Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 971
Filtrar
2.
Nature ; 599(7883): 108-113, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34551425

RESUMO

Throughout the coronavirus disease 2019 (COVID-19) pandemic, countries have relied on a variety of ad hoc border control protocols to allow for non-essential travel while safeguarding public health, from quarantining all travellers to restricting entry from select nations on the basis of population-level epidemiological metrics such as cases, deaths or testing positivity rates1,2. Here we report the design and performance of a reinforcement learning system, nicknamed Eva. In the summer of 2020, Eva was deployed across all Greek borders to limit the influx of asymptomatic travellers infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and to inform border policies through real-time estimates of COVID-19 prevalence. In contrast to country-wide protocols, Eva allocated Greece's limited testing resources on the basis of incoming travellers' demographic information and testing results from previous travellers. By comparing Eva's performance against modelled counterfactual scenarios, we show that Eva identified 1.85 times as many asymptomatic, infected travellers as random surveillance testing, with up to 2-4 times as many during peak travel, and 1.25-1.45 times as many asymptomatic, infected travellers as testing policies that utilize only epidemiological metrics. We demonstrate that this latter benefit arises, at least partially, because population-level epidemiological metrics had limited predictive value for the actual prevalence of SARS-CoV-2 among asymptomatic travellers and exhibited strong country-specific idiosyncrasies in the summer of 2020. Our results raise serious concerns on the effectiveness of country-agnostic internationally proposed border control policies3 that are based on population-level epidemiological metrics. Instead, our work represents a successful example of the potential of reinforcement learning and real-time data for safeguarding public health.


Assuntos
COVID-19/diagnóstico , COVID-19/prevenção & controle , Portador Sadio/diagnóstico , Portador Sadio/prevenção & controle , Aprendizado de Máquina , Medicina de Viagem , Viagem , COVID-19/epidemiologia , COVID-19/transmissão , Portador Sadio/epidemiologia , Portador Sadio/transmissão , Grécia , Humanos , Prevalência , Saúde Pública
3.
Curr Opin Infect Dis ; 34(5): 409-414, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34267043

RESUMO

PURPOSE OF REVIEW: The current article will review how the coronavirus disease 2019 pandemic has changed travel and travel medicine. RECENT FINDINGS: Travelers spread severe acute respiratory syndrome coronavirus 2 globally and continue to spread variants. The characteristics of the virus, the place, and time created a perfect storm that allowed the virus to quickly spread globally. The virus spread by every mode of travel with risk of transmission influenced by proximity to an infected person, duration of trip, physical characteristics of the space, and ventilation. Superspreading events were common; a small percentage of infected people accounted for most of transmission. The travel and tourist industry was devastated as lockdowns and quarantines severely restricted domestic and international travel. A trip includes multiple segments and shared sequential spaces, mostly indoors. Creating safe travel requires attention to all segments of a trip. SUMMARY: The coronavirus disease 2019 pandemic has affected every part of travel and travel medicine. The rapid development of multiple safe and effective vaccines and their deployment is allowing resumption of travel, yet many populations lack access to vaccines, and high levels of transmission continue in many areas. Providing documentation of vaccination or immunity in a consistent, verifiable, interoperable system is one of many active issues.


Assuntos
COVID-19/imunologia , Pandemias/prevenção & controle , Animais , Controle de Doenças Transmissíveis/métodos , Humanos , SARS-CoV-2/imunologia , Viagem , Medicina de Viagem/métodos , Vacinação/métodos
4.
Travel Med Infect Dis ; 43: 102143, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34256131

RESUMO

BACKGROUND: The advent of mobile applications for health and medicine will revolutionize travel medicine. Despite their many benefits, such as access to real-time data, mobile apps for travel medicine are accompanied by many ethical issues, including questions about security and privacy. METHODS: A systematic literature review as conducted following PRISMA guidelines. Database screening yielded 1795 results and seven papers satisfied the criteria for inclusion. Through a mix of inductive and deductive data extraction, this systematic review examined both the benefits and challenges, as well as ethical considerations, of mobile apps for travel medicine. RESULTS: Ethical considerations were discussed with varying depth across the included articles, with privacy and data protection mentioned most frequently, highlighting concerns over sensitive information and a lack of guidelines in the digital sphere. Additionally, technical concerns about data quality and bias were predominant issues for researchers and developers alike. Some ethical issues were not discussed at all, including equity, and user involvement. CONCLUSION: This paper highlights the scarcity of discussion around ethical issues. Both researchers and developers need to better integrate ethical reflection at each step of the development and use of health apps. More effective oversight mechanisms and clearer ethical guidance are needed to guide the stakeholders in this endeavour.


Assuntos
Aplicativos Móveis , Humanos , Privacidade , Medicina de Viagem
6.
Rev Infirm ; 70(270): 47-48, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33832732

RESUMO

Catherine is an advanced nurse practitioner working in a large general practice in the North of England. Today she is running a travel clinic. Because of the immense changes brought about by COVID-19 the world is struggling to regain a degree of normality and the possibility of travel to distant places is liberating to many. More than ever medical advice about safety precautions are necessary. Marc and Emma are consulting Catherine about a projected holiday abroad.


Assuntos
Padrões de Prática em Enfermagem , Medicina de Viagem , Prática Avançada de Enfermagem , COVID-19/epidemiologia , COVID-19/enfermagem , Inglaterra/epidemiologia , Medicina Geral , Humanos
9.
Rev. argent. salud publica ; 13: 1-7, 5/02/2021.
Artigo em Espanhol | LILACS, BINACIS, ARGMSAL | ID: biblio-1284450

RESUMO

INTRODUCCIÓN: Los envenenamientos producidos por escorpiones son un problema de salud pública en constante aumento en Argentina y el mundo. Por diversas causas, los ensambles de animales venenosos de una región varían en el tiempo. El objetivo de este trabajo fue presentar la información reciente y actualizar el elenco de escorpiones de la provincia de Misiones. MÉTODOS: Se realizó un estudio descriptivo observacional a partir de la revisión de los ejemplares depositados en la Colección de Herpetología y Arácnidos del Instituto Nacional de Medicina Tropical. RESULTADOS: Se obtuvieron los primeros registros para la provincia de Tityus confluens, mientras que nuevos registros de accidentes con Tityus trivittatus ampliaron la zona de presencia de la especie en la provincia. El ensamble de escorpiones de Misiones reúne a las cuatro especies de interés médico del país. DISCUSIÓN: La detección del elenco de escorpiones de interés médico más importante del país fue consecuencia del trabajo conjunto entre los especialistas de los distintos grupos de animales ponzoñosos y los profesionales de la salud. Es importante generar y profundizar los espacios de interacción de saberes, con el objetivo de mejorar la Vigilancia de la Salud


Assuntos
Escorpiões , Toxicologia , Medicina de Viagem , Vigilância em Saúde Pública , Ecoepidemiologia
11.
Infect Dis Now ; 51(3): 279-284, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33069841

RESUMO

OBJECTIVES: We examined the association between travellers' characteristics, compliance with pre-travel recommendations and health problems. METHODS: Volunteer travellers were enrolled and data collected using a questionnaire between 30-60 days after returning home. We analyzed the associations through bivariate and multivariate models. RESULTS: Of the 468 enrolled travelers, 68% consumed raw food and 81% food containing milk and/or eggs. 32% consumed street vendor food and 30% drinks containing ice. 24% used the recommended mechanical prophylaxis measures. 46% got sick during and/or after travel (gastrointestinal symptoms most frequently). Factors predisposing to health problems were female gender, youth/middle age, intermediate travel duration and profession. The American continent and staying in hostels and tents were significantly associated with febrile illness. Street vendor food was significantly associated with skin reactions. CONCLUSIONS: Adherence to behavioral recommendations remains low. Travellers must be informed of health risks during and after travel.


Assuntos
Comportamentos Relacionados com a Saúde , Assunção de Riscos , Doença Relacionada a Viagens , Viagem , Adolescente , Adulto , Quimioprevenção/métodos , Diarreia/prevenção & controle , Feminino , Febre/prevenção & controle , Seguimentos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Inquéritos e Questionários , Medicina de Viagem/métodos , Vacinação/métodos , Adulto Jovem
12.
Infect Dis Now ; 51(3): 266-272, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33160008

RESUMO

BACKGROUND: The present study aims to characterize knowledge, attitudes and practices in a sample of general practitioners (GPs) on management of travelers' diarrhea (TD). METHODS: A total of 158 GPs (44.3% males; mean age 40.2±12.4 years) completed a web questionnaire on antibiotic prophylaxis (AP) and/or an antibiotic treatment (AT) in TD cases. Participants were inquired on knowledge status (KS), risk perception and effectively applied recommendations for AP/AT through a specifically designed questionnaire. Multivariate odds ratios (OR) for predictors of AP/AT were calculated through regression analysis. RESULTS: All in all, while 15 (9.5%) participants recommended AP for TD, 61 of them (39.4%) recommended AT. KS was largely unsatisfying as participants extensively ignored the most recent AP/AT recommendations. Acknowledgment of TD as a severe disorder was predictive for recommendation of AP (OR 37.843, 95%CI 4.752-301.4). As for AT, it was relatively elevated in GPs≥10 years (OR 2.653, 95%CI 1.169-6.019), but more rarely reported in participants with higher KS (OR 0.056, 95%CI 0.021-0.153). CONCLUSIONS: Adherence of GPs to official recommendations for TD management was unsatisfying, particularly in older participants. Continuous Education of GPs should be improved by sharing up-to-date official recommendations on AT/AP for TD.


Assuntos
Antibacterianos/uso terapêutico , Diarreia/tratamento farmacológico , Clínicos Gerais/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Medicina de Viagem/métodos , Adulto , Antibioticoprofilaxia/métodos , Disenteria/tratamento farmacológico , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inquéritos e Questionários , Viagem
13.
Travel Med Infect Dis ; 39: 101915, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33186687

RESUMO

Air travel during the COVID-19 pandemic is challenging for travellers, airlines, airports, health authorities, and governments. We reviewed multiple aspects of COVID peri-pandemic air travel, including data on traveller numbers, peri-flight prevention, and testing recommendations and in-flight SARS-CoV-2 transmission, photo-epidemiology of mask use, the pausing of air travel to mass gathering events, and quarantine measures and their effectiveness. Flights are reduced by 43% compared to 2019. Hygiene measures, mask use, and distancing are effective, while temperature screening has been shown to be unreliable. Although the risk of in-flight transmission is considered to be very low, estimated at one case per 27 million travellers, confirmed in-flight cases have been published. Some models exist and predict minimal risk but fail to consider human behavior and airline procedures variations. Despite aircraft high-efficiency filtering, there is some evidence that passengers within two rows of an index case are at higher risk. Air travel to mass gatherings should be avoided. Antigen testing is useful but impaired by time lag to results. Widespread application of solutions such as saliva-based, rapid testing or even detection with the help of "sniffer dogs" might be the way forward. The "traffic light system" for traveling, recently introduced by the Council of the European Union is a first step towards normalization of air travel. Quarantine of travellers may delay introduction or re-introduction of the virus, or may delay the peak of transmission, but the effect is small and there is limited evidence. New protocols detailing on-arrival, rapid testing and tracing are indicated to ensure that restricted movement is pragmatically implemented. Guidelines from airlines are non-transparent. Most airlines disinfect their flights and enforce wearing masks and social distancing to a certain degree. A layered approach of non-pharmaceutical interventions, screening and testing procedures, implementation and adherence to distancing, hygiene measures and mask use at airports, in-flight and throughout the entire journey together with pragmatic post-flight testing and tracing are all effective measures that can be implemented. Ongoing research and systematic review are indicated to provide evidence on the utility of preventive measures and to help answer the question "is it safe to fly?".


Assuntos
Viagem Aérea , COVID-19/epidemiologia , COVID-19/prevenção & controle , Pandemias/prevenção & controle , Viagem Aérea/estatística & dados numéricos , Aeronaves , Aeroportos , COVID-19/diagnóstico , COVID-19/transmissão , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/normas , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , SARS-CoV-2/isolamento & purificação , Medicina de Viagem/organização & administração , Medicina de Viagem/normas
15.
Surg Endosc ; 35(4): 1579-1583, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32297055

RESUMO

BACKGROUND: Patients seeking bariatric surgery are traveling longer distances to reach Bariatric Centers. The purpose of this study was to evaluate the impact of travel distance on adherence to follow-up and outcomes after bariatric surgery. METHODS: A retrospective review of all consecutive patients who had undergone bariatric surgery from June 2013 to May 2014 was performed, and the patients were divided into two groups: those who traveled 50 miles or less and those who traveled more than 50 miles. Primary outcome assessed was the influence of distance on post-operative follow-up attrition over 4-year period. Secondary outcomes assessed were excess weight loss, length of stay (LOS), complications and readmission rates. RESULTS: A total of 228 patients underwent bariatric surgery with 4 years of follow-up available. Of these, 145 patients traveled 50 miles or less and 83 patients traveled greater than 50 miles. Patient demographics were similar between the two groups. Those who traveled more had statistically higher probability of attrition up to 3-year follow-up mark. There was no difference in percent excess weight loss at each follow-up visit between the two cohorts. Furthermore, there was no difference in readmission rates (2% vs 5%), minor complications (14% vs 10%), major complications (3% vs 2%) and LOS (2.6 days vs 2.6). CONCLUSION: The distance patients traveled for bariatric surgery did not affect their weight loss success, length of stay, postsurgical complications or readmission rate. Despite the lack of influence on postoperative outcomes, follow-up compliance was statistically affected by distance.


Assuntos
Cirurgia Bariátrica/métodos , Medicina de Viagem/métodos , Perda de Peso/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos
16.
Infect Dis Now ; 51(2): 140-145, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32565274

RESUMO

OBJECTIVES: Emerging infectious diseases are a public health issue of international concern. Identifying methods to limit their expansion is essential. We assessed the feasibility of a screening strategy in which each traveler would actively participate in the screening process after an intercontinental flight by reporting their own health status via a web-based self-administered questionnaire. PATIENTS AND METHODS: In 2015 and 2017, we invited passengers arriving at or departing from Pointe-à-Pitre international airport to answer an online health questionnaire during the four days following their arrival from or at Paris-Orly international airport. SPIRE 1 was intended for passengers arriving at Pointe-à-Pitre and was conceived as a pilot study. SPIRE 2 was an improved version of SPIRE 1 and consisted in three parts, which permitted to further assess the benefits of pre-flight request and email follow-up. Endpoints were the connection rates and response rates to online health questionnaire. RESULTS: For SPIRE 1, 4/1038 travelers (0.4%) completed the two steps of the online health questionnaire. In SPIRE 2, response rates ranged from 3/1059 (0.3%) to 19/819 (2.3%). Response rates were significantly better when passengers were approached before their flight. CONCLUSIONS: The yield of an online health questionnaire was unexpectedly low.


Assuntos
Doenças Transmissíveis Emergentes/diagnóstico , Internet , Programas de Rastreamento/métodos , Autorrelato , Viagem , Aeronaves , Estudos de Viabilidade , Nível de Saúde , Humanos , Paris , Projetos Piloto , Saúde Pública , Inquéritos e Questionários , Medicina de Viagem
18.
J Infect Chemother ; 27(5): 678-683, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33334674

RESUMO

INTRODUCTION: Travel medicine has gained importance in recent years; however, there is little data regarding travel medicine departments in Japanese hospitals. METHODS: This cross-sectional study contacted 488 hospitals designated by either the Japanese government or major Japanese associations. A questionnaire comprising 11 questions pertaining to the availability of pre-travel consultation, out-of-hours service for travel-related patients, number of medical doctors engaged in travel medicine and infectious disease specialists, and the number of negative pressure rooms available for inpatients and outpatients was distributed. It also asked about the facilities available to combat specific diseases like malaria, dengue, and post-exposure prophylaxis for rabies as these are most common diseases affecting returning travelers. RESULTS: Of the 263 hospitals (58.7%) that responded to our questionnaire, 82 hospitals (31.2%) provided pre-travel consulting, 188 hospitals (72.0%) accepted travel-related patients out-of-hours, median (interquartile range [IQR]) number of medical doctors involved in travel medicine was 1 (0-3), and median (IQR) number of patients accepted for admission was 2 (1-4). Only 106 (41%) hospitals could diagnose malaria at any time, 56 hospitals (21%) could immediately provide oral anti-malarial medicines; rapid diagnostic test for dengue was available in 99 hospitals (39%), while 67 hospitals (26%) could immediately administer post-exposure prophylaxis for rabies. CONCLUSIONS: Japan's medical care system is concerned about illnesses-especially malaria, dengue and rabies in returned travelers. We suggest construction of a medical care system centered on designated medical facilities for category I and II infectious diseases to build capacity for early diagnosis and treatment of common tropical infectious diseases.


Assuntos
Medicina de Viagem , Viagem , Estudos Transversais , Humanos , Japão/epidemiologia , Inquéritos e Questionários , Doença Relacionada a Viagens
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...