Exposure Categories Research Articles

Association between World Trade Center disaster exposures and body mass index in community members enrolled at World Trade Center Environmental Health Center

Studies suggest that environmental disasters have a big impact on population health conditions including metabolic risk factors, such as obesity and hypertension. The World Trade Center (WTC) destruction from the 9/11 terrorist attack resulted in environmental exposures to community members (Survivors) with potential for metabolic effects. We now examine the impact of WTC exposure on Body Mass Index (BMI) using the data from 7136 adult participants enrolled in the WTC Environmental Health Center (EHC) from August 1, 2005, to December 31, 2022. We characterized WTC-related exposures by multiple approaches including acute dust-cloud exposure, occupational or residential exposures, and latent exposure patterns identified by synthesizing multiplex exposure questions using latent class analysis. Employing multivariable linear and quantile regressions for continuous BMI and ordered logistic regression for BMI categories, we found significant associations of BMI with WTC exposure categories or latent exposure patterns. For example, using exposure categories, compared to the group of local residents, local workers exhibited an average BMI increase of 1.71 kg/m2 with 95% confidence intervals (CI) of (1.33, 2.09), the rescue/recovery group had an increase of 3.13 kg/m2 (95% CI: 2.18, 4.08), the clean-up worker group had an increase of 0.75 kg/m2 (95% CI: 0.09, 1.40), and the other mixer group had an increase of 1.01 kg/m2 (95% CI: 0.43, 1.58). Furthermore, quantile regression analysis demonstrated that WTC exposures adversely affected the entire distribution of BMI in the WTC EHC Survivors, not merely the average. Our analysis also extended to blood pressure and hypertension, demonstrating statistically significant associations with WTC exposures. These outcomes highlight the intricate connection between WTC exposures and metabolic risk factors including BMI and blood pressure in the WTC Survivor population.

Antidepressant exposure patterns during pregnancy and risk of adverse newborn outcomes

Studies on antidepressant use during pregnancy often rely on a simplified exposure classification. We introduce a novel data-driven method to identify complex antidepressant exposure patterns during pregnancy and estimates the risk of 24-hour hospitalization, congenital heart defects (CHD) and persistent pulmonary hypertension of the newborn (PPHN).We constructed a nationwide cohort of all newborns born to women who filled at least one antidepressant prescription 24 weeks before pregnancy in Denmark during 1997–2016 using national registries. Antidepressant exposure patterns were identified by hierarchical cluster analysis based on number of antidepressants, Anatomical Therapeutic Chemical code and timing similarities. Risk ratios were estimated using the cumulative incidences in the inverse probability treatment weighted population.The study included 33,776 newborns. Discontinuing antidepressant use during pregnancy was associated with significant decreased risk of hospitalization compared to continued exposure to Citalopram throughout pregnancy. Moreover, discontinuing monotherapy was associated with significant decreased risk of PPHN compared to continued exposure to Citalopram. No risk ratios were statistically significant for the risk of CHD.Our study suggests a potential decreased risk of 24-hour hospitalization for any reason and PPHN if mothers discontinue antidepressant use during pregnancy as compared with continuous Citalopram use.

The Association Between Cadmium Exposure and Prostate Cancer: An Updated Systematic Review and Meta-Analysis.

Prostate cancer (PCa) is a common cancer among men, and it has a multifactorial etiology. Cadmium (Cd), a toxic heavy metal classified as a carcinogen by the IARC, can cause various acute and chronic effects. This systematic review and meta-analysis aims to update previous findings on the association between Cd exposure and PCa. We carried out a literature search in PubMed, Web of Science, and Scopus up to May 2024, identifying eight new articles. The effect size from the highest and lowest exposure categories were extracted and analyzed using a random-effects model. Heterogeneity was assessed with the I2 test, and publication bias was evaluated using funnel plot asymmetry. Overall, the effect size for PCa associated with Cd exposure, combining previous and new articles, was 1.11 (95% CI 0.85-1.45). Heterogeneity was high, but no significant publication bias was detected. For studies from Europe, the effect size was 1.47 (95% CI 1.00-2.17). Notably, 11 articles from the previous systematic review and meta-analysis highlighted that higher Cd exposure is significantly associated with more aggressive histopathological types of PCa (OR 1.50, 95% CI 1.08-2.07). These findings suggest a potential public health concern, indicating the need for further research to clarify the risk associated with Cd exposure.

Improving Consistency in Classifying Child Maltreatment for Sudden Unexpected Infant Deaths.

Develop guidelines for child death review teams that will improve the consistency in classifying child maltreatment (CM) and distinguish between classification of exposure to hazards and neglect for sleep-related sudden unexpected infant deaths (SUID). Sleep-related SUID (n = 25 797) were identified from the National Fatality Review-Case Reporting System between 2004 and 2018. Key variables considered when classifying CM among sleep-related SUID were identified. Logistic regression was used to assess the strength of associations and identify factors that distinguished between exposure to hazards and neglect. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. Guidelines were developed based on these findings. Among the 13 034 sleep-related SUID with CM identified, hazards in the infant sleep environment were strongly associated with classification of both exposure to hazards and neglect, as were supervisor impairment and child welfare substantiation of the death. Comparing neglect to exposure to hazards, there was no association with sleep environment hazards with ORs ranging from 0.8 to 1.3 (95% CI 0.4-3.0), but sleep-related SUID were approximately twice as likely to be classified as neglect when the supervisor was impaired (OR 2.3, 95% CI 2.0-2.7) or child welfare action was taken (OR 1.8, 95% CI 1.5-2.0). The guidelines recommend classification of exposure to hazards for sleep environment hazards with elevation to neglect if the supervisor was impaired or child welfare substantiated the death. Among sleep-related SUID, classification of exposure to hazards is based on presence of sleep environment hazards, whereas neglect is based on supervisor impairment and child welfare action.

Differential Survival Among Patients With Cancer by COVID-19 Vaccination Status: An Analysis of the ASCO COVID-19 Registry

PURPOSE We evaluated our hypotheses that vaccine exposure before infection with SARS-CoV-2 in patients with cancer would be associated with overall survival and vaccine exposure would differ by patient demographics, area-level social determinants of health, and clinical features. METHODS Our cohort study includes patients with cancer 18 years and older who tested positive for SARS-CoV-2 infection on or after April 1, 2021, and had information on receipt (or not) of at least one COVID-19 vaccine dose. We analyzed three vaccine exposure categories reflecting recency of last dose before SARS-CoV-2 infection was defined: No dose, any recent dose (1-6 months), and last dose in >6 months. Patients with last dose in <1 month were categorized on the basis of previous dose (if present) or as no dose. RESULTS This cohort analysis included 1,765 patients with cancer diagnosed with COVID-19 disease between April 2021 and July 2023 (57% female, 68% non-Hispanic White, and 51% age <65 years). The following patient characteristics were associated with vaccination status: age, rurality, Eastern Cooperative Oncology Group performance status, cancer type, and COVID-19 diagnosis window, as well as quartiles of area-level median household income, percent unemployed, and percent high school-only graduates age >24 years. After adjusting for covariates, the hazard ratio for death was 1.60 times among patients with no dose (95% CI, 1.26 to 2.04) and 1.32 times among those with last dose in >6 months (95% CI, 1.03 to 1.69) compared with those with a dose 1-6 months before infection. CONCLUSION Our findings underscore the need for oncology-specific guidance on COVID-19 vaccination schedules and suggest that more frequent than annual administration of vaccination may be appropriate for patients with cancer.

A prediction model of PTSD in the Israeli population in the aftermath of october 7th, 2023, terrorist attack and the Israel–Hamas war

BackgroundOn October 7th, 2023, a mass terror attack was launched by Hamas militants, which was followed by the Israel-Hamas war. These events constitute a nationwide trauma with major ramifications for public mental health. This article presents an evidence-based model for the prediction of the prevalence of posttraumatic stress disorder (PTSD) related to the terrorist attack and the war.Main body: The creation of the model consisted of several steps. Firstly, the Israeli population was divided into six groups based on the intensity, context, and type of traumatic exposure (direct exposure to terror, close proximity to terror, soldiers in combat and support units, intense exposure to rocket attacks, moderate exposure to rocket attacks, and indirectly affected communities), and the population size of each group was assessed using official national databases. Secondly, an estimation of the expected prevalence of PTSD in each of the exposure groups was based on a review of the relevant literature. A random-effects meta-analysis of the prevalence rates was conducted separately per each exposure group. Finally, the predicted number of PTSD causalities in the population was calculated by multiplying the group size and the PTSD prevalence estimation. Based on population size and estimated PTSD prevalence within each exposure category, the model predicts that approximately 5.3% (N = 519,923) of the Israeli population (95% confidence interval, 1.64–9%), may develop PTSD as a result of the terrorist attack and the war.ConclusionsThe predicted number of individuals with PTSD following mass trauma is expected to be considerable. The presented model can assist policymakers, clinicians, and researchers in preparing and devising adequate interventions for the mental health needs of large populations. Moreover, this model can be applied in other instances of mass-trauma exposure.

Association between arterial oxygen tension with clinical outcomes in patients undergoing VA-ECMO support: a systematic review and dose-response meta-analysis

Abstract Background Arterial hyperoxia has been associated with a worse prognosis in critically ill patients. However, studies conducted in patients undergoing Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) used inconsistent and arbitrary thresholds for defining hyperoxia, which impeded the determination of the optimal target for arterial oxygen tension (PaO2) in this population. Purpose To investigate and visualise the dose-response relationship between post-ECMO level of PaO2 with early mortality (in-hospital and 1-month) and poor neurological outcomes in adult patients undergoing VA-ECMO support, including Extracorporeal Cardiopulmonary Resuscitation (ECPR). Methods A systematic search was conducted through Pubmed and Embase to include studies that stratified patients based on PaO2 levels and evaluated relevant outcomes. We utilised either adjusted Odds Ratio (OR) with 95% Confidence Interval (CI) when available, or unadjusted OR against the lowest exposure category. The median, mean, or midpoint value of PaO2 was assigned as the corresponding dose. A random-effects one-stage dose-response meta-analysis was performed to assess linear association for every 10 mmHg increase in PaO2, while potential non-linear relationship was explored with restricted cubic splines at 3 knots (10th, 50th, and 90th percentile). Non-linearity was assessed by using Wald test with p value <0.05 considered significant. Statistical analyses were performed using STATA 17.0. Results Fourteen eligible records were identified (cardiogenic shock/CS = 5 records; ECPR = 8 records; both = 1 record). Only four studies classified a separate category for hypoxemic patients (<60 mmHg). PaO2 levels were measured within 24-72 hours of VA-ECMO initiation, except in one study. PaO2 level was not associated with early mortality (9 studies; OR 1.021 [95% CI 0.988–1.055]; p for non-linearity = 0.893), but found to have a linear association with composite poor neurological outcomes (6 studies; OR 1.016 [1.009–1.024]; p for non-linearity = 0.346). Subgroup analysis of CS patients revealed a linear association between PaO2 >100 mmHg and early mortality (4 studies; OR 1.025 [95%CI 1.018–1.032]; p for non-linearity = 0.255). For ECPR patients, a J-shaped relationship was observed between PaO2 and early mortality (5 studies; p for non-linearity = 0.004), with the lowest odds being at PaO2 level of 110-210 mmHg, while PaO2 level >110 mmHg showed a linear trend towards higher odds of poor neurological function (4 studies; OR 1.091 [95%CI 0.938–1.269]; p for non-linearity = 0.257). Conclusion Pooled data from observational studies suggest that PaO2 >100 mmHg should be avoided in CS patients on VA-ECMO support, given its linear association with mortality, but it cannot be extrapolated to hypoxemic patients. In ECPR patients, PaO2 level around 110-210 mmHg conferred the best clinical outcomes. However, these findings should be confirmed through randomised controlled trials.

Cumulative effect of lifetime smoking history on arterial stiffness and subclinical atherosclerosis in patients with arterial hypertension

Abstract Introduction Although the effect of smoking status on blood pressure (BP) changes is well known an adverse association between cumulative smoke exposure (by pack-years) and functional and structural changes in arteries of patients with high BP has not been consistently demonstrated. Aim of the study was to explore the contributions of cumulative smoke exposure to the vascular consequences of arterial hypertension. Methods Indices of vascular function and structure including carotid-femoral pulse wave velocity (PWV), augmentation index (AIx) and carotid intima media thickness (cIMT) were measured in 485 adults aged less than 60 years old without a history of cardiovascular disease. The cohort was divided into three groups according to office systolic BP (SBP) and diastolic BP (DBP): normal (SBP <130 and DBP <85 mmHg, n=242), high normal (130≤SBP<140 or DBP 85≤DBP<90mmHg, n=96), and hypertension (SBP≥140 or DBP≥90mmHg, n=147). The cohort was subdivided according to pack-years of smoking history as never smokers (0.0 pack-years), light smokers (<20 pack-years), moderate smokers (20-40 pack-years), and heavy smokers (> 40 pack-years). Results The three BP groups had similar age and metabolic parameters (body mass index, fasting blood glucose and LDL-C). Figure shows PWV, AIx and carotid IMT by smoking exposure, stratified by BP level. The lowest PWV level was observed in never smokers with normal BP; whereas heavy smokers with hypertension exhibited the highest PWV. Also of note, heavy smokers with normal BP exhibited comparable PWV to light and never smokers with hypertension. Furthermore, in smokers with more than 20 pack-years tobacco exposure, PWV was higher among patients with high normal BP compared to subjects with normal BP (all P<0.01). In contrast to the monotonic increases in PWV and AIx by BP and pack-years smoking history, carotid IMT was generally similar among BP groups on the basis of cumulative exposure category. This finding may indicate a plateau in subclinical atherosclerotic burden over cumulative tobacco exposure for all BP categories. Conclusion Tobacco cumulative exposure adversely modify the effect of BP on arterial stiffness. Given that most adults who smoke start before the age 18 years, efforts to promote smoking cessation should continue to target younger adults with high BP.BP, tobacco exposure-vascular changes

Validation of a blood biomarker panel for machine learning-based radiation biodosimetry in juvenile and adult C57BL/6 mice

Following a large-scale radiological event, timely collection of samples from all potentially exposed individuals may be precluded, and high-throughput bioassays capable of rapid and individualized dose assessment several days post-exposure will be essential for population triage and efficient implementation of medical treatment. The objective of this work was to validate the performance of a biomarker panel of radiosensitive intracellular leukocyte proteins (ACTN1, DDB2, and FDXR) and blood cell counts (CD19+ B-cells and CD3+ T-cells) for retrospective classification of exposure and dose estimation up to 7 days post-exposure in an in-vivo C57BL/6 mouse model. Juvenile and adult C57BL/6 mice of both sexes were total body irradiated with 0, 1, 2, 3, or 4 Gy, peripheral blood was collected 1, 4, and 7-days post-exposure, and individual blood biomarkers were quantified by imaging flow cytometry. An ensemble machine learning platform was used to identify the strongest predictor variables and combine them for biodosimetry outputs. This approach generated successful exposure classification (ROC AUC = 0.94, 95% CI: 0.90–0.97) and quantitative dose reconstruction (R2 = 0.79, RMSE = 0.68 Gy, MAE = 0.53 Gy), supporting the potential utility of the proposed biomarker assay for determining exposure and received dose in an individual.

Gestational diabetes mellitus in relation to serum per- and polyfluoroalkyl substances: A scoping review to evaluate the need for a new systematic review.

Per- and polyfluoroalkyl substances (PFAS) were used or are being used in the manufacturing of products, including consumer-use products. The resulting environmental contamination has led to widespread human exposure. This review aimed to scope the characteristics of evidence covered and applied methodology of evidence to understand -- regardless of any results on the association of gestational diabetes mellitus (GDM) and PFAS -- if a new systematic review would be justified. We systematically identified reports investigating associations of PFAS with GDM following a pre-specified and pre-registered PECO framework and protocol. The previous systematic reviews included 8-11 reports and either conducted meta-analyses stratified by comparator, analyzed results based on only high and low exposure categories, or pooled results across comparators. Included 20 reports presented data on 24 PFAS with PFOA, PFOS, PFHxS, PFNA, and PFDA being examined in almost all. The comparators employed were heterogeneous across the reports. Because data from at least one new report on GDM is available since the previous systematic reviews and heterogeneous comparators, an updated systematic review using SWiM could add value to the literature.

7303 Fasting and Post-load Glucose in Exclusively Breastfeeding Women With Diabetes Risk Factors

Abstract Disclosure: N. Neamonitaki: None. T. Thaweethai: None. D. Pant: None. K. James: None. M.D. Soffer: None. E.A. Rosenberg: None. C.E. Powe: Consulting Fee; Self; Mediflix, Inc. Other; Self; Wolters Kluwer, Up to Date Author. Background: Epidemiologic studies show a reduction in type 2 diabetes incidence with increased lactation duration and intensity, but physiologic mechanisms underlying this association are incompletely characterized. We examined associations between lactation and glycemic physiology in postpartum women. ​ Methods: We conducted a secondary analysis of postpartum participants in a prospective longitudinal cohort study that examined glucose and insulin physiology via serial 2-hr 75-gram oral glucose tolerance tests during pregnancy and postpartum in women with diabetes risk factors. We used linear regression to examine associations between exclusive breastfeeding and fasting glucose, adjusting for age, race/ethnicity, education, body mass index, and number of weeks postpartum. Secondary analyses examined associations with post-load glucose and insulin physiology. Additional analyses considered exclusive breastfeeding compared to exclusive formula feeding and a combination of formula and breastfeeding separately using a categorical exposure variable. Results: Of N=108 women at a mean (SD) of 11 (5.0) weeks postpartum, 56 reported exclusively breastfeeding and 52 reported not exclusively breastfeeding (15 were exclusively formula feeding and 37 were both breast- and formula feeding). Mean (SD) fasting glucose was 83 (7.0) mg/dl in those exclusively breastfeeding and 85 (8.9) mg/dl in those who were not. Fasting glucose was not significantly different in those who were exclusively breastfeeding compared to those who were not after confounder adjustment (β [95% CI] =-1.3 [-4.6, 2.0] mg/dl, P=0.45). The 60- minute post-load glucose was nominally higher in those exclusively breastfeeding, with a mean (SD) of 132 (37.5) mg/dl versus 118 (31.6) mg/dl in those who were not; this difference did not reach statistical significance in the adjusted model (β [95% CI] =12.6 [-2.1, 27] mg/dl, P=0.09). In additional analyses, fasting glucose was not significantly different between women exclusively breastfeeding, exclusively formula feeding, or both breast- and formula feeding; however, post-load glucose at 30 and 60 minutes was higher in the exclusively breastfeeding group compared to the exclusively formula feeding group (30-minute: β [95% CI]= 16 [0.36,32] mg/dl, P=0.045); 60-minute: 26 [4.0,47] mg/dl, P=0.02) in adjusted models. We did not find significant associations with insulin physiology measures. Conclusion: We did not observe lower fasting glucose with exclusive breastfeeding. Instead, glucose levels at 30 and 60 minutes after an oral glucose load were higher in exclusively breastfeeding participants compared to exclusively formula feeding participants. Presentation: 6/2/2024

White matter hyperintensity on MRI and plasma Aβ42/40 ratio additively increase the risk of cognitive impairment in hypertensive adults.

Dementia often involves comorbid Alzheimer's and vascular pathology, but their combined impact warrants additional study. We analyzed the Systolic Blood Pressure Intervention Trial and categorized white matter hyperintensity (WMH) volume into highest versus lowest/mid tertile and the amyloid beta (Aβ)42/40 ratio into lowest versus mid/highest ratio tertile. Using these binary variables, we created four exposure categories: (1) combined low risk, (2) Aβ risk, (3) WMH risk, and (4) combined high risk. In the cohort of 467 participants (mean age 69.7±7.1, 41.8% female, 31.9% nonwhite or Hispanic) during 4.8 years of follow-up and across the four exposure categories the rates of cognitive impairment were 5.3%, 7.8%, 11.8%, and 22.6%. Compared to the combined low-risk category, the adjusted hazard ratio for cognitive impairment was 4.12 (95% confidence interval, 1.71 to 9.94) in the combined high-risk category. This study emphasizes the potential impact of therapeutic approaches to dementia prevention that target both vascular and amyloid pathology. White matter hyperintensity (WMH) and plasma amyloid (Aβ42/40) are additive risk factors for the development of cognitive impairment in the SPRINT MIND trial. Individuals in the high-risk categories of both WMH and Aβ42/40 had a near fivefold increase in risk of cognitive impairment during 4.8 years of follow-up on average. These findings suggest that treatment strategies targeting both vascular health and amyloid burden warrant further research.

Nongenetic and Genetic Factors Associated with White Matter Brain Aging: Exposome-Wide and Genome-Wide Association Study.

Human brain aging is a complex process that affects various aspects of brain function and structure, increasing susceptibility to neurological and psychiatric disorders. A number of nongenetic (e.g., environmental and lifestyle) and genetic risk factors are found to contribute to the varying rates at which the brain ages among individuals. In this paper, we conducted both an exposome-wide association study (XWAS) and a genome-wide association study (GWAS) on white matter brain aging in the UK Biobank, revealing the multifactorial nature of brain aging. We applied a machine learning algorithm and leveraged fractional anisotropy tract measurements from diffusion tensor imaging data to predict the white matter brain age gap (BAG) and treated it as the marker of brain aging. For XWAS, we included 107 variables encompassing five major categories of modifiable exposures that potentially impact brain aging and performed both univariate and multivariate analysis to select the final set of nongenetic risk factors. We found current tobacco smoking, dietary habits including oily fish, beef, lamb, cereal, and coffee intake, length of mobile phone use, use of UV protection, and frequency of solarium/sunlamp use were associated with the BAG. In genetic analysis, we identified several SNPs on chromosome 3 mapped to genes IP6K1, GMNC, OSTN, and SLC25A20 significantly associated with the BAG, showing the high heritability and polygenic architecture of human brain aging. The critical nongenetic and genetic risk factors identified in our study provide insights into the causal relationship between white matter brain aging and neurodegenerative diseases.

Association of Plastic Exposure with Cognitive Function Among Chinese Older Adults.

The widespread exposure to plastic products and the increasing number of individuals with cognitive impairments have imposed a heavy burden on society. This study aims to investigate the relationship between plastic product exposure in daily life and cognitive function in older Chinese individuals. Data were obtained from the 2023 Ningxia Older Psychological Health Cohort, comprising 4045 participants aged 60 and above. Cognitive function was assessed using the Mini-Mental State Examination scale. A population-based plastic exposure questionnaire was used to calculate plastic exposure scores (PES). Binary logistic regression was employed to analyze the relationship between PES and cognitive function, while restricted cubic splines were used to examine the dose-response relationship between PES and cognitive function. Latent profile analysis (LPA) was employed to explore the potential patterns of plastic exposure, and logistic regression was used to investigate the relationship between different exposure patterns and cognitive function. A linear regression model was utilized to investigate the relationship between PES and different dimensions of cognitive function. Among the 4045 participants, 1915 individuals were assessed with mild cognitive impairment (MCI). After adjusting for all covariates, PES (OR = 1.04, 95% CI 1.02-1.06) was significantly associated with the risk of MCI and exhibited a dose-response relationship. LPA identified two potential categories of plastic exposure, with a higher risk of MCI observed in the group using plastic utensils. This study indicates a positive correlation between plastic exposure levels and MCI risk, particularly among individuals who frequently use plastic tableware.

Occupational exposure to radiofrequency electromagnetic fields and brain tumor risk: Application of the INTEROCC job-exposure matrix.

Radiofrequency electromagnetic fields (RF-EMF, 100 kHz to 300 GHz) are classified by IARC as possibly carcinogenic to humans (Group 2B). This study evaluates the potential association between occupational RF-EMF exposure and brain tumor risk, utilizing for the first time, a RF-EMF job-exposure matrix (RF-JEM) developed in the multi-country INTEROCC case-control study. Cumulative and time-weighted average (TWA) occupational RF-EMF exposures were estimated for study participants based on lifetime job histories linked to the RF-JEM using three different methods: (1) by considering RF-EMF intensity among all exposed jobs, (2) by considering RF-EMF intensity among jobs with an exposure prevalence ≥ the median exposure prevalence of all exposed jobs, and (3) by considering RF-EMF intensity of jobs of participants who reported RF-EMF source use. Stratified conditional logistic regression models were used, considering various lag periods and exposure time windows defined a priori. Generally, no clear associations were found for glioma or meningioma risk. However, some statistically significant positive associations were observed including in the highest exposure categories for glioma for cumulative and TWA exposure in the 1- to 4-year time window for electric fields (E) in the first JEM application method (odds ratios [ORs] = 1.36, 95% confidence interval [95% CI] 1.08, 1.72 and 1.27, 95% CI 1.01, 1.59, respectively), as well as for meningioma for cumulative exposure in the 5- to 9-year time window for electric fields (E) in the third JEM application method (OR = 2.30, 95% CI 1.11, 4.78). We did not identify convincing associations between occupational RF-EMF exposure and risk of glioma or meningioma.

Real-Time Exposure to Negative News Media and Suicidal Ideation Intensity Among LGBTQ+ Young Adults

With a recent surge in anti-lesbian, gay, bisexual, transgender, or queer (LGBTQ+) policies and associated news and media coverage, there is a need to study the association of LGBTQ+ focused news or media exposure and short-term changes in suicidal ideation (SI) among LGBTQ+ youth. To examine within-person direct and indirect associations between exposure to general and LGBTQ+ negative news or media and SI intensity through expectations of rejection. This intensive longitudinal cohort study used a smartphone-based ecological momentary assessment (EMA) protocol wherein participants responded to EMAs 3 times per day for 28 consecutive days. Young adults aged 18 to 24 years who self-identified as LGBTQ+, resided in Tennessee, and had past-year SI and at least mild depression (defined as a score ≥5 on the Patient Health Questionnaire-9) were eligible for inclusion. Participants were recruited through social media advertisements, LGBTQ+ community organizations, and mental and behavioral health clinics. Participants were recruited between March 30, 2023, and August 23, 2023, and data analyses were conducted from August 28, 2023, through April 20, 2024. At each EMA, participants reported on recent exposure to negative news or media. A 3-level categorical exposure variable denoted (1) no news or media exposure (reference); (2) exposure to general negative news or media; and (3) exposure to LGBTQ+ negative news or media. Each EMA also assessed expectations of rejection due to LGBTQ+ identity on a scale of 0 (not at all) through 10 (very much). Three primary outcomes assessed current (ie, "right now") intensity of active SI, passive SI, and self-harm ideation, each measured on a scale from 0 (not at all) to 10 (very strong). Multilevel modeling approaches were used to account for the hierarchical structure of EMA data, with assessments (level 1) nested within people (level 2). Linear mixed models and multilevel mediation models were used to examine within-person associations between exposure to negative news or media and the 3 primary outcomes, as well as the mediating role of expectations of rejection. Of 31 total participants, 22 were assigned female sex at birth (71%), and 16 (52%) self-identified as transgender or gender diverse. The median (IQR) participant age was 21 (18-22) years, and a total of 2189 EMAs were completed, with a median (range) compliance of 90.5% (41.7%-100%). At the within-person level, recent exposure to LGBTQ+ negative news or media was significantly associated with increased active SI (estimate [b], 0.14; 95% CI, 0.04-0.25; P = .009), passive SI (b, 0.23; 95% CI, 0.04-0.41; P = .02), and self-harm ideation (b, 0.13; 95% CI, 0.02-0.23; P = .02). No statistically significant associations were detected for exposure to general negative news or media. In multilevel mediation models, heightened expectations of rejection explained some of the total effect of exposure to LGBTQ+ negative news or media on active SI (23%) and passive SI (37%). This intensive longitudinal cohort study found that SI intensity modestly increased in the hours immediately following exposure to LGBTQ+ negative news or media among LGBTQ+ young adults. These findings have timely implications for research and intervention, particularly within sociopolitical and geographic contexts where news or media coverage about LGBTQ+ topics is intensified.

Baby-Friendly Hospitals, Social Determinants of Health, and Disparities in Breastfeeding Initiation in a Low-Income Population, 2017-2020.

Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity. To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black. We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017-2020. Women who delivered a firstborn, singleton infant were included (N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited. Breastfeeding initiation was 57.4% (n = 1988) for women delivering in accredited hospitals versus 55.4% (n = 2540) in non-accredited hospitals and multivariable model results were non-significant (OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, (OR = 1.55, 95% CI [1.16, 2.09]). Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed.

Преконцептивное облучение матерей: Риск фетоинфантильных потерь

Safety of female personnel exposed to occupational radiation is still a topical issue of radiation epidemiology. Mayak Production Association is the first Russian atomic enterprise and women made a quarter of its personnel. Fetal and infant losses (FILs) that include stillbirths and infant mortality could be used as an important criterion for assessing the effects of maternal preconception (prior to conception) exposure. The aim of this study was to assess FILs risk among the offspring of female Mayak PA workers exposed to occupational preconception external gamma-radiation. A retrospective analysis was performed among 15307 children born in 1949–1973; mothers of 4880 of them were Mayak PA workers. FILs were analyzed taking into account sex of the offspring, period of their birth, nosologies, parental age, and dose categories of preconception exposure. Methods of non-parametrical statistics were used and calculation of relative risk was performed with 95 % confidence interval. In general, fetal and infant losses demonstrated no statistical differences, 44.5 for 103 in the main group, 38.7 for 103 in the reference group, χ2 =2.79, p = 0.95. A statistically significant increase of FILs, stillbirths and infantile mortality was detected among the offspring with only their mothers working at Mayak PA. Dynamics analysis established the period from 1949 to 1953, in which FILs, stillbirths and infantile mortality were higher among the offspring of exposed mothers. Statistically significant differences in the FILs structure were obtained for fetal death that was more often registered in the main group, 3.48 vs 1.34 for 103, χ2 = 7.54, p = 0.006. FILs risk among mothers working at Mayak PA aged under 20 was statistically significantly higher for girls, 2.42 (1.25–4.67), and for both sexes, 2.16 (1.37–3.4). FILs were associated with the dose range of preconception external gamma-radiation of mothers from 0.16 mGy to 3006 mGy. The study also established certain categories of preconception exposure of the ovaries with significantly higher stillbirth risk in the main group as opposed to the reference one.

Preconception maternal exposure: Risk of fetal and infant losses

Safety of female personnel exposed to occupational radiation is still a topical issue of radiation epidemiology. Mayak Production Association is the first Russian atomic enterprise and women made a quarter of its personnel. Fetal and infant losses (FILs) that include stillbirths and infant mortality could be used as an important criterion for assessing the effects of maternal preconception (prior to conception) exposure. The aim of this study was to assess FILs risk among the offspring of female Mayak PA workers exposed to occupational preconception external gamma-radiation. A retrospective analysis was performed among 15307 children born in 1949–1973; mothers of 4880 of them were Mayak PA workers. FILs were analyzed taking into account sex of the offspring, period of their birth, nosologies, parental age, and dose categories of preconception exposure. Methods of non-parametrical statistics were used and calculation of relative risk was performed with 95 % confidence interval. In general, fetal and infant losses demonstrated no statistical differences, 44.5 for 103 in the main group, 38.7 for 103 in the reference group, χ2 =2.79, p = 0.95. A statistically significant increase of FILs, stillbirths and infantile mortality was detected among the offspring with only their mothers working at Mayak PA. Dynamics analysis established the period from 1949 to 1953, in which FILs, stillbirths and infantile mortality were higher among the offspring of exposed mothers. Statistically significant differences in the FILs structure were obtained for fetal death that was more often registered in the main group, 3.48 vs 1.34 for 103, χ2 = 7.54, p = 0.006. FILs risk among mothers working at Mayak PA aged under 20 was statistically significantly higher for girls, 2.42 (1.25–4.67), and for both sexes, 2.16 (1.37–3.4). FILs were associated with the dose range of preconception external gamma-radiation of mothers from 0.16 mGy to 3006 mGy. The study also established certain categories of preconception exposure of the ovaries with significantly higher stillbirth risk in the main group as opposed to the reference one.

Exposure to Valsartan Products Containing Nitrosamine Impurities in the United States, Canada, and Denmark.

Following the mass recall of valsartan products with nitrosamine impurities in July 2018, the number of patients exposed to these products, the duration of exposure, and the potential for cancer remains unknown. Therefore, we assessed the extent and duration of use of valsartan products with a nitrosamine impurity in the United States, Canada, and Denmark. We conducted a retrospective cohort study using administrative healthcare data from the US FDA Sentinel System, four Canadian provinces that contribute to the Canadian Network for Observational Drug Effect Studies (CNODES), and the Danish National Prescription Registry. Patients, 18 years and older between May 2012 and December 2020 with a valsartan dispensing were identified in each database. Patients were followed from the date of valsartan dispensing until discontinuation. We defined four valsartan exposure categories based on nitrosamine impurity status; recalled generic products with confirmed NDMA/NDEA levels (recalled-tested); recalled generic products that were not tested (recalled); non-recalled generic and non-recalled branded products. In Denmark, the recalled-tested category was not included due to absence of testing data. The proportion and duration of use of valsartan episodes stratified by nitrosamine-impurity status was calculated. We identified 3.3 and 2.8 million (United States) and 51.3 and 229 thousand (Canada) recalled-tested and recalled valsartan exposures. In Denmark, where valsartan exposure was generally low, there were 10 747 recalled exposures. Immediately after the recall notices were issued, there was increased rates of switching to a non-valsartan ARB. The mean duration of use of the recalled-tested products was 167 (±223.1) and 146 (±255.8) days in the United States and Canada respectively. For the recalled products, mean cumulative duration of use was 178 (±249.6), 269 (±397.3) and 166 (±251.0) days in the United States, Canada, and Denmark, respectively. In this cohort study, despite widespread use of recalled generic valsartan between 2012 and 2018, the duration of use was relatively short and probably did not pose an elevated risk of nitrosamine-induced cancer. However, since products with nitrosamine impurity could have been on the market over a 6-year period, patients exposed to these products for longer durations could have a potentially different risk of cancer.