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Background: Lymph node metastasis is the major cause of increased recurrence and death in patients with papillary thyroid carcinoma (PTC). We evaluate the clinicopathologic factors affecting excellent response (ER) in patients with PTC with lymph node metastasis following operation and 131I ablation therapy. Methods: A total of 423 patients with PTC with lymph node metastasis who underwent thyroidectomy and postoperative 131I ablation therapy were enrolled. The relationship between clinicopathological factors affecting ER achievement was analyzed. Results: Multivariate analysis showed that the foci diameter (≤1 cm), unifocal, combination with Hashimoto's thyroiditis (HT), lymph node metastases rate (LR) (≤40%), no postoperative lymph node metastasis, low preablative stimulated thyroglobulin (ps-Tg) level (≤3.87 ng/mL), and the time of 131I ablation therapy (one time) were positively correlated with the ER achievement [odds ratio (OR): 1.744, 3.114, 3.920, 4.018, 2.074, 9.767, and 49.491, respectively; all p < 0.05]. The receiver operating characteristic (ROC) curves showed that the cutoff values of ps-Tg and LR were 4.625 ng/mL and 50.50%, respectively. The AUC of ROC of ps-Tg and LR for predicting ER achievement was 0.821 and 0.746, respectively. The Tg and the cumulative risk of non-ER elevated with the increase of LR, especially for the high-level ps-Tg (>4.625 ng/mL) group. Conclusion: The foci diameter and number, combination with HT, LR, and ps-Tg level are independent factors for ER. Ps-Tg level and LR are valid predictive factors for the efficacy of 131I therapy in patients with PTC. The predictive value of the cumulative risk of non-ER can be improved by the combination of ps-Tg and LR.
Subject(s)
Iodine Radioisotopes , Lymphatic Metastasis , Thyroid Cancer, Papillary , Thyroid Neoplasms , Thyroidectomy , Humans , Female , Male , Iodine Radioisotopes/therapeutic use , Thyroid Cancer, Papillary/pathology , Thyroid Cancer, Papillary/surgery , Thyroid Cancer, Papillary/radiotherapy , Thyroid Cancer, Papillary/therapy , Middle Aged , Adult , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Thyroid Neoplasms/radiotherapy , Thyroid Neoplasms/therapy , Treatment Outcome , Retrospective Studies , Aged , Young Adult , Adolescent , Prognosis , Follow-Up StudiesABSTRACT
Protecting populations contending with co-occurring stressors requires a better understanding of how multiple early-life stressors affect the fitness of natural systems. However, the complexity of such research has limited its advancement and prevented us from answering new questions. In human studies, cumulative risk models predict adult health risk based on early adversity exposure. We apply a similar framework in wild yellow-bellied marmots (Marmota flaviventer). We tested cumulative adversity indices (CAIs) across different adversity types and time windows. All CAIs were associated with decreased pup survival and were well supported. Moderate and acute, but not standardized CAIs were associated with decreased lifespan, supporting the cumulative stress hypothesis and the endurance of early adversity. Multivariate models showed that differences in lifespan were driven by weaning date, precipitation, and maternal loss, but they performed poorly compared with CAI models. We highlight the development, utility, and insights of CAI approaches for ecology and conservation.
Subject(s)
Marmota , Animals , Marmota/physiology , Stress, Physiological , Longevity , Female , Male , Models, BiologicalABSTRACT
BACKGROUND: Lynch syndrome (LS) is the most frequent hereditary tumor syndrome and is associated with an increased risk of colorectal cancer (CRC). While gene-specific and age-specific differences are considered in patient surveillance, gender-specific risks in the development of CRC have been reported in many studies but are not consistently documented. OBJECTIVE: This systematic review aims to investigate gender-specific differences in CRC development among LS patients. MATERIAL AND METHODS: A systematic literature search following PRISMA 2020 guidelines was conducted in the PubMed, Ovid, The Cochrane Library and Web of Science databases. A total of 688 studies were screened, and 41 met the inclusion criteria. RESULTS: Men have a higher risk of CRC and develop CRC earlier compared to women. CONCLUSION: These findings indicate gender-specific differences in the risk of CRC among LS patients, although they do not currently justify separate surveillance strategies.
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OBJECTIVE: Health-promoting behaviors carry substantial significance for miners' overall health and well-being. This study aimed to examine the association between cumulative risk (CR) and miners' health-promoting behaviors and test the mediating role of health beliefs in this relationship. METHODS: Data were collected from a sequential survey conducted among 712 frontline miners (Mage=41.7 ± 10.1 years) in China. The survey entailed online questionnaire measurements at three distinct time points, each spaced two weeks apart. This study utilized the conceptual model of health-promoting behaviors, the CR model, and structural equation modeling in the analysis of relationships. RESULTS: CR was negatively related to health-promoting behaviors, with a negative acceleration effect. CR was positively associated with perceived threat in a gradient effect, while negatively associated with perceived benefits in a gradient effect. Furthermore, CR was negatively related to self-efficacy, following a negative acceleration effect. Perceived threat, perceived benefits, and self-efficacy emerged as significant mediators in the relationship between CR and health-promoting behaviors. CONCLUSION: This study highlights the critical role of considering both CR and health beliefs in shaping miners' health-promoting behaviors. Understanding these dynamics is pivotal for developing interventions to enhance miners' health and well-being.
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Since the launch of the Chemicals Management Plan (CMP) in 2006, Health Canada has initiated screening-level risk assessments (RAs) of approximately 4300 priority substances under the Canadian Environmental Protection Act, 1999 (CEPA). With the availability of nationally representative human biomonitoring (HBM) data, over 300 of these substances were assessed using HBM-based RA approaches. Qualitative and quantitative HBM-based RA approaches for the regulatory risk assessment of the general population of Canada were developed to increase the efficiency of screening the potential health risk of CMP priority substances. To support HBM-based RAs, several biomonitoring equivalents (BE) were derived to interpret HBM data. For some CMP substances, Health Canada conducted cumulative risk assessments of chemical mixtures using HBM data as measures of exposure. In 2023, CEPA was amended to include the assessment of populations who may be disproportionately impacted (vulnerable populations) and the cumulative effects of multiple chemicals. Going forward, Health Canada is exploring modern approaches in HBM-based RAs, including biomarkers of effect and non-traditional biomarkers (e.g., hair, nails) to address CEPA amendments. This manuscript will discuss Health Canada's progress in HBM-based RAs, and the possible path forward in using HBM data to strengthen human health risk assessments.
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Left-behind children, as a large-scale disadvantaged group, encounter an array of risk factors that impede their academic development because of parental migration. The current study aimed at investigating the roles of left-behind cumulative risk and growth mindset on academic adjustment and exploring whether growth mindset moderated the association between left-behind cumulative risk and academic adjustment in left-behind middle school students. A total of 1184 left-behind middle school students (615 males; 12-16 years) participated in the study. Results indicated that left-behind cumulative risk is negatively associated with academic adjustment in middle school students (ß = -.199, t(1183) = -7.229, p < .001). Besides, growth mindset has a protective effect on left-behind middle school students' academic adjustment (ß = .386, t(1183) = 14.070, p < .001) and a moderating effect on the relationship between left-behind cumulative risk and academic adjustment (ß = .394, t(1182) = 4.057, p < .001, ΔR2 = .012). These findings suggest that family risk factors related to left-behind status affect the academic adjustment of left-behind middle school students in a superposition way, while the positive individual factor of growth mindset could protect the negative impact caused by parental migration.
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The practice of exposing honeybees to pesticides by bee-keepers or via agricultural crops, is one of the ways in which honey becomes contaminated with pesticides. Though honey has many health advantages, however, human exposure to pesticides via consumption of honey has generated public health concerns due to their endocrine-disruptive abilities. Thus, this study evaluated human exposure to endocrine-disrupting pesticides in honey from Nigeria to establish the safety of honey consumed in Nigeria. Honey were analyzed for pesticides using a gas chromatograph combined with an electron capture detector. The concentrations of ∑20 OCPs and ∑14 OPPs in the honey ranged from 0.45-1045 ng/g and 1.13-632 ng/g respectively. The values of both individual and cumulative non-carcinogenic and carcinogenic risks for humans were <1 and 1 × 10-4 respectively suggesting that there are no potential health risks via the honey consumption. The source analysis showed that pesticides in these honey originated from historical and recent/fresh use.
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In this study, the oral bioavailability of Pb, Cd, and As in three types of traditional Chinese medicines (TCMs) and TCM decoctions were investigated through in vitro PBET digestion/MDKC cell model. Furthermore, a novel cumulative risk assessment model associated with co-exposure of heavy metal(loid)s in TCM and TCM decoction based on bioavailability was developed using hazard index (HI) for rapid screening and target organ toxicity dose modification of the HI (TTD) method for precise assessment. The results revealed that the bioavailability of Pb, Cd, and As in three types of TCM and TCM decoction was 5.32-72.49% and 4.98-51.97%, respectively. After rapid screening of the co-exposure health risks of heavy metal(loid)s by the HI method, cumulative risk assessment results acquired by TTD method based on total metal contents in TCMs indicated that potential health risks associated with the co-exposure of Pb, Cd, and As in Pheretima aspergillum (E. Perrier) and Oldenlandia diffusa (Willd.) Roxb were of concern. However, considering both the factors of decoction and bioavailability, TTD-adjusted HI outcomes for TCMs in this study were <1, indicating acceptable health risks. Collectively, our innovation on cumulative risk assessment of TCM and TCM decoction provides a novel strategy with the main purpose of improving population health.
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PURPOSE: We report the chances of 14-year-old males becoming victims of firearm injury or death before age 25 in Philadelphia, Pennsylvania. METHODS: Using life table methods, we followed 4,501 Black males aged 14 years, and a comparison group of 1,751 White males, over 11 years. RESULTS: Among 14-year-old Black males, the risk of a nonfatal firearm injury before age 25 was 10.1% (95% confidence interval, 9.2%-11.0%), the risk of death from firearms was 2.5% (1.7%-3.2%), and the combined risk was 12.5% (11.0%-14.1%). Among White males, the risk of nonfatal firearm injury was 0.8% (0.3%-1.2%), the risk of death was 0.3% (0.02%-0.5%), and the combined risk was 1.0% (0.5%-1.5%). DISCUSSION: Risk estimates reveal the dire likelihood of firearm injury or death among Black adolescent males in Philadelphia. Immediate interventions are needed to de-escalate conflicts, provide supports, and address the upstream causes of violence like poverty and structural racism.
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Consumers are exposed to succinate dehydrogenase inhibitor (SDHI) pesticides through their diet. A cumulative dietary risk assessment for the French population has been performed with French monitoring data (2017-2021) and consumption data from INCA3. The calculation followed a two-tiered approach, using deterministic then probabilistic methods. It was carried out, using European health based guidance values (HBGV) derived for each active substance to characterise their toxicity. In Tier I, the calculated hazard index of 0.12 was below the threshold of 1 and in Tier II, the total margin of exposure at percentile 99.9 remains above the trigger value of 100 (1798 [1631-2311]). In Tier II, the three main risk drivers identified at the upper tail of the distribution were strawberries-fluopyram (19.1%), peaches-fluopyram (14.1%) and table grapes-boscalid (10.5%). Finally, the impact of the major sources of uncertainties was qualitatively evaluated. All together, they were considered of low impact on the outcomes. This work demonstrates the absence of unacceptable chronic risk related to the cumulative exposure of SDHI for French consumers during the 2017-2021 period.
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BACKGROUND: North American studies find that geographic indicators of disadvantage, such as concentrated poverty, significantly increase the risk of child protection involvement. Despite having one of the most extensive family support systems and progressive income redistribution policies in North America, the Canadian province of Québec still faces geographic variations in socioeconomic conditions that remain a major risk factor for child protection involvement. OBJECTIVE: This study asks how child protection involvement is distributed across socioeconomically distinct geographic areas of the province. Drawing from prior literature, we hypothesize that the highest level of child protection involvement across childhood (age 0-17) is found in the lowest socioeconomic areas. PARTICIPANTS & SETTING: This is a population-based prevalence study using administrative child protection data spanning the years 2000 to 2017 across Québec. METHODS: We constructed cumulative risk life tables of first instances of child protection events (report confirmation, compromised security or development, and out-of-home placement). Prevalence rates were mapped onto 10,650 Census dissemination areas divided into three tiers according to a validated socioeconomic status (SES) index. RESULTS: The highest childhood prevalence of confirmed child protection reports, finding of compromised security or development, and out-of-home placement was found in the lowest SES areas. Rates in low SES areas can be over twice the rates in high SES areas. CONCLUSIONS: Area-level socioeconomic vulnerability remains a robust predictor of child protection involvement even in a socially progressive context. Our findings underscore that without targeted pediatric and family services, as well as poverty-alleviation programs for high-need families in high-need areas, even well-intentioned systems may fall short of reaching the families most in need.
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Child Protective Services , Humans , Quebec/epidemiology , Child , Child Protective Services/statistics & numerical data , Child, Preschool , Prevalence , Adolescent , Infant , Female , Male , Risk Factors , Socioeconomic Factors , Infant, Newborn , Longitudinal Studies , Child Abuse/statistics & numerical data , Child Welfare/statistics & numerical data , Social ClassABSTRACT
Introduction: Ever since the use of bisphenol A (BPA) has been restricted, concerns have been raised regarding the use of its substitutes, such as bisphenol S (BPS) and bisphenol F (BPF). Meanwhile, the EU European Food Safety Authority (EFSA) issued the new tolerable daily intake (TDI) after the latest re-risk assessment for BPA, which enforced the need for cumulative risk assessment in the population. This study was conducted to identify BPA and its substitute's exposure characteristics of the general Taiwanese population and estimate the cumulative risk of bisphenol exposure. Methods: Urine samples (N = 366 [adult, 271; minor, 95]) were collected from individuals who participated in the Taiwan Environmental Survey for Toxicants 2013. The samples were analyzed for BPA, BPS, and BPF through ultraperformance liquid chromatography-tandem mass spectrometry. Daily intake (DI) levels were calculated for each bisphenol. Hazard quotients (HQs) were calculated with the consideration of tolerable DI and a reference dose. Additionally, hazard index (HI; sum of HQs for each bisphenol) values were calculated. Results: Our study found that the median level of BPA was significantly higher in adults (9.63 µg/g creatinine) than in minors (6.63 µg/g creatinine) (p < 0.001). The DI of BPS was higher in female (0.69 ng/kg/day) than in male (0.49 ng/kg/day); however, the DIs of BPF and BPS were higher in boys (1.15 and 0.26 ng/kg/day, respectively) than in girls (0.57 and 0.20 ng/kg/day, respectively). Most HI values exceeded 1 (99% of the participants) after EFSA re-establish the TDI of BPA. Discussion: Our study revealed that the exposure profiles and risk of BPA and its substitute in Taiwanese varied by age and sex. Additionally, the exposure risk of BPA was deemed unacceptable in Taiwan according to new EFSA regulations, and food contamination could be the possible source of exposure. We suggest that the risk of exposure to BPA and its substitutes in most human biomonitoring studies should be reassessed based on new scientific evidence.
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Benzhydryl Compounds , Environmental Exposure , Phenols , Sulfones , Humans , Phenols/urine , Phenols/analysis , Phenols/toxicity , Benzhydryl Compounds/urine , Benzhydryl Compounds/toxicity , Female , Male , Taiwan , Adult , Risk Assessment , Environmental Exposure/analysis , Environmental Exposure/statistics & numerical data , Child , Middle Aged , Adolescent , Sulfones/analysis , Young Adult , Aged , Child, Preschool , Tandem Mass Spectrometry , Environmental Monitoring , Surveys and Questionnaires , Environmental Pollutants/analysisABSTRACT
INTRODUCTION: The workplace's health hazard remains a significant concern to workers in the mining industry, where miners are continually exposed to various kinds of exposure sources. METHOD: First, the determinants of miners' health were systematically extracted from 259 publications, comprising chemical, physical, ergonomic, and psychosocial stressors, vulnerability factors, and common health outcomes. Then, 16 meta-analyses were performed to ascertain the epidemiological evidence for associations between four stressors and three health outcomes. The seven top contributing factors affecting miners' health were identified through 166 available prospective studies. Finally, based on the classic and domestic measurement scales, a cross-sectional survey of 559 Chinese miners was conducted to determine the core psychosocial predictors. In addition to the traditional mechanisms, complex interactive networks among the antecedents and consequences and the reversed effects of consequences were also obtained, where 379 strong association rules were yielded via the Apriori algorithm. RESULTS: The results showed that occupational dust, NO2, heavy metals, heat, vibration, awkward posture, and job stress are significant risk factors associated with individuals' health conditions. Psychological capital, coping style, job demand, social support, organizational support, justice, and culture are core psychosocial predictors of miners. CONCLUSIONS: This study presents a case for identifying the most significant occupational risk factors related to individuals' health, which could be extended and applied to other industries, as working populations around the world are suffering from various chemical, physical, ergonomic, and psychosocial stressors. PRACTICAL APPLICATIONS: Identifying the significant occupational risk factors affecting workers' health conditions is essential for comprehensive occupational health risk assessment and management. Therefore, this study could be important for health management in mines and other industries.
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Mining , Occupational Exposure , Humans , Risk Factors , Occupational Exposure/adverse effects , Occupational Exposure/statistics & numerical data , Miners/statistics & numerical data , Occupational Health , Occupational Diseases/epidemiology , Occupational Stress/epidemiology , China/epidemiologyABSTRACT
BACKGROUND: The prevalence of multiple nosocomial infections (MNIs) is on the rise, however, there remains a limited comprehension regarding the associated risk factors, cumulative risk, probability of occurrence, and impact on length of stay (LOS). METHOD: This multicenter study includes all hospitalized patients from 2020 to July 2023 in two sub-hospitals of a tertiary hospital in Guangming District, Shenzhen. The semi-Markov multi-state model (MSM) was utilized to analyze risk factors and cumulative risk of MNI, predict its occurrence probability, and calculate the extra LOS of nosocomial infection (NI). RESULTS: The risk factors for MNI include age, community infection at admission, surgery, and combined use of antibiotics. However, the cumulative risk of MNI is lower than that of single nosocomial infection (SNI). MNI is most likely to occur within 14 days after admission. Additionally, SNI prolongs LOS by an average of 7.48 days (95% Confidence Interval, CI: 6.06-8.68 days), while MNI prolongs LOS by an average of 15.94 days (95% CI: 14.03-18.17 days). Furthermore, the more sites of infection there are, the longer the extra LOS will be. CONCLUSION: The longer LOS and increased treatment difficulty of MNI result in a heavier disease burden for patients, necessitating targeted prevention and control measures.
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Cross Infection , Length of Stay , Humans , Cross Infection/epidemiology , Length of Stay/statistics & numerical data , Risk Factors , Male , Female , Middle Aged , China/epidemiology , Aged , Adult , Prevalence , Tertiary Care Centers , Anti-Bacterial Agents/therapeutic useABSTRACT
Previous studies have determined that exposure to risk and adversities may impair children's cognitive abilities. In particular, children engaged with Child Protective Services (CPS) seem to be at greater risk for enhanced detrimental effects resulting from the cumulative risk factors to which they are exposed. However, little is known about children's future thinking when they face adverse circumstances, and it is not clear how the associations among episodic foresight abilities, episodic memory, and executive functions work with children under such circumstances. The current study describes the episodic foresight abilities of CPS-involved school-aged children, its association with other cognitive abilities, and how this association is affected by the exposure to cumulative risk and adversity factors. Episodic foresight, episodic memory, executive functions, and a composite of cumulative risk factors were analyzed in a sample of 95 school-aged children engaged with CPS in Portugal. Results suggest the detrimental effect of cumulative risk on the episodic foresight abilities of CPS-involved children. Episodic memory and cognitive flexibility were significant predictors of episodic foresight abilities, and cumulative risk exposure moderated the relation between episodic memory and episodic foresight. The current study provides a better understanding of the influences of multiple adversities on CPS-involved children's episodic foresight abilities and related cognitive outcomes.
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Child Protective Services , Executive Function , Memory, Episodic , Humans , Male , Female , Child , Executive Function/physiology , Risk Factors , Thinking/physiologyABSTRACT
INTRODUCTION: Family cumulative risk (FCR) is predominantly regarded as an antecedent for adolescent mental health, as the prevailing perspective continues to emphasize the influential role of parents, despite recognizing the child's influence. To identify the interplay between family adversity (FCR, process-related FCR, and sociodemographic-related FCR), life satisfaction (LS), and anxiety and depression (AD), this study examined the cascade effects among these constructs. METHOD: Participants (N = 707; 52.9% male; grades 10 and 11) from four high schools in Wuhan, China, were recruited to participate, and they completed the measures in October 2018, April 2019, and November 2019. Family sociodemographic risk (e.g., single parenthood) and family process risk (e.g., low family cohesion) were simulated in the models for FCR, sociodemographic-related FCR, and process-related FCR. RESULTS: The random intercept cross-lagged panel models (RI-CLPMs) revealed a lagged effect from LS to FCR; lagged effects from LS and AD to process-related FCR at the within-person level; and significant associations between LS, AD, and family adversity at the between-person level. CONCLUSIONS: The lagged effects provide evidence for the influential child perspective and suggest that FCR and family process risk are sensitive to adolescent well-being and psychopathological symptoms. School mental health prevention and intervention programs that take a complete mental health approach to enhance children's well-being and alleviate symptoms would help prevent increases in family risk.
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Exposure to risk factors and adversity may cause immediate, and sometimes prolonged, psychological symptoms in adolescents. Identifying universal and specific risk factors in a particular context and examining their cumulative effects is crucial for understanding the mechanisms underlying psychological symptoms and informing about strategies for intervention. Using concurrent measures, the current study aimed to examine the role of armed conflict experiences and cumulation of other risk factors (e.g., maternal psychological symptoms, socioeconomic indicators) in predicting adolescent psychological symptoms in an underresearched community. The sample included 161 adolescents (54.7% female) aged 11-14 years (M = 12.36, SD = 1.27) and their mothers living in the east of Turkey. The cumulative risk index was calculated by summing the standardized scores of the corresponding factors. Hierarchical multiple regression analyses were conducted to predict internalizing and externalizing symptoms among adolescents by introducing demographic variables (age, gender) in the first step, armed conflict experiences and cumulative risk in the second step, and their interaction in the final step. Results showed that the levels of internalizing and externalizing symptoms were predicted by gender, armed conflict experience and cumulative risk. Being a girl was associated with higher levels of internalizing symptoms and lower levels of externalizing symptoms. Higher levels of internalizing and externalizing symptoms were predicted by exposure to armed and cumulative risk. After controlling for other factors, the interaction of armed conflict experience and cumulative risk significantly predicted externalizing, but not internalizing symptoms. These findings suggested that cumulative risk was a stronger predictor of psychological symptoms, and further amplified the strength of the association between armed conflict experiences and externalizing symptoms. These findings can be used in the formulation of intervention strategies and policies to promote psychological well-being in adolescents living in armed conflict zones under multiple risks.
Subject(s)
Armed Conflicts , Humans , Adolescent , Female , Male , Turkey/epidemiology , Child , Risk Factors , Armed Conflicts/psychology , Adolescent Behavior/psychology , Mothers/psychologyABSTRACT
BACKGROUND: Sleep problems are common among nurses and can lead to various health problems. Further, the relationship between multiple sleep problems and memory impairment in clinical nurses remains unknown. Therefore, in this study, we aimed to explore the relationship between sleep problems and memory impairment among nurses. METHODS: Multistage cluster-stratified random sampling was performed from tertiary hospitals in Shandong, China. Overall, a total of 1833 nurses were included in the final analysis. The Chinese version of the Pittsburgh Sleep Quality Index and prospective and retrospective memory questionnaire were administered to the participants. RESULTS: The sleep quality of the nurses decreased during the normal epidemic prevention and control period compared with that before the epidemic in terms of sleep duration, sleep efficiency, and sleep disturbances. Nurses who reported cumulative or specific sleep problems (e.g., high sleep latency, sleep disturbances, and daytime dysfunction) and those in the "daily disturbances" and "poor sleep quality" groups had a higher risk of memory impairment than the others. CONCLUSION: Sleep problems might be important for memory impairment among nurses. These findings may help identify nurses at considerable risk of memory impairment in clinical practice.
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EFSA updated its previous work on the establishment of specific effects that are considered relevant for grouping pesticide residues targeting the thyroid and for performing the retrospective assessment of dietary cumulative risk (CRA). The two specific effects already selected in 2019 leading to the two cumulative assessment groups (CAGs) 'hypothyroidism' and 'C-cell hypertrophy, hyperplasia and neoplasia' were reconfirmed. Compared to 2019, the list of indicators that can be used to identify these specific effects was refined to only include histopathological changes. In a second phase of the work, data will be extracted on indicators of the specific effects from the dossiers on active substances (a.s.) used as plant protection products. The criteria for including a.s. into CAGs were also updated, together with the hazard characterisation methodology and the lines of evidence for assessing CAG-membership probabilities. The tasks related to the data extraction and the establishment of the CAGs on hypothyroidism and on C-cell hypertrophy, hyperplasia and neoplasia are beyond the scope of this report. This part of the CRA process has been outsourced and will be the subject of a separate report.
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In contrast to the traditional approach to risk assessment, which focuses on a single chemical, cumulative exposure and risk assessment considers the consequences of exposure to multiple chemical combinations. A cumulative risk assessment of dietary exposure of adult females and adult males to pesticides with chronic effects on the thyroid was conducted by estimation of the Total Margin of Exposure (MOET). Exposure to each active substance was estimated using a second-order Monte Carlo simulation. Input values for the simulation were based on over 2300 conventionally produced fruit and vegetable samples analysed from 2021 to 2023 and consumption data collected using the Food Frequency Questionnaire (FFQ) and 24h recall method. MOET values, for both populations assessed, did not exceed thresholds for regulatory consideration established by risk managers. Considering that MOETs values from consumption of fresh fruits and vegetables were relatively close to the threshold value, total exposure to the pesticides could likely reach risk-associated MOET levels, through the consumption of other food products that may be contaminated.