Direct potable reuse and birth defects prevalence in Texas: An augmented synthetic control method analysis of data from a population-based birth defects registry.

Background: Direct potable reuse (DPR) involves adding purified wastewater that has not passed through an environmental buffer into a water distribution system. DPR may help address water shortages and is approved or is under consideration as a source of drinking water for several water-stressed population centers in the United States, however, there are no studies of health outcomes in populations who receive DPR drinking water. Our objective was to determine whether the introduction of DPR for certain public water systems in Texas was associated with changes in birth defect prevalence. Methods: We obtained data on maternal characteristics for all live births and birth defects cases regardless of pregnancy outcome in Texas from 2003 to 2017 from the Texas Birth Defects Registry and birth and fetal death records. The ridge augmented synthetic control method was used to model changes in birth defect prevalence (per 10,000 live births) following the adoption of DPR by four Texas counties in mid-2013, with county-level data on maternal age, percent women without a high school diploma, percent who identified as Hispanic/Latina or non-Hispanic/Latina Black, and rural-urban continuum code as covariates. Results: There were nonstatistically significant increases in prevalence of all birth defects collectively (average treatment effect in the treated = 53.6) and congenital heart disease (average treatment effect in the treated = 287.3) since June 2013. The estimated prevalence of neural tube defects was unchanged. Conclusions: We estimated nonstatistically significant increases in birth defect prevalence following the implementation of DPR in four West Texas counties. Further research is warranted to inform water policy decisions.

Perceived Challenges to Tribally Led Shellfish Toxin Testing in Southeast Alaska: Findings From Key Informant Interviews.

Shellfish harvesting is central to coastal Alaska Native ways of life, and tribes in Southeast Alaska are committed to preserving sustainable and safe access to subsistence foods. However, consumption of non-commercially harvested shellfish puts Alaska Native communities at elevated risk of exposure to shellfish toxins. To address a lack of state or federal toxin testing for subsistence and recreational harvesting, tribes across Southeast Alaska have formed their own toxin testing and ocean monitoring program. In this study, we interviewed environmental managers responsible for tribes' testing and others with shellfish toxin expertise to report on perceptions of barriers to tribally led testing in Southeast Alaska. Tribal staff identified 40 prospective key informants to interview, including all environmental managers responsible for shellfish toxin testing at subsistence sites in Southeast Alaska. All 40 individuals were invited to participate in an interview and 27 individuals were interviewed. The most frequently discussed barriers to shellfish toxin testing in Southeast Alaska relate to logistical and staffing difficulties associated with communities' remote locations, inconsistent and inadequate funding and funding structures that increase staff burdens, risk communication challenges related to conveying exposure risks while supporting subsistence harvesting, and implications of climate change-related shifts in toxin exposures for risk perception and risk communication. Participants stressed the social origins of perceived barriers. Disinvestment may create and sustain barriers and be most severely felt in Native communities and remote places. Climate change impacts may interact with social and cultural factors to further complicate risk management.

Trace element bioaccumulation, tissue distribution, and elimination in odontocetes stranded in Florida and Georgia, USA over a 15-year period (2007-2021).

Odontocetes obtain nutrients including essential elements through their diet and are exposed to heavy metal contaminants via ingestion of contaminated prey. We evaluated the prevalence, concentration, and tissue distribution of essential and non-essential trace elements, including heavy metal toxicants, in tissue (blubber, kidney, liver, skeletal muscle, skin) and fecal samples collected from 90 odontocetes, representing nine species, that stranded in Georgia and Florida, USA during 2007-2021. Samples were analyzed for concentrations of seven essential (cobalt, copper, iron, manganese, molybdenum, selenium, zinc) and five non-essential (arsenic, cadmium, lead, mercury, thallium) elemental analytes using inductively-coupled plasma mass spectrometry. Risso's dolphins (Grampus griseus) and short-finned pilot whales (Globicephala macrorhynchus) had the highest median concentrations of mercury, cadmium, and lead, while dwarf sperm whales (Kogia sima) had the lowest. Adult pygmy and dwarf sperm whales that stranded in 2019-2021 had higher concentrations of arsenic, copper, iron, lead, manganese, selenium, thallium, and zinc compared to those that stranded in 2010-2018, suggesting an increasing risk of exposure over time. The highest concentrations of many elements (e.g., cadmium, cobalt, copper, manganese, molybdenum, thallium, zinc) were in fecal samples, illustrating the usefulness of this noninvasively collected sample. Aside from fecal samples, hepatic tissues had the highest concentrations of iron, manganese, mercury, molybdenum, and selenium in most species; renal tissues had the highest concentrations of cadmium; skin had the highest concentrations of zinc; and copper, arsenic, and lead concentrations were primarily distributed among the liver and kidneys. Phylogenetic differences in patterns of trace element concentrations likely reflect species-specific differences in diet, trophic level, and feeding strategies, while heterogeneous distributions of elemental analytes among different organ types reflect differences in elemental biotransformation, elimination, and storage. This study illustrates the importance of monitoring toxic contaminants in stranded odontocetes, which serve as important sentinels of environmental contamination, and whose health may be linked to human health.

Marine Protected Area Expansion and Country-Level Age-Standardized Adult Mortality.

Many countries have adopted targets to increase marine protected areas (MPAs) to limit the degradation of water bodies. Although there is evidence that MPAs can conserve marine life and promote biodiversity, there are limited data on the human health implications of MPAs. Using panel data from 1990, 2000, and 2014, we estimated the country-level associations between MPAs (i.e., percentage of territorial waters designated as marine reserves) and age-standardized mortality (i.e., age-standardized probability of dying between 15 and 60 years from all-causes among ages 15-60/100,000 population) by sex, among 110 countries. We fit mixed-effects linear regression models of mortality as a function of current MPA coverage, gross domestic product growth, year, the prior extent of MPA, electricity coverage, governance, and country-level random effects. We observed a significant inverse association between current MPA coverage and adult mortality. For each 5-percentage-point increase in current MPA coverage, a country had 0.982 times the geometric means of female and male mortality [geometric mean ratio: 0.982 (95% CI 0·976, 0·988)] conditional on past %MPA coverage and other modeled variables. The model showed no significant residual association of mortality with past %MPA conditional on current %MPA and other modeled variables. This is one of the first studies to show a positive association between increasing marine conservation and human health. This macro-level study suggests there may be important co-benefits for human health from expanding MPAs that merit further investigation.

Water, Water Everywhere, but Every Drop Unique: Challenges in the Science to Understand the Role of Contaminants of Emerging Concern in the Management of Drinking Water Supplies.

The protection and management of water resources continues to be challenged by multiple and ongoing factors such as shifts in demographic, social, economic, and public health requirements. Physical limitations placed on access to potable supplies include natural and human-caused factors such as aquifer depletion, aging infrastructure, saltwater intrusion, floods, and drought. These factors, although varying in magnitude, spatial extent, and timing, can exacerbate the potential for contaminants of concern (CECs) to be present in sources of drinking water, infrastructure, premise plumbing and associated tap water. This monograph examines how current and emerging scientific efforts and technologies increase our understanding of the range of CECs and drinking water issues facing current and future populations. It is not intended to be read in one sitting, but is instead a starting point for scientists wanting to learn more about the issues surrounding CECs. This text discusses the topical evolution CECs over time (Section 1), improvements in measuring chemical and microbial CECs, through both analysis of concentration and toxicity (Section 2) and modeling CEC exposure and fate (Section 3), forms of treatment effective at removing chemical and microbial CECs (Section 4), and potential for human health impacts from exposure to CECs (Section 5). The paper concludes with how changes to water quantity, both scarcity and surpluses, could affect water quality (Section 6). Taken together, these sections document the past 25 years of CEC research and the regulatory response to these contaminants, the current work to identify and monitor CECs and mitigate exposure, and the challenges facing the future.

Associations between short-term ambient temperature exposure and emergency department visits for amphetamine, cocaine, and opioid use in California from 2005 to 2019.

Substance use disorder is a growing public health challenge in the United States. People who use drugs may be more vulnerable to ambient heat due to the effects of drugs on thermoregulation and their risk environment. There have been limited population-based studies of ambient temperature and drug-related morbidity. We examined short-term associations between daily ambient temperature and emergency department (ED) visits for use or overdose of amphetamine, cocaine and opioids in California during the period 2005 to 2019. Daily ZIP code-level maximum, mean, and minimum temperature exposures were derived from 1-km data Daymet products. A time-stratified case-crossover design was used to estimate cumulative non-linear associations of daily temperature for lag days 0 to 3. Stratified analyses by patient sex, race, and ethnicity were also conducted. The study included over 3.4 million drug-related ED visits. We found positive associations between daily temperature and ED visits for all outcomes examined. An increase in daily mean temperature from the 50th to the 95th percentile was associated with ED visits for amphetamine use (OR = 1.072, 95% CI: 1.058, 1.086), cocaine use (OR = 1.044, 95% CI: 1.021, 1.068 and opioid use (OR = 1.041, 95% CI: 1.025, 1.057). Stronger positive associations were also observed for overdose: amphetamine overdose (OR = 1.150, 95% CI: 1.085, 1.218), cocaine overdose (OR = 1.159, 95% CI: 1.053, 1.276), and opioid overdose (OR = 1.079, 95% CI: 1.054, 1.106). In summary, people who use stimulants and opioids may be a subpopulation sensitive to short-term higher ambient temperature. Mitigating heat exposure can be considered in harm reduction strategies in response to the substance use epidemic and global climate change.

Recreational fishing, health and well-being: findings from a cross-sectional survey.

We evaluated the associations between marine recreational fishing, stress, seafood consumption, and sleep quality in a cross-sectional questionnaire-based survey of a convenience sample of 244 fishers recruited in 2019 in Spain. Fishers' stress levels were moderate, with a mean stress index score of 36.4 units on a scale from 14 (very low stress) to 70 (very high). Their average emotional condition was positive, with a mean index of negative affect of 7.8 units on a scale from 5 (very low negative affect) to 25 (very high). Seafood intake was low, with a mean index of seafood in diets of 38.0 units on a scale from 20 (very low seafood consumption) to 160 (very high). Fishers' perceived quality of night sleep was good because the mean index of sleep problems was 39.5 units on a scale from 21 (very low sleep problems) to 107 (very high). Each hour of self-reported monthly fishing activity was associated with 0.016 units of lower stress score. Thus, the most engaged fishers reported up to 15.4% lower stress score than less avid fishers. Since recreational fishing is a highly accessible outdoor activity for people in older age groups, it is possible that public health could be improved by access to sustainably managed recreational fisheries. Fishing engagement was positively associated with seafood intake. Each hour of fishing per month was associated with one-unit higher seafood consumption. The higher seafood consumption observed among avid recreational fishers compared with less avid fishers might have health implications.

Modeling Dinophysis in Western Andalucía using an autoregressive hidden Markov model.

Dinophysis spp. can produce diarrhetic shellfish toxins (DST) including okadaic acid and dinophysistoxins, and some strains can also produce non-diarrheic pectenotoxins. Although DSTs are of human health concern and have motivated environmental monitoring programs in many locations, these monitoring programs often have temporal data gaps (e.g., days without measurements). This paper presents a model for the historical time-series, on a daily basis, of DST-producing toxigenic Dinophysis in 8 monitored locations in western Andalucía over 2015-2020, incorporating measurements of algae counts and DST levels. We fitted a bivariate hidden Markov Model (HMM) incorporating an autoregressive correlation among the observed DST measurements to account for environmental persistence of DST. We then reconstruct the maximum-likelihood profile of algae presence in the water column at daily intervals using the Viterbi algorithm. Using historical monitoring data from Andalucía, the model estimated that potentially toxigenic Dinophysis algae is present at greater than or equal to 250 cells/L between < 1% and >10% of the year depending on the site and year. The historical time-series reconstruction enabled by this method may facilitate future investigations into temporal dynamics of toxigenic Dinophysis blooms.

Epigenetics of type 2 diabetes and diabetes-related outcomes in the Strong Heart Study.

BACKGROUND: The prevalence of type 2 diabetes has dramatically increased in the past years. Increasing evidence supports that blood DNA methylation, the best studied epigenetic mark, is related to diabetes risk. Few prospective studies, however, are available. We studied the association of blood DNA methylation with diabetes in the Strong Heart Study. We used limma, Iterative Sure Independence Screening and Cox regression to study the association of blood DNA methylation with fasting glucose, HOMA-IR and incident type 2 diabetes among 1312 American Indians from the Strong Heart Study. DNA methylation was measured using Illumina's MethylationEPIC beadchip. We also assessed the biological relevance of our findings using bioinformatics analyses. RESULTS: Among the 358 differentially methylated positions (DMPs) that were cross-sectionally associated either with fasting glucose or HOMA-IR, 49 were prospectively associated with incident type 2 diabetes, although no DMPs remained significant after multiple comparisons correction. Multiple of the top DMPs were annotated to genes with relevant functions for diabetes including SREBF1, associated with obesity, type 2 diabetes and insulin sensitivity; ABCG1, involved in cholesterol and phospholipids transport; and HDAC1, of the HDAC family. (HDAC inhibitors have been proposed as an emerging treatment for diabetes and its complications.) CONCLUSIONS: Our results suggest that differences in peripheral blood DNA methylation are related to cross-sectional markers of glucose metabolism and insulin activity. While some of these DMPs were modestly associated with prospective incident type 2 diabetes, they did not survive multiple testing. Common DMPs with diabetes epigenome-wide association studies from other populations suggest a partially common epigenomic signature of glucose and insulin activity.

Influence of Life-History Parameters on Persistent Organic Pollutant Concentrations in Blubber of Eastern North Pacific Gray Whales (Eschrichtius robustus).

Exposure to persistent organic pollutants (POPs) can significantly impact marine mammal health, reproduction, and fitness. This study addresses a significant 20-year gap in gray whale contaminant monitoring through analysis of POPs in 120 blubber biopsies. The scope of this substantial sample set is noteworthy in its range and diversity with collection between 2003 and 2017 along North America's west coast and across diverse sex, age, and reproductive parameters, including paired mothers and calves. Mean blubber concentrations of polychlorinated biphenyls (∑PCBs), dichlorodiphenyltrichloroethanes (∑DDTs), and chlordanes (∑CHLs) generally decreased since previous reports (1968-1999). This is the first report of polybrominated diphenyl ethers (PBDEs) and select hexachlorocyclohexanes (HCHs) in this species. Statistical modeling of the 19 most frequently detected compounds in this dataset revealed sex-, age-, and reproductive status-related patterns, predominantly attributed to maternal offloading. Mean POP concentrations differed significantly by sex in adults (17 compounds, up to 3-fold higher in males) but not in immatures (all 19 compounds). Mean POP concentrations were significantly greater in adults versus immatures in both males (17 compounds, up to 12-fold) and females (13 compounds, up to 3-fold). POP concentrations were detected with compound-specific patterns in nursing calves, confirming maternal offloading for the first time in this species.

Knowledge Sharing to Reduce Toxin Exposure Risks from Harmful Algal Blooms: Global Networks and Political Barriers.

Harmful algal blooms (HABs) are a significant global environmental management challenge, especially with respect to microalgae that produce dangerous natural toxins. Examples of HAB toxin diseases with major global health impact include: ciguatera poisoning, paralytic shellfish poisoning (PSP), amnesic shellfish poisoning (ASP), diarrhetic shellfish poisoning (DSP), and neurotoxic (brevetoxin) shellfish poisoning (NSP). Such diseases affect communities globally and contribute to health inequalities within the United States and beyond. Sharing data and lessons learned about the factors determining bloom occurrence and associated exposure to contaminated seafood across locations can reduce public health risks. Knowledge sharing is particularly important as ongoing global environmental changes seem to alter the intensity, location, and timing of toxic HAB events, reducing the reliability of conventional guidance where toxin risks have been endemic and leading to emerging challenges in new settings. Political changes that disrupt membership in knowledge-sharing networks may impede efforts to share scientific expertise and best practices. In this commentary, we stress the importance of community and expert knowledge sharing for reducing HAB risks, both for vulnerable communities in the United States and globally. Considering the impacts of political changes, we note the indirect engagement sometimes required for continued participation in international coordination programs. As an example, we highlight how lessons learned from a Native-led toxin monitoring and testing program (the Southeast Alaska Tribal Ocean Research partnership) can inform programs in other settings. We also describe how international knowledge is mutually valuable for this program in Southeast Alaska.

Influences of climate change on long-term time series of persistent organic pollutants (POPs) in Arctic and Antarctic biota.

Time series of contaminants in the Arctic are an important instrument to detect emerging issues and to monitor the effectiveness of chemicals regulation, based on the assumption of a direct reflection of changes in primary emissions. Climate change has the potential to influence these time trends, through direct physical and chemical processes and/or changes in ecosystems. This study was part of an assessment of the Arctic Monitoring and Assessment Programme (AMAP), analysing potential links between changes in climate-related physical and biological variables and time trends of persistent organic pollutants (POPs) in Arctic biota, with some additional information from the Antarctic. Several correlative relationships were identified between POP temporal trends in freshwater and marine biota and physical climate parameters such as oscillation indices, sea-ice coverage, temperature and precipitation, although the mechanisms behind these observations remain poorly understood. Biological data indicate changes in the diet and trophic level of some species, especially seabirds and polar bears, with consequences for their POP exposure. Studies from the Antarctic highlight increased POP availability after iceberg calving. Including physical and/or biological parameters in the POP time trend analysis has led to small deviations in some declining trends, but did generally not change the overall direction of the trend. In addition, regional and temporary perturbations occurred. Effects on POP time trends appear to have been more pronounced in recent years and to show time lags, suggesting that climate-related effects on the long time series might be gaining importance.

Coping with oil spills: oil exposure and anxiety among residents of Gulf Coast states after the Deepwater Horizon Oil Spill.

In April 2010, a fatal explosion on the Deepwater Horizon drilling rig in the Gulf of Mexico resulted in the largest marine oil spill in history. This research describes the association of oil exposure with anxiety after the Deepwater Horizon Oil Spill and evaluates effect modification by self-mastery, emotional support and cleanup participation. To assess the impacts of the Deepwater Horizon Oil Spill, the Centers for Disease Control and Prevention (CDC) conducted the Gulf States Population Survey (GSPS), a random-digit-dial telephone cross-sectional survey completed between December 2010 and December 2011 with 38,361 responses in four different Gulf Coast states: Louisiana, Florida, Alabama and Mississippi. Anxiety severity was measured using the Generalised Anxiety Disorder (GAD) symptom inventory. We used Tobit regression to model underlying anxiety as a function of oil exposure and hypothesised effect modifiers, adjusting for socio-demographics. Latent anxiety was higher among those with direct contact with oil than among those who did not have direct contact with oil in confounder-adjusted models [ß = 2.84, 95% confidence interval (CI): 0.78, 4.91]. Among individuals with direct contact with oil, there was no significant interaction between participating in cleanup activities and emotional support for anxiety (p = 0.20). However, among those with direct contact with oil, in confounder-adjusted models, participation in oil spill cleanup activities was associated with lower latent anxiety (ß = -3.55, 95% CI: -6.15, -0.95). Oil contact was associated with greater anxiety, but this association appeared to be mitigated by cleanup participation.

Exposure patterns among Coast Guard responders to the Deepwater Horizon Oil Spill: A latent class analysis.

Background: The Deepwater Horizon Oil Spill was an environmental crisis for which multiple groups, including the United States Coast Guard (USCG), provided emergency response services. A cohort of 5,665 USCG oil spill responders completed postdeployment surveys eliciting information on a variety of topics, including oil spill-related exposures and experiences. Our objective was to determine the most common exposure patterns among USCG responders. Methods: We used latent class analysis based on six indicator variables reflecting different aspects of the responders' experiences: exposure to oil, exposure to engine exhaust fumes or carbon monoxide, hand sanitizer use, sunblock use, mosquito bites, and level of anxiety. We validated our interpretation of these latent classes using ancillary variables. Results: The model distinguished four distinct exposure profiles, which we interpreted as "low overall exposure" (prevalence estimate = 0.18), "low crude oil/exhaust and moderate time outdoors/anxiety (prevalence estimate = 0.18), "high crude oil/exhaust and moderate time outdoors/anxiety" (prevalence estimate = 0.25), and "high overall exposure" (prevalence estimate = 0.38). The validation analysis was consistent with our interpretation of the latent classes. Conclusions: The exposure patterns identified in this analysis can help inform future studies of the health impacts of exposure mixtures among USCG oil spill responders.

Drought and all-cause mortality in Nebraska from 1980 to 2014: Time-series analyses by age, sex, race, urbanicity and drought severity.

BACKGROUND: Climate change will increase drought duration and severity in many regions around the world, including the Central Plains of North America. However, studies on drought-related health impacts are still sparse. This study aims to explore the potential associations between drought and all-cause mortality in Nebraska from 1980 to 2014. METHODS: The Evaporative Demand Drought Index (EDDI) were used to define short-, medium- and long-term drought exposures, respectively. We used a Bayesian zero-inflated censored negative binomial (ZICNB) regression model to estimate the overall association between drought and annual mortality first in the total population and second in stratified sub-populations based on age, race, sex, and the urbanicity class of the counties. RESULTS: The main findings indicate that there is a slightly negative association between all-cause mortality and all types of droughts in the total population, though the effect is statistically null. The joint-stratified analysis renders significant results for a few sub-groups. White population aged 25-34 and 45-64 in metro counties and 45-54 in non-metro counties were the population more at risk in Nebraska. No positive associations were observed in any race besides white. Black males aged 20-24 and white females older than 85 showed protective effect against drought mainly in metro counties. We also found that more sub-populations had higher rates of mortality with longer-term droughts compared to shorter-term droughts (12-month vs 1- or 6-month timescales), in both metro and non-metro counties, collectively. CONCLUSION: Our results suggest that mortality in middle aged white population in Nebraska shows a greater association with drought. Moreover, women aged 45-54 were more affected than men in non-metro counties. With a projected increase in the frequency and severity of drought due to climate change, understanding these relationships between drought and human health will better inform drought mitigation planning to reduce potential impacts.

Arsenic in private well water and birth outcomes in the United States.

BACKGROUND: Prenatal exposure to drinking water with arsenic concentrations >50 µg/L is associated with adverse birth outcomes, with inconclusive evidence for concentrations ≤50 µg/L. In a collaborative effort by public health experts, hydrologists, and geologists, we used published machine learning model estimates to characterize arsenic concentrations in private wells-federally unregulated for drinking water contaminants-and evaluated associations with birth outcomes throughout the conterminous U.S. METHODS: Using several machine learning models, including boosted regression trees (BRT) and random forest classification (RFC), developed from measured groundwater arsenic concentrations of ∼20,000 private wells, we characterized the probability that arsenic concentrations occurred within specific ranges in groundwater. Probabilistic model estimates and private well usage data were linked by county to all live birth certificates from 2016 (n = 3.6 million). We evaluated associations with gestational age and term birth weight using mixed-effects models, adjusted for potential confounders and incorporated random intercepts for spatial clustering. RESULTS: We generally observed inverse associations with term birth weight. For instance, when using BRT estimates, a 10-percentage point increase in the probability that private well arsenic concentrations exceeded 5 µg/L was associated with a -1.83 g (95% CI: -3.30, -0.38) lower term birth weight after adjusting for covariates. Similarly, a 10-percentage point increase in the probability that private well arsenic concentrations exceeded 10 µg/L was associated with a -2.79 g (95% CI: -4.99, -0.58) lower term birth weight. Associations with gestational age were null. CONCLUSION: In this largest epidemiologic study of arsenic and birth outcomes to date, we did not observe associations of modeled arsenic estimates in private wells with gestational age and found modest inverse associations with term birth weight. Study limitations may have obscured true associations, including measurement error stemming from a lack of individual-level information on primary water sources, water arsenic concentrations, and water consumption patterns.

Considerations towards the better integration of epidemiology into quantitative risk assessment.

Environmental epidemiology has proven critical to study various associations between environmental exposures and adverse human health effects. However, there is a perception that it often does not sufficiently inform quantitative risk assessment. To help address this concern, in 2017, the Health and Environmental Sciences Institute initiated a project engaging the epidemiology, exposure science, and risk assessment communities with tripartite representation from government agencies, industry, and academia, in a dialogue on the use of environmental epidemiology for quantitative risk assessment and public health decision making. As part of this project, four meetings attended by experts in epidemiology, exposure science, toxicology, statistics, and risk assessment, as well as one additional meeting engaging funding agencies, were organized to explore incentives and barriers to realizing the full potential of epidemiological data in quantitative risk assessment. A set of questions was shared with workshop participants prior to the meetings, and two case studies were used to support the discussion. Five key ideas emerged from these meetings as areas of desired improvement to ensure that human data can more consistently become an integral part of quantitative risk assessment: 1) reducing confirmation and publication bias, 2) increasing communication with funding agencies to raise awareness of research needs, 3) developing alternative funding channels targeted to support quantitative risk assessment, 4) making data available for reuse and analysis, and 5) developing cross-disciplinary and cross-sectoral interactions, collaborations, and training. We explored and integrated these themes into a roadmap illustrating the need for a multi-stakeholder effort to ensure that epidemiological data can fully contribute to the quantitative evaluation of human health risks, and to build confidence in a reliable decision-making process that leverages the totality of scientific evidence.

The association of arsenic exposure and arsenic metabolism with all-cause, cardiovascular and cancer mortality in the Strong Heart Study.

The effect of low-moderate levels of arsenic exposure and of arsenic metabolism on mortality remains uncertain. We used data from a prospective cohort study in 3600 men and women aged 45 to 75 years living in Arizona, Oklahoma, and North and South Dakota. The biomarker of inorganic arsenic exposure was the sum of urine inorganic (iAs), monomethylated (MMA) and dimethylated (DMA) arsenic compounds (Æ©As) at baseline. The proportions of urine iAs, MMA and DMA over the Æ©iAs, expressed as iAs%, MMA%, and DMA%, respectively, were used as biomarkers of arsenic metabolism. Arsenic exposure and arsenic metabolism were associated with all-cause, cardiovascular, and cancer mortality. For each interquartile range (IQR) increase in Æ©As (12.5 µg/L, overall range 0.7-194.1 µg/L), the adjusted hazard ratios (aHRs) were 1.28 (95% CI 1.16-1.41) for all-cause mortality, 1.28 (1.08-1.52) for cardiovascular mortality and 1.15 (0.92-1.44) for cancer mortality. The aHR for mortality for each IQR increase in MMA%, when iAs% is decreasing, was 1.52 (95% CI 1.16-1.99) for cardiovascular disease, 0.73 (0.55-0.98) for cancer, and 1.03 (0.90-1.19) for all-cause mortality. These findings at low-moderate levels of arsenic exposure highlight the need to implement public health measures to protect populations from involuntary arsenic exposure and for research to advance the biological and clinical understanding of arsenic-related health effects in general populations.

Screening for Predictors of Chronic Ciguatera Poisoning: An Exploratory Analysis among Hospitalized Cases from French Polynesia.

Ciguatera poisoning is a globally occurring seafood disease caused by the ingestion of marine products contaminated with dinoflagellate produced neurotoxins. Persistent forms of ciguatera, which prove to be highly debilitating, are poorly studied and represent a significant medical issue. The present study aims to better understand chronic ciguatera manifestations and identify potential predictive factors for their duration. Medical files of 49 patients were analyzed, and the post-hospitalization evolution of the disease assessed through a follow-up questionnaire. A rigorous logistic lasso regression model was applied to select significant predictors from a list of 37 patient characteristics potentially predictive of having chronic symptoms. Missing data were handled by complete case analysis, and a survival analysis was implemented. All models used standardized variables, and multiple comparisons in the survival analyses were handled by Bonferroni correction. Among all studied variables, five significant predictors of having symptoms lasting ≥3 months were identified: age, tobacco consumption, acute bradycardia, laboratory measures of urea, and neutrophils. This exploratory, hypothesis-generating study contributes to the development of ciguatera epidemiology by narrowing the list from 37 possible predictors to a list of five predictors that seem worth further investigation as candidate risk factors in more targeted studies of ciguatera symptom duration.