Explaining the Sharp Decline in Birth Rates in Canada and the USA in 2020.

Birth rates in Canada and the USA declined sharply in March 2020 and deviated from historical trends. This decline was absent in similarly developed European countries. We argue that the selective decline was driven by incoming individuals, who would have travelled from abroad and given birth in Canada and the USA, had there been no travel restrictions during the COVID-19 pandemic. Furthermore, by leveraging data from periods before and during the COVID-19 travel restrictions, we quantified the extent of births by incoming individuals. In an interrupted time series analysis, the expected number of such births in Canada was 970 per month (95% CI: 710-1,200), which is 3.2% of all births in the country. The corresponding estimate for the USA was 6,700 per month (95% CI: 3,400-10,000), which is 2.2% of all births. A secondary difference-in-differences analysis gave similar estimates at 2.8% and 3.4% for Canada and the USA, respectively. Our study reveals the extent of births by recent international arrivals, which hitherto has been unknown and infeasible to study.

Dilemma of commercial organ transplant in the Middle East.

In recent years, the Middle East has witnessed a significant rise in commercial transplantation activities. This practice is driven by a multitude of factors including economic disparities, inadequate healthcare infrastructure, and cultural attitudes towards organ donation. In this article, we try to explore the complex landscape of commercial transplantation within the Middle East, shedding light on the ethical, legal, and socio-economic dimensions of this contentious issue.

Foreign patients and multicultural challenges in pediatric oncology: The experience of the Istituto Nazionale dei Tumori in Milan.

This paper describes the complexity of the clinical management of foreign minors suffering from cancer, through the clinical experience of an Italian referral center. The study includes 50 patients less than 18 years (22% of the patients admitted to the unit in 2023), 32 foreigners who were Italian resident and 18 who had come to Italy specifically to receive cancer treatment. Patients who migrate for healthcare reasons often arrive at the referral center with advanced disease or relapse. Numerous socio-cultural issues were reported. To address them, specific strategies were implemented to ensure equal and high-quality care for all patients, respecting their needs.

Distinct dynamics in mountain watersheds: Exploring mercury and microplastic pollution-Unraveling the influence of atmospheric deposition, human activities, and hydrology.

The intensification of human activities all around the globe has led to the spread of micropollutants in high-mountain freshwater environments. We therefore aimed to assess the geospatial distribution and determine the potential sources of (total-) mercury (THg) and microplastics (MPs) in mountain freshwater ecosystems. To do so, we analyzed THg and MP concentrations in brown trout, biofilm, and sediments from lotic and lentic ecosystems in the Pyrenees - all subjected to different types of human pressure. Additionally, we assessed the potential impacts of these pollutants on fish, and explored the bioindication capacity of brown trout (Salmo trutta fario) and biofilm regarding THg and MP pollution. For the first time, we measured concentrations of MPs trapped in the matrix of freshwater biofilm. Our results suggest that THg in the Pyrenees might be explained by both legacy (regional) and distant sources, in combination with environmental characteristics such as the presence of peatlands or streamwater physicochemistry, while MPs in fish are linked to recent local pollution sources such as single-use plastics. In contrast, MPs in biofilm matrix and sediments indicate a combination of distant (i.e., atmospheric deposition) and recent local pollution sources. Moreover, hydrodynamics and plastic density likely control MP distribution in rivers. Based on Fulton's condition factor, we also found that higher THg concentrations caused a negative impact on fish health (K < 1), while no impact of MPs could be seen. Therefore, we suggest that brown trout and biofilm can serve as bioindicators of atmospheric deposition of THg in high-altitude lakes and that biofilm is a reliable bioindicator to assess MP pollution in remote environments. Brown trout may also act as a bioindicator of MP pollution, but only efficiently in more polluted areas.

Sexual Exploitation of Children in Travel and Tourism Perpetration: An Expansion of the Ecosystem Model.

The sexual exploitation of children in travel and tourism (SECTT), also referred to as child sex tourism, involves engaging in sexual activity with someone under the age of 18 in the context of travel and/or tourism. Research on the perpetration of SECTT is vastly underdeveloped. The present review considers the operationalization of SECTT, its prevalence, and existing theoretical models. Existing theory on SECTT provides a good overview of environmental factors that contribute to SECTT, but the model is insufficient in fully accounting for individual-level risk factors related to sexual offending against children. The present paper expands an existing theoretical model of SECTT, the ecosystem model, to account for these individual risk factors and considers their interaction with environmental factors. The paper concludes by highlighting different avenues for future research.

Biliary atresia in Uganda: Current ethical challenges and advancement of public policy.

Biliary atresia is a progressive cholangiopathy in neonates, which often results in liver failure. In high-income countries, initial treatment requires prompt diagnosis followed by Kasai portoenterostomy. For those with a late diagnosis, or those in whom Kasai portoenterostomy fails, liver transplantation is the only lifesaving treatment. Unfortunately, in low- and middle-income countries, timely diagnosis is a challenge and liver transplantation is rarely accessible. Here, we discuss the ethical dilemmas surrounding treatment of babies with biliary atresia in Uganda. Issues that require careful consideration include: risk of catastrophic health expenditure to families, ethical dilemmas of transplant tourism, medical risks of maintaining the transplant in a low-resourced health system, and difficult decisions encountered by the surgeon caring for these patients. Four distinct models of the patient-physician relationship are applied to biliary atresia in Uganda. These models describe differences in patient and physician roles, and patient values and autonomy. Solid organ transplantation is a rapidly evolving segment of healthcare in Uganda and ongoing policy advancements may shift ethical considerations in the future.

Perceptions and practices of Swedish wild boar hunters in relation to African swine fever before the first outbreak in Sweden.

BACKGROUND: The first outbreak of African Swine Fever (ASF) in Sweden was detected in 2023 in wild boar. This study was conducted before the first ASF outbreak with the objective of investigating Swedish hunters' perceptions and practices pertaining to ASF ahead of any potential future outbreak. A mixed-methods interview study with Swedish wild boar hunters, consisting of focus group discussions and a questionnaire, was undertaken between October 2020 and December 2021. Six focus groups were conducted online, and an online questionnaire with questions related to practices and habits concerning hunting, the use of bait and hunting trips was sent to all members of the Swedish Hunting and Wildlife Association. A total of 3244 responses were received. RESULTS: Three general themes were identified in a thematic analysis of the data from the focus groups: hunters are willing to engage in ASF prevention and control, simplicity and feasibility are crucial for the implementation of reporting, sampling and control measures, and more information and the greater involvement of the authorities are required in ASF prevention and control. Results from the questionnaire showed that the use of bait was common. Products of animal origin were rarely used for baiting; the most common product used was maize. Hunting trips abroad, especially outside of the Nordic countries, were uncommon. CONCLUSIONS: Hunting tourism and the use of bait do not seem to constitute a major risk for the introduction of ASF to wild boar populations in Sweden. The accessibility of relevant information for each concerned stakeholder and the ease of reporting and sampling are crucial to maintain the positive engagement of hunters.

Internet interventions and therapies for addressing the negative impact of digital overuse: a focus on digital free tourism and economic sustainability.

BACKGROUND: The excessive use of information technologies (IT) and online digital devices are causing symptoms of burnout, anxiety, stress and dependency that affect the physical and mental health of our society, extending to leisure time and work relationships. Digital free tourism (DFT) is a phenomenon that emerges as a solution to technostress and pathologies derived from digital hyperconnection. The objective of this research is to advance the knowledge of new structures of motivational factors that can understand the decision of a tourist to make a DFT trip. To this end, it is investigated whether family and social engagement and health and relaxation have a positive impact on the behavioral intention of the potential tourist and whether this influences sustainability due to the importance of DFT in the new economic framework. METHODS: With a quantitative approach, the methodology used consisted of an online questionnaire among potential travelers. IBM SPSS Statistics 22.0 statistical software was used to evaluate the data obtained and confirm the relationships of the model and the research hypotheses. RESULTS: The results of the questionnaire assessed the contribution of each construct to the tourist's behavioral intention and the tourist's decision to make the decision to undertake a DFT experience. CONCLUSIONS: DFT can be a driver of economic sustainability and health therapy in tourism in the digital age. This study aims to expand the lines of research on DFT and determine the complex factors that can lead a tourist to participate in the DFT experience. The results obtained can help managers of companies in the sector to offer more efficient and sustainable services that contribute to the health and wellbeing of tourists as a differentiating factor.

Cross-border healthcare-seeking and utilization behaviours among ethnic minorities: exploring the nexus of the perceived better option and public health concerns.

BACKGROUND: Many ethnic minorities in Hong Kong seek medical tourism after encountering inequalities in access to local healthcare because of language barriers and cultural-religious differences. The present study explored the ethnic minorities' lived experiences of medical tourism and issues arising from cross-border health-seeking relevant to this specific population. METHODS: Qualitative in-depth interviews with 25 ethnic minority informants from five South Asian countries in 2019. RESULTS: The 19 informants out of the 25 have sought assistance from their international networks for home remedies, medical advice and treatments of traditional/Western medicines, for they are more costly or unavailable in Hong Kong and for issues related to racial discrimination, language barriers, transnationalism engagement, cultural insensitivity, and dissatisfaction with healthcare services in Hong Kong. DISCUSSION: Medical tourism can relieve the host country's caring responsibilities from healthcare services, so the government might no longer be hard-pressed to fix the failing healthcare system. Consequently, it could cause public health concerns, such as having patients bear the risks of exposure to new pathogens, the extra cost from postoperative complications, gaps in medical documentation and continuum of care, etc. It also triggers global inequities in health care, exacerbating unequal distribution of resources among the affordable and non-affordable groups. CONCLUSION: Ethnic minorities in Hong Kong sought cross-border healthcare because of structural and cultural-religious issues. The surge of medical tourism from rich and developed countries to poor and developing countries may infringe upon the rights of residents in destination countries. To mitigate such negative impacts, policymakers of host countries should improve hospital infrastructure, as well as train and recruit more culturally sensitive healthcare workers to promote universal health coverage. Healthcare professionals should also strive to enhance their cultural competence to foster effective intercultural communication for ethnic minority groups.

A comprehensive perspective on local drivers in community-based health tourism industry development: a qualitative study of Mazandaran Province, Iran.

BACKGROUND: Health tourism is an important component that may influence the direction of development in a region. Mazandarn, Iran, is recognized as a highly sustainable market in the region because of its abundant natural resources, temperate temperature, and strategic geographical location. Therefore, considering the importance of health tourism and its existing potential in Mazandaran, Iran, this study was conducted with the aim of exploring a comprehensive perspective on local drivers in community-based health tourism industry development and factors affecting the attraction of health tourism. METHODS: We conducted this study in Mazandarn, Iran, using a qualitative approach. Participants included a sample of Iranian people, aged 34-54 years, with previous history of health tourism or expert in it. Participants were selected from three different categories of the community: academic professionals in health tourism, managers in health tourism, and health tourists. Data were obtained via semi-structured in-depth interviews and focus group discussions. Inductive qualitative content analysis was used to converge and compare themes through participant data. The interviews kept going until data saturation was achieved. RESULTS: Based on our findings, we distilled local drivers in community-based health tourism industry development into five main categories and 30 subcategories: (Sharifabadi AM, Ardakani FA. A model for health tourism development using fuzzy TOPSIS and interpretive structural modeling in Yazd province. J Health Adm (JHA). 2014;17:55.) infrastructure and resources; (Hemmati F, Dabbaghi F, Mahmoudi G. Investigating the impact of Information Technology on the status of Health Tourism in Mashhad, Iran. Revista Publicando. 2018;5(15):54-65.) tourist attractions; (Sarabi Asiabar A, Rezapour A, Raei B, Tahernezhad A, Alipour V, Behzadifar M. Economic, Cultural, and Political Requirements for Medical Tourism Development in Iran: Insights from a Fuzzy Analytical Hierarchy Process Method. Med J Islamic Repub Iran. 2022;35:199.) socio-cultural contexts; (Mosadeghrad AM, Sadeghi M. Medical tourism: Reasons for choosing Iran. Payesh (Health Monitor). 2021;20(2):145-66.) economic-financial factors; and (Manna R, Cavallone M, Ciasullo MV, Palumbo R. Beyond the rhetoric of health tourism: shedding light on the reality of health tourism in Italy. Curr Issues Tourism. 2020;23(14):1805-19.) political-communicative factors. The findings of the study showed that, from the participants' point of view, although there are several strategies, such as the development of public service and tourism infrastructure, increasing tourist attractions, and formulating appropriate policies and procedures for the development of health tourism, they are also faced with many challenges, especially political, economic, and cultural challenges. CONCLUSION: This study showed that improving infrastructure and resources, promoting tourist attractions, informing socio-cultural contexts, improving economic and financial capacity, and developing political and communicative contexts might increase the attraction of health tourists. The suggested components are not contextually driven, although empirical outcomes may differ based on the level of service offerings in health tourism locations.

The transformation of Jordan's healthcare system in an area of conflict.

BACKGROUND: The Jordanian healthcare system has evolved over the past decades expanding its services, technological, and educational resources. A comprehensive view of this system is lacking. The objective of this report is to describe the structure of the Jordanian healthcare system, the challenges facing it, and the current and recommended health policies. MATERIALS AND METHODS: This study reviewed the current status of the Jordanian healthcare system. The following parameters were analyzed: health indicators, infrastructure, human resources, insurance system, pharmaceutical expense, health education system, and medical tourism. Data were collected from various relevant official institutions and related published literature. RESULTS: Jordan has a young population with a median age of 23.8 years. Life expectancy is 78.8 years for females and 77.0 years for males. The Jordanian healthcare system is divided into three major categories: (1) Governmental Insurance (i.e., the Ministry of Health (MOH), the Royal Medical Services (RMS) and semi-governmental insurance); (2) Private Insurance; and (3) Refugee Insurance, including the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the United Nations High Commissioner for Refugees (NHUR). The Governmental Insurance covers 64.30% of the total population. Health expenditure is 6.37% of the gross domestic product (GDP). Pharmaceutical expenses make up 26.6% of the total national healthcare budget. Human resource assessment shows a high ratio of medical staff per 10.000 inhabitants, especially concerning physicians (31.7), dentists (7.9), and pharmacists (15.1). However, the ratio of nursing staff per 10.000 inhabitants is considered low (37.5). The Hospital bed/1000 population ratio is also relatively low (1.4). Healthcare accreditation is implemented through the Joint Commission International (JCI) accreditation which was achieved by 7 hospitals and by the National Health Care Accreditation Certificate (HCAC) achieved by 17 hospitals and 42 primary healthcare centers. Postgraduate medical education covers almost all medical and surgical fields. Medical tourism is currently well-established. CONCLUSIONS: Assessment of the Jordanian healthcare system shows high ratios of physicians, dentists, and pharmacists but a low ratio of nursing staff per 10.000 inhabitants. The hospital bed/1000 population ratio is also relatively low. Pharmaceutical expenses are significantly high and medical tourism is well-developed.

Medical tourism among Indonesians: a scoping review.

BACKGROUND: International medical travel or medical tourism is not a new phenomenon in many countries, including among Indonesians. Indonesia is reported as a major source of patients from the lower, middle, to upper classes for its neighbouring countries. This scoping review aims to synthesise evidence on supporting factors for Indonesians taking medical tourism and what needs to be improved in Indonesia's health system. METHODS: We conducted a scoping review guided by a framework provided by Arksey and O'Malley. We systematically searched existing literature from 5 databases, including MEDLINE, PubMed, Scopus, ProQuest, and Wiley. Data were extracted based on study details, study design, characteristics of participants and results. Analysis followed the three-stage procedure outlined by Thomas and Harden: (1) coding the text line by line, interpreting the data and identifying concepts or themes; (2) developing descriptive themes by grouping similar concepts in theme and subtheme and (3) generating analytical themes by reviewing preliminary themes and discussing the addition or revision of themes. RESULTS: A total of 25 articles were included in this review. The review highlights a broad range of facilitators for medical tourism among Indonesians: (i) availability of health services, medical specialities, and person-centred care, (ii) region adjacency, transport, and health agency, (iii) affordability of medical treatment, (iv) religious and socio-cultural factors, and (v) reasons patients reported distrust in Indonesian doctors. CONCLUSION: The findings indicate improvements in the Indonesian health system are necessary if the increasing rates of international medical tourism by Indonesian people are to change. Addressing the factors identified in this scoping review through avenues including policy may increase people's satisfaction and trust towards health care and treatment in Indonesia, thereby reducing the number of Indonesian people taking medical tourism.

The analysis of the medical tourism expansion policy in Taiwan: a policy analysis using Kingdon's multiple streams.

BACKGROUND: Since 2006, Taiwan has actively pursued the development of its medical tourism industry. In 2013, the government sought to bolster this sector by integrating medical tourism into the Free Economic Pilot Zones. Despite narrowly missing the mark, the initiative failed to materialize into law. This qualitative study endeavors to discern the pertinent factors influencing the agenda-setting process for incorporating medical tourism into the Free Economic Pilot Zones in Taiwan. METHODS: A comprehensive examination of policies concerning the legitimation of medical tourism within the Free Economic Pilot Zones was undertaken through semi-structured interviews and a thorough review of policy documents. Key informants were strategically selected using purposive and snowball sampling techniques. Thematic analysis was applied to scrutinize the amassed data and organize it within the framework of Kingdon's multiple streams. RESULTS: In the problem stream, increasing financial strains and cost containment pressures under the National Health Insurance program have long driven health care providers to seek further opportunities in medical tourism. The existing barriers to expanding medical tourism in Taiwan included diplomatic tensions (specifically cross-strait relations), public concerns about commercialization of medical care and reduced their access to care, and legal and language barriers. Within the policy stream, factors such as franchise fees to support national health insurance, limited number of demonstration medical tourism sites and services allowed, the allowance of foreign medical personnel, regulations governing domestic physicians, the importance of demonstration, regulation, and accreditation, as well as restrictions on investment from China, were emphasized. The politics stream highlights factors such as governmental support, opposition from opposing parties, public concerns and critics from academia and non-governmental organizations, and skepticism from medical faculties. CONCLUSION: Acknowledging the recognized challenges in enacting the medical tourism provision of the Free Economic Pilot Zones Special Act and emphasizing the political will of leadership, a viable policy solution remained elusive. Although a window of opportunity existed for the passage of the bill, it waned as public concerns sidelined the issue from the national agenda. The Taiwan case underscores the necessity for meticulous consideration of issues, proposed solutions, and political dynamics to achieve successful policy enactment.

A synthetic approach to the Holiday Climate Index for the Mediterranean Coast of Türkiye.

Climate change affects the comfort level of tourists visiting coastal areas. Researching these impacts is important for a more comprehensive understanding of climate change and for developing effective adaptation solutions. Considering this fact, the study derived the Holiday Climate Index (HCI: Coast, HCI: Urban, and HCI: Combined) in the Mediterranean coastal provinces of Türkiye from 1976 to 2020. Utilizing the derived indices, the effects of climate-related holiday comfort on the number of tourist arrivals as well as on overnight stays between 1976 and 2020 were examined by panel data analysis. The study examined how comfort patterns could change during the period 2026-2050 under the pessimistic RCP8.5 scenario. It was detected that the comfort level significantly and positively affects the number of arrivals and overnight stays of tourists. Besides, comfort levels were found to deteriorate in the period 2026-2050 compared to the reference period, 1976-2020. As the comfort conditions get worse, the number of tourist arrivals and overnight stays is expected to decline in the future. It is envisaged that the results of the study can be useful for tourists, tourism professionals, operators, other stakeholders, and policymakers.

Benefits of applying hourly resolution in the assessment of the climate aptitude to manage tourist activities in arid regions.

The availability of reliable information on local climatic-tourism conditions is a growing need due to the influence it exerts on the quality of the organizational strategy of tourist destination's, and travel experience. Evaluations of the tourism potential of the climate have been carried out on a daily or monthly resolution, thus limiting the collection of detailed information that makes it possible to fine-tune tourism management and operational decision-making on an intraday scale. This research is the first case study to analyse the climatic suitability for nature tourism, using the weather types method at hourly resolution. The study applies to arid tourist destinations in Isfahan province (Iran). The detailed resolution has made it possible to identify the time slots favourable to the development of nature tourism in those periods of the year recognized as critical in the daily resolution analyses. In the same way, the hourly resolution has also identified critical bands in those periods indicated as favourable in the evaluations to daily resolution. The hourly resolution provides detailed information that can allow tourists and also tourism managers to establish intraday adaptation strategies that make it possible to develop the activity even in places with extreme climates.

Impacts of climate change on dogsledding recreation and tourism in Arctic Sweden.

The range of Arctic tourism supply is continuously increasing with a variety of tourism products on offer. However, climate change is becoming a more prominent issue threatening the operations of tourism businesses and the livelihood of some tourism actors, such as dogsledders. This article aims to fill the descriptive research gap that exists regarding the dependency on the physical environment, climate, and weather for dogsledding activities. This is achieved by studying how climate change may threaten possible climate and weather thresholds for these activities, and how climate change may affect the future opportunities for dogsledding in northern Sweden. The study is based on interviews with dogsledders in Arctic Sweden and climate projections from the Swedish Meteorological and Hydrological Institute (SMHI). The results demonstrate the following thresholds for dogsledding activities: (1) dogsledding requires 10-20 cm of packed snow and/or solid ice on bodies of water, (2) above 15 °C is too hot for dogs to pull (wheeled) sledges, (3) cold weather thresholds are determined by visitors' preferences and are not considered a problem for dogsledders or dogs, and (4) rain can cancel tours for all dogsledders, and strong wind can cancel tours for dogsledders located in the mountain regions. Finally, extreme events such as heatwaves, storms, thunderstorms, forest fires, heavy rain, floods, and more rapid weather changes have already affected some dogsledders. These necessary thresholds for dogsledding activities could already be jeopardized for the southern and coastal locations of Arctic Sweden. In addition, the climate projections from SMHI show that warmer days and more precipitation in the form of rain will become more common in the future, especially in the absence of global mitigation measures. However, further research on vulnerability/resilience and adaption strategies for dogsledding activities is necessary to truly understand the impact of climate change.

Weather, weekday, and vacation effects on webcam recorded daily visitor numbers in the alpine winter season.

Winter tourism is an important economic factor in the European Alps, which could be exposed to severely changing meteorological conditions due to climate change in the future. The extent to which meteorology influences winter tourism figures has so far been analyzed mainly based on monthly or seasonal data and in relation to skier numbers. Therefore, we record for the first time daily visitor numbers at five Bavarian winter tourism destinations based on 1518 webcam images using object detection and link them to meteorological and time-related variables. Our results show that parameters such as temperature, cloud cover or sunshine duration, precipitation, snow depth, wind speed, and relative humidity play a role especially at locations that include other forms of winter tourism in addition to skiing. In the ski resorts studied, on the other hand, skiing is mostly independent of current weather conditions, which can be attributed mainly to artificial snowmaking. Moreover, at the webcam sites studied, weekends and vacation periods had an equal or even stronger influence on daily visitor numbers than the current weather conditions. The extent to which weather impacts the (future) visitor numbers of a winter tourism destination must therefore be investigated individually and with the inclusion of non-meteorological variables influencing human behavior.

Perspectives of nature-based tourism-dependent communities on climate change in the Okavango Delta, Botswana.

The intensity and frequency of climate extremes such as heat waves, droughts and extreme rainfall events are projected to rise. This will increase the severity of their impacts across socio-ecological systems. Economic sectors such as nature-based tourism become more vulnerable because of their reliance on climate and natural capital as key resources. While attempts have been made to understand how climate change may impact tourists and the industry itself, little is known about the same on tourism-dependent communities. This paper determines the extent to which tourism-dependent communities are vulnerable to climate change in the Okavango Delta, Botswana, to enhance their wider livelihood the development of strategies for improving adaptive capacity, resilience, and reduced exposure sensitivities. A household survey of 172 households was conducted in three purposively selected villages of Mababe, Sankuyo and Khwai, actively involved in community-based tourism for their socio-economic development. Information sourced related to livelihood options, peoples' resilience, local risks, and hazards. The data was analysed using descriptive statistics and thematic analysis. The results indicate that respondents have observed climatic changes over the years such as increased temperatures, decreased rainfall, and increased frequencies of extreme events. The respondents attributed changes in natural capital to these observed climatic conditions in the form of desiccation, dwindling populations of some wildlife species, decreased fish stocks and reduced vegetation cover. This renders the tourism-dependent communities vulnerable as their livelihood is threatened. The paper thus concludes that climate change adaptation is an urgent priority for local communities who are already exposed to existing climatic and non-climatic stresses.

Increase in dengue fever in travellers returning from Egypt, Germany 2023.

Dengue virus (DENV) infections after exposure in Egypt increased in Germany in 2023, with 36 cases vs zero to eight in 2017 to 2022. Over 90% of the patients had stayed on the Red Sea Coast (mostly Hurghada), almost 50% in private residences. Case numbers increased more strongly than traveller numbers. Mosquito control is more difficult in towns than hotel grounds, increasing the risk of infection at private residences. Physicians should consider dengue for unexplained fever after return from Egypt.

Assessing the impact of dust events on the Holiday Climate Index in the Taklimakan Desert region.

As a significant sector within the tourism industry, desert tourism has developed rapidly in recent years, contributing significantly to local economic development. On the other hand, desert tourism is constantly influenced by the desert climate, characterized by high temperatures, aridity, and dust events. This study examines and analyzes the impact of dust events on the Holiday Climate Index (HCI) using an improved methodology. It incorporates comprehensive meteorological data including temperature, relative humidity, cloud cover, precipitation, wind speed and dust events of Tazhong, located in the heart of the Taklimakan Desert. The results indicate that the maximum mean monthly HCI dips from an ideal level (91) to a very good level (73), the minimum dips from good level (66) to a marginal level (47), and the annual comfortable days (HCI ≥ 80) decrease from 180.5 to 95.3 after considering the impacts of dust events. The corrective HCI indicates that autumn, especially October, offers relatively comfortable climatic conditions for tourism, with the mean monthly comfortable days reach 20.1. These findings can better guide desert tourism activities and also demonstrate that the impact of dust weather on tourism activities cannot be ignored.