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2.
Plast Reconstr Surg ; 145(2): 471-481, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985644

RESUMO

BACKGROUND: Hand surgeons can alleviate the burden associated with various congenital anomalies, burn sequelae, and trauma that debilitate individuals in low- and middle-income countries. Because few surgeons in these areas have the necessary resources to perform complex hand surgery, surgical trips provide essential surgical care. The authors aimed to determine the economic benefit of hand surgical trips to low- and middle-income countries to comprehensively determine the economic implications of hand surgery trips in low-resource settings. METHODS: The authors collected data from two major global hand surgery organizations to analyze the economic benefit of hand surgery trips in low- and middle-income countries. The authors used both the human capital approach and the value of a statistical life-year approach to conduct this cost-benefit analysis. To demonstrate the economic gain, the authors subtracted the budgeted cost of each trip from the economic benefit. RESULTS: The authors analyzed a total of 15 trips to low- and middle-income countries. The costs of the trips ranged from $3453 to $87,434 (average, $24,869). The total cost for all the surgical trips was $373,040. The authors calculated a net economic benefit of $3,576,845 using the human capital approach and $8,650,745 using the value of a statistical life-year approach. CONCLUSIONS: The authors found a substantial return on investment using both the human capital approach and the value of a statistical life-year approach. In addition, the authors found that trips emphasizing education had a net economic benefit. Cost-benefit analyses have substantial financial implications and will aid policy makers in developing cost-reduction strategies to promote surgery in low- and middle-income countries.


Assuntos
Países em Desenvolvimento/economia , Deformidades Congênitas da Mão/economia , Traumatismos da Mão/economia , Mãos/cirurgia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise Custo-Benefício , Assistência à Saúde/economia , Feminino , Deformidades Congênitas da Mão/cirurgia , Traumatismos da Mão/cirurgia , Humanos , Masculino , Turismo Médico/economia , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Gravidez , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos , Viagem/economia , Viagem/estatística & dados numéricos , Adulto Jovem
3.
Epidemiol Psychiatr Sci ; 29: e92, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31928567

RESUMO

AIMS: Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India. METHODS: We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression. RESULTS: We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98-1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small. CONCLUSIONS: Geographic accessibility - as measured by travel distance - is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.


Assuntos
Depressão/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Comportamento de Busca de Ajuda , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , População Rural/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adulto , Estudos Transversais , Depressão/diagnóstico , Depressão/psicologia , Feminino , Sistemas de Informação Geográfica , Pesquisas sobre Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Índia , Masculino , Vigilância da População , Fatores de Tempo
4.
Int J Behav Nutr Phys Act ; 16(1): 135, 2019 12 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864372

RESUMO

BACKGROUND: Innovative approaches are required to move beyond individual approaches to behaviour change and develop more appropriate insights for the complex challenge of increasing population levels of activity. Recent research has drawn on social practice theory to describe the recursive and relational character of active living but to date most evidence is limited to small-scale qualitative research studies. To 'upscale' insights from individual contexts, we pooled data from five qualitative studies and used machine learning software to explore gendered patterns in the context of active travel. METHODS: We drew on 280 transcripts from five research projects conducted in the UK, including studies of a range of populations, travel modes and settings, to conduct unsupervised 'topic modelling analysis'. Text analytics software, Leximancer, was used in the first phase of the analysis to produce inter-topic distance maps to illustrate inter-related 'concepts'. The outputs from this first phase guided a second researcher-led interpretive analysis of text excerpts to infer meaning from the computer-generated outputs. RESULTS: Guided by social practice theory, we identified 'interrelated' and 'relating' practices across the pooled datasets. For this study we particularly focused on respondents' commutes, travelling to and from work, and on differentiated experiences by gender. Women largely described their commute as multifunctional journeys that included the school run or shopping, whereas men described relatively linear journeys from A to B but highlighted 'relating' practices resulting from or due to their choice of commute mode or journey such as showering or relaxing. Secondly, we identify a difference in discourses about practices across the included datasets. Women spoke more about 'subjective', internal feelings of safety ('I feel unsafe'), whereas men spoke more about external conditions ('it is a dangerous road'). CONCLUSION: This rare application of machine learning to qualitative social science research has helped to identify potentially important differences in co-occurrence of practices and discourses about practice between men's and women's accounts of travel across diverse contexts. These findings can inform future research and policy decisions for promoting travel-related social practices associated with increased physical activity that are appropriate across genders.


Assuntos
Aprendizado de Máquina , Viagem/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Distribuição por Sexo , Reino Unido , Adulto Jovem
5.
BMC Public Health ; 19(1): 1397, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660916

RESUMO

BACKGROUND: Travellers visiting friends and relatives (VFR) define a specific population of travellers exposed to higher risks for health and safety than tourists. The aim of this study was to assess differentials in pre-travel health care in VFR travellers compared to other travellers. METHODS: A retrospective cohort study was performed including attendees of the Travel Medicine Clinic of the Hospital Universitari de Bellvitge, Barcelona, Spain, between January 2007 and December 2017. RESULTS: Over the 10-year period, 47,022 subjects presented to the travel clinic for pre-travel health care, 13.7% of whom were VFR travellers. These showed higher rates of vaccination against yellow fever and meningococcus, but lower rates for hepatitis A, hepatitis B, influenza, rabies, cholera, polio, typhoid IM vaccine and tetanus vaccine boosters. Regarding malaria prevention measures, results highlighted that VFR travellers, when compared with tourists, were more likely to be prescribed with chemoprophylaxis, particularly with mefloquine, than with atovaquone/proguanil. CONCLUSIONS: Findings from this large-scale study indicated differences in vaccination rates and completion, as well as in chemoprophylaxis for malaria, between VFR and non-VFR travellers, fostering specific interventions for promoting adherence to pre-travel health advice among migrant travellers.


Assuntos
Migrantes/psicologia , Medicina de Viagem/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adulto , Família , Feminino , Amigos , Hospitais Universitários , Humanos , Malária/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha , Migrantes/estatística & dados numéricos , Vacinação/estatística & dados numéricos
6.
Artigo em Inglês | MEDLINE | ID: mdl-31597376

RESUMO

In the global economy, tourism is one of the most noticeable and growing sectors. Thissector plays an important role in boosting a nation's economy. An increase in tourism flow canbring positive economic outcomes to the nations, especially in gross domestic product (GDP) andemployment opportunities. In South Asian countries, the tourism industry is an engine ofeconomic development and GDP growth. This study investigates the impact of tourism onPakistan's economic growth and employment. The period under study was from 1990 to 2015. Tocheck whether the variables under study were stationary, augmented Dickey-Fuller andPhillips-Perron unit root tests were applied. A regression technique and Johansen cointegrationapproach were employed for the analysis of data. The key finding of this study shows that there isa positive and significant impact of tourism on Pakistan's economic growth as well as employmentsector and there is also a long-run relationship among the variables under study. This studysuggests that legislators should focus on the policies with special emphasis on the promotion oftourism due to its great potential throughout the country. Policy implications of this recent studyand future research suggestions are also mentioned.


Assuntos
Desenvolvimento Econômico/estatística & dados numéricos , Emprego/estatística & dados numéricos , Produto Interno Bruto/estatística & dados numéricos , Viagem/economia , Viagem/estatística & dados numéricos , Humanos , Índia , Paquistão
7.
Medicine (Baltimore) ; 98(39): e17330, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574869

RESUMO

The aim of this study was to investigate the experiences of medical transportation of Korean travelers who suffered accidents abroad and then transferred home by our aeromedical team.We collected demographic and clinical data on patients injured while traveling abroad from January 2013 to July 2017. Descriptive analyses based on 4 different transportation methods and transport time since hospitalization were performed.A total of 33 patients were repatriated during the study period. Of these, 28 (84.8%) were trauma cases with pedestrian injuries being the most common (11 cases; 39.3%). Twenty patients were repatriated by flight-stretchers, 6 by flight-prestige, 2 by ship, and 5 by air ambulance. The air ambulance was the most expensive (average 61,124 US Dollars) mode of transportation (P = .001) and the ship took the longest time (14 hours) to transport patients back to Korea from regions with similar distance (P = .0023).We experienced medical repatriation of 33 seriously injured Korean travelers back to South Korea. Transfer time should be an important considering factor and directly contacting and communicating with the specialized staff of foreign hospitals could also be very important to reduce unnecessary overseas hospital stay and cost incidence.


Assuntos
Transporte de Pacientes , Viagem/estatística & dados numéricos , Ferimentos e Lesões , Acidentes/economia , Acidentes/estatística & dados numéricos , Adulto , Resgate Aéreo , Feminino , Humanos , Incidência , Seguro Saúde , Internacionalidade , Masculino , República da Coreia , Macas (Leitos) , Transporte de Pacientes/economia , Transporte de Pacientes/métodos , Transporte de Pacientes/estatística & dados numéricos , Ferimentos e Lesões/economia , Ferimentos e Lesões/epidemiologia
8.
PLoS Comput Biol ; 15(9): e1007111, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31525184

RESUMO

Prophylactic interventions such as vaccine allocation are some of the most effective public health policy planning tools. The supply of vaccines, however, is limited and an important challenge is to optimally allocate the vaccines to minimize epidemic impact. This resource allocation question (which we refer to as VaccIntDesign) has multiple dimensions: when, where, to whom, etc. Most of the existing literature in this topic deals with the latter (to whom), proposing policies that prioritize individuals by age and disease risk. However, since seasonal influenza spread has a typical spatial trend, and due to the temporal constraints enforced by the availability schedule, the when and where problems become equally, if not more, relevant. In this paper, we study the VaccIntDesign problem in the context of seasonal influenza spread in the United States. We develop a national scale metapopulation model for influenza that integrates both short and long distance human mobility, along with realistic data on vaccine uptake. We also design GreedyAlloc, a greedy algorithm for allocating the vaccine supply at the state level under temporal constraints and show that such a strategy improves over the current baseline of pro-rata allocation, and the improvement is more pronounced for higher vaccine efficacy and moderate flu season intensity. Further, the resulting strategy resembles a ring vaccination applied spatiallyacross the US.


Assuntos
Biologia Computacional/métodos , Vacinas contra Influenza/administração & dosagem , Influenza Humana , Alocação de Recursos/métodos , Análise Espaço-Temporal , Algoritmos , Bases de Dados Factuais , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Influenza Humana/transmissão , Estações do Ano , Fatores de Tempo , Viagem/estatística & dados numéricos , Estados Unidos
9.
Ann Agric Environ Med ; 26(3): 385-391, 2019 Sep 19.
Artigo em Inglês | MEDLINE | ID: mdl-31559790

RESUMO

INTRODUCTION: Arthropod-borne viruses are important causes of human morbidity worldwide. However, the available literatur and the epidemiological data concerning the importation to Poland of globally emerging arboviral infections, such as DENV, CHIKV, WNV, or ZIKV, are scarce. Only few seroepidemiologic studies concerning WNV in animals or humans in Poland have been published. OBJECTIVE: The aim of this review paper is to summarize and present the current state of knowledge and the perspectives for research concerning the importation and the risk posed by the introduction to Poland of the four above-mentioned arboviral diseases. CURRENT STATE OF KNOWLEDGE: Climate change may facilitate the northward expansion of both the vectors for diseases previously unseen in Europe, as well as of the viruses themselves, resulting in autochthonous cases of diseases previously exclusively imported. Little is known about the importation of arboviral diseases to Poland because of the frequently asymptomatic or self-limiting course of the disease, lack of epidemiologic studies or effective disease reporting, as well as inadequate access to diagnostic methods. CONCLUSIONS: Further epidemiologic studies in Polish travellers are necessary in order to prevent importation or introduction of the above-mentioned viruses, and to act against potential problems related to blood transfusion or organ transplantation from infected donors.


Assuntos
Infecções por Arbovirus/epidemiologia , Arbovirus/fisiologia , Viagem/estatística & dados numéricos , Animais , Infecções por Arbovirus/sangue , Infecções por Arbovirus/transmissão , Infecções por Arbovirus/virologia , Arbovirus/genética , Arbovirus/imunologia , Arbovirus/isolamento & purificação , Pesquisa Biomédica/tendências , Humanos , Conhecimento , Polônia/epidemiologia
10.
Artigo em Inglês | MEDLINE | ID: mdl-31416153

RESUMO

Despite worldwide efforts, maternal and child mortality remains a major health problem in many developing countries. Cambodia's maternal mortality rate has decreased over recent years through government efforts and support from various international development cooperation agencies. The purpose of this study was to investigate the factors that affected the accessibility of Cambodia's maternal healthcare services. Data from maternal health service surveys conducted in Battambang, Cambodia in 2012 and 2015 were compared and analyzed. Multiple regression analysis was conducted to identify factors related to the accessibility of integrated maternal healthcare service. The travel time to health centers was found to be related to distance from the health center (ß = 0.031, p < 0.001), travel time during the rainy season (ß = 0.166, p < 0.001), and travel cost (ß = 0.001, p < 0.001), with an explanatory power of 27% (R2 = 0.274). Based on these findings, future research and policy should focus on improving accessibility to effective maternal and child healthcare services, to reduce maternal and child mortality. This study is intended to contribute to developing a multi-directional and integrated strategy for access to maternal health services in developing countries.


Assuntos
Mortalidade da Criança , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/organização & administração , Serviços de Saúde Materna/estatística & dados numéricos , Mortalidade Materna , Viagem/estatística & dados numéricos , Adulto , Camboja , Pré-Escolar , Países em Desenvolvimento , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Inquéritos e Questionários
11.
Int J Behav Nutr Phys Act ; 16(1): 72, 2019 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438985

RESUMO

BACKGROUND: Physical activity is associated with improved physical and mental health among children, but many children do not meet the recommended hour per day of moderate-to-vigorous-intensity physical activity (MVPA). The aim of this paper is to investigate participation in active after-school clubs and active travel to and from school at age 11 and estimate the average daily minutes of MVPA associated with active club attendance and active travel. METHODS: Accelerometer data were collected on three weekdays for 1296 11-year-old children in a cross-sectional study. Children reported attendance at active after-school clubs and how they travelled to and from school for each day of the week. To account for repeat days within child and clustering within schools we used multilevel models with random effects at the school and child level, and fixed effects for all covariates. We calculated odds ratios for participation in active after-school clubs and active travel for gender, measures of socio-economic position and BMI category. We also explored the association between active club attendance, active travel and daily average MVPA. RESULTS: Boys and girls were equally likely to attend active after-school clubs. Boys were more likely to travel to school using active modes. Attendance at active after-school clubs and active travel home were not associated with each other. Attending an active after-school club was associated with an additional 7.6 min (95% CI: 5.0 to 10.3) average MVPA on that day among both boys and girls. Active travel was associated with an additional 4.7 min (95% CI: 2.9 to 6.5) average MVPA per journey for boys and 2.4 min (95% CI: 1.0 to 3.7) for girls. CONCLUSIONS: Both active after-school clubs and active travel are associated with greater physical activity on the day that children participate in these, and we saw no evidence that those attending active clubs do so at the expense of active travel home afterwards. While the increased daily MVPA is small to moderate, active after-school clubs and active travel on multiple days of the week could make important contributions as part of complex interventions aimed at increasing population levels of physical activity in children.


Assuntos
Exercício/fisiologia , Instituições Acadêmicas/organização & administração , Viagem/estatística & dados numéricos , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Reino Unido/epidemiologia
12.
Travel Med Infect Dis ; 31: 101446, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31284067

RESUMO

BACKGROUND: Dengue virus importation from abroad is still the main driver of dengue incidence in China. Using global flight data to model importation may improve our understanding and prediction of dengue virus importation and onward transmission. METHODS: A retrospective analysis was performed of surveillance cases of dengue infections imported to China and volume of air traffic to China for the years 2005 through 2014, inclusive. The data were aggregated by year, destination province, and source country. Descriptive statistics were calculated, and a random effects negative binomial model was created to predict the number of imported cases based on the volume of travelers from dengue-endemic countries. RESULTS: There were 1,822 cases of imported dengue infections over the study period. Most imported cases are from a small number of high-incidence countries with a large volume of travel to China, most notably Myanmar (22% of cases). The number of imported cases of dengue infections increased by 5.9% for every 10% increase in travel volume from dengue-endemic countries. CONCLUSION: Patterns of air travel have a measurable impact on the importation of dengue to China. Modelling dengue importation risk may be a useful strategy to direct public health surveillance and interventions.


Assuntos
Aeronaves , Dengue/epidemiologia , Viagem/estatística & dados numéricos , China/epidemiologia , Interpretação Estatística de Dados , Dengue/transmissão , Monitoramento Epidemiológico , Humanos , Incidência , Estudos Retrospectivos
13.
Malar J ; 18(1): 230, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31291951

RESUMO

BACKGROUND: Malaria was eliminated in Spain in 1964. Since then, more than 10,000 cases of malaria have been reported, mostly in travellers and migrants, making it the most frequently imported disease into this country. In order to improve knowledge on imported malaria cases characteristics, the two main malaria data sources were assessed: the national surveillance system and the hospital discharge database (CMBD). METHODS: Observational study using prospectively gathered surveillance data and CMBD records between 2002 and 2015. The average number of hospitalizations per year was calculated to assess temporal patterns. Socio-demographic, clinical and travel background information were analysed. Bivariate and multivariable statistical methods were employed to evaluate hospitalization risk, fatal outcome, continent of infection and chemoprophylaxis failure and their association with different factors. RESULTS: A total of 9513 malaria hospital discharges and 7421 reported malaria cases were identified. The number of reported cases was below the number of hospitalizations during the whole study period, with a steady increase trend in both databases since 2008. Males aged 25-44 were the most represented in both data sources. Most frequent related co-diagnoses were anaemia (20.2%) and thrombocytopaenia (15.4%). The risks of fatal outcome increased with age and were associated with the parasite species (Plasmodium falciparum). The main place of infection was Africa (88.9%), particularly Equatorial Guinea (33.2%). Most reported cases were visiting friends and relatives (VFRs) and immigrants (70.2%). A significant increased likelihood of hospitalization was observed for children under 10 years (aOR:2.7; 95% CI 1.9-3.9), those infected by Plasmodium vivax (4.3; 95% CI 2.1-8.7) and travellers VFRs (1.4; 95% CI 1.1-1.7). Only 4% of cases reported a correct regime of chemoprophylaxis. Being male, over 15 years, VFRs, migrant and born in an endemic country were associated to increased risk of failure in preventive chemotherapy. CONCLUSIONS: The joint analysis of two data sources allowed for better characterization of imported malaria profile in Spain. Despite the availability of highly effective preventive measures, the preventable burden from malaria is high in Spain. Pre-travel advice and appropriately delivered preventive messages needs to be improved, particularly in migrants and VFRs.


Assuntos
Antimaláricos/administração & dosagem , Doenças Transmissíveis Importadas/epidemiologia , Hospitalização/estatística & dados numéricos , Malária Falciparum/epidemiologia , Malária Vivax/epidemiologia , Adolescente , Adulto , Fatores Etários , Quimioprevenção/estatística & dados numéricos , Doenças Transmissíveis Importadas/parasitologia , Doenças Transmissíveis Importadas/prevenção & controle , Feminino , Humanos , Incidência , Malária Falciparum/parasitologia , Malária Falciparum/prevenção & controle , Malária Vivax/parasitologia , Malária Vivax/prevenção & controle , Masculino , Pessoa de Meia-Idade , Plasmodium falciparum/fisiologia , Plasmodium vivax/fisiologia , Prevalência , Fatores de Risco , Fatores Sexuais , Espanha/epidemiologia , Viagem/estatística & dados numéricos , Adulto Jovem
14.
Am J Public Health ; 109(9): 1216-1223, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31318587

RESUMO

Objectives. To explore US geographic areas with limited access to HIV preexposure prophylaxis (PrEP) providers, PrEP deserts.Methods. We sourced publicly listed PrEP providers from a national database of PrEP providers from 2017 and obtained county-level urbanicity classification and population estimates of men who have sex with men (MSM) from public data. We calculated travel time from census tract to the nearest provider. We classified a census tract as a PrEP desert if 1-way driving time was greater than 30 or 60 minutes.Results. One in 8 PrEP-eligible MSM (108 758/844 574; 13%) lived in 30-minute-drive deserts, and a sizable minority lived in 60-minute-drive deserts (38 804/844 574; 5%). Location in the South and lower urbanicity were strongly associated with increased odds of PrEP desert status.Conclusions. A substantial number of persons at high risk for HIV transmission live in locations with no nearby PrEP provider. Rural and Southern areas are disproportionately affected.Public Health Implications. For maximum implementation effectiveness of PrEP, geography should not determine access. Programs to train clinicians, expand venues for PrEP care, and provide telemedicine services are needed.


Assuntos
Infecções por HIV , Acesso aos Serviços de Saúde/estatística & dados numéricos , Homossexualidade Masculina/estatística & dados numéricos , Profilaxia Pré-Exposição/estatística & dados numéricos , Adulto , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Masculino , Viagem/estatística & dados numéricos , Estados Unidos/epidemiologia
15.
Travel Med Infect Dis ; 30: 73-107, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31279917

RESUMO

BACKGROUND: Malaria prevention in travellers can be complex and requires consideration of a number of factors. UK healthcare professionals providing pre-travel malaria advice can access specialist support from the National Travel Health Network and Centre (NaTHNaC) telephone advice line. The aim of this study is to characterise queries to the NaTHNaC telephone advice line regarding pre-travel malaria advice. METHOD: Telephone calls received to NaTHNaC's advice line are recorded using an online data capture form. All calls relating to malaria advice during 2016 were selected and data extracted. Analysis was undertaken using Microsoft Excel and STATA. RESULTS: During 2016, 1803 malaria-related calls were received; the majority from general practice and calls were from across the UK. The most common type of pre-travel malaria query was country-specific followed by travellers with special health needs. Many queries related to pregnant and breastfeeding travellers, children under 5 years and travellers over 60 years. CONCLUSIONS: This review presents a large and exceptional dataset and reflects the ambiguity amongst some healthcare professionals regarding malaria advice. We have identified potential knowledge gaps, and as a result will strengthen future guidance, enhance existing malaria maps, and inform the development of future clinical educational activity.


Assuntos
Malária/prevenção & controle , Consulta Remota/estatística & dados numéricos , Telefone , Viagem/estatística & dados numéricos , Humanos , Fatores de Risco , Reino Unido , Vacinação/estatística & dados numéricos
16.
Wilderness Environ Med ; 30(3): 236-243, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31204141

RESUMO

INTRODUCTION: Professional mountain guides face significant occupational health risks, including injuries, accidents, environmental exposures, chronic musculoskeletal strain, and psychological stressors. This study aims to investigate these risks and their impact on the quality of life of a group of international British mountain guides. METHODS: This self-reported online survey included demographics; acute and chronic occupational conditions; and questions on general health, lifestyle, symptoms of post-traumatic stress disorder (PTSD), and quality of life based on the World Health Organization quality of life [WHOQOL-BREF] questionnaire. RESULTS: Responses were received from 67 (32%) of the approached guides. Knee pain (75%), back and neck pain (62%), hand/upper extremity problems (51%), and lower limb injuries (49%) were the most commonly reported individual occupational health problems. Chronic eye problems were reported by 8%, and 5% reported skin cancer. Twenty-nine percent were on regular medications, which were mainly analgesics for chronic musculoskeletal complaints. Mountain guides have a healthy lifestyle, with lower rates of being overweight/obese, alcohol consumption, and smoking than the average UK population. Fourteen (61%) of the 23 guides responding to the PTSD questions reported experiencing life-threatening traumatic incidents, and 4 (25%) of this subgroup appear to have had some symptoms of PTSD. The quality of life assessment showed that the studied mountain guides have a high quality of life. CONCLUSIONS: Musculoskeletal problems are the main occupational health problems experienced by the study group. New findings include a low but important prevalence of ultraviolet radiation-associated conditions. One in 3 guides have experienced significant psychological trauma, and one quarter of these had symptoms of PTSD.


Assuntos
Montanhismo/estatística & dados numéricos , Saúde do Trabalhador/estatística & dados numéricos , Qualidade de Vida , Viagem/estatística & dados numéricos , Adulto , Idoso , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Profissionais/prevenção & controle , Medição de Risco/estatística & dados numéricos , Autorrelato , Reino Unido
17.
Environ Monit Assess ; 191(Suppl 2): 381, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31254089

RESUMO

Understanding patients' travel behavior for seeking hospital care is fundamental for understanding healthcare market and planning for resource allocation. However, few studies examined the issue comprehensively across populations by geographical, demographic, and health insurance characteristics. Based on the 2011 State Inpatient Database in Florida, this study modeled patients' travel patterns for hospital inpatient care across geographic areas (by average affluence, urbanicity) and calendar seasons, and across subpopulations (by age, gender, race/ethnicity, and health insurance status). Overall, travel patterns for all subpopulations were best captured by the log-logistic function. Patients in more affluent areas and rural areas tended to travel longer for hospital inpatient care, so did the younger, whites, and privately insured. Longer travel distances may be a necessity for rural patients to cope with lack of accessibility for local hospital care, but for the other population groups, it may indicate rather better mobility and more healthcare choices. The results can be used in various healthcare analyses such as accessibility assessment, hospital service area delineation, and healthcare resource planning.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Viagem/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Demografia , Feminino , Florida , Humanos , Lactente , Recém-Nascido , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Adulto Jovem
18.
J Infect Chemother ; 25(11): 866-872, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31105000

RESUMO

BACKGROUND: Overseas travelers should prepare for health problems at their destinations prior to travel. No prospective studies have evaluated factors related to health risk management behaviors among overseas travelers, specifically young travelers. METHODS: We prospectively collected data from pre- and post-travel questionnaire surveys, targeting students of a university in Japan who participated in short-term study abroad programs (n = 532, 6 to 38 travel days and 11 countries). We examined health information collection, receipt of travel vaccinations for the programs and medical kit preparation as health risk management behavior outcomes and their related factors among the participants (82.7% follow-up rate). RESULTS: In total, 17.5%, 8.0% (28.6% in Southeast Asia) and 68.9% of participants, respectively, collected travel health information via the Japanese or foreign official websites, received travel vaccinations and carried commonly used medicines. Female, travel experience to study destination, parental medical occupation and presence of illness in treatment were positively associated with the health risk management behaviors after adjusting for the covariates including study destination. For example, the adjusted odds ratio (OR) (95% confidence interval [CI]) of receiving travel vaccinations was 4.16 (1.70-10.2) for parental medical occupation relative to non-medical occupation. The adjusted OR (95% CI) of collecting travel health information was 2.54 (1.04-6.21) for travel experience to study destination relative to no overseas travel experience. CONCLUSIONS: Personal characteristics including overseas travel experience and parental occupation provide a useful insight into approaches to promoting health risk management among university students traveling abroad.


Assuntos
Gestão de Riscos/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Viagem/estatística & dados numéricos , Universidades/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Japão , Masculino , Estudos Prospectivos , Inquéritos e Questionários , Vacinação/estatística & dados numéricos , Adulto Jovem
19.
Travel Med Infect Dis ; 30: 54-66, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31102656

RESUMO

BACKGROUND: The experience of previous sizable outbreaks may affect travelers' decisions to travel to an area with an ongoing outbreak. METHODS: We estimated changes in monthly numbers of visitors to the Republic of Korea (ROK) in 2015 compared to projected values by selected areas. We tested whether areas' experience of a previous SARS outbreak of ≥100 cases or distance to the ROK had a significant effect on travel to the ROK during the MERS outbreak using t-tests and regression models. RESULTS: The percentage changes in visitors from areas with a previous SARS outbreak of ≥100 cases decreased more than the percentage changes in visitors from their counterparts in June (52.4% vs. 23.3%) and July (60.0% vs. 31.4%) during the 2015 MERS outbreak. The percentage changes in visitors from the close and intermediate categories decreased more than the far category. The results from regression models and sensitivity analyses demonstrated that areas with ≥100 SARS cases and closer proximity to the ROK had significantly larger percentage decreases in traveler volumes during the outbreak. CONCLUSIONS: During the 2015 MERS outbreak, areas with a previous sizable SARS outbreak and areas near the ROK showed greater decreases in percentage changes in visitors to the ROK.


Assuntos
Infecções por Coronavirus/epidemiologia , Viagem/estatística & dados numéricos , Humanos , Coronavírus da Síndrome Respiratória do Oriente Médio , Análise de Regressão , República da Coreia/epidemiologia , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/epidemiologia
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