Risk Of Adverse Health Effects Research Articles

Long-term survival in stroke patients: insights into triglyceride-glucose body mass index from ICU data

BackgroundThe Triglyceride Glucose-Body Mass Index (TyG-BMI) has been established as a robust indicator of insulin resistance (IR), reflecting metabolic health across various populations. In general, lower TyG-BMI values are often associated with better metabolic health outcomes and a reduced risk of adverse health events in non-critically ill populations. Previous studies have highlighted a significant negative association between TyG-BMI and all-cause mortality (ACM) among critically ill atrial fibrillation patients. Given the high prevalence and severe outcomes associated with stroke, understanding how TyG-BMI at the time of ICU admission correlates with ACM in critically ill stroke patients becomes imperative. This study aims to assess the correlation between TyG-BMI and ACM in this specific patient cohort, exploring how traditional associations between TyG-BMI and metabolic health may differ in the context of acute, life-threatening illness.MethodsPatient data were retrieved by accessing the Medical Information Mart for Intensive Care IV (MIMIC-IV 2.2) database, categorizing patients into three groups on the basis of TyG-BMI tertiles. The study evaluated both primary and secondary outcomes: the primary outcomes included the 90-day, 180-day, and 1-year ACM, while secondary outcomes encompassed ICU, in-hospital, and 30-day ACM. Our study employed the Kaplan–Meier (K–M) curve method for outcome comparison across the groups while utilizing multivariate Cox proportional-hazards regression models and restricted cubic splines (RCS) to explore TyG-BMI association with these outcomes. Additionally, interaction and subgroup analyses were performed, focusing on different mortality time points.ResultsAmong a cohort of 1707 individuals diagnosed with stroke, the average age was 68 years (interquartile range [IQR]: 58–78 years), with 946 (55.42%) of the participants being male. The analysis of K-M curves suggested that patients having a lower TyG-BMI level faced a heightened risk of long-term ACM, whereas the short-term ACM exhibited no statistically significant differences across the three TyG-BMI groups. Furthermore, Cox proportional-hazards regression analysis validated a statistically significant increased risk of long-term ACM among patients belonging to the lowest TyG-BMI tertile. Additionally, RCS analysis results demonstrated L-shaped correlations between the TyG-BMI index and both short- and long-term ACM. These findings underscore the TyG-BMI predictive value for long-term mortality in stroke patients, highlighting a nuanced relationship that varies over different time frames. The results revealed no interactions between TyG-BMI and the stratified variables, with the exception of age.ConclusionIn our study, lower TyG-BMI levels in critically ill stroke patients are significantly related to a higher risk of long-term ACM within the context of the United States. This finding suggests the potential of TyG-BMI as a marker for stratifying long-term risk in this patient population. However, it's crucial to note that this association was not observed for short-term ACM, indicating that the utility of TyG-BMI may be more pronounced in long-term outcome prediction. Additionally, our conclusion that TyG-BMI could serve as a reliable indicator for managing and stratifying stroke patients over the long term is preliminary. To confirm our findings and assess the universal applicability of TyG-BMI as a prognostic tool, it is crucial to conduct rigorously designed research across various populations.

Elemental composition of toxic and essential elements in rice-based baby foods from the United States and other countries: A probabilistic risk analysis

Consumption of rice-based foods provides essential nutrients required for infants and toddlers’ growth. However, they could contain toxic and excess essential elements that may affect human health. The study aims to determine the composition of rice-based baby foods in the USA and outside and conduct a multiple-life stages probabilistic exposure and risk assessment of toxic and essential elements in children. Elemental concentrations were measured using Inductively Coupled Plasma Mass Spectrometry (ICP-MS) in thirty-three rice-based baby foods. This includes 2 infant formulas, 11 rice baby cereals, and 20 rice snacks produced primarily in the United States, China, and other countries. A probabilistic risk assessment was conducted to assess risks of adverse health effects. Results showed that infant formula had higher median concentrations of selenium (Se), copper (Cu), zinc (Zn), sodium (Na), magnesium (Mg), calcium (Ca), and potassium (K) compared to rice baby cereal and rice snacks. On the contrary, rice snacks had the highest median concentration of Arsenic (As) (127 μg/kg) while rice baby cereals showed the highest median concentration of Cd (7 μg/kg). A higher lifetime estimated daily intake was observed for samples manufactured in the USA compared to those from China and other countries. Hazard quotient (HQ < 1) values were suggestive of minimal adverse health effects. However, lifetime carcinogenic risk analysis based on total As indicated an unacceptable cancer risk (>1E-04). These findings show a need for ongoing monitoring of rice-based foods consumed by infants and toddlers as supplementary and substitutes for breast milk or weaning food options. This can be useful in risk reduction and mitigation of early life exposure to improve health outcomes.

Trends in Utilization of Emergency Contraceptives in Tanzania: A Retrospective Longitudinal Study From 2018 to 2023.

Introduction Emergency contraceptives (ECs) are a critical method for preventing unwanted pregnancies following unprotected sexual intercourse. However, Tanzania is experiencing an alarming surge in the misuse ofECs among reproductive-aged females, particularly younger girls and women. Reports of their use as regular contraceptives are a rising concern. Deviations from their intended use in emergencies may not only increase the risk of contraceptive failure but also increase the risk of adverse health events. This study aims to delineate and evaluate the utilization patterns of ECs over six consecutive years using importation data obtained from the Tanzania Medicines and Medical Devices Authority (TMDA). Materials and methods We analyzed the ECdata collected by TMDA over six consecutive years using a retrospective longitudinal design. Microsoft Power BI (Microsoft® Corp., Redmond, WA) was used to clean, organize, and aggregate the data. IBMSPSSStatistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States)was used to analyze annual trend utilization using linear regression. Results We analyzed 114 importation consignments for ECs, identifying 95.6% (109 records) as oral ECs and 4.4% (five records)as intrauterine devices (IUDs) between 2018 and 2023. This data revealed a significant increase in the volume of EC imports, with its contribution increasing from 1.9% in 2018 to 60.1% in 2023. This highlights the marked increase in EC consumption in Tanzania. In 2023, the defined daily dose per 1000 inhabitants per year (DID) peaked at 3.917826, indicating an unprecedented increase of 4,983.06% compared to the lowest DID observed in 2019 at 0.0873552. The year 2023 alone accounted for 41.63% of the total DID (9.43) over the entire study period. In 2019 and 2020, there was a decrease in EC consumption, followed by a rapid increase from 2021 to 2023. The reduction in EC consumption from 2019 to 2020 was 36.9% compared to that between 2021 and 2022. Conclusions The significant rise in EC importation and utilization in Tanzania between 2018 and 2023, marked by fluctuating consumption trends and a notable surge, highlights the urgent need for targeted educational and policy intervention. This will guide the rational and informed use of ECs, ensuring access aligns with best practices for reproductive health.

Automated Text Message–Based Program and Use of Acute Health Care Resources After Hospital Discharge

Postdischarge outreach from the primary care practice is an important component of transitional care support. The most common method of contact is via telephone call, but calls are labor intensive and therefore limited in scope. To test whether a 30-day automated texting program to support primary care patients after hospital discharge reduces acute care revisits. A 2-arm randomized clinical trial was conducted from March 29, 2022, through January 5, 2023, at 30 primary care practices within a single academic health system in Philadelphia, Pennsylvania. Patients were followed up for 60 days after discharge. Investigators were blinded to assignment, but patients and practice staff were not. Participants included established patients of the study practices who were aged 18 years or older, discharged from an acute care hospitalization, and considered medium to high risk for adverse health events by a health system risk score. All analyses were conducted using an intention-to-treat approach. Patients in the intervention group received automated check-in text messages from their primary care practice on a tapering schedule for 30 days following discharge. Any needs identified by the automated messaging platform were escalated to practice staff for follow-up via an electronic medical record inbox. Patients in the control group received a standard transitional care management telephone call from their practice within 2 business days of discharge. The primary study outcome was any acute care revisit (readmission or emergency department visit) within 30 days of discharge. Of the 4736 participants, 2824 (59.6%) were female; the mean (SD) age was 65.4 (16.5) years. The mean (SD) length of index hospital stay was 5.5 (7.9) days. A total of 2352 patients were randomized to the intervention arm and 2384 were randomized to the control arm. There were 557 (23.4%) acute care revisits in the control group and 561 (23.9%) in the intervention group within 30 days of discharge (risk ratio, 1.02; 95% CI, 0.92-1.13). Among the patients in the intervention arm, 79.5% answered at least 1 message and 41.9% had at least 1 need identified. In this randomized clinical trial of a 30-day postdischarge automated texting program, there was no significant reduction in acute care revisits. ClinicalTrials.gov Identifier: NCT05245773.

THE Point prevalence of acetylcholinesterase inhibition, neuropathy and safety awareness among flower farm workers in naivasha, nakuru county, kenya.

Acetyl cholinesterase catalyses the hydrolysis of acetylcholine in the nerve synapses, thereby terminating nerve impulse, however, it is inhibited by organophosphates and carbamates. This study aimed to assess the level of acetyl cholinesterase inhibition and the resultant neuropathy in flower farm workers as well as the farmers’ awareness of safety measures and predisposing factors while handling pesticides. A cross-sectional study was conducted involving 217 participants from different flower farms. Structured questionnaire was used to collect data to assess level of safety and predisposing awareness and to assess for neuropathy. Blood samples were collected to determine the cholinesterase levels using spectrophotometry technique at 405 nm. The mean serum cholinesterase level in flower farm workers in Naivasha was 5873.26 U/L. There was a positive correlation (R= 0.07) between the numbers of years worked in the industry and serum cholinesterase levels as shown by Karl Pearson`s coefficient. The point prevalence of cholinesterase inhibition in Naivasha was 14% indicating a significant risk of adverse health effects. The level of safety awareness and predisposing factors among workers on pesticide exposure was 65%, suggesting that while the majority of workers had some level of safety awareness, there is still room for improvement. The point prevalence of neuropathy was 38% of the participants presenting with varying symptoms of adverse effects of pesticide exposure. Musculoskeletal impairment was leading at 19.81%, followed by skin irritation at 13.36%.These findings highlighted the need for better safety measures and awareness campaigns in the flower farm industry to reduce the risk of acetyl cholinesterase inhibition.

Collegiate Athletes With Diabetes: Baseline Medical Comorbidities and Preseason Concussion Testing Performance.

People with diabetes mellitus (DM) are at increased risk for adverse health events and complications throughout their lifetime. Whether DM significantly affects collegiate athletes' concussion baseline testing performance remains unclear. To (1) describe the prevalence of DM and associated comorbidities and (2) compare concussion baseline testing performance between student-athletes with DM and student-athletes without DM (NoDM). Retrospective, cross-sectional study. University. Using the Concussion, Assessment, Research and Education (CARE) Consortium research database, we matched athletes with self-reported DM (N = 229) by institution, sex, age, sport, position, testing year, and concussion history to athletes with NoDM (N = 229; total sample mean age = 19.6 ± 1.4 years, women = 42%). Descriptive statistics and χ2 tests of independence with subsequent odds ratios were calculated. Independent-samples t tests compared baseline symptoms, neurocognitive testing, and balance performance between athletes with DM and athletes with NoDM. Effect sizes were determined for significant group differences. At baseline, athletes with DM had higher rates of self-reported pre-existing balance disorders, sleep disorders, seizure disorders, motion sickness, learning disorders, vision and hearing problems, psychiatric disorders, depression, bipolar disorder, nonmigraine headaches, and meningitis than athletes with NoDM (P values < .05). We found balance differences between groups (P = .032, Cohen d = 0.17) such that, on average, athletes with DM had 1 additional error on the Balance Error Scoring System (DM = 13.4 ± 6.5; NoDM = 12.1 ± 5.9). No other comparisons yielded significant results. Although athletes with DM had high rates of self-reported balance disorders, sleep disorders, seizures, and meningitis, their baseline neurocognitive testing results were largely identical to those of athletes with NoDM. Our findings suggested that nonclinically meaningful differences were present in concussion baseline balance testing but no significant differences were noted in cognitive testing; however, the effect of DM on concussion recovery remains unknown.

Wits Wellness Facilitates Engagement and Self-Efficacy for Practicing Healthy Behaviors

ABSTRACT Most adults 65 and older have one or more chronic health conditions and 11% are at risk for or have changing cognitive abilities. Also, more adults are socially isolated, increasing their risks for adverse health effects. Classes that build self-efficacy for increasing healthy behaviors and social engagement are important for older adults’ health and well-being. Wits Wellness, a 12-week evidence-informed workshop series, was designed to encourage social interaction, intellectual engagement, and healthy behaviors. Participant-level feasibility and acceptability were examined with a survey (N = 164) and six focus groups (N = 22). Content analysis was conducted on the survey and thematic analysis was utilized for the transcribed focus groups. Participants were satisfied with Wits Wellness and described how the course is intellectually engaging, facilitates social interaction, and encourages practicing healthy behaviors/skills. Focus group findings revealed that combining enjoyable intellectual activities with health information was acceptable and feasible. Participants appreciated the opportunity for social engagement, and Wits Wellness increased their confidence to engage in healthy behaviors. Participants also described continuing to participate in healthy and socially engaging activities after the workshop ended. Course improvement suggestions include having a skilled facilitator to manage online etiquette, offering activities that appeal to diverse skill sets, and offering shorter sessions for younger older adults.

Pharmacist-led intervention for older people with atrial fibrillation in long-term care (PIVOTALL study): a randomised pilot and feasibility study

BackgroundOlder care home residents are a vulnerable group of people with atrial fibrillation (AF) at high risk of adverse health events. The Atrial Fibrillation Better Care (ABC: Avoid stroke; Better symptom management; Cardiovascular and other comorbidity management) pathway is the gold-standard approach toward integrated AF care, and pharmacists are a potential resource with regards to its’ implementation. The aim of this study was to determine the feasibility of pharmacist-led medicines optimisation in care home residents, based on the ABC pathway compared to usual care.MethodsIndividually randomised, prospective pilot and feasibility study of older (aged ≥ 65 years) care home residents with AF (ISRCTN14747952); residents randomised to ABC pathway optimised care versus usual care. The primary outcome was a description of study feasibility (resident and care home recruitment and retention). Secondary outcomes included the number and type of pharmacist medication recommendations and general practitioner (GP) implementation.ResultsTwenty-one residents were recruited and 11 (mean age [standard deviation] 85.0 [6.5] years, 63.6% female) were randomised to receive pharmacist-led medicines optimisation. Only 3/11 residents were adherent to all three components of the ABC pathway. Adherence was higher to ‘A’ (9/11 residents) and ‘B’ (9/11 residents) components compared to ‘C’ (3/11 residents). Four ABC-specific medicines recommendations were made for three residents, and two were implemented by residents’ GPs. Overall ABC adherence rates did not change after pharmacist medication review, but adherence to ‘A’ increased (from 9/11 to 10/11 residents). Other ABC recommendations were inappropriate given residents’ co-morbidities and risk of medication-related adverse effects.ConclusionsThe ABC pathway as a framework was feasible to implement for pharmacist medication review, but most residents’ medications were already optimised. Low rates of adherence to guideline-recommended therapy were a result of active decisions not to treat after assessment of the net risk–benefit.

Factors associated with diabetes concordant comorbidities among adult diabetic patients in Central Ethiopia: a cross-sectional study.

Diabetes comorbidities are a serious public health issue that raises the risk of adverse health effects and complicates diabetes management. It also harms emotional health, medication adherence, self-management, and general quality of life. However, evidence is scarce in Ethiopia, particularly in the study area. Thus, this study aimed to estimate the prevalence of diabetes concordant comorbidities and identify factors associated with the presence of concordant comorbidities among adult diabetic patients in central Ethiopia. A health facility-based cross-sectional study was conducted among 398 adult diabetic patients. A computer-generated simple random sampling was used to select study participants. Data were collected using a structured data extraction checklist. The collected data were entered into Epi info version 7.2 and exported to SPSS version 27 for analysis. A binary logistic regression model was used to analyze the association between dependent and independent variables. An adjusted odds ratio with the corresponding 95% confidence interval was used to measure the strength of the association and statistical significance was declared at a p-value < 0.05. The prevalence of diabetes-concordant comorbidities was 41% (95% CI: 36.2-46.0). The multivariable logistic regression model showed that age 41-60 (AOR = 2.86, 95% CI: 1.60-5.13), place of residence (AOR = 2.22, 95% CI: 1.33-3.70), having type two diabetes (AOR = 3.30, 95% CI: 1.21-8.99), and having positive proteinuria (AOR = 2.64, 95% CI: 1.47-4.76) were significantly associated with diabetes concordant comorbidities. The prevalence of diabetes-concordant comorbidities was relatively high. Age, place of residence, type of diabetes, and positive proteinuria were factors associated with diabetes-concordant comorbidities. Prevention, early identification, and proper management of diabetes comorbidities are crucial.

Seasonal Disparities of Human Health Risk and Particle-Bound Metal Characteristics Associated with Atmospheric Particles in a Fishery Harbor.

The effects of atmospheric pollution from ship emissions have been considered for several harbors worldwide. The health risk assessment and source apportionment of particle-bound metals in a fishery harbor were investigated in this study. The most abundant metal elements in particulate matter (PM) on all sampling days in three seasons were Fe (280.94 ± 136.93 ng/m3), Al (116.40 ± 71.25 ng/m3), and Zn (110.55 ± 26.70 ng/m3). The ratios of V/Ni were 1.44 ± 0.31, 1.48 ± 0.09 and 1.87 ± 0.06 in PM10, PM2.5, and PM1, respectively. Meanwhile, the ratios higher than 1 indicated that fuel oil combustion from ship emission in fishery harbor. The highest deposits of total particle-bound metals in the human respiratory tract were in the head airway (HA), accounting for 76.77 ± 2.29% of the total particle-bound metal concentration, followed by 5.32 ± 0.13% and 2.53 ± 0.15% in the alveolar region (AR) and tracheobronchial (TB) region, respectively. The total cancer risk (CR) of inhalation exposure to local residents exceeded 10-6. Mean total CR values followed the sequence: autumn (1.24 × 10-4) > winter (8.53 × 10-5) > spring (2.77 × 10-6). Source apportionment of related metal emissions was mobile pollution emissions (vehicle/boat) (37.10-48.92%), metal fumes of arc welding exhaust (19.68-34.42%), spray-painting process (12.34-16.24%), combustion emissions (6.32-13.12%), and metal machining processes (9.04-16.31%) in Singda fishing harbor. These results suggest that proper control of heavy metals from each potential source in fishing harbor areas should be carried out to reduce the carcinogenic risk of adverse health effects.

Superfood consumers' exposure to selected heavy metals.

Background: Superfood products are important components of the human diet, which may contain toxic heavy metals that have no beneficial function in the human body (e.g., cadmium, arsenic, mercury). Therefore, due to the high demand for these foods, maintaining their safety is a significant public health concern, resulting in an increasing number of studies in the field of health risk assessment due to population exposure to heavy metals. Aim: The aim of the study was to determine the concentration of selected heavy metals in individual superfood products. Methods: The research material consisted of 48 samples of selected superfood products such as flaxseed, chia seed, black cumin, goji berries, buckwheat, millet, almonds, quinoa and green tea. The collected samples were subjected to the mineralization process. In addition, an exposure assessment was performed by calculating the hazard quotient (HQ). Statistical analysis was performed using Statistica software for cadmium and arsenic. Results: The highest level of cadmium was observed in a sample of flaxseed (ground)-0.35 mg/kg. Again, the highest concentration of arsenic was found in green tea bags (21.94 mg/kg). The exposure assessment showed that the risk of adverse health effects is likely to occur with the consumption of flaxseed, almonds, quinoa and green tea at both the assumed average and maximum arsenic concentrations (HQ > 1). Conclusions: There are many foods on the market that contain heavy metals. The accumulation of various heavy metals in agricultural soils and edible crops should be regularly assessed to minimize public health problems.

Assessment of health risks associated with heavy metal concentration in seafood from North-Western Croatia

The following study aims at assessing the health risks associated with the consumption of the most commonly consumed seafood in the north-western part of Croatia due to the presence of heavy metals. Samples of seafood were collected and analysed for lead (Pb), cadmium (Cd), and mercury (Hg) content. Analyses of Cd and Pb were carried out by inductively coupled plasma mass spectrometry (ICP-MS) whereas Hg content was measured using atomic absorption spectrometry (AAS). Metal concentrations were in the following order Hg > Pb > Cd for the gilthead seabream, European hake, sardines, and tuna fish whereas in the Patagonian squid cadmium (Cd) was the heavy metal with the highest concentration, with the order of other metals being Cd > Hg > Pb. The heavy metal concentrations have been used to address the health risks using the Estimated Weekly Intake (EWI), Target Hazard Quotients (THQ), and Hazard Indices (HI). The findings revealed that the concentrations of the tested heavy metals, expressed on a per wet weight basis, did not exceed the Maximum Residue Levels (MRL) for those compounds mandated by national Croatian legislation. However, the HI for Hg was above 1, indicating a risk of adverse health effects due to the presence of this heavy metal in the consumed seafood. We conclude that the consumption of certain type of seafood such as the tuna fish should be limited when sensitive segments of the population such as children, elderly and pregnant women are concerned. Our results strongly advocate for a more stringent seafood quality control in the region.

Continuity of Care Versus Language Concordance as an Intervention to Reduce Hospital Readmissions From Home Health Care.

Language concordance between health care practitioners and patients have recently been shown to lower the risk of adverse health events. Continuity of care also been shown to have the same impact. The purpose of this paper is to examine the relative effectiveness of both continuity of care and language concordance as alternative or complementary interventions to improve health outcomes of people with limited English proficiency. A multivariable logistic regression model using rehospitalization as the dependent variable was built. The variable of interest was created to compare language concordance and continuity of care. The final sample included 22,103 patients from the New York City area between 2010 and 2015 who were non-English-speaking and admitted to their home health site following hospital discharge. The odds ratio (OR) average marginal effect (AME) of each included variable was calculated for model analysis. When compared with low continuity of care and high language concordance, high continuity of care and high language concordance significantly decreased readmissions (OR=0.71, 95% CI: 0.62-0.80, P<0.001, AME=-4.95%), along with high continuity of care and low language concordance (OR=0.80, 95% CI: 0.74-0.86, P<0.001, AME=-3.26%). Low continuity of care and high language concordance did not significantly impact readmissions (OR=1.04, 95% CI: 0.86-1.26, P=0.672, AME=0.64%). In the US home health system, enhancing continuity of care for those with language barriers may be helpful to address disparities and reduce hospital readmission rates.

Assessment of lead exposure in indoor shooters in central Poland

A steady increase in shooting practices is observed worldwide. Potential lead exposure at shooting ranges poses a risk to their employees and users, which is not widely reported outside of the USA, especially in Poland. Exposure to lead results from the use of bullets containing lead and the main route of exposure to this metal at shooting ranges is inhalation, i.e., during shooting or cleaning. The aim of this study was to assess lead exposure of employees and users in selected indoor shooting ranges in central Poland. Airborne lead concentrations at all locations in the shooting ranges were above Polish occupational exposure limit (OEL, 0.05 mg m−3). Elevated blood and urine lead levels, and decreased 4-aminolevulinic acid dehydratase activity (ALA-D) were found in subjects participating in shooting even for only a few (< 10) hours per week. Lead exposure at shooting ranges in central Poland, as indicated by elevated blood lead levels and decreased ALA-D activity, could represent an elevated risk for adverse health effects. Thus, information on the possible health consequences of lead exposure should be provided at these sites, and biomonitoring appears to be reasonable for regular workers and shooters.

Tire-Derived Transformation Product 6PPD-Quinone Induces Mortality and Transcriptionally Disrupts Vascular Permeability Pathways in Developing Coho Salmon.

Urban stormwater runoff frequently contains the car tire transformation product 6PPD-quinone, which is highly toxic to juvenile and adult coho salmon (Onchorychus kisutch). However, it is currently unclear if embryonic stages are impacted. We addressed this by exposing developing coho salmon embryos starting at the eyed stage to three concentrations of 6PPD-quinone twice weekly until hatch. Impacts on survival and growth were assessed. Further, whole-transcriptome sequencing was performed on recently hatched alevin to address the potential mechanism of 6PPD-quinone-induced toxicity. Acute mortality was not elicited in developing coho salmon embryos at environmentally measured concentrations lethal to juveniles and adults, however, growth was inhibited. Immediately after hatching, coho salmon were sensitive to 6PPD-quinone mortality, implicating a large window of juvenile vulnerability prior to smoltification. Molecularly, 6PPD-quinone induced dose-dependent effects that implicated broad dysregulation of genomic pathways governing cell-cell contacts and endothelial permeability. These pathways are consistent with previous observations of macromolecule accumulation in the brains of coho salmon exposed to 6PPD-quinone, implicating blood-brain barrier disruption as a potential pathway for toxicity. Overall, our data suggests that developing coho salmon exposed to 6PPD-quinone are at risk for adverse health events upon hatching while indicating potential mechanism(s) of action for this highly toxic chemical.

Calcium dynamics and associated patterns of milk constituents in early lactation multiparous Holsteins

Immediately following parturition, physiological demands for calcium increase substantially to support the onset of milk production. As a result, transitioning dairy cows may experi­ence subclinical hypocalcemia (SCH) at some point during early lactation. Cows respond to this homeostatic challenge dynamically, such that serum total calcium concentrations (tCa) at 1 and 4 days in milk (DIM) can be used to classify cows into 4 calcium dynamic groups: normocalcemic (NC: SCH at no DIM), transient (tSCH: SCH at 1 DIM only), delayed (dSCH: SCH at 4 DIM only) and persistent (pSCH: SCH at both 1 and 4 DIM). Identifying cows in the pSCH and dSCH groups is important clinically because these groups are at greater risk of adverse health events compared to the NC and tSCH cows. Our objective was to describe the temporal patterns of milk constituents for cows in each calcium group using Fourier-transform infrared (FTIR) spectroscopic analysis of milk samples. Additionally, we hoped to ascertain whether these methods might be valuable as a diagnostic tool for grouping cows based on calcium dynamics at a clinically useful timepoint.

Examining later-in-life health risks associated with sport-related concussion and repetitive head impacts: a systematic review of case-control and cohort studies

ObjectiveConcern exists about possible problems with later-in-life brain health, such as cognitive impairment, mental health problems and neurological diseases, in former athletes. We examined the future risk for adverse health...

Invited Perspective: PFAS and the Childhood Obesity Phenotype-Challenges and Opportunities.

Vol. 131, No. 6 Invited PerspectiveOpen AccessInvited Perspective: PFAS and the Childhood Obesity Phenotype—Challenges and Opportunitiesis accompanied byAssociations of Gestational Perfluoroalkyl Substances Exposure with Early Childhood BMI z-Scores and Risk of Overweight/Obesity: Results from the ECHO Cohorts Nikos Stratakis and Martine Vrijheid Nikos Stratakis https://orcid.org/0000-0003-4613-0989 Barcelona Institute for Global Health, Barcelona, Spain Universitat Pompeu Fabra, Barcelona, Spain CIBER Epidemiología y Salud Pública, Spain Search for more papers by this author and Martine Vrijheid Address correspondence to Martine Vrijheid, ISGlobal, Institute for Global Health, C/Doctor Aiguader 88, 08003, Barcelona, Spain. Telephone: 34 93 2147306. Email: E-mail Address: [email protected] https://orcid.org/0000-0002-7090-1758 Barcelona Institute for Global Health, Barcelona, Spain Universitat Pompeu Fabra, Barcelona, Spain CIBER Epidemiología y Salud Pública, Spain Search for more papers by this author Published:7 June 2023CID: 061301https://doi.org/10.1289/EHP12713AboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Childhood obesity represents a public health crisis with serious long-term consequences.1 The “metabolism-disrupting chemical” hypothesis postulates that environmental chemicals with endocrine-disrupting ability have the potential to alter the body’s metabolic systems, especially when exposure occurs during sensitive developmental periods, and to increase susceptibility to higher adiposity.2 In line with this hypothesis, per- and polyfluoroalkyl substances (PFAS), a group of manmade chemicals, have received increased attention for their potential obesogenic effects. These chemicals have been widely used in various industrial and commercial applications,3 and owing to their perfluorinated carbon moieties, they are characterized by physical stability, chemical resistance, and environmental persistence. Detectable blood levels have been reported in population studies around the world.4–7 Given that exposures are chronic and widespread across the general population, even modest increases in the relative risk of adverse health effects can translate into a large number of cases of obesity and other related metabolic complications at the population level.In their new study, Liu et al.8 relied on the Environmental influences on Child Health Outcomes (ECHO) consortium to examine associations between prenatal exposure to PFAS (assessed through maternal serum or plasma concentrations) and childhood obesity. Although not the first to report on this subject, the new study addresses key elements that previous work did not delve into,9 including assessment of sex-specific effects and examination of PFAS exposures as a mixture. The authors found that higher gestational exposure to PFAS was associated with a slightly higher risk of overweight or obesity in children 2–5 years of age, with no evidence of sex specificity. As expected, measured PFAS concentrations were significantly correlated. This probably reflects common exposure sources and provides evidence in favor of the notion that PFAS should be examined and managed as a class.10Liu et al.8 make an important contribution to the field by pooling data across eight prospective cohorts from various locations in the United States (Georgia, Colorado, Massachusetts, California, New Hampshire, New York, and Illinois), even though the overall sample size achieved through this pooling is still relatively small. The researchers assessed body mass index (BMI) and defined overweight/obesity as BMI greater than or equal to the eighty-fifth≥85th percentile for age and sex. Approximately one in every five children included in this study had overweight or obesity—a prevalence estimate that is not only worrying but also very similar to that reported previously in U.S. and European youth.11,12Obesity, traditionally defined as an excess of body fat causing prejudice to health, is usually assessed in epidemiological research by BMI given its simplicity as a tool. However, it is now well accepted that a high BMI is a heterogeneous entity, because it cannot distinguish between lean and fat mass or accompanying cardiometabolic complications.13 If PFAS do not affect BMI per se, underestimation of risk in population subgroups may occur. For instance, studies have shown that individuals with a normal or high BMI are at higher risk for cardiovascular complications if they have an excess of visceral adipose tissue, increased ectopic fat accumulation (e.g., in the liver), higher triglyceride levels, or elevated blood pressure.13–15 Several studies in experimental models have demonstrated the ability of PFAS to interfere with key metabolic and endocrine systems, and to affect a multitude of obesity-related outcomes, including liver fat accumulation and lipidemia.16 Future epidemiological research should focus on a more detailed characterization of obesity phenotype(s) by using direct measurements of body fat distribution and mass (e.g., through imaging) and by assessing markers of adiposity-related metabolic complications, including inflammation (e.g., interleukin-6, C-reactive protein), liver injury (e.g., alanine aminotransferase, hepatic fat fraction), blood pressure, lipids (e.g., triglycerides, high-density lipoprotein cholesterol), and blood glucose and insulin levels. Such efforts will inform evaluations of PFAS toxicity and ultimately provide a clearer picture of the metabolic disruption associated with this class of pervasive chemicals.Liu et al.8 assessed exposure to seven long-chain PFAS [including perfluorooctanesulfonic acid (PFOS) and perfluorooctanoic acid (PFOA)]. However, PFAS constitute a group of thousands of chemicals. Accumulating knowledge on their high mobility in the environment, bioaccumulation in living organisms, and deleterious health effects led to the monitoring of several PFAS, particularly the long-chain compounds (greater than 6>6 fluorinated carbons), and their phasing out. Following this, several other compounds, including the short-chain PFAS and the so-called “PFAS alternatives” (e.g., GenX), have been adopted as alternatives and are now increasingly being detected in the environment and in humans.17 Animal studies suggest that these chemicals also have the potential to interact with peroxisome proliferator-activated receptor pathways and affect body weight.18 Evidence of the toxic effects of the emerging PFAS homologs is largely lacking in humans. This is problematic because, in communities with high exposure to these PFAS, the magnitude of potential health impacts has not been quantified, and such information is necessary to engage in risk mitigation actions. Thus, to prevent the extensive production and use of similarly bioavailable PFAS in the future, it is imperative to accelerate research on the potential health effects of the emerging compounds, both individually and as mixtures.Many cohorts worldwide have measured PFAS in biological samples collected during pregnancy and have followed up with anthropometric measurements and, less frequently, adiposity-related biomarkers in children. Liu et al.8 make an important contribution by showing that it is possible to set up multi-cohort collaborations with access to individual data. The experiences gained by the ECHO Program and similar ongoing initiatives in Europe—which include the harmonization of data on PFAS, other environmental chemicals, and health outcomes [e.g., projects LifeCycle and Advancing Tools for Human Early Lifecourse Exposome Research and Translation (ATHLETE)]19,20—provide the opportunity for large collaborative efforts to analyze individual data from similar cohorts across continents and populations. Beyond achieving larger sample sizes, such collaborations would allow the comparison of results across diverse study populations and the in-depth exploration of potential sources of heterogeneity, including exposure sources and sociodemographic and lifestyle characteristics. This type of collaboration would provide a clear advantage over literature-based meta-analyses.Unfortunately, the pace of our research is inadequate to address the rapidly changing chemical landscape and the emerging concerns of affected populations. People living in communities with high exposures to PFAS want to know what can be done to protect their health and the health of their children. The analysis by Liu et al.8 underlines the urgent need for further research and for immediate public health action.

Effect-based evaluation of water quality in a system of indirect reuse of wastewater for drinking water production

Indirect potable reuse of wastewater is a practice that is gaining attention, aiming to increase freshwater supplies to meet water scarcity. However, reusing effluent wastewater for drinking water production comes with a paired risk of adverse health effects, due to the potential presence of pathogenic microorganisms and hazardous micropollutants. Disinfection is an established method to reduce microbial hazards in drinking water, but it has been associated with formation of disinfection by-products (DBPs). In this study, we performed an effect-based assessment of chemical hazards in a system wherein a full-scale trial of disinfection by chlorination, of the treated wastewater was performed prior discharge to the reciepient river. The presence of bioactive pollutants was assessed along the entire treatment system, starting from incoming wastewater to finished drinking water at seven sites in and around the Llobregat River in Barcelona, Spain. Samples were collected in two campaigns, with and without applied chlorination treatment (13 mg Cl2/L) to the effluent wastewater. The water samples were analysed for cell viability, oxidative stress response (Nrf2 activity), estrogenicity, androgenicity, aryl hydrocarbon receptor (AhR) activity and activation of NFĸB (nuclear factor kappa-light-chain-enhancer of activated B cells) signaling using stably transfected mammalian cell lines. Nrf2 activity, estrogen receptor activation and AhR activation was detected in all investigated samples. Overall, removal efficiencies were high in both wastewater treatment and drinking water treatment samples for most of the studied endpoints. No increase in oxidative stress (Nrf2 activity) could be attributed to the additional chlorination treatment of the effluent wastewater. However, we found an increase in AhR activity and a reduction of ER agonistic activity after chlorination treatment of effluent wastewater. The bioactivity detected in finished drinking water was considerably lower compared to what was found in effluent wastewater. We could thus conclude that indirect reuse of treated wastewater for drinking water production can be possible without compromising drinking water quality. This study contributed important knowledge in efforts to increase the reuse of treated wastewater as a source for drinking water production.

Water pollution of the Oued D'Hous River (Algeria) and its potential impact on fauna and flora

Water plays a crucial role in all aspects of our lives, including the economy, food security, production, and politics, making it essential for sustainable development. Surface water pollution, which includes rivers, lakes, and oceans, is a significant environmental concern. Oued D'Hous, located in the Wilaya of Bouira in Algeria, is the subject of our research, which examines its hydrochemical pollution resulting from the discharge of domestic, industrial, and agricultural wastewater from the city. The evaluation of the physicochemical parameters reveals that the existing pollutant levels in Oued D'Hous have significantly increased, leading to a high degree of toxicity that threatens the area's flora and fauna. This pollution also limits the use of this resource by humans. We call upon the competent authorities to promptly limit the discharge of these hazardous effluents into Oued D'Hous to prevent further water contamination and reduce the risk of adverse health effects on the public, including those who use the wells located in the vicinity. In conclusion, immediate measures are necessary to mitigate the severe pollution of Oued D'Hous, and we urge the authorities to take action to address this pressing environmental concern.