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PubMedDate not supplied

Incidence and precipitating factors of morbidity among Israeli travelers abroad.

BACKGROUND: During recent years international travel, including visits to the developing world, has become increasingly popular. Many of these travelers suffer from some sort of health problem during their trip or after their return. Travelers clinics that give pretravel immunization and counseling have emerged. This study analyzes the incidence and risk factors for health problems among Israelis traveling abroad. METHODS: The study surveyed by telephone 200 people who visited the traveler's clinic at Soroka Medical Center in Beer-Sheva during the years 1998 to 1999. The travelers were questioned after returning from their journey about the type and duration of the trip, compliance with medical advice given in the travel clinic, and health problems during the trip. RESULTS: The mean age was 26.4 +/- 9.4 years, 7% went on an organized tour, 23% traveled alone, and 77% traveled with a friend. The mean duration of the trip was 14.7 +/- 13.4 weeks. Of the travelers, 70% reported some health impairment. Problems reported most frequently were gastrointestinal tract diseases (43%), respiratory tract diseases (25%), and injuries (10%). Only 4% were admitted to a hospital during their trip. After their return, 19.5% consulted a physician. Comparing the group of travelers who were sick with the rest, a correlation between noncompliance with the keeping of food hygiene and illness was found (p =.008). Additional risk factors for illness were long duration (p <.001), solitary trip (p =.04), and young age (p <.001). Of the people who were advised to take antimalaria chemoprophylaxis, 55% reported regular use of these drugs. Compliance with treatment correlated with older age (p <.001), short duration of stay (p =.01), previous experience, and travel to Africa (p <.001). CONCLUSIONS: Most of the travelers to developing countries are young, travel for long periods, and live in basic conditions during their stay abroad. For these reasons travelers are at increased risk for morbidity. High risk travelers should be identified and counseled in order to increase their compliance with the medical advice and immunizations. A screening program for returning travelers should be considered.

Adolescent↗
PubMed1988

Preventive health advice for Australian travellers to Bali.

Five hundred travellers to Bali were surveyed with a predeparture questionnaire to assess the source and nature of health advice for international travel that is provided to Australian tourists. Eighty-seven per cent of travellers received some health advice for travel from either their family doctor, travel agent or both. Eighty-nine per cent of travellers were advised to be immunized against typhoid and 75% of travellers were advised to receive a cholera vaccination; the proportion of travellers who underwent such therapy was the same irrespective of the standard of their accommodation in Bali or their likely risk of exposure to these infections. A gamma-globulin injection was recommended to 18% of travellers and tetanus vaccine was recommended to 35% of travellers. General antimalarial measures were discussed with 59% of travellers, and 88% of travellers were advised to take antimalarial medications. Combined prophylaxis with chloroquine and a sulpha drug (usually dapsone--pyrimethamine [Maloprim]) was recommended most frequently (39% of travellers), with chloroquine alone (27% of travellers) or a sulpha drug alone (14% of travellers) also being prescribed commonly. A history of drug allergy was sought in 46% of the travellers who were advised to take antimalarial agents, and 41% of travellers were informed of possible side-effects of the antimalarial drugs. This survey showed that health advice about predeparture immunizations and antimalarial prophylaxis frequently differs from current recommendations of the Commonwealth Department of Community Services and Health and the World Health Organization.

Adolescent↗
PubMed1998

Venous thromboembolism associated with air travel: a report of 33 patients.

BACKGROUND: The medical literature suggests long distance travel, particularly air travel, may be a risk factor for venous thromboembolism, but the risk is poorly quantified. METHODS: We reviewed 134 records of patients hospitalized with venous thromboembolism for comments regarding recent travel. Patients who had traveled within 31 d prior to venous thromboembolism were defined as recent travelers. RESULTS: Of 134 patients records, 66 (49%) had documented inquiries regarding travel and 33 (50%) were recent air travelers. Data regarding demographics, mode of travel, day of onset of symptoms in relation to travel, and other risk factors for venous thromboembolism were abstracted from the records of the recent travelers. There were 12 (36%) travelers who had no other predisposition for venous thromboembolism. All had traveled non-stop by aircraft for 4 or more hours; none was identified as a crew-member. The median day of onset of venous thromboembolism was on travel day 4 (range: day 1-31). There were 8 (24%) patients who had onset during air travel or on the day of arrival, and 27 (82%) had onset by travel day 15. Air travel for 4 or more hours within the preceding 31 d was the most common risk factor for venous thromboembolism in our study patients and was present in 50%. This incidence is much higher than previously described, perhaps due to limiting the study population to those in which the presence or absence of travel was documented. CONCLUSION: Prospective studies are needed to better define the risk factors for venous thromboembolism among long distance air passengers and crew-members, and to determine effective preventive measures.

Adult↗
PubMed1998

Anxiety and health problems related to air travel.

BACKGROUND: A significant proportion of air travelers experience situational anxiety and physical health problems. Take-off and landing are assumed to be stressful, but anxiety related to other aspects of the air travel process, anxiety coping strategies, and in-flight health problems have not previously been investigated. METHODS: We aimed to investigate frequency of perceived anxiety at procedural stages of air travel, individual strategies used to reduce such anxiety, and frequency of health problems on short-haul and long-haul flights. A questionnaire measuring the occurrence and frequency of the above was administered to two samples of intending travelers during a 3 month period to: (a) 138 travel agency clients, and (b) 100 individuals attending a hospital travel clinic. RESULTS: Of the 238 respondents, two thirds were women. Take-off and landing were a perceived source of anxiety for about 40% of respondents, flight delays for over 50%, and customs and baggage reclaim for a third of individuals. Most frequent anxiety-reduction methods included alcohol and cigarette use, and distraction or relaxation techniques. Physical health problems related to air travel were common, and there was a strong relationship between such problems and frequency of anxiety. Travel agency clients reported more anxiety but not more physical health symptoms overall than travel clinic clients. Women reported greater air-travel anxiety, and more somatic symptoms than men. CONCLUSIONS: Significant numbers of air travelers report perceived anxiety related to aspects of travel, and this is associated with health problems during flights. Airlines and travel companies could institute specific measures, including improved information and communication, to reassure clients and thereby diminish anxiety during stages of air-travel. Medical practitioners and travel agencies should also be aware of the potential stresses of air travel and the need for additional information and advice.

Adult↗
PubMed1997

Medical insurance claims associated with international business travel.

OBJECTIVES: Preliminary investigations of whether 10,884 staff and consultants of the World Bank experience disease due to work related travel. Medical insurance claims filed by 4738 travellers during 1993 were compared with claims of non-travellers. METHODS: Specific diagnoses obtained from claims were analysed overall (one or more v no missions) and by frequency of international mission (1, 2-3, or > or = 4). Standardised rate of claims ratios (SSRs) for each diagnostic category were obtained by dividing the age adjusted rate of claims for travellers by the age adjusted rate of claims for non-travellers, and were calculated for men and women travellers separately. RESULTS: Overall, rates of insurance claims were 80% higher for men and 18% higher for women travellers than their non-travelling counterparts. Several associations with frequency of travel were found. SRRs for infectious disease were 1.28, 1.54, and 1.97 among men who had completed one, two or three, and four or more missions, and 1.16, 1.28, and 1.61, respectively, among women. The greatest excess related to travel was found for psychological disorders. For men SRRs were 2.11, 3.13, and 3.06 and for women, SRRs were 1.47, 1.96, and 2.59. CONCLUSIONS: International business travel may pose health risks beyond exposure to infectious diseases. Because travellers file medical claims at a greater rate than non-travellers, and for many categories of disease, the rate of claims increases with frequency of travel. The reasons for higher rates of claims among travellers are not well understood. Additional research on psychosocial factors, health practices, time zones crossed, and temporal relation between travel and onset of disease is planned.

Adult↗
PubMedDate not supplied

Travel patterns and risk behavior in solid organ transplant recipients.

BACKGROUND: International travel is associated with an increased risk of enteric, vector-borne and bloodborne infections. The risk of acquiring travel-related illness is higher in those who are immunocompromised. However, little is known about travel practices and risk behaviors in transplant recipients who travel. We herein profile transplant recipients who travel, and characterize their pre-travel precautions, travel activities, burden of illness, and exposure history. METHODS: With the use of a standardized and validated questionnaire, patients attending a transplant clinic were surveyed regarding recent travel and risk behaviors. RESULTS: Of 267 transplant recipients who participated, 95 (36%) indicated that they had recently traveled outside Canada and the USA. Their mean age was 49.9 years, 54% were male, and 54% were born outside Canada. Eighty-six percent of travelers were receiving at least two immunosuppressive drugs at the time of their trip. Sixty-six percent of travelers sought pre-travel advice, primarily from their transplant physician. Sixty-three percent traveled to areas where hepatitis A is endemic, but only 5% had received hepatitis A immunization. Fifty percent traveled to dengue- and malaria-endemic areas, but,25% adhered to mosquito prevention measures. Ten percent reported behaviors that exposed them to blood or body fluids, including injections, body piercing, and casual sexual activity. CONCLUSIONS: Solid organ transplant recipients represent a unique group of compromised travelers; however, few were adequately protected against travel-associated enteric, vector-borne and bloodborne pathogens.

Adolescent↗
PubMed2004

Regionalization of percutaneous transluminal coronary angioplasty and implications for patient travel distance.

CONTEXT: Minimum procedure volume thresholds have been proposed to improve outcomes among patients undergoing percutaneous transluminal coronary angioplasty (PTCA). How regionalization policies would affect patient travel distances is not known. OBJECTIVE: To examine the effect of regionalization of PTCA on patient travel distances. DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study of discharge records, which were examined to determine hospital and operator procedure volumes, of 97,401 patients undergoing PTCA in New York, New Jersey, and Florida in 2001. Travel distances were measured at baseline and under 2 regionalization scenarios in which hospital-operator pairs not meeting minimum volume standards stopped providing services. MAIN OUTCOME MEASURES: Observed and expected patient travel distances, and risk-adjusted mortality. RESULTS: With a minimum volume standard of 175 per operator and 400 per hospital (class 1), 25% of patients had a shorter travel distance, 10% had a longer travel distance, and 65% experienced no change. Most patients with longer travel distances under this standard would travel no more than 25 miles farther, and most patients with shorter travel distances would save no more than 10 miles. With a minimum volume standard of 75 per operator and 400 per hospital (class 2), 11% of patients had a shorter travel distance, 2% had a longer travel distance, and 87% experienced no change. Under both standards, less than 1% of patients would travel more than 50 miles farther than their observed travel distance. Risk-adjusted mortality was higher for lower-volume hospital-operator pairs (1.2% for class 3 vs 0.9% for class 2 and 0.8% for class 1; P<.001 for both comparisons). CONCLUSION: Regionalization of PTCA would not increase travel distance for most patients; however, potential costs of regionalization not related to travel must be examined before such policies can be recommended.

Angioplasty, Balloon, Coronary↗
PubMed2006

Prevention of malaria in long-term travelers.

CONTEXT: Long-term travelers, defined here as those traveling for periods of 6 months or longer, face particular challenges regarding malaria prevention. Current guidelines for malaria prevention primarily address prevention of Plasmodium falciparum infections in short-term travelers. OBJECTIVES: To examine the risk of malaria in long-term travelers, recent developments in personal protective measures, and the safety and tolerability of malaria chemoprophylaxis during long-term use and to consider prevention strategies including continuous chemoprophylaxis, stand-by emergency self-treatment, seasonal prophylaxis, and strategies to prevent primary infection and relapses from P vivax malaria. EVIDENCE ACQUISITION: Comprehensive search of scientific publications including MEDLINE via both OVID and PubMED for relevant studies and articles with a cutoff date of July 2006, using the search terms long-term travel and malaria prevention, long-term malaria chemoprophylaxis, and insect repellent and malaria. Additional references were obtained from searching the bibliographies of the selected articles, from dissertations, and from the proceedings of relevant conferences on travel medicine. There were no language restrictions. EVIDENCE SYNTHESIS: Long-term travelers have a higher risk of malaria than short-term travelers. Long-term travelers underuse personal protective measures and adhere poorly to continuous chemoprophylaxis regimens. A number of strategies are used during long-term stays: discontinuation of chemoprophylaxis after the initial period, sequential regimens with different medications for chemoprophylaxis, stand-by emergency self-treatment, and seasonal chemoprophylaxis targeting high-incidence periods or locations. All strategies have advantages and drawbacks. Counterfeit drugs sold in countries endemic for malaria pose serious concern for long-term travelers who purchase their medications overseas. Vivax malaria causes significant illness in travelers, but relapses of vivax malaria are not prevented with the current first-line chemoprophylaxis regimens. Consensus guidelines are needed for prevention of malaria in long-term travelers. CONCLUSIONS: Prevention of malaria in long-term travelers is a complex issue and requires expert advice from travel medicine specialists. Recommendations for prevention of malaria in long-term travelers must be individualized.

Algorithms↗
PubMed2001

Health risks during travel: a population-based study amongst the Hong Kong Chinese.

Between June 1998 and October 1998, a cross-sectional survey was carried out in Hong Kong on 369 Chinese residents who had travelled to mainland China or elsewhere overseas in the previous 12 months. The aim was to collect data on which intervention strategies to minimise travel-related illness among the public might be based. In interviews by telephone, information on travel-related health problems, factors related to such problems, and barriers in the acquisition of travel-health advice was gathered using a structured, pre-tested questionnaire. Most of the subjects had travelled to countries in the Asia-Pacific region, with mainland China as the most popular destination (44%), followed by Thailand (14%). Overall, 16% of the respondents had developed health (mainly alimentary and respiratory) problems during or after their travel, 8% had received pre-travel health advice but 59% reported taking some form of precaution against travel-related illness. Although only 12% had lost at least a day of work or travel because of their travel-related health problems, 40% perceived themselves at risk of future travel-related illness, and 68% said they were willing to pay for the prevention of travel-health problems. Younger travellers and those who perceived relatively few health risks in future travel were relatively more likely to have developed health problems. There appears to be a clear need to develop appropriate health-promotion strategies to reduce travel-health risks among the residents of Hong Kong and the rest of the Asia-Pacific region.

Adolescent↗
PubMed1992

Ecological effects of short-term ciprofloxacin treatment of travellers' diarrhoea.

Forty-two subjects travelling to Mexico for 11 days were enrolled in a randomized, double-blind, placebo-controlled trial comparing ciprofloxacin 250 mg twice daily for three days or placebo for treatment of travellers' diarrhoea. Seventeen (41%) subjects were randomized to treatment. By the last treatment day, all seven evaluable subjects in the ciprofloxacin group, and three of eight evaluable subjects in the placebo group were cured (P = 0.04). The mean time to cure was 26 h for ciprofloxacin and 60 h for placebo-treated patients (P = 0.03). Faecal specimen were collected pre-travel, after four days in Mexico, 48 h post-travel and four weeks post-travel. Potentially pathogenic Escherichia coli strains carrying diarrhoeagenic virulence genes were detected by DNA hybridization tests, during or after travel, in 41% of treated and 31% of asymptomatic travellers. Travel, irrespective of diarrhoea and type of treatment, had a minor impact on the aerobic and anaerobic microflora. In travellers with ongoing diarrhoea, a suppression of the numbers of anaerobic bacteria was found, but the microflora was otherwise virtually unaffected. Significantly increased frequencies of E. coli resistant to ampicillin, doxycycline, chloramphenicol and co-trimoxazole were found during and after travel in all categories of travellers, though more frequently in subjects who experienced diarrhoea. The susceptibility of Bacteroides spp. remained unchanged. The sensitivity of E. coli to ciprofloxacin was not affected by travel, except in four ciprofloxacin-treated subjects who acquired multiresistant E. coli with ciprofloxacin MICs of > or = 0.125 mg/L post-travel. Bacteroides strains with MICs of > or = 64 mg/L were isolated post-travel from four ciprofloxacin-treated patients, and from one of the other 34 travellers not treated with ciprofloxacin.

Administration, Oral↗
PubMed2000

Condom acceptance is higher among travelers in Uganda.

OBJECTIVE: To examine the role played by mobile residents in the spread of HIV through rural Uganda. DESIGN: Travel history and sexual network data were collected from a random sample of 1627 residents aged 15-49 years in Rakai District, Uganda during 1994. METHODS: Travelers and non-travelers are compared with respect to socio-demographic attributes, risk exposure, knowledge, attitudes and use of condoms using descriptive statistics and multivariate logistic regression. A demographic profile of travelers' partners is developed using information from a local network survey module. RESULTS: The population is highly mobile, with over 70% reporting travel to a potentially higher risk destination in the past year. Travelers are somewhat more likely to have higher levels of sexual risk behavior, but the risk appears to be offset by significantly greater knowledge, acceptance, and use of condoms. In multivariate analysis, the sexual risk differential for travelers is explained by occupational exposure and higher socio-economic status. The differential in condom acceptance, by contrast, appears to be associated with travel itself. Condom use with non-spousal partners is three times higher among travelers than non-travelers (P< 0.001), and travel remains a significant predictor after controlling for age, education, residence, occupation and multiple partners. Travelers are more likely to use condoms with both their local and non-local partners. Partners of male travelers are likely to be younger and better educated than those of male non-travelers. CONCLUSIONS: The mobile population in this rural region appears willing to adopt risk reduction measures appropriate to their exposure. This suggests that targeting condom promotion programs to travelers and their partners is likely to be effective in reducing the spatial diffusion of HIV, and may be an efficient method for spreading behavioral change into rural areas.

Adolescent↗
PubMedDate not supplied

Diarrhea and respiratory symptoms among travelers to Asia, Africa, and South and Central America from Scotland.

Surveillance using admissions to hospital, while being useful, is a poor indicator of the real incidence of disease encountered by travelers. An alternative is self-reported illness among those who attended at a pretravel clinic prior to their travels. Estimates of incidence and risk factors were determined for attendees at a travel clinic in Scotland using a questionnaire. Analysis for risk factors was carried out for those travelers visiting countries in Africa, Asia, or South and Central America, who had traveled for 1 week or more and had returned between 1997 and 2001 (N= 4,856). Multivariate logistic regression was used to test the hypotheses that time abroad and age-group would be significant for both respiratory and diarrheal symptoms regardless of which of the three geographical areas are visited. From 2006 returned questionnaires (response rate = 41.3%), diarrhea and respiratory symptoms were reported by 44.2 and 16.8% of respondents, respectively; the incidence was significantly greater among travelers to Asia for both diarrheal (55.5%) and respiratory (23.7%) symptoms than among travelers to Africa (36.6 and 12.2%, respectively) or South and Central America (39.5 and 16.2%, respectively). For diarrhea, age was a highly significant risk factor for travelers to Asia, South and Central America, and Africa. Being a self-organized tourist/backpacker, traveling to Asia was associated with increased risk, while for Africa and South and Central America visiting family or friends was associated with a lower risk. For travelers to Asia, traveling to the Indian subcontinent was significantly associated with increased risk. The majority of travelers had an adverse event while traveling abroad, with diarrhea and respiratory conditions being especially common despite attending a travel clinic for advice prior to departure. However, the limitations of this surveillance-based strategy have highlighted the requirement for more research to understand more fully the issues of risk and incidence among travelers to high-risk destinations from Scotland.

Adolescent↗
PubMedDate not supplied

Evaluation of a public health newsletter intended for travel agents.

OBJECTIVES: Travel agents are in a key position to encourage travelers to seek consultation in travel clinics. Since the beginning of the year 2000, a newsletter specifically designed to sensitize travel agents to travel health has been published by the public health authorities and distributed to all travel agencies in Quebec. This study was undertaken to evaluate the utilization and appreciation of the newsletter by travel agents and its impact on preventive practices. METHODS: During the autumn of 2001, a cross-sectional descriptive survey was carried out among travel agencies in Quebec. Data were collected using a self-administered questionnaire sent by fax with a postal follow-up. RESULTS: A total of 252 of the 950 travel agencies contacted (27%) answered our questionnaire. In all, 78% of respondents said their agency receives the newsletter. Among these agencies, the majority of respondents considered that the subjects discussed in the newsletter are interesting (often or in general: 96%), that the subjects and preventive recommendations for travel destinations are useful in the travel agent's practice (often or in general: 89%), and generally presented in an adequate way (96%). According to the respondents, the newsletter encouraged them, often or very often, to inform travelers about travel-related health problems (70%) or to recommend a consultation in a travel clinic (63%). The impact of the newsletter on the recommendation to consult was greater among agents having more than 10 years' experience (odds ratio [OR] 3.2). When asked about the best way to send them the newsletter, only 31% identified bulk mailing, which was the current mode of distribution. CONCLUSION: Satisfaction rate with the newsletter appears to be high among respondents who receive it. However, the low response rate to the survey may indicate that as a whole, the travel agents' interest in the newsletter is mitigated. Despite the limitations of this study, the results will allow us to modify some aspects of the publication, especially regarding its distribution.

Adolescent↗
PubMedDate not supplied

Correlation between adherence to precautions issued by the WHO and diarrhea among long-term travelers to India.

BACKGROUND: Travelers' diarrhea is the most common infectious disease afflicting travelers to developing countries. Most studies investigating the benefits of recommendations regarding the consumption of food and water have focused on short-term travelers. We investigated the benefits of adherence to the precautions from the World Health Organization (WHO) among long-term travelers. METHODS: We asked 140 incidental travelers in India traveling for at least 2 months to complete a questionnaire about their adherence to the WHO precautions and the occurrence of diarrhea. Adherence was graded on a scale of 1 to 6 (least to most). RESULTS: The mean age of the 114 travelers whose questionnaires were eligible was 26.6 +/- 5.7 years, and the median duration of their trip was 5 months. None of them adhered strictly to the entire set of rules. The mean individual adherence was 3.4 (range 1.2-5.8). The vast majority of the travelers (83%) suffered from diarrhea. Most travelers (60%) had diarrhea for up to 3% of their journey time. Diarrhea was accompanied by fever among 18% and necessitated hospitalization in 3%. Forty-five percent indicated that they had lost traveling days due to diarrhea, for an average of 0.7% of the traveling time. We found no correlation between the percentage of traveling time with diarrhea and the following variables: adherence to the WHO recommendations, receipt of advice regarding prevention, duration of the trip, age, sex, and nationality of the travelers. CONCLUSIONS: Dietary self-restraint of travelers as proposed by the WHO is both difficult to comply with and lacks a proven value for the long-term traveler to a developing country.

Adult↗
PubMed2003

[Travel advice on the prevention of infectious diseases insufficiently obtained by indigenous and non-native inhabitants of Amsterdam, the Netherlands].

OBJECTIVE: To determine the travel behaviour of inhabitants of Amsterdam, the Netherlands, with respect to age and ethnicity, as well as the impact of travel advice, in particular regarding hepatitis A vaccination of Turkish and Moroccan children. DESIGN: Descriptive. METHOD: In a sample of 2000 inhabitants of Amsterdam, a survey was carried out during the period October 1999-November 2000 on seeking medical advice prior to travelling. In addition, 429 Turkish and Moroccan parents were questioned about hepatitis A vaccination of their children when travelling to their country of origin. RESULTS: In the three years preceding the survey one third of the Amsterdam population travelled to a country where infectious diseases such as malaria and hepatitis A were endemic. Many travellers (18%) went to Asia, Central or Latin America and Africa. Others (12%) travelled to the Middle-East or North Africa. One third of the travellers had sought advice from the Municipal Public Health Service of Amsterdam. Other travellers were advised by their general practitioner (10%). A large group (38%) did not seek any advice at all. Almost one third of the travellers went to their country of origin, particularly Turkish and Moroccan inhabitants of Amsterdam. Seventy percent of Turkish and Moroccan travellers had not sought travel advice. More than half the Turkish and Moroccan parents did not have their children vaccinated against hepatitis A when travelling to their country of origin. CONCLUSION: One fifth of the indigenous Dutch population received no travel advice. More than half of Turkish and Moroccan children travelling to their country of origin were not vaccinated against hepatitis A.

Adolescent↗
PubMed2002

Asthma in adventure travelers: a prospective study evaluating the occurrence and risk factors for acute exacerbations.

BACKGROUND: Exacerbation of asthma during travel to remote regions may lead to devastating consequences. The course of asthma in travelers and the risk factors for disease exacerbation during travel have not been studied. METHODS: We screened 5835 consecutive travelers and identified 203 patients with asthma. Before travel, all enrollees were assessed for presumed risk factors for asthma exacerbation by means of an interview and an exercise test combined with spirometry. After travel, data regarding travel characteristics and asthma severity were recorded by means of a structured telephone interview. RESULTS: The 203 enrollees visited 56 countries for a median duration of 13 weeks, 147 were engaged in high-altitude trekking, and 88 had asthma attacks. Among these, 40 reported worsening asthma during travel, 32 experienced the worst asthma attack ever, and 11 reported a life-threatening asthma attack. Two independent risk factors for attacks during travel were identified: frequent use (> or = 3 times weekly) of inhaled bronchodilators before travel (relative risk [RR], 3.35; 95% confidence interval [CI], 1.75-6.39) and participation in intensive physical exertion during treks (RR, 2.04; 95% CI, 1.04-3.98). When both risk factors were present, the RR for asthma attacks increased to 5.52 (95% CI, 2.81-10.84). CONCLUSIONS: Asthma frequently worsens during travel and should not be ignored as a potentially life-threatening condition requiring pretravel consideration. Asthmatic travelers who frequently use inhaled bronchodilators before travel or participate in intensive trekking during travel are at increased risk to develop asthma attacks. Therapy should be intensified to achieve better disease control; intensive trekking should be discouraged.

Acute Disease↗
PubMed2004

Travel medicine considerations for North American immigrants visiting friends and relatives.

CONTEXT: In the United States, 10% of the population was born outside of its borders. Immigrants and their children frequently return to visit their homeland, referred to as visiting friends and relatives (VFRs). They account for a disproportionately high volume of international travel. EVIDENCE ACQUISITION: Searches of MEDLINE, World Health Organization, Centers for Disease Control and Prevention, International Society of Travel Medicine, and American Society of Tropical Medicine computerized databases, conference proceedings and abstracts, US Census Bureau, bibliographies of pertinent articles, and travel medicine texts. Priority was given to recent (1996-2003) evidence, addressing VFR travelers. General sources including travel medicine and immigrant health were also used. EVIDENCE SYNTHESIS: Immigrants visiting friends and relatives experience excessive rates of travel-related morbidity and mortality. Lack of pretravel care is common due to patient and clinician barriers to care, preexisting health beliefs, and incomplete childhood vaccinations. Travel patterns increase risk with VFRs traveling to high-risk destinations. Susceptibility to infectious and noninfectious illnesses is often increased because of multiple preexisting medical problems and extremes of age. Infectious diseases differ in etiology and magnitude from those of traditional travelers. For example with malaria, VFRs are frequently prescribed inappropriate prophylaxis or take none at all, have longer stays, spend time in high-risk areas, and do not appropriately adhere to chemoprophylaxis regimens. Effective pretravel health advice, guidelines, and services for this high-risk population are essential. There are already a number of useful and readily available databases that may aid clinicians in providing optimal travel-related preventive and therapeutic care. CONCLUSIONS: Immigrants who are visitors of friends and relatives in other countries account for a high volume of international travelers and are at markedly increased risk of travel-related illness. New strategies are needed to properly address the needs of VFR travelers. Pretravel services should be convenient, accessible, affordable, culturally competent, and if possible, located within clinics serving immigrant populations. Clinicians caring for VFRs should be knowledgeable about their travel-related risks and have access to regularly updated, detailed pretravel health information.

Emigration and Immigration↗
PubMed2001

Travel illness in British package holiday tourists: prospective cohort study.

OBJECTIVES: To examine the relationship between knowledge of travel health matters, health preparation for travel and risk of travel related illness. METHODS: Travellers on holiday charter flights from Cardiff-Wales Airport provided information on holiday preparation before departure and were surveyed 2 weeks after return for details of holiday lifestyle and travel illness. RESULTS: Travellers' diarrhoea was reported by 25.7% of 1469 travellers; 24.4% had sunburn and 7.6% had respiratory infection. Attack rates for travellers' diarrhoea were highest in people aged 15-34 years (34.1%). Rates were higher the shorter the interval between holiday booking and departure (chi(2)for linear trend 13.5, 1df, P <0.001) and lower in travellers who sought advice from their general practitioner before departure (adjusted odds ratio 0.6, 95% confidence interval 0.4-0.9). The most important predictors for travellers' diarrhoea were travel with friends, country of destination, stay in room only or bed and breakfast accommodation, and type of meals most frequently eaten. CONCLUSIONS: Better holiday preparation seems to reduce risk of travel illness, even after adjusting for variables that may reflect the more cautious personality of the traveller. Encouragement to book early, take medical advice and travel well prepared could have a positive health benefit, but intervention studies are required.

Adolescent↗