The pervasive accumulation of micro(nano)plastics (MNPs) in the environment establishes them as persistent contaminants, posing a significant threat to ecosystem integrity and human health. This review synthesizes the environmental journey of MNPs by framing them as dynamic colloidal particles and mechanistically tracing their pathway from source to biological uptake. We discuss fundamental interfacial processes, including DLVO and non-DLVO interactions, straining, and air-water interface capture, governing MNP mobility and retention in porous media. These processes control MNP dispersal and potential to contaminate groundwater and agricultural systems. The interplay of colloidal properties (size, shape, surface chemistry) with environmental parameters is examined to explain exposure routes. We also detail how this colloidal behavior dictates bioavailability, facilitating MNP uptake in plants and soil fauna and amplifying their role as vectors for co-contaminants and antibiotic resistance genes. Human biomonitoring studies reveal MNPs in blood, stool, placenta, and bronchoalveolar lavage fluid. Systematic review evidence indicates associations with cardiovascular inflammation, endothelial dysfunction, and fibrosis; in vitro studies demonstrate PS MP-induced reductions in human sperm motility, vitality, and fertility-related gene expression; and cross-sectional studies link higher fecal MNP concentrations to gut microbiota dysbiosis, including increased abundance of harmful bacteria and decreased beneficial taxa. However, causation remains unestablished due to methodological heterogeneity and the predominance of cross-sectional designs. By integrating colloid science with ecotoxicology and exposure science, this review bridges the gap between MNP physical transport and adverse health outcomes, provides a framework for risk assessment, and highlights urgent research priorities, including standardized methods, longitudinal studies, and human-relevant models.
The accumulation of antibiotic fermentation residue (AFR) and pharmaceutical waste salt (WS) poses a severe disposal challenge. Herein, we report a WS-assisted co-pyrolysis strategy is proposed to convert these hazardous waste streams into an active material for hexavalent chromium (Cr(VI)) reduction. During pretreatment, the intrinsic osmotic stress of WS disrupts AFR microbial cells in AFR, thereby promoting deep dehydration. The subsequent thermal process effectively degrades residual antibiotics and antibiotic resistance genes. During co-pyrolysis, the inherent NaCl in WS acts as a mineral-phase regulator. The salt matrix promotes pore development in the carbon matrix, forming a hierarchical pore architecture. Concurrently, the salt matrix converts calcium-rich components into Ca5(PO4)3OH. These Ca5(PO4)3OH domains enrich CrO42- near Fe-containing redox sites, where Fe-mediated electron transfer drives the aqueous reduction of Cr(VI) to Cr(III). The synthesized composite achieves more than 90% reduction of low-concentration Cr(VI). Economic evaluation confirms the financial feasibility of this integrated protocol when avoided hazardous-waste disposal costs are considered. This integrated upcycling strategy mitigates pharmaceutical solid waste while producing functional biochar for environmental remediation.
Air pollution represents a critical public health crisis in Bangladesh, driven by rapid industrialization, urbanization, and widespread emissions from brick kilns, traffic, and biomass burning. Elevated levels of fine particulate matter and toxic gases across both urban and rural regions contributes to significant reductions in life expectancy and escalating respiratory disease burdens. Therefore, the present review aims to examine the role of fine/ultrafine particulate matter and hazardous gases in respiratory health outcomes among the Bangladeshi population to synthesize evidence that can inform public health policy. We included 42 studies to obtain data related to the fine/ultrafine particulate matter and hazardous gases and their impact on respiratory health in Bangladesh from scientific databases including PubMed, Google Scholar, Scopus, Directory of Open Access Journals, Web of Science, EMBASE, and the Cochrane Library between 2013 and 2025 (last 12 years). Findings indicated that PM2.5 concentrations in major cities such as Dhaka, Chattogram, and Khulna exceed WHO guidelines by 8 to 18 times, with consistent hotspots linked to industrial zones, brick kilns, transportation, and seasonal biomass burning. These pollutants are strongly associated with increased prevalence of asthma, chronic obstructive pulmonary disease, bronchitis, acute respiratory infections, and hospital admissions, particularly among children, the elderly, and occupational groups. The discussion underscores severe monitoring gaps in peri-urban and rural areas, where exposure remains under-characterized despite comparable pollution levels. The findings of the present review indicates that the urgent regulatory enforcement, enhanced air quality monitoring, and targeted public health interventions are essential to mitigate respiratory health risks and reduce the nationwide burden of air pollution in Bangladesh. Furthermore, comprehensive geological and environmental monitoring studies are required across all districts to fully characterize exposure and guide effective public health interventions.
Understanding the longer-term health impacts of SARS-CoV-2 infection is essential for informing public health policy. While earlier studies suggested increased diabetes risk after infection, evidence for the Omicron period and the modifying effect of vaccination remains limited and inconsistent. A matched cohort study was conducted using a large-scale linked asset covering over 90% of the Australian population, integrating COVID-19 notifications with demographic information and administrative health records. Individuals aged ≥16 years diagnosed with COVID-19 between 15 December 2021 and 31 December 2022 were matched 1:1 to those without COVID-19 by age, sex, and COVID-19 vaccine recency. Cox-models were used to estimate the association between COVID-19 and initiation of diabetes treatment, adjusting for relevant demographic and health-related factors. Negative control outcomes were assessed. Among 5,736,501 matched pairs followed for a median of 200 days, 45,816 initiated diabetes treatment. Compared to those without COVID-19, individuals with COVID-19 had a 14% higher risk of subsequently initiating diabetes treatment (aHR 1.14 [95%CI 1.12; 1.17]), with the highest risk observed among those hospitalised due to COVID-19 (aHR 2.52 [95%CI 2.23; 2.84]). The risk was also higher for individuals with ≤2 COVID-19 vaccine doses compared to those boosted within the last 90 days (aHR of 1.22 [95%CI 1.18; 1.25] vs 1.08 [95%CI 1.04; 1.12]). We found an increased risk of diabetes following SARS-CoV-2 infection during the Omicron dominant period and a protective effect of COVID-19 vaccination. However, the findings should be interpreted with caution considering the potential for unmeasured confounding.
Naturally seleniferous paddy fields are threatened by geogenic cadmium (Cd), yet certain Cd-polluted paddy fields continue to yield selenium (Se)-rich rice grains being not polluted with Cd. Identifying the reasons for this situation will provide a feasible entry point for source-level Cd risk control under the high Se-Cd geogenic background. This study conducted a field sampling in six naturally seleniferous regions of China. Due to Se-Cd geogenic co-occurrence in soil, paddy fields exhibited 100% Se enrichment in soil, but 83% were simultaneously Cd-polluted. Among the rice grains, not only 61% of them were Se-enriched, but also 53% did not exhibit Cd pollution. This was related to soil Cd availability being significantly suppressed by high soil inorganic sulfur (I-S) concentrations via two mechanisms: primarily via enhancing Cd fixation by soil Fe oxides, whereas direct Cd precipitation played a minor and unstable role. Thus, when soil I-S concentrations were at a high level (above 60-70 mg/kg), compared to low soil I-S level condition, the daily Se supply from rice grains increased significantly, reaching the recommended range, while the carcinogenic risk and hazard index were significantly reduced by 50%, reaching the same safety level as commercial rice. These findings provided suggestions for the safe utilization of naturally Se-rich paddy fields under a geogenic Cd pollution background and also offered further research directions for risk control of geogenic Cd pollution.
Patients receiving voriconazole often have insufficient hepatic reserve, making it difficult to stratify the risk of severe hepatotoxicity using therapeutic drug monitoring (TDM) alone. This multicenter study aimed to evaluate whether the albumin-bilirubin (ALBI) score can stratify the risk of hepatotoxicity in patients undergoing TDM. This multicenter, retrospective cohort study included 608 patients. The primary outcome was voriconazole-induced hepatotoxicity. The cumulative risk of hepatotoxicity was evaluated using a Gray's test between ALBI score ≥-2.0 or <-2.0, and a landmark approach was applied as a sensitivity analysis. The Fine-Gray test was performed, and independent risk factors were used for decision tree analysis. The cumulative risk of hepatotoxicity was significantly higher in the ALBI score ≥-2.0 group than that in the ALBI score <-2.0 group (p = 0.006), and this trend was confirmed in a sensitivity analysis. The Fine-Gray model revealed that the ALBI score ≥-2.0 (subdistribution hazard ratio, 1.951; 95% confidence interval, 1.135-3.355; p = 0.016) was an independent risk factor. In the decision tree model, the development of hepatotoxicity was lowest (6.5%, 12/186) in patients with ALBI score <-2.0 and voriconazole trough concentration (Cmin) <4.0 μg/mL, whereas that in patients with ALBI score ≥-2.0 and Cmin ≥4.0 μg/mL was highest at 18% (27/153), with an accuracy of 88.3%. The present study demonstrated that combining an ALBI score ≥-2.0 with the Cmin of voriconazole allows risk stratification for voriconazole-induced hepatotoxicity with high accuracy, and this model may provide a practical risk stratification tool.
Evidence on the clinical utility of baseline human epididymis protein 4 levels and their kinetics in recurrent ovarian cancer remains limited. This study evaluated longitudinal human epididymis protein 4 dynamics in real-world patients treated with platinum-based chemotherapy, aiming to determine the prognostic significance of human epididymis protein 4 kinetic parameters compared with CA125 response and established prognostic factors for progression-free and overall survival. This retrospective analysis included 220 patients with recurrent epithelial ovarian cancer treated with second-line platinum-based chemotherapy between 2000 and 2020. Four mathematical models were tested to describe human epididymis protein 4 kinetics, with model selection based on goodness of fit, visual predictive checks, and prognostic performance. The prognostic value of the most informative human epididymis protein 4 kinetic parameter (the modeled residual human epididymis protein 4 level), was assessed in univariable and multi-variable analyses. Among the 93 assessable patients, no clear associations were observed between baseline human epididymis protein 4 levels and disease characteristics. Longitudinal human epididymis protein 4 kinetics differed from those of CA125 and showed an initial decline followed by a plateau at approximately 40 days. The best-fitting model was a mono-exponential decline incorporating the modeled residual human epididymis protein 4 parameter, which was subsequently evaluated as a prognostic factor. Baseline human epididymis protein 4 levels lacked prognostic significance for progression-free or overall survival. In contrast, a higher modeled residual human epididymis protein 4 level was significantly associated with shorter progression-free and overall survival in univariable analyses (residual human epididymis protein 4 ≥median vs <median; median progression-free survival: 7.2 vs 12.6 months, p =.002; median overall survival: 16.5 vs 34.9 months; p =.001) and in multi-variable models (overall survival: hazard ratio 2.65; 95% confidence interval 1.23 to 5.71, p =.012) alongside CA125 response. In this study, we identified residual HE4 levels in patients treated with second-line platinum-based chemotherapy as an independent dynamic marker of overall survival, with higher levels indicating poorer outcomes and potential chemoresistance.
Postpartum hypertension (PPHTN) drives severe maternal morbidity in women with hypertensive disorders of pregnancy (HDP). The uncharacterized effect of labor epidural analgesia (LEA) on postpartum blood pressure trajectories may explain its protective association with severe maternal morbidity. We aim to investigate whether LEA exposure is associated with a delayed onset of PPHTN during hospitalization in women with HDP. We conducted a retrospective cohort study of women with HDP from 2018 to 2023. Participants were categorized based on LEA duration, with non-recipients assigned a duration of zero. An optimal LEA duration cut-off was identified using the maximally selected log-rank statistic to facilitate group comparison. The primary outcome was in-hospital PPHTN, defined as ≥2 postpartum blood pressure measurement meeting standard hypertensive criteria. Time-to-event analyses were performed using Kaplan-Meier estimates and the Log rank test. Multivariable Cox regression with DAG-guided covariate selection was used to adjust for potential confounders. Secondary outcomes included postpartum antihypertensive treatment patterns, specifically combination therapy use and daily labetalol dose. Three prespecified sensitivity analyses assessed the robustness of results. Of 1,069 women included in the final analysis, 823 (77.0%) received LEA. Longer LEA duration was significantly associated with a reduced hazard of PPHTN (HR = 0.96 per hour; 95% CI: 0.93-0.98; P = 0.002). The optimal duration cut-off for discriminating PPHTN risk was 3.5 hours. Women with LEA duration >3.5 hours had lower in-hospital PPHTN incidence, a longer median time to onset, and reduced postpartum antihypertensive requirements, including lower rates of combination therapy and labetalol dosing, while nifedipine use was similar between groups. After multivariable adjustment, LEA >3.5 hours was independently associated with a reduced risk of PPHTN (HR = 0.72; 95% CI: 0.58-0.88; P = 0.001). Sensitivity analyses yielded consistent results in women not requiring postpartum antihypertensive therapy and across gestational hypertension and pre-eclampsia subgroups. In the cause-specific Cox model, LEA >3.5 hours was associated with a lower hazard of PPHTN, consistent with the primary model. Among women receiving postpartum antihypertensives, LEA duration was not significantly associated with PPHTN risk but was linked to lower labetalol doses. Longer LEA duration was associated with a reduced risk of postpartum hypertension and lower antihypertensive use in women with HDP. These observational findings indicate that prolonged analgesia may be associated with improved postpartum hemodynamic stability, suggesting consideration for its continuation in eligible patients; prospective studies are needed to confirm causality and guide clinical practice.
There is little evidence on health and care service utilisation among those identified as needing palliative care. We aimed to quantify the uptake of services across health and care systems in the last year of life before non-sudden death, by GP palliative care registration. Multi-state models were used to evaluate pathways of service utilisation in the last year of life using population-scale linked administrative and health data for Welsh residents who died of non-sudden causes between 2014 and 2023. Cox regression models, adjusted for age, sex, rurality, area-level deprivation and GP palliative care registration were used to estimate hazards between settings, including emergency, elective and other hospital admissions, homes, care homes (with and without nursing), and death. In total, 1.8 million transitions were modelled for 267,199 individuals. Of those, 27.7% of individuals were registered for palliative care. Men, most-deprived communities, Asian ethnic groups and those living alone were under-represented on the GP palliative care register. 90.3% of emergency admissions were from home. Palliative care registered individuals had a 23% (HR 1.23 [95% CI 1.22-1.25]) increased rate of emergency admissions from home compared with unregistered. Emergency admissions from care homes with and without nursing were 17% (HR 0.83 [95% CI 0.80-0.86]) and 18% (HR 0.82 [95% CI 0.79-0.85]) lower for palliative care registered compared with unregistered residents. Health service utilisation varied significantly by GP palliative care status. Targeted identification of individuals eligible for palliative care, and additional support at home could improve whole-system outcomes.
The timing of migratory departure represents a critical behavioural decision for long-distance migrants, influencing arrival condition at breeding grounds and reproductive success. Despite growing recognition of wind as a proximate departure cue, the relative importance of multiple meteorological variables, and whether wind selectivity changes over the departure window, remain poorly quantified at the individual level for most species. We examined meteorological drivers of individual spring migration departure in Dark-bellied Brent Geese (Branta bernicla bernicla) from the German Wadden Sea, the species' principal staging area along the East Atlantic Flyway. GPS tracking data from 43 individuals contributing 47 departure events across seven seasons (2015-2024) were combined with hourly meteorological data extracted at each bird's staging location and analysed using Cox proportional hazards models across 18,036 hourly risk intervals. The best-supported model combined wind assistance at 100 m altitude-consistent with the median sustained flight altitude of 69 m-and atmospheric pressure, with departure probability increasing by 20% per additional m/s of tailwind (HR = 1.20, 95% CI 1.12-1.29) and 10% per additional hPa (HR = 1.10, 95% CI 1.06-1.15). Relative humidity was a competitive secondary predictor, with higher humidity reducing departure probability (HR = 0.959 per %, 95% CI 0.932-0.986). Time-varying analyses revealed that wind selectivity was strongest early in the season (HR ≈ 1.69) and declined to near unity by early June (HR ≈ 0.98), reflecting increasing migratory urgency. Atmospheric pressure showed no time-varying effect, acting as a stable synoptic quality filter rather than an urgency-modulated cue. These findings demonstrate that Brent Geese fine-tune spring migration onset by integrating local wind conditions and synoptic pressure to exploit transient atmospheric opportunities, highlighting the potential vulnerability of this migration system to projected shifts in North Atlantic wind regimes under ongoing climate change.
Proteinuria is a key marker in IgA nephropathy (IgAN). However, long-term thresholds and significance of early changes in proteinuria remains unclear in US populations. Retrospective cohort study of 745 adult patients with IgA nephropathy from the TriNetX US network (2015-2023). The baseline Time-average proteinuria (TAP) were calculated and categorized as <500, 500-1,000, 1,000-2,000, and >2,000 mg/g. Starting 1 year post diagnosis, the composite kidney failure outcome (sustained eGFR ≤15 mL/min/1.73 m2, sustained >40% eGFR decline, initiation of dialysis, or all-cause mortality) was evaluated. Associations with baseline TAP and changes in TAP at first-year were evaluated using Kaplan-Meier analysis and multivariable Cox proportional hazard models. Out of 745 patients (mean age 43.5 [±16] years, 58% male, 68% White), a composite outcome occurred in 175 (23.5%) of patients over a median follow-up of 5.4 years (IQR: 3.2-7.2). Survival analysis showed 13.8% of patients with TAP <500 mg/g remained at risk of kidney failure by 8 years. Compared to TAP <500 mg/g, adjusted hazard ratios were significantly higher for TAP 1,000-2,000 mg/g (aHR 2.84; 95% CI: 1.66-4.85) and TAP >2,000 mg/g (aHR 5.68; 95% CI: 3.45-9.36); whereas TAP 500-1,000 mg/g was not significant after adjustment (aHR 1.69; 95% CI: 0.96-2.97). Higher baseline eGFR and white race were associated with better outcomes. Among 389 patients with follow up TAP data at the first-year observation period, each one-category reduction in TAP was associated with ∼40% lower risk of composite outcome, and ≥30% and ≥50% proteinuria reductions were associated with 62% and 66% lower risk of composite outcome, respectively. In US adults with IgA nephropathy, baseline proteinuria exceeding 1,000 mg/g identifies a high-risk group. Early proteinuria reductions - either by category (TAP) or percentage (≥30-50%) - strongly predict improved outcomes. This study supports use of proteinuria as a modifiable, treat-to-target surrogate for prognosis and treatment monitoring.
Patients with atherosclerotic cardiovascular disease (ASCVD) and systemic inflammation (SI) or chronic kidney disease (CKD) have poorer outcomes than those without SI or CKD. This study evaluated the impact of both SI and CKD on major adverse cardiovascular events (MACE), healthcare costs, and healthcare resource utilization (HCRU) in patients with ASCVD. This retrospective cohort study examined the association between SI and revised MACE, healthcare costs, and HCRU among adult patients with ASCVD from the Komodo Healthcare Map®. CKD stage 3-4 was determined from claims or laboratory data. SI was defined as ≥ 1 high-sensitivity C-reactive protein (hsCRP) value of 2-10 mg/l (without SI, all hsCRP values < 2 mg/l). The primary endpoint, revised MACE, was defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and all-cause mortality. Of 74,884 patients with ASCVD and ≥ 1 eligible hsCRP value, 8.5% had CKD stage 3-4, and 49.2% had SI. Patients with SI had a higher comorbidity index and a greater prevalence of obesity, hypertension, and type 2 diabetes than those without SI. Compared with patients with ASCVD without CKD or SI, SI alone was associated with a 24% higher risk (hazard ratio [HR] 1.24; 95% CI 1.15-1.34), CKD stage 3-4 with a 33% higher risk (HR 1.33; 95% CI 1.16-1.51), and both SI and CKD stage 3-4 with a 62% higher risk (HR 1.62; 95% CI 1.45-1.82) of revised MACE. In patients with ASCVD without CKD, total healthcare costs were $18,002 PPPY with SI vs. $15,070 PPPY without SI. In patients with ASCVD with CKD stage 3-4, costs were $26,089 PPPY with SI vs. $20,753 PPPY without SI. Across groups, SI was associated with higher HCRU. SI is associated with increased risk of MACE and higher total healthcare costs and HCRU in patients with ASCVD with or without CKD. Inflammation usually happens when the body needs to heal an injury or infection. Inflammation that keeps happening in your body over a long time is called sustained systemic inflammation. Systemic inflammation can cause harm instead of healing. We looked at the effect of systemic inflammation in almost 75,000 people with atherosclerotic cardiovascular disease (ASCVD). Some of these people also had chronic kidney disease (CKD). We found that people with ASCVD and systemic inflammation were more likely to have a heart attack, stroke, or die sooner. These people who had systemic inflammation also needed to visit doctors and hospitals more often and had higher doctor and hospital costs. Patients who also had CKD had an even higher risk of a heart attack, stroke, or dying sooner, as well as higher healthcare costs than patients who did not have CKD, and the additional presence of systemic inflammation increased that risk further. These results suggest that we should aim to develop and test treatments to lower inflammation in patients with ASCVD and CKD, an often understudied population, to determine if these therapies improve the patients’ health.
Prospective cohort studies analyzing the effect of plant versus animal protein intake on mortality in relatively young individuals from Mediterranean populations are limited. Moreover, a limited number of studies have performed repeated measurements of protein intake. We evaluated the relationship between plant versus animal protein intake (at baseline and at the ten-year follow-up) and mortality in the "Seguimiento Universidad de Navarra" (SUN) project. The SUN project is a prospective, multi-purpose, dynamic cohort study of Spanish university graduates. Plant and animal protein intake were assessed using a semi-quantitative food frequency questionnaire (FFQ) previously validated in Spain. Participants were divided into quartiles based on their intake of protein. Cox regression models were used, with the first quartile serving as the reference category. A total of 17,989 subjects (10,961 women and 7028 men) were included in the analysis. During 251.363 person-years of follow-up (median follow-up time: 12 years), 460 deaths were identified. The mean age at baseline was 38 years with a standard deviation of 12 years. Participants in the highest quartile of plant protein intake had a 35% lower risk of all-cause mortality compared to those in the lowest quartile after adjusting for potential confounders [hazard ratio (HR): 0.65 (95% CI: 0.45-0.93), p for trend = 0.009]. No significant association was found between animal protein intake and mortality [HR: 0.94 (95% CI: 0.70-1.26); p for trend = 0.555] nor between plant protein intake and cardiovascular or cancer mortality. Plant protein intake was inversely associated with all-cause mortality in a Mediterranean population. Animal protein intake was not associated with total mortality.
Alcohol consumption is a well-established risk factor for HCC, though its impact may vary across different age groups. Accordingly, we aimed to investigate the association between alcohol consumption and the risk of HCC across different age groups. We included 4,234,445 participants aged ≥20 years who underwent a national health examination in 2009. Cox proportional hazards regression models were used to investigate the association of alcohol consumption with the risk of HCC across age groups. Among 3,869,084 participants, 20,475 individuals were newly diagnosed with HCC during a median follow-up of 11.3 years. When stratified by 20-year age groups, increasing alcohol consumption was significantly associated with an increased risk of HCC in the ≥60 age group compared to no alcohol consumption (P for trend <0.001). Heavy alcohol consumption was significantly associated with an increased risk of HCC in the 40-59 and ≥60 age groups, with larger effect estimates observed at older ages (aHR, 1.11; 95% CI, 1.05-1.18 for the 40-59 age group; aHR, 1.47; 95% CI, 1.38-1.57 for the ≥60 age group). Our findings indicate that the association between alcohol consumption and the risk of HCC differs across age groups, with the most pronounced risk increase observed among older individuals. These findings may inform age-tailored HCC risk assessment and prevention strategies, particularly by identifying middle-aged and older heavy drinkers who may benefit from more careful risk stratification. Alcohol consumption is a well-established risk factor for hepatocellular carcinoma (HCC), but its age-specific impact remains insufficiently defined. In this nationwide cohort of 3,869,084 adults, heavy alcohol consumption was associated with increased HCC risk in the 40-59 and ≥60 age groups, with the strongest association and highest 10-year cumulative risk observed among heavy drinkers aged ≥60 years. These findings may help refine age-tailored HCC risk assessment by supporting the consideration of heavy alcohol consumption alongside established liver-related risk factors, particularly in middle-aged and older adults.
Aging out of the care system strongly predicts later homelessness, yet little is known about how levels of contact with children's social care influence youth homelessness, or whether risk peaks at particular ages. We conducted a population-wide, retrospective cohort study of individuals born January 1995-December 1997, alive and resident in Northern Ireland during follow-up (July 2011-October 2022; aged 16-28 years). Homelessness data from the Northern Ireland Housing Executive were linked to social services, administrative, and health records. Cox proportional hazards models estimated age-specific hazard ratios (HRs) for homelessness risk from age 16, comparing young people with prior social care contact ("child in need" or "child in care") to those without, adjusting for sex, area deprivation, settlement band, and mental ill health. The cohort included 90,260 individuals contributing 869,524 person-years. More than half (54.6%) of those presenting as homeless had a history of children's social care contact. Care experienced individuals faced the highest risk at age 18 (HRadj = 29.11, 95% CI 25.33-33.45), while risk among those with a child in need history peaked at age 17 (HRadj = 8.10, 95% CI 7.13-9.21), relative to peers with no social care history. Young people with a history of social care contact are markedly overrepresented among the homeless population. The transition to adulthood (ages 17-18-years) is a critical period of vulnerability, underscoring the need for targeted interventions and enhanced support so social care experienced young people can enter adulthood without homelessness.
Cancer remains the second most prevalent cause of death in the United States, claiming 605,213 lives in 2021, surpassing COVID-19 deaths. The cancer mortality rate continued to decline between 2019 and 2020, dropping by 1.5%, marking a significant 33% decrease since 1991. This ongoing improvement primarily mirrors advances in treatment, allowing patients to achieve clinical remission and recovery. Now, a cancer patient is simultaneously exposed to the risk of primary cancer as well as other risks, such as other cancer(s) or other diseases, leading to a competing risks scenario. Analysis of survival data under competing risks and the presence of cured patients have been extensively studied individually, but there is limited work in the current literature that models the possibility of cure from one risk in the presence of competing risks. Moreover, such a model should allow for the possibility of cure from the cause-specific risk of the primary cancer; however, the overall survival probability should eventually approach zero, thereby incorporating the prevalent belief of eventual failure with certainty. We propose a novel unified competing risks cure model, based on the cause-specific hazard approach, that satisfies the aforementioned desired properties. The conditions required to establish model identifiability are studied in detail. To find the maximum likelihood estimates of the model parameters, a computationally efficient expectation maximization algorithm is developed. An extensive simulation study is carried out to demonstrate the performance of the proposed model and estimation method under different parameter settings and in the presence of multiple competing risks. Finally, an application is illustrated using breast cancer data from the SEER cancer database.
Staphylococcus epidermidis is a leading pathogen of implant-associated bone and joint infection (BJI) and is frequently resistant to multiple antibiotics. In this study, we aimed to analyse risk factors for multiresistance and the association of multiresistance with treatment outcomes in patients with S. epidermidis implant-associated BJI. We performed a single-center cohort study including patients with implant-associated BJI due to S. epidermidis at the University Hospital Basel, Switzerland, between January 2013 and December 2020. Risk factors for multiresistance and their association with treatment failure as primary outcome were assessed using logistic models and piecewise Cox models, respectively. Of 1,776 patients screened with intraoperative S. epidermidis, 279 were eligible, of which 250 patients (90%) were included with implant-associated BJI: Half had a monomicrobial implant-associated BJI (125/250) and 56% (141/250) presented with multiresistant S. epidermidis. Previous antibiotic treatment exhibited the strongest association with multiresistance in S. epidermidis implant-associated BJI (adjusted odds ratios, 2.13; 95% confidence interval [CI], 1.21-3.81). Overall, 32% of patients (80/250) experienced a treatment failure. Multiresistance was associated with treatment failure occurring more than two weeks after revision surgery (adjusted hazard ratio, 4.29; 95% CI, 1.51-12.19). Our results suggest that previous antibiotic treatments select for multiresistant S epidermidis, which increases the risk of treatment failure in implant-associated BJI. This study emphasizes the need for prudent antibiotic use and calls for new strategies against this still underestimated pathogen.
Climate change is affecting our world, and the impact of rising temperatures on health is not well understood. Prior work found exposure to heat was associated with reduced gestational age, increased prematurity and smaller birth weights. The goal of the Maternal and Pregnancy Health and Elevated Heat (MAGENTA) project is to determine if these patterns exist in a UK population. Utilising healthcare and environmental exposure data held in the Secure Anonymised Information Linkage (SAIL) Databank we developed a cohort of mothers who were pregnant between 2010 and 2023, and the associated daily maximum temperatures experienced during each pregnancy. Modelled Land Surface Temperature accounts for the effects of the built environment. The primary outcome was time to birth. We used a joint longitudinal and time-to-event model, constructed in a Bayesian framework to capture full parameter uncertainty and fit using the Integrated Nested Laplace Approximation (INLA). The longitudinal process modelled temperature experienced during the pregnancy with linear and quadratic terms for time. Time to birth was modelled using a Cox regression model with a spline baseline hazard, and smoothed at second order. Joint modelling is a flexible, powerful set of tools for understanding associations in healthcare research, and approximation methods such as INLA enable analysis in large-scale electronic health record datasets. Work is ongoing to produce fully adjusted models, which will be used in simulation studies in conjunction with climate change projections to explore the impact of future scenarios to inform mitigation and adaptation strategies.
To match disease cohorts with the general population, researchers often exclude individuals with the disease ("healthy controls"). Alternatively, they may include those disease-free at baseline who may develop it later ("general controls"). Few studies have compared these methods. We examined how control selection affects cause-specific hazard ratios (csHR) for post-stroke dementia among stroke survivors and matched controls. Using Ontario's population-based Discharge Abstract Database (2002-2022), we identified adults hospitalized with stroke. Each stroke survivor was hard-matched 1:1 to residents without prior stroke on age, sex, rural residence, neighborhood deprivation, and vascular comorbidities. Matching was conducted separately for healthy and general control groups. Cause-specific hazard models, accounting for death as a competing risk (from the linked Registered Persons Database), estimated associations between stroke and incident dementia. General controls who subsequently experienced stroke were censored at stroke onset. Of 175,980 stroke survivors, 174,787 (99.3%) and 174,817 (99.3%) were successfully matched to healthy and general controls, respectively. At 20 years of follow-up, the cumulative incidence of dementia among stroke survivors was similar across both match types (0.302 vs. 0.302). However, healthy controls had a higher incidence than general controls (0.249 [95% CI: 0.244-0.253] vs. 0.238 [95% CI: 0.234-0.242]). The csHR comparing strokes with healthy controls (1.694 [95% CI: 1.668-1.720]) was significantly lower than that with general controls (1.759 [95% CI: 1.731-1.787]). Using healthy controls may underestimate post-stroke dementia risk. General controls more accurately represent the population at risk and are recommended for matched cohort studies.
Bangladesh's fisheries sector, central to national nutrition, food security, and rural livelihoods, is increasingly threatened by the convergence of zoonotic pathogens, antimicrobial resistance (AMR), and environmental degradation. Using a One Health framework, this review synthesizes evidence from 87 peer-reviewed articles, institutional reports, and regional studies to demonstrate how interactions among aquatic ecosystems, farmed and wild fish populations, and human communities drive the emergence and transmission of disease. Zoonotic parasites including trematodes, cestodes, nematodes, and protozoa persist through contaminated water, inadequate market hygiene, and exposure to domestic and wild animals. Aquaculture systems are further burdened by zoonotic bacteria (e.g., Vibrio spp., Aeromonas spp., and Mycobacterium spp.) and microsporidian parasites (e.g., Enterocytozoon spp.), together posing significant occupational and foodborne risks. Emerging fungal pathogens, notably Saprolegnia spp. and Aphanomyces invadans, intensify disease burdens under poor farm management and environmentally stressed conditions. Critical contamination pathways, industrial and agricultural runoff, cross-contamination in fish markets, unregulated chemical use, and weak biosecurity link aquatic pollution with human and animal health outcomes. The introduction of non-native fish species (e.g., tilapia, pangas, carp) and the expanding ornamental fish trade further amplify pathogen risks, facilitating the silent spread of bacterial, parasitic, and fungal agents with zoonotic potential. Climate change, biodiversity loss, and socioeconomic vulnerabilities exacerbate these pressures by destabilizing aquatic ecosystems, reducing resilience, and accelerating AMR dissemination across aquatic, human, and livestock interfaces. By integrating insights from parasitology, microbiology, epidemiology, and environmental science, this review underscores the urgent need for coordinated surveillance, diagnostic capacity, regulatory enforcement, and risk communication strategies. Embedding One Health and climate-smart approaches into fisheries governance is essential to mitigate zoonotic hazards, safeguard food safety, and ensure the long-term sustainability of Bangladesh's aquaculture sector under accelerating environmental change.