Ecological Studies Research Articles

A targeted study to determine the conservation status of a Data Deficient montane lizard, the Eungella shadeskink (Saproscincus eungellensis)

Context Combatting biodiversity loss is often hamstrung by a lack of species-specific knowledge. Species considered Data Deficient (DD) on the IUCN Red List are poorly understood and often neglected in conservation investment, despite evidence they are often threatened. Reptiles have the highest percentage of DD species for any terrestrial vertebrate group. Aims We aimed to assess the conservation status of the DD Eungella shadeskink (Saproscincus eungellensis), which is endemic to Eungella National Park, Queensland, Australia. Methods A combination of a targeted field survey, ecological studies, and species distribution modelling were used. Key results Saproscincus eungellensis typically occurred within 25 m of streams, at elevations between 700 and 1000 m. The species is thigmothermic, with a low active body temperature (~23–26°C) and was predominantly observed on rocks and fallen palm fronds. The species has a highly restricted distribution with an estimated Area of Occupancy of 36 km2 and Extent of Occurrence of 81.7 km2, comprising one location (defined by the threat of climate change) with an estimated 16,352–52,892 mature individuals. The main threats are fire, invasive alien species and climate change, with the species forecast to lose all suitable habitat by 2080 under all climate change scenarios. Conclusions The species meets listing criteria for Critically Endangered under Criterion B of the International Union for Conservation of Nature. Implications Our results support recent studies indicating that some DD species are highly threatened. Our approach provides a template for conducting targeted studies to determine the conservation status of DD species, especially those with restricted ranges.

Diversity of fish otoliths from the Gulf of Mexico and the Caribbean Sea: Report on the first digital collection of fish otoliths (Actinopterygii) from the Atlantic region of Mexico

The Otolith Collection of Fishes from the Gulf of Mexico and Caribbean Sea was created with the objective to conserve and illustrate the diversity of these structures from species living in the Gulf of Mexico, the Caribbean Sea, and the freshwater and brackish systems of the Yucatan Peninsula, incorporating morphological descriptions and morphometric data. Otoliths, non-skeletal calcareous structures that develop in the inner ear of fish, are essential for balance and hearing. They have become pivotal tools for age and growth determination, population analysis, and ecological, trophic, and archaeological studies due to their resistance to degradation and the extensive information they provide about the environment and physiology of fish. The collection now includes otoliths from 214 species, representing 67 families, obtained through sampling campaigns and collaborations with local fishermen. The otoliths are extracted using techniques that ensure the integrity of the structures for later preservation. High-resolution images were obtained using optical and scanning electron microscopy, and these images are stored in an online database. This database facilitates research and teaching by providing public access to digital specimens and associated data. In addition to fostering academic development, this collection represents a significant step towards the creation of a national platform for otolith data analysis, aligned with international efforts to digitize biological collections. Despite the financial and logistical challenges involved in building and maintaining biological collections, this collection demonstrates its value as an essential resource for taxonomic, systematic, and ecological studies, as well as for biodiversity education and awareness. The online availability of the collection not only facilitates access to data but also promotes innovation and international collaboration in the study of fishes and their habitats.

Health Impacts of Disasters and Social Indicators: An Ecological Study

Abstract The objective of this study is to investigate the correlation between certain social indicators and the mortality and morbidity in disasters recorded in the EM-DAT database within countries in the last decade. The correlation between the mortality and morbidity in disasters recorded in the EM-DAT database between March 1, 2014-2024 and the most recent data on Human Development Index (HDI), Gender Inequality Index (GII), Gini Coefficient (GC), Government Health Expenditure as a share of GDP (GHE/GDP) and Corruption Perception Index (CPI) were analyzed. During the period of the study, disasters from a total of 207 countries/regions were recorded in the database. The median (IQR) values of countries in disasters were found to be 35.1 (67.5) for death per million and 76.3 (783.0) for injury per million. The most frequent types of disasters, the most frequent cause of mortality and the most frequent cause of injury in each country were found to be floods, extreme temperatures, and epidemics, respectively. While there was no significant difference between the social indicators analyzed and the total number of deaths, there was a negative correlation between the number of injuries and the HDI, CPI, GHE/GDP values of the countries, and a positive correlation between the GC and GII values (for all tests, Spearman correlation test, p < 0.001). The correlation coefficient was interpreted as ‘weak’ in all other pairwise analyses except for the GHE/GDP value (moderate). Countries with social indicators closer to the positive threshold have been found to have less injuries in disasters. The possible reason for the insignificant correlation with the mortality is thought to be the difficulties in detecting mortality, especially in ‘extreme temperatures’, and the fact that it is mostly recorded in countries where social indicators are relatively more advanced. More research is needed to investigate the relationality between social indicators and disaster harms. Key messages • Disasters are critical mediators between social determinants and health. Addressing and reducing inequalities should remain on the public health agenda to prevent disasters and protect health. • Analysis of disasters shows that ‘extreme temperatures’, which cause the most deaths in some countries, are barely detected in developing countries. Disaster recording systems need to be strengthened.

Long-Term exposure to NO2 and Stroke Mortality in Portugal: an ecological study from 2001 to 2021

Abstract Background Air pollution is an important contributing factor for many pathologies, including stroke. Nitrogen dioxide (NO2), an air pollutant, has been associated in multiple studies with strokes’ mortality. Aim This study aims, for the first time, to estimate the number of deaths by stroke due to long-term, ambient exposure to nitrogen dioxide in Portugal for the years 2001-2021. Methods An ecological study was considered, including data for NO2 outdoor concentration from Portugal. Mortality data by stroke was obtained divided in 5-year groups. It was also obtained life expectancy for each year to calculate the years of life lost (YLL). The hazard ratio (HR) was obtained from literature (1.009, CI 1.003-1.016). The population attributable fraction (PAF) of YLL by stroke due to ambient NO2 long-term exposure was calculated. Results The annual average NO2 concentration in Portugal decreased from its peak in 2001 of 29.4 to 12.2 µg/m3 in 2021. The YLL by stroke decreased from an estimated 57452 to 31204 from 2001 to 2021. The PAF of YLL by stroke due to ambient NO2 long-term exposure reached its peak in 2001, when an estimated 5.2% of all the YLL by stroke, corresponding to 3029 YLL, were due to NO2 exposure and a bottom in 2021, when 2.2%, corresponding to 682 YLL, where due NO2 exposure. Conclusions The policies and legislation implemented to curb down NO2 seem to have had an effect in Portugal. A reduction in NO2 emissions was achieved, having a significant impact on YLL by stroke in Portugal, suggesting that curbing the NO2 emissions down had a positive effect on mortality by stroke in Portugal. To further enhance our knowledge on the real impacts of NO2, further studies must be conducted to estimate the morbidity associated with NO2 on stroke as well as in other diseases. Key messages • Pollution by nitrogen dioxide decreased significantly from 2001 to 2021. • Around 20000 years of life were lost just in Portugal due to nitrogen dioxide between 2001 and 2021.

Extreme Heat and Specific-Cause Mortality during Summer 2018 in Mainland Portugal

Abstract Climate change has led to increased frequency and duration of extreme heat periods, impacting human health and mortality. During the 2003 heatwave, it was estimated that there were between 25,000 and 70,000 excess deaths in Western Europe. Specific-cause mortality analysis was conducted in Portugal that year and has not been assessed since. The goal of this study is to estimate the impact of an extreme heat period in 2018 on specific-cause mortality in mainland Portugal. An ecological study was conducted comparing observed and expected deaths, from August 2 to 9, 2018, in Portugal. Two comparison periods were chosen: from July 19 to 26, 2018 (C1) and the average deaths from August 2 to 9 in 2017 and 2019 (C2). Excesses, ratios, and respective 95% confidence intervals were calculated in R. Analyses were stratified by sex, age group, and district. Consistent excess deaths were observed between comparators, showing a greater impact in circulatory diseases (C1: 283, 95% CI: 210; 356 and C2: 239, 95% CI: 164; 314) and respiratory diseases (C1: 98, 95% CI: 55; 141 and C2: 95, 95% CI: 52; 138). Regarding death ratios, with C1, the highest death ratios were observed for exposure to excessive natural heat (50.00, 95% CI: 37.11; 65.92) and ischemic stroke (4.00, 95% CI: 2.07; 6.99). With C2, the highest death ratios were observed for exposure to excessive natural heat (50.00, 95% CI 37.11; 65.92) and atherosclerosis (2.71, 95% CI 1.63; 4.24). The excesses and ratios of deaths were higher in more urbanized districts, females, and age groups above 75 years. The results suggest that the extreme heat in 2018 had an impact on mortality. Elevated death ratios and excesses were observed for various causes of death with considerable statistical magnitude and significance. These findings align with other national and international studies. Public health action is increasingly critical to mitigate the observed rise in mortality during periods of extreme heat. Key messages • Specific-cause mortality analysis during extreme heat suggests a greater impact in circulatory and respiratory diseases, in residents of urbanized districts, females, and individuals of 75+ years. • Understanding these specific causes can better inform public health actions and planning, thereby mitigating the adverse effects of extreme heat.

Agenda 2030 for sustainable development in Portuguese Speaking Countries, indicators inequalities

Abstract Background Achieving the SDG Sustainable Development goals represents a major global challenge. The Community of Portuguese Speaking Countries (CPLP) is made up of countries: Angola, Cape Verde, Guinea-Bissau, Equatorial Guinea, Mozambique, São Tomé and Príncipe, Brazil, Portugal, and East Timor. Studies on SDG indicators are little studied among these countries. The study analyzes SDG health indicators in the Community of Portuguese Speaking Countries (CPLP) and their projections for 2030, and investigates the correlation between the countries’ level of development and the performance of these indicators. Methods Ecological epidemiological study. Estimates from the Global Burden of Disease (GBD) study between 1990 and 2021 were analyzed, referring to fifteen indicators: universal health coverage, sanitation, smoking, maternal and child health, vaccination coverage and communicable diseases. The GBD study generated projections by calculating the annual change since 1990 for each country and year and then calculating the weighted annualized rate of change. The correlation between the Sociodemographic Index (SDI) and the SDG indicators was investigated using the Spearman test, at a significance level of 5%. Results The best performances of the analyzed indicators were seen for Portugal, followed by Brazil, Cape Verde and São Tomé and Príncipe. In other countries, high rates of infectious diseases, maternal and childhood mortality, malnutrition, low vaccination coverage and sanitation were observed. There was a negative correlation between the SDI and the indicators of childhood mortality rate (R=-0.82; p < 0.05), malnutrition (R=-0.7; p < 0.05), incidence of tuberculosis (R =-0.73; p < 0.05) and positive between SDI and sewage coverage (R=-0.83; p < 0.05). Conclusions The CPLP presents internal differences regarding the health indicators analyzed, making it essential to advance cooperation between countries to achieve the SDG targets in 2030. Key messages • There are great inequalities between SDG indicators in Portuguese-speaking countries. • It is important to advance technical cooperation between countries to formulate solutions and leave no one behind.

Incomplete barriers to heterospecific mating among Somatochlora species (Odonata: Corduliidae) as revealed in multi-gene phylogenies.

Mating between species occurs within many insect orders. The result of heterospecific mating depends upon the effectiveness of pre- and post-reproductive barriers. Incomplete reproductive barriers lead to introgression of DNA into one species or both. Intricate genital morphology among dragonflies provides little assurance of species specificity given that heterospecific mating or mating attempts have been observed among many species. The genetic consequence is unknown for many heterospecific matings. For example, Somatochlora species mating and genetic exchange have been hypothesized based on observational records and individuals with hybrid morphology. We investigate the potential of heterospecific mating between North American Somatochlora species as inferred from multi-gene phylogenies. We used mitochondrial genes (COI and ND3) and nuclear genes (EF1-α and ITS2) to construct phylogenies using maximum parsimony. Observation of non-monophyletic mtDNA lineages but monophyletic nDNA lineages between Somatochlora sister-species would indicate mtDNA introgression and suggest heterospecific matings. Our results highlighted three instances of non-monophyly of mtDNA clades in the following groups: (i) S. hineana + S. tenebrosa; (ii) S. kennedyi + S. forcipata + S. franklini; and (iii) S. calverti + S. provocans + S. filosa. Analysis of partitioned Bremer support indicates that mtDNA COI largely contributed to the non-monophyly of these species, thus suggesting mtDNA introgression resulting from heterospecific matings. Additionally, the topology resulting from the combined data analysis was concordant with previous taxonomic understanding of Somatochlora species groups. These multi-gene phylogenies of North American Somatochlora are the first, providing a foundation for future ecological and evolution studies and knowledge for effective decision-making and public policy, which is especially important for the endangered species, S. hineana.

Escalating Health Crisis: Dissecting Mortality Causes and Trends Among Indigenous Populations in Northeast Brazil.

In Northeast Brazil, the poorest region of the country, indigenous communities face critical health care challenges. Despite legal entitlements to the Unified Health System (SUS), systemic barriers persist, exacerbating health disparities and mortality. This ecological study analyzed mortality trends and causes of death within the Special Indigenous Sanitary District (DSEI) Alagoas-Sergipe over a decade. Data on deaths from 2012 to 2022 were obtained from the Indigenous Health Secretariat. Causes of death were classified into 13 categories. Mortality rates per 1,000 indigenous inhabitants were calculated, and trends were analyzed using the Mann-Kendall test. The study also compared causes of death by age group. Mortality rates ranged from 3.3 to 5.2 per 1,000, showing a moderate upward trend over time (τ = 0.5, p = 0.042). Predominant causes included heart and vascular disorders (24.3%), external causes (12.4%), respiratory issues (11.1%), and infections (10.9%). About one-third of pediatric deaths were associated with general neonatal complications. This study highlights increasing mortality in indigenous communities in Northeast Brazil. The predominant causes of death reflect broader public health concerns. These trends emphasize the urgency for more effective, culturally sensitive public health policies and improved health care access.

Proton-pump inhibitor use in older adults: Public vs. Private Prescribing in Portugal

Abstract Background Proton pump inhibitors (PPI) are frequently overprescribed, posing challenges to patients and healthcare systems. In Portugal, the publicly funded National Health Service (NHS) provides universal coverage and reimburses the cost of medications regardless of the prescription origin. If private practices may benefit from longer consultation times allowing better prescription, they do not face any incentive to avoid over-prescription. We aimed to compare outpatient prescription trends, patterns, and costs of PPI among older adults in private and public sectors. Methods Nationwide retrospective ecological study on PPI prescribed for older adults in Portugal 2020-2022. Data on defined daily doses (DDD) and costs were obtained from a national public database by healthcare sector, sex (female/male), and age group (65-74, ≥75). We analysed trends, market share of DDD per 1000 older adults per day (DID), and mean cost per DDD (€/DDD) for all PPI substances. Results We observed a decrease in prescribed PPI from 349.0 DID in 2020 to 341.9 DID in 2022. Omeprazole (reference and cheaper substance) was the most prescribed drug for females and pantoprazole for males in the public sector. Similar pattern was observed among those aged ≥75 in the private sector while for those aged 65-74, esomeprazole was the most prescribed drug. Overall, the private sector prescribed PPI with a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances (rabeprazole +0.032 €/DDD; lansoprazole +0.029 €/DDD; esomeprazole +0.021 €/DDD). Conclusions PPI prescription followed similar trends in both sectors, but private practitioners tend to prescribe more expensive drugs, because their patients can afford them and because there is no incentive for more rational prescription. Since the NHS financially supports drugs prescribed in private practices, financial incentives towards rationale prescription should also fall in this sector. Key messages • Overall, the private sector prescribed PPI with a 20% higher price (0.126 €/DDD) than the public (0.106 €/DDD), with greater differences among the most expensive substances. • Since the National Health Service financially supports drugs prescribed in private practices, financial incentives towards rationale prescription should also fall in this sector.

Income transfer and COVID-19 pandemic in Brazil: wrong and right at the same time

Abstract To alleviate the effects of socioeconomic inequalities and of the fall in economic activity on vulnerable populations during the COVID-19 pandemic, many countries have implemented or expanded income distribution programs. Brazil, amid the political and economic 2020 crisis, exacerbated by the pandemic, established Emergency Aid (EA). This longitudinal ecological study aimed to analyze whether the availability of EA contributed to the reduction of morbidity and mortality due to COVID-19 in the Brazilian 5,570 municipalities, from March 2020 to December 2021. The theoretical model considered as control covariates socioeconomic, sociodemographic and morbidity characteristics and access to health services, including COVID-19 testing availability and vaccination. Classical variable selection methods were applied considering the theoretical model, culminating in the adjustment of Bayesian hierarchical models with the inclusion of spatial and temporal effects. First dose COVID-19 vaccine coverage and EA had a protective effect against hospitalization (RR = 0.982 and RR = 0.986) and mortality (RR = 0.978 and RR = 0.976) due to COVID-19 in Brazil, when controlled by socioeconomic variables, access to health services and spatial-temporal effects. The results highlight the important role of income transfer in morbidity and mortality due to the disease, however, the way in which EA was implemented in Brazil presented a series of problems, the main ones being discontinued payment of aid, reduction in values throughout the duration of the benefit, in addition to the use of public resources to pay people who did not meet the eligibility criteria. Such problems might not have happened if the federal government had maintained the registration structure of Bolsa Familia Program (BFP), which did not happen. Furthermore, vaccination was started late for several reasons, that is, its role in reducing morbidity and mortality could have been even greater if started as soon as it become available. Key messages • Even with planning and execution problems, income transfer and specific vaccination were important in reducing COVID-19 morbidity and mortality in Brazil during the COVID-19 pandemic. • Income transfer during the COVID-19 pandemic in Brazil was not done in the best way possible, due to discontinued payment, reduction in values and payment to not eligible people.

Population health status and green urban areas: impact on health outcomes in two Italian regions

Abstract Background Living in urban areas has been linked to a rise in noncommunicable diseases. Nevertheless, there is scarcity of evidence emphasizing the combined impacts of certain urban attributes (e.g. pollution, excessive soil sealing, urban temperatures) and the existence of green spaces on health outcomes. Further studies are imperative to evaluate the association between chronic illnesses such as dementia and ischemic heart disease, and the presence of urban green areas. Methods We conducted an ecological study in two Italian regions. Prevalence of chronic diseases in Tuscany and Latium were obtained at the municipality level from public health databases available online and Normalized Difference Vegetation Index (NDVI) was calculated for 2023. Descriptive analyses and Poisson regression models were run to assess the association between green space and chronic diseases prevalence, adjusting for age, sex, education, employment, foreign residents, income, urbanicity and spatial correlation. Results Preliminary analyses were conducted on 273 municipalities in Tuscany. Mean prevalence per 1000 inhabitants of dementia and ischemic heart disease were 15.75 (SD = 5.3) and 48.25 (SD = 11.06), respectively. Mean NDVI across municipalities was 0.37 (SD = 0.04). Higher green exposure is associated with lower prevalence of ischemic heart disease (β= -0.21; p < 0.05) and dementia (β=-0.3, p < 0.05). Analyses will be executed for the Latium region and complete results will be available by mid-June. Conclusions The presence of urban greenery appears to be associated with a reduction in chronic illnesses. While further studies are warranted, it is crucial to adopt urban policies focused on green spaces and citizens’ health outcomes. Generating evidence for decision-makers is essential for shaping urban environments in ways that promote both health and overall human wellbeing. Key messages • Living in green urban areas appears to positively impact human health, reducing chronic disease prevalence. • Greenery serve as a tool for mitigating and adapting to the climate crisis, promoting health.

Association between gender inequality and climate adaptation across the global

Abstract Introduction Climate change has a disproportionate impact on women in comparison to men and women have a key role to play in climate adaptation. However, evidence is lacking on how gender inequalities may be associated with climate vulnerability and ability to respond at country level. Methods This ecological study investigated the association between climate adaptation, measured by the Notre Dame Global Adaptation Initiative Country Index (ND-GAIN), and gender inequality, measured by the Global Gender Gap Index (GGGI) developed by the World Economic Forum and the Gender Inequality Index (GII) developed by the United Nations. Simple linear regression was used to estimate the associations between the indices and their subdomains for 146 countries. Results There was an approximately linear association between the GGGI and climate adaptation. Each 1% increase in gender equality was associated with a 0.6% increase in the ND-GAIN score (slope 0.59, 95% confidence interval [0.33 to 0.84]). This was driven by a negative association between gender equality and vulnerability (-0.41 [-0.62 to -0.20]), and a positive association between gender equality and readiness (0.77 [0.44 to 1.10]). Gender equality in the education domain of the GGGI had the strongest association with climate adaptation. There was a strong negative linear association between the GII and climate adaptation, which explained most (87%) of the between-country variation in climate adaptation. Each 1% increase in gender inequality was associated with a 0.5% decrease in the ND-GAIN score (-0.53 [-0.57 to -0.50]). The association between gender inequality and readiness was stronger than the association with vulnerability (0.40 [0.37 to 0.44] for vulnerability versus -0.67 [-0.72 to -0.61] for readiness). Conclusions Gender inequality measured broadly across different domains of life is associated with climate adaptation at country level, both in terms of vulnerability to impact and readiness to respond. Key messages • Gender inequality, considered broadly across multiple domains of life, is associated with increased vulnerability to climate change and poor readiness to respond. • Addressing gender inequality needs to be a priority for governments and inter-governmental organisations if populations worldwide are to adapt to climate change.

Inequalities in local funding cuts to environmental and regulatory service expenditure in England

Abstract Background The financial crisis in 2008 has led to governments across Europe introducing austerity measures. England has experienced significant financial cuts to local authority (LA) services. Environmental and regulatory (ER) services provide key functions in public protection such as, Food Safety (FS) and Animal and Public Health Infectious Disease Control (APH), services which are key infectious disease resilience. Here we investigate inequalities in local funding cuts to ER services by socioeconomic deprivation, LA type, and urbanicity, and impact on key ER service indicators. Methods This ecological study uses longitudinal modelling techniques to analyse trends in ER expenditure since the introduction of austerity and the inequalities present. We use Generalised Estimating Equations to estimate the annual percent change of ER service expenditure, and FS and APH expenditure between 2009/10 and 2020/21 in relation to deprivation, LA type and population density. Quasi-Poisson regression is used to assess impact of cuts on ER service indicators. Results Areas of higher deprivation had the largest reduction in expenditure, with ER and FS and APH cuts of 2% and of 23% respectively, compared to a 1% and 8% reduction in the least deprived areas. The share of ER expenditure spent on FS and APH decreased by 13% in the most deprived authorities compared to 6% in the least deprived areas. London boroughs had the greatest reductions in FS and APH expenditure, decreasing by 10%. Both ER and FS and APH expenditure decreased with increasing population density. Preliminary analysis shows inequalities in food business hygiene ratings in addition to other key ER service indicators since the introduction of these cuts. Conclusions The unequal distribution of cuts shows the need for increased and equitable investment into these services to enable resilience to infectious disease threats, and to prevent widening of health inequalities. Key messages • This work provides strong evidence of inequalities in local funding cuts to ER services and highlights where investment should be focused, in order to protect environmental and public health. • This work introduces the impact of local funding cuts on a vital public health service and lays the foundation for future work into the unequal impact of cuts to these services on health outcomes.

Revisiting COVID-19 Maps with Bayesian Hierarchical Modelling: Socioeconomic Insights from Istanbul

Abstract Objectives This study explores the spatial disparities in COVID-19 incidence across neighborhoods in Uskudar, Istanbul, and examines the relationship between these disparities and neighborhood-level socioeconomic status. Methods This ecological study analyzed cumulative COVID-19 case data for 33 neighborhoods in Uskudar, collected up to 31 December 2020. Socioeconomic status was assessed using the Socioeconomic Development Index (SEDI) scores from Istanbul Metropolitan Municipality. Spatial analysis included Moran’s I statistics and Local Indicators of Spatial Association (LISA) cluster analysis. Bayesian Hierarchical Modeling with the Besag-York-Mollie (BYM) model was employed to decompose spatially structured and unstructured variations, adjusting for SEDI scores and their sub-components. Model validation involved convergence diagnostics and Monte Carlo error assessments. Results A total of 29,834 COVID-19 cases were identified, with an incidence rate of 56.1 per 1000 residents. Spatial analysis revealed significant clustering of high incidence rates in peripheral and inner city neighborhoods. Moran’s I statistic for COVID-19 incidence was 0.331 (p = 0.003), indicating positive spatial autocorrelation. SEDI scores were also spatially autocorrelated (Moran’s I = 0.293; p = 0.005) and negatively correlated with COVID-19 incidence (r = -0.570; p = 0.001). Bayesian hierarchical models confirmed the association between lower socioeconomic status and higher COVID-19 incidence, even after adjusting for spatial autocorrelation. Conclusions The study highlights significant spatial and socioeconomic disparities in COVID-19 incidence in Uskudar, Istanbul. Lower socioeconomic status is associated with higher COVID-19 incidence, underscoring the need for region-specific public health strategies that consider socioeconomic factors. These findings can guide future interventions to mitigate the impact of the pandemic on vulnerable populations. Key messages • Study reveals COVID-19 incidence in Uskudar is significantly influenced by socioeconomic status, highlighting need for targeted health interventions. • Positive spatial autocorrelation found in COVID-19 cases and socioeconomic index suggests clustering in specific Uskudar neighborhoods.

Temporal trends, regional and socio-economic disparities of colorectal cancer burden in Cyprus

Abstract Background Colorectal cancer (CRC) is one of the main causes of mortality and morbidity worldwide and it is the third most common cancer in Cyprus. Previous studies have documented variations in CRC burden over time, across regions and area-based socio-economic deprivation. The aim of this study was to analyse the burden of CRC over time, across regions and area-based socio-economic deprivation in Cyprus for the time period 2000 to 2015. Methods A small area ecological study was performed, with census tracts as units of spatial analysis. The incidence and death date, sex and age of CRC were obtained from the population-based cancer registry of Cyprus. Indirect standardization was used to calculate the sex and age Standardize Incidence Ratios (SIRs) and Standardized Mortality Ratios (SMRs) of CRC while the smoothed estimates of SIRs and SMRs were derived from the Spatiotemporal Bayesian Poisson log-linear model. To investigate temporal trends in the association between area-based socioeconomic deprivation and CRC burden, we have used the national socio-economic index. Results The burden of CRC was rising over time. The CRC cumulative incidence increase from 243.7 in the time period 2000-2007 to 347.3 per 100,000 persons in the time period 2008-2015.There was also a more pronounced geographical variation in SIR and SMR in the time period 2008-2015. Four areas out of 369 had smoothed SIR>1.15 while twenty-six areas had smoothed SMR>1.15, with most of those areas located at the east coast of the island and around the capital city. There was a temporal trend in the socio-economic inequalities of CRC burden. The areas in the third and fourth quartile of the socio-economic index had 23% and 45% lower rates of CRC incidence, and 33% and 47% lower rates of CRC mortality in the period 2008-2015. Conclusions These findings could shape national prevention policies, such as the national screening program of CRC starting in 2025 and protection strategies for CRC mortality. Key messages • Colorectal cancer screening should be geographically targeted for efficient resource allocation. • Public health interventions to improve colorectal-specific mortality risk should be geographically targeted.

Cancer mortality attributable to air pollution in Slovakia

Abstract Introduction Air pollution is considered one of the most significant global environmental health risks. According to the Global Burden of Disease estimates, fine particulate matter, a key component of ambient air pollution, was the fifth leading risk factor for mortality worldwide in 2015, contributing to 4.2 million deaths (7.6% of total global deaths). In 2019, ambient air pollution was responsible for 4.5 million deaths. This rise is attributed to the growing levels of air pollution and the increasing incidence of NCDs associated with air pollution. Aim This contribution aims to clarify the possible association between environmental air pollution and cancer in Slovakia in the years 2015-2019 overall and by gender and age. Methodology This ecological study focuses on the population of Slovakia from 2015 to 2019. The data used are from the Global Burden of Disease study (IHME, 2019), the Statistical Office of the Slovak Republic and the Slovak Hydrometeorological Institute. Results In 2019, mortality from NCDs related to environmental pollution accounted for 6.6% of total mortality in Slovakia, which is lower than the global average of 8.3%. Cancer mortality attributable to ambient particulate matter pollution (APMP) was lower in 2019 (2.97 per 100,000, CI 95% 4.43-1.76) than in 2015. Higher cancer mortality rates attributable to APMP, were observed mainly in men (7.18 per 100,950, CI % 10.67-4.31 in 2015) and especially in the 80-84 age group (59.49 per 100,000; CI 95 % 94.60-32.20) in 2015 and in men aged 75-79 (510.76 per 510.76 per 100,000) in 2019. Conclusions While Slovakia has experienced a long-term decline in cancer mortality, bucking the global trend, challenges persist due to the country’s relatively poorer outcomes associated with environmental pollution. Addressing environmental pollution remains a critical aspect of ongoing efforts to enhance population health through targeted strategies and policies. Key messages • The significant impact of environmental pollution on cancer mortality underscores the urgent need for targeted interventions and policies to improve public health outcomes in Slovakia. • Cancer mortality attributable to air pollution differs by gender.

The sweet path of Hansel and Gretel: pollination system of Masdevallia hortensis (Orchidaceae: Pleurothallidinae) in a cloud montane forest of the Cordillera Occidental, in Colombia

Pollination by deception is assumed as the general rule among pleurothallid orchids. However, considering the exceptional diversity of this group (44 genera and over 5100 species) and the relatively limited number of available studies (pollination ecology has been assessed in only 17 genera), generalized trends about their pollination systems might disregard a wide variety of specific life-history traits and inconspicuous honest signals/rewards for pollinators. The few known associations of pleurothallid orchids with a large assortment of fly taxa further support the assumption of generalized pollination by deception. We investigated the natural pollination system of Masdevallia hortensis, a strictly endemic species of cloud forests in the Western Andes of Colombia. This species exhibited a sophisticated and unique pollination mechanism, producing sugary secretions in the lateral sepals along purple dotted patches, fed upon by different visiting species of fruit flies (Drosophilidae). The sucrose concentration in these secretions varied throughout the day and significantly decreased after pollinaria removal. Visiting fruit flies appeared to be guided towards a chamber between the mobile lip and the column, by dotted lines in the lateral sepals. During visitations, individuals of the most abundant species in our observations (Drosophila sp. 1) were singly entrapped in the chamber until eventually freeing themselves with the pollinaria attached to their bodies. We also demonstrated that M. hortensis is strictly self-incompatible, which makes fly pollination an essential process for the maintenance of natural populations of the species. The flowers of M. hortensis offer rewards for visiting insects, an aspect that should be thoroughly evaluated before making generalizations. In this way, we urge integrative ecological studies to understand the reproductive evolutionary patterns in this group of orchids.

Regional variation in incidence and mortality due to hypertension in Sao Tome and Principe

Abstract Background The analysis of incidence and mortality due to hypertension (HT) provides statistical data for addressing public health programs, particularly in low-income countries where poor health systems impose constraints to address non-communicable diseases (NCDs). This study aims to assess the geographic pattern of incidence and mortality due to HT in Sao Tome and Principe (STP). Methods This is a descriptive ecological study. Aggregated data on new cases of and deaths due to HT by gender, age-group and district (2022-2023) were extracted from the Health National Database (STP Ministry of Health). Age-standardized incidence and mortality rates (ASIR and ASMR) and respective 95% confidence interval (95%CI) were obtained. Mortality-to-incidence ratio (MIR) was computed by district (lower values indicate better quality of care). Comparison between districts was done through standardized incidence ratios (SIR) and respective p-value. Analyses were stratified by gender. Results ASIR and ASMR per 100,000 were, respectively, 1168.9 (95%CI:1103.3-1237.6) and 76.8 (95%CI:62.0-96.2) among men and 2460.6 (95%CI:2365.0-2559.0) and 99.7 (95%CI:81.4-121.6) among women. Incidence of HT was significantly higher than expected (p < 0.001) in Agua Grande, Caue and Lemba with SIR varying from 122.8% (Agua Grande) to 201.1% (Caue) in men and from 125.1% (Lemba) to 224.1% (Caue) in women. Instead, Mé-Zochi presented much lower incidence than expected for both, men (SIR=43.1%;p<0.001) and women (SIR=38.4%;p<0.001). Large differences between districts were observed in MIR, varying from 0% (Caue and Lobata) to 84% (Mé-Zochi) in men and from 0% (Lobata) to 57% (Mé-Zochi) in women. Conclusions According to our findings there is, not only, a high incidence rate of HT, but also regional variation in this rate, deserving particular attention from policy-makers. Regional variation in hypertension incidence could be partially explained by differences in the quality of healthcare services. Key messages • Awareness should be given to the high incidence of hypertension demanding preventive strategies in the field of public health. • Public health strategies should address the quality of care in regards to the prevention, diagnosis and monitoring of hypertension.

Physiographic determinants of suicide mortality in Pernambuco: an ecological study

Suicide is a serious and universal public health problem, reflecting a polysemic event with individual and collective repercussions. This study analysed aspects of suicide deaths in the state of Pernambuco, associating suicide indicators with physiographic factors. This is an ecological study, based on records of suicide deaths in Pernambuco from 1981 to 2020 from the Mortality Information System, using multiple linear regression to associate mortality indicators with extrinsic factors. The models constructed showed the influence of the proportion of trees, Gross Domestic Product and urbanisation. In this context, the most effective strategy for reducing the scale of suicide requires intersectoral interventions that impact on the population's quality of life and produce a healthier environment, taking on a character that goes beyond individual factors.

Amorphous infrastructure: Contesting the proposed Yuam River water diversion project in the Salween River Basin

Recent studies in human geography and political ecology have examined the anticipatory politics of proposed infrastructure and their effects. Less work analyses how speculation and rumour are mobilised to promote or resist such infrastructures. In this paper, I examine how speculative ideas about long-proposed hydropower dams and transbasin water diversions in the Salween River Basin are strategically deployed by differently placed actors working towards project development or demise. I draw on empirical research on the proposed Yuam River water diversion project in Northwest Thailand and near the Thai–Myanmar border. I develop a conceptualisation of proposed infrastructures as amorphous as they constantly change form and enrol a shifting network of actors, and development plans and imaginaries. The Yuam diversion becomes amorphous through the contested ‘facts’ of the case and over time. I illustrate this using two longitudinal examples. First, infrastructure is made amorphous through protracted development processes for the Yuam diversion and earlier iterations. Second, I examine speculative ideas about how the Yuam diversion is intertwined with proposed dams in the Basin including the Hatgyi Dam in Myanmar. In this case, the lack of confirmed project developers and financiers for the Yuam diversion, and rumours of Chinese actors’ involvement under the Belt and Road Initiative, creates strategic space for project promotion and resistance. What is at stake is not just theorising proposed infrastructures as speculative ideas but how the ‘amorphous’ qualities of infrastructure are deployed strategically, by whom, and to what effect.