positively correlated, with considerably stronger correlation in urine of the second than the first sampling (Spearman's rank coefficient: 0.49 vs 0.22, respectively). Urine levels of As, Pb, Co, Zn and Cu were significantly higher in participants with GLY and/or AMPA levels ≥LOQ than with levels

Contribution of Drinking Water Softeners to Daily Phosphate Intake in Slovenia.

The cumulative phosphate intake in a typical daily diet is high and, according to several studies, already exceeds recommended values. The exposure of the general population to phosphorus via drinking water is generally not known. One of the hidden sources of phosphorus in a daily diet is sodium polyphosphate, commonly used as a drinking water softener. In Slovenia, softening of drinking water is carried out exclusively within the internal (household) drinking water supply systems to prevent the accumulation of limescale. The aim of the study was to determine the prevalence of sodium phosphates in the drinking water in Slovenia in different types of buildings, to determine residents' awareness of the presence of chemical softeners in their drinking water, and to provide an exposure assessment on the phosphorus intake from drinking water. In the current study, the presence of phosphates in the samples of drinking water was determined using a spectrophotometric method with ammonium molybdate. In nearly half of the samples, the presence of phosphates as water softeners was confirmed. The measured concentrations varied substantially from 0.2 mg PO4/L to 24.6 mg PO4/L. Nearly 70% of the respondents were not familiar with the exact data on water softening in their buildings. It follows that concentrations of added phosphates should be controlled and the consumers should be informed of the added chemicals in their drinking water. The health risks of using sodium polyphosphate as a drinking water softener have not been sufficiently investigated and assessed. It is highly recommended that proper guidelines and regulations are developed and introduced to protect human health from adverse effects of chemicals in water intended for human consumption.

Consumption of fruits and vegetables and probabilistic assessment of the cumulative acute exposure to organophosphorus and carbamate pesticides of schoolchildren in Slovenia.

OBJECTIVE: Adequate consumption of fruits and vegetables is a part of recommendations for a healthy diet. The aim of the present study was to assess acute cumulative dietary exposure to organophosphorus and carbamate pesticides via fruit and vegetable consumption by the population of schoolchildren aged 11-12 years and the level of risk for their health. DESIGN: Cumulative probabilistic risk assessment methodology with the index compound approach was applied. SETTING: Slovenia, primary schools. SUBJECTS: Schoolchildren (n 1145) from thirty-one primary schools in Slovenia. Children were part of the PRO GREENS study 2009/10 which assessed 11-year-olds' consumption of fruit and vegetables in ten European countries. RESULTS: The cumulative acute exposure amounted to 8.3 (95% CI 7.7, 10.6) % of the acute reference dose (ARfD) for acephate as index compound (100 µg/kg body weight per d) at the 99.9th percentile for daily intake and to 4.5 (95% CI 3.5, 4.7) % of the ARfD at the 99.9th percentile for intakes during school time and at lunch. Apples, bananas, oranges and lettuce contributed most to the total acute pesticides intake. CONCLUSIONS: The estimations showed that acute dietary exposure to organophosphorus and carbamate pesticides is not a health concern for schoolchildren with the assessed dietary patterns of fruit and vegetable consumption.

Prediction of cadmium concentration in selected home-produced vegetables.

Soil contaminated with cadmium presents a potential hazard for humans, animals and plants. The latter play a major role in the transfer of cadmium to the food chain. The uptake of cadmium and its accumulation by plants is dependent on various soil, plants and environmental factors. In order to identify soil properties with statistically significant influence on cadmium concentration in vegetables and to reduce the collection of data, time and costs, regression models can be applied. The main objective of this research was to develop regression models to predict the concentration of cadmium in 9-vegetable species: zucchini, tomato, cabbage, onion, potato, carrot, red beet, endive and chicory, based on soil properties. Soil samples were collected from 123 home gardens of the Municipality of Celje and 59 of these gardens were also included in vegetable sampling. The concentration of elements (e.g. arsenic, cadmium, copper, lead, and zinc) in the samples was determined by Inductively Coupled Plasma Mass Spectrometry. Single (for cabbage, potato, red beet and chicory) and multiple (for tomato, onion, carrot and endive) linear regression models were developed. There was no statistically significant regression model for zucchini. The most significant parameter for the influencing the cadmium concentration in vegetables was the concentration of cadmium in soil. Other important soil properties were the content of organic matter, pH-value and the concentration of manganese. It was concluded that consuming carrots, red beets, endives, onions, potatoes and chicory which are grown in gardens with Cd concentrations (mgkg(-1) DW) above 2.4, 3.2, 6.3, 7.9, 8.3 and 10.9, respectively, might represent an important contribution to dietary Cd exposure.

Interregional differences in health in Slovenia. II. Estimated prevalence of selected behavioral risk factors for cardiovascular and related diseases.

AIM: To estimate the prevalence of selected behavioral risk factors for cardiovascular and related diseases in western, central, and eastern region of Slovenia and to determine interregional differences. METHODS: A national survey on health status and health behavior of the adult population included 15,379 Slovene inhabitants, aged 25 to 64. The overall response rate to a mailed questionnaire was almost 64%, and 9,043 questionnaires were eligible for analysis. Prevalence rates per 100 population (smoking, nutrition, alcohol intake, physical activity, stress) were determined, chi-square test was used for global assessment of interregional differences, and logistic regression for adjusting them for sex and age. RESULTS: Interregional differences in prevalence were observed in very unhealthy nutrition related to obesity and diabetes (west: 34.0, center: 30.6, east: 41.8; p<0.001), very unhealthy nutrition related to hypertension (west: 25.5, center: 29.4, east: 28.4; p=0.011), very unhealthy nutrition related to atherosclerosis-based diseases (angina pectoris, myocardial and brain infarction, etc.) (west: 33.1, center: 31.8, east: 44.1; p<0.001), heavy alcohol drinking (west: 11.2, center: 12.0, east: 15.2; p<0.001), and physical inactivity (west: 18.0, center: 21.0, east: 15.3; p<0.001), but not in smoking (west: 22.4, center: 24.5, east: 23.9; p=0.230) or stress (west: 23.2, center: 24.4, east: 24.7; p=0.388). CONCLUSION: We confirmed significant interregional differences in the prevalence of most observed behavioral risk factors. In behaviors with statistically significant interregional differences, the highest prevalence was confirmed for eastern Slovenia.

Exposure assessment of male recruits in Slovenia to cadmium and lead due to biological monitoring.

AIMS: In Slovenia, there were no data available for an assessment of cadmium and lead levels in the population till 2001. The present study was conducted to evaluate the cadmium and lead burden from all sources (air, food, water) with the aim of obtaining initial information on cadmium and lead levels in blood of healthy and occupationally unexposed young males. METHODS: There were 464 participants included in the analysis of blood cadmium and lead levels, aged between 18 and 27 years, the median age being 20 years. Blood samples of maximum 2 ml were taken from the cubital vein for analysis of cadmium and lead levels. RESULTS: There were 463 blood samples analyzed for cadmium and 464 for lead. Of all tested persons, 38.2% had less than 0.5 microg/l of cadmium in their blood and 28.2% up to 1 microg/l. The median level of blood cadmium was 0.5 microg/l. The percentage of recruits with blood lead level over 100 microg was 3.1%. The median level of blood lead was 35 microg/l. The differences in blood levels of both pollutants were statistically significant with regard to the region of permanent residence (P<0.001). CONCLUSIONS: The results of the study give a good assessment of cadmium and lead burdening of young Slovene male population. The information obtained provides a foundation for further comparative research at the international level as well as for further study and risk assessment of individual population groups exposed to greater risk due to their lifestyle and eating habits.

Cadmium measurements in blood and hair of occupationally non-exposed military recruits and in the foods of plant origin produced in Slovenia.

AIM: To determine cadmium content in the most frequently consumed foods of plant origin grown in different regions of Slovenia, assess cadmium content in the biological materials (blood and hair) from Slovenian young men, and verify the hypothesis that the cadmium pollution of the environment varies across regions in Slovenia. METHODS: We analyzed cadmium concentration in 982 composite samples of foods of plant origin, and determined the cadmium burden in the population by analyzing cadmium content in whole blood and hair samples from 742 randomly selected healthy men aged 18-26 years. RESULTS: There were significant differences in cadmium content in the analyzed foods with respect to the regions in Slovenia where were the foods of plant origin were produced (p<0.001). The median cadmium content in 463 blood specimens was 0.5 microg/L, and 4 ng/g in 245 hair specimens. Cadmium content in the blood and hair samples from study participants varied significantly across regions in Slovenia (p<0.001 and p<0.003, respectively). Cadmium content in foods of plant origin and cadmium burden in the blood showed only a weak correlation (Spearman's r=0.13), whereas the correlation between cadmium content in the foods and hair was much stronger (Spearman's r=0.55). CONCLUSION: Our research confirmed the hypothesis of regionally different environmental pollution with cadmium, and clearly showed the connection between cadmium burden in foods and in population in Slovenia.

Assessment of dietary intake of cadmium, lead and mercury via foods of the plant and animal origin in Slovenia.

Due to lack of data the Slovene Ministry of Health--Department of Health Inspection initiated a study of dietary intake of contaminants at the national level. The Institute of Public Health Celje conducted two phases of the study: The assessment of dietary intake of cadmium, lead and mercury in foods of the plant (1st phase) and animal origin (2nd phase). 1583 samples from 17 groups of plant and 11 groups of animal origin foods were taken in total. Sampling was implemented in nine Slovene regions, and thus at least 6 randomly composed samples of foods from the particular group were taken in each region. For assessment of dietary intake of different food items national food consumption data were applied. The estimated weekly intake of cadmium with foods of plant and animal origin that represent 84.6% of total food intake is 91.7 ig (18.8% of PTWI for cadmium. The weekly lead intake with foods of plant and animal origin is 422.3 g (24.2% PTWI for lead). The mercury content in foods disposable in Slovenia is low, therefore, the quantity of mercury consumed with analysed foods is 12.3% of PTWI for mercury.