Hepatitis A seroprevalence among special populations in the Rio de Janeiro Metropolitan Area, Brazil / Soroprevalência da hepatite A entre populações especiais na Região Metropolitana do Rio de Janeiro, Brasil / Seroprevalencia de la hepatitis A en poblaciones especiales em el Área Metropolitana de Río de Janeiro, Brasil

The objectives were to estimate hepatitis A virus seroprevalence in subjects attending to a travel medicine and immunization clinic in Rio de Janeiro, Brazil, and to develop a prediction model for hepatitis A virus seroprevalence. This retrospective research included individuals sequentially from April 2011 to June 2019 at a travel medicine and special population immunization clinic with an anti-hepatitis A virus IgG chemiluminescence result. Participants' data were verified via electronic medical records. Data were split into development and validation set taking 2018 as the date break. A cross-validated elastic generalized linear model with binomial distribution was performed. In total, 2,944 subjects were analyzed. Hepatitis A virus overall seroprevalence was 67.8%. Health professionals, travelers, and those who had contact with immunocompromised subjects had lower seroprevalence (40%-55%), whereas subjects with chronic conditions (heart, lung, and liver) ranged from 89% to 94%. The retained predictors in the final model were sex, age, year of birth, travelers, HIV/AIDS, spleen dysfunction, transplant candidates, household communicators, cancer-related immunosuppression, health care professionals. Area under the curve was 0.836 and maximum error was 0.051. Users can make predictions with the following calculator: https://pedrobrasil.shinyapps.io/INDWELL/. The groups with lower seroprevalence should be evaluated more carefully regarding need for hepatitis A virus vaccination even when they seek immunization clinics for other purposes.

Este estudo teve como objetivo estimar a soroprevalência do vírus da hepatite A, em indivíduos atendidos em uma clínica de medicina de viagem e imunização no Rio de Janeiro, Brasil, e desenvolver um modelo de predição para a soroprevalência do vírus da hepatite A. Esta pesquisa retrospectiva incluiu indivíduos sequencialmente de abril de 2011 a junho de 2019, em uma clínica de medicina de viagem e uma clínica de vacinação de população especial, que, por qualquer motivo, tem um resultado de quimioluminescência IgG antivírus da hepatite A . Os dados dos participantes foram verificados em prontuário eletrônico. Os dados foram divididos em desenvolvimento e validação, tomando 2018 como data limite da divisão. Um modelo linear generalizado elástico com distribuição binomial submetido a validação cruzada foi aplicado. Foram analisados 2.944 indivíduos atendidos. A soroprevalência geral do vírus da hepatite A foi de 67,8%. Profissionais de saúde, viajantes e contatantes de indivíduos imunocomprometidos apresentaram menor soroprevalência, variando de 40% a 55%, enquanto indivíduos com condições crônicas (coração, pulmão e fígado) tiveram soroprevalência variando de 89% a 94%. Os preditores retidos no modelo final foram sexo, idade, ano de nascimento, viajantes, HIV/aids, asplenia funcional, candidatos a transplante, comunicante domiciliar, imunossupressão relacionada ao câncer e profissionais de saúde. A área sob a curva foi de 0,836 e o erro máximo foi de 0,051. Os usuários podem fazer previsões com uma calculadora (https://pedrobrasil.shinyapps.io/INDWELL/). Os grupos com menor soroprevalência devem ser avaliados com mais cuidado quanto à necessidade de vacinação contra o vírus da hepatite A, mesmo quando procuram clínicas de vacinação para outros fins.

Los objetivos del estudio son estimar la seroprevalencia de hepatitis A en sujetos que asisten a una clínica de medicina para viajeros e inmunización en Río de Janeiro, Brasil, y desarrollar un modelo de predicción de la seroprevalencia de hepatitis A. Esta investigación de seguimiento retrospectivo incluyó a individuos de forma secuencial desde abril de 2011 hasta junio de 2019 en una clínica de medicina para viajeros y de vacunación de poblaciones especiales que por cualquier motivo tienen un resultado de quimioluminiscencia IgG anti-hepatitis A. Los datos de los participantes se verificaron en los registros médicos electrónicos. Los datos se dividieron en conjunto de desarrollo y validación tomando 2018 como fecha de corte. Se realizó un modelo lineal generalizado validado cruzado elástico con distribución binomial. Se analizaron un total de 2.944 sujetos atendidos. La seroprevalencia global del hepatitis A fue del 67,8%. Los profesionales sanitarios, los viajeros y las personas en contacto con sujetos inmunodeprimidos presentaron una seroprevalencia más baja, que osciló entre el 40% y el 55%, mientras que los sujetos con afecciones crónicas (cardíacas, pulmonares y hepáticas) presentaron una seroprevalencia que varió entre el 89% y el 94%. Los predictores retenidos en el modelo final fueron el sexo, la edad, el año de nacimiento, los viajeros, el VIH/SIDA, la disfunción del bazo, los candidatos a trasplante, los comunicadores domésticos, la inmunosupresión relacionada con el cáncer y los profesionales sanitarios. Su área bajo la curva fue de 0,836 y el error máximo de 0,051. Los usuarios pueden hacer predicciones con una calculadora (https://pedrobrasil.shinyapps.io/INDWELL/). Los grupos con menor seroprevalencia deben ser evaluados más cuidadosamente en cuanto a la necesidad de vacunación contra hepatitis A, incluso cuando acudan a las clínicas de vacunación con otros fines.

American Tegumentary Leishmaniasis: case series describing an enigmatic and neglected disease / Leishmaniasis americana tegumentaria: series de casos describiendo una enigmática y olvidada enfermedad

Abstract American Tegumentary Leishmaniasis (ATL) is an infectious disease affecting the skin and mucous membranes. ATL is caused by parasites of the Leishmania genus with around one million cases are reported each year worldwide. This paper describes three rare cases of tegumentary leishmaniasis treated at a tropical disease research center.

Resumen La Leishmaniasis Tegumentaria Americana es una enfermedad infecciosa que afecta la piel y las mucosas. La ATL es causada por parásitos del género Leishmania y cada año se reportan alrededor de un millón de casos en todo el mundo. Este artículo describe tres casos raros de leishmaniasis tegumentaria tratados en un centro de investigación de enfermedades tropicales.

MALARIA: NARRATIVE REVIEW

Malaria is a vector-borne tropical parasitic disease that occurs through the bite of a female Anopheles spp mosquito that transmits protozoa of the genus Plasmodium. P. vivax and P. falciparum are the most frequent species. The clinical presentation of the disease is a febrile syndrome accompanied by nonspeci?c symptoms. Diagnosis is based on tests for microscopic detection of the parasite (thick smear, blood smear) or rapid antigen diagnostic tests. Treatment will depend on the infecting species of plasmodium and whether it is a complicated disease. There are multiple tools for prevention such as the use of mosquito nets, repellents, chemoprevention, and vaccination. Various strategies have been proposed for its eradication, considering that it is a public health problem and represents a great burden of morbidity and mortality worldwide.

Travel Medicine in the Dominican Republic / La Medicina del Viajero en República Dominicana

Introduction: Travel Medicine specialty has existed for more than 40 years. However, this is practically unknown by Dominicans despite the large number of people who travel to and from our country. Methods: With the objective of determining the knowledge of Dominicans about the existence of Travel Medicine specialty and their attitudes in relation to it, we conducted a virtual survey of 8 questions, in which 2,584 Dominicans participated. Results: Despite the fact that more than 80 % of those surveyed knew that to travel to certain countries they had to take certain vaccines, less than 25 % had heard of the specialty of Traveler's Medicine. After knowing the definition and objectives of the specialty, more than 90 % of the participants considered it important to consult a specialist prior to the trip. Conclusion: The lack of knowledge of the specialty and the absence of this service in the public health system are the main barriers to the access of Dominicans to the Travel Medicine consultation. It is necessary to publicize the specialty, using scientific evidence and taking as an example the worldwide dissemination of COVID-19 through travelers, to make the population aware of the importance of pre and post-trip consultation, as well as the creation of this service in public hospitals

Introducción: la especialidad Medicina del Viajero existe hace más de 40 años. Sin embargo, esta es prácticamente desconocida por los dominicanos a pesar de la gran cantidad de personas que viajan desde y hacia nuestro país. Material y métodos: Con el objetivo de determinar el conocimiento de los dominicanos sobre la existencia de la Medicina del Viajero y sus actitudes en relación a esta, realizamos una encuesta virtual de 8 preguntas, de la cual participaron 2,584 dominicanos. Resultados: a pesar de que más del 80 % de los encuestados sabían que para viajar a determinados países debían tomar ciertas vacunas, menos del 25 % había escuchado hablar de la especialidad Medicina del Viajero. Tras conocer la definición y objetivos de la especialidad más del 90 % de los participantes consideró importante realizar una consulta previa al viaje con un especialista. Conclusión: el desconocimiento de la especialidad y la ausencia de este servicio en el sistema público de salud son las principales barreras para el acceso de los dominicanos a la consulta de Medicina del Viajero. Es necesario dar a conocer la especialidad, utilizando evidencia científica y tomando como ejemplo la difusión mundial de la COVID-19 a través de los viajeros, concienciar a la población de la importancia de la consulta pre y post viaje, así como la creación de este servicio en hospitales públicos

Efectos de la migración venezolana sobre la notificación de casos de VIH en Colombia / Effects of the Venezuelan migration phenomenon on the notification of HIV cases in Colombia

Resumen Introducción: En la última década, millones de venezolanos han emigrado de su país; Colombia ha sido su principal destino. Es importante evaluar las repercusiones de la migración sobre eventos de interés en salud pública como la infección por el VIH, a fin de adoptar políticas pertinentes para atender la epidemia. Sin embargo, la información del estado de salud de la población migrante y su impacto sobre la salud pública en Colombia es escasa. Objetivos: Evaluar el papel de los casos de VIH importados desde Venezuela en el comportamiento del evento VIH/SIDA/ mortalidad por VIH en Colombia. Metodología: Mediante cálculo integral se compara el área bajo las curvas de casos de VIH totales e importados notificados al Sistema Nacional de Vigilancia en Salud Pública de Colombia. Resultados: La curva de casos de VIH importados desde Venezuela tiene una contribución menor (2,26 %) en el incremento de casos notificados en Colombia. Conclusiones: La migración venezolana no es el principal factor responsable del incremento de casos de VIH en Colombia, deben evaluarse otros factores involucrados en la difusión de la pandemia a nivel local.

Abstract Introduction: Millions of Venezuelans have emigrated due to their country's socio-economic crisis in the last decade; Colombia has been their main destination. To adopt relevant policies to address the problem, it is important to assess the impact of migration on public health interest events such as HIV infection. However, information on the health status of immigrants and its repercussions on public health in Colombia is scarce. Objective: Outline how the Venezuelan migration phenomenon has impacted HIV notification within Colombia. Methodology: Through an integral calculation, the area under the curves of total and imported HIV cases reported to the National Public Health Surveillance System of Colombia are compared. Incidence measures are carried out among the migrant population and the Colombian regions with the highest concentration of migrants are analyzed in greater depth. Results: The curve of HIV cases imported from Venezuela has a smaller contribution (2.26%) in the increase of cases notified in Colombia. Conclusions: The migratory crisis is not the main cause responsible for the increase in cases in Colombia. Other factors involved in the spread of the pandemic at the local level must be evaluated.

Caracterización de viajeros confirmados a la COVID-19, según número reproductivo básico, provincia Camagüey

Introducción: Las enfermedades importadas constituyen un problema de salud para el individuo y para la población general. Debido al peligro sanitario que conlleva los viajes internacionales y el riesgo de introducción de enfermedades en la provincia. Objetivo: Caracterizar los viajeros notificados a la COVID-19 con fuente de infección en el extranjero según número reproductivo básico en la provincia Camagüey. Métodos: Se realizó un estudio observacional, descriptivo, transversal. El universo de estudio estuvo constituido por todos los viajeros notificados con la COVID-19 en la provincia que cumplieron con los criterios de inclusión y exclusión. Resultados: El escenario de intervención del 70 % de los notificados fue los centros de aislamiento para viajeros, predominaron los procedentes de Venezuela y el mes de marzo fue el de mayor incidencia, el 100 % procedían de áreas de transmisión de la enfermedad, el 55 % se encontraban asintomáticos en el momento del diagnóstico y el número reproductivo básico fue menor que uno en los municipios de destino y a nivel provincial. Conclusiones: Los centros de aislamientos para viajeros disminuyó el riesgo de dispersión de la enfermedad en los municipios de destino, los viajeros notificados tenían alta probabilidad de enfermar por proceder de países con transmisión de la enfermedad y los asintomáticos complejizaron el escenario de actuación.

Introduction: The cared illnesses constitute an important problem of health for the individual and for the general population. Due to the sanitary danger that bears the international trips and the risk of introduction of illnesses cared in the county, an investigation was carried out. Objective: To characterize the travelers notified to the COVID-19 with infection source abroad according to basic reproductive number in Camagüey's province. Methods: A observational, descriptive, traverse study was carried out. The study universe was constituted by all the travelers notified with the COVID-19 in the county that fulfilled the inclusion approaches and exclusion. Results: The scenario of intervention of 70% of those notified was the isolation centers for travelers, prevailing those coming from Venezuela and the month of March was that of more incidence, 100% came from areas of transmission of the illness, 55% was asymptomatic in the moment of the diagnosis and the basic reproductive number was smaller than one in the destination municipalities and at provincial level. Conclusions: The centers of isolations for travelers diminished the risk of dispersion of the illness in the destination municipalities, the notified travelers had high probability of making sick to come from countries with transmission of the illness and the asymptomatic ones worsen the performance scenario.

Scorpions from the province of Misiones, Argentina: An assemblage of medical interest / Escorpiones de la provincia de misiones, argentina: un elenco de interés médico

RESUMEN 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 Títyusconfluens, mientras que nuevos registros de accidentes con Títyus trívíttatus 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.

ABSTRACT INTRODUCTION : Scorpíon poísoníng ís a growíng publíc health problem ín Argentina and around the world. For varíous reasons, the poísonous animal assemblages ín a regíon vary over tíme. The aím of thís work was to present recent ínformatíon and update the assemblage of scorpions ín the province of Misiones. METHODS : An observatíonal descríptíve study was carríed out by revíewíng the specímens deposíted ín the Collectíon of Herpetology and Arachníds of the National Instítute of Tropical Medicine. RESULTS : The first records of Tityus confluens were obtaíned for the province, whíle new records of accídents wíth Tityus trivittatus extended the area of presence of the specíes ín the province. The scorpíon assemblage of Misiones gathers all the four specíes of medical interest ín the country. DISCUSSION : The detectíon of the most ímportant assemblage of scorpions of medical interest ín the country arose from the joínt work between specíalísts ín the dífferent groups of poísonous anímals and health professíonals. It ís ímportant to generate and deepen the spaces of knowledge ínteractíon, wíth the objectíve of ímprovíng Health Surveíllance.

Hematoma subperiosteal orbitário secundário a barotrauma em aviação civil / Orbital subperiosteal hematoma secondary to barotrauma in civil aviation

RESUMO Os diagnósticos diferenciais que compõem as proptoses agudas são, muitas vezes, desafiadores. A anamnese e o exame clínico exigem do oftalmologista atenção especial aos detalhes que permitem diferenciar quadros relativamente benignos e autolimitados de quadros que evoluirão com incapacidades permanentes. Relatamos o caso de uma paciente de 49 anos que, durante viagem de avião, apresentou dor ocular, hematoma periorbitário e proptose do olho esquerdo súbitos. Referia diplopia aguda incapacitante. Exames de tomografia e angiorressonância magnética confirmaram diagnóstico de sinusopatia do seio etmoidal esquerdo e hematoma subperiosteal da órbita esquerda, associado ao barotrauma. Apesar de raro, o diagnóstico de hematoma subperiosteal não traumático deve ser considerado diferencial em relação a proptoses agudas, sendo a anamnese fundamental para essa elucidação diagnóstica.

ABSTRACT Differential diagnoses of acute proptosis are often challenging. History and clinical examination require from ophthalmologists special attention to details, which make it possible to differentiate relatively benign and self-limited conditions from those that will progress to permanent disabilities. We report a 49-year-old female patient who had sudden eye pain, periorbital hematoma and proptosis of the left eye during a commercial flight. She also complained of disabling acute diplopia. Computed tomography and magnetic resonance angiography imaging confirmed the diagnosis of subperiosteal hematoma of the left orbit, associated with left ethmoid sinus disease. Although rare, non-traumatic subperiosteal hematoma should be considered in differential diagnoses of acute proptosis, and history taking is fundamental to elucidate the picture.

Meias elásticas de compressão graduada como medida profilática de tromboembolismo venoso e edema de membros inferiores desencadeados por viagens aéreas: uma revisão sistemática de ensaios clínicos / Graduated compression stockings as a prophylactic measure in venous thromboembolism and edema of lower limbs triggered by air travel: a systematic review of clinical trials

Resumo Com o aumento da duração e frequência das viagens aéreas, observou-se um aumento da prevalência de tromboembolismo venoso nos passageiros. Este estudo avaliou a eficácia do uso de meias elásticas de compressão graduada para a prevenção de tromboembolismo venoso desencadeado por viagens aéreas com duração maior que 3 horas de voo. Trata-se de uma revisão sistemática de ensaios clínicos. A qualidade metodológica dos estudos e o nível de evidência científica foram avaliados pelo Consolidated Standards of Reporting Trials e Grading of Recommendations Assessment, Development and Evaluation. Foram identificados 34 artigos, entretanto apenas oito atenderam aos critérios de elegibilidade. Os desfechos incidência de tromboembolismo venoso e edema foram avaliados em 2.022 e 1.311 passageiros, respectivamente. Os estudos demonstraram evidências de alta qualidade para a prevenção de edema e de moderada qualidade para a redução da incidência de tromboembolismo venoso com o uso de meias elásticas de compressão graduada durante viagens aéreas.

Abstract The increase in duration and frequency of flights has led to an increase in the prevalence of venous thromboembolism among airline passengers. This study assesses the efficacy of graduated compression stockings for prevention of venous thromboembolism triggered by flights lasting more than 3 hours. The design is a systematic review of clinical trials. The methodological quality of studies and the level of scientific evidence were evaluated using the Consolidated Standards of Reporting Trials and Grading of Recommendations Assessment, Development and Evaluation standards. A total of 34 articles were identified, but only eight met the eligibility criteria. The outcomes incidence of venous thromboembolism and edema were assessed in 2,022 and 1,311 passengers, respectively. The studies presented high quality evidence demonstrating prevention of edema and moderate quality evidence of reduced incidence of venous thromboembolism associated with wearing graduated compression stockings during flights.

Examining geographical disparities in the incubation period of the COVID-19 infected cases in Shenzhen and Hefei, China

BACKGROUND@#Current studies on the COVID-19 depicted a general incubation period distribution and did not examine whether the incubation period distribution varies across patients living in different geographical locations with varying environmental attributes. Profiling the incubation distributions geographically help to determine the appropriate quarantine duration for different regions.@*METHODS@#This retrospective study mainly applied big data analytics and methodology, using the publicly accessible clinical report for patients (n = 543) confirmed as infected in Shenzhen and Hefei, China. Based on 217 patients on whom the incubation period could be identified by the epidemiological method. Statistical and econometric methods were employed to investigate how the incubation distributions varied between infected cases reported in Shenzhen and Hefei.@*RESULTS@#The median incubation period of the COVID-19 for all the 217 infected patients was 8 days (95% CI 7 to 9), while median values were 9 days in Shenzhen and 4 days in Hefei. The incubation period probably has an inverse U-shaped association with the meteorological temperature. The warmer condition in the winter of Shenzhen, average environmental temperature between 10 °C to 15 °C, may decrease viral virulence and result in more extended incubation periods.@*CONCLUSION@#Case studies of the COVID-19 outbreak in Shenzhen and Hefei indicated that the incubation period of COVID-19 had exhibited evident geographical disparities, although the pathological causality between meteorological conditions and incubation period deserves further investigation. Methodologies based on big data released by local public health authorities are applicable for identifying incubation period and relevant epidemiological research.

"As glebas bárbaras do Brasil Central": os sertões de Mato Grosso e Goiás nas narrativas de viagem de Hermano Ribeiro da Silva, 1935-1936 / "The barbarous glebes of Central Brazil: " the hinterlands of Mato Grosso and Goiás in the travel narratives of Hermano Ribeiro da Silva, 1935-1936

Resumo O artigo analisa as narrativas de viagem ao interior de Mato Grosso e Goiás publicadas em 1935 e 1936 pelo explorador paulista Hermano Ribeiro da Silva, que obtiveram considerável sucesso editorial e impacto no meio letrado brasileiro. Concentramo-nos em suas ideias sobre a relação entre o ambiente do Brasil Central e o homem sertanejo, sobre as potencialidades de exploração econômica da região e sobre o papel do Estado na condução de iniciativas capazes de promover sua incorporação efetiva à nacionalidade. Buscamos também compreender a fundamentação de seu discurso em conceitos e esquemas científicos genéricos dotados de poder retórico e argumentativo.

Abstract The article analyzes the travel narratives to the hinterlands of the states of Mato Grosso and Goiás published in 1935 and 1936 by the São Paulo-based explorer Hermano Ribeiro da Silva, which proved a great publishing success and had a considerable impact on lettered society in Brazil. The analysis focuses on his ideas about the relationship between the environment in Central Brazil and the man who inhabited it, the potential economic exploitation of the region, and the role of the State in orchestrating initiatives capable of promoting its effective incorporation into the nationhood. It also seeks to understand how he grounded his discourse on generic scientific concepts and schemas endowed with rhetorical and argumentative power.

Oxygen Therapy During Air Travel in Argentina. A Survey Ten Years Later

In 2007, we carried out a descriptive study about the use of oxygen therapy during air travel (OAT) in our country (Medicina BA 2008; 68:433-36). In this study we evaluate the current OAT service, both in domestic airlines (D) and international airlines (I). We conducted a telephone survey using the same methodology of the previous study. We communicated with 29 airlines (4 D and 25 I). We consulted them about the necessary requirements, costs and the possibility of obtaining information through their website, and then compared the results with the previous study. 25 airlines were evaluated (4 were discarded for lack of information, 16% of I airlines). Only one of them (4%) didn't allow the use of OAT. Three airlines (12%) have an additional cost. The survey was resolved with only one phone call in most cases (2 calls for I) with an average duration of 5:53 minutes (± 1:31 min) for the D airlines and 8:42 minutes (± 3:45 min) for the I airlines. In order to provide the service, all the airlines request a previous medical report and 19 (79%) need a special form. 32% of the airlines provide the interface. 29% of the companies demand that the oxygen supply model should be part of the list of the Federal Aviation Administration (FAA). 80.5% has information available through the website. In conclusion, the information has been more easily provided with the website version. An improvement has been observed in services rendered by I flights, which have more demands in relation to the period of notice, controls and necessary requirements; also, a lower number of airlines imposes an additional cost for the service.

Rutas aerocomerciales y distribución internacional de Covid-19 / Commercial airline routes and international distribution of COVID-19

Resumen La novel enfermedad COVID-19 ha tenido una rápida diseminación. Desde China, el virus viajó por todo el mundo. El potencial de la propagación global de COVID-19 fue anticipado y calculado mediante el uso de modelos matemáticos precisos. A estos modelos predictores se puede agregar información obtenida mediante la comparación de mapas gratuitos que representan la propagación internacional de la enfermedad y la densidad de las rutas aerocomerciales. Este análisis proporciona información de lo que parece ser una relación directa entre la distribución mundial inicial desigual de la enfermedad y la densidad del flujo aerocomercial. Esta comparación también puede estar sugiriendo la presencia de centros internacionales de distribución secundaria fuera de China. Con esta información de rápido acceso se puede contribuir a la mejor comprensión del derrame internacional de COVID-19 y orientar los esfuerzos de las políticas de salud para el control de esta y otras enfermedades infecciosas respiratorias agresivas.

Abstract COVID-19 has had a rapid dissemination. Departing from China, the virus has traveled all around the world. With the use of accurate mathematical models, the global spread of the disease was anticipated. Some additional information to these predictive models could be provided by the comparison of freely available maps depicting commercial air travel routes and disease spread. This analysis informs on what seems to be a direct relationship between the initially unequal worldwide distribution of the disease and the density of the commercial air traffic. This comparison may also help to identify international distributional hubs of the disease out of China. The observation of this easily accessible information may contribute to the understanding of COVID-19 spill over and help health control policies to better focus on the spread of this and other aggressively spreading respiratory infectious diseases.

The World- After COVID-19 Apocalypse

Corona virus disease which originated from Wuhan in China has engulfed the whole globe. Covid-19 is leading the list of diseasespeople are extremely concerned about, followed by cancer and HIV/AIDS, according to the study by market research and analysiscompany Velocity MR. This disease has brought around many changes in the lives of people. The medical officials and scientistsare working all day long to find a cure for this disease or to create a vaccine. But the question that rises is will there ever be acure?. Will the world be normal again? For how long will this disease cause a havoc in the life of the people? And many suchquestions which still remain unanswered. But in this article we have discussed about how will the world change after COVID-19pandemic.

Children commute to schools in Bangalore urban and rural districts: travel pattern, behaviour and perceptions

Background: Children form vulnerable road users during their regular school commute. School children safety is not taken into consideration before construction of road network. The total number of persons injured in India during 2015 near schools or colleges or educational institutions due to road traffic accidents are 13,270 in urban areas according to National Crime Records Bureau which is quite alarming. Current study is the first attempt in both rural and urban Karnataka towards understanding travel pattern, behaviour and perceptions among school children during commute to schools. The objectives of the present study were to assess travel pattern, behaviour and perception of school children in Bangalore urban and rural districts and to assess factors associated with travel pattern.Methods: A cross sectional study was conducted using a representative sample of schools selected by simple random sampling. Data was collected using a pre-tested, semi-structured questionnaire which was analysed using SPSS version 20.Results: Nearly 86% of school children travelled less than 5 kms to reach their schools. Nearly 39% of school children travelled alone to school. Most common mode of travel to school was by walk. Nearly 27.4% did not cross the main roads safely. Adherence to road safety behaviour was insufficient. Vehicular traffic was perceived as a major apprehension by children during school commute.Conclusions: Commute of children to schools in both urban and rural part of Bangalore was unsafe with least adherence to safety measures, which might increase their vulnerability to road traffic injuries.

Transporte aéreo e passageiros com deficiência auditiva: barreiras e facilitadores / Air transport and passengers with hearing impairments: barriers and facilitators

Este estudo teve como objetivo compreender as barreiras e facilitadores para a participação das pessoas com deficiência auditiva em viagens aéreas. Fundamentou-se na abordagem da ergonomia da atividade. Os dados foram coletados por meio de questionário, observações diretas durante as viagens e entrevistas de autoconfrontação com passageiros com deficiência auditiva. Constatou-se a existência de barreiras relacionadas a fatores sociais, como comunicação, e ambientais, como sinalização nos aeroportos. Entre os facilitadores das viagens destacaram-se a comunicação com trabalhadores que têm conhecimento da língua de sinais e legendas nos conteúdos de entretenimento a bordo. Este estudo espera dar visibilidade às experiências de viagens de passageiros com deficiência auditiva e, a partir disso, contribuir para a melhoria das condições e procedimentos do transporte aéreo e orientar a formação de pessoal visando prestar serviços adequados aos diversos passageiros

This study aims to understand the barriers and facilitators to the participation of persons with hearing disability in air travel. This study was based on the assumptions of activity-centered ergonomics. Data was collected by means of a questionnaire, direct observations during trips and self-confrontation interviews with passengers with hearing disability. The study findings include barriers related to social factors, such as communication, and environmental factors, such as airport signage. Air travel facilitators included communication in sign language with workers and closed-captioned in-flight entertainment for passengers. This study hopes to give visibility to travel experiences of passengers with hearing disability, and from that to contribute to the improvement of air transport conditions and procedures and to guide staff training aiming to provide adequate services to diverse passengers

Road traffic accidents attending casualty in a tertiary care hospital : a 03 year study from South Western India

Background: Road Traffic Accident (RTA) is any vehicular accident occurring on the roadway i.e. originating on, terminating on, or involving a vehicle partially on the roadway. Road traffic accidents are a human tragedy which has an immeasurable impact on the families affected. The WHO estimates that over 1.2 million people pass away every year on the world’s roads, and between 20 and 50 million fall victims to non-fatal injuries.  The incidence of RTA remains poorly measured in India.Methods: The present study is conducted at casualty department of a tertiary care hospital in South Western India among victims of road traffic accident. This cross sectional study was conducted to elucidate the role of various factors involved in road traffic accidents and to study demographic profile and injury pattern among RTA victims. All the reported RTA cases from 1st January 2016 to 31st December 2018 were included in the study.Results: A total of 875 cases of RTA were studied. There were 83.77%(n=733) male and 16.23%(n=142) female accident victims. Most of the patients were aged between 21 and 30 years. Monsoons witnessed 46.63%(n=408) cases. Most cases occurred between 6 and 12pm (54.4%, n=476). Commonest injury was a simple injury (72.91%, n=638), dangerous injuries (27.09% percent, n=237) and dead was (7.43%, n=65). The highest number of accidents took place in the month of June (19.09%, n=167) and on Sundays (22.17%). Among the motorized vehicles, two-wheeler drivers were more (76.91%, n=673) involved in accidents. In this study 17.60% (n=154) were under influence of alcohol while driving.Conclusions: This study shows there are multiple factors associated with road traffic accidents. Most of the factors responsible for RTA and its fatal consequences are preventable. India, as a signatory to the Brasilia declaration, intends to reduce road accidents and traffic fatalities by 50% by 2022. A comprehensive multipronged approach can mitigate most of them.

Space travel in a high altitude environment: Biology by-passing the pressure laws of physics and BioSpaceForming

After the accident on Apolo1, with 100% oxygen in the cabin, all spaceships now travel with a sea level pressure and 20.9% oxygen. Extravehicular activity requires lowering the pressures. It is complex and time consuming. Permanently reducing the cabin pressure would be a great advantage. A paper by NASA in 2013, proposed for the spaceflight environment: 8 psia / 32% O2 (reducing the sea level pressure (14.7 psi / 20.9% O2), but increasing the fraction of oxygen in order to replicate the sea level PaO2). However, we question this proposal, as it is based on the fear of hypoxia. Our proposal back in 2007 suggested that space travel should take place in a hypobaric environment of 9.5 psi / 20.9% O2 (like in the city of La Paz-Bolivia (3,600m) [11,811ft]). The logic behind it is that at all altitudes on planet Earth, life thrives in a 20.9% Oxygen, 79% Nitrogen. PaCO2 also needs to be considered. In a physiological manner, over 200 million inhabitants of high altitude above 2,000m [6,561ft], have perfectly normal lives. The astronauts could benefit of a Extra-Vehicular Activity (EVA) suit pressure of only 149 mmHg [2.8psi] (lighter, much more comfortable and efficient spacesuits) and space travel anemia could be reduced. The preparation prior-to-space travel could be carried out by adapting and living in a high altitude environment. We consider chronic hypoxia a fundamental step in BioSpaceForming (Adaptation to life in space). As all living beings start to move out of Earth into space, they will have to change their biology and adapt to new conditions.

Después del accidente del Apolo 1, ocurrido con 100 % de oxígeno en la cabina, todas las naves espaciales viajan con una presión de nivel del mar y 20,9 % de oxígeno. La actividad extravehicular requiere que se reduzcan las presiones. Es un proceso complejo que consume mucho tiempo. Reducir la presión de la cabina de manera permanente sería una gran ventaja. En un artículo de la NASA de 2013 se proponen las siguientes condiciones para el entorno de los vuelos espaciales: 8 psia / 32 % O2 (reduciendo la presión de nivel del mar (14,7 psi / 20,9 % O2), pero incrementando la fracción de oxígeno para replicar la PaO2 de nivel del mar). Sin embargo, nosotros nos cuestionamos esa propuesta, ya que está basada en el miedo a la hipoxia. La propuesta que hicimos en 2007 sugería que los vuelos espaciales se realizaran en un entorno hipobárico de 9,5 psi / 20,9 % O2 (como en la ciudad de La Paz, Bolivia (3 600 m) [11 811 ft]). El fundamento lógico es que en el planeta Tierra la vida se desarrolla a todas las alturas con 20,9 % oxígeno, 79 % nitrógeno, aunque también hay que tener en cuenta la PaCO2. Desde el punto de vista fisiológico, más de 200 millones de habitantes de grandes alturas de más de 2 000 m [6 561 ft] tienen una vida perfectamente normal. Para la Actividad Extra-Vehicular (EVA) a los astronautas les convendría más que el traje tuviera una presión de sólo 149 mmHg [2,8 psi], es decir, un traje más ligero y mucho más cómodo y eficiente, a la vez que se reduciría la ocurrencia de anemia espacial. La preparación previa al vuelo espacial podría basarse en la adaptación a un entorno de gran altitud y la vida en el mismo. Consideramos que la hipoxia crónica es un paso fundamental en la adaptación biológica y la supervivencia en el espacio. Todo organismo vivo que se traslade de la Tierra al espacio debe cambiar su biología y adaptarse a las nuevas condiciones.

A viagem a lazer como experiência (trans)formadora para idosos / Leisure travel as a (trans)formative experience for the elderly / El viaje de ócio como experiência (trans)formadora para ancianos / Les voyages de loisir en tant qu'expérience (trans) formative pour les personnes âgées

O envelhecimento já se apresenta como uma realidade nas sociedades contemporâneas com o rápido crescimento da população idosa, motivado pelo aumento da expectativa de vida e pela redução da fertilidade e mortalidade. A partir daí, surgem desafios para esse segmento etário, principalmente em países que não se prepararam para tal tendência social, como é o caso do Brasil. Nesse contexto, esta pesquisa propõe-se a compreender os significados da viagem a lazer para o idoso. Como método investigativo, a pesquisa desenha-se como exploratória e descritiva, com abordagem qualitativa, de enfoque etnográfico. Teve-se como lócus de investigação a cidade de São Luís, Maranhão, a partir de um projeto voltado para o idoso da Universidade Integrada da Terceira Idade - UNITI. Como técnicas e instrumentos de coleta, utilizaram-se entrevistas narrativas, observação participante e diário de campo. Como técnica de análise, utilizou-se a análise de conteúdo de Bardin, para que se pudesse elaborar categorias. A coleta de dados segmentou-se em três etapas: a expectativa da viagem, a viagem e a pós-viagem. As categorias de análise e a interpretação dos conteúdos nos indicam que a viagem é uma atividade que atribui sentido à vida do idoso e estimula processos de autonomia, independência, qualidade de vida e expectativa de vida saudável, contribuindo para um envelhecimento com qualidade.

Aging is already a reality in contemporary societies with the rapid growth of the elderly population, motivated by increased life expectancy and reduced fertility and mortality. From then on, challenges arise for this age segment, especially in countries that have not prepared for such a social trend, such as Brazil. In this context, this research aims to understand the meaning of leisure travel for the elderly. As an investigative method, the research is designed as exploratory and descriptive, with a qualitative approach, ethnographic approach. The research locus was the city of São Luís, Maranhão, from a project aimed at the elderly of the Integrated University of the Third Age - UNITI. As collection techniques and instruments, narrative interviews, participant observation, and field diary were used. As an analysis technique, Bardin's content analysis was used, so that categories could be elaborated. Data collection was divided into three stages: travel expectation, travel, and post-trip. The categories of analysis and interpretation of the contents indicate that travel is an activity that gives meaning to the life of the elderly and stimulates processes of autonomy, independence, quality of life, and healthy life expectancy, contributing to quality aging.

El envejecimiento ya es una realidad en las sociedades contemporáneas con el rápido crecimiento de la población de ancianos, motivado por el aumento de la expectativa de vida y por la disminución de la fertilidad y mortandad. A partir de ahí, surgen retos para este segmento de edad, principalmente en países que no se prepararon para tal tendencia social, como es el caso de Brasil. En este contexto, esta investigación propone comprender los significados del viaje de ocio para el anciano. Como método la investigación se dibuja como exploratoria y descriptiva, con enfoque cualitativo, etnográfico. El locus de investigación fue la ciudad de São Luis, Maranhão, a partir de un proyecto especialmente para el anciano de la Universidad Integrada de la Tercera Edad - UNITI. Como técnicas e instrumentos de colecta, se utilizó entrevistas narrativas, observación participante y diario de campo. Como técnica de análisis, se utilizo el análisis de contenido de Bardin, para que se pudiera elaborar categorías. La colecta de datos se dividió en tres etapas: la expectativa del viaje, el viaje y el post- viaje. Las categorías de análisis y la interpretación de los contenidos indican que el viaje es una actividad que atribuye sentido a la vida del anciano y estimula procesos de autonomía, independencia, calidad de vida y expectativa de vida saludable, contribuyendo para un envejecimiento con calidad.

Le vieillissement est déjà une réalité dans les sociétés contemporaines avec la croissance rapide de la population âgée, motivée par une augmentation d'espérance de vie et une réduction de fécondité et de mortalité. Dès lors, des défis se posent à ce groupe d'âge, en particulier aux pays qui ne sont pas préparés à cette tendance sociale, comme le Brésil. Dans ce contexte, cette recherche se propose de comprendre la signification des voyages de loisirs pour les personnes âgées. En tant que méthode d'investigation, la recherche est conçue comme exploratoire et descriptive, avec une approche qualitative et ethnographique. Le site de recherche a été la ville de São Luís, au l'état du Maranhão au Brésil. Il s'agit d'un projet destiné aux personnes âgées de l'Université Intégrée du Troisième Âge - UNITI. On a utilisé comme techniques et instruments de collecte des entretiens narratifs, de l'observation des participants et un journal de terrain. La technique d'analyse utilisée a été l'analyse du contenu de Bardin afin de pouvoir élaborer des catégories. La collecte des données a été divisée en trois étapes: les attentes des voyageurs, le voyage et l'après le voyage. Les catégories d'analyse et d'interprétation des contenus indiquent que les voyages sont un activité qui donne de sens à la vie des personnes âgées et stimule les processus d'autonomie, d'indépendance, de qualité de vie et d'espérance de vie en bonne santé. Cela contribue au vieillissement en qualité.

An Exploratory Study of Medical Cover Policies Offered by the Travel Health Insurance Industry

Background: Travel insurance represents the most important safety measure for travellers in case of unfortunate events incurred during travel abroad. There are many travel insurance companies which offer services to residents of their state under a wide range of terms and regulations. Objective: This study attempts to explore the different types of medical coverage policies offered by travel insurance organizations operating in the Republic of Ireland. Methods: A web-based content analysis using the Google search engine was performed. Results: Total 16 travel insurance policies were identified for analysis. Each insurance policy identified provides a different travel health cover plans to policyholders, particularly tourists embarking on international journeys. The variance in medical coverage offered by the insurance companies depends on their business strategy and product differentiation. There were differences among the companies offering travel medical insurance. Total 6 out of 16 medical travel plans in the Irish market offer cover for pre-existing conditions provided that clients submit themselves for medical screening tests and pay higher premiums. Only 4 companies offer cover to older travellers and there are 2 travel insurers who specifically excluded acute mental illnesses in their basic cover plan. Conclusion: All the insurance firms within the Irish market insure unexpected illnesses or disorders, dental care, funeral services costs in the event of death, and medical evacuations. However, few policies consider covering unlisted medical conditions such as cancer, mental and heart disorders unless the traveller pays extra premiums.