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Age-related cognitive and motor decline impairs daily functioning and increases fall risk. Although both domains interact in everyday activities, they are often assessed separately, limiting ecological validity. This study examined reliability and construct validity of an assessment device for agility and motor-cognitive reactive stepping performance in older adults. In a test-retest design, 72 older adults (48 women; 73.7 ± 7.6 years) completed agility tests (Random Star Run and a dual task with multiple object tracking) and motor-cognitive tasks on the SKILLCOURT across four sessions: familiarisation, test day 1 and day 2 (7 days apart), and test day 3 (3 months later). Agility tasks required reactive changes of direction in response to visual cues, while motor-cognitive stepping tasks assessed simple and choice reaction time, task switching, 2-back, and Stroop word-color interference. Intersession Reliability was evaluated using intraclass correlation coefficients (ICC) and coefficients of variation (CV), learning effects with linear mixed models, and construct validity via age-adjusted regression against established motor (Timed-up-and-Go; TUG; single-/dual task) and seated PC-based cognitive measures of reaction speed and executive functions corresponding to the SKILLCORT tasks. Significant learning effects were observed mainly between test days 1 and 2. Relative reliability was moderate to excellent for SKILLCOURT agility, simple reaction time, and Stroop word-color performance (ICC = 0.70-0.94), but lower for choice reaction time, task switching, and the 2-back task (ICC = 0.49-0.66). Absolute reliability was generally good (CV = 4.6-7.2%), except for the SKILLCOURT task switching and 2-back (~12%) and, in particular, the dual task agility test (32%). Random Star Run agility was predicted by TUG single-task performance, PC-based Stroop interference control, and simple reaction time (R2 = 0.77), while dual task agility was predicted by TUG dual task and PC-based 2-back performance (R2 = 0.37). All motor-cognitive outcomes were significantly associated with corresponding PC-based cognitive measures (R2 = 0.20-0.41). The SKILLCOURT demonstrated good reliability for the Random Star Run agility test and most motor-cognitive measures, although adequate familiarisation appears necessary to minimise learning effects. Construct validity was confirmed for agility measures, while reactive stepping tasks appeared to involve greater motor demands and task interference, which may weaken correlations with comparable PC-based cognitive tests.
Background/Objectives: Small-scale workplaces often have limited access to occupational health services, despite potential exposure to hazardous solvents. Biological monitoring can provide worker-level evidence of internal exposure when routine environmental monitoring is limited. This study evaluated urinary biomarkers of benzene and toluene exposure among workers in small-scale printing workplaces in South Korea and examined whether self-reported chemical handling corresponded with biomarker patterns. Methods: In this cross-sectional field biomonitoring study, 21 workers from eight printing companies provided end-of-shift urine samples. Creatinine-adjusted urinary concentrations of trans,trans-muconic acid (t,t-MA), S-phenylmercapturic acid (SPMA), phenol, and o-cresol were analyzed and compared with applicable biological reference values. Associations between reported chemical handling and elevated biomarker levels were estimated using Firth's penalized logistic regression, and correlations among log-transformed biomarkers were explored. Results: Nine workers (42.9%) had urinary o-cresol concentrations at or above the American Conference of Governmental Industrial Hygienists (ACGIH) biological exposure index of 300 μg/g creatinine. Workers reporting benzol handling, a local term for petroleum-based cleaning products, had higher odds of elevated SPMA, although the estimate was imprecise and hypothesis-generating (age-adjusted OR 6.04, 95% CI 0.75-104.90, p = 0.093). The correlation between SPMA and t,t-MA was stronger among workers reporting benzol handling (r = 0.94) than among those reporting toluene handling (r = -0.01). Conclusions: These exploratory findings indicate that toluene-related internal exposure is a relevant occupational health concern in small-scale printing workplaces, while reported benzol handling may indicate possible low-level benzene-related exposure. Urinary biomonitoring may support exposure surveillance and preventive occupational healthcare in small enterprises when interpreted alongside workplace observations, product information, ventilation, protective equipment use, and worker education.
Diverse environmental exposures - home, occupational, and traffic-related - may impact asthma, but population-based studies on objectively assessed asthma are lacking. We aimed to investigate the impact of these exposures on future inhaled corticosteroid (ICS) use. Data from two Swedish population-based cohorts (performed in 2008-2010) were linked to the National Prescribed Drug Registry from 2005 to 2018 to form the REGAL study. This analysis included 31,768 participants from Stockholm, Gothenburg, Uppsala, and Umeå. Participants reported asthma diagnosis, asthma-related symptoms, and home and occupational exposures via questionnaires, while ICS prescriptions were retrieved from registry. Among 31,768 participants, 6.9% (n = 2,103) reported asthma medication via questionnaire at baseline, and 5.3% (n = 1,679) initiated ICS therapy during the follow-up period (median follow-up time: 10.7 years). The prevalence of floor dampness, irritating air at home, traffic exposure at home, and occupational exposure to gas, smoke, or dust were 3.8%, 17.9%, 4.0%, and 36.7%, respectively. Floor dampness (odds ratio OR = 1.32, 95%CI 1.06-1.63), irritating air (OR = 2.08, 95%CI 1.85-2.33), traffic exposure at home (OR = 1.48, 95%CI 1.21-1.81), and occupational exposure to gas, smoke, or dust (OR = 1.55, 95%CI 1.39-1.72) were associated with self-reported asthma medication. An increased risk of initiating ICS therapy during the follow-up period was found for floor dampness at home (hazard ratio HR = 1.42, 95%CI 1.14-1.77), irritating air at home (HR = 1.46, 95%CI 1.29-1.65), and previous occupational exposure to gas, smoke, or dust (HR = 1.25, 95%CI 1.12-1.40). Indoor dampness, irritating air at home, and occupational exposure to gas/smoke/dust were associated with self-reported asthma medication at baseline and future initiation of ICS.
Modern buildings, designed for energy efficiency often lead to poor indoor air quality (IAQ), combined with prolonged indoor working activity resulting in Sick Building Syndrome (SBS) symptoms among occupants. This study aimed to assess the prevalence of SBS symptoms especially ocular and general symptoms and their association with IAQ and ergonomic factors among office workers in a healthcare facility. A cross-sectional study involving 261 office workers was conducted, assessing demographics, working conditions, and SBS symptoms using questionnaires. Indoor Environmental Quality (IEQ) parameters were measured, including thermal comfort, chemical, and biological parameters, light, and building inspection. Results revealed a substantial prevalence of ocular (27.2%) and general (22.2%) SBS symptoms, associated with prolonged computer usage and elevated formaldehyde levels. Multivariable analysis revealed that every hour of increase in computer screen time beyond seven hours increased the risk of ocular and general SBS by 21% and 23%, respectively. Formaldehyde concentrations ≥ ocular 0.74 ppm increased the probability of ocular SBS by 5.9 times. Furthermore, repetitive wrist and shoulder movements increased the risk of general SBS by 2.48 times. Recommendations include optimizing IAQ, reducing formaldehyde emissions, and implementing ergonomic workstation strategies to mitigate SBS effects. This study emphasizes the importance of comprehensive workplace interventions for healthier indoor environments and improved occupational health and productivity.
This study aimed to examine the association between cumulative occupational noise exposure, using high-frequency hearing loss as an objective marker, and hypertension among Air Force ground staff. Active-duty Air Force ground staff ( n  = 451) completed standardized questionnaires and underwent pure-tone audiometry, and their blood pressure (BP) and laboratory profiles were measured. High-frequency hearing loss was defined as the average 4-kHz hearing threshold in both ears and was categorized into low (< 7.5 decibels [dB], 2nd quartile), medium (7.5-12.5 dB), and high (≥ 12.5 dB, 3rd quartile) groups. Hypertension was defined as systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg, or a previous diagnosis. Multiple logistic and linear regression models were used to estimate associations. The prevalence of hypertension increased progressively across the hearing loss categories (40.9%, 63.5%, and 82.1%, respectively). Compared with the low group, the odds of hypertension were significantly higher in the medium (adjusted odds ratio [aOR] = 1.90, 95% confidence interval [CI]: 1.08-3.34) and high (aOR = 4.81, 95% CI: 2.51-9.02) groups. Each 5-dB increase in the 4-kHz hearing threshold was associated with double the likelihood of hypertension (aOR = 2.15, 95% CI: 1.57-2.94) and with increases in SBP and DBP (adjusted beta coefficients [aβ] = 0.63 and 0.46 mmHg, respectively). High-frequency hearing loss as a proxy for cumulative noise exposure was strongly associated with hypertension among the Air Force ground staff. These findings suggest that occupational noise may be associated with an increased risk of hypertension.
The zinc-to-copper ratio (ZCR) reflects essential metal balance and may be relevant to cardiovascular regulation, yet its association with hypertension in populations exposed to environmental heavy metals remains unclear. We conducted a cross-sectional study of 966 adults (≥ 30 years, recruited in 2008) comprising an exposed group (n = 564) residing within 4 km of the Janghang copper smelter and a non-exposed control group (n = 402) from a rural area approximately 15 km away. Serum zinc, copper, and nickel, along with blood lead, mercury, and urinary cadmium and arsenic were measured. Associations between ZCR and blood pressure were examined using multivariable linear regression, logistic regression, Bayesian kernel machine regression (BKMR), and restricted cubic spline (RCS) analyses, with sensitivity analyses. Higher ZCR was associated with increased systolic and diastolic blood pressure in fully adjusted linear models (SBP: β = 1.75, p = 0.002; DBP: β = 1.47, p < 0.001), with consistent associations in both exposed and control groups. In logistic regression, participants in the highest ZCR tertile had higher odds of hypertension than those in the lowest tertile (adjusted OR = 1.91; 95% CI: 1.25-2.93; p = 0.003). When stratified, the association was more pronounced in the non-exposed group (OR = 2.29; 95% CI: 1.18-4.45; p = 0.014) and somewhat attenuated but still suggestive in the exposed group (OR = 1.71; 95% CI: 0.96-3.06; p = 0.069); the formal interaction test was not statistically significant (p = 0.561). Sensitivity analyses, including exclusion of antihypertensive medication users, yielded consistent findings (OR = 1.83; 95% CI: 1.19-2.80), and the E-value (1.97) indicated limited-to-moderate robustness to unmeasured confounding. Higher ZCR is consistently associated with hypertension across analytical approaches and subgroups, with a suggestive but not statistically significant pattern of effect modification by environmental metal exposure. These findings support ZCR as a potentially informative indicator of essential metal imbalance relevant to blood pressure, warranting further investigation in prospective settings.
Human Epidermal Growth Factor Receptor 2-positive (HER2+) breast cancer poses significant therapeutic challenges, particularly concerning treatment administration pathways and their associated costs. This study evaluates the managerial and economic impacts of different therapeutic administration scenarios for HER2-positive breast cancer patients, focusing on optimizing hospital workflows, resource utilization, and patient outcomes in Italian oncological centers. A decision tree model was developed to simulate and compare five treatment administration pathways: Standard, Drug-Change, Drug Day, Dedicated Ambulatory, and Optimal Pathway scenarios. The model integrates patient and healthcare professional (HCP) activity and waiting times, infusion chair occupation, and direct and indirect costs. Sensitivity analyses assessed variability in model outcomes. Switching from endovenous (EV) to subcutaneous (SC) administration substantially reduced patient throughput times and HCP workloads. The Optimal Pathway scenario yielded the highest resource optimisation, reducing HCP activity time by up to 48 hours, infusional chair occupational time by up to 150 hours, and patients' total time by up to 753 hours per 100 patients monthly. Cost analyses indicated significant savings in both direct and indirect cost for all the proposed scenarios in comparison to the Standard one. The adoption of SC formulations and innovative pathway optimizations enhances treatment organizational efficiency and reduces both direct and indirect costs. These findings underscore the value of tailored approaches to administration based on the structural and organizational characteristics of individual oncology centers, aligning with current Italian healthcare reforms.
Accessible and trustworthy health information sources support informed decisions. Longitudinal evidence on how health information sources influence behavioural changes in community-dwelling populations remains limited. Thus, we examined associations between health information sources and behaviour changes in walking time, balanced meal consumption, and smoking cessation. Baseline (2021) and follow-up (2023) survey questionnaires were distributed to residents randomly selected from the 18 residential areas. Health information sources were classified into five categories: print media, television (TV) and radio, the Internet, family and friends, and professionals. Desirable health behaviours were defined as walking for ≥60 min/day; consuming ≥2 meals per day comprising staple grains, main dishes, and side items (SMS); and smoking cessation. Meeting these criteria was classified as good; not meeting them as poor. Improvement was defined as poor at baseline and good at follow-up. Maintenance was defined as good at both surveys. Improvement analyses included participants with poor baseline conditions. Maintenance analyses included those with good baseline conditions. Associations were analysed using multilevel modified Poisson regression models, accounting for clustering within residential areas and adjusting for covariates. Risk ratios (RRs) and 95% confidence intervals (95% CIs) were calculated. Of the 12 119 baseline participants, 6620 (54.6%) completed the follow-up. The most common health information sources were TV and radio (68.5%), the Internet (56.8%), and print media (48.9%). Use of family and friends as information sources was associated with improvement in walking time (RR: 1.19; 95% CI: 1.02-1.39), as was use of professionals (RR: 1.15; 95% CI: 1.03-1.28). Professionals showed a marginal association with sustained walking time (RR: 1.07; 95% CI: 0.99-1.15). TV and radio was associated with improvement in SMS meal consumption (RR: 1.13; 95% CI: 1.02-1.26), while print media was associated with maintenance of SMS meal consumption (RR: 1.05; 95% CI: 1.01-1.08). No sources were related to smoking cessation. Health information sources showed distinct associations with improved and maintained health behaviours. Interpersonal sources were relevant for improving walking time, while mass media were linked to dietary improvement and maintenance. These findings suggest tailoring health communication strategies to specific health behaviours.
Singapore and Japan have well-established workers' compensation systems which differ significantly in their structure and approach. The objectives of the paper are to identify key differences between the two systems, highlight successful practices for consideration, and critically assess the advantages and disadvantages of each approach. A comparative analysis of workers' compensation systems in Singapore and Japan was conducted in the form of a narrative review, drawing upon published data from peer-reviewed scientific journals, official national sources and key international organizations. Singapore's workers' compensation system focuses on ensuring employer competitiveness while providing workers with basic financial protection and limiting spillover costs to society through tightly scoped compensation coverage. In contrast, Japan's workers' compensation system prioritizes worker health with more comprehensive compensation benefits, coverage, and clearer insurance mechanisms to recognize the true costs of poor workplace safety and health. Both Singapore and Japan face similar challenges for workers' compensation in terms of apportioning attributability of occupational diseases and underreporting of work-related incidents. A better understanding of the underlying principles and trade-offs within each workers' compensation system allows for identification of opportunities to strengthen fairness and ensure more equitable outcomes for workers, employers, and society. Both Singapore and Japan can benefit from closer collaboration to share best practices, innovative solutions, and research efforts to address shared challenges.
This study assessed perceptions of health and science students and academic staff regarding the health risks, environmental impact, and regulation of dental amalgam (DA). As DA faces increasing restrictions, understanding the views of students and academic staff is essential for evaluating educational and policy readiness. A cross-sectional survey was distributed to 1,230 participants in the Czech Republic. The questionnaire explored awareness of mercury exposure from DA, health and environmental concerns, and familiarity with regulations. Responses were statistically compared across disciplines. Overall, 35.8% of respondents did not recognize DA as a mercury source, and 48.5% did not view it as a health risk. Most did not consider DA an occupational hazard for dental professionals. However, 55.3% saw it as an environmental pollutant. While 59.2% supported restricting DA use in pregnant women and 51.0% in children, only 22.0% supported a complete ban. Most respondents preferred composites for aesthetic reasons (88.5%) rather than health concerns. Dental students differed significantly from other groups in several key areas, particularly regarding perceived health risks and support for restrictions on dental amalgam use. Perceptions of dental amalgam differed according to educational background. While most participants supported restricting its use in vulnerable populations, dental students were less likely to perceive it as a significant health risk and were less supportive of a complete ban. These findings highlight the importance of evidence-based education and public health communication regarding dental amalgam and mercury-related issues.
Brick kiln workers in Nepal face high exposure to respirable silica but are not required to use personal protective equipment (PPE). We sought to understand factors influencing PPE use, design and pilot a PPE training and distribution intervention and assess its feasibility. We used a human-centred design approach guided by the Discover, Design, Build, Test framework and conducted four pre-intervention workshops (36 participants), a 21-day randomised controlled trial (RCT) and three post-intervention workshops (19 participants) at a kiln in Bhaktapur, Nepal. Workers and leadership aged ≥18 years were purposively sampled for workshops and randomly selected for the RCT (20 intervention, 20 control). Intervention participants received PPE training, weekly reminders and free N95 respirators and eyewear. Control participants received counselling and information on where to purchase PPE. Pre-intervention workshops revealed barriers to PPE use, including cost, discomfort and work efficiency concerns. Workers preferred expert-led, hands-on PPE training. We identified high feasibility (mean Feasibility of Intervention Measure, 4.6±0.5 points) among workers; leadership rated feasibility lower due to cost concerns. Observed N95 use was higher in the intervention group (78.9%, 71/90 visits) compared with none in the control group (0%, 0/93 visits; p<0.001). Post-intervention feedback showed workers felt N95s reduced dust exposure and respiratory symptoms without impacting efficiency, but eyewear needed adaptation for sustained use. With worker-centred training, N95 respirators are feasible to reduce silica exposure in this setting. However, broader adoption may depend on improving the affordability and accessibility of PPE through advocacy and policy changes. NCT06090370.
While adverse respiratory health effects of exposure to disinfectants and cleaning products (DCPs) are well-documented in cleaners/healthcare workers, no study has investigated their impact on daycare workers. We evaluated cross-sectional associations between occupational exposures to DCPs, considering them as a mixture of chemical compounds and asthma in CRESPI daycare workers. Use of DCPs in daycares was assessed using a smartphone application. We retrieved their chemical compounds, classifying them as irritants, sensitisers, quaternary ammonium compounds and biocides. Latent class analysis (LCA) was conducted to identify exposure profiles for the weekly used DCPs/compounds. We assessed associations of the identified exposure profiles with the asthma symptom score (0-5) using negative binomial regressions, adjusted for age, smoking status and body mass index and accounted for daycare centre. Analyses included 311 women (43 years, people who smoke: 11%). The LCA identified three exposure profiles: no weekly use of DCPs (LC1 prevalence: 24%), weekly use of a moderate number of irritants (LC2: 37%), weekly use of a high number of irritants, respiratory sensitisers and biocides (LC3: 39%). Women in LC2 and LC3 had a higher risk for asthma symptoms compared with those in LC1. The association was borderline statistically significant for LC3 (mean score ratio (MSR)=1.56; 95% CI 0.99 to 2.46) and weaker for LC2 (MSR=1.34 95% CI 0.85 to 2.13). Our results show positive associations between weekly occupational use of numerous DCPs and those with multiple types of chemical compounds in daycares and asthma symptoms in daycare workers.
Air pollution is an established risk factor for cardiovascular and metabolic diseases, but evidence on chronic kidney diseases (CKD) remains limited. We aim to examine the association between long-term exposure to air pollutants and CKD incidence. We followed 24,581 female nurses from the Danish Nurse Cohort, recruited in 1993 or 1999, for their first-ever hospital contact with a primary or secondary CKD diagnosis until 2018. We estimated annual mean levels of particulate matter with a diameter < 2.5 µm (PM2.5) and 10 µm (PM10), nitrogen dioxide (NO2), and black carbon (BC) at nurses' residential addresses using the DEHM/UBM/AirGIS modeling system. We used Cox regression models to examine the association of 14-year running means of air pollutants with CKD incidence and to explore the effect modification of this association by lifestyles. Over 521,211 person-years of follow-up, 429 nurses developed CKD. We found positive associations of modest magnitude between long-term exposure to air pollutants and CKD, with hazard ratios (95% confidence intervals) per interquartile range: 1.18 (0.93-1.50) per 2.86 µg/m3 for PM2.5, 1.14 (0.93-1.40) per 3.33 µg/m3 for PM10, 1.13 (0.99-1.28) per 8.09 µg/m3 for NO2, and 1.09 (1.00-1.20) per 0.34 µg/m3 for BC. The associations between long-term exposure to NO2 and CKD incidence were greater in never smokers than in ever-smokers. Associations with NO2 and BC remained unchanged in two-pollutant models, whereas those with PM10 and PM2.5 attenuated. Our study adds important new findings to the growing evidence suggesting that air pollution may be associated with CKD incidence. This study provides longitudinal evidence that long-term exposure to ambient air pollution contributes to chronic kidney disease (CKD) incidence, even in a relatively healthy occupational cohort and at comparatively low pollution levels. Although effect sizes were modest, consistent positive associations, particularly for NO2 and black carbon, highlight traffic-related pollution as a potential renal risk factor. Stronger associations among never-smokers suggest that environmental exposures may independently influence kidney health. These findings reinforce the need to integrate air pollution into CKD risk assessment and prevention strategies. Strengthening air quality policies and reducing long-term residential exposure could help lower CKD burden and protect kidney health at the population level.
Occupational exposures are contributors to chronic respiratory diseases, particularly in low- and middle-income countries (LMICs), where regulatory policies are limited. We investigated associations between occupational exposures and respiratory outcomes using longitudinal data from the Burden of Obstructive Lung Disease study. We analysed data from 4237 participants across 17 sites, mostly in LMICs. Occupational exposures were assessed by self-report (never vs ever) and the ALOHA+Job Exposure Matrix for vapours, gases, dusts, fumes (VGDF), pesticides, solvents and metals (cumulative exposure). Respiratory outcomes included: forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), the FEV₁/FVC and respiratory symptoms. Associations were examined using multilevel linear and logistic regression models adjusted for age, sex, smoking, pack-years, education, body mass index and baseline FVC. We further explored sex differences and non-linear relationships for symptoms. Over a median 10 years of follow-up, FEV₁/FVC decline was associated with moderate (β=-1.34; 95% CI -2.32 to -0.35) and high (β=-1.79; 95% CI -3.33 to -0.20) exposure to VGDF and low (β=-1.11; 95% CI -2.11 to -0.08) and high (β=-2.16; 95% CI -4.08 to -0.24) exposure to pesticides. Increased risk of wheeze was associated with moderate (Relative Risk (RR) =1.45; 95% CI 1.05 to 2.15) and high (RR=1.89; 95% CI 1.100 to 3.26) exposure to pesticides. Associations did not differ by sex. There was weak evidence of non-linear exposure-response relationships and no associations with solvents or metals. A significant decline in FEV1/FVC was associated with exposure to VGDF and pesticides. Increased risk of wheeze was also associated with exposure to pesticides. These findings underscore the need for continued monitoring in high-exposure settings, particularly in LMICs.
Real-world vaccine effectiveness (VE) and relative VE (rVE) data of protein-based and mRNA COVID-19 vaccines against symptomatic SARS-CoV-2 infections inform policy recommendations and reinforce public confidence. The study aim was to assess the safety and VE of the 2023-2024 protein-based and mRNA COVID-19 vaccines (XBB.1.5) in a real-world setting. The single-site, pragmatic BEEHIVE clinical trial was conducted among participants aged ≥18 years from the Salt Lake City, Utah, area, who had previously received ≥2 mRNA COVID-19 vaccines, from November 17, 2023, through September 9, 2024. Randomized participants received a protein-based or mRNA COVID-19 vaccine in a double-blind manner. An unblinded, nonrandomized comparator control group that did not receive a study vaccine was also enrolled. The primary aim measured VE between the randomized and comparator groups. The secondary aim was to measure rVE between the 2 vaccine platforms. In the modified intention-to-treat (mITT) analysis, VE and rVE were estimated using a proportional-hazards model for symptomatic infections confirmed by weekly self-administered rapid antigen tests (RATs) over 24 weeks, adjusted for covariates. Reactogenicity and treatment-emergent adverse events (TEAEs) were recorded. Randomized cohorts (N = 909; protein-based, n = 452; mRNA, n = 457) were largely well-balanced with some differences in baseline covariates versus the comparator group (n = 279), mostly age-related. The mITT population had 142 RAT-confirmed symptomatic SARS-CoV-2 cases with an adjusted VE of 43.6% (95% CI, 18.3-61.0); rVE (protein-based vs mRNA) was -26.7% (90% CI, -78.6% to 10.1%) and did not reach statistical significance. Safety and reactogenicity were comparable to previously reported findings, with no serious study vaccine-related TEAEs, myocarditis/pericarditis, hospitalization, or death. This is one of the earliest real-world trials evaluating the VE of the 2023-2024 COVID-19 vaccines (XBB.1.5). These results suggest that both protein-based and mRNA vaccines are well-tolerated and significantly reduce the risk of symptomatic SARS-CoV-2 infections.
Some drinking water contaminants, including disinfection byproducts, are known or suspected carcinogens with endocrine-disrupting properties. Few epidemiologic studies have evaluated associations with uterine cancer. To investigate prospective associations between multiple regulated contaminants in drinking water and the risk of uterine cancer. The California Teachers Study is a prospective cohort of female California educators. Participants who were cancer-free and had not undergone hysterectomy at enrollment (1995-1996) were followed up through December 31, 2020. Data were analyzed from November 2024 to October 2025. The 15-year mean concentrations (1990-2005) of individual and total trihalomethanes (THMs) and haloacetic acids (HAAs), nitrate, arsenic, and uranium were calculated. The mixture effects of individual THMs, arsenic, uranium, and nitrate were also evaluated using quantile-based g-computation. Associations with incident uterine cancer overall, endometrioid tumors, and nonendometrioid tumors were analyzed categorically by tertile and continuously per log2 increase in water contaminant exposures, using Cox models adjusted for age, body mass index, and smoking status. This study included 53 100 women (median [IQR] age, 50 [43-60] years) with enrollment addresses linked to a community water supply among women with residential duration at enrollment of 10 years or more. Higher levels of total THMs were associated with a higher risk of uterine cancer (hazard ratio [HR], 1.18 [95% CI, 1.02-1.38]; P for trend = .06) and endometrioid tumors specifically (HR, 1.23 [95% CI, 1.05-1.46]; P for trend = .01). Positive associations were found for the individual THM chloroform. Higher levels of the sum of 5 HAAs were associated with nonendometrioid tumors (HR, 1.86 [95% CI, 1.06-3.25]; P for trend = .01), with similar associations for the HAA monochloroacetic acid. No associations were observed with nitrate, arsenic, or uranium levels. Associations per IQR increase in the drinking water contaminant mixture composed of individual THMs, nitrate, arsenic, and uranium were 1.21 (95% CI, 0.96-1.53) and 1.34 (95% CI, 1.04-1.74) for uterine and endometrioid histotypes, respectively. The THMs chloroform and dibromochloromethane were the major contributors. In this cohort study of female California educators, associations between drinking water THMs and uterine cancer overall and with endometrioid tumors specifically were consistent with findings from the only prior study, conducted in the midwestern US. Further investigation of drinking water contaminants as modifiable risk factors for this common gynecologic cancer is warranted.
To assess the work-related quality of life (WRQoL) of anesthesiologists and various health issues that may have an impact on it. We conducted a cross-sectional, anonymous electronic survey of active American Society of Anesthesiologists (ASA) members to evaluate sex-specific health conditions and WRQoL. The WRQoL included validated domains of job satisfaction, stress at work, home-work interface, control at work, and working conditions, along with demographic and professional characteristics. Descriptive statistics and multivariable analyses were used to identify factors independently associated with lower WRQoL scores. The survey was distributed to approximately 37,000 ASA members from September 2024 to December 2024, yielding 2292 responses. About 45.9% of respondents were women, slightly overrepresenting female anesthesiologists compared with the ASA population. Occupational and psychosocial exposures were common: 78.8% reported lifetime exposure to occupational hazards, 49.7% to harassment, and 74.6% to burnout, all of which significantly correlated with lower WRQoL (P<.001). Multivariable analysis identified occupational hazards, harassment, and burnout as independent predictors of lower WRQoL. Female anesthesiologists had higher odds of burnout and occupational hazard exposure impacting their quality of life, whereas older physicians reported lower burnout risk. Commonly endorsed workplace improvements included consistent schedules, reduced call burden, and flexible leave policies. This national survey represents the first large-scale assessment of WRQoL among US anesthesiologists. Findings highlight the multidimensional nature of professional well-being and underscore the importance of organizational culture, workload management, and targeted strategies to support high-risk subgroups. Addressing these factors may improve workforce sustainability.
Loss of muscle mass and quality (myopenia and myosteatosis) are hallmarks of aging and predictors of disability, yet their relationship with biological aging in younger adults is unclear. This prospective cohort study included 165,015 adults (mean age 39.9) who underwent low-dose chest computed tomography (CT) between 2010 and 2020. A longitudinal subset of 61,669 participants had repeated scans (median follow-up 4.1 years). We adopted blood-based Phenotypic Age acceleration (PhenoAgeAccel) and chest radiograph-based biological age acceleration (CXR-AgeAccel). Myopenia and myosteatosis were defined as muscle area and density values more than two standard deviations below young sex-specific reference means. Multivariable multinomial logistic and Cox proportional hazard models estimated associations between biological age acceleration and prevalent or incident muscle abnormalities, adjusting for sociodemographic, lifestyle, and clinical factors. PhenoAgeAccel was associated with higher odds of myopenia (OR 1.16, 95% CI 1.08-1.25), myosteatosis (OR 1.24, 95% CI 1.18-1.29), and combined myopenia-myosteatosis (OR 1.51, 95% CI 1.41-1.63). In longitudinal analyses, PhenoAgeAccel was associated with increased risk of incident myopenia (HR 1.21, 95% CI 1.08-1.35), myosteatosis (HR 1.18, 95% CI 1.09-1.28), and the combined myopenia-myosteatosis (HR 1.29, 95% CI 1.08-1.55). Associations were consistent, though attenuated, with CXR-AgeAccel (OR 1.34, 95% CI 1.20-1.50; HR 1.18, 95% CI 0.96-1.45). Associations persisted among participants < 40 years. Accelerated biological aging measured from routine blood and imaging data was associated with early deterioration in muscle mass and quality. Biological age may represent a practical marker for identifying individuals at risk of early musculoskeletal decline.
Sarcomas show heterogeneous responses to immune-checkpoint blockade (ICB), and cancer-associated fibroblasts (CAFs) are considered to shape the tumor immune microenvironment, yet CAF programs that predict ICB outcomes in sarcoma remain unclear. We investigated the interaction between different cell types in the sarcoma tumor microenvironment and their effects on immune-checkpoint blockade response, with a focus on identifying signature genes and molecular mechanisms that distinguish tumor-promoting from tumor-suppressive CAFs at the single-cell level. We analyzed single-cell data from two different sarcoma cohorts, transcriptome profiles of 206 sarcoma patients recruited from The Cancer Genome Atlas, and predicted immune-checkpoint blockade (ICB) response data inferred using the TIDE algorithm from 64 TCGA sarcoma patients. We found 134 stem-like CAF-related signature genes in the recurrent group and eight signature genes in the metastasis group, defining three CAF subtypes (myofibroblastic CAF, antigen-presenting CAF, and inflammatory CAF). SIG134 and SIG8 were associated with TIDE-inferred ICB response in subtype-specific analyses: SIG134 in STLMS and ULMS, and SIG8 in MFS, STLMS, and ULMS. In addition, the MDK-NCL ligand-receptor signal transduction pathway was linked to the infCAF subtype and myoCAFs in metastatic sarcoma. Furthermore, SIG4 (MDK, SDC2, LRP1, and NCL) was highly expressed in inflammatory CAFs. Single-cell-derived CAF signatures may reflect sarcoma subtype-specific stromal programs associated with predicted ICB response and clinical outcome. SIG4 is proposed as a candidate prognostic signature that warrants further validation.
Prenatal air pollution exposure has been associated with impaired fetal growth. However, the underlying biological mechanisms, potentially involving the placenta, remain poorly understood. This study aimed to investigate the effects of maternal air pollution exposure on placental biomarkers of oxidative stress and cellular ageing, and to determine whether these biomarkers contribute to the association between air pollution exposure and birth weight. The study included 499 participants from the Barcelona Life Study Cohort (BiSC), recruited between October 2018 and April 2021. Maternal exposure to nitrogen dioxide (NO2), black carbon, and particulate matter ≤2.5 μm (PM2.5) during pregnancy was estimated using hybrid Land Use Regression (LUR)-dispersion models. Placental relative mitochondrial DNA content (mtDNAcn) and telomere length (TL) were measured by qPCR, and associations between exposure and placental biomarkers were estimated using linear mixed-effects regression models adjusted for covariates. Increasing levels of NO2 and PM2.5 during the 1st and 3rd trimesters and across the entire pregnancy, as well as black carbon during the 3rd trimester, were significantly associated with an increase in placental mtDNAcn. No significant associations were observed between prenatal air pollution exposure and placental TL, nor between either placental biomarker and birth weight. In conclusion, prenatal air pollution exposure was associated with differences in placental mtDNAcn but not TL, and neither biomarker was significantly associated with birth weight.