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PubMedDate not supplied

Corporate travel medicine: benefit analysis of on-site services.

BACKGROUND: Corporations with employees who travel internationally address their travel-related medical needs in a variety of ways. Options utilized include corporate medical departments, local health departments, and local clinics, both contracted and independent. METHODS: A travel clinic at a university medical center routinely provided preventive travel medicine services for many of the local companies. Two of these companies had on-site medical clinics which routinely saw patients for occupational and personal health reasons. At these companies , the university travel clinic assisted in moving employee travel medicine services to the on-site clinic. Direct and indirect costs for new, predeparture employee travel care at each company were compared before, and after, the move on-site. RESULTS: When measured per patient, total cost savings associated with the on-site travel clinic were greater than 15% at both companies (17%, 25%), primarily due to the value of the employees' time saved with decreased travel. Utilization increased at one company by 24% over the first 8 months and lead to higher overall cost, but this cost increase was only 4%. Informal assessments of the value of the on-site service at both companies was uniformly positive. CONCLUSION: For certain corporate settings, on-site clinics may be effective ways of providing travel medicine services.

Ambulatory Care Facilities↗
PubMedDate not supplied

Problems and risks of unsolicited e-mails in patient-physician encounters in travel medicine settings.

BACKGROUND: International travel and use of modern information technology are expressions of modern life style. Seeking on-line travel health advice via E-mail for preventive (teleprevention) or diagnostic reasons may become increasingly popular among patients with financial resources and Internet access. This study was undertaken to compare the behavior of travel clinic or tropical medicine physicians and other providers of travel-related medical information services toward unsolicited E-mails from fictitious patients in pretravel and post-travel scenarios. We also wanted to test the potential of E-mail advice for preventive medicine (teleprevention), and to find out how the "Good Samaritan Law" is observed. METHODS: Two different E-mails were posted to E-mail addresses of 171 physicians (members of travel health and/or tropical medicine societies) and services offering advice on travel health issues identified by an AltaVista search. These E-mails, from two different fictitious travelers, were asking for advice regarding malaria prophylaxis in a pretravel scenario and describing symptoms suggesting acute malaria. RESULTS: Of the contacted addresses 43.3% and 49.7% respectively, replied to the pre- and post-travel E-mail. Of those suggesting antimalarial chemoprophylaxis in the pretravel scenario, 13.2% proposed inadequate regimens, and at least 3.5% of the post-travel replies were inappropriate. The "Good Samaritan Law" was observed by a significant number of physicians. CONCLUSION: Both patients and physicians have to be aware of the limitations of E-mail communication. Guidelines protecting physicians against legal and ethical consequences of this new communication technology are urgently needed.

Computer Communication Networks↗
PubMedDate not supplied

Evaluation of the Coca-Cola company travel health kit.

BACKGROUND: The Coca-Cola travel health kit has been used for about one decade for international travelers and required evaluation to see if the items contained were appropriate for the employees. METHODS: Two hundred thirty-four travelers were sampled and filled out a voluntary survey including questions about demographic information, travel history, and usage and value of the contents of the travel health kit. RESULTS: One hundred eighty-one surveys were returned; 65% of the respondents were male, and the majority of travelers were between the ages of 36 and 45 years. The most useful items were analgesics and medications used for gastrointestinal problems. In general, the items identified as being the least useful were those requiring specialized use by a medical practitioner, such as needles and syringes. Suggestions of items to be added to the kit included vitamins, cough drops, sleep aids, and eye drops. A surprising result that Coca-Cola employees expressed the desire for brand name rather than generic items. CONCLUSIONS: Evaluation of the Coca-Cola Company travel health kit revealed it to be very useful to most corporate travelers. Suggestions that were made will be taken into consideration in designing a new kit, and consideration is being given to whether a basic travel health kit should be provided to which travelers can add other items depending on their personal needs.

Adult↗
PubMedDate not supplied

Travel health advice as recalled by 552 tourists to Peru.

BACKGROUND: The process of health advice/education affects two groups of people, the health professionals who give the advice and the recipients who are offered this advice. The content of travel health advice has been investigated many times and has often been found to be of varying quality. However, little is known about how much advice clients recall. This study examined the travel health advice-seeking behavior of travelers to Peru, the degree of recall, and the amount of advice remembered. METHOD: This descriptive study was based on questionnaires completed by 552 travelers to Peru while in Cusco. Information was collected on travel health-seeking behavior, sources of advice, tourists' degree of recall of information, and advice remembered. RESULTS: Sixty-two percent (n=492) claimed to always seek health advice before traveling whereas 96% sought advice only for this specific trip. Most advice was obtained from travel clinics (37.7%), general practitioners (20.2%), or a guidebook (19.6%). Most tourists (60.4%) claimed to recall most of the advice; 23.4%, everything; 15.5%, some; and 0.6%, none (n=470). The number of items remembered ranges from 0 to 11. CONCLUSION: Findings from the study indicated that the usefulness of travel health advice depends on the quality of information given and the recall of this advice. Both aspects need to be considered in order to be certain that the objective of travel health advice is met, which is the informed and safe travel health behavior. Further research is recommended.

Adult↗
PubMedDate not supplied

Travel in pregnancy: pregnant women's experiences and knowledge of health issues.

BACKGROUND: Long-distance travel is becoming increasingly common, and there are few evidence-based recommendations for pregnant women in this area. We aimed to investigate our patients in the third trimester to establish how common foreign travel was, how much knowledge they had, and where they had obtained information. METHODS: We performed a questionnaire survey of our patients in the third trimester in 2001 at the time of a routine ultrasound scan. All women booked to deliver in our unit were included. RESULTS: We received 138 out of a possible 151 replies, and over half had traveled abroad in this pregnancy. Over a third of the trips were outside Europe. Over a third of the women traveled without sufficient insurance. Only a third sought advice prior to travel, and the commonest people consulted were their general practitioner and midwife. In general, knowledge on the subject was good, and was better among those who traveled. However, a third of the total group, and a quarter of those who traveled, did not know that air travel increased the risk of venous thromboembolism. CONCLUSIONS: Long-distance travel is common in pregnancy, and women are not always adequately prepared in terms of insurance and travel advice. More studies are required to provide evidence-based guidelines for this increasingly large proportion of women.

Aircraft↗
PubMedDate not supplied

High rates of substance abuse among long-term travelers to the tropics: an interventional study.

BACKGROUND: Drug abuse constitutes a worldwide problem. The purpose of this study was to investigate the characteristics of illicit drug use during long-term travel to the tropics, and to estimate the effects of antidrug brochures provided before travel on the use of drugs during travel. METHODS: An interventional study was done on 1,000 travelers to the tropics aged 18 to 30 years. Pretravel brochures explaining the hazards of drug abuse were provided to 500 of them. A control group of 500 travelers did not receive the brochures. Questionnaires exploring drug abuse habits were sent to all travelers after their return. RESULTS: Among 223 travelers (108 and 115 of the intervention and control groups, respectively) who returned their questionnaires, 82 (36.8%, 95% CI 30.5-43.5%) had experienced illicit drug use during their trip, whereas only 52 of them had tried drugs before (p<0.01). More travelers had used drugs in the Far East (43.3%) than in South America (25.6%, p< 0.01). The strongest predictors of drug abuse were: the compound of female gender and travel to Asia (odds ratio (OR), 4.3), education <or=12 school years (OR 3.5), age <or=25 years (OR 2.7), and no malaria prophylaxis (OR 2.6). The brochures failed to decrease the rate of drug abuse (38.9% vs. 34.8% in the control group, p=NS). CONCLUSIONS: More than one-third of young Israelis who travel to the tropics use illicit drugs. For many, the trip was their first encounter. Brochures as a sole agent are inadequate, and further means are needed to reduce this alarming trend.

Adolescent↗
PubMedDate not supplied

A description of travel medicine in general practice: a postal questionnaire survey.

BACKGROUND: Travel-related diseases are important aspects of public health. The number of UK residents traveling abroad is increasing at a rate of 16% a year, thereby increasing exposure to travel-related morbidity. Provision of comprehensive pretravel health advice is essential to reduce this trend. In the UK, pretravel health advice is predominantly provided through general practices. METHODS: A postal questionnaire was sent to all 91 general practices in South Cheshire Health Authority. The questionnaires were to be completed by the lead advisor in travel medicine for each practice. Questions were asked on service provision, training and reference resources used, subjects advised on, and health promotion material used. Nonresponders were contacted and sent a further questionnaire. RESULTS: A response rate of 86% (78/91) was achieved. Of the lead advisors, 97% were nurses and 3% general practitioners. Thirty-eight sources of advice were quoted, the commonest of which comprised wall immunization charts (72%). Duration of consultation ranged from less than 5 min to over 30 min, with a median and mode of 11 to 15 min. Most respondents reported advising on most travel-associated risks, 40% of practices lacked a protocol, and 83% of providers had attended a training course on travel medicine for 2 days or less. CONCLUSIONS: This survey identified inadequacies of training and use of multiple sources of reference which may lead to inconsistencies in advice. Most practitioners could not define their workload in travel medicine. For effective protection of travelers, a careful risk assessment, clear risk communication and health education with detailed health promotion are necessary, but these are not likely to be provided within an average consultation time of 11 to 15 min. There is no evidence of consistent governance, planned training and monitoring of service quality of travel medicine practice. This may be due to lack of a national policy on best practice and guidance in this subject. National protocols with validated information resources, set standards of training, along with adequate consultation time for educating, advising, and prescribing, will lead to improved health of the traveling public.

Communicable Disease Control↗
PubMedDate not supplied

Enteric fever in Israeli travelers: a nationwide study.

BACKGROUND: Enteric fever (EF) has become a travel-related disease in industrialized countries. The possible effects of vaccination on typhoid epidemiology in travelers are unknown. We compared the incidence and clinical and microbiologic findings in travelers returning with EF, according to pretravel vaccination status and vaccine type. METHODS: We performed a nationwide descriptive analysis of EF incidence in Israeli travelers; EF is a notified disease in Israel. Data from 1995 through 2003 were evaluated; all cases of EF acquired during recent travel (6 wk) were included. From 1995 to 1999, the Ty21a oral vaccine was used exclusively in Israel. It was replaced with the Vi vaccine from 2000 to 2003. Patients with pretravel typhoid vaccination were compared with unvaccinated patients, and according to vaccine type. RESULTS: Seventy-eight cases met our criteria. The causative agents were Salmonella typhi in 79.5% and Salmonella paratyphi A in 20.5%; 74.4% were acquired by travelers to the Indian Subcontinent. S. paratyphi A accounted for 10.5% of cases among Ty21a vaccinees as compared with 47.4% among Vi vaccinees (p = .02). For the Indian Subcontinent, the general attack rate of S. typhi and S. paratyphi A during the period of vaccination with Ty21a was 2.37 in 10,000 and 0.26 in 10,000 travelers, respectively, whereas during the period of vaccination with Vi, the attack rate was 1.40 in 10,000 and 0.79 in 10,000. There were no deaths; however, more complications and relapses occurred in the S. paratyphi A group. CONCLUSIONS: Among Israeli travelers S. typhi infection is declining whereas S. paratyphi A is increasing, with most cases occurring in vaccinated travelers. Prior typhoid vaccination did not modify the course of the disease. S. paratyphi A infection in travelers is not milder than S. typhi infection. Although this is not a prospective, controlled, randomized trial, it appears that the Ty21a vaccine may be less effective for S. typhi but may offer some protection against S. paratyphi A. Sequential vaccination with the available oral and Vi vaccine may merit consideration. A more effective vaccine for S. typhi and S. paratyphi A is urgently needed.

Chi-Square Distribution↗
PubMed1999

Hepatitis E seroconversion in United States travelers abroad.

Sporadic cases of symptomatic hepatitis E virus (HEV) infection have been reported in United States travelers to developing countries, including Mexico and Pakistan. To evaluate the risk of exposure in United States travelers, 356 patients seen in our Travel Clinics were tested for antibodies to HEV before and 6 weeks after traveling. Samples obtained 6 months after traveling were available for 211 travelers. IgG and IgM antibodies to HEV were assayed with HEV ELISA diagnostic kits containing 3 recombinant antigens expressed in Escherichia coli representing immunodominant epitopes within open reading frames 2 and 3 of HEV. Nine patients were IgG seropositive in specimens obtained before travel. Four individuals seroconverted. In all 4 patients, IgG seroconversion was demonstrated in samples obtained at least 6 months after return. Samples obtained 6 weeks after return were seronegative for HEV in all 3 patients for whom such samples were available. Travel destinations were diverse: Thailand, China, Russia, and Peru. These data are consistent with an infection acquired while traveling. None of the seropositive subjects reported any symptoms of hepatitis before or after travel. In the absence of overt disease, these results imply that exposure to HEV resulted in subclinical infections.

Adult↗
PubMed2005

Health disparities among travelers visiting friends and relatives abroad.

For an estimated 10 million trips abroad by U.S. residents in 2002, "visiting friends and relatives" (VFR) was a purpose for travel. Made up largely of foreign-born U.S. residents and their children, this population shows disparities in the number of reported cases of many preventable travel-related illnesses compared with people who travel for other purposes, such as tourism. High-risk illnesses in VFR travelers include childhood vaccine-preventable illnesses, hepatitis A and B, tuberculosis, malaria, and typhoid fever. Gaps in the prevalence of disease and access to care both between countries and within the United States uniquely influence disease risk in this population of travelers. We describe this population, a framework for understanding travel-related health disparities, and recommendations for improving the effective delivery of preventive travel-related care to VFR travelers. In addition to transnational efforts to control and eradicate disease, preventing illness in U.S. resident VFR travelers requires focused efforts to remove barriers to their care. In the United States, barriers exist at the systems level (for example, low insurance coverage), patient level (for example, misperception of disease risk), and provider level (for example, inadequate knowledge of travel medicine).

Communicable Disease Control↗
PubMed2000

From Livingstone to ecotourism. What's new in travel medicine?

OBJECTIVE: To review recent developments in the field of travel medicine and to outline the knowledge and resources family physicians need for providing health advice to travelers headed for tropical or developing countries. QUALITY OF EVIDENCE: Personal files; references from review articles and from a recent textbook of travel medicine; current guidelines on pretravel advice; and a review of the 1996 to 1999 MEDLINE database using "travel medicine" as a term and subject heading, "trave(l)lers' diarrhea" as a text word and subject heading, "immunization + travel," and "malaria + chemo prevention" were used as information sources. Priority was given to randomized controlled trials and recommendations of expert or national bodies. MAIN MESSAGE: Some elements of travel medicine, such as malaria chemoprophylaxis, have become more complex. Some valuable new preventive measures, such as hepatitis A vaccine, treated bed nets, and antimalarial drugs, have become available. Some health risks, such as cholera, have been overemphasized in the past, whereas others, such as tuberculosis and sexually transmitted diseases, have been underemphasized. Information sources relevant for providing travel health advice have improved and expanded. Canadian evidence-based guidelines addressing most important travel health issues are now available. CONCLUSIONS: Travel medicine is a rapidly evolving field. Physicians intending to provide health advice to travelers to high-risk parts of the world should be well prepared and have access to good, up-to-date information.

Delivery of Health Care↗
PubMed2003

Travel and the risk of symptomatic venous thromboembolism.

Whether long-distance travel and symptomatic venous thromboembolism (VTE) are associated is debated. On the basis of the available literature a fair risk estimate cannot be obtained. We estimated an accurate odds ratio for the relationship between recent travelling and symptomatic VTE. From three case-control studies consisting of 788 and 170 patients with clinically suspected deep vein thrombosis (DVT) and 989 patients with clinically suspected pulmonary embolism (PE) referred for diagnostic work-up, a pooled odds ratio for the relation between travel and symptomatic VTE was calculated. Cases were patients in whom the diagnosis was confirmed according to a diagnostic management strategy, whereas controls were patients in whom the diagnosis was excluded and who had an uneventful clinical follow-up. Patients were seen in the period April 1997 to September 2000. Travel history was recorded prior to diagnostic work-up. The pooled odds ratio for the association between any travel and symptomatic venous thromboembolism was 0.9 (95% CI: 0.6-1.4). The median travel time was 7 h (quartile range 4 to 10 h). Separate analyses performed for different types of transport (plane, car, bus or train) yielded comparable odds ratios. The analysis for duration of travelling showed an increased odds ratio of 2.5 (95% CI: 1.0-6.2) in the category of 10-15 h of travelling. This study shows that the average traveller does not have an increased risk for symptomatic venous thromboembolism. Only very long travelling (more than 10 h) may be associated with venous thromboembolic disease.

Adolescent↗
PubMedDate not supplied

Immunizations for foreign travel.

One of the most important aspects of preparing travelers for destinations throughout the world is providing them with immunizations. Before administering any vaccines, however, a careful health and immunization history and travel itinerary should be obtained in order to determine vaccine indications and contraindications. There are three categories of immunizations for foreign travel. The first category includes immunizations which are routinely recommended whether or not the individual is traveling. Many travelers are due for primary vaccination or boosting against tetanus-diphtheria, measles-mumps-rubella, pneumococcal pneumonia, and influenza, for example, and the pre-travel visit is an ideal time to administer these. The second category are immunizations which might be required by a country as a condition for entry; these are yellow fever and cholera. The final category contains immunizations which are recommended because there is a risk of acquiring a particular disease during travel. Typhoid fever, meningococcal disease, rabies, and hepatitis are some examples. Travelers who are pregnant or who are infected with the human immunodeficiency virus require special consideration. Provision of appropriate immunizations for foreign travel is an important aspect of preventing illness in travelers.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Travel health nursing: expanding horizons for occupational health nurses.

Pre-travel care, with its focus on disease prevention and health promotion, is the cornerstone of travel health nursing practice. Pre-travel nursing services include risk assessment, immunizations, health counseling, and referrals. Individual travel health and safety risks vary and depend upon a number of different factors. These include: traveler health status, destination, trip duration, season of travel, type of accommodation, trip activities, and prevention efforts. More than 35% of U.S. international travel is business travel. Occupational health nurses have an important role to play to keep traveling employees, including frequent flyers, long stay expatriates, and special needs travelers, healthy, safe, and productive in the "global marketplace."

First Aid↗
PubMed1989

Health hazards of international travel.

The growth of travel and the increasing numbers of those affected by travel-related illnesses, some of a serious nature, will cause this subject to demand the attention of the medical profession, the travel trade, travellers themselves and the health authorities of countries receiving tourists. Provision of appropriate advice for the traveller is a shared responsibility, best channelled mainly through travel agencies; it can moreover be shown to be cost-beneficial. Continued monitoring of illness in travellers and provision of information systems geared to this problem and its prevention are fully justified. They should be based on traditional channels of communication and currently-available modern technology, and be readily accessible to medical and related workers. Increased collaboration between medical workers, health educators and those involved in the travel trade would be a positive and useful contribution towards the reduction of illness and discomfort among travellers and the associated expense incurred by the various national health services concerned. There are clearly economic benefits from the development of international tourism, but these have to be balanced in countries accepting tourists by attention to the prevention of illnesses associated with travel.

Adolescent↗
PubMed1993

[Real information needs of the traveller before his departure. Results of a survey by questionnaire].

This study is based upon 727 questionnaires completed by French travellers 10 days after intercontinental travel. The response rate was 40%. Two out of 5 travellers had generally mild health problems: fever (12%), diarrhoea (36%). Forty-six of them took drugs, which they had brought with them during their travel. Ten per cent had a satisfactory visit to a local physician. Medical informations given before departure appears to be sufficient, useful and relevant in more than 90% of cases. The traveller would like to receive them from his own physician or from vaccination centers. Other informations as insurance, assistance, administration, finances, appeared to have been incorrectly perceived by 20% of the travellers. The travel agent is the one who should provide adequate information. The traveller, in general, plans to do more travelling for his own well being if not for his work. Would not the bigger risk for him be "not to travel at all".

Adult↗
PubMed1999

Genetic basis of transferase-deficient galactosaemia in Ireland and the population history of the Irish Travellers.

Transferase-deficient galactosaemia, resulting from deficient activity of galactose-1-phosphate uridyltransferase (GALT), is relatively common among the Travellers, an endogamous group of commercial/industrial nomads within the Irish population. This study has estimated the incidence of classical transferase-deficient galactosaemia in Ireland and determined the underlying GALT mutation spectrum in the Irish population and in the Traveller group. Based upon a survey of newborn screening records, the incidence of classical transferase-deficient galactosaemia was estimated to be 1 in 480 and 1 in 30,000 among the Traveller and non-Traveller communities respectively. Fifty-six classical galactosaemic patients were screened for mutation in the GALT locus by standard molecular methods. Q188R was the sole mutant allele among the Travellers and the majority mutant allele among the non-Travellers (89.1%). Of the five non-Q188R mutant alleles in the non-Traveller group, one was R333G and one F194L with three remaining uncharacterized. Anonymous population screening has shown the Q188R carrier frequency to be 0.092 or 1 in 11 among the Travellers as compared with 0.009 or 1 in 107 among the non-Travellers. The Q188R mutation was shown to be in linkage disequilibrium with a Sac I RFLP flanking exon 6 of the GALT gene. This represents the first molecular genetic description of classical transferase-deficient galactosaemia in Ireland and raises intriguing questions concerning the genetic history of the Irish Travellers.

Cohort Studies↗
PubMed1995

Frequency of Travel of Adults Infected with HIV.

Background: Little is known about the frequency and pattern of travel in the HIV-infected population. Method: A test questionnaire administered to patients cared for at a public hospital HIV clinic examined the frequency, destinations, and motivations for travel of persons with HIV disease. Results: Of 89 persons surveyed, 46% had traveled within the preceding 2 years within the United States for a minimum of 1 week, or to a foreign destination. Forty patients (45%) had traveled to a mean of 3.4 destinations within the United States for an average trip duration of 16 days. In addition, 18 patients (20%) had traveled to at least one foreign country for an average of 20 days. Of the 25 foreign destinations that were specified, 15 (60%) were in lesser developed countries. Patients stated that they undertook 30% of their trips because they thought it was their last chance to travel. At the time of completion of the survey, the majority of those patients who had traveled were severely immunosuppressed (median CD4+ count, 120/mm3). Conclusions: These data provide information by which the clinician can anticipate the health care needs of patients who travel and develop appropriate travel medicine guidelines. (J Travel Med 2:85-88, 1995)

Journal Article↗