Residual burden of severe RSV disease in infants during the first season of maternal RSVpreF immunization in Argentina: A hospital-based, multicentre, retrospective cohort study.

Objectives. To summarize and present a visual representation of the complex implementation context of cardiovascular disease prevention interventions and identify opportunities to increase an emphasis on equity. Methods. From May to October 2021, we conducted 24 interviews with people knowledgeable about cardiovascular disease prevention activities in the Denver, Colorado, metropolitan area, guided by the framing of a resource generator network analysis and the levels (clinical, behavioral support, health promotion/access, and regulatory/taxes) of the Prevention Impacts Simulation Model. We selected 4 program examples to demonstrate how subsets of the network carry out cardiovascular disease prevention activities. Results. There were 82 active and 7 inactive programs. We categorized organizations into 10 types. We identified the following health equity topic areas: tracking metrics, making referrals to basic needs services, offering non-health care services, addressing hunger and food insecurity, focusing programs on low-income and minoritized groups, and regulating industry. Conclusions. We recommend increasing the use of systems science methods in public health to reorient efforts toward prevention and equitable allocation of resources and to increase links across levels. (Am J Public Health. 2026;116(S3): S152-S161. https://doi.org/10.2105/AJPH.2026.308537).

The Role of Geography in United States Retinoblastoma Care.

Human-modified landscapes alter species interactions, yet the spatial scale at which landscape features influence predator-prey interactions remains poorly understood. Caudal autotomy, a widespread antipredator defense in many reptile species, has been proposed as a proxy of predation pressure. We investigated landscape-scale variation in tail autotomy frequency in two synanthropic lizards, Podarcis muralis and P. siculus, across four metropolitan areas in Italy. We combined extensive field sampling (386 individuals) across 33 localities along a gradient of urbanization with multi-scale analyses of landscape composition and configuration, as well as proxies of predator occurrence (citizen-science records, species distribution models, and the distribution of colonies of free-ranging cats). Using generalized linear mixed models, we assessed which landscape features and spatial scales best explained variation in autotomy frequency. Overall, 66% of individuals exhibited autotomy. The frequency of autotomy was higher in P. muralis than in P. siculus and increased significantly with body size. Landscape composition strongly influenced the frequency of autotomy. Forest cover within 50 m of capture sites was the strongest predictor of autotomy, with individuals from areas characterized by lower forest cover showing a higher probability of tail loss. The explanatory power of landscape composition decreased at broader spatial scales. Instead, neither landscape configuration metrics, estimated predator richness, nor proximity to cat colonies significantly improved model performance. The frequency of caudal autotomy in Podarcis lizards varies along the urbanization gradient and is primarily associated with fine-scale habitat structure. These findings underscore the strong role of landscape composition in shaping multiple animal traits and support the use of morphological indicators to assess the ecological effects of human-driven landscape change.

Investigating immigrants' work-life balance in metropolitan areas: A latent class modeling approach

Integrated policy network helps mitigate economic development imbalance: An empirical study of China's metropolitan area

IntroductionLymphogranuloma venereum (LGV), caused by Chlamydia trachomatis (CT) serovars L1-L3, has re-emerged in Europe since the early 2000s, predominantly affecting men who have sex with men (MSM), particularly people living with HIV (PLWH). The widespread implementation of HIV pre-exposure prophylaxis (HIV-PrEP) and the associated expansion of sexually transmitted infection (STI) screening programmes may have influenced the epidemiology and clinical presentation of LGV. MethodsWe analysed the clinical and epidemiological characteristics of rectal LGV cases diagnosed in the Bologna metropolitan area during the HIV-PrEP era (2022-2025) and compared them with those of a historical cohort from the pre-HIV-PrEP era (2016-2020). ResultsOverall, 93 rectal LGV cases were identified during 2022-2025, all among MSM, with a median age of 37 years; 66% were symptomatic, 48% were HIV-positive, 31% had concurrent rectal Neisseria gonorrhoeae infection, and 21% were diagnosed with early syphilis. Although the absolute number of LGV cases was higher than in 2016-2020 (93 vs 76), this difference occurred in the context of a substantial increase in anorectal CT testing during the HIV-PrEP era. Accordingly, LGV prevalence among anorectal swabs declined markedly (from 4% to 0.7%). When stratified by population group, HIV-PrEP users with LGV (n = 38) were younger than non-HIV PrEP users (n = 55, including 45 PLWH and 10 non-HIV MSM) and were significantly more likely to be asymptomatic, with lower rates of concurrent bacterial STIs.ConclusionThese findings suggest that rectal LGV remains endemic in our setting but may present with different clinical patterns in the HIV-PrEP era, with a higher proportion of asymptomatic infections among PrEP users, likely reflecting intensified STI screening. Continued epidemiological surveillance is needed to better understand LGV transmission dynamics and to inform tailored prevention and screening strategies among MSM.

Prenatal exposure to metal mixtures and mitochondrial DNA content and telomere length in newborns: Potential modulation by TERT gene variants.

Exploring the awareness and effects of environmental pollutants among food market vendors in Akure metropolitan area

Human milk banks rely on voluntary donations from lactating individuals producing more milk than their baby needs, to make pasteurised donor human milk (PDHM) for preterm babies. Demand for PDHM is increasing, as is the need for donors. Few Australian studies have explored potential donors' awareness and perceived feasibility of donating to a milk bank. We aimed to survey women breastfeeding their own child (< 24 months) or pregnant (and intending to breastfeed), and residing in major metropolitan areas of Australia, to determine their awareness of milk banks, and interest in and perceived feasibility (ease, eligibility) of donating to a milk bank. 1221 participants completed the survey (112 pregnant women, 1109 breastfeeding women). Most (78%) had heard of milk banks, and 81.7% lived in an area eligible to donate to a milk bank, yet only 11% were aware of a milk bank in their area. Most (60%) pregnant women would prefer to use online sources or health professionals to find information about donation. Most breastfeeding women (77%) were interested in donating milk, however only 26% thought it would be easy to meet milk bank requirements, and that they would be eligible to donate. Barriers to donating for breastfeeding women involved having no excess milk to donate, lack of time to express/donate, and lack of space to store milk. Awareness raising of local milk banks, promotion of donation information amongst healthcare professionals, and modifications to improve feasibility of donation will likely engage new potential donors and ensure sustainability of milk banks.

Ketamine is increasingly prescribed in an off-label manner to treat psychiatric disorders, raising concerns about direct-to-consumer advertising and the proliferation of clinics offering ketamine for at-home use without direct medical supervision. We aimed to identify and characterize clinics advertising ketamine for psychiatric conditions online in the New York metropolitan area (New York, New Jersey, and Connecticut), with attention to advertising suggesting ketamine is prescribed for at-home use. In 2025, systematic web searches were conducted to identify clinics advertising prescription ketamine for psychiatric indications. Public-facing website content was reviewed to describe clinic characteristics: service delivery modality, clinician credentials, routes of administration, disorders treated, and advertising practices. A generalized linear model was used to delineate correlates of clinics advertising ketamine for at-home use. 233 clinics were located; 36.5% prescribed ketamine for at-home use. 51.5% listed a medical doctor as part of their team and 42.9% advertised oral ketamine. Depression was the most commonly listed disorder treated (94.0%) and 21.9% advertised ketamine to treat substance use disorder. In the multivariable model, advertising ketamine for at-home use was more common among clinics advertising oral ketamine (aPR = 4.10, 95% CI: 2.20-7.60) and less common among clinics listing a medical doctor (aPR = 0.54, 95% CI: 0.30-0.99). Over a third of clinics advertised ketamine for at-home use. A limitation is that we only focused on public-facing websites. Advertising practices and clinician representation suggest clinics may be advertising in a more consumer-oriented manner, underscoring the need for monitoring and clearer guidance to mitigate potential safety risks.

This study explores how perceived safety influences sleep quality among Wixárika individuals in Mexico. We compared the sleep quality of those living in a rural town in northern Jalisco with those living in the Guadalajara Metropolitan Area (GMA). We aimed to assess differences in perceived safety, model its association with sleep outcomes, and test for gendered effects. Sleep was measured using actigraphy and surveys. Perceived neighborhood safety (PNS) was measured with survey items. Sleep outcomes included efficiency, fragmentation, wake after sleep onset (WASO), self-rated quality, and daytime dysfunction. Analyses used Mann-Whitney U tests, linear mixed effects models, and logistic regression. Our sample included 127 participants. In the rural location (n = 61), the mean age was 38.02 years (SD = 12.18, range = 18-65), with 72.13% comprised of women. In the GMA, the mean age was 29.59 years (SD = 8.43, range = 18-57), of whom 65.15% were women. PNS was significantly higher in the rural town than in the GMA. Gender moderated the association between PNS and sleep quality, with women showing improved sleep quality with greater PNS. Poorer mental health predicted lower sleep quality in rural participants and greater odds of daytime dysfunction in urban participants. In our analyses, living in urban contexts is associated with reduced perceived safety, which interacts with gender to shape sleep. Women's sleep appears to be particularly sensitive to perceived safety, reflecting broader intersecting vulnerabilities and health inequities faced by Indigenous migrant women. Policies addressing housing and neighborhood safety, alongside culturally grounded supports, may improve sleep health in these communities.

Survey of equine pasture best management practices and soil fertility in southeast Pennsylvania after the grazing season.

Despite sustained estimated reductions in anthropogenic precursor emissions, ozone design values remain above the 2015 8-hour National Ambient Air Quality Standard in four large, urban nonattainment areas (NAAs) in the Intermountain Western U.S.: Phoenix-Mesa, Arizona; Las Vegas, Nevada; Wasatch Front, Utah; and Denver Metro/North Front Range, Colorado. We synthesize recent field campaigns, regulatory analyses, and observationally-constrained modeling to summarize shared drivers of stalled progress and the region-specific mechanisms that modulate ozone accumulation. Across these areas, elevated background ozone, terrain-driven recirculation, and meteorological conditions favoring stagnation and vertical coupling all reduce the effectiveness of local emission controls. However, many important factors also differ by airshed: Phoenix is strongly influenced by monsoon-modulated photochemistry and boundary-layer dynamics; Las Vegas by frequent entrainment of ozone-rich layers from aloft and a high ozone "floor"; the Wasatch Front by corridor confinement, elevated background concentrations, and multi-day recirculation; and the Front Range by complex terrain flows interacting with spatially heterogeneous precursor sources, including strong within-NAA oil and gas emissions. Together, each of these case studies underscores the need for ozone management strategies tailored to each airshed's structural and dynamical constraints, supported by coordinated collaborative science.Implication: Robinson et al. "Urban ozone nonattainment: interconnected challenges in the Intermountain Western U.S." Despite decades of declining anthropogenic precursor emissions, four major Intermountain Western U.S. metropolitan areas - Phoenix, Las Vegas, Salt Lake City, and Denver - continue to exceed the 2015 8-hour ozone standard. This synthesis identifies both shared and airshed-specific factors driving persistent nonattainment. Elevated background ozone, wildfire smoke, terrain-driven recirculation, and vertical entrainment all substantially limit the effectiveness of local controls, though the dominant mechanisms differ between areas. For lawmakers and regulators, these issues underscore the need for region-specific strategies, enhanced vertical profiling and speciated precursor monitoring, and improved attribution of controllable versus transported contributions to support technically defensible regulatory decisions.

Occurrence of Corynosoma cystacanths in commercially distributed marine fish within and outside Hokkaido, Japan.

The World Health Organization classifies extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing Klebsiella pneumoniae as critical-priority pathogens due to their high incidence, mortality, transmissibility, rapid resistance acquisition, and limited treatment options. Beyond clinical settings, their detection in wastewater treatment plants (WWTPs) provides an opportunity to assess their prevalence, persistence, and circulation within wastewater systems. This study characterized 37 antibiotic-resistant K. pneumoniae-related species strains isolated from two WWTPs in the metropolitan area of Barcelona, analyzing their antimicrobial resistance (AMR) profiles, antimicrobial resistance genes (ARGs), biocide and heavy metal tolerance genes (HMTGs), virulence factor genes (VFGs), biofilm-forming capacity, and conjugation ability. Among them, 70.3% were multidrug-resistant (MDR), and 16.2% were extensively drug-resistant. Whole-genome sequencing revealed diverse ARGs; all strains carried β-lactam resistance genes (14 ESBL and 12 carbapenemase producers), nearly all (96.9%) carried biocide or HMTGs, 64.9% harbored integrases, and all carried VFGs. Core-genome SNP analysis identified closely related strains across sampling periods and treatment stages, suggesting long-term persistence within the wastewater treatment system, despite biological and chemical processes in secondary treatment. Most strains (67.6%) displayed biofilm-forming capacity, and conjugation assays confirmed horizontal gene transfer in five of the seven ESBL-producing strains tested. High-risk clones were predominantly detected in the IFAS secondary treatment stage of the Gavà-Viladecans WWTP. The three strains recovered from the reclaimed water of the Baix Llobregat WWTP were ESBL or carbapenemase producers. Altogether, these results provide genomic and phenotypic evidence of the persistence and circulation of antibiotic-resistant K. pneumoniae-related species within wastewater treatment systems.IMPORTANCEWWTPs are essential for urban sanitation and environmental protection. Understanding how clinically relevant pathogens, such as ESBL and carbapenemase-producing K. pneumoniae-related species strains, behave in these settings may inform public health considerations. Investigating the presence and persistence of high-risk MDR pathogens in WWTPs helps identify circulation of AMR, assess the risk of gene transfer, and evaluate the potential for co-selection with other contaminants. This knowledge supports efforts to improve wastewater treatments, strengthen environmental surveillance, and develop integrated One Health strategies to limit the spread of AMR across human, animal, and environmental sectors.

ABSTRACT Earlier studies have documented psychoactive substance use and nicotine exposure among commercial drivers in Ghana. However, those studies relied solely on self-reported questionnaires, which are prone to recall and response bias. This study aimed to provide a more accurate estimate by using a chromatographic immunoassay urine drug test. This exploratory cross-sectional study was conducted between January and August 2024 in the Tamale metropolitan area of Ghana. The study included 70 consenting commercial drivers aged from 26 to 78 years. Sociodemographic, anthropometric and occupational factors were collected using a semi-structured questionnaire. Urine samples were then obtained from the participants and tested for Amphetamine (AMP), Barbiturates (BAR), Benzodiazepines (BZO), Cocaine (COC), Tetrahydrocannabinol (THC), Morphine (MOP), Opiates (OPI), nicotine exposure using Cotinine (COT), Tramadol (TML), and Tricyclic Antidepressants (TCA) using the 10-panel Multi-Drug One Step chromatographic immunoassay test kit. The total urine prevalence of psychoactive substances and nicotine exposure was 61.4%, consisting of COT (37.1%), THC (24.3%), BZO (11.4%), Tramadol (5.7%) and AMP (2.9%). While the self-reported smoking prevalence was 10%, the urine cotinine prevalence was 37.1%. In addition, 14(20%) of the urine samples tested positive for two substances. Contrary to expectations, commercial drivers with no history of accident were more likely to test positive for TML [AOR = 8.667(95%CI: 1.025–73.249)], or two substances [AOR = 5.000(95%CI: 1.051–23.789)]. The urine samples of commercial drivers tested positive for psychoactive substances and nicotine exposure. However, positivity for a psychoactive substance or nicotine exposure may not be associated with a history of road traffic accidents. Further studies are recommended.

Dementia, termed major neurocognitive disorder in the DSM-5-TR, and substance use disorders (SUD) are major and increasingly overlapping public health concerns in the United States. However, population-level trends examining their combined contribution to mortality remain limited. This study evaluates national mortality trends involving both conditions. We conducted a retrospective analysis of the CDC WONDER Multiple Cause of Death database (2000-2023). Deaths listing both dementia and SUD as underlying or contributing causes were identified using ICD-10 codes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated using the 2000 U.S. standard population. Trends were analyzed using Joinpoint regression, reporting annual percent change (APC) and average annual percent change (AAPC) with 95% confidence intervals (CIs). A total of 283,206 deaths were identified. The overall AAMR increased significantly from 0.58 in 2000 to 7.63 in 2023 (AAPC: 13.29%; 95% CI: 10.42-16.23; p<0.001). Sex-stratified analysis showed higher mortality in males (AAMR: 0.87→9.61) than females (0.41→6.23), although females demonstrated a greater relative increase (AAPC: 14.07% vs 12.55%; both p<0.001). By race, non-Hispanic (NH) White individuals had the highest absolute rates (AAMR: 0.60→8.57), while NH Black individuals exhibited the highest long-term burden (AAPC: 12.69%; p<0.001). Hispanic individuals showed lower rates but consistent increases (AAMR: 0.22→3.33; p<0.001). Age-stratified analysis demonstrated increasing age-adjusted mortality rates among individuals aged 45-64 years (0.14→0.61; p<0.001). Among older adults (≥65 years), mortality rates initially increased substantially (2.79→41.94) through 2020 (p<0.001), then declined sharply, reaching 0.61 in 2023 (p<0.001). Regionally, the Midwest had the highest mortality (AAMR: 0.58→10.8; AAPC: 14.38%; p<0.001), while the Northeast had the lowest rates (0.29→4.95; p<0.001). All regions showed significant upward trends (p<0.001). Urbanization analysis revealed increasing mortality in metropolitan (0.56→3.5) and non-metropolitan areas (0.71→3.8), with stronger growth in non-metropolitan regions (AAPC: 16.72% vs 15.82%; p<0.001). Mortality involving both dementia and substance use disorders has increased substantially in the United States over the past two decades, with significant disparities across sex, race, geography, and urbanization. These findings highlight the growing burdens of neurodegenerative disease and substance use, emphasizing the need for integrated public health strategies targeting both conditions.

Population aging leads to rising chronic disease burden and healthcare costs. The metropolitan area of Genoa (Liguria), the oldest in Italy, is particularly affected. Since 2017, ASL3 has implemented a comprehensive health promotion strategy including risk-factor reduction initiatives and multidisciplinary care pathways for multimorbid patients. To evaluate the impact of the comprehensive health promotion program on the prevalence of heart failure (HF), chronic kidney disease (CKD), and chronic liver disease (CLD), and on healthcare resource use. Using the ASL3 data warehouse, we analyzed trends in HF, CKD, and CLD prevalence from 2011 to 2023 and compared yearly prevalence between 2011 and 2019 and 2020-2023. Hospitalization, outpatient activity and drug-prescription data were assessed; production and pharmaceutical costs were calculated. Regression models evaluated changes in prevalence trajectories. The resident population and average age increased slightly (from 704,355 to 711,133 people; from 49 to 51 years old). The unadjusted and standardized prevalence of HF, CKD and CLD rose significantly over the study period. However, after regression analysis, significance was confirmed only for the period 2011-2019. In 2020-2023, prevalence continued to rise, but at a substantially slower rate, suggesting an attenuation of the upward trend. A multifaceted, system-wide prevention and care model may attenuate the upward trend in chronic-disease prevalence in highly aged populations. These findings support integrated health-promotion strategies as a sustainable approach to chronic disease management and resource stewardship.

Rapid urbanisation and increasing passenger demand in metropolitan areas have intensified pressure on commuter rail station platforms, particularly in densely populated cities such as those within the Jakarta Metropolitan Area. This condition frequently leads to overcrowding, which affects passenger comfort, safety, and perceived service quality. However, existing Level of Service (LOS) frameworks primarily rely on technical density measures and do not fully capture user perceptions of crowding conditions. This study therefore aims to analyse passenger acceptance of platform crowding and determine the critical density threshold that reflects the transition between acceptable and unacceptable conditions. The research employs a stated preference survey involving 297 respondents at Depok Commuter Station, generating 2,970 observations. Data were analysed using binary logistic regression to model the relationship between passenger density and acceptance probability. The results show that passenger density significantly influences acceptance levels, with a negative relationship indicating that higher density reduces acceptance probability. The critical density was identified at 6.70 passengers/m², corresponding to an acceptance distance of 0.386 metres. These findings demonstrate a gap between theoretical LOS standards and actual passenger perceptions. In conclusion, integrating user perception into crowding evaluation provides a more accurate and human-centred assessment of platform service quality. The study contributes to transit planning by offering empirical thresholds for crowd management and station design improvements.