Search Results (161)

Shark ecotourism is an ever-expanding reality, with hundreds of thousands of tourists involved annually. Although it represents a fundamental tool for sharing the urgent need to safeguard sharks with the public, the implications for the health and well-being of sharks must be taken into due consideration. In South Africa, cage-diving has been an important form of ecotourism since the 1990s. In Gansbaai, over a 14-year period from 2009 to 2024, excluding the 2020–2021 pandemic years, data was collected from cage diving operators’ boats on the frequency of sightings of white sharks. After approximately 560 h of field observations, averaging about 45 h per year and about 9 h per year between 2023 and 2024, 423 sharks were observed with five re-sightings. We highlighted that the number of sightings did not increase during the presence of cage diving operators and that site fidelity has not been observed by white sharks frequenting this area. Full article

The concept ‘mobility of care’ captures all the daily travel necessary for the upkeep of a household, including trips to grocery stores, health-related appointments, errands, and caring activities for dependents. Since it was originally coined in 2009, a handful of studies have shown how poorly mobility of care trips are captured in transportation surveys. These preliminary analyses also find that care trips comprise a substantial proportion of daily mobility. As women disproportionately engage in ‘mobility of care’ travel, the under-consideration of care trips is argued to result in a gender bias in transport planning. Despite this, transport policy related to mobility of care has received less attention. Given that transport policy shapes how transport systems operate, this paper explores the extent to which recent transport policies consider mobility of care. A critical policy review framework is used to systematically examine seven policy documents (435 pages) from the Toronto Transit Commission (TTC), the largest transit agency in Canada. Results indicate that mobility of care is rarely directly considered or significantly discussed. Instead, transport policy often uses the commute to work as the default trip. Mentions of care destinations and trip characteristics associated with mobility of care are more common in recent years and most frequently discussed in relation to the COVID-19 pandemic or specialized services for seniors and people with disabilities. Policies that likely facilitate mobility of care indirectly are also identified, including fare discounts, transfer windows, and accessibility policies. The review concludes with preliminary recommendations on how transit agencies can more directly plan for mobility of care. Full article

Background: During the influenza A(H1N1) and COVID-19 pandemics, empirical antibiotic treatment (EAT) was widely administered to critically ill patients despite low rates of confirmed bacterial co-infection (COI). The clinical benefit of this practice remains uncertain and may contradict antimicrobial stewardship principles. Objective: To evaluate whether EAT at ICU admission reduces ventilator-associated pneumonia (VAP) incidence or ICU mortality in critically ill patients with pandemic viral pneumonia, stratified by presence of COI. Methods: This retrospective analysis combined two national multicentre ICU registries in Spain, including 4197 adult patients requiring invasive mechanical ventilation for influenza A(H1N1) or COVID-19 between 2009 and 2021. Primary outcomes were ICU mortality and VAP incidence. Analyses were stratified by microbiologically confirmed bacterial COI. Propensity score matching, Cox regression, General Linear (GLM), and random forest models were applied. Results: Among patients without COI (n = 3543), EAT was not associated with lower ICU mortality (OR = 1.02, 95%CI 0.81–1.28, p = 0.87) or VAP (OR = 1.02, 95%CI 0.79–1.39, p = 0.89). In patients with confirmed COI (n = 654), appropriate EAT was associated with reduced VAP (17.4% vs. 36.3%, p < 0.001) and ICU mortality (38.4% vs. 49.6%, OR = 1.89, 95%CI 1.13–3.14, p = 0.03) compared to inappropriate EAT. Conclusions: EAT was not associated with a lower incidence of VAP or higher survival rates and could be harmful if administered incorrectly. These findings support a more targeted approach to antibiotic use, guided by microbiology, biomarkers and stewardship principles. Full article

During the 2009 H1N1 pandemic (pdm09), the poor replication of PR8-derived vaccine strains in embryonated chicken eggs (ECEs) delayed vaccine production, necessitating costly adjuvants. To improve egg-based yield, we generated PB2-substituted H1N1 strains via reverse genetics, replacing PR8 PB2 with a PB2 lacking mammalian-adaptive mutations (dtxPB2), cognate pdm09 PB2 (19PB2), or avian PB2. All PB2-substituted strains achieved over tenfold higher titers than the conventional PR8 PB2-containing strain (rGD19), with rGD19/dtxPB2 and rGD19/19PB2 exhibiting significantly higher titers and reduced murine virulence. Among these, rGD19/19PB2 produced the highest hemagglutinin (HA) yield and, when administered intranasally as a binary ethyleneimine (BEI)-inactivated whole-virion vaccine, elicited a significantly stronger broncho-alveolar IgA response than rGD19. Both rGD19 and rGD19/19PB2 provided comparable protection against a homologous H1N1 challenge, yet only rGD19/19PB2 conferred full survival protection after a lethal heterologous H3N2 challenge. These findings show that incorporation of cognate PB2 enhances H1N1 replication in ECEs and antigen yield, reduces murine virulence, and confers robust homo- and heterosubtypic protection via intranasal immunization, underscoring the promise of PB2-modified H1N1 strains as inactivated mucosal whole-virion vaccines for future vaccine development. Full article

Background/Objectives: This study introduces the Multi Group Cost Malmquist Index ($CM{g}_m$), a novel tool for comparing and ranking the cost efficiency of multiple groups of similar decision-making units operating in different contexts. It was applied to Greek public hospitals to assess productivity change between 2009 and 2021, covering the period before the economic recession and after the second lockdown during the COVID-19 pandemic. The study aimed to determine the impact of these external shocks on hospital efficiency and to identify differences in cost productivity based on hospital size and regional location. Methods: Data envelopment analysis was employed to compute the Malmquist indices for productivity change and ranking. Overall, 109 Greek public hospitals were analysed using three models: as a single group, classified by bed capacity, and classified by regional health authority (RHA). Cost productivity was decomposed into its core measures. Results: During the economic crisis, hospitals improved their cost productivity by 13.2%, whereas during the pandemic, it declined by 32.1%, primarily due to cost frontier deterioration resulting from increased healthcare demand and strained resources. Medium-sized hospitals exhibited higher cost efficiency than small and large hospitals. Regional disparities were also observed, with hospitals in the 5^th and 7^th RHAs outperforming those in 1^st and 2^nd RHAs. Conclusions: The findings highlight the pandemic’s disruptive impact on hospital cost productivity compared to the efficiency gains during the economic crisis. It is encouraging, though, that hospitals are recovering again after the lifting of strict lockdown measures. The $CM{g}_m$ is a valuable tool for policymakers, offering insights into hospital performance across multiple groups. Future healthcare policies should prioritise resource optimisation and address regional disparities to enhance system-wide efficiency and resilience in times of crisis. Full article

During the 2017–2018 influenza season, there was high influenza activity, with a predominance of influenza A(H1N1)pdm09 circulation in the country. The influenza circulation pattern in the area of the Yucatan Peninsula was different from that of the rest of the country. However, in the summer of 2018, there was a sudden increase in the number of identified cases. A retrospective analysis was performed using data generated by four molecular diagnostic laboratories of the Mexican Social Security Institute. Demographics, influenza positivity, seasonality and case fatality rates were recorded. We used odds ratios to compare outpatients who were confirmed by laboratory tests to be positive with those who were confirmed to be negative. The Kaplan–Meier method and Cox multivariate analysis were used to calculate cumulative risk. There were 4460 cases of ILI/SARI between Yucatan and Quintana Roo, which represented 53.1% of the total number of cases reported. Compared with that in 2009, the epidemic wave in 2018 was shorter and more expansive, with a greater number of reported cases, as well as a greater number of people who required hospitalization. The dominant pattern of A(H1N1)pdm09 influenza activity on the Yucatan Peninsula in the summer of 2018 has not been observed since the influenza pandemic of 2009. Full article

Educational farms provide students with hands-on experience in agricultural and animal practices. However, the close contact between humans and farm animals creates a significant interface for zoonotic disease transmission, yet research on infectious diseases in such settings remains limited. This study investigates the ongoing spillovers of human-origin influenza A virus (IAV) into swine at an educational farm in central Chile, describing IAV prevalence, outbreak dynamics, and the genomic characterization of detected strains. The Menesianos educational farm, located in Melipilla, central Chile, houses approximately 40 swine alongside other domestic animals, such as horses and cows. As part of an active IAV surveillance project, monthly nasal swab samples were collected from pigs between June 2019 and September 2023 for IAV detection via RT-qPCR targeting the M gene, with positive samples subsequently sequenced. During the study period, monthly IAV prevalence ranged from 0% to 52.5%, with a notable outbreak detected between May and June 2023. The outbreak lasted 5 weeks, peaking at 52.5% prevalence during week 3. Nine IAV strains were isolated over the study period, eight of which were obtained during weeks 2 and 3 of the outbreak. Phylogenetic analysis revealed that all strains were closely related to the pandemic H1N1 2009 influenza virus, with the closest related strains being those circulating in humans in Chile during the same years. These findings highlight the importance of conducting regular IAV surveillance on educational farms, where close interactions between animals and individuals—particularly children and young people—can facilitate viral spillovers and potential reverse zoonosis events. Full article

Influenza A viruses (IAVs) evolve rapidly, exhibit zoonotic potential, and frequently adapt to new hosts, often establishing long-term reservoirs. Despite advancements in genetic sequencing and phylogenetic classification, current influenza nomenclature systems remain static, failing to capture evolving epidemiological patterns. This rigidity has led to delays or misinterpretations in public health responses, economic disruptions, and confusion in scientific communication. The existing nomenclature does not adequately reflect real-time transmission dynamics or host adaptations, limiting its usefulness for public health management. The 2009 H1N1 pandemic exemplified these limitations, as it was mischaracterized as “swine flu” despite sustained human-to-human transmission and no direct pig-to-human transmission reported. This review proposes a real-time, transmission-informed nomenclature system that prioritizes host adaptation and sustained transmissibility (R₀ > 1) to align influenza classification with epidemiological realities and risk management. Through case studies of H1N1pdm09, H5N1, and H7N9, alongside a historical overview of influenza naming, we demonstrate the advantages of integrating transmission dynamics into naming conventions. Adopting a real-time, transmission-informed approach will improve pandemic preparedness, strengthen global surveillance, and enhance influenza classification for scientists, policymakers, and public health agencies. Full article

The standardization of catch per unit effort (CPUE) is essential for accurate stock assessment in fisheries management. This study focuses on CPUE standardization for red snow crab (Chionoecetes japonicus) in South Korea, incorporating both spatiotemporal and socioeconomic factors into a generalized additive model (GAM) framework. Using fishery-dependent data from 2009 to 2023, we analyzed the influence of variables such as the proportion of live catch, oil prices, global export prices, and the COVID-19 pandemic on CPUE trends. To quantify the contribution of each variable, a stepwise exclusion analysis was conducted. The results show that excluding socioeconomic variables leads to a more stable CPUE trajectory, indicating that nominal CPUE fluctuations are partially driven by economic conditions rather than changes in biological abundance. These findings highlight the importance of accounting for external drivers, particularly socioeconomic factors when standardizing CPUE. By doing so, the year effect extracted from the model can more accurately reflect relative stock abundance. The approach presented here offers a practical solution for improving CPUE estimates in data-limited fisheries and supports adaptive, evidence-based fisheries management. Full article

Rattus norvegicus (brown rat), a widely distributed rodent and common biomedical model, is a known reservoir for many zoonotic pathogens but has not been traditionally recognized as a host for influenza A virus (IAV). To evaluate their susceptibility, we intranasally inoculated Sprague-Dawley rats with various IAV subtypes, including H5Nx, H7N9, H9N2, H10N8 and the 2009 pandemic H1N1. All strains productively infected the rats, inducing seroconversion without overt clinical signs. While replication efficiency varied, all viruses caused significant lung injury with a preferential tropism for the upper respiratory tract. Investigation of receptor distribution revealed a predominance of α2,3-linked sialic acid (SA) in the nasal turbinates and trachea, whereas α2,6-linked SA was more abundant in the lungs. Notably, both receptor types coexisted throughout the respiratory tract, aligning with the observed tissue-specific replication patterns and broad viral infectivity. These findings demonstrate that rats are permissive hosts for multiple IAV subtypes, challenging their exclusion from IAV ecology. The asymptomatic yet pathogenic nature of infection, combined with the global synanthropy of rats, underscores their potential role as cryptic reservoirs in viral maintenance and transmission. This study highlights the need for expanded surveillance of rodents in influenza ecology to mitigate zoonotic risks. Full article

The COVID-19 pandemic altered the holiday plans of many people. Whether it was due to travel bans or the fear of contracting the infection, people modified, among other aspects, their chosen destination, travel transport, accommodations, length of stay, and activities to be undertaken during the stay. In this context, we aim to disentangle the effect of these changes on tourist satisfaction. Previous research on the effects of COVID-19 on the tourism sector has studied the shrinkage of tourism demand, changes in tourist behaviour and adaptation processes on the supply side. Nonetheless, few works have analysed changes in tourists’ plans. Two main hypotheses have been put forward. First, tourists might be dissatisfied given that they could not attain their holiday expectations. In contrast, the second hypothesis suggests that those individuals who changed their holiday plans might be more satisfied because they diminished their perceived risk of contagion. We have used data drawn from a survey of tourists (N = 2009) who visited Costa Daurada, a very popular Mediterranean coastal destination just after the end of the Spanish lockdown. Then, statistically significant differences in satisfaction levels between the groups that altered their plans and those who did not are assessed by means of Kruskal–Wallis and Wilcoxon Rank Sum tests. Results signal that tourists were not more dissatisfied when they had modified their initial holiday plans. Indeed, the overall satisfaction of those visitors who switched their initial destination to travel to Costa Daurada was slightly lower, and the difference was significant, compared to the ones who were planning to travel there from the very beginning. Satisfaction was not significantly lower for those who changed their holiday plans in the case of the rest of the items analysed (transportation, length of stay, accommodation, and overall activities). On the contrary, in the case of activities, changes apparently contributed to mitigate the risk perception and led to a better tourist experience. Results also suggest that tourists were willing to adapt to a new situation in order not to renounce their holidays. In terms of implications for destination management and stakeholders, the main conclusion is that continuous cooperation and mutual trust are key to adapting to turbulent environments in which risk perception becomes central. Full article

(1) Background: Mental health significantly impacts personal relationships and societal integration. Portugal faces a high prevalence of psychiatric illnesses and psychological distress, which the COVID-19 pandemic might have exacerbated. Therefore, this study aims to study risk factors that lead to psychological problems, using data available in the primary health care centers of the region of Aveiro. (2) Methods: This observational and retrospective study analyzes data from 2009 to 2022 on psychological consultations in the Aveiro municipalities. Variables considered are municipality, International Classification of Primary Care problem, sex, and comorbidities (cancer, obesity, and diabetes). Summary statistics and graphs were employed for data understanding, with R software used for analysis. Regression models, odds ratios, and association tests were calculated. Also, cluster analysis was performed on municipalities. (3) Results: A new, significant increase in the appointment growth rate was observed in 2021 and 2022. Anxiety and depressive disorders contribute to the identified growth. Women reported more problems than men. Cancer was the most present comorbidity. (4) Conclusions: The study reveals increased mental health problems, with primary health care users in Aveiro experiencing worsened psychosocial health, resulting in more medical consultations for psychological reasons. Risk factors included being female and having chronic conditions such as cancer. The findings provide insights into the burden of mental health issues in the region, highlighting the need for effective mental health interventions and resources to address health inequalities and support at-risk groups. Full article

To identify measures that mitigate the impact of influenza in Latin America and the Caribbean, we compared the burden and detection capacity in humans and animals after the 2009 pandemic. The incidence rate in people was higher in Chile (23.72 per 100,000 people), but the impact was greater for Guatemala (503.78 disability-adjusted life years per 100,000 people). Brazil, Peru, Argentina, and Mexico built better medical testing, with typing being less frequent in Chile and Argentina, where costs for medical care were higher. The positivity rate among avian and nonhuman mammals was 5.8%, with more cases in Mexico, but constant testing in Chile. H5N1, H5N2, and H7N6 are deadly to poultry, whereas H1N1 is common in swine, and H3N8 in equines. By June 2023, H5N1 had caused severe influenza in two persons and killed millions of birds and hundreds of mammals with aquatic lifestyles. An analysis of the efforts in response to this outbreak revealed that handling of outbreaks in animals needs homogeneity and reinforcement of vaccination. Surveillance in exposed individuals requires articulation of medical and animal health authorities, and the region also demands decentralized typing and networks for genomic characterization. Full article

Background/Objectives: Excessive or inadequate use of antimicrobial drugs may lead to the emergence of resistant strains. For this reason, it is important to monitor consumption indicators to assess drugs’ utilization over time. This study aimed to analyze the consumption of medically prescribed azole antifungal drugs in mainland Portugal from 2014 to 2023, focusing on those directed to genital infections: fluconazole, isoconazole, itraconazole, and sertaconazole. Methods: For each drug, the evaluated parameters were the total number of packages, number of packages per 1000 inhabitants, defined daily dose (DDD) per 1000 inhabitants per day, and total costs. For this purpose, we used data from community pharmacies’ sales, which are available through INFARMED (the Portuguese national authority on medicines and health products). Results: Several trends emerged from data analysis. The COVID-19 pandemic negatively affected the consumption of all azole antifungal drugs included in this study. However, after 2020, fluconazole and sertaconazole consumption has been increasing. In the specific case of fluconazole, there was an increase in expenditure, although the total number of packages suffered a decrease over the 10-year study period. Additionally, the defined daily dose (DDD) per 1000 inhabitants per day for fluconazole and itraconazole was lower compared to estimates from the last available survey (2009). Conclusions: Although our findings represent a lesser pressure on fungi, further monitoring is needed to better understand the evolution of fluconazole and itraconazole consumption over time, particularly due to the trends observed in this study. Full article

Background: Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated inflammatory disorder of the central nervous system (CNS), typically characterized by the acute onset of multifocal demyelination. The pathogenesis of ADEM remains unclear, but it is believed to be triggered by an autoimmune response, often following viral infections or vaccinations. Case report: This case report describes a 3-year-old child who developed ADEM after receiving two concurrent influenza vaccines: one for seasonal influenza and one for the 2009 H1N1 pandemic. The patient presented with motor regression, mild pleocytosis in cerebrospinal fluid (CSF), and typical MRI findings of ADEM. Steroid pulse therapy resulted in rapid improvement, and the patient recovered fully without sequelae. Results: Although the influenza vaccine has been linked to ADEM in some studies, it remains uncertain whether the simultaneous administration of both vaccines contributed to the onset of ADEM. While influenza vaccines are considered safe and effective by health organizations such as the CDC, data suggest that the incidence of ADEM and other neurological complications is significantly higher after natural influenza infections compared to vaccination. This highlights the importance of vaccination in preventing severe outcomes. Conclusions: This case underscores the importance of monitoring and reporting adverse events following vaccination to refine our understanding of rare complications like ADEM. While simultaneous vaccine administration warrants further research, the benefits of vaccination in preventing severe complications from natural infections far outweigh the risks. Continued vigilance and improved surveillance systems are essential for maintaining public confidence in vaccination programs. Full article