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.

Social Efficiency of Public Transportation Policy in Response to COVID-19: Model Development and Application to Intercity Buses in Seoul Metropolitan Area

Although more than two years have passed since the appearance of the coronavirus disease 2019 (COVID-19), few policies on public transportation have been implemented to reduce its spread. It is common knowledge that public transportation is vulnerable to COVID-19, but it has not been easy to formulate an appropriate public transportation policy based on a valid rationale. In this study, a modified SEIHR model was developed to evaluate the socioeconomic effects of public transportation policies. By applying the developed model to intercity buses in the Seoul metropolitan area, the socioeconomic efficiency of the policy of reducing the number of passengers was evaluated. The analysis showed that the optimal number of passengers decreased as the number of initially infected people increased; in addition, the basic reproduction number R₀, illness cost per person, and probability of infection with a single virus were higher. However, depending on these variable conditions, the policy to reduce the number of passengers in a vehicle may not be required, so it is necessary to make an appropriate judgment according to the situation. In particular, the emergence of a new mutant COVID-19 will necessitate the development of appropriate countermeasures by comprehensively examining the change in the number of infected individuals and the fatality rate. This study can guide the development of such countermeasures.

Green Space Cooling Effect and Contribution to Mitigate Heat Island Effect of Surrounding Communities in Beijing Metropolitan Area

With the rapid process of urbanization and global warming, many metropolises are vulnerable to high temperatures in summer, threatening the health of residents. However, green spaces can generate a cooling effect to mitigate the urban heat island effect in big cities. They can also help to improve the living quality and wellbeing of surrounding residents. In this paper, we utilized the radiative transfer equation algorithm, k-means clustering algorithm, big data crawling, and spatial analysis to quantify and map the spatial distribution, cooling capacity, and cooling contribution for surrounding communities of 1,157 green spaces within Beijing Fifth Ring Road, a typical metropolitan area. The findings showed that (1) the area proportion of the heat island in the study area is larger than that of the cooling island. Accounting for only about 30% area in the study area, the green spaces reduce the average land surface temperature by 1.32°C. (2) The spatial features of green space, such as area and shape complexity, have a significant influence on its cooling effect. (3) Four clusters of green spaces with specific spatial features and cooling capacity were identified. And there were differences among these clusters in green space cooling contribution for the surrounding communities. (4) The differences in green space cooling contribution also existed in different urban zones. Specifically, the middle zone performed significantly better than the inner and outer zones. (5) We furthered in finding that some green spaces with medium and high cooling contributions need to improve their cooling capacity soon, and some green spaces with low cooling contributions or no contributions have a good potential for constructing new communities in the future. Our study could help planners and government understand the current cooling condition of green spaces, to improve their cooling capacity, mitigate the urban heat island effect, and create a comfortable and healthy thermal environment in summer.

Evolution of prescribing practices and outcomes in the COVID-19 pandemic in metropolitan areas

INTRODUCTION

We wanted to characterize the evolution of the COVID-19 pandemic in a typical metropolitan area.

METHODS

Data were extracted from the Detroit COVID-19 Consortium database for hospitalized COVID-19 patients treated in Southeast Michigan over the 12-month period from March 2020 to February 2021. Demographic and outcomes data were compared to CDC data.

RESULTS

A total of 4,775 patients were enrolled during the study period. We divided the pandemic into three phases: Phase-1 (Spring Surge); Phase-2 (Summer Lull); and Phase-3 (Fall Spike). Changes in hydroxychloroquine, remdesivir, corticosteroid, antibiotic and anticoagulant use closely followed publication of landmark studies. Mortality in critically-ill patients decreased significantly from Phase-1 to Phase-3 (60.3% vs. 47.9%, Chisq p=0.0110). Monthly mortality of all hospitalized patients ranged between 14.8% - 21.5% during Phase-1 and 9.7 to 13.4% during Phase 3 (NS).

DISCUSSION

The COVID-19 pandemic presented in three unique phases in Southeast Michigan. Medical systems rapidly modified treatment plans, often preceding CDC and NIH recommendations. Despite improved treatment regimens, intubation rates and mortality for hospitalized patients remained elevated.

CONCLUSION

Preventive measures aimed at reducing hospitalizations for COVID-19 should be emphasized.

Using Open Data to Monitor the Status of a Metropolitan Area: The Case of the Metropolitan Area of Turin

The paper presents and discusses the method adopted by Compagnia di San Paolo, one of the largest European philanthropic institutions, to monitor the advancement, despite the COVID-19 situation, in providing specific input to the decision-making process for dedicated projects. An innovative approach based on the use of daily open data was adopted to monitor the metropolitan area with a multidimensional perspective. Several open data indicators related to the economy, society, culture, environment, and climate were identified and incorporated into the decision support system dashboard. Indicators are presented and discussed to highlight how open data could be integrated into the foundation's strategic approach and potentially replicated on a large scale by local institutions. Moreover, starting from the lessons learned from this experience, the paper analyzes the opportunities and critical issues surrounding the use of open data, not only to improve the quality of life during the COVID-19 epidemic but also for the effective regulation of society, the participation of citizens, and their well-being.

Association between Post-Diagnosis Particulate Matter Exposure among 5-Year Cancer Survivors and Cardiovascular Disease Risk in Three Metropolitan Areas from South Korea

Cancer survivors are at an increased risk for cardiovascular disease (CVD). However, the association between particulate matter (PM) and CVD risk among cancer survivors (alive >5 years since diagnosis) is unclear. We investigated the risk of CVD among 40,899 cancer survivors within the Korean National Health Insurance Service database. Exposure to PM was determined by assessing yearly average PM levels obtained from the Air Korea database from 2008 to 2011. PMs with sizes <2.5 (PM2.5), <10 (PM10), or 2.5-10 (PM2.5-10) μm in diameter were compared, with each PM level exposure further divided into quintiles. Patients were followed up from January 2012 to date of CVD event, death, or December 2017, whichever came earliest. Adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for CVD were calculated using Cox proportional hazards regression by PM exposure levels. Compared with cancer survivors in the lowest quintile of PM2.5 exposure, those within the highest quintile had a greater risk for CVD (aHR 1.31, 95% CI 1.07-1.59). Conversely, increasing PM10 and PM2.5-10 levels were not associated with increased CVD risk (p for trend 0.078 and 0.361, respectively). Cancer survivors who reduce PM2.5 exposure may benefit from lower risk of developing CVD.

Trends in extreme rainfall and hydrogeometeorological disasters in the Metropolitan Area of São Paulo: a review

Our paper reviews recent progress in the study and understanding of observed trends in extreme rainfall events in the Metropolitan Area of São Paulo (MASP). These are discussed in relation to hydrometeorological hazards that trigger natural disasters, such as flash floods, landslides, and droughts, that affect the population and local economies. A review of the most updated literature on rainfall and extremes in the MASP shows a significant increase in the total volume of rainy-season rainfall during the last seven decades. While there were practically no days with heavy rain (more than 50 mm) in the 1950s, these days have been occurring two to five times a year in the last 10 years. This, together with the inappropriate occupation of risky areas, such as slopes and banks of watercourses, leads to inundation, flooding, and landslides. Changes in extremes can be partly due to natural climate variability but can also be related to global warming and/or urbanization. There is ample evidence of an increasing risk of rainfall-related hazards in the MASP. This is particularly so for landslides in vulnerable areas. Exposure will continue to lead to risk increases. This calls for significant improvement in climate and disaster risk reduction and management efforts in the MASP region.

Managing Cross-Border Conflicts Through Volunteer Commitment: A Comparative Study Between Religious and Non-profit Organizations in the San Diego-Tijuana Area

San Diego and Tijuana configure two big cities that have faced each other across the international boundary between United States and Mexico for over 180 years. Within this context, the relationship emerging at the border can be characterized under different categories of individual, social, economic, and political situations connecting each side. Additionally, in recent years, the literature on cross-border conflicts has extensively focused on volunteers as informal agents helping children and other groups of population, but relatively little research has addressed the practical and managerial work and implications of the volunteers themselves. As actors of cross-border communities, volunteers play a relevant role in effective short-term migrants' settlement, but it is also observed that the profile of volunteers in religious organizations differs from those belonging to non-profit institutions. Grounded on the theories of Planned Behavior and Reasoned Action suggesting that intentions to cooperate with non-government institutions are influenced directly by attitudinal values and indirectly by their beliefs related to social conflicts, this paper analyzes the nature of volunteer commitment in religious and non-profit organizations (NPOs) providing information about managerial practices for newly arrived migrants. The main purpose of this study is to investigate the relevance of volunteer commitment as an instrument for managing cross-border conflicts in the particular context of San Diego and Tijuana Area. Based on research using interview data collected from beneficiaries by volunteers, institutional representatives, and documentary references, this manuscript highlights a psychological and individual-centric perspective of volunteer commitment, but it also explores a collective communicative action expanding the range of relevant voices in decisions about volunteering. Moreover, this study provides new insights into how organizational and relational elements impact sustainable volunteer management and points out the role played by attitudes toward non-government institutions such as religious and NPOs demonstrating the relevance of volunteer commitment, transforming part of the positive attitude toward social problems into a significant intention to cooperation. Understanding the importance of the organization's images in order to attract volunteers, these results show that commitment may become a key determinant of the volunteers' identity linked to strategies devoted to organizational activities.

Retaining nurses in metropolitan areas: insights from senior nurse and human resource managers

AIM

To investigate the views of senior nurse and human resource managers of strategies to retain hospital nurses in a metropolitan area.

BACKGROUND

Against a global shortage, retaining nurses is a management imperative for the quality of hospital services.

METHOD

Semi-structured interviews, thematically analysed.

RESULTS

Metropolitan areas have many health organisations in geographical proximity, offering nurses choices in employer and employment. Senior nurse and human resource managers recognised the complexity of factors influencing nurse turnover, including those that 'pulled' nurses out of their jobs to other posts and factors that 'pushed' nurses to leave. Four themes emerged in retaining nurses: strategy and leadership, including analysis of workforce and leavers' data, remuneration, the type of nursing work and career development and the immediate work environment.

CONCLUSIONS

In contexts where multiple organisations compete for nurses, addressing retention through strategic leadership is likely to be important in paying due attention and apportioning resources to effective strategies.

IMPLICATIONS FOR NURSING MANAGEMENT

Aside from good human resource management practices for all, strategies tailored to different segments of the nursing workforce are likely to be important. This metropolitan study suggests attention should be paid to strategies that address remuneration, progressing nursing careers and the immediate work environment.

Cancer mortality trends between 1988 and 2009 in the metropolitan area of Naples and Caserta, Southern Italy: Results from a joinpoint regression analysis

Mortality data by geographic area and trend-based surveillance are particularly relevant in orienting public health decisions targeting specific populations. We analyzed overall and site-specific cancer mortality between 1988 and 2009 in the metropolitan area of Naples and Caserta in southern Italy. Age-standardized mortality rates (SMR) were computed for each 5-y age group, by gender, primitive cancer site and specific Province in the overall population and age-defined subgroups. Cancer mortality trends were quantified by annual percent change (APC) and 95% confidence interval (CI). From Naples and Caserta, the reduction observed between 1988 and 2009 in SMR in males, but not in females, was significantly lower compared with the decrease reported at a national level (-11.4% and -28.4%, respectively). In elderly men, differences between local and national SMR were more pronounced (+13.6% compared with -2.7%). In males, the joinpoint regression analysis showed the following APC and 95% CI: -0.9%/year (-1.2; -0.7) and -0.6%/year (-1.0; -0.2) for Naples and Caserta, respectively. In females, estimates were -0.6%/year (-0.8; -0.5) and -0.7%/year (-1.2; -0.3). The overall orientation toward declining cancer mortality trends appeared in antithesis with the slight, but significant, increase for some tumors (e.g., pancreatic cancer in both genders). A complex mixture of heterogeneous factors concurs to explain the evidence observed including lifestyle, access to screening procedures, advancements in cancer diagnosis and treatment. Further details might eventually derive from biomonitoring studies for ascertaining the causal link between exposure to potential contaminants in air, water, and soil and cancer-related outcomes in the area of interest.

The residential segregation patterns of whites by socioeconomic status, 2000-2011

In light of increasing racial and ethnic diversity, a recent housing crisis, and deep economic recession, arguments pertaining to the role of socioeconomic status (SES) in shaping patterns of racial/ethnic segregation remain salient. Using data from the 2000 decennial census and the 2007-2011 American Community Survey, we provide new evidence on the residential segregation patterns of whites from minorities by SES (income, education, and poverty). Results from our comprehensive analyses indicate that SES matters for the segregation patterns of whites from minorities. In particular, we find that whites as a whole are less segregated from higher-SES minority group members than lower-SES ones. Among whites, those of higher SES are more segregated from blacks and Hispanics as a whole and less segregated from Asians, indicating the importance of SES differentials across racial/ethnic groups in shaping residential patterns. We also find that during the 2000s, white-black segregation remained stable or declined, while whites became more segregated from Hispanics and Asians by all SES indicators. Fixed-effects models indicate that increasing white-minority SES segregation was fueled in part by increases in a metropolitan area's immigrant and elderly populations, minority poverty rate, and home values, while declining segregation was associated with rising education levels and new housing construction.

Cancer incidence and mortality in the Bucaramanga metropolitan area, 2003-2007

INTRODUCTION

Cancer is an important cause of morbidity and mortality worldwide. Population-based cancer registries (PBCRs) make possible to estimate the burden of this condition.

AIM

To estimate cancer incidence and mortality rates in the Bucaramanga Metropolitan Area (BMA) during 2003-2007.

METHODS

Incident cases of invasive cancer diagnosed during 2003-2007 were identified from the Bucaramanga Metropolitan Area PBCR (BMA-PBCR). Population counts and mortality were obtained from the Colombian National Administrative Department of Statistics (NADS). We estimated total and cancer-specific crude incidence and mortality rates by age group and sex, as well as age-standardized (Segi's world population) incidence (ASIR(W)) and mortality (ASMR(W)) rates. Statistical analyses were conducted using CanReg4 and Stata/IC 10.1.

RESULTS

We identified 8,225 new cases of cancer excluding non-melanoma skin cancer (54.3% among women). Of all cases, 6,943 (84.4%) were verified by microscopy and 669 (8.1%) were detected only by death certificate. ASIR(W) for all invasive cancers was 162.8 per 100,000 women and 177.6 per 100,000 men. Breast, cervix, colorectal, stomach and thyroid were the most common types of cancer in women. In men, the corresponding malignancies were prostate, stomach, colorectal, lung and lymphoma. ASMR(W) was 84.5 per 100,000 person-years in women and 106.2 per 100,000 person-years in men. Breast and stomach cancer ranked first as causes of death in those groups, respectively.

CONCLUSION

Overall, mortality rates in our region are higher than national estimates possibly due to limited effectiveness of secondary prevention strategies. Our work emphasizes the importance of maintaining high-quality, nationwide PBCRs.

Neighborhood Diversity, Metropolitan Constraints, and Household Migration

Focusing on micro-level processes of residential segregation, this analysis combines data from the Panel Study of Income Dynamics with contextual information from three censuses and several other sources to examine patterns of residential mobility between neighborhoods populated by different combinations of racial and ethnic groups. We find that despite the emergence of multiethnic neighborhoods, stratified mobility dynamics continue to dominate, with relatively few black or white households moving into neighborhoods that could be considered multiethnic. However, we also find that the tendency for white and black households to move between neighborhoods dominated by their own group varies significantly across metropolitan areas. Black and white households' mobility into more integrated neighborhoods is shaped substantially by demographic, economic, political, and spatial features of the broader metropolitan area. Metropolitan-area racial composition, the stock of new housing, residential separation of black and white households, poverty rates, and functional specialization emerge as particularly important predictors. These macro-level effects reflect opportunities for intergroup residential contact as well as structural forces that maintain residential segregation.