Structural Racism as a Contributor to Lung Cancer Incidence and Mortality Rates Among Black Populations in the United States.

BACKGROUND: Although racial disparities in lung cancer incidence and mortality have diminished in recent years, lung cancer remains the second most diagnosed cancer among US Black populations. Many factors contributing to disparities in lung cancer are rooted in structural racism. To quantify this relationship, we examined associations between a multidimensional measure of county-level structural racism and county lung cancer incidence and mortality rates among Black populations, while accounting for county levels of environmental quality. METHODS: We merged 2016-2020 data from the United States Cancer Statistics Data Visualization Tool, a pre-existing county-level structural racism index, the Environmental Protection Agency's 2006-2010 Environmental Quality Index (EQI), 2023 County Health Rankings, and the 2021 United States Census American Community Survey. We conducted multivariable linear regressions to examine associations between county-level structural racism and county-level lung cancer incidence and mortality rates. RESULTS: Among Black males and females, each standard deviation increase in county-level structural racism score was associated with an increase in county-level lung cancer incidence of 6.4 (95% CI: 4.4, 8.5) cases per 100,000 and an increase of 3.3 (95% CI: 2.0, 4.6) lung cancer deaths per 100,000. When examining these associations stratified by sex, larger associations between structural racism and lung cancer rates were observed among Black male populations than among Black females. CONCLUSION: Structural racism contributes to both the number of new lung cancer cases and the number of deaths caused by lung cancer among Black populations. Those aiming to reduce lung cancer cases and deaths should consider addressing racism as a root-cause.

Analysis of Hospitalizations and Deaths due to Stroke in Different Regions of Brazil Before and During the COVID-19 Pandemic / Análisis de Hospitalizaciones y Muertes por Accidente Cerebrovascular en Diferentes Regiones de Brasil Antes y Durante la Pandemia de COVID-19 / Análise das internações e óbitos por Acidente Vascular Cerebral em diferentes regiões do Brasil antes e durante a Pandemia de COVID-19

Considered the second leading cause of death worldwide, Stroke poses a significant public health issue, also responsible for a substantial disability burden, with COVID-19 potentially predisposing individuals to cerebrovascular complications. Objective: To analyze stroke admissions and deaths in different regions of Brazil, before and during the COVID-19 pandemic. Methodology: An observational ecological time series study utilizing secondary data from the Hospital Information Systems (SIH) of the Unified Health System's Informatics Department (DATASUS), covering 2008 to 2022. Criteria included ICD-10 Category: I64 as unspecified hemorrhagic or ischemic stroke, all Brazilian federal units, with data compiled for hospital morbidity (SIH/SUS), including admissions and deaths for both males and females. Results: Data analysis showed a significant increase in admission cases (R2= 0.9437, p=<0.0001) and deaths (R2=0.8894, p=<0.0001) from 2008 to 2022. Conclusion: The study highlights the continued rise in stroke admissions and deaths in Brazil, with a pause during the pandemic's peak period, followed by a return to growth. These findings serve as a warning for public health managers to reassess and adapt stroke prevention and care strategies in the post-pandemic context.

Considerado la segunda causa principal de muerte en todo el mundo, el accidente cerebrovascular representa un problema significativo de salud pública, también responsable de una carga sustancial de discapacidad, con COVID-19 potencialmente predisponiendo a los individuos a complicaciones cerebrovasculares. Objetivo: Analizar las admisiones y muertes por accidente cerebrovascular en diferentes regiones de Brasil, antes y durante la pandemia de COVID-19. Metodología: Estudio ecológico observacional de series temporales utilizando datos secundarios de los Sistemas de Información Hospitalaria (SIH) del Departamento de Informática del Sistema Único de Salud (DATASUS), que abarca desde 2008 hasta 2022. Los criterios incluyeron la Categoría ICD-10: I64 como accidente cerebrovascular hemorrágico o isquémico no especificado, todas las unidades federales brasileñas, con datos compilados para la morbilidad hospitalaria (SIH/SUS), incluyendo admisiones y muertes tanto de hombres como de mujeres. Resultados: El análisis de datos mostró un aumento significativo en los casos de admisiones (R2= 0.9437, p=<0.0001) y muertes (R2=0.8894, p=<0.0001) desde 2008 hasta 2022. Conclusión: El estudio destaca el aumento continuo en las admisiones y muertes por accidente cerebrovascular en Brasil, con una pausa durante el período pico de la pandemia, seguido de un retorno al crecimiento. Estos hallazgos sirven como advertencia para los gestores de salud pública para reevaluar y adaptar las estrategias de prevención y cuidado del accidente cerebrovascular en el contexto posterior a la pandemia.

Considerado a segunda causa de morte no mundo, o Acidente Vascular Cerebral representa um problema de saúde pública, sendo também responsável por uma carga importante de incapacidade, sendo que a COVID-19 pode predispor os indivíduos a complicações cerebrovasculares. Objetivo: analisar internações e óbitos de Acidente Vascular Cerebral em diferentes regiões do Brasil, antes e durante a pandemia de COVID-19. Método: estudo observacional ecológico de série temporal, utilizando-se de dados secundários provenientes do Sistema de Informações Hospitalares do SUS (SIH) do Departamento de Informática do SUS (DATASUS). Os dados foram extraídos considerando o período de 2008 a 2022. As buscas respeitaram os seguintes critérios: Categoria CID 10: 164 indicado como Acidente Vascular Cerebral não especificado hemorrágico ou isquêmico, todas as unidades federativas Brasil, selecionadas como abas Morbidade Hospitalar do SUS (SIH /SUS), compilando os dados de internações e óbitos para os sexos masculino e feminino. Resultados: A análise dos dados demonstrou um aumento significativo dos casos de internação (R2= 0,9437 p=<0,0001) e óbitos (R 2 =0,8894, p=<0,0001) ao longo dos anos de 2008 a 2022. Conclusão: o estudo destaca a contínua ascensão das internações e óbitos por AVC no Brasil, com uma interrupção durante o período mais agudo da pandemia, seguida por um retorno ao crescimento. Estas descobertas são um alerta para os gestores de saúde pública reavaliarem e adaptarem as estratégias de prevenção e cuidado ao AVC no contexto pós-pandêmico

Geographical association of biodiversity with cancer and cardiovascular mortality rates: analysis of 39 distinct conditions.

Background: Biodiversity has been recognized as a positive contributor to human health and wellbeing. Cardiovascular disease and cancer are the two most significant global health burdens, and understanding their relationship with biodiversity forms an essential step toward promoting biodiversity conservation and human health. Methods: The species richness of birds is a common indicator of biodiversity, given their vast numbers, distinctive distribution, and acute sensitivity to environmental disturbances. This ecological study utilized avian observation data derived from the eBird database, human health data from the International Health Metrics and Evaluation, and county-level statistics, including population characteristics, socio-economics, healthcare service, residential environment, and geographic and climatic characteristics in 2014. We aimed to extensively explore the individual associations between biodiversity (i.e., avian species richness) and age-standardized cause-specific mortalities for different types of cancers (29 conditions) and cardiovascular diseases (10 conditions) across the United States (US). Results: Our multiple regression analyses that adjusted for a variety of socio-demographic and geographical factors showed that increased rarefied species richness of birds was associated with reduced mortality rates for three of the five most common cancers, namely, tracheal, bronchus, and lung cancer, breast cancer (in women only), and colon and rectal cancer. For cardiovascular conditions, a similar relationship was observed for ischemic heart disease and cerebrovascular disease-the two most frequent causes of mortality. This study provided extended details regarding the beneficial effects of biodiversity on human health.

Asymmetric impact of climatic parameters on hemorrhagic fever with renal syndrome in Shandong using a nonlinear autoregressive distributed lag model.

Hemorrhagic fever with renal syndrome (HFRS) poses a major threat in Shandong. This study aimed to investigate the long- and short-term asymmetric effects of meteorological factors on HFRS and establish an early forecasting system using autoregressive distributed lag (ARDL) and nonlinear ARDL (NARDL) models. Between 2004 and 2019, HFRS exhibited a declining trend (average annual percentage change = - 9.568%, 95% CI - 16.165 to - 2.451%) with a bimodal seasonality. A long-term asymmetric influence of aggregate precipitation (AP) (Wald long-run asymmetry [WLR] = - 2.697, P = 0.008) and aggregate sunshine hours (ASH) (WLR = 2.561, P = 0.011) on HFRS was observed. Additionally, a short-term asymmetric impact of AP (Wald short-run symmetry [WSR] = - 2.419, P = 0.017), ASH (WSR = 2.075, P = 0.04), mean wind velocity (MWV) (WSR = - 4.594, P < 0.001), and mean relative humidity (MRH) (WSR = - 2.515, P = 0.013) on HFRS was identified. Also, HFRS demonstrated notable variations in response to positive and negative changes in ∆MRH(-), ∆AP(+), ∆MWV(+), and ∆ASH(-) at 0-2 month delays over the short term. In terms of forecasting, the NARDL model demonstrated lower error rates compared to ARDL. Meteorological parameters have substantial long- and short-term asymmetric and/or symmetric impacts on HFRS. Merging NARDL model with meteorological factors can enhance early warning systems and support proactive measures to mitigate the disease's impact.

Correlation between socioeconomic indices and epidemiological indices of thyroid cancer from 1990 to 2019 year: a global ecologic study.

BACKGROUND: The incidence of thyroid cancer as the most common type of endocrine gland malignancy has risen more significantly than any malignancies in recent years. Estimated new cases of thyroid cancer in the United States in 2024 were 12,500 and 31,520 for men and women, respectively, and estimated deaths were 1,180 for women and 990 for men. Indices of socio-economic have been commonly used to measure the development of countries. Therefore, this study aimed to examine the correlation between indices of socioeconomic status and epidemiological indices of thyroid cancer throughout the world. In addition, this study has compared two indices of human development and a socio-demographic index. METHOD: This worldwide ecological study used data on thyroid cancer incidence, mortality, human development index (HDI), and sociodemographic index (SDI) between 1990 and 2019 from the Global Burden of Disease (GBD). We evaluated the correlation between incidence and mortality rates with socioeconomic indices by using Pearson's correlation coefficient. Furthermore, for the first time, the generalized additive model (GAM) was employed for modeling. The statistical software R, version 4.2.2, was used to conduct all statistical analyses. RESULTS: The correlation between the incidence of thyroid cancer and the HDI was significant and positive (r = 0.47, p-value < 0.001). While the correlation between thyroid cancer mortality and HDI was not statistically significant (r = 0.01, p-value = 0.076). Besides, the incidence of thyroid cancer was significantly positively correlated with SDI (r = 0.48, p-value < 0.001). The multiple GAM showed that for one unit increase in HDI, the risk of thyroid cancer was increased by 2.1 times (RR = 2.1, 95%CI = 2.04 to 2.19), and for one unit increase in SDI, the risk of thyroid cancer was shown to increase by 2.2 times. (RR = 2.2, 95%CI = 2.19 to 2.35). CONCLUSION: It has been evident that countries with higher incidence of thyroid cancer display higher socioeconomic indices. While, countries with higher socioeconomic indices, report lower mortality rates. However, based on the modeling results, it can be concluded that the SDI is slightly more useful in this regard. Therefore, examining the epidemiological indices of thyroid cancer by socio-economic indices can be useful to reflect a clear image of the distribution of this cancer in each country, and can be used for planning cancer prevention strategies.

The association of the physical and social environment with mortality in urban areas: an ecological study on the city of Bologna, Italy.

AIMS: The urban environment influences health through many pathways. The aim of the present study was to map the distribution of mortality, environmental predictors (distribution of green areas and transport networks), and social predictors (income deprivation) in the mid-sized city of Bologna (Italy), and to analyse the relationship between these variables. METHODS: The study employed an ecological cross-sectional design using data from public sources. The units of analysis were the 18 city districts. The percentage of green areas, percentage of transport networks and age-standardised mortality rates were calculated for each district. These variables, and an indicator of income deprivation, were plotted on the city map to analyse their distribution. Simple and multiple linear regressions with mortality as the outcome and environmental and social data as predictors were run. RESULTS: The results showed an unequal distribution of the variables in the city, with the north-eastern districts presenting worse values. Green areas did not result significantly in being related to mortality. The income indicator and transport networks have an impact on mortality in the simple regression, but only transport networks were found to have a statistically significant relation with mortality in the multiple regression. CONCLUSIONS: The results suggested that living close to major transport networks could affect mortality rates in the city, but further research is needed. Future studies are also needed to analyse the interaction between environmental exposures and socioeconomic factors in affecting health. These findings can be useful for urban planning and health promotion interventions.

A population-based time-series analysis of opioid agonist treatment dispensed during pregnancy.

BACKGROUND AND AIMS: Identifying effective opioid treatment options during pregnancy is a high priority due to the growing prevalence of opioid use disorder across North America. We assessed the temporal impact of three population-level interventions on the use of opioid agonist treatment (OAT) during pregnancy in Ontario, Canada. DESIGN: This was a population-based time-series analysis to identify trends in the monthly prevalence of pregnant people dispensed methadone and buprenorphine. The impact of adding buprenorphine/naloxone to the public drug formulary, the release of pregnancy-specific guidance and the start of the COVID-19 pandemic were assessed. SETTING AND PARTICIPANTS: The study was conducted in Ontario, Canada between 1 July 2013 and 31 March 2022, comprising people who delivered a live or stillbirth in any Ontario hospital during the study period. MEASUREMENTS: We identified any prescription for methadone or buprenorphine dispensed between the estimated conception date and delivery date and calculated the monthly prevalence of OAT-exposed pregnancies among all pregnant people in Ontario. FINDINGS: Overall, rates of OAT during pregnancy have declined since mid-2018. Methadone-exposed pregnancies decreased from 0.46% of all pregnancies in Ontario in 2015 to a low of 0.16% in 2022. In the primary analysis, none of the interventions had a statistically significant impact on overall OAT rates; however, in the stratified analyses, there was a small increase in buprenorphine after the formulary change [0.006%, 95% confidence interval (CI) = 0.0032-0.0081, P < 0.0001] and a decrease in buprenorphine after the release of the 2017 guidelines (-0.005%, 95% CI = -0.0080 to -0.0020, P = 0.001) and the start of the COVID-19 pandemic (-0.003%, 95% CI = -0.0054 to -0.0006, P = 0.015). CONCLUSION: Despite changes in guidance and funding, opioid agonist treatment during pregnancy has been declining in Ontario, Canada since 2018.

Traditional japanese diet score and the sustainable development goals by a global comparative ecological study.

BACKGROUND: Reducing the environmental impact of the food supply is important for achieving Sustainable Development Goals (SDGs) worldwide. Previously, we developed the Traditional Japanese Diet Score (TJDS) and reported in a global ecological study that the Japanese diet is associated with reducing obesity and extending healthy life expectancy etc. We then examined the relationship between the TJDS and environmental indicators. METHODS: The average food (g/day/capita) and energy supplies (kcal/day/capita) by country were obtained from the Food and Agriculture Organization of the United Nations Statistics Division database. The TJDS was calculated from eight food groups (beneficial food components in the Japanese diet: rice, fish, soybeans, vegetables, and eggs; food components that are relatively unused in the traditional Japanese diet: wheat, milk, and red meat) by country using tertiles, and calculated the total score from - 8 to 8, with higher scores meaning greater adherence to the TJDS. We used Land Use (m2), Greenhouse gas (GHG) emissions 2007/2013 (kg CO2eq), Acidifying emissions (g SO2eq), Eutrophying emissions (g PO43- eq), Freshwater (L), and water use (L) per food weight by Poore et al. as the environmental indicators and multiplied these indicators by each country's average food supply. We evaluated the cross-sectional and longitudinal associations between the TJDS and environmental indicators from 2010 to 2020. This study included 151 countries with populations ≥ 1 million. RESULTS: Land use (ß ± standard error; -0.623 ± 0.161, p < 0.001), GHG 2007 (-0.149 ± 0.057, p < 0.05), GHG 2013 (-0.183 ± 0.066, p < 0.01), Acidifying (-1.111 ± 0.369, p < 0.01), and Water use (-405.903 ± 101.416, p < 0.001) were negatively associated with TJDS, and Freshwater (45.116 ± 7.866, p < 0.001) was positively associated with TJDS after controlling for energy supply and latitude in 2010. In the longitudinal analysis, Land Use (ß ± standard error; -0.116 ± 0.027, p < 0.001), GHG 2007 (-0.040 ± 0.010, p < 0.001), GHG 2013 (-0.048 ± 0.011, p < 0.001), Acidifying (-0.280 ± 0.064, p < 0.001), Eutrophying (-0.132 ± 0.062, p < 0.05), and Water use (-118.246 ± 22.826, p < 0.001) were negatively associated with TJDS after controlling for confounders. CONCLUSIONS: This ecological study suggests that the traditional Japanese dietary pattern might improve SDGs except Fresh water.

Natural variables separate the endemic areas of Clonorchis sinensis and Opisthorchis viverrini along a continuous, straight zone in Southeast Asia.

BACKGROUND: Clonorchiasis and opisthorchiasis, caused by the liver flukes Clonorchis sinensis and Opisthorchis viverrini respectively, represent significant neglected tropical diseases (NTDs) in Asia. The co-existence of these pathogens in overlapping regions complicates effective disease control strategies. This study aimed to clarify the distribution and interaction of these diseases within Southeast Asia. METHODS: We systematically collated occurrence records of human clonorchiasis (n = 1809) and opisthorchiasis (n = 731) across the Southeast Asia countries. Utilizing species distribution models incorporating environmental and climatic data, coupled machine learning algorithms with boosted regression trees, we predicted and distinguished endemic areas for each fluke species. Machine learning techniques, including geospatial analysis, were employed to delineate the boundaries between these flukes. RESULTS: Our analysis revealed that the endemic range of C. sinensis and O. viverrini in Southeast Asia primarily spans across part of China, Vietnam, Thailand, Laos, and Cambodia. During the period from 2000 to 2018, we identified C. sinensis infections in 84 distinct locations, predominantly in southern China (Guangxi Zhuang Autonomous Region) and northern Vietnam. In a stark contrast, O. viverrini was more widely distributed, with infections documented in 721 locations across Thailand, Laos, Cambodia, and Vietnam. Critical environmental determinants were quantitatively analyzed, revealing annual mean temperatures ranging between 14 and 20 °C in clonorchiasis-endemic areas and 24-30 °C in opisthorchiasis regions (P < 0.05). The machine learning model effectively mapped a distinct demarcation zone, demonstrating a clear separation between the endemic areas of these two liver flukes with AUC from 0.9 to1. The study in Vietnam delineates the coexistence and geographical boundaries of C. sinensis and O. viverrini, revealing distinct endemic zones and a transitional area where both liver fluke species overlap. CONCLUSIONS: Our findings highlight the critical role of specific climatic and environmental factors in influencing the geographical distribution of C. sinensis and O. viverrini. This spatial delineation offers valuable insights for integrated surveillance and control strategies, particularly in regions with sympatric transmission. The results underscore the need for tailored interventions, considering regional epidemiological variations. Future collaborations integrating eco-epidemiology, molecular epidemiology, and parasitology are essential to further elucidate the complex interplay of liver fluke distributions in Asia.

The association between influenza vaccination uptake and influenza and pneumonia-associated deaths in the United States.

BACKGROUND: The influenza mortality burden has remained substantial in the United States (US) despite relatively high levels of influenza vaccine uptake. This has led to questions regarding the effectiveness of the program against this outcome, particularly in the elderly. The aim of this evaluation was to develop and explore a new approach to estimating the population-level effect of influenza vaccination uptake on pneumonia and influenza (P&I) associated deaths. METHODS: Using publicly available data we examined the association between state-level influenza vaccination and all-age P&I associated deaths in the US from the 2013-2014 influenza season to the 2018-2019 season. In the main model, we evaluated influenza vaccine uptake in all those age 6 months and older. We used a mixed-effects regression analysis with generalised least squares estimation to account for within state correlation in P&I mortality. RESULTS: From 2013-2014 through 2018-2019, the total number of all-age P&I related deaths during the influenza seasons was 480,111. The mean overall cumulative influenza vaccine uptake (age 6 months and older) across the states and years considered was 46.7%, with higher uptake (64.8%) observed in those aged ≥ 65 years. We found that overall influenza vaccine uptake (6 months and older) had a statistically significant protective association with the P&I death rate. This translated to a 0.33 (95% CI: 0.20, 0.47) per 100,000 population reduction in P&I deaths in the influenza season per 1% increase in overall influenza vaccine uptake. DISCUSSION: These results using a population-level statistical approach provide additional support for the overall effectiveness of the US influenza vaccination program. This reassurance is critical given the importance of ensuring confidence in this life saving program. Future research is needed to expand on our approach using more refined data.

Malacological, socio-environmental evaluation, and evidence of local transmission and maintenance of schistosomiasis in an urban area of Northeast Brazil.

To present the current epidemiological scenario of schistosomiasis related to urban transmission through an epidemiological risk assessment in Porto de Galinhas, a coastal area of Pernambuco, Brazil. Malacological and parasitological surveys were performed between the years 2018 and 2020. Snails were identified taxonomically and examined to confirm infection by Schistosoma mansoni, and so to identify Schistosomiasis Transmission Foci (STF) by the artificial light exposure technique. Stool samples were examined using the Kato-Katz method to identify schistosomiasis cases. Socioeconomic, environmental, behavioural and health data were collected by a questionnaire applied to participates in the survey and used to predict the schistosomiasis risk occurrence by multivariate logistic regression. In all, a total of 6466 snails of Biomphalaria glabrata were collected and 36 breeding sites were identified, of which 25 % were STF. A total of 2236 individuals took part of the survey which identified 187 cases of schistosomiasis, registering a positivity percentage of 8.36 %. The surveys identified the neighbourhoods with the highest risk for transmission while the socioenvironmental analysis identifies other risk factors for disease occurrence, such as gender, age range, level of education and absence of water drainage. We found that areas with poor sanitation, flooding during winter periods and dwellings located near mangroves should be treated by health authorities as priority areas for health interventions to minimize disease transmission. In addition, efforts to improve the population's educational level could certainly contribute to the adoption of measures to prevent and control this neglected tropical disease.

State expansion of Supplemental Nutrition Assistance Program eligibility and rates of firearm-involved deaths in the United States.

INTRODUCTION: Poverty is a consistent correlate of firearm-involved mortality, yet little work has considered the effects of social and economic policies on these deaths. This study examined associations of state elimination of the asset test and increases in the income limit for Supplemental Nutrition Assistance Program (SNAP) eligibility with rates of firearm-involved suicide and homicide deaths in the United States. METHODS: This ecological repeated cross-sectional study used 2015-2019 data from the SNAP Policy Database and death certificate data from the National Vital Statistics System. The exposures were (1) state elimination of the asset test for SNAP eligibility and (2) state elimination of the asset test and increases in the income limit for SNAP eligibility, compared with (3) state adoption of neither policy. The outcomes were firearm-involved suicide deaths and firearm-involved homicide deaths. The research team conducted mixed-effects regressions to estimate associations. RESULTS: State elimination of the asset test for SNAP eligibility (incidence rate ratio (IRR), 0.67; 95% CI, 0.48 to 0.91) and state adoption of both eliminating the asset test and increasing the income limit for SNAP eligibility (IRR, 0.68; 95% CI, 0.49 to 0.92) were associated with decreased rates of firearm-involved suicide deaths compared with state adoption of neither policy. There were no associations with state firearm-involved homicide rates. CONCLUSIONS: SNAP is an important social safety net programme that addresses food insecurity, and the present results suggest it may also contribute to reducing firearm-involved suicide.

Trends in ultra-processed food availability and its association with diet-related non-communicable disease health indicators in the Portuguese population.

Broad variations in dietary and physical activity patterns are part of nutritional transition concept. An additional nutritional transition has as main characteristic the change of consumption of processed foods for ultra-processed foods (UPF). This study aims to evaluate trends of UPF availability in Portuguese population and its association with diet-related non-communicable diseases (NCD) health indicators. This ecological study used data from the Household Budget Surveys conducted by the National Statistics Institute each 5 years within a national representative sample of households. The percentage of UPF was calculated based on the total daily amount of food and beverages available per capita (in grams). Data from the years 1990, 1995, 2000 and 2005 were used, which were retrieved from DAFNE-Anemos Software. NCD age-standardised mortality, prevalence and incidence were obtained from the Global Burden of Disease database, for the years 2000, 2005, 2010 and 2015. Between 1990 and 2005, the UPF availability increased from 3·9 % to 13·8 %. Over the years, almost all food and beverages categories increased the UPF availability contribution, mainly noticeable for milk, sugar, cereal and meat products. Positive correlations were observed between UPF availability and digestive diseases both in prevalence (r = 0·062; P = 0·037) and incidence (r = 0·005; P = 0·010) measures. Neoplasms incidence also showed positive correlation with UPF availability (r = 0·002; P = 0·012). Trends in UPF availability in Portugal increased exponentially. At the same time, there is a trend towards a decrease in unprocessed and processed food availability. The Portuguese population should be made aware of the health risks resulting from excessive consumption of UPF.

Snakebites epidemiology in Mexico: a 13-year ecological analysis.

BACKGROUND: Globally, snakebites have a significant impact on public health and represent substantial costs for health services. Their severity is particularly relevant in developing countries due to the lack of resources and accessibility to health facilities. Additionally, the number of cases may be underestimated, highlighting the urgent need for improved prevention measures. METHODS: An observational ecological study was undertaken using the records identified with X200-X209 codes registered in the Ministry of Health injuries database during 2010-2022. Variables included information related to the patient, the snakebite and the healthcare provided. Statistical analysis was carried out with STATA 16 and Microsoft Excel 2020. RESULTS: A total of 10 420 snakebites were registered. The average number of cases per year was 788 (IQR 615, 875) and 82.74% occurred during the rainy season. The median age was 35 (IQR 19, 52) y and early adulthood was the most affected age group; bites were most common on the hand and in the living place. The Eastern region of Mexico registered the highest number of cases, with 3496 (33.71%) of snakebites. The lethality rate was 18.23 per 10 000. CONCLUSIONS: Snakebites are a significant health problem in Mexico. Most injuries occur among men in early adulthood, in households and in the upper extremities.

Regional Variations in Coronavirus Disease 2019 Mortality in Japan: An Ecological Study.

Introduction: As the characteristics of coronavirus disease 2019 (COVID-19) vary across regions and countries, the relationship between regional characteristics, such as the distribution of physicians and hospital beds, and COVID-19 mortality was assessed in the 47 prefectures of Japan. Methods: This ecological study was based on the number of patients with COVID-19 by prefecture during the seventh wave of COVID-19 in Japan (June-October 2022). COVID-19 mortality was indexed as the number of COVID-19 deaths divided by the number of new COVID-19 cases. Data on regional factors, such as population size, number of physicians, and hospital beds by prefecture, were obtained from government statistics. Correlations between regional characteristics and COVID-19 mortality index were analyzed by dividing the 47 prefectures into two groups at the median level of population size (more populated group [MPG] ≥ 1.6 million and less populated group [LPG] < 1.6 million). Results: The COVID-19 mortality index (mean 12.7, minimum-maximum: 4.7-25.7) was correlated negatively with the number of physicians per hospital bed (r = -0.386, p = 0.007) and positively with the number of long-term care facilities per 10,000 population (r = 0.397, p = 0.006) and aging rate (the proportion of population aged ≥ 65 years) (r = 0.471, p = 0.001). The two groups varied with respect to the number of physicians (28.7 physicians in the LPG vs. 26.1 physicians in the MPG, p = 0.038) and hospital beds (156 beds in the LPG vs. 119 beds in the MPG, p < 0.001) per 10,000 population. In the multiple regression analysis, the COVID-19 mortality index was correlated negatively with the number of physicians per hospital bed (ß = -0.543, p = 0.024) and positively with the aging rate (ß = 0.434, p = 0.032) in the LPG, with nonsignificant correlations in the MPG. Conclusions: The data may suggest a need of improvement in the distribution of physicians and hospital beds in the healthcare system in regions with smaller and older populations to reduce the rate of COVID-19.

Determinants of oral health status: an ecological study in Iran.

OBJECTIVES: The aim of this ecological study was to assess the association between behavioral, social position, circumstance factors, and caries experience in 35- to 44-year-old adults in Iran at a provincial level. MATERIALS AND METHODS: The data from the 2011 Iranian Oral Health Survey were obtained from all 31 provinces across Iran on the population level. Oral health status was measured as the number of decayed, missing (MT), and filled (FT) teeth and the percentage of the population who were edentulous. Data were also gathered from each province on the percentage of smokers (Non-Communicable Diseases Risk Factors Surveillance Provincial Report 2009), per capita consumption of free sugars, concentration of fluoride in the drinking water (National and Sub-national Burden of Disease (NASBOD) Survey), number of dentists per 10,000 people, mean years of schooling of adults, expected years of schooling of children, life expectancy at birth and Gross National Income (Integrated Public Use Microdata Series, Global Data Lab). The data were analyzed using simple and multiple linear regression (α = 0.05). RESULTS: Mean DMFT was positively associated with the percentage of smokers (B = 0.01 95%CI 0.01-0.14), and negatively with fluoride concentration (B =-2.6 95%CI -4.3- -0.96). The edentulousness percentage was positively associated with smoking (B = 0.2 (with 95%CI: 0.07-0.37) and negatively with mean years of education (B =-1.08 (with 95%CI: -2.04- -0.12). DT was associated with expected years of schooling (B =-0.6 (with 95%CI: -1.07- -0.17), negatively. Mt was negatively associated with life expectancy (B =-0.5 (with 95%CI: -1.1- -0.007), fluoride concentration (B =-3.4 (with 95%CI: -4.5- -1.5) and number of dentists per 10,000 people (B =-0.4 (with 95%CI: -0.8- -0.01). Mean Years of Schooling (B = 0.5 (with 95%CI: 0.2-0.8) and number of dentists per 10,000 people (B =-0.62 (with 95%CI: 0.51 - 0.48) were positively in associated with FT. CONCLUSIONS: The present findings indicate that there were differences in the oral health measures and their social determinants among the provinces of Iran. Regarding the limitations of the study especially the limitation of the number of independent variables, it seems, this discrepancy could be better explained by social variables of the provinces such as income than by environmental factors.

Social Vulnerability and the Prevalence of Opioid Use Disorder Among Older Medicare Beneficiaries in U.S. Counties.

OBJECTIVES: Recent research has investigated the factors associated with the prevalence of opioid use disorder (OUD) among older adults (65+), which has rapidly increased in the past decade. However, little is known about the relationship between social vulnerability and the prevalence of OUD, and even less is about whether the correlates of the prevalence of OUD vary across the social vulnerability spectrum. This study aims to fill these gaps. METHODS: We assemble a county-level data set in the contiguous United States (U.S.) by merging 2021 Medicare claims with the CDC's social vulnerability index and other covariates. Using the total number of older beneficiaries with OUD as the dependent variable and the total number of older beneficiaries as the offset, we implement a series of nested negative binomial regression models and then analyze by social vulnerability quartiles. RESULTS: Higher social vulnerability is associated with higher prevalence of OUD in U.S. counties. This association cannot be fully explained by the differences in the characteristics of older Medicare beneficiaries (e.g., average age) and/or other social conditions (e.g., social capital) across counties. Moreover, the group comparison tests indicate correlates of the prevalence of OUD vary across social vulnerability quartiles in that the average number of mental disorders is positively related to OUD prevalence in the least and the most vulnerable counties and social capital benefits the less vulnerable counties. DISCUSSION: A perspective drawing upon contextual factors, especially social vulnerability, may be more effective in reducing OUD among older adults in U.S. counties than a one-size-fits-all approach.

Performance Level Affects Full Body Kinematics and Spatiotemporal Parameters in Trail Running-A Field Study.

Trail running is an emerging discipline with few studies performed in ecological conditions. The aim of this work was to investigate if and how biomechanics differ between more proficient (MP) and less proficient (LP) trail runners. Twenty participants (10 F) were recruited for a 9.1 km trail running time trial wearing inertial sensors. The MP athletes group was composed of the fastest five men and the fastest five women. Group differences in spatiotemporal parameters and leg stiffness were tested with the Mann-Whitney U-test. Group differences in joint angles were tested with statistic parametric mapping. The finish time was 51.1 ± 6.3 min for the MP athletes and 60.0 ± 5.5 min for the LP athletes (p < 0.05). Uphill sections: The MP athletes expressed a tendency to higher speed that was not significant (p > 0.05), achieved by combining higher step frequency and higher step length. They showed a tendency to shorter contact time, lower duty factor and longer flight time that was not significant (p > 0.05) as well as significantly lower knee flexion during the stance phase (p < 0.05). Downhill sections: The MP athletes achieved significantly higher speed (p < 0.05) through higher step length only. They showed significantly higher knee and hip flexion during the swing phase as well as higher trunk rotation and shoulder flexion during the stance phase (p < 0.05). No differences were found with respect to leg stiffness in the uphill or downhill sections (p > 0.05). In the uphill sections, the results suggest lower energy absorption and more favorable net mechanical work at the knee joint for the MP athletes. In the downhill sections, the results suggest that the more efficient motion of the swing leg in the MP athletes could increase momentum in the forward direction and full body center of mass' velocity at toe off, thus optimizing the propulsion phase.

Food environment index and preterm birth rate in the counties of the United States.

OBJECTIVES: To determine the relationship between Food Environment Index (FEI) and Preterm Birth (PTB) rate at the county level of the United States of America (USA) (primary), while evaluating the interaction of multiple factors within a framework of sociodemographic, maternal health, maternal behavioral, and environmental factors. METHODS: This is a population-based retrospective cohort ecological study from 2015-2018. The study compares the characteristics of the population of the counties of the USA. All counties with complete data on their PTB rate and the independent variables were included in the study. Independent variables with greater than 20% missing data were excluded from the study. Purposive sampling technique was applied. A total of 2983/3142 counties were included in the study. RESULTS: The median PTB rate of all counties was 9.90%. The highest PTB rate (23.3%) was in Tallapoosa County, Alabama and the lowest (3.4%) in San Juan County, Washington State. After adjusting for variables, PTB rate had a significant association with FEI (coefficient of correlation - 0.36, p < 0.01, 95% CI - 0.19 to - 0.04). Increase in the rate of unemployment, African American race, adult smoking, obesity, uninsured rate, sexually transmitted diseases (STD), high school education and air pollution was associated with an increase in PTB rate, while an increase in FEI and alcohol abuse rates was associated with a decrease in PTB rate. CONCLUSIONS: FEI can predict the PTB rate in USA counties after adjusting for sociodemographic, health, behavioral and environmental factors. Future studies are needed to confirm these associations and consider them when making policies to reduce PTBs.

Risk mapping and risk factors analysis of rabies in livestock in Bangladesh using national-level passive surveillance data.

Rabies is a major zoonotic disease around the world, causing significant mortality to both humans and animals, especially in low- and middle-income countries. In Bangladesh, rabies is transmitted mostly by the bite of infected dogs and jackals to humans and domestic livestock, causing severe economic losses and public health hazards. Our study analyzed national passive surveillance data of veterinary hospital-reported rabies cases in cattle, buffalo, sheep, and goats from 2015 to 2017 in all 64 districts of Bangladesh. We used a zero-inflated negative binomial regression model to identify the main environmental and socio-economic risk factors associated with rabies occurrence in livestock, and we used model results to generate risk maps. Our study revealed that monsoon precipitation (RR=1.28, p-value=0.043) was positively associated with rabies cases in livestock, and the percentage of adults who have completed university education was also a significant predictor (RR=0.58, p-value<0.001) likely suggesting that districts with higher education levels tended to have a lower reporting of rabies cases in livestock. The standardized incidence ratio maps and predicted relative risk maps revealed a high risk of rabies cases in southeast areas in Bangladesh. We recommend implementing risk-based vaccination strategies in dogs and jackals in those high-risk areas before monsoon to reduce the burden of rabies cases in domestic ruminants and humans in Bangladesh.