Care Patterns and Outcomes for Intrahepatic Cholangiocarcinoma by Rurality of Patient Residence in a Midwestern State.

BACKGROUND: Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy of the liver and has the worst prognosis of any tumor arising from the liver, with a 5-year survival as low as 10%. However, whether the rurality of a patient's residence impacts care received and survival has not been well studied. We aimed to assess differences in care patterns associated with the rurality of patient's residences and their impact on survival outcomes, hypothesizing that patients in rural areas would experience lower survival. METHODS: Adult patients diagnosed with ICC between 2010 and 2020 were identified in the Iowa Cancer Registry. Chi-square tests were used to compare values categorical variables by rural/urban status. Cox proportional hazards regression was used to determine associations with cancer-specific mortality. RESULTS: Of 672 patients diagnosed with ICC during the study period, 53%, 27%, and 21% resided in metropolitan, micropolitan, and rural areas, respectively. There were no significant differences in age, sex, stage at diagnosis, the proportion receiving chemotherapy within 12 weeks of diagnosis, and undergoing surgery across all groups. Additionally, the proportion receiving definitive care at a National Cancer Institute (NCI) designated center was comparable across the three groups (37% metro vs. 43% micro vs. 35% rural). However, rural residents had the highest proportion of traveling ≥ 50 miles for definitive care (22% metro vs. 41% micro vs. 56% rural). In multivariable analysis of patients with Stage 1-3 disease, younger age, receipt of chemotherapy, surgery, and definitive care at an NCI center were independently associated with decreased mortality risk. However, rural residence was not significantly associated with survival (HR: 0.64 [95% CI: 0.38-1.06]). CONCLUSION: Similar to other complex cancer diagnoses, we found that definitive care at an NCI center was associated with decreased mortality risk for patients with ICC. Although rural residence was not independently associated with survival in this cohort, rural residents traveled significantly longer distances to access definitive care. This highlights a crucial need to improve access to specialized centers for complex cancer care.

Deprivation and Its Association with Child Health and Nutrition in the Greater Kampala Metropolitan Area of Uganda.

African cities are experiencing increasing living standard disparities with limited evidence of intra-urban health disparities. Using data from the 2006-2016 Uganda Demographic and Health Surveys, we employed the UN-Habitat definition to examine slum-like household conditions in the Greater Kampala Metropolitan Area (GKMA). Subsequently, we developed a slum-like severity index and assessed its association with under-5 common morbidities and healthcare access. We also assessed the characteristics of people in slum-like household conditions. We identified five slum-like conditions: substandard housing conditions, limited water access, overcrowding, unclean cooking fuel, and limited toilet access. By 2016, 67% of GKMA households were classified as slum-like conditions, including 31% in severe conditions. Limited toilet access, overcrowding, and limited water access were the main forms of deprivation.Living in slum-like household conditions correlated with lower education levels, youth status, unprofessional jobs, and marriage. Compared to neighboring Kampala city urban outskirts, Kampala city households had lower slum-like prevalence. Children in GKMA living in slum-like household conditions were more likely to experience diarrhea (moderate: OR = 1.21[95% CI: 1.05-1.39], severe: OR = 1.47 [95% CI: 1.27-1.7]); fever (moderate: OR = 2.67 [95% CI: 1.23-5.8], severe: OR = 3.09 [95% CI: 1.63-5.85]); anemia (moderate: OR = 1.18 [95% CI: 0.88-1.58], severe: OR = 1.44 [95% CI: 1.11-1.86]); and stunting (moderate: OR = 1.23 [95% CI: 1.23-1.25], severe: OR = 1.40 [95% CI: 1.41-1.47]) compared to those living in less slum-like conditions. However, seeking treatment for fever was less likely in slum-like household conditions, and the association of slum-like household conditions with diarrhea was insignificant. These findings underscore the precarious urban living conditions and the need for targeted health interventions addressing the social determinants of health in urban settings.

An updated status of currently used pesticides in India: Human dietary exposure from an Indian food basket.

Currently used pesticides (CUPs) were introduced to have lower persistence and bioaccumulation, and lesser bioavailability towards non-target species. Nevertheless, CUPs still represent a concern for both human health and the environment. India is an important agricultural country experiencing a conversion from the use of obsolete organochlorine pesticides to a newer generation of phytosanitary products. As for other developing countries, very little is known about the transfer of CUPs to the human diet in India, where systematic monitoring is not in place. In this study, we analyzed ninety four CUPs and detected thirty CUPs in several food products belonging to five types: cereals and pulses, vegetables, fruits, animal-based foods, and water. Samples were taken from markets in Delhi (aggregating food produced all over India) and in the periurban area of Dehradun (northern India) (representing food produced locally and through more traditional practices). Overall, chlorpyrifos and chlorpropham were the most detected CUPs with a detection frequency of 33% and 25%, respectively. Except for vegetables and fruits, the levels of CUPs in all other food types were significantly higher in samples from Delhi (p < 0.05). Exposure dosage of CUPs through different food matrices was calculated, and chlorpropham detected in potatoes had the maximum exposure dosage to humans (2.46 × 10-6 mg/kg/day). Risk analysis based on the hazard quotient technique indicated that chlorpyrifos in rice (2.76 × 10-2) can be a concern.

The influence of climate and human factors on a regional heat island in the Zhengzhou metropolitan area, China.

The development of urbanization and the establishment of metropolitan areas causes the urban heat island to cross the original single-city scale and form a regional heat island (RHI) with a larger influence range. Due to the decreasing distance between cities, there is an urgent need to reevaluate RHI for urban agglomerations, considering all cities instead of a conventional single-city perspective. The impact of climatic conditions and human factors on heat islands still lacks a general method and framework for systematic evaluation. Therefore, we used land and night light data as background conditions to study the diurnal and seasonal changes of heat islands in the Zhengzhou metropolitan area, China. Pearson correlation analysis and random forest regression analysis were then used to explore the influence of climatic conditions and human factors on RHI and its internal relationship. We found that the daytime RHI had strong spatial heterogeneity and seasonal differences from 2001 to 2020. The daytime RHI was stronger than nighttime in spring, summer, and autumn, and the nighttime RHI was stronger than daytime in winter. From spring to winter, RHI increased first and then decreased during the daytime, while the opposite was observed at night. In this study, temperature has a greater effect on daytime RHI; CO2 and NL have a greater effect on nighttime RHI. There was strong spatial heterogeneity in the effects of climatic conditions and human factors on the RHI, with climatic conditions contributing more to the daytime RHI in the northern mountainous areas, while human factors had a greater impact on the nighttime RHI in the main urban areas of each location. The results of this study highlight more targeted and informed strategies for RHI mitigation in the Zhengzhou metropolitan area and provide helpful insights into RHI evaluation in other urban agglomerations.

Association between compound extreme weather event types and the spectrum of emergency ambulance calls: A metropolitan study in Shenzhen.

BACKGROUND: Compound extreme weather events, a combination of weather and climate drivers that lead to potentially high-impact events, are becoming more frequent with climate change. The number of emergency ambulance calls (EACs) is expected to increase during compound extreme weather events. However, the extent of these increases and the trends over time have not been fully assessed. METHODS: We obtained 242,165 EAC records for Shenzhen from January 1, 2020, to June 30, 2023. A compound extreme weather event was defined as the occurrence of at least two extreme weather events on the same day. A distributed lag non-linear model was used to explore the exposure-response and lag-response relationships between various compound extreme weather events and all-cause and specific-cause EACs. FINDING: Compound Cold & Strong Monsoon events had more significant impacts on EACs for all causes and endocrine diseases, with the cumulative relative risk (CRR) of 1.401 (95% confidence interval (CI):1.290-1.522) and 1.641 (95% CI:1.279-2.105). Compound Heat Wave & Lightning events had more obvious impacts on digestive disease and endocrine disease EACs, with the CRRs of 1.185 (95% CI:1.041-1.348) and 1.278 (95% CI:0.954-1.711), respectively. Compound Rainstorm & Lightning & Heat Wave events also led to increased RRs of EACs for all causes (CRR: 1.168, 95% CI:1.012-1.348), cardiovascular diseases (CRR: 1.221, 95% CI:0.917-1.624), digestive diseases (CRR: 1.395, 95% CI:1.130-1.721), and endocrine diseases (CRR: 1.972, 95% CI:1.235-3.149). There was no increased RR in the compound Rainstorm & Lightning events for all types of EACs. INTERPRETATION: Our study explored the relationship between EACs and compound extreme weather events, suggesting that compound extreme weather events are associated with the acute onset of cardiovascular diseases, digestive diseases, and endocrine diseases, increasing the burden on emergency ambulance resources for both all causes and specific diseases mentioned above.

Evaluation of the telemedical health care network "SAFE BIRTH" for pregnant women at risk, premature and sick newborns and their families: study protocol of a cluster-randomized controlled stepped-wedge trial.

BACKGROUND: The Perinatal Center of the University Hospital Carl Gustav Carus Dresden has initiated the telemedical healthcare network "SAFE BIRTH" to coordinate and improve specialized care in non-metropolitan regions for pregnant women and newborns. The network incorporates five intervention bundles (IB): (1) Multi-professional, inter-disciplinary prenatal care plan; (2) Neonatal resuscitation; (3) Neonatal antibiotic stewardship; (4) Inter-facility transfer of premature and sick newborns; (5) Psycho-social support for parents. We evaluate if the network improves care close to home for pregnant women, premature and sick newborns. METHODS: To evaluate the complex healthcare intervention "SAFE BIRTH" we will conduct a cluster-randomized controlled stepped-wedge trial in five prenatal medical outpatient offices and eight non-metropolitan hospitals in Saxony, Germany. The offices and hospitals will be randomly allocated to five respectively eight sequential steps over a 30-month period to implement the telemedical IB. We define one specific primary process outcome for each IB (for instance IB#1: "Proportion of patients with inclusion criterion IB#1 who have a prenatal care plan and psychosocial counseling within one week"). We estimated a separate multilevel logistic regression model for each primary process outcome using the intervention status as a regressor (control or intervention group). Across all IB, a total of 1,541 and 1,417 pregnant women or newborns need to be included in the intervention and control group, respectively, for a power above 80% for small to medium intervention effects for all five hypothesis tests. Additionally, we will assess job satisfaction and sense of safety of health professionals caring for newborns (questionnaire survey) and we will assess families' satisfaction, resilience, quality of life and depressive, anxiety and stress symptoms (questionnaire surveys). We will also evaluate the cost-effectiveness of "SAFE BIRTH" (statutory health insurance routine data, process data) and barriers to its implementation (semi-structured interviews). We use multilevel regression models adjusting for relevant confounders (e.g. socioeconomic status, age, place of residence), as well as descriptive analyses and qualitative content analyses. DISCUSSION: If the telemedical healthcare network "SAFE BIRTH" proves to be effective and cost-efficient, strategies for its translation into routine care should be developed. TRIAL REGISTRATION: German clinical trials register. DRKS-ID: DRKS00031482.

Aging trajectories of subscales in higher-level functional capacity among community-dwelling older Japanese adults: the Otassha study.

BACKGROUND: Maintaining higher-level functional capacity is important for independent living in older age. The aging trajectory of the Tokyo Metropolitan Institute of Gerontology Index of Competence (TMIG-IC) has three patterns; however, the subscale patterns are unclear. AIMS: This study aimed to clarify the aging trajectory patterns of the TMIG-IC subscales among community-dwelling older Japanese. METHODS: Participants were 3,169 community-dwelling older Japanese who participated in the 2012-2022 mail survey of the Otassha study. The aging trajectory patterns of the TMIG-IC total and subscale scores for those aged 65-90 years were identified using group-based trajectory modeling. Further, the combination frequency of the subscale trajectory patterns was determined. RESULTS: Three patterns were identified: early-onset decreasing, late-onset decreasing, and high-stable. DISCUSSION: The instrumental activities of daily living (IADL) trajectory was maintained until approximately 80 years of age; however, chronic disease prevailed the most in the early-onset decreasing pattern. The early-onset decreasing pattern of intellectual activity (IA) was present in 25% of participants, showing impaired IA from 65 years of age. The late-onset decreasing pattern of social roles (SR) was present in 30% of participants, showing a sharp decline compared to other subscales. For many people, the patterns of decrease in SR and IA overlapped. CONCLUSIONS: To maintain higher-level functional capacity, interventions that include disease management and prevention of decline in IADL and increase the awareness of the social support provided throughout old age and interventions for people with an early decline in IA should be implemented.

Quantifying the noncarcinogenic and carcinogenic risks resulting from the inhalation of PM2.5-bound metals: A multicity analysis and implications for public health.

Toxic metals in PM2.5 represent a growing public health concern because of their potential health effects. Ambient PM2.5 samples were collected from five provinces around Bangkok from December 2020 to December 2021. The concentrations of PM2.5 and metals (arsenic, cadmium, chromium, cobalt, nickel, lead, and vanadium) were analyzed. The noncarcinogenic and carcinogenic risks were evaluated via Monte Carlo simulations in four age groups (0 to <6, 6 to <12, 12 to <18, 18-70 years), with a dataset comprising 2282 heavy metal assays within the particulate matter. Significantly higher PM2.5 concentrations were detected in provinces with higher factory densities, as well as higher concentrations during haze periods than during non-haze periods. The HI values for all age groups and provinces were lower than 1, indicating acceptable noncarcinogenic risks. The carcinogenic risks from PM2.5-bound metals varied between 7.08×10-7 and 4.29×10-6, indicating increased cancer risks, for preschool children and adults. Cancer risk was highest in industrial areas, followed by areas with dense traffic, and lowest in agricultural areas. The results indicated that Thailand's current air quality regulations, which primarily provide only lead limits, are insufficient considering the high carcinogenic potential of other metals. The Monte Carlo simulation results confirmed that lowering Thailand's 24-h PM2.5 standard from 37.5 to either 25 or 15 µg m-3, as specified in the 2021 World Health Organization guidelines, would decrease cancer risk by 9.63-43.18 %.

Coupled relationships between landscape pattern and ecosystem health in response to urbanization.

Rapid urbanization has highlighted ecological problems in the metropolitan area, with increasing landscape fragmentation and severe threats to ecosystem health (EH). Studying the spatio-temporal coupled relationship between landscape pattern and EH and its response to urbanization in the Fuzhou metropolitan area (FMA) can provide scientific reference for its long-term development planning. We examined the coupled relationship between landscape pattern and EH and its driving mechanism in the FMA at grid and township scales to address the gap. The results show that landscape heterogeneity, diversity, and dispersion are gradually increasing, and EH is rising progressively in the FMA from 2000 to 2020. The spatial distribution of landscape pattern indices and EH indicators showed a "high in the south and low in the north" trend. During the study period, the coupled relationship between landscape patterns and EH was increasingly powerful but with remarkable spatial heterogeneity. The study also found an inverted U-shaped relationship between urbanization and coupled relationships. Ecological landscapes' heterogeneity, diversity, and connectivity in low-urbanization areas are conducive to EH. The opposite is true for high-urbanization areas. This study provides a valuable reference for optimizing landscape planning and ecological management in metropolitan areas.

Application of AERMOD dispersion model for assessment PM10 concentrations from mobile sources in Kuala Lumpur Metropolitan City, Malaysia.

Deterioration of air quality in Kuala Lumpur caused by mobile sources and traffic-related activities with interaction with climatic conditions and dispersion in the atmosphere. This study was focused on predicting the averaged 1-h concentration of particulate matter (PM10) that was emitted from private cars in Kuala Lumpur by applying the air dispersion model American Meteorological Society (AMS)/United States Environmental Protection Agency (EPA) Regulatory Model (AERMOD) in 2014. The AERMOD model indicates that private cars in Kuala Lumpur recorded 1-h concentration of PM10 below the Malaysian Ambient Air Quality Guidelines (RMAQG) in 2014. The highest concentration was 59.2 µg/m3 in 2014 and mainly concentrated around the city center and highway networks. The highest concentrations are recorded in early morning and late at night, with the highest concentrations at 4 am and 2 am and 48.68 µg/m3 and 38.42 µg/m3, respectively. Late night to early morning is identified as the dominant time interval for pollutant dispersion. The findings demonstrated that air quality had a significant impact on the 1-h concentration of PM10 emitted from private cars in Kuala Lumpur.

Atmospheric gaseous mercury and associated health risk assessment in the economic capital of India.

Mercury cycling in coastal metropolitan areas on the west coast of India becomes complex due to the combined effects of both intensive domestic anthropogenic emissions and marine air masses. The present study is based on yearlong data of continuous measurements of gaseous elemental mercury (GEM) concentration concurrent with meteorological parameters and some air pollutants at a coastal urban site in Mumbai, on the west coast of India, for the first time. The concentration of GEM was found in a range between 2.2 and 12.3 ng/m3, with a mean of 3.1 ± 1.1 ng/m3, which was significantly higher than the continental background values in the Northern Hemisphere (~ 1.5 ng/m3). Unlike particulates, GEM starts increasing post-winter to peak during the monsoon and decrease towards winter. July had the highest concentration of GEM followed by October, and a minimum in January. GEM exhibited a distinct diurnal cycle, mainly with a broad peak in the early morning, a narrow one by nightfall, and a minimum in the afternoon. The peaks and their timing suggest the origin of urban mobility and the start of local activities. A positive correlation between SO2, PM2.5, temperature, relative humidity, and GEM indicates that emissions from local industrial plants in the Mumbai coastal area. Principal component analysis (PCA) and cluster analysis (CA) confirm this fact. Monthly back trajectory analysis showed that air mass flows are predominantly from the Arabian Sea and local human activities. Assessment of human health risks by USEPA model reveals that the hazardous quotient, HQ < 1, implies negligible carcinogenic risk. GEM observations in Mumbai during the study period are below the World Health Organization's (WHO) safe limit (200 ng/m3) for long-term inhalation.

Temporal variation of the PM2.5/PM10 ratio and its association with meteorological factors in a South American megacity: Metropolitan Area of Lima-Callao, Peru.

The Metropolitan Area of Lima-Callao (MALC) is a South American megacity that has suffered a serious deterioration in air quality due to high levels of particulate matter (PM2.5 and PM10). Studies on the behavior of the PM2.5/PM10 ratio and its temporal variability in relation to meteorological parameters are still very limited. The objective of this study was to analyze the temporal trends of the PM2.5/PM10 ratio, its temporal variability, and its association with meteorological variables over a period of 5 years (2015-2019). For this, the Theil-Sen estimator, bivariate polar plots, and correlation analysis were used. The regions of highest mean concentrations of PM2.5 and PM10 were identified at eastern Lima (ATE station-41.2 µg/m3) and southern Lima (VMT station-126.7 µg/m3), respectively. The lowest concentrations were recorded in downtown Lima (CDM station-16.8 µg/m3 and 34.0 µg/m3, respectively). The highest average PM2.5/PM10 ratio was found at the CDM station (0.55) and the lowest at the VMT station (0.27), indicating a predominance of emissions from the vehicular fleet within central Lima and a greater emission of coarse particles by resuspension in southern Lima. The temporal progression of the ratio of PM2.5/PM10 showed positive and highly significant trends in northern and central Lima with values of 0.03 and 0.1 units of PM2.5/PM10 per year, respectively. In the southern region of Lima, the trend was also significant, showcasing a value of 0.02 units of PM2.5/PM10 per year. At the hourly and monthly level, the PM2.5/PM10 ratio presented a negative and significant correlation with wind speed and air temperature, and a positive and significant correlation with relative humidity. These findings offer insights into identifying the sources of PM pollution and are useful for implementing regulations to reduce air emissions considering both anthropogenic sources and meteorological dispersion patterns.

Factors influencing nursing and allied health recent graduates' rural versus urban preferred principal place of practice: A cross-sectional data linkage study.

INTRODUCTION: Disparities between metropolitan and non-metropolitan health workforce must be addressed to reduce inequities in health care access. Understanding factors affecting early career practitioners' choice of practice location can inform workforce planning. OBJECTIVE: To investigate influences on rural practice location preferences of recent graduates. DESIGN: Cross-sectional analysis linked university enrolment, Graduate Outcomes Survey (GOS) and Australian Health Professional Regulation Agency (Ahpra) principal place of practice (PPP) for 2018 and 2019 nursing and allied health graduates from two Australian universities. Chi-squared tests and logistic regression compared rural versus urban PPP and locational preference. FINDINGS: Of 2979 graduates, 1295 (43.5%) completed the GOS, with 63.7% (n = 825) working in their profession and 84.0% of those (n = 693) in their preferred location. Ahpra PPP data were extracted for 669 (81.1%) of those working in their profession. Most reported influences were 'proximity to family/friends' (48.5%), 'lifestyle of the area' (41.7%) and 'opportunity for career advancement' (40.7%). Factors most influential for rural PPP were 'cost of accommodation/housing' (OR = 2.26, 95% CI = 1.23-4.17) and 'being approached by an employer' (OR = 2.10, 95% CI = 1.12-3.92). Having an urban PPP was most influenced by 'spouse/partners employment/career' (OR = 0.53, 95% CI = 0.30-0.93) and 'proximity to family/friends' (OR = 0.41, 95% CI = 0.24-0.72). DISCUSSION: While the findings add strength to the understanding that graduates who originated from a rural area are most likely to take up rural practice in their preferred location, varied social and professional factors are influential on decision-making. CONCLUSIONS: It is imperative to recruit students from non-metropolitan regions into health professional degrees, as well as addressing other influences on choice of practice location.

'We know the lack of services': Service lead's perspective of enablers and barriers to hearing assessment for children in metropolitan, regional and rural Australia: A qualitative study.

OBJECTIVE: To explore potential enablers and barriers to accessing paediatric hearing assessment from the perspective of Australian service leads, extending previous studies on this topic from the perspectives of two other stakeholder groups - parents and speech pathologists. DESIGN: This qualitative study, expanding upon previous mixed-methods studies, applied a pragmatism paradigm. SETTING: The study was undertaken online via Zoom and included participants who were service leads of organisations that offer hearing assessment in metropolitan, regional, rural and remote parts of Australia. PARTICIPANTS: Eight Australian service leads participated in semi-structured interviews. RESULTS: Barriers identified were similar to barriers in previous studies. Three main themes were identified. First, children with hearing loss in Australia are well identified at birth. The second theme focused on the reduced and inconsistent hearing assessment services available after this age. Finally, service leads discussed the importance of embracing technology to solve service access difficulties. CONCLUSION: Consultation with key stakeholders, to consider the needs of different communities within Australia, will be crucial when identifying new service delivery options.

Monkeypox Virus in Wastewater Samples from Santiago Metropolitan Region, Chile.

Sewage surveillance provides useful epidemiologic and public health information on viral infections at the population level. We detected monkeypox virus DNA from sewage samples covering 85% of the population in Santiago Metropolitan Region Chile. We also isolated infective viruses from those samples. Wastewater surveillance could complement clinical surveillance for monkeypox virus.

SARS-CoV-2 Molecular Evolutionary Dynamics in the Greater Accra Region, Ghana.

To assess dynamics of SARS-CoV-2 in Greater Accra Region, Ghana, we analyzed SARS-CoV-2 genomic sequences from persons in the community and returning from international travel. The Accra Metropolitan District was a major origin of virus spread to other districts and should be a primary focus for interventions against future infectious disease outbreaks.

Traffic-related air pollution is associated with spontaneous extremely preterm birth and other adverse perinatal outcomes.

BACKGROUND: Although there is growing awareness of the relationship between air pollution and preterm birth, limited data exist regarding the relationship with spontaneous preterm birth and severe neonatal outcomes. OBJECTIVE: This study aimed to examine the association between traffic-associated air pollution exposure in pregnancy and adverse perinatal outcomes including extremes of preterm birth, neonatal intensive care unit admissions, low birthweight, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation. STUDY DESIGN: This was a retrospective cohort study of singleton pregnancies of patients residing in a metropolitan area in the southern United States. Using monitors strategically located across the region, average nitrogen dioxide concentrations were obtained from the Environmental Protection Agency Air Quality System database. For patients living within 10 miles of a monitoring station, average exposure to nitrogen dioxide was estimated for individual patients' pregnancy by trimester. Logistic regression models were used to assess the effect of pollutant exposure on gestational age at birth, indicated vs spontaneous delivery, and neonatal outcomes while adjusting for maternal age, self-reported race, parity, season of conception, diabetes mellitus, body mass index, registered Health Equity Index, and nitrogen dioxide monitor region. Adjusted odds ratios and 95% confidence intervals were calculated for an interquartile increase in average nitrogen dioxide exposure. RESULTS: Between January 1, 2013 and December 31, 2021, 93,164 patients delivered a singleton infant. Of these, 62,189 had measured nitrogen dioxide exposure during the pregnancy from a nearby monitoring station. Higher average nitrogen dioxide exposure throughout pregnancy was significantly associated with preterm birth (adjusted odds ratio, 1.94; 95% confidence interval, 1.77-2.12) and an increase in neonatal intensive care unit admissions, low birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation. This relationship persisted for nulliparous patients and spontaneous preterm birth, and had a greater association with earlier preterm birth. CONCLUSION: In a metropolitan area, increased exposure to the air pollutant nitrogen dioxide in pregnancy was associated with spontaneous preterm birth and had a greater association with extremely preterm birth. A greater association with neonatal intensive care unit admissions, low-birthweight infants, neonatal respiratory diagnosis, neonatal respiratory support, and neonatal sepsis evaluation was found even in term infants.

Impact of cystic fibrosis multidisciplinary virtual clinics on patient experience, time commitments and costs.

BACKGROUND AND AIMS: The experience of outpatient care may differ for select patient groups. This prospective study evaluates the adult patient experience of multidisciplinary outpatient cystic fibrosis (CF) care with videoconferencing through telehealth compared with face-to-face care the year prior. METHODS: People with CF without a lung transplant were recruited. Patient-reported outcomes were obtained at commencement and 12 months into the study, reflecting both their face-to-face and telehealth through videoconferencing experience, respectively. Three patient cohorts were analysed: (i) participants with a regional residence, (ii) participants with a nonregional including metropolitan residence and (iii) participants with colonised multiresistant microbiota. RESULTS: Seventy-four patients were enrolled in the study (mean age, 37 ± 11 years; 50% male; mean forced expiratory volume in the first second of expiration, 60% [standard deviation, 23]) between February 2020 and May 2021. No differences between models were observed in the participants' rating of the health care team, general and mental health rating, and their confidence in handling treatment plans at home. No between-group differences in the Cystic Fibrosis Questionnaire - Revised (CFQ-R) were observed. Travel duration and the cost of attending a clinic was significantly reduced, particularly for the regional group (4 h, AU$108 per clinic; P < 0.05). A total of 93% respondents preferred to continue with a hybrid approach. CONCLUSION: In this pilot study, participants' experience of care and quality of life were no different with face-to-face and virtual care between the groups. Time and cost-savings, particularly for patients living in regional areas, were observed. Most participants preferred to continue with a hybrid model for outpatient care.

Behavioral changes of preventive activities of influenza among children in satellite cities of a metropolitan area of Tokyo, Japan, by the COVID-19 pandemic.

OBJECTIVE: In children in a metropolitan area of Tokyo, Japan, behavioral change and influenza infection associated with the frequency of nonpharmaceutical interventions (NPI) was assessed from the 2018-2019 season (Preseason) and the 2020-2021 season (coronavirus disease 2019 [COVID-19] season). METHODS: We conducted an exclusive survey among children attending preschool, elementary school, and junior high school in the Toda and Warabi regions, Japan, during the 2018-2019 (Preseason, distributed via mail) and 2020-2021 seasons (COVID-19 season, conducted online). The proportion of preventive activities (hand washing, face mask-wearing, and vaccination) was compared in the Preseason with that of the COVID-19 season. The multivariate logistic regression model was further applied to calculate the adjusted odds ratio (AOR) with 95% confidence intervals (CIs) for influenza infection associated with NPI frequency (hand washing and face mask wearing) in each Preseason and COVID-19 season. RESULTS: The proportion of vaccinated children who carried out hand washing and face mask wearing was remarkably higher during the COVID-19 season (48.8%) than in the Preseason (18.2%). A significant influenza infection reduction was observed among children who washed hands and wore face masks simultaneously (AOR, 0.87; 95% CI, 0.76-0.99; P = 0.033). CONCLUSIONS: A strong interest and performance in the intensive measures for the prevention of influenza under the COVID-19 pandemic was demonstrated. Positive association was observed from a combination of NPI, hand washing, and face mask-wearing and influenza infection. This study's findings could help in activities or preventive measures against influenza and other communicable diseases in children.

Assessing the use of constructs from the consolidated framework for implementation research in U.S. rural cancer screening promotion programs: a systematic search and scoping review.

BACKGROUND: Cancer screening is suboptimal in rural areas, and interventions are needed to improve uptake. The Consolidated Framework for Implementation Research (CFIR) is a widely-used implementation science framework to optimize planning and delivery of evidence-based interventions, which may be particularly useful for screening promotion in rural areas. We examined the discussion of CFIR-defined domains and constructs in programs to improve cancer screening in rural areas. METHODS: We conducted a systematic search of research databases (e.g., Medline, CINAHL) to identify studies (published through November 2022) of cancer screening promotion programs delivered in rural areas in the United States. We identified 166 records, and 15 studies were included. Next, two reviewers used a standardized abstraction tool to conduct a critical scoping review of CFIR constructs in rural cancer screening promotion programs. RESULTS: Each study reported at least some CFIR domains and constructs, but studies varied in how they were reported. Broadly, constructs from the domains of Process, Intervention, and Outer setting were commonly reported, but constructs from the domains of Inner setting and Individuals were less commonly reported. The most common constructs were planning (100% of studies reporting), followed by adaptability, cosmopolitanism, and reflecting and evaluating (86.7% for each). No studies reported tension for change, self-efficacy, or opinion leader. CONCLUSIONS: Leveraging CFIR in the planning and delivery of cancer screening promotion programs in rural areas can improve program implementation. Additional studies are needed to evaluate the impact of underutilized CFIR domains, i.e., Inner setting and Individuals, on cancer screening programs.