Large Metropolitan Areas Research Articles

Growth and globalization of the Central African wildlife economy: Insights from a 23-year study of wild meat markets on Bioko Island, Equatorial Guinea

The commercial trade in wild meat is booming in Central Africa. Addressing this issue is a global priority because the trade poses a major threat to biodiversity and human health. We investigated the impact of socioeconomic factors, public health emergencies, and conservation efforts on the wild meat trade using daily surveys of wild meat markets on Bioko Island, Equatorial Guinea (EG), from 1997 through 2021. Bioko is an ideal location for examining how external factors impact the wild meat market trade. Although small, the island has large areas of intact forest that host populations of commercially valuable wildlife; low-cost protein substitutes are available; and Malabo, the island’s only large metropolitan area and wild meat trading hub, hosts a wealthy class of urbanites. We found significant associations between global market trends and the wild meat trade, especially China’s foreign investment and oil production in the US and EG. Economic crises like EG’s 2009 economic downturn that followed a global crash in oil prices and reduced production, redirected demand towards cheaper mainland wildlife carcasses amid reduced consumer demand. Public health emergencies had the most comprehensive impact on the wild meat trade. The 2014 Ebola outbreak and the COVID-19 pandemic both induced shifts in market demand, and the COVID-19 pandemic disrupted trade routes, affecting both urban and rural markets. Internally, we observed market decentralization over the last decade and changes in wildlife supply chains during public health emergencies. Conservation policies, including anti-poaching measures and educational outreach, temporarily influenced wildlife market trends, sometimes leading to trading surges in endangered primate carcasses. Our study highlights the importance of monitoring global market trends, public health campaigns, and adapting conservation strategies to disrupt wildlife supply chains and curb consumer demand for wild meat.

The Association between the Type of Mental Health Treatment Received, Metropolitan Status and Gender.

The purpose of this study is to examine the relationship between the type of mental health care received and metropolitan status. We combined data from the National Survey for Drug Use and Health (NSDUH) to examine mental health treatment. We grouped participants by metropolitan status and receipt of mental health treatment. We conducted a logistic regression using interaction terms to compare the likelihood of receiving inpatient and/or outpatient treatment for mental health, relative to prescription medication alone. There was an association between the type of mental health treatment received and metropolitan status. For women, living outside a large metropolitan area was associated with a higher likelihood of receiving only prescription medication (p < 0.001). Policy makers may use these results to consider ways to increase access to care, including increasing funding for behavioral health or recruitment incentives for specialists.

Abstract 4131228: Where Adults with Advanced Heart Failure Die: Insights from the CDC-WONDER Database

Background: Adults with heart failure (HF) are becoming more and more prevalent. The location of death and related disparities in these patients are poorly understood. Aim: The purpose of the study was to look at the locations of adult deaths from HF and identify any age, race, or ethnicity-related variations over a 25-year period. Methods: The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Database provided death certificate data and the National Center for Health Statistics provided individual-level mortality data for the trend-level analysis of adults aged (20-64 and 65+ years) conducted from 1999-2023. Hospital, home, hospice and nursing home/long-term care were the categories for the places of death. Results: Between 1999 and 2023, a total of 7,644,759 adult deaths from HF were recorded (87.9% White, 53.4% female). HF-related deaths decreased from 1999 (3.60% and 143.6 AAMR) to 2010 (3.47% and 123.1 AAMR). From 2010 onwards, a gradual rise is seen, with the rate of HF deaths reaching 5.18% and 168.1 AAMR in 2023. Notably, deaths at home increased from 18.41% (50,648 of 275,132) in 1999 to 33.47% (132,470 of 395,826) in 2023 and deaths in hospice/nursing homes increased from 30.95% (85,144 of 275,132) in 1999 to 34.71% (116,634 of 336,014) in 2017 and then sudden fall was observed until 2023 to 29.54% (116,931 of 395,826). Older adults (65+) were more likely to die in inpatient facilities. Gender, ethnicity, and urbanization influenced the place of death, with males, whites, and those residing in large metropolitan areas more likely to die in medical facilities. Conclusion: Prioritize end-of-life planning for HF patients with poor prognosis, regardless of age, to improve quality of life and death.

Greenhouse gas emissions from urban river waters of China's major cities

Urban rivers are emerging as potent emitters of greenhouse gases (GHGs). However, the magnitude and drivers of GHG emissions from urban rivers are not well understood at a national level. Using a quantitative synthesis of 4633 data records collected from urban river waters of 23 major Chinese cities, this study delved into a systematic analysis of GHG emissions from urban rivers across China. The study showed that GHG emissions in these urban rivers varied spatially and temporally, with the highest carbon emission (CO2 + CH4) from the rivers draining large metropolitan areas and during the summertime. CO2, CH4, and N2O concentrations in the urban river waters ranged from 22.53 to 1052.20 (188.41 ± 223.10) μmolL−1, 0.02 to 21.32 (1.35 ± 1.59) μmolL−1, and 0.01 to 16.81 (0.21 ± 0.72) μmolL−1, respectively, with an average flux of 148.98 ± 245.30 mmolm−2d−1 for CO2, 9.41 ± 25.08 mmolm−2d−1 for CH4, and 0.19 ± 0.65 mmolm−2d−1 for N2O. Urban rivers also received large domestic sewage with high nutrient and carbon loadings due to huge populations, indicating the effect of wastewater treatment plant effluent and urban runoff on GHG production. These findings imply that direct GHG contributions from rivers in urban areas should be accurately quantified and consequently be included in GHG inventories of riverine GHG emissions.

Computer-aided analysis: Correlation between urban green spaces and crime rates

Abstract. Urban green spaces have been associated with various social and environmental benefits, including their potential impact on crime rates. This study investigates the correlation between urban green spaces and crime rates using a combination of Geographic Information Systems (GIS) and advanced statistical analysis. By analyzing data from a large metropolitan area, we examine how green space characteristics such as size, type, and maintenance influence crime patterns. Our findings indicate that well-maintained green spaces with diverse amenities can significantly reduce crime rates, whereas neglected areas may become hotspots for criminal activities. The study also explores temporal patterns of crime in relation to green spaces, revealing that adequate lighting and community presence are crucial for nighttime safety. Policy recommendations are provided to help urban planners and policymakers leverage green spaces to enhance urban safety. By integrating multiple analytical techniques, this research contributes to a comprehensive understanding of the role of green spaces in urban crime prevention and offers actionable insights for future urban planning.

Transport and social (dis)advantage in ride-hailing

ABSTRACT App-based mobility (ABM) is an umbrella term for several transport services enabled through a smartphone application. Ride-hailing is the most popular ABM service, and even more than a decade after its introduction, it continues to raise concerns about its impacts on urban mobility. Previous ride-hailing research has primarily focused on understanding such impacts. However, how ride-hailing affects accessibility and social exclusion remains an understudied topic. Prior research highlights this knowledge gap and proposes a framework linking ABM with transport poverty, (in)accessibility and the resulting transport-related social exclusion (TRSE). Yet, empirical evidence is lacking to test such a framework. This paper addresses this gap by providing empirical evidence on how ABM affects accessibility using survey data collected for three large metropolitan areas in Latin America. We follow three related lines of analysis. First, we compare ride-hailing to other transport modes based on the most regular trips reported in the survey. Second, we calculate novel social and transport (dis)advantage indices to extend the comparison of transport modes. Third, we shed light on why respondents have used ride-hailing services in the past.

Quantitative Analysis of the Future of the Sharing Economy, Housing, White-Collar Labor Markets, and Problems in Big Cities

This research project explores the future of the sharing economy and its profound effects on housing markets, white-collar labor dynamics, and socio-economic challenges in large metropolitan areas. Using quantitative economics and econometric techniques, the study evaluates how platforms such as Airbnb, Uber, and coworking spaces are reshaping urban life, exacerbating housing affordability issues, and altering labor market structures. By analyzing housing market data, labor statistics, and platform economy data from major cities like New York, London, and Istanbul, this research provides empirical insights into how the sharing economy influences urban economic landscapes. The study employs difference-in-differences (DiD) and multivariate regression models to assess causal relationships, particularly in terms of housing market disruptions caused by short-term rental platforms and labor market fragmentation driven by the rise of gig and remote work. Spatial econometric techniques are also used to explore geographic disparities in housing and employment impacts across urban districts. Preliminary findings indicate that the proliferation of sharing economy platforms has contributed to housing shortages and increased prices in central urban areas, while labor markets experience growing polarization, with high-skilled workers benefiting from remote work opportunities and low-skilled gig workers facing economic precarity. This research offers valuable policy insights into the regulation of short-term rentals and the protection of gig economy workers, highlighting the need for regulatory frameworks that address urban inequality and labor market shifts. By integrating data from multiple sources, this study contributes to the academic discourse on urban economics and provides a framework for understanding the long-term socio-economic implications of the sharing economy in big cities.

Impact of chronic pelvic pain on quality of life in diverse young adults.

To examine the relationship between quality of life (QoL) and chronic pelvic pain (CPP), including an evaluation of whether differences exist between reported races and coping mechanisms used. We used a cross-sectional survey design and analyzed data using descriptive and inferential statistics. We administered two surveys: the World Health Organization Quality of Life-BREF (26 items) and the Impact of Female Chronic Pelvic Pain Questionnaire (8 items). We recruited young adults aged 18-25 who menstruate from college campuses in a large metropolitan area in the Midwest region of the United States, utilizing flyers, online social media platforms, and snowball sampling techniques. Out of the 585 respondents, 153 (26%) reported "yes," and 95 (16%) were "unsure" they had CPP. Those with CPP and unsure reported using various coping mechanisms for pain. They had lower scores in all four domains (physical health, psychological, social relationship, and environment) and statistically significant lower scores in three domains (physical health, social relationship, and environment) on the World Health Organization Quality of Life-BREF when compared to those who said "no." Respondents identifying as Black, Indigenous, or People of Color had statistically significantly lower QoL in the physical health and environment domains compared to white respondents. Young adults with CPP experience a significantly lower QoL than those without CPP, and racial differences further widen this gap. Future research should explore coping mechanisms that could benefit young adults' daily lives.

Derived cannabinoid product availability among online vape shops

ObjectivesTo determine the proportion of online vape shops that offer derived cannabinoid products in a large metropolitan area (San Diego, California), measure their compliance with state hemp regulations, and estimate whether these shops receive more website traffic compared to those that offered nicotine or tobacco. MethodsWe obtained vape shops (n = 109) using browser-based (i.e., Google Search) and map-based (i.e., Google Maps and Yelp) searches in San Diego from March to August 2023 and conducted a content analysis of their websites to identify derived cannabinoid products offered for mail-order purchasing. Using website traffic data, we examined the association between derived cannabinoid product availability and monthly website visits. ResultsAmong the 109 online vape shops in the study sample, 35.8 % offered derived cannabinoid products for mail-order purchase and 26.6 % sold flavored (excluding terpenes) and inhalable cannabinoid products. Compared to vape shops that did not offer derived cannabinoid products (Mean: 23,619; 95 % CI: 23,605–23,634), those offering flavored and inhalable cannabinoid products received 2.5 times more monthly website visits (Mean: 57,950; 95 % CI: 57,913–57,986) and those offering any derived cannabinoid products received 5.5 times more monthly website visits (Mean: 130,694; 95 % CI: 130,607–130,782). ConclusionThe prevalence of flavored and inhalable derived cannabinoid products, despite being prohibited under California’s hemp regulations, highlights the need for additional enforcement measures to ensure retailer compliance. The higher website traffic observed among vape shops offering cannabinoid products may be indicative of greater popularity of retailers selling derived cannabinoid products compared to those selling nicotine or tobacco products alone.

Energy-efficient and reliable coordinated scheduling for water distribution systems: enhancing hydraulic conditions and water quality

ABSTRACT Multi-objective operation optimization of water distribution systems (WDSs) in large metropolitan areas is essential; however, it is complex and time-consuming. Effective and reliable scheduling of WDSs can significantly enhance the efficiency and reliability of urban water resources management, which requires further research. This paper develops an optimization method combining genetic algorithm and multiple criteria analysis that coordinates energy conservation, hydraulic condition improvement, and water age optimization in WDSs. Results showed that the optimal scheduling method could achieve a 23.0, 16.7, and 2.5% decrease in energy consumption, and water supply volume with unsatisfied pressure, and average water age, respectively. To achieve optimal results, this study indicated that it is crucial to properly allocate water supply volume and pressure across multiple drinking water treatment plants. This finding provides important guidance for water utilities in scheduling. Furthermore, the emergency scenario analysis shows that the newly proposed method can significantly enhance the social and economic sustainability of WDSs through the coordinated optimization of energy consumption, hydraulic conditions, and water age.

Heterogeneity in disparities by income in cardiovascular risk factors across 209 US metropolitan areas

ObjectiveThe United States has a lower life expectancy and wider income inequality than its similarly developed counterparts, and disparities continue to widen. The objective of our study is to examine the heterogeneity of disparities by income in cardiovascular disease (CVD) risk factors among U.S. metropolitan areas. MethodsData was obtained from the Behavioral Risk Factor Surveillance System for 2012–2019. We used self-reported data for respondent characteristics and for CVD risk factors/prevalence, and on metropolitan-level demographic and socioeconomic characteristics. We computed the relative index of inequality (RII) for each outcome using a multilevel Poisson model, sequentially adjusted for age, sex, and race/ethnicity with a random slope for income. We also included interactions between income and the metropolitan-level variables. ResultsOur sample included 1.4 million participants from 209 metropolitan areas. All CVD risk factors and CVD demonstrated income-related disparities. There were no clear regional patterns for risk factors, though seven of the top 10 large metropolitan areas with the widest disparities in CVD prevalence were in the South. Improved socioeconomic conditions were associated with wider disparities in the five risk factors, and contextual variables explained almost half of the variability in income disparities in smoking, sedentarism, and obesity, even after adjusting for age, sex, and race/ethnicity. ConclusionsThis study found that CVD risk factors and prevalence in U.S. metropolitan areas have heterogeneous income disparities, especially in advantaged metropolitan areas. Further studies with improved data collection may shed more light into potential drivers of income-based disparities in cardiovascular risk.

Environmental Benefits of Hydrogen-Powered Buses: A Case Study of Coke Oven Gas

This study conducted a Life Cycle Assessment (LCA) of alternative (electric and hydrogen) and conventional diesel buses in a large metropolitan area. The primary focus was on hydrogen derived from coke oven gas, a byproduct of the coking process, which is a crucial step in the steel production value chain. The functional unit was 1,000,000 km traveled over 15 years. LCA analysis using SimaPro v9.3 revealed significant environmental differences between the bus types. Hydrogen buses outperformed electric buses in all 11 environmental impact categories and in 5 of 11 categories compared to conventional diesel buses. The most substantial improvements for hydrogen buses were observed in ozone depletion (8.6% of diesel buses) and global warming (29.9% of diesel buses). As a bridge to a future dominated by green hydrogen, employing grey hydrogen from coke oven gas in buses provides a practical way to decrease environmental harm in regions abundant with this resource. This interim solution can significantly contribute to climate policy goals.

Clinical Evaluation of Blood Culture Identification Gram-Positive Panel on Methicillin Resistant Gene Testing in a Large Metropolitan Teaching Hospital

Abstract Introduction The ePlex blood culture identification (BCID) gram-positive panel is a PCR-based approach used for the detection of common pathogens associated with bloodstream infections and corresponding antibiotic-resistance genes. One of the genes, mecA, is associated with methicillin, penicillin, and other penicillin-like-antibiotic-resistant gram-positive bacteria (GPB). It is unclear whether the BCID panel has predictive utility and accuracy in treating hospital infections due to GPB. This retrospective study attempts to determine the consistency and accuracy of BCID gene testing compared to more traditional susceptibility methods at a large public hospital. Method A search query was performed for all BCID results at one teaching hospital in a large metropolitan area for one year (2022). The query included demographic information, BCID results, culture results, and combined susceptibility data. The results were filtered to include only cases in which the mecA gene was detected. The filtered results were then analyzed to determine if the susceptibility results from the susceptibility platform (VITEK) were consistent with the expected susceptibility of the target gene, specifically for oxacillin and vancomycin. The susceptibility cutoff was set as &amp;gt;0.5 mcg/mL and &amp;lt;1 mcg/mL respectively, the standard threshold used at the institution. Results A total of 1211 culture results were obtained, of which the mecA gene was identified by BCID in 321 cases, along with the following GPB: Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus sp. (not aureus). The corresponding cultures grew the following isolates: S. aureus, S. epidermidis, S. hominis, and S. haemolyticus. Of the 321 BCID results, 75 were identified as S. aureus. The isolates grew methicillin-resistant Staph aureus (MRSA) (69/75) 92%, while the typical S. aureus grew (6/75) in 8% of the isolates. In these cases, we compared susceptibility testing for both isolates as either sensitive or resistant, with a MIC of &amp;gt;0.5 mcg/mL for oxacillin to be designated as resistant, and &amp;lt;1 mcg/mL to be designated as sensitive to vancomycin. Of the 75 specimens, the concordance rate was 97% (73/75) for oxacillin and 100% (75/75) for vancomycin. The average receipt to verification turnaround time (TAT) was 36 hours for BCID results and 121 hours (about 5 days) for culture sensitivity results. Conclusion The results show that oxacillin resistance can be predicted by detecting S. aureus and the mecA gene using the BCID panel. However, the mecA gene can be identified in other GPB such as S. epidermidis, in which it should not be used to infer oxacillin or vancomycin susceptibilities. In the case of mecA and S. aureus detection by BCID, treating the patient as a MRSA infection may be appropriate before the susceptibilities have been performed. This approach can reduce the turnaround time for antimicrobial resistance reporting and improve antimicrobial stewardship efforts.

Socioeconomic disparities in reception of limb-sparing surgery versus amputation for lower extremity sarcoma

BackgroundIn lower extremity sarcoma treatment, limb salvage approaches present superior alternatives to amputation due to reduced postoperative morbidity and improved quality of life. This study provides a novel analysis of socioeconomic disparities that may affect reception of limb-sparing surgery. MethodsPatients with lower extremity bone or soft tissue sarcoma who received either limb-sparing surgery or amputation from 2007 to 2021 were identified in the Surveillance, Epidemiology and End Results (SEER) database. Demographic, socioeconomic, and oncologic variables were collected for each patient. Multivariate binary logistic regression was conducted to assess preoperative demographic and oncologic risk factors for amputation (p < 0.05). ResultsA total of 6465 patients were identified in the final cohort, 586 (9.1%) of whom received amputation. After controlling for tumor size, stage, and neoadjuvant therapy administration, non-Hispanic American Indian/Alaskan Native race/ethnicity predicted the highest odds of amputation (OR: 1.78, 95% CI: 1.12–2.85, p = 0.015). Nonmetropolitan residence (OR: 1.69, 95% CI: 1.43–2.00, p < 0.001) also conferred higher risk of amputation compared with residence in a large metropolitan area. Overall, amputation was associated with a higher risk of ten-year cancer-specific mortality (p < 0.001) even when controlled by sociodemographic and clinical characteristics. ConclusionsThere are significant disparities in limb-sparing surgery and amputation rates in lower extremity sarcoma management, even when accounting for differences in baseline oncologic characteristics. Further study into socioeconomic drivers of these trends will allow the development of initiatives that improve disparities in reconstructive outcomes.

Effects of the Spatial Pattern of Forest Vegetation on Urban Cooling in Large Metropolitan Areas of China: A Multi-Scale Perspective

Effects of the Spatial Pattern of Forest Vegetation on Urban Cooling in Large Metropolitan Areas of China: A Multi-Scale Perspective

Adolescents and Social Media: Longitudinal Links Between Motivations for Using Social Media and Subsequent Internalizing Symptoms.

Knowledge is lacking on whether adolescents' motivations for social media use predict internalizing symptoms, and few studies have considered the moderating role of extraversion. In 2017 (T1) and 2018 (T2), 197 adolescents (49.70% girls, Mage = 13.15, SD = 0.36) from a large metropolitan area participated in this study. Adolescents reported on their social media use motivations and extraversion (at T1) and depressive and anxiety symptoms (T1 and T2). Latent class analysis revealed four motivation profiles at T1: (1) entertainment and fun (30.97%); (2) avoidance and escapism (14.21%); (3) meeting new people, feel involved (16.75%); (4) boredom (38.07%). Social motivations (profile 3) predicted elevated internalizing symptoms at T2. Avoidance and boredom motivations (profile 2 and 4) predicted internalizing symptoms for adolescents with low extraversion. Social media use motivations and extraversion distinguish adolescents who benefit from social media from those who experience difficulties.

Mortality Patterns of Esophageal Cancer in the United States: A 21-Year Retrospective Analysis.

Esophageal cancer (EC) is the sixth leading cause of cancer-related deaths in the United States, with a mere 20% survival rate in the first 5 years, making it a significant public health concern. Considering the lack of comprehensive evaluations of mortality trends, this study aims to provide an update on the mortality rates of esophageal cancer and its trends in the United States. The mortality trends among adults with EC were analyzed using data from the CDC WONDER database. Crude and age-adjusted mortality rates (AAMRs) per 100,000 people were extracted. Annual percent changes (APCs) in AAMRs with 95% CI were obtained using joinpoint regression analysis across different demographic (sex, race/ethnicity, and age) and geographic (state, urban-rural, and regional) subgroups. Between 1999 and 2020, 309,725 documented deaths were attributed to esophageal cancer. The overall AAMR decreased from 1999 to 2020 (6.69 to 5.68). Males had higher consistently higher AAMRs than females (10.96 vs. 2.24). NH White had the highest overall AAMR (6.88), followed by NH Black (6.46), NH American Indian (4.95), Hispanic or Latino (3.31), and NH Asian or Pacific Islander (2.57). AAMR also varied by region (overall AAMR: Midwest: 7.18; Northeast: 6.75; South: 6.07; West: 5.76), and nonmetropolitan areas had higher AAMR (non-core areas: 7.09; micropolitan areas: 7.19) than metropolitan areas (large central metropolitan areas: 5.75; large fringe areas: 6.33). The states in the upper 90th percentile of esophageal cancer-related AAMR were Vermont, District of Columbia, West Virginia, Ohio, New Hampshire, and Maine, and exhibited an approximately two-fold increase in AAMRs, compared with states falling in the lower 10th percentile. Over the last 2 decades, there has been an overall decline in mortality related to EC in the United States. However, demographic and geographic discrepancies in EC-related mortality persist, necessitating additional exploration and development of specifically directed treatments.

High hospitalization rates and risk factors among frail patients with cirrhosis: A 10-year population-based cohort study

Cirrhosis-related inpatient hospitalizations have increased dramatically over the past decade. We used a longitudinal dataset capturing a large metropolitan area in the US from 2011-2021 to evaluate contemporary hospitalization rates and risk factors among frail patients with cirrhosis. We conducted a retrospective, longitudinal cohort study using the Chicago Area Patient-Centered Outcomes Research Network (CAPriCORN) database, an electronic health record (EHR) repository that aggregates de-duplicated data across seven healthcare systems in the Chicago metropolitan area, from 2011-2021. The primary outcome of our study was the rate of hospitalization encounters. Frailty was defined by the Hospital Frailty Risk Score. Hospitalization rates were reported per 100 patients per year and a multivariable logistic regression analysis identified predictors of annual hospitalization probability. During the study period, of 36,971 patients, 16,265 patients (44%) were hospitalized (compensated: 18.4%, decompensated: 81.6%). Hospitalization rates were highest in patients with decompensated cirrhosis, reaching nearly 77.3 hospitalizations/100 patients per year. Hospitalization rates among patients with compensated cirrhosis were also high (14.2 vs. 77.3 hospitalization/100 patients per year), with odds of annual hospitalization three times (OR 3.1; 95%CI 2.9-3.4) as high among compensated patients with intermediate frailty and five times (OR 5.2; 95%CI 4.5-6.0) as high among those with severe frailty (compared to compensated patients with low frailty). Compensated and decompensated cirrhosis patients with intermediate to severe frailty face a substantially increased odds of annual hospitalizations compared to those with low frailty. Future work should focus on targeted interventions to incorporate routine frailty screenings into cirrhosis care and to ultimately minimize high hospitalization rates.

Commercial milk formula marketing entry points: setting the course of infant and young child feeding trajectories

BackgroundThere is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF.MethodsWomen of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels.ResultsHospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding.ConclusionsThe cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford.

Using syndromic surveillance for unintentional and undetermined intent drowning surveillance in a large metropolitan area

IntroductionA drowning definition is available for use with National Syndromic Surveillance Program (NSSP) data. However, its accuracy in capturing drowning emergency department and urgent care visits at the regional level is unknown. We tested the ability of the syndromic surveillance (SS) definition in capturing unintentional and undetermined intent drowning (UUID) and describe UUID SS visit trends in a large metropolitan area.MethodsWe applied the drowning definition to NSSP data from 2016 to 2022 for the 8-county metropolitan Houston region. We queried the dataset for UUID ICD-10-CM codes and manually reviewed the chief complaint (CC) and discharge diagnosis (DD) for SS visits. True-positives were calculated by dividing the number of UUID cases identified by UUID ICD-10-CM codes and CC/DD review by the total visits captured by the SS definition. Demographics and trends of UUID visits were calculated from 2018 to 2022 due to limited data from 2016 to 2017 in NSSP.Results2,759 visits were captured by the SS definition. After case review, 2,019 (73.2%) had ICD-10-CM drowning codes of any intent; and 2,015 of those (99.8%) were classified as UUID. Of the remaining 740 cases with no ICD-10-CM codes that were pulled by the SS definition, 690 (93.2%) had a CC/DD diagnosis of drowning/submersion/underwater related to aquatic exposure. Taken together, 2,705 (98.0%) were true-positive UUID visits based on the SS drowning definition.. Children (aged < 18 years) constituted 79% of UUID visits. Black, White and Asian/Pacific Islander persons comprised 17%, 60% and 4% of UUID visits respectively. Rates of UUID visits were lowest in 2020.ConclusionSyndromic surveillance is a novel and accurate method to conduct real-time drowning surveillance in a large metropolitan region.