Human health risks associated to trace elements and metals in commercial fish from the Brazilian Amazon.

Fish constitutes the main protein source for the Amazonian population. However, the impact of different anthropogenic activities on trace element and metal accumulation in fish and their risks for human health at a regional scale remain largely unexplored. Here we assessed exposure levels of 10 trace elements and metals (Cr, Mn, Fe, Ni, Cu, Zn, As, Cd, Pb, and Hg) in 56 samples belonging to 11 different species of fish from the Brazilian Amazon. We studied the relationship between exposure levels, fish origin, and fish feeding habits, and assessed toxicological and carcinogenic risks for the Amazonian population. No significant correlation was found between sampling site and exposure levels to the studied elements, but a significant difference was found between the accumulation of some metals and the position of the fish species in the food chain. The concentrations of Cr and Hg in fish flesh were found to exceed the Brazilian limits for human consumption. This study shows that current fish consumption patterns can lead to estimated daily intakes of Hg, As and Cr that exceed the oral reference dose, thus posing a toxicological concern. Furthermore, carcinogenic risks may be expected due to the continued exposure to Cr and As. The results of this study show that the consumption of wild caught fish in the Amazon region should be controlled. Moreover, continued monitoring of trace element and metal contamination in fish and on the health of the Amazonian population is recommended, particularly for riverine and indigenous communities.

Occupational risks associated with chronic kidney disease of non-traditional origin (CKDnt) in Brazil: it is time to dig deeper into a neglected problem / Riscos ocupacionais associados à doença renal crônica de origem não tradicional (DRCnt) no Brasil: é hora de nos aprofundarmos em um problema negligenciado

Abstract In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD's etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety.

Resumo Nas últimas décadas, uma epidemia de doença renal crônica (DRC) tem sido associada a fatores ambientais e ocupacionais (estresse térmico decorrente de cargas de trabalho elevadas em altas temperaturas e exposição a produtos químicos, como agrotóxicos e metais), denominada DRC de origem não tradicional (DRCnt). Esta revisão descritiva tem como objetivo apresentar evidências recentes sobre estresse térmico, agrotóxicos e metais como possíveis causas de DRCnt e fornecer uma visão geral das estratégias brasileiras de regulamentação, fiscalização e vigilância sanitária relacionadas. Os trabalhadores brasileiros são comumente expostos a condições extremas de calor e outros fatores de risco de DRCnt, incluindo o aumento da exposição a agrotóxicos e metais. Além disso, há uma falta de regulamentação e fiscalização, políticas públicas e estratégias adequadas para proteger a saúde renal dos trabalhadores em relação aos principais fatores de risco. É provável que a DRCnt seja uma causa significativa de DRC no Brasil, uma vez que a etiologia da doença é desconhecida em muitos pacientes e diversas condições para seu desenvolvimento estão presentes no país. Estudos epidemiológicos devem ser realizados para explorar associações causais e estimar o impacto do calor, dos agrotóxicos e dos metais na DRCnt no Brasil. Além disso, as políticas públicas devem priorizar a redução da exposição dos trabalhadores e a promoção de sua saúde e segurança.

A taxonomy of cyber risk taxonomies.

The field of cyber risks is rapidly expanding, yet significant research remains to be conducted. Numerous taxonomy-based systems have been proposed in both the academic literature and industrial practice to classify cyber risk threats. However, the fragmentation of various approaches has resulted in a plethora of taxonomies, often incongruent with one another. In this study, we undertake a comprehensive review of these alternative taxonomies and offer a common framework for their classification based on their scope. Furthermore, we introduce desirable properties of a taxonomy, which enable comparisons of different taxonomies with the same scope. Finally, we discuss the managerial implications stemming from the utilization of each taxonomy class to support decision-making processes.

Association between longest-held occupation and mortality risk.

BACKGROUND: Occupation is associated with a large part of daily activities, affecting lifestyle and social status. However, limited research exists on the association between longest-held occupation (LHO) and early mortality. We examine if LHO is associated with mortality risk among US adults 51 years of age and older. METHODS: Using Health and Retirement Study data from 1992 to 2020, we followed 26,758 respondents 51 years of age and older for up to 29 years. We used competing-risks analysis methodology to estimate the risk of mortality. RESULTS: Across the average 20.5 follow-up years, women with LHO in the categories of machine operators (subhazard ratio [SHR]: 1.42), food preparation (SHR: 1.39), handlers and helpers (SHR: 1.35), and sales (SHR: 1.15), were more likely to die earlier than women with the LHO in the professional and technical support occupation, the reference occupation. Men with LHO in the categories of food preparation (SHR: 1.43), machine operators (SHR: 1.36), personal services (SHR: 1.34), handlers and helpers (SHR: 1.32), protective services (SHR: 1.31), clerical (SHR: 1.27), farming and fishing (SHR: 1.26), sales (SHR: 1.23), and precision production (SHR: 1.20) had elevated risks of mortality compared to men whose LHO was in the referent professional and technical support occupation. CONCLUSIONS: Findings from this study provide comprehensive and current evidence that occupation can be one of the risk factors for adverse health outcomes and ultimately for early mortality.

Ethical considerations in public engagement: developing tools for assessing the boundaries of research and involvement.

Public engagement with research (PEwR) has become increasingly integral to research practices. This paper explores the process and outcomes of a collaborative effort to address the ethical implications of PEwR activities and develop tools to navigate them within the context of a University Medical School. The activities this paper reflects on aimed to establish boundaries between research data collection and PEwR activities, support colleagues in identifying the ethical considerations relevant to their planned activities, and build confidence and capacity among staff to conduct PEwR projects. The development process involved the creation of a taxonomy outlining key terms used in PEwR work, a self-assessment tool to evaluate the need for formal ethical review, and a code of conduct for ethical PEwR. These tools were refined through iterative discussions and feedback from stakeholders, resulting in practical guidance for researchers navigating the ethical complexities of PEwR. Additionally, reflective prompts were developed to guide researchers in planning and conducting engagement activities, addressing a crucial aspect often overlooked in formal ethical review processes. The paper reflects on the broader regulatory landscape and the limitations of existing approval and governance processes, and prompts critical reflection on the compatibility of formal approval processes with the ethos of PEwR. Overall, the paper offers insights and practical guidance for researchers and institutions grappling with ethical considerations in PEwR, contributing to the ongoing conversation surrounding responsible research practices.

Deciphering the pollution risks, sources and their links of heavy metals in soils.

Heavy metals in soils pose serious ecological and health risks. To make efficient strategies for mitigating the underlying hazards, it is critical to reveal the pollution sources and their links with the risks. Researchers have investigated source identification and risk evaluation of heavy metals in soils, yet few have systematically deciphered the source-sink relationship of soil metals and the links between source apportionment and risk assessment. In the study, an integrated technological framework has been proposed to address the gaps, and applied to characterize the pollution risks, sources and their links of soil metals in a typical coal resource city in China. The assessment using geochemical tool and ecological risk index shows the soils in study area are polluted by Cd, Hg, Cr, As and Pb in varied degrees, and particularly, Cd and Hg present significant ecological risk. Two advanced receptor models (multivariate curve resolution-weighted alternating least-squares and multilinear engine 2) are comparatively applied for apportioning the potential sources of soil metals, and the results suggest the two models have identified similar sources (r2 > 0.90), including agricultural activities, atmospheric depositions and industrial discharges with contributions of 35.5 %-38.3 %, 30.3 %-35.1 %, and 26.6 %-34.1 %, respectively. Then, apportionment results of the two models are jointly employed for evaluating the source-specific health risks of metals in the environment using a probabilistic risk assessment model. The risk levels within the area are overall acceptable or tolerable, and relatively, the industrial discharges present higher contribution on the non-carcinogenic and carcinogenic risks of soil metals to public. Findings will help the managers to design targeted policies for reducing the risks of soil metals, and the framework proposed provides a useful guideline to better understand the source-risk relationship of soil metals in other environments worldwide.

Unveiling the impacts of microplastics on cadmium transfer in the soil-plant-human system: A review.

The co-contamination of soils by microplastics (MPs) and cadmium (Cd), one of the most perilous heavy metals, is emerging as a significant global concern, posing risks to plant productivity and human health. However, there remains a gap in the literature concerning comprehensive evaluations of the combined effects of MPs and Cd on soil-plant-human systems. This review examines the interactions and co-impacts of MPs and Cd in soil-plant-human systems, elucidating their mechanisms and synergistic effects on plant development and health risks. We also review the origins and contamination levels of MPs and Cd, revealing that sewage, atmospheric deposition, and biosolid applications are contributors to the contamination of soil with MPs and Cd. Our meta-analysis demonstrates that MPs significantly (p<0.05) increase the bioavailability of soil Cd and the accumulation of Cd in plant shoots by 6.9 and 9.3 %, respectively. The MPs facilitate Cd desorption from soils through direct adsorption via surface complexation and physical adsorption, as well as indirectly by modifying soil physicochemical properties, such as pH and dissolved organic carbon, and altering soil microbial diversity. These interactions augment the bioavailability of Cd, along with MPs, adversely affect plant growth and its physiological functions. Moreover, the ingestion of MPs and Cd through the food chain significantly enhances the bioaccessibility of Cd and exacerbates histopathological alterations in human tissues, thereby amplifying the associated health risks. This review provides insights into the coexistence of MPs and Cd and their synergistic effects on soil-plant-human systems, emphasizing the need for further research in this critical subject area.

Prevalence of financial hardship and health-related social needs among patients with missed radiology appointments.

PURPOSE: We aimed to evaluate the prevalence of financial hardship and Health-Related Social Needs (HRSN) among patients who missed their radiology appointment. METHODS: English-speaking adult patients, with a missed outpatient imaging appointment at any of a tertiary care imaging centers between 11/2022 and 05/2023 were eligible. We measured self-reported general financial worry using Comprehensive Score for Financial Toxicity (COST), imaging hardship (worry that the current imaging is a financial hardship to patient and their family), material hardship (e.g., medical debt), cost-related care nonadherence, and HRSNs including housing instability, food insecurity, transportation problems, and utility help needs. RESULTS: 282 patients were included (mean age 54.7 ± 15.0 years; 70.7 % female). Majority were non-Hispanic White (52.4 %), followed by Asian (23.0 %) and Hispanic (16.0 %) racial/ethnic background. Most missed appointments were patient-initiated (74.8 %); 13.5 % due to cost or insurance coverage and 6.4 % due to transportation and parking. Mean COST score was 26.8 with 44.4 % and 28.8 % reporting their illness and imaging as a source of financial hardship. 18.3 % and 35.2 % endorsed cost-related care nonadherence and material hardship. 32.7 % had at least one HRSNs with food insecurity the most common (25.4 %). Only 12.5 % were previously screened for financial hardship or HRSNs. Having comorbidity and living in more disadvantaged neighborhoods was associated with higher report of financial hardship and HRSNs. CONCLUSION: Financial hardship and HRSNs are common among those who miss radiology appointments. There needs to be more rigorous screening for financial hardship and HRSNs at every health encounter and interventions should be implemented to address these.

A Bayesian competing risk analysis of renal cancer patients based on SEER database.

BACKGROUND: Renal cell carcinoma (RCC) remains a global health concern due to its poor survival rate. This study aimed to investigate the influence of medical determinants and socioeconomic status on survival outcomes of RCC patients. We analyzed the survival data of 41,563 RCC patients recorded under the Surveillance, Epidemiology, and End Results (SEER) program from 2012 to 2020. METHODS: We employed a competing risk model, assuming lifetime of RCC patients under various risks follows Chen distribution. This model accounts for uncertainty related to survival time as well as causes of death, including missing cause of death. For model analysis, we utilized Bayesian inference and obtained the estimate of various key parameters such as cumulative incidence function (CIF) and cause-specific hazard. Additionally, we performed Bayesian hypothesis testing to assess the impact of multiple factors on the survival time of RCC patients. RESULTS: Our findings revealed that the survival time of RCC patients is significantly influenced by gender, income, marital status, chemotherapy, tumor size, and laterality. However, we observed no significant effect of race and origin on patient's survival time. The CIF plots indicated a number of important distinctions in incidence of causes of death corresponding to factors income, marital status, race, chemotherapy, and tumor size. CONCLUSIONS: The study highlights the impact of various medical and socioeconomic factors on survival time of RCC patients. Moreover, it also demonstrates the utility of competing risk model for survival analysis of RCC patients under Bayesian paradigm. This model provides a robust and flexible framework to deal with missing data, which can be particularly useful in real-life situations where patients information might be incomplete.

The Effects of Daily-Living Risks on Breast Cancer-Related Lymphedema.

BACKGROUND: Conventional advice to reduce the risk of breast cancer-related lymphedema (BCLE) suggests avoidance of daily-living risks, and limited research has investigated these risks. OBJECTIVE: This study aimed to examine the occurrence, patterns, and effects of daily-living risks on BCLE. METHODS: A cross-sectional design was used to collect data from 567 patients at a metropolitan cancer center in the United States. The Lymphedema Risk-Reduction Behavior Checklist was used to assess the occurrence of 11 daily-living risks. Descriptive, regression, and factor analyses were performed. RESULTS: Significant odds of BCLE were associated with infection (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.95-3.42), cuts/scratches (OR 2.65, 95% CI 1.97-3.56), sunburn (OR 1.89, 95% CI 1.39-3.56), oil splash or steam burns (OR 2.08, 95% CI 1.53-3.83), and insect bites (OR 1.59, 95% CI 1.18-2.13). The daily-living risks were clustered into factors related to skin trauma and carrying objects. Skin trauma risk was significantly associated with BCLE (B = 0.539, z = 3.926, OR 1.714, 95% CI 1.312-2.250; p < 0.001). Having three, four, or five skin trauma risks significantly increased the odds of BCLE to 4.31, 5.14, and 6.94 times, respectively. The risk of carrying objects had no significant or incremental effects on BCLE. CONCLUSION: Complete avoidance of daily-living risks is challenging given 52.73% of patients incurred more than five daily-living risks. Our study findings underscore the importance of 'what to do' strategies to minimize infection and skin trauma.

Impact of Flooding and Drought Risks on the Cost of Bond Financing for Water Utilities.

The global water cycle has experienced significant changes due to the interplay of climate shifts and human activities, resulting in more frequent and severe droughts and floods. These shifts have started to impact the operational efficiency of water treatment and delivery systems. This, in turn, has implications for the economic performance of these assets and the climate-impacted cost of their financing through the issuing of municipal bonds. Analyzing a decade of water bond data (2009-2019), this study offers empirical evidence for the impact of flood and drought risks on bond investor demand to offset water risks. The results reveal that bond markets factored in coastal flood risks between 2013 and 2019, adjusting by 3-6 basis points (bps) per risk score unit, and riverine flood risks from 2009 to 2013, with a 5-11 basis points increase per risk score unit. These effects were primarily driven by bonds issued in the Pacific Coast and Great Plains regions, respectively. In contrast, the pricing of drought risks in the bond market followed a more nuanced pattern. Additionally, we show the channeling effects of water consumption and investor perceptions of climate change on water risk pricing in the bond market. These findings have significant implications for water risk management in the public sector as regions with heightened water risk exposure are perceived as riskier by market participants, leading to a higher cost of capital for municipalities and water agencies.

A Machine Learning Model for Risk Stratification of Postdiagnosis Diabetic Ketoacidosis Hospitalization in Pediatric Type 1 Diabetes: Retrospective Study.

BACKGROUND: Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in pediatric type 1 diabetes (T1D), occurring in approximately 20% of patients, with an economic cost of $5.1 billion/year in the United States. Despite multiple risk factors for postdiagnosis DKA, there is still a need for explainable, clinic-ready models that accurately predict DKA hospitalization in established patients with pediatric T1D. OBJECTIVE: We aimed to develop an interpretable machine learning model to predict the risk of postdiagnosis DKA hospitalization in children with T1D using routinely collected time-series of electronic health record (EHR) data. METHODS: We conducted a retrospective case-control study using EHR data from 1787 patients from among 3794 patients with T1D treated at a large tertiary care US pediatric health system from January 2010 to June 2018. We trained a state-of-the-art; explainable, gradient-boosted ensemble (XGBoost) of decision trees with 44 regularly collected EHR features to predict postdiagnosis DKA. We measured the model's predictive performance using the area under the receiver operating characteristic curve-weighted F1-score, weighted precision, and recall, in a 5-fold cross-validation setting. We analyzed Shapley values to interpret the learned model and gain insight into its predictions. RESULTS: Our model distinguished the cohort that develops DKA postdiagnosis from the one that does not (P<.001). It predicted postdiagnosis DKA risk with an area under the receiver operating characteristic curve of 0.80 (SD 0.04), a weighted F1-score of 0.78 (SD 0.04), and a weighted precision and recall of 0.83 (SD 0.03) and 0.76 (SD 0.05) respectively, using a relatively short history of data from routine clinic follow-ups post diagnosis. On analyzing Shapley values of the model output, we identified key risk factors predicting postdiagnosis DKA both at the cohort and individual levels. We observed sharp changes in postdiagnosis DKA risk with respect to 2 key features (diabetes age and glycated hemoglobin at 12 months), yielding time intervals and glycated hemoglobin cutoffs for potential intervention. By clustering model-generated Shapley values, we automatically stratified the cohort into 3 groups with 5%, 20%, and 48% risk of postdiagnosis DKA. CONCLUSIONS: We have built an explainable, predictive, machine learning model with potential for integration into clinical workflow. The model risk-stratifies patients with pediatric T1D and identifies patients with the highest postdiagnosis DKA risk using limited follow-up data starting from the time of diagnosis. The model identifies key time points and risk factors to direct clinical interventions at both the individual and cohort levels. Further research with data from multiple hospital systems can help us assess how well our model generalizes to other populations. The clinical importance of our work is that the model can predict patients most at risk for postdiagnosis DKA and identify preventive interventions based on mitigation of individualized risk factors.

Xanthelasma Palpebrarum is Not Associated with Dyslipidemia or Cardiovascular Disease: A Case Control Study.

OBJECTIVE: To determine whether Xanthelasma palpebrarum (XP) is associated with dyslipidemia, cardiovascular disease (CVD) and other systemic conditions in a large population. DESIGN: Case-control study conducted at a single tertiary care center. PARTICIPANTS: Individuals who were examined at a medical screening institute from 2001 to 2020. METHODS: Medical records were reviewed to extract data on ophthalmic evaluations, blood tests, and systemic diagnoses. Patients identified with XP in at least one eye comprised the study group. A control group without XP was established matched by age and sex at a 10:1 ratio to allow robust statistical analysis. MAIN OUTCOME MEASURES: Associations between XP and dyslipidemia and CVD. Lipid profiles, diagnosis of dyslipidemia and CVD were compared between the case and control groups. RESULTS: The database included 35,452 individuals, 24,287 males (69%), mean age 52.2±12.2 years. The study population included 203 XP patients (0.6%) and 2030 matched controls. The prevalence of dyslipidemia diagnosis and the usage rates of statins, fibrates, or other cholesterol-lowering medications was similar between the two groups. Lipid profiles were similar between the groups, including median total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglyceride levels (187 controls vs. 192 XP, 48 controls vs. 47 XP, 120 controls vs. 125 XP, 111 controls vs. 105 XP, respectively, P>0.05 for all). The rate of CVD was similar as well (10% controls vs. 8.9%, XP P=0.56). The prevalences of related conditions, including hypertension, diabetes mellitus, and history of cerebrovascular accident, were similar between groups (24% controls vs. 23% XP, 14% controls vs. 10% XP, 1.3% controls vs. 1% XP, respectively P>0.05). CONCLUSIONS: XP was not associated with increased rates of dyslipidemia or CVD. This questions the extent to which XP serves as an indicative marker for heightened systemic risk.

A competing risks model to estimate the risk of graft failure and patient death after kidney transplantation using continuous donor-recipient age combinations.

Graft failure and recipient death with functioning graft are important competing outcomes after kidney transplantation. Risk prediction models typically censor for the competing outcome thereby overestimating the cumulative incidence. The magnitude of this overestimation is not well-described in real-world transplant data. This retrospective cohort study analyzed data from the European Collaborative Transplant Study (CTS; n = 125 250) and from the American Scientific Registry of Transplant Recipients (SRTR; n = 190 258). Separate cause-specific hazard models, using donor and recipient age as continuous predictors, were developed for graft failure and recipient death. The hazard of graft failure increased quadratically with increasing donor age and decreased decaying with increasing recipient age. The hazard of recipient death increased linearly with increasing donor and recipient age. The cumulative incidence overestimation due to competing risk-censoring was largest in high-risk populations for both outcomes (old donors/recipients), sometimes amounting to 8.4 and 18.8 percentage points for graft failure and recipient death, respectively. In our illustrative model for post-transplant risk prediction, the absolute risk of graft failure and death is overestimated when censoring for the competing event, mainly in older donors and recipients. Prediction models for absolute risks should treat graft failure and death as competing events.

Impact of dietary risk on global ischemic heart disease: findings from 1990-2019.

Ischemic heart disease (IHD) is a condition in which the heart is starved of oxygen. Knowing the dietary risk factors implementing appropriate nutritional interventions in this regard seems essential. Therefore, the present study was carried out to determine the epidemiological features of IHD affected by dietary risks. This study used data from the Global Burden of Disease (GBD) study. In this study, we collected information on death, years lived with disability (YLD), and disability-adjusted life years (DALYs) of IHD affected by dietary risks in one hundred thousand people with 95% confidence based on the direct Age Standard Rate (ASR). We applied these data based on the Socio-demographic Index (SDI). In 2019, the number of IHD deaths, YLDs, and DALYs attributable to dietary risks was 62.43 million (95% UI [50.97-73.63] per 100,000 population), 36.88 (95% UI [23.87-53.32] per 100,000 population), and 1271.32 (95% UI [1061.29-1473.75] per 100,000 population), respectively. We found that the lowest DALYs of IHD affected by dietary risks by ASR are for high SDI countries. Most dietary risk factors related to IHD in countries with high and high middle SDI were related to a diet high in red and processed meat, sodium, and low in legumes, but in countries with low and low middle SDI, it was related to a diet low in fiber, fruit, nuts and seeds, PUFA, seafood W3 fatty acids, vegetables and whole grain. Considering that the dietary risk factors related to IHD are different based on SDI, it is necessary to consider nutritional interventions according to SDI.

Life-Suspending Technologies, Cryonics, and Catastrophic Risks.

I defend the claim that life-suspending technologies can constitute a catastrophic and existential security factor for risks structurally similar to those related to climate change. The gist of the argument is that, under certain conditions, life-suspending technologies such as cryonics can provide self-interested actors with incentives to efficiently tackle such risks-in particular, they provide reasons to overcome certain manifestations of generational egoism, a risk factor of several catastrophic and existential risks. Provided we have reasons to decrease catastrophic and existential risks such as climate change, we also have a (defeasible) reason for investing in developing and making life-suspending technologies (more) widespread.

Improving Identification of Gig Workers in National Health and Behavior Surveys.

This paper describes the work-related information collected in several important U.S. national health and behavior surveys, to highlight data gaps that prevent identifying responses by vulnerable workers in the gig economy, with emphasis on the growing digital platform sector of the work force. The national information systems used to understand health status and health behaviors, including drug use, rely on outdated census categories for self-employed workers. This paper describes the importance of understanding the needs of this growing part of the labor sector and describes how some of the most well-known and utilized national surveys fail to meet this need. For the agencies conducting national health and behavior surveys, we propose revisions to the categories used to classify type of worker and recommend adoption of a new Worker-Employer Relationship Classification model.

Link between remnant cholesterol and the reversion to normoglycemia in Chinese adults with prediabetes: a 5-year cohort study.

Despite the clear association between remnant cholesterol (RC)and diabetes risk, no study to date has examined the relationship between RC and reversal of prediabetes to normoglycemia. This retrospective cohort study included a total of 15,023 patients with prediabetes who underwent a physical examination between 2010 and 2016. The link between initial RC levels and the reversion from prediabetes to normoglycemia was analyzed using the Cox proportional-hazards regression model. Additionally, the study explored the possible relationship between RC and the probability of returning normoglycemia by applying Cox proportional hazards regression models with cubic spline functions. To address competing risks, a multivariate Cox regression analysis was undertaken, treating the onset of diabetes as a competing risk event for reversing prediabetes to normoglycemia. Additionally, the study incorporated extensive subgroup analyses alongside multiple sensitivity analyses, enhancing the reliability and robustness of the results. After adjusting for covariates, the findings indicated that RC was inversely associated with the likelihood of reverting to normoglycemia (per 5 mg/dL increase, HR = 0.918, 95% CI 0.909-0.927). The analysis also revealed a nonlinear relationship between RC and normoglycemia reversion, with an inflection point at 51.08 mg/dL. For RC values below this inflection point (RC < 50.08 mg/dL), the HR for the probability of returning to normoglycemia was 0.907 (95% CI 0.897-0.917 per 5 mg/dL). Additionally, the competing risks model demonstrated a negative relationship between RC and the reversal of prediabetes to normoglycemia (SHR = 0.92, 95% CI 0.91-0.93). Sensitivity analyses confirmed the robustness and stability of these results. This study demonstrated a negative and non-linear association between RC and the probability of reversion to normoglycemia in Chinese adults with prediabetes. By actively intervening to reduce RC levels, at least to below 51.08 mg/dL, further reduction of RC may significantly increase the probability of returning to normoglycemia from prediabetes.

Professional profile in veterinary oncology: A Brazilian nationwide survey.

INTRODUCTION: Veterinary oncology is constituted mainly by human-use drugs with hazardous agents. Occupational risks are present in all stages of handling. Many studies highlighted that veterinarians and pharmacists staff present a lack of knowledge and insufficient structure for promoting safety practices. This study investigated the professional profile and structure of veterinary antineoplastic chemotherapy in Brazilian services. METHODS: A nationwide survey was carried out through digital platforms by a self-applicable from 2020 to 2021. The characteristics of the structure, facilities, professional profiles, practices related to antineoplastic chemotherapy services, and inspections provided by regulatory companies were investigated. Frequency and ranges were used to examine and describe data. RESULTS: This study analyzed 108 respondents from all Brazilian regions where 36 participants worked in veterinary oncology. Dogs and cats comprised more than 90% of animals assisted. Vincristine, doxorubicin, carboplatin, vinblastine, and cyclophosphamide were the most commonly used drugs. Considering pharmacists-led (n = 4) vs veterinarians-led (n = 18) services, structure with safety for handling hazardous drugs (4 vs 9), correct PPE usage (3 vs 0), and occurrence of occupational accident (0 vs 5) were registered. Almost 60% were dissatisfied with the structure and the managerial unwillingness to promote facility improvements. The majority of participants reported an absence of service inspection. CONCLUSION: The results demonstrated worrying concerning the inadequacy of the physical structure of the facilities, human resources, and handling hazardous drugs increased occupational health risk. The lack of competent authority standards and supervision corroborates practices that expose professionals, the population, and the environment to hazardous agents.