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Profile and complexity of travel medicine consultations in Chile: unicentric cross-sectional study | BMJ Open.

[Open Access] [Received February 20, 2020; Revised July 14, 2020; Accepted August 6, 2020; First published September 3, 2020; Online issue publication September 03, 2020]

Abstract.

Objective. To analyse the spectrum, vaccination needs and pretravel advice complexity of travellers presenting at a travel medicine clinic in Santiago, Chile.

Design. Cross-sectional study.

Setting Pretravel consultations in a private healthcare centre in Chile, an ‘emerging market’ country in South America.

Participants. Travellers (n=1341) seeking pretravel advice at the Travel Medicine Program of Clínica Alemana, Santiago, from April 2016 to March 2018.

Primary and secondary outcome measures. Demographical and travel characteristics, indications for travel vaccines and malaria prophylaxis, and complexity of travel consultations.

Results. Of 1341 travellers, 51% were female; the median age was 33 years. Most frequent travel reasons were tourism (67%) and business (20%). Median travel duration and time to departure were 21 days and 28 days, respectively. Most destinations were located in America (41%), followed by Asia (36%) and Africa (26%); 96% visited less developed countries, mostly in tropical regions, with risk of arboviral infections (94%) and malaria (69%). The indicated vaccine indications comprised hepatitis A (84%), yellow fever (58%), typhoid fever (51%), rabies (29%), polio (8%), Japanese encephalitis (6%) and meningococcal meningitis (5%). More than 60% of consultations were classified as complex.

Conclusion. The studied population mostly visited less developed tropical regions, resulting in a high requirement of yellow fever and other travel-related vaccinations. Most consultations were complex and required a comprehensive knowledge and training in travel medicine.


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WHO Director-General's opening remarks at the media briefing on COVID-19 - 7 September 2020 | ReliefWeb.

[News and Press Release] [Source: WHO] [Posted: 7 Sep 2020] [Originally Published: 7 Sep 2020] [Origin: View original]

  • When the next pandemic comes, the world must be ready. Part of every country’s commitment to build back better must therefore be to invest in public health, as an investment in a healthier and safer future.There are many examples of countries that have done exactly that. Many of these countries have done well because they learned lessons from previous outbreaks of SARS, MERS, measles, polio, Ebola, flu and other diseases.

  • Tomorrow, the Review Committee of the International Health Regulations will begin its work to evaluate the functioning of the IHR during the pandemic so far, and recommend any changes it believes are necessary. The names of members of the committee were published on WHO’s website yesterday.

  • Today is the first International Day of Clean Air for Blue Skies. The pandemic – and the measures taken in many countries to contain it – have taken a heavy toll on lives, livelihoods and economies. But there have also been some unexpected benefits. In many places, we have seen a significant drop in air pollution.

Good morning, good afternoon and good evening.

COVID-19 is teaching all of us many lessons.

One of them is that health is not a luxury item for those who can afford it; it’s a necessity, and a human right.

Public health is the foundation of social, economic and political stability. That means investing in population-based services for preventing, detecting and responding to disease.

This will not be the last pandemic. History teaches us that outbreaks and pandemics are a fact of life. But when the next pandemic comes, the world must be ready – more ready than it was this time.

In recent years, many countries have made enormous advances in medicine, but too many have neglected their basic public health systems, which are the foundation for responding to infectious disease outbreaks.

Part of every country’s commitment to build back better must therefore be to invest in public health, as an investment in a healthier and safer future.

In fact, there are many examples of countries that have done exactly that.

Thailand is reaping the benefits of 40 years of health system strengthening.

A robust and well-resourced medical and public health system, allied with strong leadership informed by the best available scientific advice, a trained and committed community workforce with 1 million village health volunteers, and consistent and accurate communication, have built trust and increased public confidence and compliance.

As you know, Italy was one of the first countries to experience a large outbreak outside China, and in many ways was a pioneer for other countries.

Italy took hard decisions based on the evidence and persisted with them, which reduced transmission and saved many lives. National unity and solidarity, combined with the dedication and sacrifice of health workers, and the engagement of the Italian people, brought the outbreak under control.

Mongolia acted very early, activating its State Emergency Committee in January. As a result, despite neighbouring China, Mongolia’s first case was not reported until March and it still has no reported deaths.

Mauritius has high population density, with high rates of non-communicable diseases and many international travellers, which meant it was at high-risk. But quick, comprehensive action, initiated in January, and previous experience with contact tracing paid off.

Although the Americas has been the most-affected region, Uruguay has reported the lowest number of cases and deaths in Latin America, both in total and on a per capita basis.

This is not an accident.

Uruguay has one of the most robust and resilient health systems in Latin America, with sustainable investment based on political consensus on the importance of investing in public health.

Pakistan deployed the infrastructure built up over many years for polio to combat COVID-19. Community health workers who have been trained to go door-to-door vaccinating children for polio have been utilized for surveillance, contact tracing and care.

There are many other examples we could give, including Cambodia, Japan, New Zealand, the Republic of Korea, Rwanda, Senegal, Spain, Viet Nam and more.

Many of these countries have done well because they learned lessons from previous outbreaks of SARS, MERS, measles, polio, Ebola, flu and other diseases.

That’s why it’s vital that we all learn the lessons this pandemic is teaching us.

Although Germany’s response was strong, it is also learning lessons.

I welcome the announcement by Chancellor Angela Merkel over the weekend that her government will invest 4 billion euros by 2026 to strengthen Germany’s public health system.

I call on all countries to invest in public health, and especially in primary health care, and follow Germany’s example.

===

Tomorrow, the Review Committee of the International Health Regulations will begin its work.

The International Health Regulations is the most important legal instrument in global health security.

As a reminder, the review committee will evaluate the functioning of the IHR during the pandemic so far, and recommend any changes it believes are necessary.

It will review the convening of the Emergency Committee, the declaration of a public health emergency of international concern, the role and functioning of national IHR focal points, and will examine progress made in implementing the recommendations of previous International Health Regulations review committees.

The names of the members of the committee were published on WHO’s website yesterday.

Depending on progress made, the committee may present an interim progress report to the resumed World Health Assembly in November, and a final report to the Assembly in May next year.

The committee will also communicate as needed with other review bodies, including the Independent Panel for Pandemic Preparedness and Response – IPPR – and the Independent Oversight Advisory Committee – IOAC – for the WHO Health Emergencies Programme.

===

Finally, today is the first International Day of Clean Air for Blue Skies.

The pandemic – and the measures taken in many countries to contain it – have taken a heavy toll on lives, livelihoods and economies.

But there have also been some unexpected benefits.

In many places, we have seen a significant drop in air pollution. We have been reminded of how starved our lungs have been of clean, unpolluted air.

We have had a glimpse of our world as it could be.

And that is the world we must strive for.

Ultimately, we are not just fighting a virus. We’re fighting for a healthier, safer, cleaner and more sustainable future.

I thank you.


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Upper Extremity Tendon Transfers: A Brief Review of History, Common Applications, and Technical Tips | Indian Journal of Plastic Surgery.

[Open Access] [Publication Date: 29 August 2020 (online)]

Abstract.

Background. Tendon transfer in the upper extremity represents a powerful tool in the armamentarium of a reconstructive surgeon in the setting of irreparable nerve injury or the anatomic loss of key portions of the muscle-tendon unit. The concept uses the redundancy/expendability of tendons by utilizing a nonessential tendon to restore the function of a lost or nonfunctional muscle-tendon unit of the upper extremity. This article does not aim to perform a comprehensive review of tendon transfers. Instead it is meant to familiarize the reader with salient historical features, common applications in the upper limb, and provide the reader with some technical tips, which may facilitate a successful tendon transfer.

Learning Objectives. (1) Familiarize the reader with some aspects of tendon transfer history. (2) Identify principles of tendon transfers. (3) Identify important preoperative considerations. (4) Understand the physiology of the muscle-tendon unit and the Blix curve. (5) Identify strategies for setting tension during a tendon transfer and rehabilitation strategies.

Design. This study was designed to review the relevant current literature and provide an expert opinion.

Conclusions. Tendon transfers have evolved from polio to tetraplegia to war and represent an extremely powerful technique to correct neurologic and musculotendinous deficits in a variety of patients affected by trauma, peripheral nerve palsies, cerebral palsy, stroke, and inflammatory arthritis. In the contemporary setting, these very same principles have also been very successfully applied to vascularized composite allotransplantation in the upper limb.


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Parent reported outcomes to measure satisfaction, acceptability, and daily life impact after vaccination with whole-cell and acellular pertussis vaccine in Chile | Vaccine.

[Pay to View Full Text] [Received 27 May 2020, Revised 17 August 2020, Accepted 18 August 2020, Available online 2 September 2020] [In Press, Corrected Proof]

Highlights.

* Chile incorporated a hexavalent acellular pertussis vaccine, only in Latin America during study.

* Parental acceptability and satisfaction were significantly higher with the new hexavalent vaccine.

* There was significantly less interruption on daily activities after the new vaccine.

Abstract.

Aim.

To compare parental satisfaction and impact on daily life among parents of children receiving whole-cell pentavalent + oral polio vaccine (Arm 1) with an acellular hexavalent vaccine (Hexaxim; Arm 2).

Methods.

Self-administered electronic questionnaire at vaccination and one week later in six community health clinics of metropolitan Santiago, Chile, exploring parent-reported outcomes on satisfaction, acceptability, and impact on daily life after immunization. Univariate and multivariate analyses were conducted to determine differences in the responses in both groups (α = 0.05).

Results.

The study enrolled 800 participants and 65% (222 in Arm 1, 296 in Arm 2) were included for according-to-protocol analysis. Demographic characteristics were comparable, except for a higher proportion of mothers answering the questionnaire at the 6-month visit. Regardless of the study arm, parental knowledge and perception of the immunization practices were good, and there were no differences in vaccination experiences in the prior 5 years. However, satisfaction with vaccination and intention to vaccinate were statistically significantly higher in Arm 2 after the 6-month visit. Also, more parents in Arm 2 reported no disruption in several aspects of the everyday activities of the parent, the child, and other children in the household. Parents in Arm 2 were more likely to be satisfied with the vaccine received (OR 2.82; 95% CI, 1.22–7.07); return for other vaccine dose (OR 2.62; 95% CI, 1.45–4.84); follow a healthcare professional recommendation (OR 2.24; 95% CI, 1.57–3.21); and, to be confident that the vaccine will not disrupt the family’s daily routine (OR 1.89; 95% CI, 1.32–2.71).

Conclusions.

Overall, satisfaction, intention for future vaccination, and lower impact on the family daily routine were significantly better in the group receiving the hexavalent vaccine. We also found that health care providers’ recommendations to vaccinate and participants’ access to health services were important factors favoring immunization.


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