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Following a recent cadmium exposure alert from the Union régionale des professionnels de santé-Médecins libéraux, a French regional body representing private practice physicians, attention has shifted to per- and polyfluoroalkyl substances (PFAS), a group of long-lasting industrial chemicals linked to serious health risks.

Générations Futures, a France-based environmental non-governmental organisation headquartered in Paris that monitors the health and environmental impacts of chemical pollution, raised an alarm after analysing data from the European Food Safety Authority (EFSA), showing widespread PFAS contamination in food across Europe.

PFAS, often referred to as “forever chemicals,” persist in the environment for decades and enter the human body primarily through dietary exposure.

According to the French Agency for Food, Environmental and Occupational Health and Safety, this chemical class includes thousands of compounds that have been widely used since the 1950s in industrial and consumer products, including textiles, food packaging, firefighting foams, refrigerant gases, non-stick coatings, cosmetics, medical devices, and pesticides.

Despite their extensive use, only three PFAS are routinely monitored, and four are subject to regulatory restrictions. However, many others contaminate water and food at levels well above health-based thresholds. PFAS are associated with multiple health risks, including endocrine disruption (such as thyroid dysfunction), metabolic effects (including elevated cholesterol levels), hepatic and renal toxicity, carcinogenicity, reproductive and developmental toxicity, and immune system impairment.

Alarming Levels

Générations Futures found that 69% of fish, 55% of offal, 55% of molluscs, 39% of eggs, 27% of crustaceans, 23% of milk, and 14% of meat samples contained at least one of the four PFAS currently regulated in food. In addition, the group identified seven other hazardous, non-regulated PFAS in samples of offal, fish, and eggs.

The EFSA has established a tolerable weekly intake (TWI) of 4.4 ng ingested per kg of body weight for the combined exposure to the four regulated PFAS.

According to the data analysed in the report, a 4-year-old child consuming a single egg would exceed this limit by 1.4 times. A 60-kg adult consuming 500 g of meat would ingest 2.5 times the TWI.

The report highlighted that current regulatory limits prioritise economic considerations over public health. Authorities have set threshold limits on contamination levels according to observed contamination levels, aiming to remove only the most polluted products from the market. These limits also vary by food type and lack a consistent scientific basis.

Générations Futures calls on public authorities to follow the example of Germany and the Netherlands by implementing systematic monitoring of PFAS levels across all food types, not just meat, offal, and fish, and by strengthening regulations to limit emissions and reduce exposure.

The group supports the adoption of the PFAS restriction proposal 2023 under the Registration, Evaluation, Authorisation and Restriction of Chemicals regulation, which aims to ban or limit approximately 10,000 PFAS compounds. The group also called for the revision of the PFAS limits set at the European level to better protect public health.

This story was translated from Univadis France.

TOPLINE:

A study showed that more than 28% of patients who exhibited violent behavior continued exhibiting that violence in subsequent healthcare settings, often beginning out-of-hospital and continuing in the emergency department (ED) or hospital.

METHODOLOGY:

• Researchers conducted an observational cohort study to assess violence across multiple care settings at a large academic center from December 2022 to November 2023.
• Data were collected from emergency medical service (EMS), ED, hospital, and security records.
• The analysis included 4721 violent patient encounters (comprising 2791 distinct encounters from 2251 unique patients). Of these, 206 were out-of-hospital, 868 were ED, and 3561 were non-ED hospital violent encounters.
• The primary outcome was violent patient encounters, including verbal abuse, physical assault, and threats.

TAKEAWAY:

• Of the 2791 violent encounters, 28.1% continued into a second care setting, 12.6% into a third, and 7.5% into a fourth.
• Out-of-hospital settings had the highest rate of violence (18.02 events per 10 hours), followed by the ED (0.35 events per 10 patients); 41.7% of patients who were violent out-of-hospital were violent again in the hospital, with 26.2% specifically in the ED.
• Out-of-hospital violence occurred in 0.78 per 100 encounters, with ED violence at 1.06 per 100 encounters and non-ED hospital violence at 6.37 per 100 encounters.
• Patients aged 65 years or older had the lowest incidence of violence in the ED (3.7% vs 24.5%; relative risk [RR], 0.17; 95% CI, 0.13-0.23) and the highest on the general hospital floor (54.1% vs 21.1%; RR, 2.39; 95% CI, 1.37-2.49) compared with younger patients.

IN PRACTICE:

“Our findings reveal that workplace violence spans multiple care settings, beginning in the out-of-hospital setting, continuing through the ED, and persisting into inpatient units following admission,” the authors wrote, reflecting on the importance of exploring “contributing factors such as care transitions and underlying risk factors to inform targeted interventions aimed at preventing violence and safeguarding healthcare staff.”

SOURCE:

The study was led by Sarayna McGuire, MD, MS, Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota. It was published online on June 18, 2025, in Annals of Emergency Medicine.

LIMITATIONS:

The study results may not be generalizable to patient populations in rural or community hospitals served by EMS agencies that are not affiliated with hospitals and may have limited application to populations other than non-Hispanic White individuals. Other limitations were the potential underreporting of violent events and lack of data on other types of workplace violence.

DISCLOSURES:

The authors reported no funding information or relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

TOPLINE:

Among recipients of subcutaneous implantable cardioverter defibrillators, the omission of defibrillation testing (DT) was not associated with significant differences in mortality, or in the rates of appropriate and inappropriate shocks. Obesity and high shock impedance, however, predicted testing failure.

METHODOLOGY:

• Current guidelines recommend DT during the implantation of a subcutaneous implantable cardioverter-defibrillator (S-ICD); omissions of DT has yielded conflicting results regarding mortality and shock efficacy.
• Researchers analyzed data from an ongoing observational study, including 4924 patients who were implanted with S-ICD systems in France between October 2012 and December 2019.
• The analysis compared outcomes in patients who underwent DT (n = 4066; mean age, 49.6 years; 23.6% women) and those who did not (n=858; mean age, 51.2 years; 22.1% women) over a mean follow-up of 4.2 years.
• The outcomes included overall mortality, cardiovascular mortality, sudden cardiac death, a composite of sudden cardiac death or death of unknown origin, and appropriate and inappropriate shocks.

TAKEAWAY:

• The omission of DT was not associated with an increased risk for any of the outcomes, including all death-related endpoints, or inappropriate and appropriate shocks.
• DT was successful in 99% of patients; independent predictors of test failure were obesity (adjusted odds ratio [aOR], 2.17; P = .042) and shock impedance ≥ 89 Ω (aOR, 4.60; P < .001).
• Ineffective appropriate shocks occurred only in patients who underwent testing.
• Serious complications related to testing occurred in 0.07% of patients, and two related deaths were reported.

IN PRACTICE:

“These findings suggest that omitting DT [defibrillator testing] may be safe for most S-ICD recipients, challenging the necessity of routine testing in all cases,” the researchers reported.

“Fourth, to our knowledge, this is the first study to report the incidence of complications directly associated with S-ICD testing, estimated at < 1 per 1000, including a 1 per 2000 risk” for death related to testing, they wrote. “However, the occurrence of DT-related deaths in patients with severely impaired LVEF [left ventricular ejection fraction] highlights the importance of a careful risk-benefit assessment in this vulnerable subgroup,” they added. In these cases, the risks associated with testing “may outweigh its potential benefits, warranting individualized clinical decision-making.”

“The risk-benefit ratio of routinely performing DT seems to favor not doing routine testing,” Raul Weiss, MD, and Jose Sleiman Morales, MD, wrote in an editorial accompanying the journal article. 

“A commonsense approach, therefore, would be to perform a low-risk 10-J synchronized shock in sinus rhythm to evaluate the system HV [high-voltage] impedance. If the impedance is elevated, (z > 90 U), then the system implantation features should be reevaluated with attention to posterior and preferably intermuscular implantation of the generator and minimal distance between the shocking coil and the sternum. These measures are likely to reduce the HV impedance. If the value remains elevated, then perhaps, in this scenario, DT offers clinical value,” they added.

SOURCE:

This study was led by Fawzi Kerkouri, MD, MPH, of European Georges Pompidou Hospital in Paris, France. It was published online on June 30, 2025, in the Journal of the American College of Cardiology. 

LIMITATIONS:

Clinicians may have omitted DT in patients with low risk or those with favorable procedural characteristics, introducing selection bias. Residual confounding may have persisted despite adjustments. Some cases of sudden cardiac death may have been misclassified as deaths of unknown origin.

DISCLOSURES:

This study was funded by the French Federation of Cardiology and the French Society of Cardiology. The studied device was manufactured by Boston Scientific, which supported the annual meeting of the study investigators. Several authors reported serving as consultants and/or receiving fees from Boston Scientific.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.