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BACKGROUND: Indigenous Peoples living on the land known as Canada are comprised of First Nations, Inuit, and Métis people and because of the Government of Canada's mandatory evacuation policy, those living in rural and remote regions of Ontario are required to travel to urban, tertiary care centres to give birth. When evaluating the risk of travelling for birth, Indigenous Peoples understand, evaluate, and conceptualise health risks differently than Eurocentric biomedical models of health. Also, the global COVID-19 pandemic changed how people perceived risks to their health. Our research goal was to better understand how Indigenous parturients living in rural and remote communities conceptualised the risks associated with evacuation for birth before and during the COVID-19 pandemic. METHODS: To achieve this goal, we conducted semi-structured interviews with 11 parturients who travelled for birth during the pandemic and with 5 family members of those who were evacuated for birth. RESULTS: Participants conceptualised evacuation for birth as riskier during the COVID-19 pandemic and identified how the pandemic exacerbated existing risks of travelling for birth. In fact, Indigenous parturients noted the increased risk of contracting COVID-19 when travelling to urban centres for perinatal care, the impact of public health restrictions on increased isolation from family and community, the emotional impact of fear during the pandemic, and the decreased availability of quality healthcare. CONCLUSIONS: Using Indigenous Feminist Methodology and Indigenous Feminist Theory, we critically analysed how mandatory evacuation for birth functions as a colonial tool and how conceptualizations of risk empowered Indigenous Peoples to make decisions that reduced risks to their health during the pandemic. With the results of this study, policy makers and governments can better understand how Indigenous Peoples conceptualise risks related to evacuation for birth before and during the pandemic, and prioritise further consultation with Indigenous Peoples to collaborate in the delivery of the health and care they need and desire.
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COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/etnologia , COVID-19/prevenção & controle , Feminino , Gravidez , SARS-CoV-2 , Adulto , Pandemias , Povos Indígenas/psicologia , Feminismo , Ontário/epidemiologia , Medição de Risco , Parto/psicologia , Viagem , Pesquisa QualitativaRESUMO
We reviewed all diagnoses of Shigella species notified to the UK Health Security Agency from January 2016 to March 2023. An overall increase in notifications of shigellosis was seen between 2016 (n = 415/quarter) and 2023 (n = 1 029/quarter). However, notifications dramatically declined between March 2020 and September 2021 during the COVID-19 pandemic (n = 208/quarter) highlighting the impact of travel and social distancing restrictions on transmission. S. sonnei diagnoses were more affected by lockdown restrictions than S. flexneri, most likely due to a combination of species-specific characteristics and host attributes. Azithromycin resistance continued to be associated with epidemics of sexually transmissible S. flexneri (adult males = 45.6% vs. adult females = 8.7%) and S. sonnei (adult males = 59.5% vs. adult females = 14.6%). We detected resistance to ciprofloxacin in S. sonnei from adult male cases not reporting travel at a higher frequency (79.4%) than in travel-associated cases (61.7%). Extensively drug-resistant Shigella species associated with sexual transmission among men almost exclusively had ESBL encoded by blaCTX-M-27, whereas those associated with returning travellers had blaCTX-M-15. Given the increasing incidence of infections and AMR, we recommend that enhanced surveillance is used to better understand the impact of travel and sexual transmission on the acquisition and spread of MDR and XDR Shigella species.
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Disenteria Bacilar , Humanos , Disenteria Bacilar/epidemiologia , Disenteria Bacilar/microbiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adolescente , Inglaterra/epidemiologia , Idoso , Adulto Jovem , Criança , Pré-Escolar , Lactente , COVID-19/epidemiologia , COVID-19/transmissão , Notificação de Doenças/estatística & dados numéricos , Idoso de 80 Anos ou mais , Farmacorresistência Bacteriana , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Shigella/efeitos dos fármacos , Viagem/estatística & dados numéricos , Recém-Nascido , Shigella sonnei/efeitos dos fármacos , Shigella flexneri/efeitos dos fármacos , Shigella flexneri/isolamento & purificaçãoRESUMO
A 74-year-old man, previously healthy, presented at the Dermatology department with an asymptomatic hand lesion persisting for two months. The general practitioner initially treated the lesion with betamethasone and fusidic acid cream. Examination revealed a 3 cm livid plaque with central crusts. A biopsy confirmed cutaneous leishmaniasis tropica. The patient travelled to Greece, Spain, and Southern France before the lesion occurred, which is consistent with the endemicity of leishmaniasis in the Mediterranean. Treatment involved cryotherapy and antimony injections, resulting in lesion resolution after two sessions. This case underscores the importance of considering travel history and endemic diseases in diagnosing and managing dermatological conditions, especially in regions prone to specific infections.
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Leishmaniose Cutânea , Humanos , Masculino , Idoso , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/patologia , Resultado do Tratamento , Crioterapia , Viagem , Mãos/patologiaRESUMO
OBJECTIVE: To describe the adoption of international travel measures during the first year of the COVID-19 pandemic. METHODS: To comprehensively analyze the measures adopted, we constructed a dataset based on the WHO's Public Health and Social Measures (PHSM) database, which covered 252 countries, territories, or other areas (CTAs), including all 194 WHO Member States, from December 31, 2019, to December 31, 2020. We examined the adoption of measures by type, over time, and by the implementing and targeted CTA, including their levels of income. FINDINGS: We identified 11,431 international travel measures implemented during the first year of the pandemic. The adoption of measures was rapid and widespread: over 60% of Member States had adopted a travel measure before the WHO declared COVID-19 a Public Health Emergency of International Concern on January 30, 2020. Initially, health screening and travel restrictions were the most adopted measures; however, quarantine and testing became more widely adopted over time. Although only a small portion of the total measures adopted constituted full border closure, approximately half of all Member States implemented this measure. Many travel measures targeted all CTAs but were unlikely to have been adopted universally enough to provide public health benefits. Low-income countries relied more on more universal measures, including full border closure, and were slower in scaling up testing compared to higher-income countries. CONCLUSION: The adoption of international travel measures during the first year of the COVID-19 pandemic varied across jurisdictions and over time. Lower-income countries used a different mix and scaled-up measures slower than higher-income countries. Understanding what measures were used is crucial for assessing their effectiveness in controlling the spread of COVID-19, reviewing the usefulness of the International Health Regulations, and informing future pandemic preparedness and response activities.
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COVID-19 , Viagem , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Saúde Global , Internacionalidade , Quarentena , Organização Mundial da Saúde , PandemiasRESUMO
OBJECTIVE: Hajj is among the oldest pilgrimages in the world, there is a limited study that evaluates the epidemiological pattern of Diabetes Mellitus [1] and the medical care required and provided to pilgrims. The present study assessed the prevalence and pattern of DM in Iranian pilgrims from 2012-22. METHOD: All demographic information, risk factors, and the prevalence of DM were extracted from the database and medical records of the Hajj Pilgrimage Medical Centre, Iranian Red Crescent Society through file reading. Also, to investigate the effect of the risk factors considered in the study, the multiple logistic regression model was used. RESULTS: The present study included data from 469,581 Hajj pilgrims. Most pilgrims were in the age group of 45 to 70 years (73.25%). The prevalence of diabetes in patients over 70 years old was the highest (16.73%). The prevalence of DM was estimated at 14.64% in women and 12.51% in men. The lowest DM prevalence was in Lorestan (7.81%), North Khorasan (9.07%), Sistan and Baluchistan (9.29%), and Hamedan (9.41), respectively. The highest prevalence rate was in Khuzestan (20.12%), Yazd (19.14), and Mazandaran (17.55), respectively. Our analysis reveals that, for instance, with each yearly increase in the age of the pilgrims (assuming other variables remain constant), the odds of having DM increase by 0.04. For the gender, the odds of having DM among women is 0.33 higher than among men, when the other variable is constant. CONCLUSIONS: The study results show a significant difference in the prevalence of diabetes in age, gender, and distribution in different provinces. Therefore, appropriate screening, diagnosis, and management by primary care physicians are necessary to prevent adverse health outcomes and reduce the economic burden of mortality and morbidity.
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Diabetes Mellitus , Islamismo , Humanos , Masculino , Feminino , Irã (Geográfico)/epidemiologia , Pessoa de Meia-Idade , Idoso , Diabetes Mellitus/epidemiologia , Estudos Retrospectivos , Prevalência , Adulto , Viagem/estatística & dados numéricos , Fatores de Risco , Atenção à Saúde/estatística & dados numéricos , Fatores Etários , Fatores Sexuais , Idoso de 80 Anos ou mais , Adulto JovemRESUMO
Shared values play an important role in attracting new tourists, retaining existing ones and gaining an important competitive advantage. Building upon the Commitment-Trust model, this study tested the role of shared ecological values in the creation of tourist trust and relationship commitment, and finally tourist behavioral intention. To test the hypotheses, a sample consisting of 480 mountaineering tourists of two representative travel agencies were surveyed, and a mixed-method approach based on a quantitative survey (n = 436) and qualitative interviews (n = 60) was also adopted to examine their relationships. Results revealed that shared ecological values between tourists and travel agencies were significantly negative predictors of credibility, while credibility and benevolence emerged as significantly positive predictors of relationship commitment. Moreover, credibility and relationship commitment were partially positively predictors of tourist's behavioral intentions. The findings enrich the extant knowledge on mountaineering tourist relationship marketing and human-nature relationships and provide implications for destination management and wildlife protection.
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Montanhismo , Turismo , Humanos , Masculino , Adulto , Feminino , Montanhismo/psicologia , Inquéritos e Questionários , Pessoa de Meia-Idade , Confiança , Viagem/psicologia , Adulto Jovem , IntençãoRESUMO
BACKGROUND: Influenza is the most common vaccine-preventable infection among travelers, affecting approximately one percent of those travelling to subtropical and tropical destinations. METHODS: We analysed demographic, travel-related and clinical information from travelers diagnosed with influenza at our travel clinic between January 2015 and March 2020 and influenza-negative controls. RESULTS: We included 68 travelers diagnosed with influenza and 207 controls. In total, 22.1% of influenza patients (n = 15) were older than 60 years and/or had comorbidities for which annual influenza vaccination is recommended, but only one had received an influenza vaccine. Patients with respiratory and musculoskeletal symptoms who presented during the German influenza season had the highest risk proportion of positive tests (54%, n = 25/46). Overall, three (4.4%) influenza patients were hospitalised, two (2.9%) received antiviral treatment, and eight (11.8%) received antibiotic therapy. CONCLUSIONS: Influenza occurs throughout the year in international travelers and can cause significant morbidity. Travelers with febrile illness should be tested for influenza, especially if they have respiratory or musculoskeletal symptoms, present during the local influenza season, or have travelled to South-East Asia. Influenza vaccination coverage among international travelers needs to be improved among high-risk individuals.
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Vacinas contra Influenza , Influenza Humana , Viagem , Humanos , Influenza Humana/epidemiologia , Influenza Humana/tratamento farmacológico , Alemanha/epidemiologia , Masculino , Feminino , Pessoa de Meia-Idade , Estudos de Casos e Controles , Estudos Retrospectivos , Viagem/estatística & dados numéricos , Adulto , Idoso , Vacinas contra Influenza/administração & dosagem , Vacinação/estatística & dados numéricos , Adulto Jovem , Adolescente , Antivirais/uso terapêutico , Estações do Ano , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: The 2018 UNOS allocation policy change deprioritized geographic boundaries to organ distribution, and the effects of this change have been widespread. The aim of this investigation was to analyze changes in donor transplant center distance for organ travel and corresponding outcomes before and after the allocation policy change. METHODS: The UNOS database was utilized to identify all adult patients waitlisted for heart transplants from 2016 to 2021. Transplant centers were grouped by average donor heart travel distance based on whether they received more or less than 50% of organs from >250 miles away. Descriptive statistics were provided for waitlisted and transplanted patients. Regression analyses modeled waitlist mortality, incidence of transplant, overall survival, and graft survival. RESULTS: Centers with a longer average travel distance had a higher mean annual transplant volume with a reduction in total days on a waitlist (86.6 vs. 149.2 days), an increased cold ischemic time (3.6 vs. 3.2 h), with no significant difference in post-transplant overall survival or graft survival. CONCLUSIONS: The benefits of reducing waitlist time while preserving post-transplant outcomes extend broadly. The trends observed in this investigation will be useful as we revise organ transplant policy in the era of new organ procurement and preservation techniques.
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Sobrevivência de Enxerto , Transplante de Coração , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Listas de Espera , Humanos , Obtenção de Tecidos e Órgãos/estatística & dados numéricos , Transplante de Coração/mortalidade , Masculino , Feminino , Prognóstico , Doadores de Tecidos/provisão & distribuição , Seguimentos , Pessoa de Meia-Idade , Taxa de Sobrevida , Viagem/estatística & dados numéricos , Adulto , Fatores de Risco , Estados UnidosRESUMO
Background: The towering peaks of the Himalayas lie in troves of captivating hill destinations, especially in India. Each destination aims to provide tourists with unique experiences and breath-taking landscapes. Understanding the tapestry of factors that weave the allure of these destinations and draw visitors from diverse backgrounds remains intriguing. Method: This study delves into the socio-demographic tapestry of Himalayan hill destination selection, unraveling the complex interplay of demographic characteristics, social influences, and individual motivations that shape tourists' choices. Results: This study aims to answer why different tourists have different travel choices and what factors are the drivers behind such choices. The results show that destination selection factors are similar irrespective of respondents' socio-demographic variabilities; however, for a few factors, the results are reversed. Conclusion: The study has implications for policymakers and the limitations of the research discussed at the end.
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Demografia , Humanos , Masculino , Índia , Feminino , Adulto , Pessoa de Meia-Idade , Fatores Socioeconômicos , Turismo , Comportamento de Escolha , Adulto Jovem , Motivação , Viagem , Fatores SociodemográficosRESUMO
BACKGROUND: Encouraging alternatives to the car such as walking, cycling or public transport is a key cross-sector policy priority to promote population and planetary health. Individual travel choices are shaped by individual and environmental contexts, and changes in these contexts - triggered by key events - can translate to changes in travel mode. Understanding how and why these changes happen can help uncover more generalisable findings to inform future intervention research. This study aimed to identify the mechanisms and contexts facilitating changes in travel mode. METHODS: Prospective longitudinal qualitative cohort study utilising semi-structured interviews at baseline (in 2021), three- and six-month follow up. Participants were residents in a new town in Cambridgeshire, UK, where design principles to promote walking, cycling and public transport were used at the planning stage. At each interview, we followed a topic guide asking participants about previous and current travel patterns and future intentions. All interviews were audio recorded and transcribed. Data analysis used the framework approach based on realist evaluation principles identifying the context and mechanisms described by participants as leading to travel behaviour change. RESULTS: We conducted 42 interviews with 16 participants and identified six mechanisms for changes in travel mode. These entailed increasing or reducing access, reliability and financial cost, improving convenience, increasing confidence and raising awareness. Participants described that these led to changes in travel mode in contexts where their existing travel mode had been disrupted, particularly in terms of reducing access or reliability or increasing cost, and where there were suitable alternative travel modes for their journey. Experiences of the new travel mode played a role in future travel intentions. IMPLICATIONS: Applying realist evaluation principles to identify common mechanisms for changes in travel mode has the potential to inform future intervention strategies. Future interventions using mechanisms that reduce access to, reduce reliability of, or increase the financial cost of car use may facilitate modal shift to walking, cycling and public transport when implemented in contexts where alternative travel modes are available and acceptable.
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Ciclismo , Pesquisa Qualitativa , Meios de Transporte , Viagem , Caminhada , Humanos , Estudos Longitudinais , Feminino , Masculino , Adulto , Meios de Transporte/métodos , Estudos Prospectivos , Pessoa de Meia-Idade , Reino Unido , Entrevistas como Assunto , Comportamentos Relacionados com a Saúde , Adulto Jovem , IdosoRESUMO
Car-sharing is a travel mode that can serve as an alternative to private cars, helping to reduce urban pollution. However, currently, there is a low willingness among travelers to use car-sharing, which is reflected in both low market penetration and user frequency. Therefore, it is essential for the government to encourage the use of car-sharing by providing subsidies. To better encourage the usage of car-sharing, this paper applies a two-fold evolutionary game model involving travelers and the government to explore the impact of subsidies on travelers' choices, and the factors that could affect the subsidies' efficiency. A simulation, using data from Beijing, was conducted to determine the implications of subsidy policies. The results show that a mileage-based subsidy and a fixed subsidy are applicable to travel of high and low mileages respectively, and under both subsidy modes, subsidies for trips with short duration or short pick-up and return time are more effective. Furthermore, we find that the efficiency of subsidies increases as the scale of car-sharing users, demand elasticity, or total number of travelers increases. Additionally, the subsidy levels should be lower than the environmental benefits of car-sharing but higher than the difference in travel costs between private cars and car-sharing. Future work will involve other game players such as car-sharing operators in order to draw deeper conclusions, and will involve the collection of data from more countries and cities to develop the robustness of the conclusions.
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Automóveis , Viagem , Humanos , Automóveis/economia , Viagem/economia , Teoria dos JogosRESUMO
This study employs a mathematical model to analyze and forecast the severe outbreak of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), focusing on the socio-economic ramifications within the Thai population and among foreign tourists. Specifically, the model examines the impact of the disease on various population groups, including susceptible (S), exposed (E), infected (I), quarantined (Q), and recovered (R) individuals among tourists visiting the country. The stability theory of differential equations is utilized to validate the mathematical model. This involves assessing the stability of both the disease-free equilibrium and the endemic equilibrium using the basic reproduction number. Emphasis is placed on local stability, the positivity of solutions, and the invariant regions of solutions. Additionally, a sensitivity analysis of the model is conducted. The computation of the basic reproduction number (R0) reveals that the disease-free equilibrium is locally asymptotically stable when R0 is less than 1, whereas the endemic equilibrium is locally asymptotically stable when R0 exceeds 1. Notably, both equilibriums are globally asymptotically stable under the same conditions. Through numerical simulations, the study concludes that the outcome of COVID-19 is most sensitive to reductions in transmission rates. Furthermore, the sensitivity of the model to all parameters is thoroughly considered, informing strategies for disease control through various intervention measures.
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Número Básico de Reprodução , COVID-19 , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/transmissão , COVID-19/virologia , Humanos , Tailândia/epidemiologia , SARS-CoV-2/isolamento & purificação , Modelos Teóricos , Viagem , Quarentena , Turismo , EpidemiasAssuntos
Dengue , Viagem , Humanos , Equador , Colômbia , Dengue/diagnóstico , Masculino , Púrpura/etiologia , Adulto , Doenças Transmissíveis Importadas/diagnóstico , FemininoRESUMO
BACKGROUND: The increasing prevalence of falsified and counterfeit medicines globally poses risks to international travellers. This narrative literature review examines the global challenge of falsified and counterfeit medicines, with a specific focus on risks for travellers. The aim is to provide a comprehensive understanding of this multidimensional issue, exploring potential solutions for effective intervention. METHODS: A comprehensive search of databases, including PubMed, MEDLINE, and Scopus, as well as relevant reports from international organisations, was undertaken. There was a focus on extracting information pertaining to the prevalence, types, and geographical patterns of falsified and counterfeit medicines encountered by international travellers. Synthesising this information helped to identify overarching trends and patterns. This narrative review utilised a thematic analysis approach to synthesise the findings. RESULTS: The findings revealed a diverse range of counterfeit drug categories, spanning from antibiotics to lifestyle medications, posing unique risks to travellers navigating the global pharmaceutical landscape. The review emphasises the geographical distribution of these drugs, with varying consequences for both high- and low-income nations. The inadequate formulations and inconsistent drug release arising from these practices pose severe threats to public health, especially for individuals travelling abroad. The review also highlights the significance of international collaboration in addressing this global challenge, as pharmaceutical supply chains seamlessly cross borders, necessitating a collaborative approach for effective regulation and enforcement. CONCLUSIONS: This review underscores the need for targeted research, collaborative interventions, and technological innovations to address the complexities associated with falsified and counterfeit medicines, ensuring the safety and well-being of international travellers.
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Medicamentos Falsificados , Humanos , Viagem , Saúde Global , FraudeRESUMO
Introduction: Community-level changes in population mobility can dramatically change the trajectory of any directly-transmitted infectious disease, by modifying where and between whom contact occurs. This was highlighted throughout the COVID-19 pandemic, where community response and nonpharmaceutical interventions changed the trajectory of SARS-CoV-2 spread, sometimes in unpredictable ways. Population-level changes in mobility also occur seasonally and during other significant events, such as hurricanes or earthquakes. To effectively predict the spread of future emerging directly-transmitted diseases, we should better understand how the spatial spread of infectious disease changes seasonally, and when communities are actively responding to local disease outbreaks and travel restrictions. Methods: Here, we use population mobility data from Virginia spanning Aug 2019-March 2023 to simulate the spread of a hypothetical directly-transmitted disease under the population mobility patterns from various months. By comparing the spread of disease based on where the outbreak begins and the mobility patterns used, we determine the highest-risk areas and periods, and elucidate how seasonal and pandemic-era mobility patterns could change the trajectory of disease transmission. Results and discussion: Through this analysis, we determine that while urban areas were at highest risk pre-pandemic, the heterogeneous nature of community response induced by SARS-CoV-2 cases meant that when outbreaks were occurring across Virginia, rural areas became relatively higher risk. Further, the months of September and January led to counties with large student populations to become particularly at risk, as population flows in and out of these counties were greatly increased with students returning to school.
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COVID-19 , SARS-CoV-2 , Estações do Ano , Humanos , COVID-19/epidemiologia , COVID-19/transmissão , Virginia/epidemiologia , Pandemias , Viagem/estatística & dados numéricos , Dinâmica Populacional , Surtos de DoençasRESUMO
BACKGROUND: Japan implemented strict border control measures and all incoming passengers were subject to entry screening with reverse transcription-polymerase chain reaction or antigen testing. From late 2020, exit screening within 72 h of departure to Japan also became mandatory. In this study, we evaluated the effectiveness of the exit screening policy in Japan by analyzing airport screening data from October 2020 to April 2022. METHODS: In addition to assessing entry screening data over time of passengers from the United Kingdom, we examined the prevalence of coronavirus disease 2019 (COVID-19) in the United Kingdom based on the Office of National Statistics infection survey. We constructed a statistical model that described entry screening positivity over time using Office of National Statistics prevalence data as the explanatory variable. Ideally, the time-dependent patterns of entry screening and Office of National Statistics prevalence data should resemble each other; however, we found that, sometimes, they were different and regarded the difference to statistically partly reflect the effectiveness of exit screening. RESULTS: The average proportion positive in one month before mandatory exit screening was implemented among Japanese passengers was 0.67% (95% confidence interval [CI]: 0.45, 0.98), whereas the proportion positive decreased to 0.49% (95% CI: 0.21, 1.15) in the first month of exit screening. Adjusting for time-dependent prevalence at the origin, we concluded that exit screening contributed to reducing passenger positivity by 59.3% (95% CI: 19.6, 81.3). The overall positivity values among passengers during the Delta and Omicron variant periods were 3.46 times and 1.46 times that during the pre-Delta variant period, respectively. CONCLUSIONS: We used a simplistic statistical model and empirical data from passengers arriving in Japan from the United Kingdom to support that exit screening helped to reduce the proportion positive by 59%. Although the proportion positive later increased considerably and precluded preventing the introduction of imported cases, submitting a certificate for a negative test result contributed to reducing the positivity among travelers.
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Aeroportos , COVID-19 , Programas de Rastreamento , SARS-CoV-2 , Humanos , COVID-19/epidemiologia , COVID-19/diagnóstico , Japão/epidemiologia , Reino Unido/epidemiologia , SARS-CoV-2/isolamento & purificação , Programas de Rastreamento/métodos , Prevalência , Viagem/estatística & dados numéricos , Teste para COVID-19/métodos , Teste para COVID-19/estatística & dados numéricosRESUMO
Beginning in late 2023, Oropouche virus was identified as the cause of large outbreaks in Amazon regions with known endemic transmission and in new areas in South America and the Caribbean. The virus is spread to humans by infected biting midges and some mosquito species. Although infection typically causes a self-limited febrile illness, reports of two deaths in patients with Oropouche virus infection and vertical transmission associated with adverse pregnancy outcomes have raised concerns about the threat of this virus to human health. In addition to approximately 8,000 locally acquired cases in the Americas, travel-associated Oropouche virus disease cases have recently been identified in European travelers returning from Cuba and Brazil. As of August 16, 2024, a total of 21 Oropouche virus disease cases were identified among U.S. travelers returning from Cuba. Most patients initially experienced fever, myalgia, and headache, often with other symptoms including arthralgia, diarrhea, nausea or vomiting, and rash. At least three patients had recurrent symptoms after the initial illness, a common characteristic of Oropouche virus disease. Clinicians and public health jurisdictions should be aware of the occurrence of Oropouche virus disease in U.S. travelers and request testing for suspected cases. Travelers should prevent insect bites when traveling, and pregnant persons should consider deferring travel to areas experiencing outbreaks of Oropouche virus disease.
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Infecções por Bunyaviridae , Humanos , Estados Unidos/epidemiologia , Feminino , Adulto , Masculino , Infecções por Bunyaviridae/epidemiologia , Pessoa de Meia-Idade , Idoso , Orthobunyavirus/isolamento & purificação , Viagem , Adulto Jovem , Doença Relacionada a Viagens , Surtos de Doenças , Cuba/epidemiologiaRESUMO
BACKGROUND: A significant portion of the Muslim community participates in the Arba'een pilgrimage, with participant numbers increasing each year. There have been relatively few studies on the health of Arba'een Mass gathering (MG). Researching the prevalence and distribution of diseases among Arba'een pilgrims is essential to recognize any outbreaks and take timely responses to contain them. The current study aimed to identify exposures and risk factors for diarrheal disease in pilgrims who referred to the clinics located in Iraq among the Arba'een MG in 2023. METHODS: This case-control study randomly selected 200 outpatients (100 cases and 100 controls) who were referred to Iraq clinics. Cases were patients with gastrointestinal symptoms (diarrhea), while controls were randomly selected from unaffected pilgrims at the same time for the cases. The study groups matched for age, and sex. Face-to-face interviews using a reliable field based checklist of the Center for Disease Control and Prevention of Iran's Ministry of Health to collect potential exposures and risk factors for diarrheal disease. Multiple logistic regression was used to estimate the crude and adjusted odds ratio (AOR) for the risk of diarrhea with a 95% confidence interval (CI). RESULTS: The average age of the participants was 38.6 years. Diarrhea in 100% and fever in 81% were the most common clinical symptoms in patients. Having underlying diseases was not associated with an increased risk of diarrhea disease (P > 0.05). Regarding risk factors for diarrheal, the final analysis after adjusting for potential confounders indicated that consumption of insanitary (unpackaged) drinking water (AOR = 1.95; 95% CI: 1.05-3.6; P = 0.024), inappropriate hand washing (AOR = 3.82; 95% CI: 1.7-8.6; P = 0.001), ritual foods (AOR = 2.56; 95% CI: 1.3-5.2; P = 0.004), and public toilets (AOR = 1.46; 95% CI: 1.04-4.3; P = 0.038) were significantly increased the likelihood of diarrheal disease. CONCLUSIONS: Contamination of water sources, food, inadequate and poor hand washing were the most common sources of diarrheal diseases among Arba'een pilgrims. The results indicate that the potential occurrence of outbreaks, especially water- and foodborne diseases, threatens participants in the Arba'een MG. It is recommended to provide risk assessment, improve pilgrims' awareness, pre-and post-screening, vaccination, compliance with personal hygiene, improvement of the environment, provision of sanitary water and food sources and hygienic disposal of sewage, laboratory diagnosis to identify the common types of pathogens in Arba'een MG.
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Diarreia , Humanos , Estudos de Casos e Controles , Masculino , Feminino , Diarreia/epidemiologia , Fatores de Risco , Adulto , Pessoa de Meia-Idade , Iraque/epidemiologia , Islamismo , Prevalência , Adulto Jovem , Irã (Geográfico)/epidemiologia , Viagem/estatística & dados numéricos , IdosoRESUMO
Women's football has grown in popularity, competitiveness and professionalism, increasing the demands placed on players and their injury risk. This study aimed to identify differences in the match workload and international travel between injured and non-injured professional women's footballers. The study was conducted as an observational, retrospective, case-control study over two football seasons (2021/2022 and 2022/2023) in four top-tier European women's football leagues. Fifty-eight professional women football players (81 injuries) formed the injury group and were matched with 81 elite women football players (162 non-injuries), from the same league, to form the control group. For each injury, cumulative match workload (minutes played, appearances, days between matches, rest) and international travel (distances, time, time zones crossed) were calculated over a 28-day period preceding the injury, for both the injured players and matched controls. The injured group had a higher number of instances of less than 5 days between matches compared to the controls (p = 0.03, effect size = 0.3, small). The anterior cruciate ligament injury group made more appearances (p = 0.09, effect size = 0.8, moderate), had more instances of less than 5 days between matches (p = 0.09, effect size = 0.8, moderate) and had less rest time (p = 0.12, effect size = 0.8, moderate) than the control group. No meaningful differences were observed between the hamstring injury group and the control group. These findings underscore the importance of careful consideration when developing match fixture schedules in elite women's football, particularly concerning the number of matches scheduled in a short period. Strategies to increase rest and recovery are recommended to safeguard players against injuries.