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Purpose Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center. Methods All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1–5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00–5:59, 6:00–11:59, 12:00–17:59 and 18:00–23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test. Results Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1–5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00–17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age. Conclusion The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.

Objectives: Syria’s protracted conflict has resulted in ideal conditions for the transmission of tuberculosis (TB) and the cultivation of drug-resistant strains. This paper compares TB control in Syria before and after the conflict using available data, examines the barriers posed by protracted conflict and those specific to Syria, and discusses what measures can be taken to address the control of TB in Syria. Results: Forced mass displacement and systematic violations of humanitarian law have resulted in overcrowding and the destruction of key infrastructure, leading to an increased risk of both drug-sensitive and resistant TB, while restricting the ability to diagnose, trace contacts, treat, and follow-up. Pre-conflict, TB in Syria was officially reported at 22 per 100 000 population; the official figure for 2017 of 19 per 100 000 is likely a vast underestimate given the challenges and barriers to case detection. Limited diagnostics also affect the diagnosis of multidrug- and rifampicin-resistant TB, reported as comprising 8.8% of new diagnoses in 2017. Conclusions: The control of TB in Syria requires a multipronged, tailored, and pragmatic approach to improve timely diagnosis, increase detection, stop transmission, and mitigate the risk of drug resistance. Solutions must also consider vulnerable populations such as imprisoned and besieged communities where the risk of drug resistance is particularly high, and must recognize the limitations of national programming. Strengthening capacity to control TB in Syria with particular attention to these factors will positively impact other parallel conditions; this is key as attention turns to post-conflict reconstruction. Keywords: Tuberculosis, Syria, Conflict, Refugees, Drug resistance, Prisoners, Besiegement

Additive manufacturing (AM) in the plastics industry is the core area of sustainable manufacturing, commonly recognised for its high efficiency in enabling cost-effective production towards sustainability. For these reasons, the present research addresses and pertains to several areas and techniques, such as Collection-Recycling-Manufacturing (CRM), processes benchmarking, and business model evaluation, which together can be driving forces of sustainability. However, these combined are insufficient for AM to effectively achieve sustainability, as AM’s realisation requires human factors such as multi-entity authorities, policy making, and AM-based society to initiate and achieve AM. The strategic control model focuses on human-centric approaches such as urban-rural interdependence, policy, and population planning. It investigates each nation’s statistics, and enables strategy and planning, for instance, relocate overcrowding populations to rural or suburban areas. It also creates robust workforces to support AM and materials recycling in suburb or rural areas. Through strategic control model, the construction of AM processes in low-population areas protects ecosystems, creates job opportunities, and eliminates society issues. The strategic control model further covers infrastructure of new residents, and supports the home-based businesses (HBB) of AM. This can improve manufacturing efficiency and reduce CO 2 emission, prevent pandemic crises such as the COVID-19. Eventually, it achieves sustainable urban-rural interdependence.

Objectives\ud Socioeconomic factors such as elevated incidence of chronic disease, overcrowding, and increased occupational exposure result in higher risk of infectious disease. The COVID-19 pandemic has appeared to disproportionately affect communities affected by deprivation and discrimination, who also appear to be at greater risk of severe disease. Our aim was to investigate the evolution of the socioeconomic groups affected by COVID-19 over the course of the first wave of the pandemic by examining patients presenting to an acute NHS trust.\ud \ud Study design\ud and methods: A retrospective study using the postcodes of patients presenting to the Brighton and Sussex University Hospitals NHS Trust who tested PCR-positive for COVID-19 were used to determine average house price and index of multiple deprivation. These were used as markers of affluence to examine the trend in the socioeconomic status of affected patients from February to May 2020.\ud \ud Results\ud 384 cases were included. The postcodes of those individuals who were initially infected had higher average house prices and index of multiple deprivation, both of which followed downward trends as the outbreak progressed.\ud \ud Conclusion\ud Our data shows that the outbreak spread from higher to lower affluence groups through the course of the pandemic. We hypothesise that this was due to wealthier individuals initially transmitting the virus from abroad. Therefore, an earlier and more effective quarantine could have reduced spread to members of the community at greater risk of infection and harm. We suggest that hospitals systematically record the socioeconomic status of affected individuals in order to monitor trends, identify those who may be at risk of severe disease, and to push for more equitable public health policy.

Solid waste management is a significant public health and environmental concern in urban areas of many developing countries, with the situation worse in many of Africa's cities. Illegal dumping of waste, squatting and overcrowding, among other things, are some of the concerns experienced in Bulawayo. This study explored the spatial distribution of illegal dumpsites and their health impacts (prevalence of Diarrhoeal diseases) on the people living proximal to these sites in Makokoba Township in Bulawayo, Zimbabwe. A cross-sectional survey utilising semi-structured questionnaires and a handheld Global Positioning Device was conducted on respondents who resided in Makokoba for at least six months preceding the data collection in February to March 2019. The Fishers' Exact and logistic regressions were computed to determine associations between variables and diarrhoeal disease prevalence. Prevalence rates were calculated and compared between cases and controls. Seventeen illegal dumpsites were identified and mapped. A total of 147 individuals out of 480 (31%) reported having suffered from diarrhoeal diseases. Of these 147 cases, 84 (57%) stayed within the 90-metre buffer zone. There was a strong correlation between proximity to dumpsite and those living within the 90metre buffer, showing a higher risk of developing diarrhoeal diseases than those staying outside the buffer zones, as evidenced by the hotspot maps. Age, Occupation, Location, and Involvement in waste handling were significantly associated with diarrhoeal diseases. In conclusion, a significant number of dumpsites were identified. There was a higher prevalence of diarrhoeal diseases in the population that lived within the 90metre radius from the dumpsites than those who lived outside these perimeters. There, therefore, a need for improvement of waste management techniques to eliminate the illegal dumpsites. This would, in turn, reduce the prevalence rates of diarrhoeal diseases.

A growing line of research underscores that sociodemographic factors may contribute to disparities in the impact of COVID-19. Further, stages of disease theory suggests that disparities may grow as the pandemic unfolds and more advantaged areas are better able to apply growing knowledge and mitigation strategies. In this paper, we focus on the role of county-level household overcrowding on disparities in COVID-19 mortality in U.S. counties. We examine this relationship across three theoretically important periods of the pandemic from April–October 2020, that mark both separate stages of community knowledge and national mortality levels. We find evidence that the percentage of overcrowded households is a stronger predictor of COVID-19 mortality during later periods of the pandemic. Moreover, despite a relationship between overcrowding and poverty at the county-level, overcrowding plays an independent role in predicting COVID-19 mortality. Our findings underscore that areas disadvantaged by overcrowding may be more vulnerable to the effects of COVID-19 and that this vulnerability may lead to changing disparities over time., Highlights • County-level overcrowding is positively associated with COVID-19 mortality rates. • The overcrowding-mortality relationship is strongest during June and July. • Overcrowding and poverty additively shape county-level COVID-19 mortality. • Social disparities in mortality may change with new knowledge and disease spread. • Policies must consider how social disadvantages shape COVID-19 mortality over time.

A panel of experts was convened by the International Society for Infectious Diseases (ISID) to overview evidence based strategies to reduce the transmission of pathogens via the hands of healthcare workers and the subsequent incidence of hospital acquired infections with a focus on implementing these strategies in low- and middle-income countries. Existing data suggests that hospital patients in low- and middle-income countries are exposed to rates of healthcare associated infections at least 2-fold higher than in high income countries. In addition to the universal challenges to the implementation of effective hand hygiene strategies, hospitals in low- and middle-income countries face a range of unique barriers, including overcrowding and securing a reliable and sustainable supply of alcohol-based handrub. The WHO Multimodal Hand Hygiene Improvement Strategy and its associated resources represent an evidence-based framework for developing a locally-adapted implementation plan for hand hygiene promotion. Keywords: Hand hygiene, Infection prevention and control, Low- and middle-income countries

This paper investigates how the housing and functional complexity of territory impacted the intensity of infection in Bergamo and especially in the Seriana Valley, where the first Covid-19 outbreak was recorded. The underlying assumption of our research is that living patterns in the current mobile and urbanized world lead to overcrowding and reticular contacts which facilitate viral spread. Digital mapping is used to demonstrate that in the province of Bergamo and, most notably, the Seriana Valley a set of factors exist which favor contagion, such as: population density caused by conurbation in the Lower Valley; strong school and work commuting; a dense industrial production network with national and international import–export links; a high number of elderly people and the substantial presence of Nursing and Residential Care Facility (RSAs).

Brazil has the third largest prison population on the planet. In this situational framework, Brazil's state prisons experience brutal riots. Here we show that, the risks of prison violence are exacerbated by a lack of opportunities for inmates once they've entered the penal system. Prisoners in Brazil do not have adequate access to healthcare services and neither is properly reached by the healthcare system. Overcrowding makes it hard for prison authorities to keep rival factions separate. The identification of the presence of mental problems when the individuals are admitted to prisons is a necessary task that may guide the adoption of measures to reduce suffering beyond the penalty of deprivation of freedom. The burden of psychiatric disorders in the prisoner's population is not known. The prevalence of major psychiatric disorders is high. Regardless of whether mental disorders are the cause or consequence of prison, it is elucidated that the stressing factors inherent to the inmate condition do not contribute to the prevention of mental disorders.

Summary: Background: Neonatal sepsis is a major cause of morbidity and mortality in low-income settings. As signs of sepsis are non-specific and deterioration precipitous, antibiotics are often used profusely in these settings where diagnostics may not be readily available. Harare Central Hospital, Zimbabwe, delivers 12000 babies per annum admitting ∼4800 to the neonatal unit. Overcrowding, understaffing and rapid staff turnover are consistent problems. Suspected sepsis is highly prevalent, and antibiotics widely used. We audited the impact of training and benchmarking intervention on rationalizing antibiotic prescription using local, World Health Organization-derived, guidelines as the standard. Methods: An initial audit of admission diagnosis and antibiotic use was performed between 8th May - 6th June 2018 as per the audit cycle. An intern training programme, focusing on antimicrobial stewardship and differentiating between babies ‘at risk of’ versus ‘with’ clinically-suspected sepsis was instituted post-primary audit. Re-audit was conducted after 5 months. Results: Sepsis was the most common admitting diagnosis by interns at both time points but reduced at repeat audit (81% versus 59%, P

With the increased need for mobility and the overcrowding of cities, the area of intelligent transportation aims at improving the efficiency, safety, and productivity of transportation systems by relying on communication and sensing technologies. One of the main challenges faced in intelligent transportation systems pertains to the real-time collection of traffic- and road-related data, in a cost-effective, efficient, and scalable manner. The current approaches still suffer from problems related to the energy consumption of mobile devices and overhead in terms of communications and processing. To tackle the aforementioned challenges, we propose in this paper a novel infrastructure-less on-demand vehicular sensing framework that provides accurate road-condition monitoring, while reducing the number of participating vehicles, energy consumption, and communication overhead. Our approach is adopting the concept of mobile sensing as a service, in which mobile owners participate in the data-collection activities and decide to offer the sensing capabilities of their phones as services to other users.

SUMMARY Overcrowding in emergency departments is a problem in many countries around the world, including the United States and Chile. Emergency department (ED) overcrowding causes problems for patients and staff, including increased waiting times, increased ambulance diversion, increased length of stay, increased medical errors, increased patient mortality, and increased harm to hospitals due to financial losses. This article aims to describe the etiology of ED overcrowding and potential solutions through an examination of the evidence. Ultimately, ED overcrowding originates from hospital overcrowding and thus the solutions to this complex problem lie in the ED itself as well as outside of the ED.

Background Every year millions of young people between the ages of 10 and 24 years in central Asia and Africa migrate to urban areas in search of better opportunities. Common factors driving youth migration include environmental degradation, war and conflict, and lack of economic opportunity and poverty. In collaboration with the United Nations Population Fund (UNFPA), our aim was to study the effect of migration on the sexual and reproductive health (SRH) needs of youth in Nairobi, Cairo, Beirut, and Tunis through the development of technological solutions for data collection and identification of youth most vulnerable to SRH issues. Methods We designed a web application useful for both migrants and researchers that contains a 27-question survey to collect migrant data on basic profile metrics such as their geographical journey and their sexual relations. This data can be used to inform the UNFPA's service, delivery, and policy efforts. The website also features a geographical healthcare centres map and safety tips for migrants. Additionally, we artificially created a dataset of 1000 migrant profiles to train a machine learning model to predict SRH vulnerabilities in young people. Findings The neural network model and the support vector machines algorithm demonstrated high accuracies of 0·92 and 0·90 respectively in predicting the most vulnerable youth. We optimised our algorithm to minimise false-negatives, even at the cost of a few false-positives. Interpretation Our results provide an opportunity to identify vulnerable youth for local officials to potentially reach out to in order to prevent SRH issues and to understand how such vulnerabilities might stem from their environmental and structural migration factors. Furthermore, researchers can investigate based on data collected from the web application how overcrowding of migrants in urban areas outstrips the areas of resources to further compromise the SRH health of the migrants. Funding None.

Overcrowding has been regarded as indicating material deprivation and treated as a proxy measure for individual socioeconomic status. Conventionally, ‘persons per room’ (PPR) has been employed to identify overcrowded households in UK survey data, though the ‘bedroom standard’ (BS) approach or the ‘modified bedroom standard’ (MBS) approach has been thought to capture overcrowded households better. Little is known about which overcrowding measure will perform well in regard to construct and face validity. In this work, associations between three overcrowding measures and socioeconomic (income and household tenure status) and health (satisfied with health and GHQ12) indicators were assessed, using the UK Household Longitudinal Study Wave 6 data. PPR, BS and MBS were derived using relevant housing grid information and housing information from the dataset, which were aggregated at a household level (N = 18,848). Raw scores were categorised into ‘under occupied (rooms, Highlights • Two newer overcrowding measures moderately agreed with the person per room ratio (82). • All three overcrowding measures were similarly related to other SEP indicators (81). • Components of the overcrowding measures uniquely correlated with the SEP indicators (86). • Overcrowding's complexity suggests relevant household data is needed in surveys. (81).

Summary Background Indigenous peoples worldwide carry a disproportionate tuberculosis burden. There is an increasing awareness of the effect of social determinants and proximate determinants such as alcohol use, overcrowding, type 1 and type 2 diabetes, substance misuse, HIV, food insecurity and malnutrition, and smoking on the burden of tuberculosis. We aimed to understand the potential contribution of such determinants to tuberculosis in Indigenous peoples and to document steps taken to address them. Methods We did a systematic review using seven databases (MEDLINE, Embase, CINAHL, Global Health, BIOSIS Previews, Web of Science, and the Cochrane Library). We identified English language articles published from Jan 1, 1980, to Dec 20, 2017, reporting the prevalence of proximate determinants of tuberculosis and preventive programmes targeting these determinants in Indigenous communities worldwide. We included any randomised controlled trials, controlled studies, cohort studies, cross-sectional studies, case reports, and qualitative research. Exclusion criteria were articles in languages other than English, full text not available, population was not Indigenous, focused exclusively on children or older people, and studies that focused on pharmacological interventions. Findings Of 34 255 articles identified, 475 were eligible for inclusion. Most studies confirmed a higher prevalence of proximate determinants in Indigenous communities than in the general population. Diabetes was more frequent in Indigenous communities within high-income countries versus in low-income countries. The prevalence of alcohol use was generally similar to that among non-Indigenous groups, although patterns of drinking often differed. Smoking prevalence and smokeless tobacco consumption were commonly higher in Indigenous groups than in non-Indigenous groups. Food insecurity was highly prevalent in most Indigenous communities evaluated. Substance use was more frequent in Indigenous inhabitants of high-income countries than of low-income countries, with wide variation across Indigenous communities. The literature pertaining to HIV, crowding, and housing conditions among Indigenous peoples was too scant to draw firm conclusions. Preventive programmes that are culturally appropriate targeting these determinants appear feasible, although their effectiveness is largely unproven. Interpretation Indigenous peoples were generally reported to have a higher prevalence of several proximate determinants of tuberculosis than non-Indigenous peoples, with wide variation across Indigenous communities. These findings emphasise the need for community-led, culturally appropriate strategies to address smoking, food insecurity, and diabetes in Indigenous populations as important public health goals in their own right, and also to reduce the burden of tuberculosis. Funding Canadian Institutes of Health Research.

Introduction Previous studies indicate that crowding scales may not perform well in low-volume emergency departments (EDs). In this study, face-validity of the Modified National ED OverCrowding Score (mNEDOCS) was assessed in a high-volume ED as well as in a low-volume ED. Methods A prospective observational cohort study was performed in the Netherlands. The correlation of the mNEDOCS with ED staff perceptions of crowding were assessed, using weighted Kappa (κ) and Pearson correlation. Subsequently, ED process measures (elapsed target times to triage, elapsed target times to treatment and patients’ LOS) were described under different levels of ED crowding. Results Correlation between the categorized crowding scores was low (weighted κ 0.34 resp. 0.26). However, good correlations of 0.73 and 0.82 were found between the uncategorized mNEDOCS and ED staff’s perception of crowding. Percentages of patients with elapsed target times to treatment increased simultaneously with increasingly busy periods when measured with mNEDOCS. Conclusions The uncategorized mNEDOCS correlates well with perceived crowding, even at a low-volume ED. Determining a cut-off level at which a specific ED can be identified as crowded is important, because the predefined mNEDOCS categories may not be optimal for all EDs.

Species distribution and population abundance are keystone patterns in ecology, and currently also in epidemiology. The aggregation of individuals in the population is closely related to distribution and abundance, but they are not totally equivalent patterns. Despite the great efforts made in recent decades to harmonise the sampling protocols used to collect distribution and abundance data, studies regarding the development and testing of aggregation indices are scarce, even when individuals’ aggregation is quite relevant and necessary for the design of effective wildlife management policies. One of the most popular aggregation indices is the overcrowding index (m*), which quantifies the number of individuals per group, and does not, therefore, take into account how the individuals and groups are distributed in a given territorial unit. In this study, we describe and assess a new spatially explicit aggregation index (SAI) in which the distribution of individuals within the group and the groups in the territorial units are included in the formulation. A comparative evaluation of the proposed index was carried out in relation to m*, including a specific assessment of the biological meaning of these indices by relating aggregation indices with pathogen prevalence in a multi-host epidemiological scenario. Our results showed that SAI – but not m* – responded to changes in the aggregation level of individuals in the population in both theoretical scenarios and with real data obtained from a case study. Spatial information is, therefore, required to quantify individuals’ aggregation and the processes that are associated with it. This is particularly relevant when our understanding of processes needs to be addressed on a fine local scale, as is the case when working in epidemiology. Our results reinforce this idea, since the capacity of SAI to explain the prevalence of animal tuberculosis at a community level was significantly higher than that observed for m*, the latter being to a great extent based in the abundance of individuals in the area. We concluded that SAI has a great potential for wildlife monitoring in general and for epidemiological studies in particular and may, together with abundance data, provide practical information to evaluate wildlife management actions and define effective policies for diseases control., The present work has benefited from the financial support of AGL2013-48523-C3-1-R (MINECO-FEDER, UR). EL and JAB are supported by a JCCM predoctoral contract and a “Juan de la Cierva” contract (FJCI-2015-23643) from MINECO-UCM, respectively. RTO holds a pre-doctoral scholarship from the UCLM. PA is supported by MINECO-UCLM through a “Ramón y Cajal” contract (RYC-2012-11970) and partly by AGL2016-76358-R (MINECO-FEDER, UE). Part of this study was conducted within the Projects Aeromab, (Andalusia Government, Project for Excellence, 2007, P07-RNM-03246) and Planet (European Commission 7th FP Grant Agreement 257649) granted to JJN, Doñana Biological Station, CSIC.

Objectives:\ud High levels of excess mortality (i.e. that not explained by deprivation) have been observed for Scotland compared with England & Wales, and especially for Glasgow in comparison with similar post-industrial cities such as Liverpool and Manchester. Many potential explanations have been suggested. Based on an assessment of these, the aim was to develop an understanding of the most likely underlying causes.\ud \ud Note that this paper distils a larger research report, with the aim of reaching wider audiences beyond Scotland, as the important lessons learnt are relevant to other populations.\ud \ud Study design:\ud Review and dialectical synthesis of evidence.\ud \ud Methods:\ud Forty hypotheses were examined, including those identified from a systematic review. The relevance of each was assessed by means of Bradford Hill's criteria for causality alongside—for hypotheses deemed causally linked to mortality—comparisons of exposures between Glasgow and Liverpool/Manchester, and between Scotland and the rest of Great Britain. Where gaps in the evidence base were identified, new research was undertaken. Causal chains of relevant hypotheses were created, each tested in terms of its ability to explain the many different aspects of excess mortality. The models were further tested with key informants from public health and other disciplines.\ud \ud Results:\ud In Glasgow's case, the city was made more vulnerable to important socioeconomic (deprivation, deindustrialisation) and political (detrimental economic and social policies) exposures, resulting in worse outcomes. This vulnerability was generated by a series of historical factors, processes and decisions: the lagged effects of historical overcrowding; post-war regional policy including the socially selective relocation of population to outside the city; more detrimental processes of urban change which impacted on living conditions; and differences in local government responses to UK government policy in the 1980s which both impacted in negative terms in Glasgow and also conferred protective effects on comparator cities. Further resulting protective factors were identified (e.g. greater ‘social capital’ in Liverpool) which placed Glasgow at a further relative disadvantage. Other contributory factors were highlighted, including the inadequate measurement of deprivation.\ud \ud A similar ‘explanatory model’ resulted for Scotland as a whole. This included: the components of the Glasgow model, given their impact on nationally measured outcomes; inadequate measurement of deprivation; the lagged effects of deprivation (in particular higher levels of overcrowding historically); and additional key vulnerabilities.\ud \ud Conclusions:\ud The work has helped to further understanding of the underlying causes of Glasgow's and Scotland's high levels of excess mortality. The implications for policy include the need to address three issues simultaneously: to protect against key exposures (e.g. poverty) which impact detrimentally across all parts of the UK; to address the existing consequences of Glasgow's and Scotland's vulnerability; and to mitigate against the effects of future vulnerabilities which are likely to emerge from policy responses to contemporary problems which fail sufficiently to consider and to prevent long-term, unintended social consequences.

Background and Aim. Hepatitis E virus (HEV) infection represents a risk for mortality in pregnant women. The seroepidemiology of HEV infection in rural pregnant women in the Americas is largely unknown. The aim of the study was to determine the seroepidemiology of anti-HEV IgG antibodies in rural pregnant women in Durango, Mexico. Materials and methods. The presence of anti-HEV IgG antibodies was determined in 439 pregnant women in rural Durango, Mexico using an enzyme-linked immunoassay. Seroprevalence association with socio-demographic, clinical and behavioral characteristics of the women was also investigated. Results. Twenty five (5.7%; 95% CI: 3.88-8.27) of the 439 women (mean age: 24.53 ± 6.1 years) had anti-HEV antibodies. Multivariate analysis showed that HEV seropositivity was associated with increasing age (OR = 1.11; 95% CI: 1.03-1.20; P = 0.004), consumption of unpasteurized cow milk (OR = 5.37; 95% CI: 1.17-24.63; P = 0.03), and overcrowding at home (OR = 2.36; 95% CI: 1.13-4.92; P = 0.02). In contrast, the variables educational level, occupation, socio-economic status, foreign travel, consumption of untreated water and raw or undercooked meat, and raising animals did not show associations with HEV seropositivity. Exposure to HEV was associated with the number of deliveries but not with the number of cesarean sections or miscarriages. Conclusions. This is the first report of seroprevalence and contributing factors for HEV infection in rural pregnant women in the Americas, and of an association of the consumption of unpasteurized cow milk with HEV exposure. Results of this study should be useful for designing optimal preventive measures against HEV infection.

Restricted access to primary care can lead to avoidable, excessive use of expensive emergency care. Since 2013, partly to alleviate overcrowding at the Accident & Emergency (A&E) units of hospitals, the UK has been piloting 7-day opening of General Practitioner (GP) practices to improve primary care access for patients. We evaluate the impact of these pilots on patient attendances at A&E. We estimate that 7-day GP opening has reduced A&E attendances by patients of pilot practices by 9.9% with most of the impact on weekends which see A&E attendances fall by 17.9%. The effect is non-monotonic in case severity with most of the fall occurring in cases of moderate severity. An additional finding is that there is also a 9.9% fall in weekend hospital admissions (from A&E) which is entirely driven by a fall in admissions of elderly patients. The impact on A&E attendances appears to be bigger among wealthier patients. We present evidence in support of a causal interpretation of our results and discuss policy implications.

Rheumatic fever (RF) and rheumatic heart disease (RHD) are the most-common cardiovascular disease in young people aged

The problems at Pediatric Emergency Services (PES) are primarily related to unpredictable patient flow. Overcrowding at these services provokes considerable waiting times, and all indicators prove that reducing overcrowding is not always easily controlled. To face these problems, we suggest a mathematical formulation of the scheduling problem and an open and dynamic Multi-agent System (MAS), for managing patient care-related problems. In this chapter, we shall focus mainly on the behavior of the Scheduling Agent (SA), which belongs to this architecture. The SA makes it possible to optimize patient flows and to schedule the activity of care processes previously represented by a Workflow. The SA builds optimized schedules for medical staff in order to guarantee a controlled execution of the system, which ensures quick and qualitative care by managing the hospital’s resources. In the last section of this chapter, we will study some approaches of Workflow dynamic orchestration done by a SA in order to optimize different criteria used during Workflow execution.

This chapter discusses the birth and death rates in eastern and western countries. The East is the greatest morass of human and animal misery that the world has ever seen. Hunger and nakedness, dirt and sores, flies and vermin, deformity and depravity, mange and cruelty, overcrowding and illiteracy, disease and decrepitude—all the ghastly concomitants of life in the worst slums of Casablanca or La Fanguito, all the degradations of an involuntary Buchenwald, range for thousands of miles across the south-eastern half of Asia and await relief that only a reduction of population can accomplish. The very magnitude of the problem has reached such proportions as to defy all attempts at its mitigation. Owing partly to the resurgent birthrate but more substantially to the very low death rate, the natural increase is faster at present in the United States than in India.

Scabies is an important health problem characterized by continuous transmission throughout the year. It is ubiquitous, contagious, and debilitating parasitic dermatoses, known since antiquity and having widespread distribution in the tropics. The worldwide prevalence has been estimated at about 300 million cases yearly, although it may be an overestimate.1 Scabies occurs in both sexes, at all ages, in all ethnic groups, and at all socioeconomic levels. In India, the incidence ranges from 13% to 59% in rural2 and urban areas.3 Scabies is a Latin word that simply means to scratch and is caused by the mite Sarcoptes scabiei var-hominis, and is usually associated with conditions of overcrowding, low socioeconomic standards, low level of education and poor hygiene.4 Overcrowding and sexual contacts are the most common, but not exclusive modes of transmission. The mite of scabies burrows into the outer layer of the skin (stratum corneum) and feeds on skin cells and fluids. It is this feeding action, and its products (digestive secretions and feces) that provoke an immune reaction from the body which results in itching and other symptoms of scabies. Scabies causes considerable discomfort and can result in severe secondary complications such as impetigo, cellulitis, pyoderma, bacteraemia and post-streptococcal glomerulonephritis.5–7 The study was undertaken in the Rural Health Training Centre of a medical college located at Kasurdi village, in Pune district of Maharashtra. During routine visits, three school going children of a nearby orphanage reported with the clinical symptoms suggestive of Scabies i.e. insomnia due to severe itching at night, rashes, irritability leading to school absenteeism and poor quality of life. On examination, the children were found to be having scabies. Scabies in orphanages are not uncommon but unfortunately are hard to treat because of reasons like delayed diagnosis, inadequate treatment, malnutrition, associated allergic and bacterial infections and inadequate follow-up.8 It was thus decided that all the children at the orphanage be examined and an intervention to cure all children of the orphanage be undertaken. The study thus aimed to assess the prevalence of Scabies in an orphanage in a rural village of Maharashtra State and to conduct a mass Scabies treatment and follow-up of all children and care givers. The study in addition also provided health education and trained the care givers for timely management of scabies in the setup.

Many studies of the effects of crowding on humans have analysed the negative consequences of high population density on health and well-being. The differences that exist among the contributions on this subject include their methodology (different population groups, diverse localities, housing conditions, dependent and independent variables, and the most problematic one of all – different measures of density itself). The lack of a shared theoretical and methodological framework precludes the ability to draw general conclusions. However, in general, it can be concluded that physical population density (the objective measure of the number of housing units or people per unit area) has little effect on human behaviour or health. The accumulated evidence also shows clearly that at larger geographical scales (metropolitan areas and regions) there is no direct correlation between high population density and social pathology. There is almost no evidence, however, regarding the residential neighbourhood level, although this is the actual level of density that people experience in their daily lives. Concerning indoor population density of housing (measured objectively either as the amount of floor area per person, or the number of persons per habitable room) the evidence does indicate some effect on behaviour and health but the degree is difficult to quantify. The majority of contributions ignore the possibility of positive effects on the emotions or cognition of those experiencing high density.

Floods are the most frequent natural disasters, representing approximately 35% of the total number of reported natural disasters worldwide. They may affect human health through either direct or indirect pathways, resulting in various health impacts whose magnitude, at the population level, will depend on the characteristics of the floods as well as on the environmental, economic, and social contexts of the areas in which these floods occur. Direct health impacts mainly consist of deaths and injuries at the acute phase of floods – mainly flash floods. Epidemics may emerge through indirect pathways; examples include the disruption of water and sanitation infrastructures and overcrowding leading to waterborne and respiratory diseases, and environmental changes producing changes in vector- and rodent-borne disease transmissions. Other indirect effects include mental health problems as well as the worsening of chronic conditions due to disruption in health care and access to medication. This article will cover the most frequent health impacts of floods in light of the lessons and evidence gathered in the past decades about different types of floods and about various socioeconomic and environmental contexts, and apply these evidences for improving mitigation and preparedness among vulnerable populations.

11 páginas, 9 figuras, 3 tablas., Beaches are the main asset of tourist destinations in the NorthwesternMediterranean. When developing beach management frameworks, managers request reliable information for decision-making. Frequentation patterns are one of the main, environmentally significant aspects to be considered. We discuss the use of frequently visited beaches in the light of increases in tourist frequentation and overcrowding problems. This paper presents a photographic protocol to obtain baseline information on frequentation patterns to measure: sandavailability per beachuser, number of users, user time on the beach, and turnover coefficients. A comparison of beach frequentation patterns is made over an 18-year period. Although the resident population, the number of secondary homes and associated tourism activities increased sharply over this period, only a slight increase was observed in the number of users. Beachusers may have restructured their behaviour and now substitute some of the time previously spent on beaches for other leisure activities., This work has been carried out within the framework of the projects 2FD97-0489, REN2003-09029-C03/MAR, and CGL2006-13953-C04/BOS J. A. Jiménez would like to thank the government of Catalonia (DURSI) for its support through the University Research Promotion Award for Young Researcher.