bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitude of Romanian students and their families concerning waste management
Authors: Prejbeanu I , Dina M E , Prejbeanu D F 
Published: October 2024

Abstract

Waste recovery, recycling included, is an important step in waste management, preceding final disposal. In 2018, according to Eurostat, the recycling rate of municipal waste was 47% in the European Union and only 11.1% in Romania. Thus governmental institutions have implemented new measures in order to reduce environmental pollution by ineffective waste management. In 2022, 535 students aged 22-24.5 years, males and females, studying in Craiova (one of the six largest academic cities of Romania), were asked to answer an 18-item questionnaire regarding their and their families’ attitude towards waste recycling. Most of the students (60.7%) were residents in the university city, while the others - in smaller cities or in villages of the region. Only 38.3% of the subjects (N = 205) declare their families recycle waste; the most common excuse for no-recycling (37.8%) is the lack of recycle bins in the house proximity. Only 20 families (3.7%), all of them living in Craiova, take the fried oil to collecting points in supermarkets; most of the others eliminate it in the sewerage system, especially those from outside the city (p &lt; 0.01). Seventy-five students (14%) are not able to mention any recent measure taken by the government in order to reduce plastics environmental pollution; the others discuss about the increased number of recycle bins around the city (53.2%), recycling of single-use plastics (34.5%) or use of biodegradable bags (25.2%). No-recycling (42%), using daily his/her own car (18.7%, p &lt; 0.01 males vs. females), using too much plastics (11.2%) are the most frequent self-reported students’ disregards for the environment. Most of the subjects consider environmental health of essential importance (88.7%) and would like to participate in environment protection actions (92.5%). Romanian students seem to have a positive attitude and like to be involved in the environment protection, without a significant influence regarding the gender and the residence place.

Key messages
• Education and information are essential tools to make people ecologically aware.
• Recycling is one of the best ways to have a positive impact on both natural and community environment.
Long-term ozone exposure and asthma: a systematic review and meta-analysis
Authors: Hassen H Y , Charalampous P , Luyten A , Martins C , Breitner-Busch S , Devleesschauwer B , Haagsma J A , Buekers J 
Published: October 2024

Abstract

Background
Ambient air pollution, particularly surface ozone, is a significant global health concern, with 9 out of 10 people exposed to levels exceeding WHO guidelines. This exposure is linked to approximately 7 million premature deaths annually, a number expected to double by 2050. While the effects of short-term exposure to ozone on exacerbation of asthma symptoms and mortality are well-documented, the impact of long-term exposure remains unclear.

Aim
This systematic literature review aims to quantify the association between long-term exposure to ozone and asthma incidence and prevalence and derive an exposure-response relationship.

Methods
International electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science, were searched, supplemented by grey literature sources such as Google Scholar and WHO - Global Index Medicus from conception to July 31, 2023. Observational epidemiological cohort, case-control, or cross-sectional studies reporting quantitative associations between exposure and outcome were included. Meta-analysis will synthesize effect size estimates using a Meta-Regression - Bayesian, Ensemble, Regularized, Trimmed (MR-BRT) model.

Results
A total of 5,947 titles were initially identified from databases, and following the removal of duplicates, 3,235 titles and abstracts were screened, resulting in 84 articles deemed eligible for full-text review. The full-text screening identified 29 studies comprising 38 articles. A comprehensive overview of the included studies will be provided. We will describe the study settings, design, and measurement methods used by the identified studies. Furthermore, results of the MR-BRT model will be summarized, and exposure-response functions will be discussed. Funding: This work is part of the BEST-COST project which is funded by the European Union’s Horizon Europe programme under Grant Agreement No.101095408.

Key messages
• This research fills the gap in understanding the association between long-term exposure to ambient ozone and asthma incidence and prevalence.
• Developing exposure-response functions would enable estimation of the disease burden associated with long-term ozone exposure.
Fluoride exposure and risk of fractures: a systematic review and dose-response meta-analysis
Authors: Iamandii I , Mazzoli R , De Pasquale L , Vinceti M , Filippini T 
Published: October 2024

Abstract

Introduction
Fluoride (F) is a widespread natural element, whose exposure occurs mostly through drinking water, fluoridated foods and use of toothpastes. At high levels, it may adversely affect human health by altering thyroid and cognitive function in children, and inducing dental and skeletal fluorosis. Since bone health significantly impacts quality of life, we performed a systematic review and meta-analysis to evaluate the effect of F exposure on risk of bone fractures.

Methods
We conducted a literature search in online databases and selected studies that were carried out in humans and reported risk estimates with 95% confidence intervals for bone fractures according to F exposure. We eventually performed a meta-analysis using a random effects model, comparing the highest versus the lowest exposure, and one-stage dose-response model, to explore the shape of the association.

Results
Of the 1052 potentially eligible articles, 28 were included in the quantitative analyses. Most studies were conducted in adults (n = 26) and in Western countries (North America=16, Europe=11) and assessed fluoride exposure in drinking water, urine, serum, toenail or diet. The preliminary dose-response curve showed a positive non-linear relation between F exposure through drinking water and bone fracture risk, regardless of site, starting at 1.5 mg/L. Sex-stratified analyses, based on a lower number of studies, showed similar trends, with an indication of higher susceptibility in males compared with females.

Conclusions
Overall, risk of bone fractures appears to non-linearly increase along with exposure to fluoride in drinking water, regardless of bone site and sex, at levels of exposure above the WHO standard and similar to those that have associated to altered thyroid and cognitive function. Under a public health perspective, fluoride in drinking water should be kept below 1.5 mg/L to prevent bone fractures.

Key messages
• Our analysis revealed a positive non-linear association between fluoride in drinking water and bone fracture risk.
• Public Health actions should be oriented in keeping fluoride in drinking water below 1.5 mg/L to prevent bone fractures.
Spatially varying associations between community-level predictors and COVID-19 outcomes in NYC
Authors: Thompson R L , Johnson G D , Gordon R , Nakaya T 
Published: October 2024

Abstract

Background
The cumulative impacts of COVID-19 on hospitalization and mortality were not uniformly distributed across New York City (NYC). To better understand potential drivers of this observed geospatial disparity, we explored the associations between community-level sociodemographic characteristics and cumulative COVID-19 hospitalizations and mortality using geographically weighted Poisson regression (GWPR).

Methods
Cumulative COVID-19 hospitalization and mortality rates in 177 NYC modified ZIP code tabulation areas as of Dec 2022 were taken from the NYC Department of Health and Mental Hygiene, and sociodemographic predictors were taken from the 2018 American Community Survey. GWPR was applied using both non-multiscale (single bandwidth) and multiscale (flexible bandwidth) models to assess which predictors were significant and which associations varied spatially (allowing them to potentially act as both risk and protective factors, depending on the location).

Results
Multiscale GWPR models outperformed non-multiscale models in rendering residual spatial autocorrelation insignificant. Although multiscale GWPR allowed flexible bandwidths for each predictor, most yielded global bandwidths, suggesting geographically consistent effects. For mortality, the percent of residents without health insurance acted solely as a risk factor. Similarly, for hospitalizations, the percent of residents with a disability acted solely as a risk factor. The percent of residents with a bachelors degree or higher acted solely as a protective factor against both outcomes.

Conclusions
Even when associations were allowed to vary spatially in GWPR models, we still found geographically consistent associations between many sociodemographic predictors and cumulative COVID-19 outcomes in NYC. Consistent risk factors, such as prevalence of disability, or protective factors, such as prevalence of higher education, highlight potential areas for city-wide policies to reduce the burden of future epidemics.

Key messages
• For cumulative COVID-19 outcomes across NYC communities, geographically consistent risk factors include disability prevalence for hospitalization and lack of health insurance for mortality.
• Increasing prevalence of higher education acted as a geographically consistent protective factor against both hospitalization and mortality due to COVID-19.
Deprivation and stroke incidence, treatment and mortality in Germany
Authors: Belau M , Becher H , Riefflin M , Bartig D , Schwettmann L , Schwarzbach C J , Grau A 
Published: October 2024

Abstract

Background
Previous research suggests that regional deprivation significantly influences the risk of stroke. However, little is known about regional differences in stroke incidence and mortality within Germany.

Methods
We utilized data from the Diagnosis Related Groups statistics (2016-2019) and the German Federal Register of Physicians (2019). We used negative binomial regression analysis to investigate the relationship between the German Index of Multiple Deprivation 2015, covering 401 districts and district-free cities in Germany, and stroke incidence, treatment, and mortality.

Results
The adjusted rate ratios of stroke incidence and mortality with the highest deprivation level compared with the least deprived area were 1.16 (95% CI [1.14, 1.17]) and 1.19 (95% CI [1.14, 1.23]), respectively. Furthermore, this study showed that the density of physicians was higher in district-free cities than in districts.

Conclusions
The findings document a relationship between regional deprivation and stroke incidence and mortality, and call for a more targeted approach to stroke prevention in deprived regions.

Key messages
• Regional deprivation in Germany linked to increased stroke incidence and mortality rates.
• Policy action needed for effective prevention measures.
EHT and environmental justice at EPA Victoria: Aspirations and regulatory realities
Authors: Chaston T , Mavoa S , Dennekamp M , Hadgraft N 
Published: October 2024

Abstract

EPA Victoria (Australia) is a statutory authority that regulates polluting activities and advises other Victorian government departments on relevant policy settings. In 2016, a public health function was installed at EPA Vic to provide emergency health messaging during pollution events, review research evidence of environmental-health relationships and assess industry-contracted health risk assessments of polluting entities. An Environmental Health Tracking Network (EHTN) is under development to support these activities. The EHTN is an agile data and analytical infrastructure for translating expertise across an expanding multidisciplinary network of public health researchers, EPA operational staff and public sector policy makers. Its current interactive dashboards calculate health impacts and associated costs of air pollution scenarios, model land-use influences on land and water contamination and identify coincidences of sociodemographic-, urban environment- and pollution exposure-disadvantage in a high spatial resolution environmental justice (EJ) framework. Regulatory leverage of EHTN intelligence, however, requires legislated EJ thresholds and/or legally tractable costing of industry-externalised human health impacts. Thus, to establish triggers for more stringent conditions on polluting activities and promote equity of interventions and regulations, novel regionally and EJ specific health risk functions are required. Considering these ambitions and challenges, the EHTN at EPA Vic is focussed on 1) identifying and characterising vulnerable populations at high spatial resolution, 2) estimating associated exposure-health effect size modifications using primary epidemiological methods and 3) applying these to health impact and cost assessments of pollution and waste. We seek defensible grounds on which to impose more stringent standards for polluters and redress entrenched social, health and economic disadvantage.

Speakers/Panelists
Hanna Tolonen
THL, Helsinki, Finland
Past-year mental health issues: discrepant survey & administrative data
Authors: Vinko M , Zaletel Kragelj L , Kukec A 
Published: October 2024

Abstract

Introduction
Accurately measuring mental health disorder prevalence is crucial for public health planning. Administrative and survey data are common methods, but often yield differing results. This study compares case identification of mental health issues across these data sources in Slovenia.

Methods
We linked the 2019 European Health Interview Survey (EHIS) with three Slovenian health administrative databases: the National Hospital Health Care Statistics Database, Outpatient Prescription Drugs Database, and Absence From Work Database. Case identification utilized self-report of any mental health issue in the past 12 months and healthcare utilization records in 12 months preceding participation in EHIS. Multinomial logistic regression was used to examine the association between socio-demographic factors and case identification across data sources.

Results
Significant differences were found in 12 month prevalence of any mental health issue estimates between data sources. Only 45.9% of self-reported cases were identified in administrative data, and 36.6% of administrative cases self-reported mental health issues (Kappa = 0.302). Socio-demographics, including age, gender, education, and employment status, were significantly associated with the likelihood of identification in specific data sources.

Discussion
Our findings underscore the importance of data source and assessment tool selection on mental health prevalence estimates. Variations in identification across population subgroups could reflect differences in healthcare access and self-disclosure biases. Linking data sources and considering their inherent limitations is crucial for accurate burden estimation.

Key messages
• Data source and assessment methods significantly impact how we identify individuals with mental health issues in the past year.
• Combining data sources and understanding their limitations is essential for improving mental health burden estimation.
Waiting for hip fracture surgery: Analysis of individual heterogeneity and discriminatory accuracy
Authors: Öberg J , Khalaf K , Perez R , Merlo J 
Published: October 2024

Abstract

Background
Evaluation of healthcare inequality could be improved by considering (i) the intersection of socioeconomic axes of inequality, (ii) the existence of individual heterogeneity and (iii) criteria to quantify group differences and how those differences translate into recommendations for universal or targeted interventions. In this study we illustrate how to achieve these improvements.

Methods
We applied analysis of individual heterogeneity and discriminatory accuracy (AIHDA) to analyze data from the Swedish patient registry for the quality indicator hip fracture (HF) surgery within the same day. We analyzed 57,340 patients residing in Sweden during 2011-2014 and belonging to 36 socioeconomic strata defined by age, sex, income, and country of birth and the 21 Swedish regions. We calculated prevalences and 95% confidence intervals as well as the absolute number of cases. The benchmark was set to 80%. To quantify group differences, we evaluated the discriminatory accuracy (DA) using the area under the ROC curve (AUC).

Results
68% (39,073/57,340) of the patients were operated in time. The prevalence across the 36 sociodemographic strata ranged from 51% (43-58%) to 81% (67-91%). However, the DA was low (AUC= 0.562) indicating very small group differences. About half of the operated HP (n = 20,287) occurs in 18/36 strata with the lowest prevalences of operations in time. The regions’ prevalences ranged from 37% (36-38%) to 88% (88-89%) with a rather high DA (AUC= 0.736) indicating larger differences. About half of the operated HP (n = 19,677) occurs in 12/21 regions with the lowest prevalence of operations in time.

Conclusions
The 80% benchmark was only achieved in one socioeconomic stratum and the group differences were very small. 6/21 regions achieved the benchmark and the group differences were large. Interventions aiming to reach the benchmark in the entire population should proportionately target regions and be universal and tailored to sociodemographic strata.

Key messages
• The AIHDA-framework improves evaluations of healthcare inequalities.
• Both differences between group averages and the groups’ DA need be considered when planning healthcare interventions.
Factors associated with drowning in Portugal, 2019-2023
Authors: Marques Mendes P , Alves T , Gaio V , Aniceto C , Horta Correia F , Matias Dias C 
Published: October 2024

Abstract

Worldwide, mortality from drowning amounted to 236.000 individuals in 2019, corresponding to 8% of the total global mortality, making drowning the third leading cause of death from unintentional injuries and a universal public health problem. Portugal has a coastal zone of 950 km long, with 658 bathing waters and, in 2023, 157 people died due to drowning. This work aims to determine the factors associated with drownings that occurred in Portugal, between 2019 and 2023. This epidemiological descriptive-analytical study used the National Maritime Authority database, regarding the users of the portuguese coastal zone who suffered maritime incidents between 2019 and 2023. SPSS was used for statistical analysis and the results of the Poisson regression models are presented as adjusted prevalence ratios (APR) with 95% confidence intervals, according to individual (sex, age group and nationality), temporal (period of the week and day) and environmental (maritime department and beach surveillance status) variables. The total sample was 406 drownings and 15 860 other maritime incidents. Overall, the frequency of drownings in Portugal was higher in men (APR=1.393, 95%CI=1.130-1.717, p=.002), in the &gt;55y age group (APR=1.780, 95%CI=1.005-3.152, p=.048), in foreigners (APR= 1.293, 95%CI=1.037-1.612, p=.022), on weekends (APR=1.299, 95%CI=1.063-1.586, p=.010), in the afternoon (APR=1.584, 95%CI=1.127-2.226, p=.008) and on unsupervised beaches (APR=2.436, 95%CI=1.958-3.029, p&lt;.001) in comparison with users who suffered other maritime incidents. Individual, temporal and environmental factors are associated with a higher frequency of drownings in Portugal. Despite the limitation of the study that only includes users suffering maritime incidents and not all users of the portuguese coastal zone, our results allow a preliminary characterization of the drowning profile in Portugal and can contribute to the design of preventive strategies and policies to address this public health problem.

Key messages
• This study shows that there are individual, temporal and environmental factors strongly associated with a higher frequency of drownings in Portugal.
• Portugal has a large coastal zone and the characterization of a drowning profile is the first step for the development of prevention strategies in order to oppose drowning morbidity and mortality.
Race/Ethnicity, Education, and All-Cause Mortality in US Adults: Mediation by Telomere Length
Authors: Kodali H , Jones H , Wyka K , Valeri L , Borrell L 
Published: October 2024

Abstract

Background
Racial/ethnic inequities in mortality risk are pervasive in the United States even after controlling for socioeconomic status indicators such as educational attainment. Although the mechanisms underlying these inequities remain unclear, telomere length (TL) has emerged as a potential mediator. We aimed to investigate the joint association of race/ethnicity and education with all-cause mortality risk, and the contribution of TL to this relationship.

Methods
We used data from the U.S. National Health and Nutrition Examination Survey, 1999 to 2002, and 2019 Linked Mortality File (n = 6,526 non-institutionalized adults aged 25 years or older, including 2,166 deaths), a retrospective cohort study with a follow-up period to December 31, 2019. Cox proportional hazards regression and causal mediation analysis were used to address these aims. We reported hazard ratios (HR) and 95 % confidence intervals (CI). Furthermore, for the mediation analysis, we reported the total, direct, and indirect effects measured as HR and 95 % CI.

Results
After adjusting for age and sex, among White individuals, those with less than a high school education had a 2.26 times higher (95% CI: 1.93, 2.65) rate of all-cause mortality compared to those with some college or higher education. When compared with White adults with at least a college degree, Black adults with at least a college degree had a 1.38 higher rate of dying (95% CI: 1.04, 1.84). There was no significant joint association of race/ethnicity and education on all-cause mortality in Mexican Americans. In the mediation analysis, TL did not significantly contribute to the joint association of race/ethnicity and education with all-cause mortality risk.

Discussion
These findings underscore the need for a better understanding of the joint relationship of race/ethnicity and education on mortality risk inequities and their potential mechanisms to improve population health ultimately.

Key messages
• Lower educational attainment was associated with higher mortality rates among White individuals, disparities persisted among the Black population, despite higher education levels.
• Our analysis did not find a significant mediation effect of telomere length on the joint effect of race/ethnicity and education-mortality relationship.