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PubMed1994

A profile of HIV-risk behaviours among travellers--a population based study of Danes visiting Greenland.

The population of Greenland has behavioural characteristics that indicate a high risk of HIV spread once HIV is introduced into the population. Much depends, however, on the degree of exposure from visitors, particularly in an initial phase. We used a national questionnaire survey of 4,680 randomly selected Danes between 18-59 years to study HIV risk behaviours among Danes with (+travellers) and without (-travellers) travel experience to Greenland. Median number of lifetime sexual partners was more than twice as high among male +travellers (median = 12 partners) compared to -travellers (median = 5; p < 0.0001) and also slightly higher among women (p = 0.03). Furthermore, a significantly higher percentage of male +travellers than -travellers reported prostitute contact (OR = 2.3 (95% CI: 1.4-3.9)), with a peak of 32.0% among men aged 40-49 years. A history of a sexually transmitted disease was three times (95% CI: 2.0-4.5) as common among +travellers as in -travellers. +Travellers were also significantly more likely to have visited other places outside Europe and Greenland, including HIV endemic areas (OR = 2.9 (2.0-4.1)). Overall, sexual contact with someone considered at high risk of HIV infection (a homo/bisexual man, intravenous drug user, prostitute, or previous or present resident of Sub-Saharan Africa) was reported by 33.5% of male +travellers compared to 15.6% of -travellers and among women by 9.7% and 5.0%, respectively. In conclusion, travellers tend to have more sexual partners and more sexual interaction with high HIV-risk group members than non-travellers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

An estimate of the incidence of hepatitis A in unimmunized Canadian travelers to developing countries.

BACKGROUND: There is a paucity of data describing the risk of acquiring hepatitis A while traveling in the developing world. This paper uses available data to calculate the risk to Canadian travelers. METHODS: Information was gathered from Canadian and international sources on the following: the yearly incidence of hepatitis A among Canadians; the proportion of cases of hepatitis A associated with travel to developing countries; the number of days of such travel by Canadians per year; and the percentage of travelers immunized before departure. Calculations were performed on these figures to arrive at an estimated risk of infection for unimmunized Canadian travelers. RESULTS: The annual incidence of hepatitis A in Canada over the period 1996-2001, adjusted for underreporting, averaged 6.15 cases/100,000 people. During that time, Canadians traveled approximately 36.5 million days/year in developing countries. The literature shows that 4% to 28% (mean 16%) of cases are estimated to have been acquired abroad. It also shows that 14% to 24% (mean 19%) of such travelers are immunized before departure. Based on these figures, the risk of acquiring hepatitis A during 1 month of travel in the developing world is calculated to be approximately 1 case per 3,000 unimmunized travelers. CONCLUSION: Hepatitis A is an important travel-related disease, preventable by immunization. However, our calculations indicate that the risk of acquiring hepatitis A while traveling in the developing world is lower than some previously published estimates. The results represent an average for all types of travel to all such countries. The actual risk will vary considerably, depending on the destination and style of travel.

Canada↗
PubMed1994

Health problems and self-medication among Swedish travellers.

500 consecutive travellers seeking pre-travel health advice were issued a questionnaire before leaving Sweden to continuously record health problems and use of medication during travel. Of 442 subjects who turned in assessable questionnaires (232 male and 210 female, mean age 37 years), 81% travelled to areas at high risk for the acquisition of diarrhea. The mean duration of travel was 4 weeks. During travel 218 (49% at 95% CI 44.3 to 53.7%) of the travellers experienced some illness and 61 (14%) had symptoms of more than one illness. The mean duration of illness was 4.5 days, and 65 subjects (30% of ill travellers) were confined to bed for a mean duration of 2 days. The incidence of illness was significantly (p < 0.01) higher among travellers to high risk than to low risk areas (55% vs 26%), among young travellers than among elderly (65% vs 33%), and among those going on adventure tours compared with recreational tourists (74% vs 41%). Diarrhea was reported by 36% (95% CI 31.6 to 40.5%), and respiratory tract infection by 21% (95% CI 17.2 to 24.8%). Self-medication with one or several drugs was initiated by 163 (75%) travellers experiencing illness during travel. Thus, every second Swedish traveller to tropical and subtropical areas experienced some kind of travel-related, often incapacitating, health problem.

Adolescent↗
PubMed1996

Prevalence, Intensity, and Sex Differences in Travel Related Stressors.

Background: The objective of this study was to investigate anxiety provoking features of international travel and the degree of anxiety experienced in travelers and in people who had not traveled abroad in the previous year. Methods: A retrospective study of a 20% age- and sex-stratified quota sample of patients aged 15 years and over who had attended a group medical center in Stirling during 1994 was carried out. A standardized, structured, 16-point questionnaire was presented to people who attended the center for any purpose. A comparison, in terms of sex and intensity of travel-related worry, was made between foreign travelers and nontravelers within the preceding year. Experience of actual illness in relation to travel-related worry was also investigated. Results: One thousand seven hundred and seventy one respondents met quota entry criteria, and 1649 subjects, 836 men and 935 women, completed the questionnaire (response rate 97%). Seven hundred and forty three subjects had traveled abroad. Travel-related worries were common, e.g., worries about infected food (32.1%), contaminated water (32.0%), and flying (24.4%). Females were more worried than males, and nontravelers were more worried than travelers regarding many travel-related stressors. The intensity of certain travel-related worries was greater for nontravelers than travelers. Conclusions: For travelers, worries about infected food, contaminated water, and illness appeared justified by actual experience of travelers' diarrhea.

Journal Article↗
PubMed2005

Risk assessment and disease prevention in travelers visiting friends and relatives.

Although VFR travelers are at risk for acquiring infections and experiencing illness while traveling, many of these diseases are preventable. A comprehensive approach to decreasing their travel-related morbidity requires continued surveillance, data collection, systematic analysis, and action. A review of the literature provides few examples of interventions designed specifically to address VFR travel needs. Given the geographic and cultural diversity of these populations, models grounded in health behavior theory provide the best potential for clinically relevant replication. Outreach aimed at improving knowledge and care-seeking behaviors among VFR travelers may be facilitated through community-based campaigns in areas with large foreign-born populations. In developed countries, policies must be reviewed to ensure that travel-related services are accessible, affordable, and appropriate for these diverse populations. In the clinical setting, providers must develop culturally appropriate methods of communicating with traveling populations to influence behavior. In particular, primary care providers should take an active approach through screening for high-risk travel, and increasing their competency in travel medicine. Special attention should be given to illness that is prevented by routine childhood immunization (eg, varicella, measles, and hepatitis B); by disease prevented by travel vaccines (eg, typhoid fever and hepatitis A); and disease that can be prevented by careful avoidance measures or compliance with preventive medication (eg, malaria and tuberculosis). With increased immigration from developing to developed regions and widely affordable travel, the number of VFR travelers is expected to increase. As such, increased efforts to prevent VFR traveler morbidity serve the individual while also contributing to global public health.

Chickenpox↗
PubMed2002

Characteristics of deep vein thrombosis associated with prolonged travel.

OBJECTIVES: to identify the incidence of prolonged travel among consecutive patients with deep venous thrombosis (DVT) and to investigate any differences in the patterns of traveller's thrombosis versus DVT's with no history of prolonged recent travel. METHODS: of 137 consecutive patients, who were confirmed to have DVT by duplex ultrasonography, 36 were excluded because of either prolonged immobilisation or recent surgery. All patients were asked whether they had travelled within 2 weeks for more than 3h. The presence of other classic risk factors for DVT was also recorded. Patients who were unlikely to travel as a result of prolonged immobility for more than 2 weeks and those who underwent surgery within 2 weeks were excluded from the study. The extent and location of thrombi was also verified by duplex scanning in each patient. RESULTS: of 101 patients, eligible for the final analysis, 15 (15%) claimed to have a recent travel, of whom 9 (9%) travelled by air. By comparison of a group of 106 patients with similar symptoms at presentation, but who had negative duplex finding 12 (11%) had a history of prolonged travel (p=0.8, Fisher's exact test). Travel-related DVT occurred to a significantly younger age group than non travellers. Thirteen (87%) out of 15 patients with travel-related DVT had another coexisting risk factor and 7 out of 10 patients had a positive thrombophilia screen. CONCLUSION: The majority of those with travel-related DVT had other concomitant risk factors and a high incidence of a positive thrombophilia screen, suggesting that travel itself may act as an additive risk among those with pre-existing risk factors for DVT.

Adult↗
PubMed2006

Spectrum of disease and relation to place of exposure among ill returned travelers.

BACKGROUND: Approximately 8 percent of travelers to the developing world require medical care during or after travel. Current understanding of morbidity profiles among ill returned travelers is based on limited data from the 1980s. METHODS: Thirty GeoSentinel sites, which are specialized travel or tropical-medicine clinics on six continents, contributed clinician-based sentinel surveillance data for 17,353 ill returned travelers. We compared the frequency of occurrence of each diagnosis among travelers returning from six developing regions of the world. RESULTS: Significant regional differences in proportionate morbidity were detected in 16 of 21 broad syndromic categories. Among travelers presenting to GeoSentinel sites, systemic febrile illness without localizing findings occurred disproportionately among those returning from sub-Saharan Africa or Southeast Asia, acute diarrhea among those returning from south central Asia, and dermatologic problems among those returning from the Caribbean or Central or South America. With respect to specific diagnoses, malaria was one of the three most frequent causes of systemic febrile illness among travelers from every region, although travelers from every region except sub-Saharan Africa and Central America had confirmed or probable dengue more frequently than malaria. Among travelers returning from sub-Saharan Africa, rickettsial infection, primarily tick-borne spotted fever, occurred more frequently than typhoid or dengue. Travelers from all regions except Southeast Asia presented with parasite-induced diarrhea more often than with bacterial diarrhea. CONCLUSIONS: When patients present to specialized clinics after travel to the developing world, travel destinations are associated with the probability of the diagnosis of certain diseases. Diagnostic approaches and empiric therapies can be guided by these destination-specific differences.

Adult↗
PubMed2006

Illness in travelers visiting friends and relatives: a review of the GeoSentinel Surveillance Network.

Travelers returning to their country of origin to visit friends and relatives (VFRs) have increased risk of travel-related health problems. We examined GeoSentinel data to compare travel characteristics and illnesses acquired by 3 groups of travelers to low-income countries: VFRs who had originally been immigrants (immigrant VFRs), VFRs who had not originally been immigrants (traveler VFRs), and tourist travelers. Immigrant VFRs were predominantly male, had a higher mean age, and disproportionately required treatment as inpatients. Only 16% of immigrant VFRs sought pretravel medical advice. Proportionately more immigrant VFRs visited sub-Saharan Africa and traveled for >30 days, whereas tourist travelers more often traveled to Asia. Systemic febrile illnesses (including malaria), nondiarrheal intestinal parasitic infections, respiratory syndromes, tuberculosis, and sexually transmitted diseases were more commonly diagnosed among immigrant VFRs, whereas acute diarrhea was comparatively less frequent. Immigrant VFRs and traveler VFRs had different demographic characteristics and types of travel-related illnesses. A greater proportion of immigrant VFRs presented with serious, potentially preventable travel-related illnesses than did tourist travelers.

Adolescent↗
PubMedDate not supplied

Travel clinics in Québec (Canada).

To continuously improve its assistance to Québec travel health providers, the Québec Advisory Committee on Travel Health conducted an exploratory and descriptive survey of dedicated travel clinics in Québec (Canada). During autumn 2003, a cross-sectional descriptive survey was carried out among the 97 travel health clinics listed in Québec. Data were collected using a self-administered questionnaire sent by mail. The response rate was 94%. More than three quarters of travel clinics in Québec are located in community health centers; the others are in private clinics and in hospitals. Although 80% of the clinics are located outside the most densely inhabited regions of Québec, they carry out less than 30% of the total number of pretravel consultations. Almost 60% of the clinics have fewer than 500 consultations a year. Overall, more than 114,000 travel health consultations are performed annually in Québec travel health clinics. Preventive services to travelers, including the most commonly used vaccines for travelers, are available in all regions of Québec, except in the northernmost region. Smaller clinics offer fewer services to travelers in terms of antimalarial prescriptions, less common vaccines, and post-travel consultations. The main sources of information for travel health practitioners are guidelines provided by public health authorities. Data obtained provide an up-to-date portrait of the services available in travel clinics in Québec that should assist public health authorities adapt their interventions to the needs and realities of these clinics.

Ambulatory Care Facilities↗
PubMed2002

Mental health insurance claims among spouses of frequent business travellers.

OBJECTIVES: Following up on two earlier publications showing increased psychological stress and psychosocial effects of travel on the business travellers this study investigated the health of spouses of business travellers. METHODS: Medical claims of spouses of Washington DC World Bank staff participating in the medical insurance programme in 1997-8 were reviewed. Only the first of each diagnosis with the ninth revision of the international classification of diseases (ICD-9) recorded for each person was included in this analysis. The claims were grouped into 28 diagnostic categories and subcategories. RESULTS: There were almost twice as many women as men among the 4630 identified spouses. Overall, male and female spouses of travellers filed claims for medical treatment at about a 16% higher rate than spouses of non-travellers. As hypothesised, a higher rate for psychological treatment was found in the spouses of international business travellers compared with non-travellers (men standardised rate ratios (RR)=1.55; women RR=1.37). For stress related psychological disorders the rates tripled for both female and male spouses of frequent travellers (>or= four missions/year) compared with those of non-travelling employees. An increased rate of claims among spouses of travellers versus non-travellers was also found for treatment for certain other diagnostic groups. Of these, diseases of the skin (men RR=2.93; women RR=1.41) and intestinal diseases (men RR=1.31; women RR=1.47) may have some association with the spouses' travel, whereas others, such as malignant neoplasms (men RR=1.97; women RR=0.79) are less likely to have such a relation. CONCLUSION: The previously identified pattern of increased psychological disorders among business travellers is mirrored among their spouses. This finding underscores the permeable boundary between family relations and working life which earlier studies suggested, and it emphasises the need for concern within institutions and strategies for prevention.

Adult↗
PubMed2004

Regional risks and seasonality in travel-associated campylobacteriosis.

BACKGROUND: The epidemiology of travel-associated campylobacteriosis is still largely unclear, and various known risk factors could only explain limited proportions of the recorded cases. METHODS: Using data from 28,704 notifications of travel-associated campylobacteriosis in Sweden 1997 to 2003 and travel patterns of 16,255 Swedish residents with overnight travel abroad in the same years, we analysed risks for travel-associated campylobacteriosis in 19 regions of the world, and looked into the seasonality of the disease in each of these regions. RESULTS: The highest risk was seen in returning travellers from the Indian subcontinent (1,253/100,000 travellers), and the lowest in travellers from the other Nordic countries (3/100,000 travellers). In Africa, large differences in risk between regions were noted, with 502 /100,000 in travellers from East Africa, compared to 76/100,00 from West Africa and 50/100,000 from Central Africa. A distinct seasonal pattern was seen in all temperate regions with peaks in the summer, while no or less distinct seasonality was seen in tropical regions. In travellers to the tropics, the highest risk was seen in children below the age of six. CONCLUSIONS: Data on infections in returning travellers together with good denominator data could provide comparable data on travel risks in various regions of the world.

Adolescent↗
PubMedDate not supplied

Resources used by general practitioners for advising travelers from New Zealand.

BACKGROUND: The risks of the destination and any specific requirements for travel health advice may be obtained from a variety of resources. This study was designed to investigate the usefulness of various resources available in New Zealand for providing travel health advice and the extent to which GPs used these resources in providing travel health advice. METHOD: Four hundred GPs (400/2830) were randomly selected from the register of the New Zealand Medical Council and sent self-administered questionnaires. Two reminders were sent. RESULTS: Three hundred and thirty-two (332/400, 83%) GPs responded. The usefulness of various resources was reported, including Health Advice for Overseas Travellers (277/289, 96%), New Ethicals (256/278, 92%), New Zealand Public Health Report (79/164, 48%), International Travel and Health (41/144, 28%), computerized databases (6/122, 5%), journals (14/130, 11%), and other resources (44/139, 32%). Health Advice for Overseas Travellers was regarded as significantly more useful than International Travel and Health (x2 = 4,68, df = 1, p <.05). Only 23% (70/309) of respondents indicated that they always used these resources in their practice of travel medicine. Fifty percent (154/309) of respondents indicated that they usually used these resources, while 27% (83/309) of respondents indicated that they used these resources sometimes. Only 1% (2/309) of GPs did not use resources at all for their practice of travel medicine. CONCLUSIONS: The most useful resource was Health Advice for Overseas Travellers, which outlines the New Zealand recommendations for medical practitioners providing travel health advice. It may be useful for GPs to gain access to and training in association with a greater range of specialist resources to use in conjunction with the provision of travel health advice. These might include international guidelines, journals, and access to computerized databases and the internet. With the recent introduction of a widely accessible computerized database in New Zealand, follow-up studies could be instituted to determine if GPs' use of computerized databases becomes more widespread and whether access to and use of these computerized databases influences the provision of travel health advice by GPs. Further studies are needed to examine the appropriateness of the advice provided by the various resources used by GPs in New Zealand.

Communications Media↗
PubMedDate not supplied

Sexual behavior in travelers visiting Cuzco.

BACKGROUND: In South America, little is known about sexual behavior and risk factors for acquiring sexually transmitted diseases (STDs) among travelers and among local people sexually interacting with travelers. There is evidence that, in Peru, significant sexual interaction between these groups exists. METHOD: An anonymous written questionnaire was administered to travelers in the airport and bus stations before they left Cuzco. RESULTS: Of the travelers,5.6% engaged in sexual activity with a new partner during their stay in Cuzco. Sexual intercourse with other travelers was most common (76/140, 54.3%), followed by sex with local partners (57/140, 40.7%), and with commercial sex workers (3/140, 2.15%). Consistent condom use was reported by 97/140 (69.3%). In the multivariate analysis, the following variables were independently associated with casual sex: male gender, single marital status, age between 15 and 35 years, non-United States travelers (NUSTs), traveling alone or with friends, length of stay more than 30 days, homosexual or bisexual orientation, and expectation of having sex before traveling. Homosexual and bisexual travelers had 3 or more new sexual partners more frequently than heterosexual travelers (4/8, 18/129, OR=6.17 (1.16<OR<33.5)). NUSTs received more pretravel advice (698/1587, 210/718, OR=1.86 (1.54<OR<2.24)) and engaged in more sexual activity (100/1,587, 25/722, OR=1.86 (1.20<OR<2.93)) than United States travelers (USTs). CONCLUSION: Travelers visiting Cuzco engage in sexual activities that put them at risk of acquiring STD and transmitting it, both in their home country and in Peru. We recommend the inclusion of Peru and possibly other Latin American countries in the list of destinations where there is substantial risk of transmission of STD and the provision of pretravel advice regarding this issue to travelers to Peru.

Adolescent↗
PubMedDate not supplied

Nationwide survey of the role of travel medicine in primary care in Germany.

BACKGROUND: With more persons traveling to (sub)tropical destinations, travel medicine is an increasing challenge for the health care system in many countries. This study investigated the role and scope of travel medicine provided by general practitioners (GPs) in primary health care, assessed the determinants of specific prophylactic recommendations, and identified the needs of GPs regarding training and cooperation in travel medicine. METHODS: A national survey was conducted among randomly selected GPs in Germany. Information on the type and extent of activities in travel medicine, the number and characteristics of patients, the use of specific information systems, and training and cooperation, was obtained with a standardized postal questionnaire. Representativeness was assessed by a computer-assisted telephone survey among nonrespondents. Univariate and multivariate statistical analysis was performed. RESULTS: Of all GPs (n=1,320), 95% provided medical pretravel advice or post-travel counseling (13.2 patients/month). The most common topics in pretravel consultation were immunizations (95%), malaria chemoprophylaxis (94%), advice on exposure prophylaxis (41%), and advice on protection from sexually transmitted infections (STIs) (43%). GPs frequently advised certain patient groups (e.g., cardiovascular patients 68%, pregnant women 20%). Travelers' diarrhea was the most common topic in post-travel consultation (89%), followed by fever (38%). Of the GPs, 25% cooperated regularly with institutions with special expertise in travel medicine or tropical diseases. Sixty-four percent had received some training in travel medicine, and 86% stated a need for additional training. In the multivariate analysis, independent determinants for advice on exposure prophylaxis and STI risks included special training in travel medicine, use of country-specific information sources, and location of the practice in the former West Germany and urban areas. CONCLUSIONS: Travel medicine is of importance in primary health care in Germany. There is a need for improved counseling on exposure and STI prophylaxis. GPs' training in travel medicine and cooperation with institutions such as institutes, clinics and laboratories for tropical medicine should be improved.

Adult↗
PubMed1998

[The value of screening serology in anti-hepatitis A vaccination of travelers].

UNLABELLED: To select the travellers most likely to benefit from anti-hepatitis A (HA) antibody testing, the following criteria have been proposed: (A) being born before 1945, (B) a stay over 1 year in a developing country or (C) a history of jaundice. We present a prospective study to assess the practical use of these criteria. Following a recent survey in the general population of Lausanne showing HA seroprevalence of 52.6% in the age group over 45, we included an A1 criterion (A extended to birth before 1950). Anti-HA IgG testing and a questionnaire were proposed to all travellers presenting one or more criteria. RESULTS: Out of 1187 consecutive travellers, 176 (14.8%) had one or more criteria (219 [18.5%] when A1 was used). Criteria A applied to 8.5% of all travellers, A1 to 13.8%, B to 6.3% and C to 3.1%. Only 3% of travellers had more than one criterion. Overall seroprevalence among the selected group was 48.3%. Seroprevalence of travellers below 60 years old was under 30%, unless a second criterion was present in which case seroprevalence was 10% higher. Eighty percent of travellers with a history of jaundice were found to be positive. The use of the recommended criteria spared 94 travellers (46.3% of those tested and 7.9% of all travellers) unnecessary immunisation. Among travellers older than 60 years, a 30% economy on the total sum for immunising all of them, without any prior testing was realised. CONCLUSIONS: Among the population of travelers consulting our travel clinic, the seroprevalence for HA is lower than in the general population. We recommend that testing should be proposed only to travellers aged over 60, or with a history of jaundice, or to those with a combination of 2 out of 3 criteria.

Adult↗
PubMed1996

Malaria and Casual Sex: What Travelers Know and How They Behave.

Background: Travelers to the tropics have been reported to comply poorly with recommendations regarding malaria and AIDS. This study addresses the problem of influencing travelers' behavior through different approaches to conveying advice. Method: 3509 people attending a large travel clinic were randomly allocated to different interventions, including brochures about the implications of "sex tourism" and the possibility of participating in a contest assessing knowledge of malaria and AIDS. A comparison group (n = 607) of travelers to Kenya was contacted at an airport. Anonymous, self-administered questionnaires were sent to all travelers after their return. Results: Compliance with chemosuppressive regimen for malaria was 87%. Well-informed travelers did not protect themselves more efficiently against malaria. The efficacy of a given intervention was found to vary according to the age, sex, or travel experience of the participants. Of travelers, 51% reported casual sex abroad (M/F: 69/31). Thirty-eight percent of these contacts were unprotected. Casual sex abroad and condom use were correlated with a history of casual sex in the home country. Condom use was especially low in young women, who were also more likely to have casual sex with fellow travelers than with local partners. Eight percent of the "sex tourism" brochure readers had engaged in casual sex with local partners (all travelers, 4%). Conclusions: Lack of knowledge does not appear to be the problem. Travelers need to be motivated to put their knowledge into practice. Our results suggest that risks relating to malaria and AIDS are perceived in a different manner and that counseling should be individualized. Contest questions can help start a discussion on ethical and health-responsible behavior. The target group of the "sex tourism" brochure was reached, but their behavior appears not to have changed. Objective criteria can help physicians recognize "high-risk" travelers. Travelers need to be made aware that they may encounter environments conducive to risky behavior and that, while abroad, they may react in unexpected ways.

Journal Article↗
PubMed2006

The effect of the development of an emergency transfer system on the travel time to tertiary care centres in Japan.

BACKGROUND: In Japan, the emergency medical system is categorized into three levels: primary, secondary, and tertiary, depending on the severity of the condition of the patient. Tertiary care centres accept patients who require 24-h monitoring. In this research, the average travel times (minutes) from the centroids of all municipalities in Japan to the nearest tertiary care centre were estimated, using the geographic information system. The systems affecting travel time to tertiary care centres were also examined. Regression analysis was performed to determine the factors affecting the travel time to tertiary care centres, using selected variables representing road conditions and the emergency transfer system. Linear regression analysis was performed to identify specific benchmarks that would be effective in reducing the average travel time to tertiary care centres in prefectures with travel times longer than the average 57 min. RESULTS: The mean travel time was 57 min, the range was 83 min, and the standard deviation was 20.4. As a result of multiple regression analysis, average coverage area per tertiary care centre, kilometres of highway road per square kilometre, and population were selected as variables with impact on the average travel time. Based on results from linear regression analysis, benchmarks for the emergency transfer system that would effectively reduce travel time to the mean value of 57 min were identified: 26% pavement ratio of roads (percentage of paved road to general roads), and three tertiary care centres and 108 ambulances. CONCLUSION: Regional gaps in the travel time to tertiary care centres were identified in Japan. The systems we should focus on to reducing travel time were identified. Further reduction of travel time to tertiary care centres can be effectively achieved by improving these specific systems. Linear regression analysis showed that a 26% pavement ratio and three tertiary care centres are beneficial to prefectures with an average time longer than the mean score, to achieve a reduction of travel time. Measures for reducing travel time need to be considered in policy-making to re-evaluate the current locations of tertiary care centres to provide equality of access to emergency medicine.

Catchment Area, Health↗
PubMed2000

Travel time and concurrent-schedule choice: retrospective versus prospective control.

Six pigeons were trained on concurrent variable-interval schedules in which two different travel times between alternatives, 4.5 and 0.5 s, were randomly arranged. In Part 1, the next travel time was signaled while the subjects were responding on each alternative. Generalized matching analyses of performance in the presence of the two travel-time signals showed significantly higher response and time sensitivity when the longer travel time was signaled compared to when the shorter time was signaled. When the data were analyzed as a function of the previous travel time, there were no differences in sensitivity. Dwell times on the alternatives were consistently longer in the presence of the stimulus that signaled the longer travel time than they were in the presence of the stimulus that signaled the shorter travel time. These results are in accord with a recent quantitative account of the effects of travel time. In Part 2, no signals indicating the next travel time were given. When these data were analyzed as a function of the previous travel time, time-allocation sensitivity after the 4.5-s travel time was significantly greater than that after the 0.5-s travel time, but no such difference was found for response allocation. Dwell times were also longer when the previous travel time had been longer.

Animals↗