The pathologies of migrants who travel by boat documented on imaging.

The migration phenomenon is increasingly common worldwide. It is essential for radiologists to be aware of the endemic diseases of the migrant's country as well as the characteristics of the journey to be able to understand and interpret radiological findings when admitted to our centre. This article aims to use imaging from our centre to describe the most common pathologies that migrant patients present with after long journeys by boat.

Identifying the determinants of tourism receipts of Thailand and relevant determinant-determinant interactions.

The study examined the determinants that affect tourism receipts in Thailand. To this end, quarterly data from eight main provinces of Thailand from the period 2015-2019 were used and constituted a repeated measures design. Accordingly, a generalized linear mixed model was applied for developing two different random intercept models by treating 1) province, and 2) a combination of province and calendar quarter as cluster-specific effects. It was found that determinants that increased tourism receipts were the number of visitors, the average cost per day, the length of stay of visitors, the presence of low-cost airlines, and a relatively low offence rate. Moreover, an increase in the number of visitors in the fourth quarter produced a higher amount of additional receipts as compared to a similar increase in the first quarter. Specifically, for Thailand attracting high-spending tourists and extending tourist visas for more than 30 days is recommended. Beyond Thailand, uncovering interaction effects as described above may help tourism agencies to focus their limited resources on the determinants that matter.

Improving accessibility to radiotherapy services in Cali, Colombia: cross-sectional equity analyses using open data and big data travel times from 2020.

In this study, we evaluated and forecasted the cumulative opportunities for residents to access radiotherapy services in Cali, Colombia, while accounting for traffic congestion, using a new people-centred methodology with an equity focus. Furthermore, we identified 1-2 optimal locations where new services would maximise accessibility. We utilised open data and publicly available big data. Cali is one of South America's cities most impacted by traffic congestion. METHODOLOGY: Using a people-centred approach, we tested a web-based digital platform developed through an iterative participatory design. The platform integrates open data, including the location of radiotherapy services, the disaggregated sociodemographic microdata for the population and places of residence, and big data for travel times from Google Distance Matrix API. We used genetic algorithms to identify optimal locations for new services. We predicted accessibility cumulative opportunities (ACO) for traffic ranging from peak congestion to free-flow conditions with hourly assessments for 6-12 July 2020 and 23-29 November 2020. The interactive digital platform is openly available. PRIMARY AND SECONDARY OUTCOMES: We present descriptive statistics and population distribution heatmaps based on 20-min accessibility cumulative opportunities (ACO) isochrones for car journeys. There is no set national or international standard for these travel time thresholds. Most key informants found the 20-min threshold reasonable. These isochrones connect the population-weighted centroid of the traffic analysis zone at the place of residence to the corresponding zone of the radiotherapy service with the shortest travel time under varying traffic conditions ranging from free-flow to peak-traffic congestion levels. Additionally, we conducted a time-series bivariate analysis to assess geographical accessibility based on economic stratum. We identify 1-2 optimal locations where new services would maximize the 20-min ACO during peak-traffic congestion. RESULTS: Traffic congestion significantly diminished accessibility to radiotherapy services, particularly affecting vulnerable populations. For instance, urban 20-min ACO by car dropped from 91% of Cali's urban population within a 20-min journey to the service during free-flow traffic to 31% during peak traffic for the week of 6-12 July 2020. Percentages represent the population within a 20-min journey by car from their residence to a radiotherapy service. Specific ethnic groups, individuals with lower educational attainment, and residents on the outskirts of Cali experienced disproportionate effects, with accessibility decreasing to 11% during peak traffic compared to 81% during free-flow traffic for low-income households. We predict that strategically adding sufficient services in 1-2 locations in eastern Cali would notably enhance accessibility and reduce inequities. The recommended locations for new services remained consistent in both of our measurements.These findings underscore the significance of prioritising equity and comprehensive care in healthcare accessibility. They also offer a practical approach to optimising service locations to mitigate disparities. Expanding this approach to encompass other transportation modes, services, and cities, or updating measurements, is feasible and affordable. The new approach and data are particularly relevant for planning authorities and urban development actors.

Where should we go - Estimating travel times for modelling accessibility to 24-hour emergency departments in Canada.

Estimating travel time to 24-hour emergency services is an important component to modelling accessibility of health services, particularly for rural areas. However, methods used to estimate travel time vary significantly, are not representative of the residential population, and are not openly validated. This makes the assessment of travel-based accessibility metrics between studies incomparable. To address this issue and develop a standardized measurement of emergency service access, this study utilized small geographic units (Dissemination Areas - DA) and geographical boundaries representative of municipal equivalents (Census Subdivision - CSD). Estimated travel times between the centroid of an inhabited DA to each 24-hr emergency department was computed with population-weighted travel times generated for each CSD. This dataset provides a nationally consistent measurement of proximity to emergency services accounting for travel pathing and population distribution. This methodology can be extended to generate estimated shortest travel routes for other healthcare resources or develop actual travel routes based on individuals' experiences with the healthcare system.

A travel time matrix data set for the Helsinki region 2023 that is sensitive to time, mode and interpersonal differences, and uses open data and novel open-source software.

Travel times between different locations form the basis for most contemporary measures of spatial accessibility. Travel times allow to estimate the potential for interaction between people and places, and is therefore a vital measure for understanding the functioning, sustainability, and equity of cities. Here, we provide an open travel time matrix dataset that describes travel times between the centroids of all cells in a grid (N = 13,132) covering the metropolitan area of Helsinki, Finland. The travel times recorded in the dataset follow a door-to-door approach that provides comparable travel times for walking, cycling, public transport and car journeys, including all legs of each trip by each mode, such as the walk to a bus stop, or the search for a parking spot. We used the r5py Python package, that we developed specifically for this computation. The data are sensitive to diurnal variations and to variations between people (e.g. slow and fast walking speed). We validated the data against the Google Directions API and present use cases from a planning practice. The five key principles that guided the data set design and production - comparability, simplicity, reproducibility, transferability, and sensitivity to temporal and interpersonal variations - ensure that urban and transport planners, business and researchers alike can use the data in a wide range of applications.

Understanding the secondary outcomes of international travel measures during the covid-19 pandemic: a scoping review of social impact evidence.

BACKGROUND: Assessment of the effective use of international travel measures during the COVID-19 pandemic has focused on public health goals, namely limiting virus introduction and onward transmission. However, risk-based approaches includes the weighing of public health goals against potential social, economic and other secondary impacts. Advancing risk-based approaches thus requires fuller understanding of available evidence on such impacts. METHODS: We conducted a scoping review of existing studies of the social impacts of international travel measures during the COVID-19 pandemic. Applying a standardized typology of travel measures, and five categories of social impact, we searched 9 databases across multiple disciplines spanning public health and the social sciences. We identified 26 studies for inclusion and reviewed their scope, methods, type of travel measure, and social impacts analysed. RESULTS: The studies cover a diverse range of national settings with a strong focus on high-income countries. A broad range of populations are studied, hindered in their outbound or inbound travel. Most studies focus on 2020 when travel restrictions were widely introduced, but limited attention is given to the broader effects of their prolonged use. Studies primarily used qualitative or mixed methods, with adaptations to comply with public health measures. Most studies focused on travel restrictions, as one type of travel measure, often combined with domestic public health measures, making it difficult to determine their specific social impacts. All five categories of social impacts were observed although there was a strong emphasis on negative social impacts including family separation, decreased work opportunities, reduced quality of life, and inability to meet cultural needs. A small number of countries identified positive social impacts such as restored work-life balance and an increase in perceptions of safety and security. CONCLUSIONS: While international travel measures were among the most controversial interventions applied during the COVID-19 pandemic, given their prolonged use and widespread impacts on individuals and populations, there remains limited study of their secondary impacts. If risk-based approaches are to be advanced, involving informed choices between public health and other policy goals, there is a need to better understand such impacts, including their differential impacts across diverse populations and settings.

Life space limitations in visually impaired older adults.

SIGNIFICANCE: Future work should develop and evaluate interventional strategies to help overcome visual and health-related barriers to travel in visually impaired seniors and mitigate adverse impacts of loneliness for those who do not leave town. PURPOSE: Life space refers to the area in which a person travels within a given time period. We explored whether demographics, vision, and/or health characteristics were related to restrictions in self-reported life space for visually impaired seniors. METHODS: Visually impaired (n = 114) clinical trial participants aged ≥55 years learned visual assistive iPhone apps and completed the following baseline questionnaires: Life Space, 36-Item Short-Form Health Survey, University of California, Los Angeles Loneliness Scale, and New-General Self-efficacy Scale. Multiple logistic regressions evaluated associations between life space and patient factors after accounting for their distance to the next county or state. RESULTS: During 2021 to 2023, 17%, 43%, and 70% of participants had not left their town, county, or state, respectively, in the past 3 months, or planned to in the next 3 months. Those with reduced distance best-corrected visual acuity had greater odds of not leaving the county in these time frames (odds ratio [OR] = 3.5; p=0.04). Minority race was associated with greater odds of not leaving town or the county in the past 2 weeks or future 3 months (OR = 4.3 to 6.4; p=0.009 to 0.049). Increased self-efficacy was associated with reduced odds of not leaving the state in the past 3 months, next 3 months, or past and/or future 3 months (OR = 0.54 to 0.55; p=0.02 to 0.03). Better physical function was associated with reduced odds of not leaving the state in the past 2 weeks or 3 months (OR = 0.96 to 0.98; p=0.01 to 0.04). Increased loneliness was related to greater odds of not leaving town in the past and/or future 3 months (OR = 1.8 to 2.0; p=0.007 to 0.009). CONCLUSIONS: Minority race, reduced vision, self-efficacy, and physical health were related to life space restrictions in this cohort of visually impaired seniors, whereas loneliness was greater among those who were not leaving town.

The association of travel burden with prenatal care utilization, what happens after provider-selection.

BACKGROUND: Birthing people in the United States face numerous challenges when accessing adequate prenatal care (PNC), with transportation being a significant obstacle. Nevertheless, previous studies that relied solely on the distance to the nearest provider cannot differentiate the effects of travel burden on provider selection and care utilization. These may exaggerate the degree of inequality in access and fail to capture perceived travel burden. This study investigated whether travel distances to the initially visited provider, to the predominant PNC provider, and perceived travel burden (measured by the travel disadvantage index (TDI)) are associated with PNC utilization. METHODS: A retrospective cohort of people with live births were identified from South Carolina Medicaid claims files in 2015-2018. Travel distances were calculated using Google Maps. The estimated TDI was derived from local pilot survey data. PNC utilization was measured by PNC initiation and frequency. Repeated measure logistic regression test was utilized for categorical variables and one-way repeated measures ANOVA for continuous variables. Unadjusted and adjusted ordinal logistic regressions with repeated measure were utilized to examine the association of travel burdens with PNC usage. RESULTS: For 25,801 pregnancies among those continuously enrolled in Medicaid, birthing people traveled an average of 24.9 and 24.2 miles to their initial and predominant provider, respectively, with an average TDI of -11.4 (SD, 8.5). Of these pregnancies, 60% initiated PNC in the first trimester, with an average of 8 total visits. Compared to the specialties of initial providers, predominant providers were more likely to be OBGYN-related specialists (81.6% vs. 87.9%, p < .001) and midwives (3.5% vs. 4.3%, p < .001). Multiple regression analysis revealed that every doubling of travel distance was associated with less likelihood to initiate timely PNC (OR: 0.95, p < .001) and a lower visit frequency (OR: 0.85, p < .001), and every doubling of TDI was associated with less likelihood to initiate timely PNC (OR: 0.94, p = .04). CONCLUSIONS: Findings suggest that the association between travel burden and PNC utilization was statistically significant but of limited practical significance.

Designing strategies of Pingyao lacquerware tourist souvenirs based on tourists' demand.

The continuous development of the economy and the constant improvement in living standards have led tourists to have higher expectations for the entire travel experience. However, outdated Pingyao lacquerware tourism souvenirs have struggled to attract tourists' attention and cannot better meet their demands. It is worth considering whether analyzing tourists' demands could solve the current issues with lacquerware tourism souvenirs. To address this question, tourists in the Pingyao region were surveyed, and semi-structured interviews and questionnaires as research methods. Initially, semi-structured interviews were conducted with tourists in the Pingyao region to obtain the initial demand indicators for Pingyao lacquerware tourism souvenirs. Based on a literature review and expert summaries, 21 demand indicators were selected for the KANO model questionnaire, and 400 tourists were surveyed using stratified sampling. Data analysis revealed that of the 21 demand indicators evaluated by tourists, 5 as must-be quality, 7 as one-dimensional quality, 5 as attractive quality, and 4 as indifferent quality. The results of this study indicate that the demand attributes evaluated are related to tourists' satisfaction levels, and the lack of these attributes could lead to dissatisfaction with lacquerware tourism souvenirs. Tourists have shown a strong demand for appearance and a desire for functional diversification in lacquerware souvenirs, with higher expectations for regional and commemorative aspects. Due to the uniqueness of lacquerware materials, tourists have highly prioritized safety and environmental friendliness. Combining the KANO model and AHP have better-assisted researchers in identifying the quality types and importance of tourist demands, providing more targeted insights for designing Pingyao lacquerware tourism souvenirs.

Use of wastewater from passenger ships to assess the movement of COVID-19 and other pathogenic viruses across maritime international boundaries.

Objective: The worldwide spread of SARS-CoV-2 and the resulting COVID-19 pandemic has been driven by international travel. This has led to the desire to develop surveillance approaches which can estimate the rate of import of pathogenic organisms across international borders. The aim of this study was to investigate the use of wastewater-based approaches for the surveillance of viral pathogens on commercial short-haul (3.5 h transit time) roll-on/roll-off passenger/freight ferries operating between the UK and the Republic of Ireland. Methods: Samples of toilet-derived wastewater (blackwater) were collected from two commercial ships over a 4-week period and analysed for SARS-CoV-2, influenza, enterovirus, norovirus, the faecal-marker virus crAssphage and a range of physical and chemical indicators of wastewater quality. Results: A small proportion of the wastewater samples were positive for SARS-CoV-2 (8% of the total), consistent with theoretical predictions of detection frequency (4%-15% of the total) based on the national COVID-19 Infection Survey and defecation behaviour. In addition, norovirus was detected in wastewater at low frequency. No influenza A/B viruses, enterovirus or enterovirus D68 were detected throughout the study period. Conclusion: We conclude that testing of wastewater from ships that cross international maritime boundaries may provide a cost-effective and relatively unbiased method to estimate the flow of infected individuals between countries. The approach is also readily applicable for the surveillance of other disease-causing agents.

Evaluating the Connection Between Rural Travel Time and Health: A Cross-Sectional Analysis of Older Adults Living in the Northeast United States.

INTRODUCTION: To characterize the impact of rural patients' travel time to obtain healthcare on their reported utilization of preventive healthcare services and personal health outcomes. METHODS: Online survey data from rural adults ages 50+ years living in the Northeastern United States were collected from February to August 2021. Study measures included self-reported travel time to obtain healthcare, use of preventive healthcare, and health outcomes. The associations between travel time with use of preventive care and health outcomes were assessed using linear, Poisson, and logistic regression analyses controlling for demographic variables. RESULTS: Our study population included 1052 rural adults, with a mean travel time of 18.5 min (range: 0-60). Travel time was greater for racial/ethnic minority participants and for higher-income participants (both P < .05), but it was not associated with use of preventive healthcare. Greater travel time was associated with poorer mental health and more comorbidities, including cancer and diabetes (all P < .05). CONCLUSIONS: Travel time varied by patient demographic factors, and it was associated with mental health and comorbidities. There was no association between travel time and preventive care use, suggesting that other barriers likely contribute to suboptimal use of these services within rural communities. Further research is needed to elucidate the causal pathways linking travel time to mental health and comorbidities within rural communities, as increased travel may exacerbate intrarural health disparities.