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PubMed2004

Ranking of cities according to public health criteria: pitfalls and opportunities.

Popular magazines often rank cities in terms of various aspects of quality of life. Such ranking studies can motivate people to visit or relocate to a particular city or increase the frequency with which they engage in healthy behaviors. With careful consideration of study design and data limitations, these efforts also can assist policymakers in identifying local public health issues. We discuss considerations in interpreting ranking studies that use environmental measures of a city population's public health related to physical activity, nutrition, and obesity. Ranking studies such as those commonly publicized are constrained by statistical methodology issues and a lack of a scientific basis in regard to design.

Cities↗
PubMed2005

Psychopathology among New York city public school children 6 months after September 11.

CONTEXT: Children exposed to a traumatic event may be at higher risk for developing mental disorders. The prevalence of child psychopathology, however, has not been assessed in a population-based sample exposed to different levels of mass trauma or across a range of disorders. OBJECTIVE: To determine prevalence and correlates of probable mental disorders among New York City, NY, public school students 6 months following the September 11, 2001, World Trade Center attack. DESIGN: Survey. SETTING: New York City public schools. PARTICIPANTS: A citywide, random, representative sample of 8236 students in grades 4 through 12, including oversampling in closest proximity to the World Trade Center site (ground zero) and other high-risk areas. MAIN OUTCOME MEASURE: Children were screened for probable mental disorders with the Diagnostic Interview Schedule for Children Predictive Scales. RESULTS: One or more of 6 probable anxiety/depressive disorders were identified in 28.6% of all children. The most prevalent were probable agoraphobia (14.8%), probable separation anxiety (12.3%), and probable posttraumatic stress disorder (10.6%). Higher levels of exposure correspond to higher prevalence for all probable anxiety/depressive disorders. Girls and children in grades 4 and 5 were the most affected. In logistic regression analyses, child's exposure (adjusted odds ratio, 1.62), exposure of a child's family member (adjusted odds ratio, 1.80), and the child's prior trauma (adjusted odds ratio, 2.01) were related to increased likelihood of probable anxiety/depressive disorders. Results were adjusted for different types of exposure, sociodemographic characteristics, and child mental health service use. CONCLUSIONS: A high proportion of New York City public school children had a probable mental disorder 6 months after September 11, 2001. The data suggest that there is a relationship between level of exposure to trauma and likelihood of child anxiety/depressive disorders in the community. The results support the need to apply wide-area epidemiological approaches to mental health assessment after any large-scale disaster.

Adolescent↗
PubMed2003

The prevalence of dementia in a metropolitan city of South Korea.

BACKGROUND: There are few studies on the prevalence of dementia in South Korea. This study was designed to estimate the prevalence rate of dementia in a metropolitan city of South Korea, Busan. METHODS: This was a cross-sectional epidemiological study of 1101 residents aged 65 or over in a metropolitan city (Busan) as of 31 December 2001 who were selected with the stratified three-stage cluster sampling. Dementia was assessed by two-stage examination with Mini-Mental State Examination-Korean version (MMSE-K), psychometric measures and the Barthel index. Crude and sex-age adjusted prevalence rate were obtained. RESULTS: The crude rate was 7.4% (men 2.4%, women 10.5%). The sex-age adjusted rate was 7.0% (men 2.5%, women 9.0%) and 8.0% (men 2.7%, women 10.0%) when adjusted with Busan and whole Korean population, respectively. CONCLUSION: These results were lower than those of other domestic studies. This is the first well-designed total-population based epidemiologic study on the prevalence rate of dementia of the aged residing in Busan city. Further studies for evaluating the relationships with type and severity of dementia are needed.

Age Factors↗
PubMedDate not supplied

Pro-inflammatory effects of Dunkerque city air pollution particulate matter 2.5 in human epithelial lung cells (L132) in culture.

Exposure to urban airborne particulate matter (PM) has been associated with adverse health effects. The majority of research articles published on air pollution PM relate to PM10. However, increasing emphasis and stringent regulations have been placed on PM2.5. The mechanisms for PM-induced adverse health effects are not well understood, but inflammation seems to be of importance. We focused our attention also on the capacity of air pollution PM2.5 to induce cytotoxic and inflammatory responses in human epithelial lung cells (L132) in culture. Particulate matter was collected in Dunkerque, a French seaside city characterized by the proximity of industrial activity and heavy motor vehicle traffic. Size distribution results showed that the cumulative frequency of PM2.5 was 92.15% and their specific surface area was 1 m2 g(-1). Inorganic and organic chemicals usually associated with the natural environment but also so-called anthropogenic elements were found in PM, suggesting that much of the PM was derived from wind-borne dust from the industrial complex and the heavy diesel motor vehicle. We observed PM concentration-dependent cytotoxic effects in L132 cells (LC10 = 18.84 microg PM ml(-1); LC50 = 75.36 microg PM ml(-1)). We showed that exposure to Dunkerque City's PM2.5 induced significant increases (in a concentration- and time-dependent manner) in protein secretion and/or gene expression of inflammatory cytokines (i.e. TNF-alpha, IL-1beta, IL-8, GM-CSF, IL-6, TGF-beta1). We hypothesized also that the occurrence of the acute inflammatory response might rely on the capacity of such air pollutants to generate oxidative species, which have been implicated in the stringent regulation of the cytokine network. Hence, we suggest that the development of inflammatory effects that worsen over time stems from the cytotoxicity in Dunkerque City's PM2.5-exposed L132 cells in culture.

Air Pollutants↗
PubMedDate not supplied

Development and applications of a city-level alcohol availability and alcohol problems database.

Data on alcohol availability and problems in all cities in Los Angeles County were collected from several different sources and linked together to form a Local Alcohol Availability Database (LAAD). The two major purposes of the project are to provide a city-level alcohol availability and alcohol-related problems database needed by local community alcohol policy planners and to collect the data necessary for research on the relationship between these measures. The prevalence of drunk driving arrests is displayed on a map. We describe how the LAAD has been used to guide alcohol policy decisions. A fixed year and city effects regression model suggests that outlet density is positively related to several alcohol-related problems.

Accidents, Traffic↗
PubMed2002

Evolution of the Shanghai city region 1978-1998: an analysis of indicators.

Building on a description of the present situation in Shanghai, a series of ten regionally relevant indicators are identified and described. Using data from 1978-1998, relationships between these economic, social and environmental indicators are explored using correlation and regression analysis. The analysis indicated that, in Shanghai, conflict between economy and environment existed throughout the research period and the evolution of the city region system seems to lack regularity. The key elements affecting trends in the development of the Shanghai city region are Gross Domestic Product, Total Investment and Urban Living Area per Head. The city region system seemed more sustainable, indicated by an improvement in environmental quality and relative lower investment growth rate, when the annual change rate of Gross Domestic Product was less than 7-8%.

China↗
PubMed2002

Health status and hospital utilization of recent immigrants to New York City.

BACKGROUND: This paper examines hospital utilization, estimated hospital costs, and mortality rates for U.S.-born, foreign-born, and Puerto Rican-born persons residing in New York City. METHODS: We conducted a multivariate regression analysis using New York City neighborhoods as the unit of analysis. We utilized data from the Statewide Planning and Research Cooperative System data set and from the 1997 Housing and Vacancy Survey. We also examined mortality rates using 1990 death certificate data and decennial census data. RESULTS: The foreign-born are much less likely to be hospitalized for most major categories of illness and have lower mortality rates than either U.S.-born or Puerto Rican-born New Yorkers. The life expectancy at 1 year of age of the foreign-born is 4 years longer than for U.S.-born persons and 6 years longer than Puerto Rican-born persons. We estimate that the overall cost of providing hospital-based care to the foreign-born was $611 million US dollars less than the cost of providing hospital-based care to an equivalent number of U.S.-born persons in 1996. CONCLUSION: The foreign-born in New York City appear to be healthier and consume fewer hospital resources than U.S.-born populations. It is possible that the cost of hospital utilization would be lower still if the foreign-born population had better access to ambulatory and preventive services.

Adult↗
PubMed1993

Project CONNECT: an interagency partnership to confront new challenges facing at-risk women and children in New York City.

Project CONNECT is a New York State--New York City collaborative venture to facilitate access to, coordinate and expand the delivery of health and human services, during the perinatal period to women and children in the three areas of New York City with the highest rates of morbidity and mortality. Based on the concept of comprehensive case management, CONNECT coordinates diverse providers around existing resources. Services implemented by community-based case managers for families in need include: medical care, substance/alcohol abuse treatment, foster care preventive services, parent education, developmental assessment, screening and child care. The initial points of entry to CONNECT are specific hospitals within the three targeted neighborhoods. Additional points of entry, including other hospitals and prenatal care sites, are being added on an incremental basis. Enrollment in CONNECT is also enrollment in Medicaid and participants are eligible for Medicaid services. It is expected that the CONNECT program will result in improved birth and health outcomes for women and their children, reduction in chemical dependency and improved family preservation. The state and city agencies that created CONNECT hope that by working together, through a very specific interagency agreement monitored by the offices of the Governor and the Mayor, they will be able to reach those families who have many needs, but traditionally have been difficult to engage and keep involved in the service delivery system. The ultimate benefit will go to the family as a whole, particularly the children, both the newborns and their siblings.(ABSTRACT TRUNCATED AT 250 WORDS)

Child, Preschool↗
PubMed2005

Spatial heterogeneity of DTPA-extractable zinc in cultivated soils induced by city pollution and land use.

The spatial heterogeneity of DTPA-extractable zinc in the cultivated soils of Shenyang suburbs in Liaoning Province of China was investigated, and its map was drawn by the methods of geostatistics combined with geographic information system. The data of soil DTPA-extractable zinc fitted normal distribution after logarithm transformation, and its semivariogram fitted a spherical model. The semivariogram indicated that the spatial dependence of soil DTPA-extractable zinc content was moderate, with the spatial dependence range of 1.69 km and the fractal dimension of 1.96. Stochastic factors contributed to 49.9% of the spatial variability, while structural factors contributed to 50.1% of it. The spatial heterogeneity of soil DTPA-extractable zinc shown by a kriged interpolation map was deeply influenced by stochastic factors such as city pollution, land use pattern and crop distributions. For example, the average content of Zn in vegetable garden soils was 2.5-4 times as much as in their originated soils, and was lower in paddy soils than in their originated soils. The areas with a higher content of soil DTPA-extractable zinc appeared in the near suburbs and the riverside along Hunhe River and the wastewater drainage of Xihe River, and the extremely high values in the near suburb of the city's residential area were a striking feature, indicating the key role of city pollution in the spatial heterogeneity of soil DTPA-extractable zinc. When recorded in the form of a soil pollution map, the results of such a survey make it possible to identify the unusually polluted areas, and to provide more information for precise agriculture and environmental control.

Agriculture↗
PubMed2003

Clinical evaluation of the Emergency Medical Services (EMS) ambulance dispatch-based syndromic surveillance system, New York City.

Since 1998, the New York City Department of Health has used New York City Emergency Medical Services (EMS) ambulance dispatch data to monitor for a communitywide rise in influenzalike illness (ILI) as an early detection system for bioterrorism. A clinical validation study was conducted during peak influenza season at six New York City emergency departments (EDs) to compare patients with ILI brought in by ambulance with other patients to examine potential biases associated with ambulance dispatch-based surveillance. We also examined the utility of 4 EMS call types (selected from 52) for case detection of ILI. Clinical ILI was defined as fever (temperature higher than 100 degrees F) on history or exam, along with either cough or sore throat. Of the 2,294 ED visits reviewed, 522 patients (23%) met the case definition for ILI, 64 (12%) of whom arrived by ambulance. Patients with ILI brought in by ambulance were older, complained of more severe symptoms, and were more likely to undergo diagnostic testing, be diagnosed with pneumonia, and be admitted to the hospital than patients who arrived by other means. The median duration of symptoms prior to presenting to the ED, however, was the same for both groups (48 hours). The selected call types had a sensitivity of 58% for clinical ILI, and a predictive value positive of 22%. Individuals with symptoms consistent with the prodrome of inhalational anthrax were likely to utilize the EMS system and usually did so early in the course of illness. While EMS-based surveillance is more sensitive for severe illness and for illness affecting older individuals, there is not necessarily a loss of timeliness associated with EMS-based (versus ED-based) surveillance.

Adolescent↗
PubMed2004

Evaluation of heritage trees for conservation and management in Guangzhou City (China).

The recent fast pace of urbanization in China and other developing countries has exerted pressure on urban trees, which constitute a key urban environmental asset. The most outstanding trees should be treated as natural-cum-cultural heritage. Guangzhou City's growth has threatened its rich urban-tree endowment, a diversified assemblage of 200,000 trees represented by 254 species and located in three major habitats: roadside, park, and institutional grounds. Mainly based on age and performance, 348 trees were officially designated as heritage specimens. They were evaluated in the field for tree dimensions, habitat, performance, and landscape contribution, to establish enhanced conservation and management strategies. With only 25 species, heritage trees were dominated by five cultivated natives and encompass some of the city's rare species; some common urban-forest species were not represented. Older districts and roadside habitats, despite their compact town plan and limited growing space, had the largest tree dimensions and largest share of heritage trees. Many heritage trees were large with long life expectancy and the potential for biomass expansion, and had pivotal cityscape impacts where they occur. Old neighborhoods, traditional haven for the arborescent treasure, are being changed by construction activities and periodic typhoon and windstorm damages. Increasing development density could degrade the heritage trees and their growing space, and reduce tree quality and life span. Upgrading the statutory-administrative systems and arboricultural care can enhance long-term survival of the precious natural-cum-cultural heritage. The experience of Guangzhou in identifying and preserving its high-quality urban trees can provide management strategies for other cities.

China↗
PubMed2005

Analysis of roadside inhalable particulate matter (PM10) in major Korean cities.

A data analysis of three major Korean cities was conducted to assess roadside inhalable particulate matter 10 microm or smaller in aerodynamic diameter (PM10), including temporal and meteorological variations, over a recent period of 4 to 6 years. The yearly roadside PM10 concentrations presented a well-defined increasing trend or no trend depending on the roadside monitoring station. Most mean values exceeded or approximated the Korean standard of 70 microg/m3 per year for PM10. A representative roadside diurnal trend was characterized by a distinct morning maximum. In most cases, the Sunday roadside concentrations were similar to or somewhat lower than the weekday concentrations, and the PM10 concentrations presented a well-defined seasonal variation, with the maximum concentration in March. The monthly maximum concentrations observed in March were most likely attributable to Asian dust storms. In two metropolitan cities (Seoul and Busan), the frequency of days with roadside PM10 concentrations exceeding the standard of 150 microg/m3 per 24 h was much lower for the roadside monitoring stations than for the residential monitoring station, whereas in the third city (Daegu), this result was reversed. Interestingly, the average maximum concentrations observed for the roadside sites in Seoul and Busan during March were higher than those for the residential sites, suggesting that the roadside concentrations responded more to the dust storms than the residential areas. The relationship between the pollutant concentrations and five important meteorological parameters (solar radiation, wind speed, air temperature, relative humidity, and precipitation) showed that the number and type of meteorological variables included in the equations varied according to the monitoring station or season. Finally, the current results confirmed that attention should be given to the PM10 exposure of residents living near roadways.

Air Pollutants↗
PubMed2006

[Cocaine abuse in Vienna and European cities--a multi-center study].

INTRODUCTION: As cocaine consumption seems to have increased over the last decades, the EU has funded this multi-center, cross-sectional survey to investigate cocaine consumption in three different target groups. The study was conducted by the Addiction Clinic, Department of Psychiatry, Medical University Vienna and other nine European cities. METHODS: Data were collected by structured face-to-face interviews. The sample was composed of 211 cocaine abusers out of three target groups: (1) treatment group undergoing opioid maintenance therapy, (2) marginalized scene group and (3) integrated party group. Sociodemographic data such as age, education, employment, monthly expenses on cocaine/crack, data on consumption patterns, physical and mental health and personal needs regarding cocaine consumption were evaluated. Urine toxicology results for cocaine in the treatment group completed the analysis. RESULTS: The marginalized scene group was the oldest with a mean age of 29.35 years, with the highest unemployment rate (mean 25.11 days) and the longest duration of cocaine consumption (mean 5.80 years). They had the highest cocaine consumption pattern with a mean of 22.32 days within the last month. On average 1969 Euros/months was spent for their addiction. The treatment group had the lowest school education with a mean of 10.36 years, but showed a sufficient insight in their cocaine problem. However, the party group (with the lowest mean age, 25.64 years) highly underestimated their drug problem, the mean amount of money they spent for their addiction was 588.99 Euro/months. Structured urine toxicology between 1996 and 2002 in patients undergoing opioid maintenance therapy ("treatment group") revealed a significant increase of concomitant cocaine consumption (1996: 33.1%; 2002: 40.2%; p = 0.044). DISCUSSION: The European trend of increased cocaine use could also be observed in Vienna. One of the greatest barriers for establishing adequate treatment settings for this target group is the difficulty to reach this population. In addition, multiple substance abuse seems to be one of the predominating patterns of cocaine consumption and this aspect should be integrated within treatment (in the treatment and scene groups additional heroin and benzodiapzepines abuse is observed, in the party group intensive alcohol consumption). The Viennese results are in line with those of the other European cities; however, it could not be confirmed that consumption of crack cocaine and binge play a similarly significant role as in cities such as Hamburg or London.

Adolescent↗
PubMed2006

Helicobacter pylori infection is associated with a high incidence of intestinal metaplasia in the gastric mucosa of patients at inner-city hospitals in New York.

Gastric carcinogenesis is a multistep process progressing from chronic gastritis, through glandular atrophy (GA), intestinal metaplasia (IM) and dysplasia. Infection of the stomach with H. pylori increases the risk of developing gastric cancer. Few studies have examined the degree to which Hp-induced changes occur in specific populations. In the present study, we examined the association between Hp infection and histological changes in the gastric mucosa of patients at two inner-city hospitals in New York. Patients enrolled in this study were undergoing endoscopy for gastrointestinal complaints. One antral biopsy was taken for detecting and genotyping Hp by PCR. Additional biopsies were taken from the antrum and fundic region for histological analysis and were scored with respect to acute and chronic inflammation, GA, IM and Hp infestation according to the Sydney classification. Hp strains infecting these patients were genotyped with respect to the expression of Hp virulence factors including VacA, CagA, and BabA2. Samples were collected from 126 patients at Kings County Hospital in Brooklyn and St. John's Episcopal Hospital in Queens. Hp infection rates were highest in Blacks (41.6%) and Hispanics (29.4%) and lowest in Caucasians (18.8%). Scores for acute and chronic inflammation and IM were higher in Hp-infected individuals in both the antrum and fundic regions, whereas Hp infection did not affect the incidence or intensity of GA. In Hp-infected individuals, the incidence of IM was greater in the antrum (Hp-infected 37.8% vs. non-infected 9.2%, p < 0.05) and fundic region (Hp-infected 15.1% vs. noninfected 1.8%, p < 0.05). Genotyping of the Hp strains infecting these patients revealed that the predominant VacA allele was s1 bm 1 and that the CagA gene was present in 69.8% of Hp-infected samples. Interestingly, the BabA2 gene was detected in only four samples (9.3%). The incidence of IM in the antrum was higher in CagA + samples when compared with CagA- samples (52.2% vs. 15.4%, respectively). Our findings indicate that the virulent Hp strain infecting minority patients treated at inner-city hospitals in New York City is associated with a high incidence of IM and that these patients may be at greater risk for developing gastric cancer than the general population.

Case-Control Studies↗
PubMed2006

Formulaic expert method to integrate evaluation and valuation of heritage trees in compact city.

Urban trees serve important environmental, social and economic functions, but similar to other natural endowments they are not customarily depicted in monetary terms. The needs to augment protection, funding and community support for urban greening call for proper valuation. Heritage trees (HTs), the cream of urban-tree stock, deserve special attention. Existing assessment methods do not give justice to outstanding trees in compact cities deficient in high-caliber greenery, and to their social-cultural-historical importance. They artificially separate evaluation from valuation, which should be a natural progression from the former. Review of tree valuation methods suggested the formula approach to be more suitable than contingent valuation and hedonic pricing, and provided hints on their strengths and weaknesses. This study develops an alternative formulaic expert method (FEM) that integrates evaluation and valuation, maximizes objectivity, broadly encompasses the key tree, tree-environment and tree-human traits, and accords realistic monetary value to HTs. Six primary criteria (dimension, species, tree, condition, location, and outstanding consideration) branched into 45 secondary criteria, each allocated numerical marks. Each primary criterion was standardized to carry equal weight, and a tree's maximum aggregate score is capped at 100. A Monetary Assignment Factor (MAF) to consign dollar value to each score unit was derived from three-year average per m(2) sale price of medium-sized residential flats. The applicability of FEM was tested on selected HTs in compact Hong Kong. The aggregate score of a tree multiplied by MAF yielded monetary value, which was on average 66 times higher than the result from the commonly-adopted Council of Tree and Landscape Appraisers method. The computed tree values could be publicized together with multiple tree benefits to raise understanding and awareness and rally support to protect HTs. The property-linked FEM could be flexibly applied to other cities, especially to assess HTs in compact developing cities.

Cities↗
PubMed2006

Stroke risk among Chinese immigrants in New York City.

BACKGROUND: Little is known of risk factors for stroke among Chinese immigrants to the United States. We have conducted a case-control study to identify risk factors for stroke among foreign-born Chinese in New York City. METHODS: From September 2000 to June 2003, 187 sequential stroke cases (44 hemorrhagic) and 204 controls matched on age, gender, and years since immigration were recruited from New York Downtown Hospital, which was located next to New York City Chinatown. Risk factor status was assessed by questionnaire interview and medical chart review, which included clinical factors, sociodemographic characteristics, personal and family histories, and behavior and lifestyle factors, as well as behavioral changes after immigration to the United States. RESULTS: For cases and controls, mean ages were 74.8 and 74.7 years, 47.3% of cases and 47.5% of controls were male, and mean years since immigration to the United States were 26.7 and 26.8, respectively. Sociodemographic characteristics and behavioral pattern including cigarette smoking, exercise, and usage of special diet or dietary supplements were similar between cases and controls. However, stroke patients were more likely to have hypertension (76% vs. 59%, p<or/=0.001), increased blood pressure (165/84 mmHg vs. 140/74 mmHg, p<or=0.001) and left ventricular hypertrophy (LVH) (10.1% vs. 4.3%, p<or=0.05), and less likely to consume poultry (odds ratio 0.80, 95% confidence interval (CI) 0.59-1.00); fish (0.70, 95% CI 0.42-0.96), fruit and vegetable juice (0.83, 95% CI 0.70-0.95), and grains (0.79, 95% CI 0.62-0.96) than were controls. CONCLUSION: Among Chinese immigrants in New York City, as in general population, poor controlled hypertension was related to the risk of stroke. Therefore, Chinese immigrants presenting with hypertension and/or a family history of hypertension should be detected and followed up regularly to monitor the blood pressure level. In addition, difference in food intake between stroke and control patients may present an opportunity for behavior intervention to prevent stroke.

Aged↗
PubMed2006

Perspectives on tuberculosis among traditional Chinese medical practitioners in New York City's Chinatown.

This article discusses the perspectives of Chinatown's traditional Chinese medical practitioners on tuberculosis among New York City's Chinese laborers. The practice of traditional Chinese medicine (TCM) in the United States is neither regulated nor well understood. Some public health providers have expressed their concern that the use of TCM could prevent Chinese tuberculosis patients from receiving proper, biomedical treatment. Contrary to the suspicion of public health providers, the traditional Chinese medical practitioners in the context of New York City's Chinatown provide diverse methods of health care, many being familiar with the biomedical explanation for tuberculosis. All TCM informants in this study stated that biomedicine is more effective than Chinese medicine in treating tuberculosis. TCM in tuberculosis therapy is said to complement biomedicine and to restore bodily balance and the general health of patients. This study discusses the political-economic context shaping the explanation and treatment of tuberculosis among traditional Chinese medical practitioners and broadens our understanding of the various contexts in which TCM and biomedicine can be integrated. Furthermore, it is suggested that an opportunity exists for tuberculosis control programs to incorporate TCM practitioners in the effort to control the disease within New York City.

Adult↗
PubMed1983

Daily patterns of asthma in New York City and New Orleans: an epidemiologic investigation.

Examination of records of daily visits to emergency rooms for asthma covering 25 years from New Orleans and 9 years from New York City reveals a distinct day-of-the-week pattern in New York City whereas no such pattern is discernible in New Orleans. The difference in daily patterns of asthma attacks in the populations from the two cities strongly suggests a different environmental etiologic agent acting on these two populations. It is proposed herein that in New York susceptible individuals are exposed to some agents or factors triggering attacks which are present in the home environment where most of their time is spent on weekends, while in New Orleans, homes are not as sealed off from the outside air, because of the warmer climate, so that the agent triggering attacks is as common outdoors as indoors, and thus there is little difference between weekend and weekday exposure.

Adult↗