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Food consumption based on the nutrient profile system underlying the Nutri-Score and renal function in older adults
(Elsevier, 2022-05-14) Montero-Salazar, Henry; Guallar Castillón, Pilar; Banegas, José Ramón; Åkesson, Agneta; Rey García, Jimena; Rodríguez-Artalejo, Fernando; Donat Vargas, Carolina
Background: The impact of the Nutri-Score labelling system on renal function is unknown. Objective: To assess the association between food consumption based on the nutrient profile system underlying the Nutri-Score and renal function decline in older adults. Methods: We used data from the Spain-based Seniors-ENRICA cohort, a study with 1312 community-dwelling adults aged ≥60 years recruited during 2008-2010 and followed up to December 2015. At baseline, a validated dietary history was obtained. Based on their nutritional quality, foods consumed were categorized into five labels (A/Green-best quality, B, C, D, E/Red-worst quality) using the established Nutri-Score algorithm. For each participant, a Nutri-Score dietary index (DI) was calculated in g/day/kg of weight. At baseline and at follow-up, measured serum creatinine (SCr) and estimated glomerular filtration rate (eGFR) levels were obtained, and time changes were calculated. A combined outcome for renal decline was defined as: any increase in SCr or any decrease in eGFR beyond expected-for-age. Statistical analyses were performed with logistic regression adjusting for socioeconomic, lifestyle, total energy intake, fresh foods, and comorbidity confounders. Results: A total of 183 cases of renal-function decline occurred over a mean 6-year follow-up. Participants with a higher (less favorable) Nutri-Score DI (interquartile range (IQR)13.2-17.7 (g/day/kg of weight); 46 cases) had higher probability of renal decline than those with a lower Nutri-Score DI (IQR 36.6-46.2; 44 cases); the corresponding odds ratios (95% confidence interval) across increasing quartiles of Nutri-Score DI were 1 (reference), 1.26 (0.78-2.04), 1.55 (0.92-2.62), and 1.82 (1.01-3.30), P-trend = 0.045. Per each 10-point increase in the Nutri-Score DI the odds of renal decline increased by 27% (6%-52%). Conclusions: Higher Nutri-Score DI, reflecting the consumption of foods with less favourable Nutri-Score rating, was associated with higher kidney function decline in older adults. Consequently, Nutri-Score labeling might be a useful policy tool for preventing kidney function decline, adding to the potential health benefits of this front-of-pack labelling system.
Only virgin type of olive oil consumption reduces the risk of mortality. Results from a Mediterranean population-based cohort
(Nature Publishing Group, 2022-10-14) Donat Vargas, Carolina; López-García, Esther; Banegas, José Ramón; Martínez-González, Miguel Ángel, 1957-; Rodríguez-Artalejo, Fernando; Guallar Castillón, Pilar
Background: Evidence on the association between virgin olive oil (OO) and mortality is limited since no attempt has previously been made to discern about main OO varieties.Objective: We examined the association between OO consumption (differentiating by common and virgin varieties) and total as well as cause-specific long-term mortality METHODS: 12,161 individuals, representative of the Spanish population ≥18 years old, were recruited between 2008 and 2010 and followed up through 2019. Habitual food consumption was collected at baseline with a validated computerized dietary history. The association between tertiles of OO main varieties and all-cause, cardiovascular and cancer mortality were analyzed using Cox models.Results: After a mean follow-up of 10.7 years (129,272 person-years), 143 cardiovascular deaths, and 146 cancer deaths occurred. The hazard ratio (HR) (95% confidence interval) for all-cause mortality in the highest tertile of common and virgin OO consumption were 0.96 (0.75-1.23; P-trend 0.891) and 0.66 (0.49-0.90; P-trend 0.040). The HR for all-cause mortality per a 10 g/day increase in virgin OO was 0.91 (0.83-1.00). Virgin OO consumption was also inversely associated with cardiovascular mortality, with a HR of 0.43 (0.20-0.91; P-trend 0.017), but common OO was not, with a HR of 0.88 (0.49-1.60; P-trend 0.242). No variety of OO was associated with cancer mortality.Conclusion: Daily moderate consumption of virgin OO (1 and 1/2 tablespoons) was associated with a one-third lower risk of all-cause as well as half the risk of cardiovascular mortality. These effects were not seen for common OO. These findings may be useful to reappraise dietary guidelines.
Urinary phosphate is associated with cardiovascular disease incidence
(Wiley, 2023-06-26) Donat Vargas, Carolina; Guallar Castillón, Pilar; Nyström, Jenny; Larsson, Susanna C.; Kippler, Maria; Vahter, Marie; Faxén-Irving, Gerd; Michaëlsson, Karl; Wolk, Alicja; Stenvinkel, Peter; Åkesson, Agneta
Introduction: Elevated phosphate (P) in urine may reflect a high intake of inorganic P salts from food additives. Elevated P in plasma is linked to vascular dysfunction and calcification. Objective: To explore associations between P in urine as well as in plasma and questionnaire-estimated P intake, and incidence of cardiovascular disease (CVD). Methods: We used the Swedish Mammography Cohort-Clinical, a population-based cohort study. At baseline (2004-2009), P was measured in urine and plasma in 1625 women. Dietary P was estimated via a food-frequency questionnaire. Incident CVD was ascertained via register-linkage. Associations were assessed using Cox proportional hazards regression. Results: After a median follow-up of 9.4 years, 164 composite CVD cases occurred (63 myocardial infarctions [MIs] and 101 strokes). Median P (percentiles 5-95) in urine and plasma were 2.4 (1.40-3.79) mmol/mmol creatinine and 1.13 (0.92-1.36) mmol/L, respectively, whereas dietary P intake was 1510 (1148-1918) mg/day. No correlations were observed between urinary and plasma P (r = -0.07) or dietary P (r = 0.10). Urinary P was associated with composite CVD and MI. The hazard ratio of CVD comparing extreme tertiles was 1.57 (95% confidence interval 1.05, 2.35; P trend 0.037)-independently of sodium excretion, the estimated glomerular filtration rate, both P and calcium in plasma, and diuretic use. Association with CVD for plasma P was 1.41 (0.96, 2.07; P trend 0.077). Conclusion: Higher level of urinary P, likely reflecting a high consumption of highly processed foods, was linked to CVD. Further investigation is needed to evaluate the potential cardiovascular toxicity associated with excessive intake of P beyond nutritional requirements.
Emergence of Oropouche virus among international travelers: A growing concern in non-endemic areas Aparición del virus Oropouche entre viajeros internacionales: una preocupación creciente en zonas no endémicas
(Elsevier, 2025-10-01) Peiró Mestres, Aida; Riera González, Elisa; Flores Calderón, Claudia; Navero Castillejos, Jessica; Martínez Yoldi, Miguel Julián; Camprubí Ferrer, Daniel
Introduction Oropouche fever is an emerging disease caused by an arthropod-borne virus, Oropouche virus. This virus is mainly circulating in Central and South America. In 2024 they have been reported an ongoing outbreak. Methods For this study, travelers returning from endemic areas with dengue-like symptoms and negative results for dengue from March to October 2024, were tested for Oropouche through RT-PCR. Results Among 43 patients tested, we detected an imported case of Oropouche fever imported from Cuba in a traveler presenting biphasic fever and neurological symptoms. The virus was detected by RT-PCR in urine samples collected more than one month after the onset of symptoms, suggesting prolonged viral shedding and expanding the diagnostic period for molecular confirmation of the infection. Conclusion Although only few cases have been yet reported in European travelers, the expansion of the virus in the Americas supports laboratory preparedness and clinical awareness.
Global assessment of chemical quality of drinking water: The case of trihalomethanes
(Elsevier Ltd., 2023-01-03) Eng, Amanda; Janák, Karel; Rush, Samantha C.; Reckhow, David; Krasner, Stuart W.; Vineis, Paolo; Richardson, Susan D.; Kogevinas, Manolis; Rodriguez-Susa, Manuel; Luzati, Arben; de Cássia Dos Santos Nery, Telma; Pastén, Pablo A.; Quiñones, Marisa; Regli, Stig; Weisman, Richard; Dong, Shaoxia; Ha, Mina; Phattarapattamawong, Songkeart; Villanueva, Cristina M.; Evlampidou, Iro; Ibrahim, Fathelrahman; Donat Vargas, Carolina; Valentín, Antònia; Tugulea, Anca Maria; Echigo, Shinya; Jovanovic, Dragana; Lebedev, Albert T.; Lemus-Pérez, Mildred; Manasfi, Tarek; Musah, Shaibu-Imodagbe Egbenya
Background: Trihalomethanes (THM), a major class of disinfection by-products, are widespread and are associated with adverse health effects. We conducted a global evaluation of current THM regulations and concentrations in drinking water.Methods: We included 120 countries (∼7000 million inhabitants in 2016), representing 94% of the world population. We searched for country regulations and THM routine monitoring data using a questionnaire addressed to referent contacts. Scientific and gray literature was reviewed where contacts were not identified or declined participation. We obtained or estimated annual average THM concentrations, weighted to the population served when possible.Results: Drinking water regulations were ascertained for 116/120 (97%) countries, with 89/116 (77%) including THM regulations. Routine monitoring was implemented in 47/89 (53%) of countries with THM regulations. THM data with a varying population coverage was obtained for 69/120 (58%) countries consisting of ∼5600 million inhabitants (76% of world's population in 2016). Population coverage was ≥90% in 14 countries, mostly in the Global North, 50-89% in 19 countries, 11-49% among 21 countries, and ≤10% in 14 countries including India, China, Russian Federation and Nigeria (40% of world's population).Discussion: An enormous gap exists in THM regulatory status, routine monitoring practice, reporting and data availability among countries, especially between high- vs. low- and middle-income countries (LMICs). More efforts are warranted to regulate and systematically assess chemical quality of drinking water, centralize, harmonize, and openly report data, particularly in LMICs.
Per- and polyfluoroalkyl substances and cardiometabolic diseases: A review
(Wiley, 2023-10-22) Schillemans, Tessa; Donat Vargas, Carolina; Åkesson, Agneta
Per- and polyfluoroalkyl substances (PFAS) are a group of persistent and widespread environmental pollutants that represent a high concern for human health. They have been shown to be associated with several important physiological processes such as lipid metabolism and the immune system. Consequently, PFAS are suspected to play a role in cardiometabolic disease development. However, the evidence regarding associations between PFAS and overt cardiovascular disease and type 2 diabetes remains limited and inconsistent. To address this, we conducted a review of the epidemiological evidence. A deeper understanding of potential underlying molecular mechanisms may help to explain inconsistencies in epidemiological findings. Thus, to gain more mechanistic insight, we also summarized evidence from omics and laboratory studies into an adverse outcome pathway framework. Our observations indicate the potential for associations of PFAS with multiple molecular pathways that could have opposite associations with disease risk, which could be further modified by mixture composition, lifestyle factors or genetic polymorphisms. This identifies the need for exposome studies considering mixture effects, the use of multi-omics data to gain insight in relevant pathways and the integration of epidemiological and laboratory studies to enhance mechanistic understanding and causal inference. Improved comprehension is essential for environmental health risk assessments.
Understanding public perceptions and discussions on opioids through Twitter: Cross-sectional infodemiology study
(JMIR Publications, 2023-10-31) Carabot, Federico; Fraile-Martínez, Óscar; Donat Vargas, Carolina; Santoma-Vilaclara, Javier; García-Montero, Cielo; Pinto da Costa, Mariana; Molina-Ruiz, Rosa M.; Ortega, Miguel Ángel; Álvarez-Mon, Melchor; Álvarez-Mon, Miguel Ángel
Background: Opioids are used for the treatment of refractory pain, but their inappropriate use has detrimental consequences for health. Understanding the current experiences and perceptions of patients in a spontaneous and colloquial environment regarding the key drugs involved in the opioid crisis is of utmost significance. Objective: The study aims to analyze Twitter content related to opioids, with objectives including characterizing users participating in these conversations, identifying prevalent topics and gauging public perception, assessing opinions on drug efficacy and tolerability, and detecting discussions related to drug dispensing, prescription, or acquisition. Methods: In this cross-sectional study, we gathered public tweets concerning major opioids posted in English or Spanish between January 1, 2019, and December 31, 2020. A total of 256,218 tweets were collected. Approximately 27% (69,222/256,218) were excluded. Subsequently, 7000 tweets were subjected to manual analysis based on a codebook developed by the researchers. The remaining databases underwent analysis using machine learning classifiers. In the codebook, the type of user was the initial classification domain. We differentiated between patients, family members and friends, health care professionals, and institutions. Next, a distinction was made between medical and nonmedical content. If it was medical in nature, we classified it according to whether it referred to the drug's efficacy or adverse effects. In nonmedical content tweets, we analyzed whether the content referred to management issues (eg, pharmacy dispensation, medical appointment prescriptions, commercial advertisements, or legal aspects) or the trivialization of the drug. Results: Among the entire array of scrutinized pharmaceuticals, fentanyl emerged as the predominant subject, featuring in 27% (39,997/148,335 posts) of the tweets. Concerning user categorization, roughly 70% (101,259/148,335) were classified as patients. Nevertheless, tweets posted by health care professionals obtained the highest number of retweets (37/16,956, 0.2% of their posts received over 100 retweets). We found statistically significant differences in the distribution concerning efficacy and side effects among distinct drug categories (P<.001). Nearly 60% (84,401/148,335) of the posts were devoted to nonmedical subjects. Within this category, legal facets and recreational use surfaced as the most prevalent themes, while in the medical discourse, efficacy constituted the most frequent topic, with over 90% (45,621/48,777) of instances characterizing it as poor or null. The opioid with the greatest proportion of tweets concerning legal considerations was fentanyl. Furthermore, fentanyl was the drug most frequently offered for sale on Twitter, while methadone generated the most tweets about pharmacy delivery. Conclusions: The opioid crisis is present on social media, where tweets discuss legal and recreational use. Opioid users are the most active participants, prioritizing medication efficacy over side effects. Surprisingly, health care professionals generate the most engagement, indicating their positive reception. Authorities must monitor web-based opioid discussions to detect illicit acquisitions and recreational use.
Per- and polyfluoroalkyl substances (PFAS) and fetal growth: A nation-wide register-based study on PFAS in drinking water
(Elsevier Ltd., 2024-05-08) Säve-Söderbergh, Melle; Gyllenhammar, Irina; Schillemans, Tessa; Lindfeldt, Emelie; Vogs, Carolina; Donat Vargas, Carolina; Ankarberg, Emma; Glynn, Anders; Ahrens, Lutz; Helte, Emilie; Åkesson, Agneta
Background: There is inconclusive evidence for an association between per- and polyfluoroalkyl substances (PFAS) and fetal growth. Objectives: We conducted a nation-wide register-based cohort study to assess the associations of the estimated maternal exposure to the sum (PFAS4) of perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA) and perfluorohexane sulfonic acid (PFHxS) with birthweight as well as risk of small- (SGA) and large-for-gestational-age (LGA). Materials and methods: We included all births in Sweden during 2012-2018 of mothers residing ≥ four years prior to partus in localities served by municipal drinking water where PFAS were measured in raw and drinking water. Using a one-compartment toxicokinetic model we estimated cumulative maternal blood levels of PFAS4 during pregnancy by linking residential history, municipal PFAS water concentration and year-specific background serum PFAS concentrations in Sweden. Individual birth outcomes and covariates were obtained via register linkage. Mean values and 95 % confidence intervals (CI) of β coefficients and odds ratios (OR) were estimated by linear and logistic regressions, respectively. Quantile g-computation regression was conducted to assess the impact of PFAS4 mixture. Results: Among the 248,804 singleton newborns included, no overall association was observed for PFAS4 and birthweight or SGA. However, an association was seen for LGA, multivariable-adjusted OR 1.08 (95% CI: 1.01-1.16) when comparing the highest PFAS4 quartile to the lowest. These associations remained for mixture effect approach where all PFAS, except for PFOA, contributed with a positive weight. Discussions: We observed an association of the sum of PFAS4 - especially PFOS - with increased risk of LGA, but not with SGA or birthweight. The limitations linked to the exposure assessment still require caution in the interpretation.
Analysis of user-generated posts on social media of adjuvant analgesics: A machine learning study
(Ivyspring International, 2025-01-01) Carabot, Federico; Álvarez-Mon, Miguel Ángel; Donat Vargas, Carolina; Lara-Abelenda, Francisco J.; Fraile-Martínez, Oscar; Santoma-Vilaclara, Javier; García-Montero, Cielo; Valadés, Teresa; Gutiérrez-Rojas, Luis; Martínez González, Miguel A.; Ortega, Miguel Ángel; Álvarez-Mon, Melchor
Background: Antiepileptics and antidepressants are frequently prescribed for chronic pain, but their efficacy and potential adverse effects raise concerns, including dependency issues. Increased prescriptions, sometimes fraudulent, prompted reclassification of antiepileptics in some countries. Our aim is to comprehend opinions, perceptions, beliefs, and attitudes towards co-analgesics from online discussions on X (formerly known as Twitter), offering insights closer to reality than conventional surveys. Methods: In this cross-sectional study, we collected 77,183 public posts about co-analgesics in English or Spanish from January 1st 2019 to December 31st, 2020. A total of 51,167 post were included, and 2,000 were manually analyzed using a researcher-created codebook. Machine learning classifiers were then applied to the remaining datasets to determine the number of publications for each user type and identify categories through content analysis. Results: Of the 51,167 posts analyzed, 78% discussed anticonvulsants and 24% discussed analgesic antidepressants (Percentages add up to more than 100% because there were 1,300 posts containing references to both types of medications). Only 13% were authored by healthcare professionals, while 67% were from patients. Medical content predominated, with 70% noting low medication efficacy and almost 50% referencing side effects. Non-medical content included challenges in dispensing (25%), complaints about high costs (15%), and trivialization of medication use (10%). Conclusions: This study offers valuable insights into public perceptions of co-analgesics. Findings aid in designing public health communications to raise awareness of associated risks, urging both healthcare providers and the public to optimize drug use.
Assessment of beliefs and attitudes towards benzodiazepines using machine learning based on social media posts: An observational study
(BioMed Central, 2024-10-08) Álvarez-Mon, Melchor; Quintero Gutiérrez del Álamo, Javier; de Anta, Laura; Álvarez-Mon, Miguel Ángel; Pereira-Sanchez, Victor; Donat Vargas, Carolina; Lara-Abelenda, Francisco J.; Arrieta, María; Montero-Torres, María; García-Montero, Cielo; Fraile-Martínez, Óscar; Mora Mínguez, Fernando; Ortega, Miguel Ángel
Background: Benzodiazepines are frequently prescribed drugs; however, their prolonged use can lead to tolerance, dependence, and other adverse effects. Despite these risks, long-term use remains common, presenting a public health concern. This study aims to explore the beliefs and opinions held by the public regarding benzodiazepines, as understanding these perspectives may provide insights into their usage patterns. Methods: We collected public tweets published in English between January 1, 2019, and October 31, 2020, that mentioned benzodiazepines. The content of each tweet and the characteristics of the users were analyzed using a mixed-method approach, including manual analysis and semi-supervised machine learning. Results: Over half of the Twitter users highlighted the efficacy of benzodiazepines, with minimal discussion of their side effects. The most active participants in these conversations were patients and their families, with health professionals and institutions being notably absent. Additionally, the drugs most frequently mentioned corresponded with those most commonly prescribed by healthcare professionals. Conclusions: Social media platforms offer valuable insights into users' experiences and opinions regarding medications. Notably, the sentiment towards benzodiazepines is predominantly positive, with users viewing them as effective while rarely mentioning side effects. This analysis underscores the need to educate physicians, patients, and their families about the potential risks associated with benzodiazepine use and to promote clinical guidelines that support the proper management of these medications.
Metabolic Screening of Gut Microbiota by Fourier-Transform Infrared Spectroscopy
(American Chemical Society, 2026-06-12) Sayol Altarriba, Anna; Aira Gómez, Andrea; Martín-López, Eva; Villasante, Anna; Albarracín, Rosa; Faneca, Joana; Pitart, Cristina; Roca Subirà, Ignasi; Casals Mercadal, Gregori; Marco Colás, Santiago; Villanueva Cañas, José Luis; Casals Pascual, Climent
Short-chain fatty acids (SCFAs) are bacterial metabolites with crucial roles in host homeostasis and immune system modulation. Given their benefits, they have been proposed as markers of healthy microbiota. However, accurate SCFA quantification typically requires gas chromatography coupled with mass spectrometry (GC-MS), which is time-consuming, expensive, and requires specialized personnel and equipment, limiting its routine use for stool quality assessment in clinical contexts. In this initial feasibility study, we explored the use of Fourier transform infrared (FT-IR) spectroscopy as a rapid metabolic screening approach for stool samples. Analysis of SCFA-associated spectral windows enhanced discrimination between healthy and dysbiotic stool samples with Clostridioides difficile infection using principal component analysis. FT-IR is not intended to replace GC-MS for precise SCFA quantification but rather to provide a rapid screening of metabolically relevant differences. Although additional validation is still needed, the present study provides a robust proof-of-concept demonstrating the feasibility of applying FT-IR spectroscopy to clinical stool samples. Combined with the widespread availability of this technology in most hospitals, these advantages highlight its potential for future development as a tool for routine screening in clinical laboratories.
Characterizing Aeromonas spp. as a Potential Sentinel Organism for Antimicrobial Resistance Dissemination in Wastewater and Drinking Water Treatment Systems: A Case Study in the Barcelona Metropolitan Area, Spain
(MDPI, 2026-03-01) Mondéjar, Laura; Gabasa, Yaiza; Castellsagués, Laura; Vilaró, Carles; Galofre, Belén; González-Díaz, Aida; Martí Martí, Sara; Sanz, Sergi; Soto González, Sara M.; Ballén, Victoria; Pinar-Méndez, Anna
Background: Wastewater treatment plants (WWTPs) are hotspots of antimicrobial resistance (AMR) due to inputs from diverse anthropogenic sources. Aeromonas spp., ubiquitous in aquatic environments, often carry clinically relevant antibiotic resistance genes (ARGs) and can persist beyond fecal contamination indicators, making them promising sentinel organisms for AMR dissemination. The aim of this study was to assess the suitability of Aeromonas spp. in this role by characterizing resistance profiles, associated virulence factor genes (VFGs), genetic mobility, and persistence across wastewater and drinking water treatment processes in the Barcelona metropolitan area, Spain. Methods: Isolates were phenotypically characterized and screened for ARGs, VFGs, integrons, and heavy metal tolerance genes, followed by whole-genome sequencing (WGS). Biofilm formation was assessed in vitro. Conjugation assays with Escherichia coli evaluated horizontal gene transfer (HGT) potential. Results: A total of 428 antibiotic-resistant Aeromonas spp., the most abundant antibiotic-resistant bacteria isolated during the 2023 sampling campaigns from two WWTPs and one drinking water treatment plant (DWTP), were characterized. Trimethoprim/sulfamethoxazole (SXT) non-susceptibility was most frequent (72%), followed by cefoxitin resistance (65.4%). The sul1 (57.5%) and blaMOX (78.6%) genes predominated among SXT- and β-lactam-resistant isolates. The merA gene was detected in 23.6%; 97.9% harbored at least one VFG (aerA, act, fla, alt, or hlyA), and 70.3% carried intI1. Half formed biofilm. Conjugation confirmed bi-directional HGT, and WGS revealed persistent ST3458 clones across treatment stages. Conclusions: WWTPs and DWTPs act as reservoirs of antibiotic-resistant Aeromonas spp., demonstrating persistence and HGT potential. Findings support their use as sentinel organisms for AMR surveillance in aquatic environments and for assessing treatment efficacy, highlighting variability across treatment types and locations, and reinforcing their relevance for urban water reclamation monitoring. Keywords: Aeromonas spp.; antimicrobial resistance; antibiotic resistance genes; wastewater treatment plants; drinking water treatment; horizontal gene transfer; biofilms; environmental surveillance
Fetal exposure to perfluoroalkyl substances (PFAS) in drinking water and congenital malformations: A nation-wide register-based study on PFAS in drinking water
(Elsevier Ltd., 2025-03-14) Säve-Söderbergh, Melle; Gyllenhammar, Irina; Schillemans, Tessa; Lindfeldt, Emelie; Vogs, Carolina; Donat Vargas, Carolina; Ankarberg, E. H.; Glynn, Anders; Ahrens, Lutz; Helte, Emilie; Åkesson, Agneta
Background: Teratogenic properties of perfluoroalkyl substances (PFAS) have been assessed in a few studies, however, epidemiological evidence for an association is inconclusive. Objectives: We conducted a Swedish nation-wide register-based cohort study to assess the associations of estimated fetal exposure to the sum of drinking water perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA) and perfluorohexane sulfonic acid (PFHxS) with major congenital malformations. Methods: We included all births in Sweden during 2012-2018 of mothers residing ≥four years prior to partus in localities served by municipal drinking water where PFAS concentrations have been measured in drinking water. We estimated the fetal PFAS4 exposure by using a one-compartment toxicokinetic model - including maternal residential history, municipal PFAS water concentration and year-specific PFAS maternal background concentrations as input data - and accounting thereafter PFAS-specific transplacental transfer factors to estimate the fetal PFAS4 exposure. By register linkage we obtained birth outcomes and covariates. Odd ratios (OR) and 95 % confidence intervals (CI) of the associations between estimated PFAS in foetuses and major congenital malformations were estimated by logistic regressions and, complementary, by quantile g-computation regression for mixture effects. Results: Analyses of 256,659 newborns of which 5,357 were diagnosed with major congenital malformations, revealed associations between fetal PFAS4 exposure and malformations on the nervous system OR, 2.84 (95 % CI: 1.38-5.84, p-trend: 0.008) and chromosomal anomalies OR, 1.50 (95 % CI: 1.07-2.10, p-trend: 0.009) comparing extreme quartiles. For the individual PFAS and in the quantile g-computation model, there were indications of an association between PFAS and urinary defects, OR 1.96 (95 % CI: 1.59-2.43, p-trend mixed effect: <0.001), primarily driven by PFOA and PFHxS. Discussion: Modelled fetal sum of PFAS4 was associated with malformations of the nervous system and chromosomal anomalies, while the mixture assessment revealed associations with defects on urinary system. As the underlying toxicological mechanisms remains unclear, further investigation is warranted.
Per- and polyfluoroalkyl substances (PFAS) in drinking water, gestational diabetes mellitus, hypertension and preeclampsia: A nation-wide register-based study on PFAS in drinking water
(Elsevier Ltd., 2025-03-26) Gyllenhammar, Irina; Schillemans, Tessa; Lindfeldt, Emelie; Vogs, Carolina; Donat Vargas, Carolina; Helte, Emilie; Ankarberg, Emma; Glynn, Anders; Ahrens, Lutz; Åkesson, Agneta; Säve-Söderbergh, Melle
Background: There is inconclusive evidence of associations between exposure to per- and polyfluoroalkyl substances (PFAS) and diabetes and hypertensive disorders during pregnancy. Objectives: We conducted a nation-wide register-based cohort study to assess the associations of the estimated maternal drinking water exposure to the sum of four major PFAS (PFAS4; perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA), perfluorononanoate (PFNA) and perfluorohexanoate (PFHxS)) with gestational diabetes mellitus (GDM), hypertension and preeclampsia. Materials and methods: We included nulliparous women giving birth in Sweden during 2012-2018 in large localities served by municipal drinking water where PFAS were measured in raw and drinking water. Using a one-compartment toxicokinetic model, we estimated cumulative maternal blood levels of PFAS4 during pregnancy considering residential history, municipal PFAS water concentration and year-specific maternal PFAS background serum levels. The outcomes and individual covariates were ascertained via register linkage. Mean values and 95% Confidence Intervals (CI) of Odds Ratios (OR) were estimated by logistic regression. Results: Among the 109,031 nulliparous women included, with an estimated average 7.8 ng PFAS4/mL serum (standard deviation: 2.0 ng/mL), there were indications of a non-monotonic inverse association for PFAS4 and GDM, corresponding to multivariable-adjusted OR 0.72 (95 % CI: 0.61-0.84) when comparing extreme quartiles. An inverse association were also seen for each PFAS individually. No clear associations were seen for hypertension or preeclampsia, although individual PFAS indicated significant associations, both inverse (PFAS and PFHxS) and direct (PFOS and PFNA) for hypertension. Conclusion: In the present study, we observed indications of inverse, non-monotonic associations for PFAS4 and GDM. Some individual PFAS were also associated with hypertension, both direct and inverse. The limitations linked to the exposure assessment still require caution in the interpretation.
Longitudinal assessment of nitrate and trihalomethanes in drinking-water and breast cancer in the CONSTANCES cohort: a prospective population-based study in France
(Elsevier Ltd., 2025-10-11) Lafontaine, Antoine; Donat Vargas, Carolina; Lequy, Emeline; Lee, Sewon; Glorennec, Philippe; Le Bot, Barbara; Goldberg, Marcel; Zins, Marie; Jacquemin, Bénédicte; Villanueva, Cristina M.
Nitrate and trihalomethanes (THMs) in drinking water are widespread and potential human carcinogens. We evaluated the association between time-varying exposure to nitrate and THMs in drinking water and female breast cancer (BC) among adults from CONSTANCES, a large French population-based prospective cohort. Our analysis included 26,669 women (18.5-72.5 years old) enrolled in 2012-2020, followed until 2021, with information on residential history, type of water consumed, type of filter used, and bathing and showering frequency. We used water quality data for 2004-2020 from the drinking surveillance national database (SISE-Eaux). Annual median concentrations of nitrate, chloroform, chlorodibromomethane, bromodichloromethane, and bromoform at the participants' residential addresses were estimated. Waterborne ingested exposure was estimated considering type of water, filter used, and liters/day consumed. Estimated exposure in showers and baths combined residential concentrations with showers/baths duration and frequency. Incident BC cases were ascertained in the French national health data system (SNDS) for 2012-2021. Extended Cox models with attained age as time-scale and time-varying weighted average exposures, adjusted for individual and area-level covariables, were used to estimate hazard ratios (HR) and confidence intervals (CI) by exposure tertiles. Average age at enrolment was 49.3 years, and median exposure window was 13 years. Median follow-up was 5 years (153,742 person-years), resulting in 437 new BC diagnoses. Median residential nitrate, brominated (Br)-THMs and chloroform concentrations were, respectively, 15.8 mg/L, 14.2 μg/L, and 2.7 μg/L. HR (95 %CI) of BC associated with waterborne ingested nitrate (mg/day) for the second (>4.8-15.1) and third tertile (>15.1) compared to the first (≤4.8) were 1.35 (1.01-1.81) and 1.51 (1.10-2.07), respectively. Residential THM concentrations were not associated with BC, however HR (95 %CI) of BC for showering and bathing Br-THMs exposure (μg/L × min/day) was 1.18 (0.84-1.64) for the third (>125) vs. first tertile (≤51.5). Findings suggest that ingested nitrate could be a risk factor of BC.
Association of faecal and urinary micro- and nanoplastics with markers of gut integrity and renal function
(Elsevier, 2026-03-04) Miguela-Benavides, Maria; Calikanzaros, Emma; Donat Vargas, Carolina; Aguilar, Ruth; Raimondi, Felipe; Iraola Guzmán, Susana; Dobaño, Carlota, 1969-; Cid, Rafael de; Llorca Casamayor, Marta; Farré Albaladejo, Magí; Villanueva, Cristina M.
Micro and nanoplastics (MNPs) constitute an emerging environmental concern due to their persistence and ubiquity, but evidence on health effects remains limited. We explored the association between MNPs exposure and markers of gut integrity and renal function in a cross-sectional study in Barcelona (Spain). We enrolled 50 healthy adults who self-collected spot urine and stool samples. MNPs (0.7-20 μm) were measured using high-performance liquid chromatography coupled to high-resolution mass spectrometry (HPLC-HRMS). Calprotectin, zonulin, lysozyme, β-defensin-2 and lactoferrin were measured in stool samples via ELISA. Urea, creatinine and albumin were measured in urine through kinetic and immunoturbidimetric methods. Generalized linear models adjusting for potential confounders were performed to evaluate the association between MNP presence in biological samples and the mentioned biomarkers. Six MNP polymers were detected across 52% of stool and 48% of urine samples. Polyamide was the most frequently detected polymer in stool (34%) and urine samples (16%). Polypropylene (PP) detection in stool was negatively associated with calprotectin (Ratio of means-ROM [95%CI] = 0.52 [0.31-0.94]). In urine, the presence of any MNP polymer was positively associated with the albumin-creatinine ratio (uACR) (ROM [95%CI] = 2.18 [1.17-4.01]). Negative associations between PP in stool and lactoferrin, and polybutene-1 (PB1) in urine and uACR were observed, although these must be cautiously interpreted due to substantial lactoferrin measurement variability (lactoferrin undetected in 32% of samples) and a small number of PB1 detected samples (N = 5). Findings of this exploratory study suggest oral exposure to MNPs may be associated with renal function and gut integrity.
Time to positivity as a diagnostic tool for catheter-related candidemia: a species-specific analysis
(Elsevier B.V., 2026-09) Albanell Fernández, Marta; Vergara Gómez, Andrea; Cardozo Espinola, Celia; Herrera, Sabina; Verdejo, Miguel Ángel; Malano-Barletta, Daniel; Pitart, Cristina; Hernández Meneses, Marta; Cuervo Requena, Guillermo; García Vidal, Carolina; López, Néstor; Rio, Ana del; Espasa, Mateu; Casals Pascual, Climent; Morales, Javier; Juan, Paula; García Alcaide, Felipe; Mensa Pueyo, Josep; Morata Ruiz, Laura; Tuset Creus, Montserrat; Bodro, Marta; Soriano Viladomiu, Alex
Objectives: Early identification of the source of candidemia is critical for catheter management. Time to positivity (TTP) is an accessible marker of catheter-related bloodstream infection in bacteremia, but its role in candidemia remains unclear. We evaluated the ability of TTP to predict catheter-related can- didemia across major species and compared its performance with differential time to positivity (DTP). Methods: Single-center retrospective study assessing the diagnostic utility and optimal TTP cut-offs for catheter-related candidemia. Predictors of catheter-related source were analyzed using multivariable lo- gistic regression. Results: Among 544 episodes, 407 were analyzed. In C. albicans (n = 133) and C. parapsilosis (n = 100), TTP differed significantly by source. In C. albicans , TTP ≤27 h predicted catheter-related candidemia (sen- sitivity 71.8%, specificity 70.2%, Positive Predictive Value (PPV) 50.0%, Negative Predictive Value (NPV) 85.7%) and was the only independent predictor (OR 5.1 [2.1-12.1], P < 0.001). In C. parapsilosis , TTP ≤35 h showed sensitivity 77.5%, specificity 51.7%, PPV 51.7%, NPV 77.5%, and remained independently associated (OR 3.1 [1.2-8.0], P = 0.017). Although DTP ≥2 h was more frequent in catheter-related candidemia by C. parapsilosis , the TTP ≤35 h was the strongest predictor. Conclusion: TTP outperformed DTP in identifying catheter-related sources in C. albicans and C. parapsilosis candidemia and may support timely catheter management.
Operational performance of a programmatic mass drug administration campaign for malaria in southern Mozambique: a comprehensive mixed-methods evaluation of implementation outcomes
(BioMed Central, 2026-04-07) Fuente Soro, Laura; Tusell Rabassa, Maria; Vecchio, Jacopo; Nhangave, Amancio; Bapu, Khalid; Riley, Christina; Materrula, Felisbela; Dimene, Mércia; Sibindy, Samira; Candrinho, Baltazar; Aide, Pedro Carlos Paulino; Guinovart, Caterina
BACKGROUND: The World Health Organization (WHO) recommends Mass Drug Administration (MDA) to reduce malaria transmission in low-transmission settings, with a target coverage of at least 80%. To maximize impact, the development of effective and sustainable programmatic implementation strategies is essential. Between December 2022 and February 2023, two rounds of programmatic MDA (pMDA) were implemented in Chidenguele, in Gaza province, Mozambique. The target population was approximately 59,271 individuals. Door-to-door drug distribution, using dihydroartemisinin-piperaquine, was guided by satellite imagery-based mapping. METHODS: A mixed-methods evaluation was conducted to assess operational performance —including acceptability, appropriateness, coverage, feasibility, fidelity, and adoption— using a community household survey (n = 770), a health staff survey (n = 28), and field observations (n = 149). RESULTS: Among household survey participants eligible for medication during round 2, 96,2% (607/631) accepted to participate in the pMDA. All health staff survey participants and 91,3% (703/770) of household survey participants considered taking antimalarials while asymptomatic to be an acceptable preventive measure. All health staff survey participants (28/28) and 84,1% (648/770) of household survey participants felt the intervention was appropriate for reducing malaria transmission in the community. Programmatic or contact coverage (proportion of survey participants that received pMDA treatment) reached 73,9% (569/770), while operational coverage (proportion of those present at the time of the intervention that received pMDA treatment) was 90,2% (569/631). All health staff survey participants (28/28) considered the pMDA implementation strategy feasible to implement. In terms of fidelity, direct observations of pMDA household visits showed that pMDA distribution teams correctly explained the purpose of the visit in 74,5% (111/149) of interactions, requested verbal consent in 86,6% (129/149), and emphasized the importance of completing the treatment in 60,4% (90/149). Health staff survey participants showed strong willingness to adopt the procedures, with 86.0% (24/28) and 96.0% (27/28) expressing high commitment in rounds 1 and 2, respectively. CONCLUSIONS: Despite the pMDA delivery strategy being implemented with good operational performance and being well accepted by the community and health staff, reaching the 80% coverage target remains challenging. Sustained collaboration and active engagement from communities, partners, and policymakers, and enhancement of some key outcomes, such as the fidelity of the implementation, are critical to improving coverage and ensuring the success of pMDA campaigns.
HPV Vaccination in Women with Cervical Intraepithelial Neoplasia Undergoing Excisional Treatment: Insights into Unsolved Questions.
(MDPI, 2022-06-01) Henere, Carla; Torné Bladé, Aureli; Llupià Garcia, Anna; Aldea, Marta; Martí Delgado, Cristina; Glickman, Ariel; Saco, Adela; Marimon, Lorena; Manzotti, Carolina; Rakislova, Natalia; Ordi Maja, Jaume; Pino Saladrigues, Marta del
Several questions regarding the role of vaccination in women treated for high-grade cervical intraepithelial lesion (HSIL) have not been clarified. One of the main queries is whether the time at which the vaccine is administered (before or after treatment) influences the protection against post-treatment HSIL. A second unanswered question is whether the vaccine has any effect in women with persistent HPV after treatment. We aimed to address these questions in a study of 398 women undergoing excisional treatment from July 2016 to December 2019. Vaccination was funded and offered to all women undergoing treatment. A total of 306 women (76.9%) accepted HPV vaccination (vaccinated group): 113 (36.9%) received the first dose before excision and 193 (63.1%) after the procedure. A total of 92 women (23.1%) refused the vaccine (non-vaccinated group). Women vaccinated before treatment showed a lower rate of post-treatment HSIL compared with non-vaccinated women (0.9% vs. 6.5%; p = 0.047). Among women with persistent HPV infection after treatment, those who had received the vaccine showed a lower prevalence of post-treatment HSIL than non-vaccinated women (2.6% vs. 10.5%; p = 0.043). In conclusion, this study shows that HPV vaccination before treatment reduces the prevalence of post-treatment HSIL and suggests that vaccination might even benefit women with persistent HPV after treatment.
A sustainable development goal framework to guide multisectoral action on NAFLD through a societal approach
(John Wiley & Sons, 2021-12-05) Lazarus, Jeffrey V.; Mark, Henry E.; Colombo, Massimo; Demaio, Sandro; Dillon, John F.; George, Jacob; Hagström, Hannes; Hocking, Samantha; Lee, Nancy; Nieuwenhuijsen, Mark J.; Rinella, Mary E.; Schattenberg, Jörn M.; Romero-Gomez, Manuel; Soriano, Joan B.; Tacke, Frank; Tsochatzis, Emmanuel A.; Valenti, Luca; Zelber-Sagi, Shira; Dirac, M. Ashworth; Huang, Terry T-K.
Background: Non-alcoholic fatty liver disease (NAFLD) is a highly prevalent condition that requires a comprehensive and coordinated response across sectors and disciplines. Aims: In the absence of a multisectoral framework to tackle this condition, we developed one using the sustainable development goals (SDGs) as the basis for converging thinking about the design and delivery of public health responses. Methods: A multidisciplinary group identified the SDG targets and indicators for inclusion in the new framework through a two-stage process. Firstly, a core team of three researchers independently reviewed the 169 targets and 231 indicators of the SDGs to select a shortlist. Over two Delphi rounds, a multidisciplinary group of 12 experts selected which of the shortlisted targets and indicators to include. Respondents also provided written feedback on their selection. Targets and indicators with 75% or greater agreement were included in the final framework. Results: The final framework comprises 16 targets—representing 9% of all targets and 62% (16/26) of the shortlisted targets—and seven indicators, accounting for 50% (7/14) of the shortlisted indicators and 3% of all indicators. The selected targets and indicators cover a broad range of factors, from health, food and nutrition to education, the economy, and the built environment. Conclusions: Addressing the challenge of NAFLD will require a re-envisioning of the liver health landscape, with greater focus on joined-up systems thinking and action. This new framework can help guide this process, including by outlining the stakeholders with whom the liver health community needs to engage.

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