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- Temporal variations in the short-term effects of ambient air pollution on cardiovascular and respiratory mortality: a pooled analysis of 380 urban areas over a 22-year periodPublication . Schwarz, Maximilian; Peters, Annette; Stafoggia, Massimo; de'Donato, Francesca; Sera, Francesco; Bell, Michelle L; Guo, Yuming; Honda, Yasushi; Huber, Veronika; Jaakkola, Jouni J.K.; Urban, Aleš; Vicedo-Cabrera, Ana Maria; Masselot, Pierre; Lavigne, Eric; Achilleos, Souzana; Kyselý, Jan; Samoli, Evangelia; Hashizume, Masahiro; Fook Sheng Ng, Chris; Silva, Susana; Madureira, Joana; Garland, Rebecca M.; Tobias, Aurelio; Armstrong, Ben; Schwartz, Joel; Gasparrini, Antonio; Schneider, Alexandra; Breitner, Susanne; Kan, Haidong; Osorio, Samuel; Orru, Hans; Indermitte, Ene; Maasikmets, Marek; Ryti, Niilo; Pascal, Mathilde; Katsouyanni, Klea; Analitis, Antonis; Entezari, Alireza; Mayvaneh, Fatemeh; Kim, Yoonhee; Alahmad, Barrak; Hurtado Diaz, Magali; Félix Arellano, Eunice Elizabeth; Rao, Shilpa; Diz-Lois Palomares, Alfonso; Scovronick, Noah; Acquaotta, Fiorella; Kim, Ho; Lee, Whanhee; Íñiguez, Carmen; Forsberg, Bertil; Ragettli, Martina S.; Guo, Yue Leon; Pan, Shih-Chun; Li, Shanshan; Zanobetti, AntonellaBackground: Ambient air pollution, including particulate matter (such as PM10 and PM2·5) and nitrogen dioxide (NO2), has been linked to increases in mortality. Whether populations' vulnerability to these pollutants has changed over time is unclear, and studies on this topic do not include multicountry analysis. We evaluated whether changes in exposure to air pollutants were associated with changes in mortality effect estimates over time. Methods: We extracted cause-specific mortality and air pollution data collected between 1995 and 2016 from the Multi-Country Multi-City (MCC) Collaborative Research Network database. We applied a two-stage approach to analyse the short-term effects of NO2, PM10, and PM2·5 on cause-specific mortality using city-specific time series regression analyses and multilevel random-effects meta-analysis. We assessed changes over time using a longitudinal meta-regression with time as a linear fixed term and explored potential sources of heterogeneity and two-pollutant models. Findings: Over 21·6 million cardiovascular and 7·7 million respiratory deaths in 380 cities across 24 countries over the study period were included in the analysis. All three air pollutants showed decreasing concentrations over time. The pooled results suggested no significant temporal change in the effect estimates per unit exposure of PM10, PM2·5, or NO2 and mortality. However, the risk of cardiovascular mortality increased from 0·37% (95% CI -0·05 to 0·80) in 1998 to 0·85% (0·55 to 1·16) in 2012 with a 10 μg/m3 increase in PM2·5. Two-pollutant models generally showed similar results to single-pollutant models for PM fractions and indicated temporal differences for NO2. Interpretation: Although air pollution levels decreased during the study period, the effect sizes per unit increase in air pollution concentration have not changed. This observation might be due to the composition, toxicity, and sources of air pollution, as well as other factors, such as socioeconomic determinants or changes in population distribution and susceptibility.
- Biomonitoring of firefighters’ exposure to priority pollutant metal(loid)s during wildland fire combat missions: Impact on urinary levels and health risksPublication . Paiva, Ana Margarida; Barros, Bela; Azevedo, Rui; Oliveira, Marta; Alves, Sara; Esteves, Filipa; Fernandes, Adília; Vaz, Josiana; Alves, Maria José; Slezakova, Klara; Pereira, Maria do Carmo; Teixeira, João Paulo; Costa, Solange; Almeida, Agostinho; Morais, SimoneWildland firefighters are exposed to metal(loid)s released during wildfires through vegetation combustion, which also promotes remobilization of accumulated anthropogenic metal(loid)s. Studies biomonitoring metal(loid)s exposure promoted exclusively by wildfire suppression activities are lacking. This work aimed to characterize, for the first time, the impact of real-life wildland firefighting operations on urinary levels of priority pollutant metal(loid)s [14 included in ATSDR, 11 in USEPA, and 4 in Human Biomonitoring for Europe Initiative priority lists] in firefighters. Spot urines were sampled pre-exposure (105 non-smokers, 76 smokers) and post-exposure to firefighting activities (20 non-smokers, 25 smokers); among those, paired samples were collected from 14 non-smoking and 24 smoking firefighters. Smokers displayed significantly higher baseline levels of zinc (28 %), lithium (29 %), cadmium (55 %), rubidium (13 %), and copper (20 %) than non-smokers. Following wildfire suppression, the concentration of the WHO potentially toxic metal(loid)s rose from 2 % to 3 % in smokers and 2 % to 5 % in non-smokers (up to 4 % for all firefighters and up to 5 % in paired samples). Levels of nickel (33-53 %), antimony (45-56 %), and cesium (40-47 %) increased significantly post-exposure in non-smokers (in all firefighters and in paired samples), whose urinary concentrations were generally more impacted by wildfire emissions than those of smokers. Arsenic (80 %) displayed the only significant increase post-exposure in smokers, being the best discriminant of exposure to wildfire emissions in these subjects. Significant positive correlations were found for age and/or career length with cadmium, lead, barium, strontium, and mercury, and for body mass index with arsenic. The reference/guidance values were exceeded for arsenic, zinc, cesium, nickel, antimony, cadmium, lead, thallium, mercury, copper, and cobalt in 1-90 % of firefighters suggesting augmented health risks due to wildfire combating and emphasizing the need of mitigation strategies. This study also provides biomonitoring data to help setting reference values for the occupationally exposed part of population.
- Safety evaluation of curdlan as a food additivePublication . Andreassen, Monica; Aquilina, Gabriele; Bastos, Maria Lourdes; Boon, Polly; Fallico, Biagio; FitzGerald, Reginald; Frutos Fernandez, Maria Jose; Grasl‐Kraupp, Bettina; Gundert‐Remy, Ursula; Gürtler, Rainer; Houdeau, Eric; Kurek, Marcin; Louro, Henriqueta; Morales, Patricia; Passamonti, Sabina; Barat Baviera, José Manuel; Degen, Gisela; Gott, David; Herman, Lieve; Leblanc, Jean‐Charles; Moldeus, Peter; Waalkens‐Berendsen, Ine; Wölfle, Detlef; Civitella, Consuelo; Entrena, Jaime Aguilera; Mech, Agnieszka; Multari, Salvatore; Ruggeri, Laura; Smeraldi, Camilla; Tard, Alexandra; Vermeiren, Sam; Castle, Laurence; EFSA FAF Panel (EFSA Panel on Food Additives and Flavourings)The EFSA Panel on Food Additives and Flavourings (FAF) provides a scientific opinion on the safety of curdlan as a new food additive used as firming and gelling agent, stabiliser, thickener. Curdlan is a high molecular weight polysaccharide consisting of β-1,3-linked glucose units, produced by fermentation from Rhizobium radiobacter biovar 1 strain NTK-u. The toxicological dataset consisted of sub-chronic, chronic and carcinogenicity, reproductive and developmental toxicity studies as well as genotoxicity. In vivo data showed that curdlan is not absorbed as such but is extensively metabolised by the gut microbiota into CO2 and other innocuous compounds. Curdlan was not genotoxic and was well-tolerated with no overt organ-specific toxicity. Effects observed at very high doses of curdlan, such as decreased growth and increased cecum weight, are common for indigestible bulking compounds and therefore considered physiological responses. In a combined three-generation reproductive and developmental toxicity study, decreased pup weight was observed during lactation at 7500 mg curdlan/kg body weight (bw) per day, the highest dose tested. The Panel considered the observed effects as treatment-related and adverse, although likely secondary to nutritional imbalance and identified a conservative no observed adverse effect level (NOAEL) of 2500 mg/kg bw per day. Despite the limitations noted in the dataset, the Panel was able to conclude applying the margin of exposure (MOE) approach. Given that curdlan and its break-down products are not absorbed and that the identified adverse effect is neither systemic nor local, no adjustment factor was deemed necessary. Thus, an MOE of at least 1 was considered sufficient. The highest exposure estimate was 1441 mg/kg bw per day in toddlers at the 95th percentile of the proposed maximum use level exposure assessment scenario. The Panel concluded that there is no safety concern for the use of curdlan as a food additive at the proposed uses and use levels.
- Nutrition remains a top priority in Ukraine despite the ongoing war: the fight against trans fatsPublication . Gonzales, Gerard Bryan; Fino Alberto da Motta, Carla Alexandra; Farrand, Clare; Habicht, Jarno; Kuriata, Olena; Phyo, Pyi Pyi; Skipalskyi, Andrii; Wickramasinghe, KremlinDespite the ongoing war, nutrition remains a top priority in Ukraine. In collaboration with the WHO, Ukraine remains steadfast in its mission to eliminate trans fats in the food supply as a measure to reduce non-communicable diseases in the country. Ukraine has passed legislation on the monitoring and regulation of trans fats in foods, and WHO has been supporting the country in building laboratory capacity to achieve this goal.
- The Multi-Country Multi-City Collaborative Research Network: An international research consortium investigating environment, climate, and healthPublication . Gasparrini, Antonio; Vicedo-Cabrera, Ana Maria; Tobias, Aurelio; behalf of the MCC Collaborative Research NetworkResearch on the health risks of environmental factors and climate change requires epidemiological evidence on associated health risks at a global scale. Multi-center studies offer an excellent framework for this purpose, but they present various methodological and logistical problems. This contribution illustrates the experience of the Multi-Country Multi-City Collaborative Research Network, an international collaboration working on a global research program on the associations between environmental stressors, climate, and health in a multi-center setting. The article illustrates the collaborative scheme based on mutual contribution and data and method sharing, describes the collection of a huge multi-location database, summarizes published research findings and future plans, and discusses advantages and limitations. The Multi-Country Multi-City represents an example of a collaborative research framework that has greatly contributed to advance knowledge on the health impacts of climate change and other environmental factors and can be replicated to address other research questions across various research fields.
- Exploring Cynara cardunculus L. by-products potential: Antioxidant and antimicrobial propertiesPublication . Barbosa, Cássia H.; Duarte, Maria Paula; Andrade, Mariana A.; Mateus, Ana Rita; Vilarinho, Fernanda; Fernando, Ana Luisa; Silva, Ana SanchesCynara cardunculus L. (cardoon), a perennial crop indigenous to the Mediterranean region, has gained recognition for its remarkable resilience to diverse weather conditions and its multifaceted applications across various industries, which includes the use of the flower as a vegetable rennet to produce some cheeses, as a source of biomass for energy, or its seed oil for human consumption, biodiesel, and animal feed. In some applications (e.g. biomass or seed production), when crop is harvested at the end of the growth cycle, the leaves remain as the main by-products, along with the flowers. In the context of a circular economy, the aim of this work was to undergone studies to determinate their biological properties (antioxidant and antimicrobial). Methanolic and ethanolic extracts of C. cardunculus L. (globe artichoke var. scolymus (L.) Fiori) and cultivated cardoon (var. altilis DC.)) leaves and flowers were characterised in terms of their polyphenol profile (total phenolic content (TPC), total flavonoid compounds (TFC), and ultra-high performance liquid chromatography coupled with time-of-flight mass spectrometry (UHPLC-ToF-MS)), antioxidant capacity (free radical DPPH inhibition system, β-carotene bleaching assay), and antimicrobial capacity (minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), antifungal). In addition, the cultivated cardoon leaves extracts were assessed before and after they were dried in an oven with forced air circulation to evaluate if this treatment affected their bioactive profile. Chlorogenic acid, apigenin, and luteolin were the most quantified of a total of sixteen compounds identified by UHPLC-ToF-MS. Cultivated cardoon dry leaf extract presented the best antioxidant capacity for both methanolic (EC50 = 0.8 mg/mL, antioxidant activity coefficient (AAC) = 279.67) and ethanolic (EC50 =2.1 mg/mL, AAC = 448.06) extracts, compared to the cardoon flower extracts and the globe artichoke leaf ex tracts. Dried cultivated cardoon leaf extracts presented higher antioxidant capacity than fresh cultivated cardoon leaf extracts, but a greater number of polyphenolic compounds were identified in fresh cultivated cardoon leaf extract. The Gram-positive bacteria were more sensitive to the activity of both ethanolic and methanolic extracts than the Gram-negative and cultivated cardoon dry leaf ethanolic extract presented lower MIC and MBC values (125–2000 µg/mL) for most of the tested microorganisms, thus showing higher antimicrobial activity. As for the cultivated cardoon leaf extracts, the dried leaf extracts exhibited better antimicrobial activity, with lower MIC values, than the fresh leaf extracts. The extracts only demonstrated a slight inhibition against the fungi Aspergillus fumigatus. In conclusion, studies performed indicate that dried leaves maintain their biological activities compared to fresh leaves, and that flowers present significant biological activity which suggests the great.
- Mark–Release–Recapture Trial with Aedes albopictus (Diptera, Culicidae) Irradiated Males: Population Parameters and Climatic FactorsPublication . Amaro, Fátima; Amaro F.; Soares, Patricia; Velo, Enkelejda; Oliveira Carvalho, Danilo; Gomez, Maylen; Balestrino, Fabrizio; Puggioli, Arianna; Bellini, Romeo; Osório, HugoAedes albopictus is considered one of the major invasive species in the world and can transmit viruses such as dengue, Zika, or chikungunya. The Sterile Insect Technique (SIT) can be used to suppress the native populations of Ae. albopictus. Mark–release–recapture (MRR) studies are crucial to support the development of the release strategy during the SIT application. Meanwhile, weather conditions can affect the MRR trial’s results and it is critical to understand the influence of climatic factors on the results. In October 2022, 84,000 irradiated sterile males were released for three consecutive weeks in Faro, Southern Portugal. Mosquitoes were recaptured by human landing collection (HLC) one, two, four, and six days after release. Generalized linear models with a negative binomial family and log function were used to estimate the factors associated with the number of recaptured mosquitoes, prevalence ratios, and the 95% confidence intervals (CIs). A total of 84,000 sterile male mosquitoes were released, with 528 recaptured (0.8%) by HLC. The prevalence of recaptured mosquitoes was 23% lower when the wind intensity was moderate. Marked sterile males had an average median distance travelled of 88.7 m. The median probability of daily survival and the average life expectancy were 61.6% and 2.1 days, respectively. The wild male population estimate was 443.33 males/ha. Despite no statistically significant association being found with humidity, temperature, and precipitation, it is important to consider weather conditions during MRR trial analyses to obtain the best determinant estimation and a more efficient application of the SIT in an integrated vector management program.
- Distribution of Chlamydia trachomatis ompA-genotypes over three decades in PortugalPublication . Lodhia, Zohra; Cordeiro, Dora; Correia, Cristina; João, Inês; Carreira, Teresa; Vieira, Luís; Nunes, Alexandra; Ferreira, Rita; Schäfer, Sandra; Aliyeva, Elzara; Portugal, Clara; Monge, Isabel; Pessanha, Maria Ana; Toscano, Cristina; Côrte-Real, Rita; Antunes, Marília; Gomes, Joao Paulo; Borges, Vítor; José Borrego, MariaObjectives: Chlamydia trachomatis is classified into 15 major genotypes, A to L3, based on the diversity of ompA gene. Here, we evaluated and characterised the distribution and diversity of ompA-genotypes over 32 years (1990-2021) in Portugal. Methods: The collection of the Portuguese National Reference Laboratory for Sexually Transmitted Infections includes 5824 C. trachomatis-positive samples that were successfully ompA-genotyped between 1990 and 2021. An in-depth analysis of ompA-genotypes distribution across the years, as well as by biological sex, age and anatomical site of infection was performed. Results: ompA-genotype E was consistently the most frequently detected across the years, with a median frequency of 34.6%, followed by D/Da (17.6%), F (14.3%) and G (10.7%). The prevalence of lymphogranuloma venereum (LGV) genotypes (mostly L2, 62.0%, followed by L2b, 32.1%) increased since 2016, reaching the highest value in 2019 (20.9%). LGV, G and Da genotypes were associated with biological sex, specifically with being male, and were the most frequent among anorectal specimens (37.7%, 19.4% and 17.7%, respectively). Notably, LGV ompA-genotypes represented 38.9% of the male anorectal specimens since 2016, and were also detected among oropharynx and urogenital samples. ompA-genotype E was the most frequently detected at the oropharynx (28.6%) and urogenital (33.9%) sites during the study period, followed by D/Da (17.4%) and F (16.0%) in the urogenital specimens, and by G (26.1%) and D/Da (25.7%) in oropharynx specimens. Our data also highlight the emergence of the recombinant L2b/D-Da strain since 2017 (representing between 2.0% and 15.5% of LGV cases per year) and the non-negligible detection of ompA-genotype B in urogenital and anorectal specimens. Conclusions: This study provides a comprehensive landscape of C. trachomatis molecular surveillance in Portugal, highlighting the continued relevance of ompA-genotyping as a complement to rapid LGV-specific detection tests. It also contributes to a deeper understanding of C. trachomatis epidemiology, diversity and pathogenicity.
- The spread of the invasive mosquito Aedes albopictus (Diptera: Culicidae) in Portugal: a first genetic analysisPublication . Zé-Zé, Líbia; Campos Freitas, Inês; Silva, Manuel; Soares, Patricia; Alves, Maria João; Osório, HugoBackground: Aedes albopictus, commonly known as the Asian tiger mosquito, has become one of the most invasive mosquito species. Over the last 5 decades, it has been introduced and established in various tropical and temperate regions worldwide. First reported in Europe in 1979 in Albania and later in Italy in 1990, the species is now established in 13 European Union (EU)/European Economic Area (EEA) countries and 337 regions (2023). In Portugal, Ae. albopictus was first detected in the Algarve and Penafiel regions in 2017, followed by Alentejo in 2022 and Lisbon in 2023. This mosquito species poses a significant public health risk as a vector for numerous pathogenic viruses, including dengue, Zika, and chikungunya. Methods: Aedes albopictus collected in Lisbon in 2023 were analyzed using cytochrome c oxidase I (COX) gene sequencing to understand their genetic relationships. Results: Our data indicate that the Ae. albopictus mosquito populations detected in three locations in Lisbon in 2023 correspond to recent but distinct introduction events. Conclusions: Although there has been no local transmission of Aedes-transmitted viruses in mainland Portugal to date, the spread of the mosquito and increased international travel increase the risk of Aedes-borne disease outbreaks. The ongoing spread of Ae. albopictus in the country and the confirmed multiple introductions in new locations raise awareness of the need to monitor mosquito vectors to control and prevent autochthonous Aedes-borne disease outbreaks.
- Long COVID is not the same for everyone: a hierarchical cluster analysis of Long COVID symptoms 9 and 12 months after SARS-CoV-2 testPublication . Moniz, Marta; Ruivinho, Carolina; Goes, Ana Rita; Soares, Patricia; Leite, AndreiaBackground: Identifying symptom clusters in Long COVID is necessary for developing effective therapies for this diverse condition and improving the quality of life of those affected by this heterogeneous condition. In this study, we aimed to identify and compare symptom clusters at 9 and 12 months after a SARS-CoV-2 positive test and describe each cluster regarding factors at infection. Methods: This is a cross-sectional study with individuals randomly selected from the Portuguese National System of Epidemiological Surveillance (SINAVE) database. Individuals who had a positive RT-PCR SARS-CoV-2 test in August 2022 were contacted to participate in a telephonic interview approximately 9 and 12 months after the test. A hierarchical clustering analysis was performed, using Euclidean distance and Ward's linkage. Clustering was performed in the 35 symptoms reported 9 and 12 months after the SARS-CoV-2 positive test and characterised considering age, sex, pre-existing health conditions and symptoms at time of SARS-CoV-2 infection. Results: 552 individuals were included at 9 months and 458 at 12 months. The median age was 52 years (IQR: 40-64 years) and 59% were female. Hypertension and high cholesterol were the most frequently reported pre-existing health conditions. Memory loss, fatigue or weakness and joint pain were the most frequent symptoms reported 9 and 12 months after the positive test. Four clusters were identified at both times: no or minor symptoms; multi-symptoms; joint pain; and neurocognitive-related symptoms. Clusters remained similar in both times, but, within the neurocognitive cluster, memory loss and concentration issues increased in frequency at 12 months. Multi-symptoms cluster had older people, more females and more pre-existing health conditions at 9 months. However, at 12 months, older people and those with more pre-existing health conditions were in joint pain cluster. Conclusions: Our results suggest that Long COVID is not the same for everyone. In our study, clusters remained similar at 9 and 12 months, except for a slight variation in the frequency of symptoms that composed each cluster. Understanding Long COVID clusters might help identify treatments for this condition. However, further validation of the observed clusters and analysis of its risk factors is needed.