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.

El impacto del transporte público en las fracturas de cadera: una comparación entre dos grandes ciudades de España y China / The impact of public transportation facilities on hip fractures: a comparison between two major cities in Spain and China

Objetivo: Explorar la influencia de los medios de transporte público en diferentes países en las fracturas de cadera. Materiales y métodos: Los sujetos del estudio fueron pacientes con fractura de cadera intervenidos en el Xi’an Daxing Hospital, China y en el Hospital Universitario Virgen Macarena de Sevilla, España del 1 de enero al 30 de diciembre de 2017. Sexo, edad, el lugar de la caída, el tiempo de la caída, la clasificación de ASA, el alcance principal de las actividades antes y después de la lesión, las razones para restringir las salidas y la satisfacción con las instalaciones de transporte público del paciente se recopilaron mediante la consulta de registros médicos y el seguimiento ambulatorio durante un año. Resultados: Se incluyeron 178 pacientes en Sevilla (España), con una edad media de 83,2 ± 6,9 años, 45 varones (25,3%) y 131 mujeres (74,7%); 139 pacientes en Xi’an (China), con una edad media de 77,8 ± 8,2 años, y 47 hombres (33,8%), 92 mujeres (66,2%). La proporción de pacientes españoles que se lesionó al aire libre y durante el día fue significativamente mayor que la de los pacientes chinos (p = 0,000 y p = 0,017, respectivamente). El alcance de las actividades de los pacientes españoles antes y después de la lesión fue significativamente mayor que el de los pacientes chinos (p = 0,000 y p = 0,000, respectivamente). Entre las razones que impiden que los pacientes salgan antes de la lesión, el factor más importante para los pacientes en Xi’an fueron las instalaciones de transporte público, mientras que en Sevilla fue su propia debilidad y movilidad inconveniente. En la encuesta de satisfacción con los medios de transporte público, la satisfacción de los pacientes españoles fue significativamente superior a la de los pacientes chinos (p = 0,000). Conclusión: El transporte público tiene un gran impacto en los viajes de las personas mayores...(AU)

Objetive: To explore the influence of public transportation facilities in different countries on hip fractures. Materials and methods: The subjects of the study were hip fracture patients who underwent operations at the Daxing Hospital in Xi’an, China and the Hospital Universitario Virgen Marcarena in Seville, Spain from January 1 to December 30, 2017. The patient’s gender, age, place of injury, time of injury, ASA classification, main scope of activities before and after injury, reasons for restricting going out, and satisfaction with public transportation facilities were collected by consulting medical records and outpatient follow-up for one year. Results: A total of 178 patients were enrolled in Seville (Spain), with an average age of 83.2±6.9 years, 45 males (25.3%), and 131 females (74.7%); a total of 139 patients in Xi’an (China), with an average age of 77.8±8.2 years old, and 47 males (33.8%), 92 women (66.2%). The proportion of Spanish patients who were injured outdoors and during the day was significantly greater than that of Chinese patients (p=0.000 and p=0.017, respectively). The scope of activities of Spanish patients before and after injury was significantly greater than that of Chinese patients (p=0.000 and p=0.000, respectively). Among the reasons that restrict patients from going out before injury, the biggest factor for patients in Xi’an was public transportation facilities, while in Seville was its own weakness and inconvenient mobility. In the survey of satisfaction with public transportation facilities, the satisfaction of Spanish patients was significantly higher than that of Chinese patients (p=0.000). Conclusion: Public transportation has a great impact on the travel of the elderly. Municipal governments of various countries should pay attention to and...(AU)

Influências estrangeiras e concretizações nos intentos de regionalização da rede hospitalar em Portugal (1946-1974) / Foreign influence and achievements in the regionalization of Portugal's hospital network (1946-1974) / Influencias extranjeras y concretizaciones en los intentos de regionalización de la red hospitalaria en Portugal (1946-1974)

O presente artigo aborda os propósitos de regionalização da rede hospitalar portuguesa durante o regime ditatorial do Estado Novo (1933-1974), lançados no após Segunda Guerra Mundial. Almejando um sistema hospitalar coordenado com base regional, o governo português limitou-se a comparticipar a construção e a remodelação de edifícios, relegando as múltiplas tarefas envolvidas no funcionamento hospitalar para instituições particulares, o que dificultou o desenvolvimento e o acesso a cuidados de saúde a uma parte significativa da população. Com base na análise de viagens de estudo realizadas por administradores hospitalares e engenheiros sanitários nas décadas de 1940 e 1950, sobretudo a países europeus como Itália, França e Inglaterra, pondera-se acerca da importância dos contatos com redes internacionais de especialistas e da influência exercida pelos exemplos estrangeiros sobre as medidas de organização da assistência hospitalar em Portugal estabelecidas nos anos seguintes. (AU)

This article analyzes the regionalization of Portugal's hospital network during the "New State" dictatorial regime (1933-1974), launched after the second world war. In an attempt to create a regionally-based hospital system, the Portuguese government limited itself to subsidizing the construction and refurbishment of buildings, relegating the multiple tasks involved in hospital management to private organizations, hampering access to health care for a significant part of the population. Through the analysis of study trips made by hospital administrators and sanitary engineers in the 1940s and 1950s, mainly to European countries such as Italy, France and England, this article reflects on the importance of contacts with international networks of experts and influence of foreign experiences on the approach to the organization of hospital care in Portugal adopted in subsequent years. (AU)

El presente artículo aborda los principios de regionalización de la red hospitalaria portuguesa durante el régimen dictatorial del Estado Novo (1933-1974), lanzados después de la Segunda Guerra Mundial. El gobierno portugués, que anhelaba un sistema hospitalario coordinado con base regional, se limitó a coparticipar la construcción y remodelación de edificios, relegando a instituciones particulares las múltiples tareas envueltas en el funcionamiento hospitalario, lo que dificultó el desarrollo y el acceso a cuidados de salud para una parte significativa de la población. Por medio del análisis de viajes de estudio realizados por administradores hospitalarios e ingenieros sanitarios durante las décadas de 1940 y 1950, principalmente a países europeos como Italia, Francia e Inglaterra, se pondera sobre la importancia de los contactos con redes internacionales de especialistas y de la influencia ejercida por los ejemplos extranjeros sobre las medidas de organización de la asistencia hospitalaria en Portugal, establecidas en los años siguientes. (AU)

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.

Predicament and Pilgrimage: Hearing Families of Deaf Children in Mexico City.

In this article, I trace the most salient features of Mexican families' complex journeys as they coped with the "predicament" of childhood deafness. Framing support seeking through the theoretical lens of pilgrimage brings into focus family introspection and captures their tenacity while facing culture-specific obstacles. Ultimately, families realized their quests were not about "fixing" their children's hearing, but finding more reliable communication in sign language. Pilgrimage, as a metaphor for the journeys described by participants, helps us understand families' realizations that the biomedical options most commonly available in Mexico City were of limited efficacy, and reveals collective desire for alternatives to these options.

Eosinophilia prevalence and related factors in travel and immigrants of the network +REDIVI. / Prevalencia de la eosinofilia y factores relacionados en los viajeros e inmigrantes de la red +REDIVI.

The population movements during the last decades have resulted in a progressively increasing interest in certain infectious diseases. Eosinophilia is a common finding in immigrants and travellers. One of the most common causes of eosinophilia is helminth infection, and some intestinal protozoa. The aim of this paper is to describe the epidemiological characteristics of cases with eosinophilia and its association with the presence of parasites in the REDIVI data network. This is a multicentre prospective observational study that includes patients diagnosed with eosinophilia registered in the cooperative network for the study of infectious diseases in travellers and immigrants (+REDIVI) from January 2009 to December 2012. A total of 5,255 episodes were recorded in the network during the study period, and eosinophilia was observed in 8.1-31.3% of cases (depending on the immigration group). There were 60.2% men, with a median age of 31years. There were 72.4% immigrants, and 81.2% were asymptomatic. The most commonly identified parasites were S.stercoralis (34.4%), Schistosoma sp. (11.0%), and hookworm (8.6%). The relationship between eosinophilia and parasite infection was significant for all helminths (except for cutaneous larva migrans). The symptoms and duration of the journey did not significantly determine the presence of eosinophilia. In the case of eosinophilia in a person who has lived in helminth endemic areas, it is advisable to carry out targeted studies to diagnose the infection, regardless of immigration type, length of stay, or the presence of symptoms.

Viajes y redes profesionales en los orígenes del alienismo español / Travel and professional networks in the origins of Spanish psychiatry

Resumen Este artículo examina la importancia de los viajes y las redes profesionales en los orígenes de la psiquiatría en España. Tras una revisión de los antecedentes ilustrados y los periplos terapéuticos y profesionales en el primer alienismo, se describen los desplazamientos a instituciones psiquiátricas extranjeras, durante el segundo tercio del siglo XIX, de un grupo de médicos exiliados, comisionados y pioneros españoles. Posteriormente, con su afianzamiento social, institucional y profesional, algunas figuras de la medicina mental española estrecharon sus vínculos y su proyección internacional organizando o asistiendo a congresos y otros eventos científicos. Su caso ilustra así el importante papel desempeñado por las relaciones internacionales y las redes científicas y profesionales en la difusión de los discursos y prácticas psiquiátricas.

Abstract This article examines the importance of travel and professional networks in the origins of Spanish psychiatry. After reviewing the early alienists’ Enlightenment predecessors and their therapeutic and professional trajectories, it describes the trips to foreign psychiatric institutions made during the second third of the nineteenth century by a group of exiled Spanish doctors, commissioners and pioneers. Later, as they became more socially, institutionally and professionally established, some figures of Spanish psychological medicine cultivated their connections and international profile by organizing or attending conferences and other scientific events. This case illustrates the important role of international relations and scientific and professional networks in the spread of psychiatric discourses and practices.

[Vaccination for international travelers]. / Vacunación en viajeros internacionales.

Traveler's vaccination is one of the key strategies for the prevention of infectious diseases during international travel. The risk of acquiring an infectious disease is determined in each case by the characteristics of the traveler and the travel, so the pre-departure medical advice of the traveler must be individualized. The World Health Organization classifies travelers vaccines into three groups. - Vaccines for routine use in national immunization programs: Haemophilus influenzae type b, hepatitis B, polio, measles-mumps-rubella, tetanus-diphtheria-whooping a cough, and chickenpox. - Vaccinations required by law in certain countries before to enter them: yellow fever, meningococcal disease and poliomyelitis. - Vaccines recommended depending on the circumstances: cholera, japanese encephalitis, tick-borne encephalitis, meningococcal disease, typhoid fever, influenza, hepatitis A, hepatitis B, rabies and BCG. This review is intended to introduce the reader to the field of international vaccination.

Clinical guidelines for Western clinicians engaged in primary care medical service trips in Latin America and the Caribbean: an integrative literature review.

OBJECTIVE: Participation in primary care-focused medical service trips (MSTs) by North American providers is increasingly common, with many of these being conducted in Latin America. The literature has yet to comprehensively explore the nature of MST practice, including the use of evidence-based clinical guidelines. This integrative review presents an analysis of guidelines employed in MSTs in Latin America. METHODS: MEDLINE and LILACs were searched using the terms 'medical brigades', 'Latin America', 'primary health care' and related terms. The search was limited to articles published between 2000 and 2015 in any language. Qualitative or quantitative articles were subsequently included if they described management protocols in the context of patient care on an MST occurring in Latin America. Additional publications were identified by searching the citations of articles reviewed in full. Themes were extracted to an Excel file, and objective instruments were used to evaluate article quality (Mixed Methods Assessment Tool) and the quality of guidelines (Appraisal of Guidelines for Research & Evaluation II). RESULTS: Of 391 abstracts screened, eight met inclusion criteria. All described MSTs operating in rural settings in Central America. Five were qualitative descriptive, including two travel reports, an ethics thesis paper, and a description of a dermatologic MST. Four described subjective clinician experiences while describing non-evidence-based treatment suggestions or practices. Only one described evidence-supported primary care interventions. Three studies were quantitative descriptive, including two epidemiological articles, one of which used case definitions for select diagnoses. One described the application of American Family Physician guidelines to the description of UTI prevalence on a MST. Article scores in MMAT quality domains were variable, and only one article achieved a positive overall AGREE II score for guideline quality. CONCLUSIONS: Existing literature demonstrates minimal development or use of clinical guidelines on MSTs in Latin America. Future work must focus on the development, implementation, and evaluation of culturally sensitive, evidence-based guidelines for the management of patients receiving care from MSTs.

Viajar con niños. Lo que debe saber el pediatra / Travelling with children

Cada vez resulta más frecuente que los niños realicen viajes a sitios muy diferentes de su lugar de residencia. Independientemente de cuál sea su motivo, implica una exposición a un medioambiente con características propias que deben ser tenidas en cuenta. De igual manera, el traslado en sí mismo puede generar ansiedad en la familia y presenta sus propios riesgos. Es frecuente que los padres realicen una consulta con un profesional, habitualmente su pediatra de cabecera, durante la planificación de un viaje. El objetivo del presente trabajo es revisar las recomendaciones para el asesoramiento previo. Inicialmente, se abordarán recomendaciones generales en la preparación del viaje y luego la prevención de enfermedades transmitidas por insectos.

The number of children who travel outside their home countries has increased dramatically. Whatever the reason for it, it involves exposure to an environment with characteristics that must be taken into account. Similarly, the transfer itself can generate anxiety in the family and presents the risk of vehicle-related injuries (which is the leading cause of death in children who travel). Parents will often seek for pre-travel advice. The aim of this paper is to review the recommendations to assess a family who is planning to travel with children. Initially, general recommendations will be addressed in the preparation of the trip and afterwards insect-borne diseases prevention.

Current legal framework and practical aspects of oxygen therapy during air travel.

It is unusual for pulmonologists to be familiar with the European and US regulations governing the administration of oxygen during air travel and each airline's policy in this respect. This lack of knowledge is in large part due to the scarcity of articles addressing this matter in specialized journals and the noticeably limited information provided by airlines on their websites. In this article we examine the regulations, the policies of some airlines and practical aspects that must be taken into account, so that the questions of a patient who may need to use oxygen during a flight may be answered satisfactorily.

Entre o Instituto e as cidades: percorrendo quilômetros em direção à formação psicanalítica / Between the institute and the cities: traveling miles toward psychoanalytic training / Entre el Instituto y las ciudades: recorriendo kilómetros rumbo a la formación psicoanalítica

A formação psicanalítica nos institutos da IPA é, de modo geral, um processo longo, difícil, intenso e gerador de profundas mudanças na vida daqueles que a realizam. O Instituto "Durval Marcondes", sediado na cidade de São Paulo, tem atualmente 328 membros filiados, sendo que 36% destes não residem na capital. Este artigo objetiva refletir sobre a formação, considerando algumas das especificidades dessa condição de membro filiado que precisa viajar até o Instituto para fazer a sua formação...

Psychoanalytic training at IPA Institutes is generally a long and difficult process, one which generates intense and profound changes in the lives of those who do it. The Durval Marcondes Institute, situated in São Paulo, currently has 328 affiliated members, 36% of which do not live in the city. This paper aims to discuss the training, considering some of the specific implications of these members' needs, including the distance they must travel to get and complete their training...

La formación psicoanalítica en los institutos de la IPA es generalmente un largo, difícil e intenso proceso que genera profundos cambios en la vida de aquellos que la realizan. El Instituto de Psicoanálisis Durval Marcondes, con sede en la ciudad de San Pablo, cuenta actualmente con 328 miembros afiliados, siendo que el 36% de ellos no reside en la capital paulista. Este artículo tiene como objetivo reflexionar sobre la formación psicoanalítica teniendo en cuenta algunos aspectos específicos de la condición del analista en formación que precisa viajar hasta el Instituto para realizarla...

Entre o Instituto e as cidades: percorrendo quilômetros em direção à formação psicanalítica / Between the institute and the cities: traveling miles toward psychoanalytic training / Entre el Instituto y las ciudades: recorriendo kilómetros rumbo a la formación psicoanalítica

A formação psicanalítica nos institutos da IPA é, de modo geral, um processo longo, difícil, intenso e gerador de profundas mudanças na vida daqueles que a realizam. O Instituto "Durval Marcondes", sediado na cidade de São Paulo, tem atualmente 328 membros filiados, sendo que 36% destes não residem na capital. Este artigo objetiva refletir sobre a formação, considerando algumas das especificidades dessa condição de membro filiado que precisa viajar até o Instituto para fazer a sua formação.(AU)

Psychoanalytic training at IPA Institutes is generally a long and difficult process, one which generates intense and profound changes in the lives of those who do it. The Durval Marcondes Institute, situated in São Paulo, currently has 328 affiliated members, 36% of which do not live in the city. This paper aims to discuss the training, considering some of the specific implications of these members' needs, including the distance they must travel to get and complete their training.(AU)

La formación psicoanalítica en los institutos de la IPA es generalmente un largo, difícil e intenso proceso que genera profundos cambios en la vida de aquellos que la realizan. El Instituto de Psicoanálisis Durval Marcondes, con sede en la ciudad de San Pablo, cuenta actualmente con 328 miembros afiliados, siendo que el 36% de ellos no reside en la capital paulista. Este artículo tiene como objetivo reflexionar sobre la formación psicoanalítica teniendo en cuenta algunos aspectos específicos de la condición del analista en formación que precisa viajar hasta el Instituto para realizarla.(AU)

No todo es diversión: papiledema y montana rusa / Not everything is fun: papilledema and roller coaster

Presentamos el caso de una paciente de 30 años de edad previamente saludable, quien desarrolló luego de numerosos viajes en una montaña rusa un hematoma subdural espontáneo y un higroma contralateral. La estroma velocidad y despliegue de fuerza G, la sucesión de momentos de aceleración y desaceleración, los bruscos movimientos cefálicos con tironeo lateral del cerebro y el número de veces que permitió el viaje, constituyeron un riesgo significativo de ruptura de venas puente, siendo posible que las reiteradas caídas de una boya remolcada hayan constituido el último trauma y desencadenamiento final

We present the case of a 30-year-old previously healthy patient, who developed ofter numerous trips on a roller coaster a spontaneous hematoma subdural and a contralateral hygroma. Extreme speed and G-force deployment, the succession of moments of acceleration and deceleration, sudden cephalic movements with snarling side of the brain and the number of times that he repeated the trip, they constituted a significant risk of rupture of veins bridge, being possible that repeated falls from a towed buoy have produced the latest trauma and final trigger