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PubMed1998

Travel medicine: helping patients prepare for trips abroad.

One third of persons who travel abroad experience a travel-related illness, usually diarrhea or an upper respiratory infection. The risk of travelers' diarrhea can be reduced by eating only freshly prepared, hot foods. Combination therapy with a single dose of ofloxacin plus loperamide usually provides relief from travelers' diarrhea within 24 hours. Using a diethyltoluamide (deet)-containing insect repellent and wearing permethrin-coated clothing can reduce the risk of malaria, yellow fever and other diseases contracted from insects. Routine immunizations such as tetanus, measles, mumps and rubella, and influenza should be updated if necessary before the patient embarks on the trip. Hepatitis A immunization should be administered to persons traveling to places other than Canada, Australia, New Zealand, Japan and western European countries. Typhoid vaccination should be considered for travelers going to developing countries. Yellow fever immunization is indicated for travelers going to endemic areas of South America and Africa. Malaria prophylaxis with chloroquine is indicated for travelers going to Mexico and Central America. Mefloquine is recommended for those traveling to areas where malaria is resistant to prophylactic treatment with chloroquine. Medical advice for patients planning trips abroad must be individualized and based on the most current expert recommendations.

Humans↗
PubMed2002

The seasonal daily travel in a group of Sichuan snub-nosed monkey (Pygathrix roxellana) in Shennongjia Nature Reserve, China.

The seasonal daily travel of a group of snub-nosed monkey (Pygathrix roxellana) was investigated using the group's straight-line distance method. The group was followed from dawn to dusk for 30 consecutive days during each season to encompass all aspects of daily travel patterns. The results showed that in Summer and Autumn, the mean daily travel distance (m) was significantly longer than in Winter and Spring. There was no significant difference in the mean daily travel distance between Summer and Autumn or between Winter and Autumn. The mean travel distance (m/hr) during daytime was significantly higher in Summer and Autumn than in Spring, and in Autumn than in Winter. The travel of the group in all seasons had similar patterns. Traveling showed morning and afternoon peaks, with a rest period at the noon in a day. Seasonal food availability, length of daytime, and mean travel distance (m/hr) during daytime might have contributed to the different daily travel distances in different seasons.

Animals↗
PubMed2005

Sexually Transmitted Diseases in Travelers.

International travelers engaging in casual sex are at risk for acquiring sexually transmitted diseases (STDs), including HIV. The frequency of international travel emphasizes the need for a travel sexual activity history to be included in the clinical assessment of any returned traveler. When formulating a differential diagnosis, the STD prevalence rates at the travel destination and the risk profile of the traveler and the sexual partner need to be considered. Casual sex with host country nationals residing in tropical and subtropical areas of the developing world increases the traveler's risk for acquiring STDs rarely seen in industrialized countries, particularly bacterial genital ulcer diseases. Pretravel counseling needs to include education on STD prevention. A post-travel STD diagnostic evaluation is indicated when casual sexual activity has occurred during travel, regardless of whether symptoms are present.

Journal Article↗
PubMed2000

Finger motion, wrist motion and tendon travel as a function of keyboard angles.

OBJECTIVE: This study assessed the impact of keyboard angles (in terms of Pitch, Roll and Yaw) on tendon travel and wrist and finger joint kinematics for the flexor digitorum profundus and flexor digitorum superficialis.DESIGN. A repeated measures, laboratory study was conducted. Independent variables were three Pitch angles, three Roll angles, three Yaw angles, and three keyboard separation distances. Dependent variables were tendon travel, wrist deviation, wrist and finger joint kinematics, and Borg comfort rating. BACKGROUND: The increased usage of computers and the risk of cumulative trauma disorders have led to the development of alternate keyboards. This study is a biomechanical assessment of several keyboard designs.METHODS. Lightweight wrist and finger goniometers were used to measure motion of the wrist in three planes, and for three finger joints. Fifteen experienced typists (eight women, seven men) typed a standard text on 30 keyboard conditions. Regression equations were used to calculate tendon travel from joint positions. RESULTS: Tendon travel is sensitive to changes in Pitch, Roll and Yaw angles with approximately 13% difference between the minimal and maximal tendon travel. A flat keyboard produced more tendon travel than keyboards with greater Pitch and Roll angles.CONCLUSIONS. There is a trade-off between wrist and finger positions; as the wrist extends more, the finger joints flex more to compensate. Keyboards imposed different trade-offs between the wrist and finger positions, affecting the overall tendon travel. Relevance Alternate keyboard designs can significantly affect tendon travel and may address reduced repetitiveness in typing by reducing the amount of tendon travel.

Adult↗
PubMed1991

Travel behavior of nursing home residents perceived as wanderers and nonwanderers.

A video-based observational methodology was used to assess the travel behaviors of 40 nursing home residents, 24 of whom were identified by nursing staff as wanderers. Travel was monitored continuously for 30 days, resulting in the recording of over 5,000 unassisted travel events. Four basic travel patterns were observed: direct travel (86.8%), lapping (11.6%), random travel (.9%), and pacing (.7%). Travel efficiency (percentage of direct travel) was significantly related to cognitive status (r = .56), with inefficient travel most prevalent in severely demented participants.

Aged↗
PubMed2001

Health status of Gypsy Travellers.

BACKGROUND: Although previous studies suggest that Gypsy Travellers have poorer health status and excess mortality compared with the general population, there is no epidemiological evidence using validated measures in this nomadic ethnic group. The aim of this study was to compare the health status of traditional Gypsy Travellers with norms from the UK population, and with a concurrent comparison group using the Euroqol health status measure (EQ-5D). METHODS: Eighty-seven adult Gypsy Travellers were matched for age and sex with English or Irish residents, registered with an urban general practice in an area of high social deprivation. Both samples completed the EQ-5D questionnaire by interview. A comparison was also made with normative data from the UK general population. RESULTS: Travellers had poorer health status than their settled counterparts on two of the five dimensions (mobility and activity) but not on the overall summary score. Travellers reported significantly poorer health than the matched comparison group on the EQ-5D visual analogue scale. Both the Travellers and the comparison group had much poorer health status on the EQ-5D index than the UK population norms, even when compared with the lowest socioeconomic group. CONCLUSIONS: Health status of Gypsy Travellers was significantly poorer than in the lowest socio-economic UK population group, but was not so markedly different from a concurrent, matched, socially deprived resident group. Gypsy Travellers did have poorer health status than matched comparators in relation to mobility, activity and perception of overall health. Quantitative assessment of health status in the Traveller community is feasible.

Activities of Daily Living↗
PubMed1995

Observational Study of Travelers' Diarrhea.

Background: European air travelers returning from Algeria, Egypt, Mexico, Morocco, and Tunisia were interviewed about their experience of travelers' diseases upon arrival in Brussels. Diarrhea was mentioned by 37% of the adults and 27% of the children. These subjects were questioned about the types of measures taken, type and duration of drug treatment (if any), and about duration of diarrhea and side effects experienced. Methods: Final analysis was performed based on 2160 interviews. The largest proportion of diarrhea was reported in the age group 15-24 years (46%). Results: The majority of the 2160 subjects had opted for drug treatment (81%): 927 subjects for loperamide alone, 235 for loperamide in combination with nifuroxazide, and 178 for nifuroxazide alone. Other drugs had been used less frequently. The median time to recovery was 2.4 days with loperamide compared to 3.2 days with nifuroxazide and to 3.4 days for the no-treatment group. Conclusions: A stratification of the results by severity of the diarrhea suggests a rank of antidiarrheal potency as follows: loperamide > nifuroxazide > no-drug treatment. The side effect with the highest incidence was constipation (2.4% with loperamide). (J Travel Med 2:11-15, 1995) Travelers' diarrhea is usually defined as the passage of at least three unformed stools per day or any number of such stools when accompanied by fever, abdominal cramping, or vomiting. The definition may be broadened to include more trivial bowel disturbance.1,2 The duration of this self-limited disease generally is 3 to 5 days. Medical intervention aims at shortening the duration of disease, thus allowing the sufferer to resume his or her usual activities at an early stage. A shortened period of recovery to physical well-being has obvious favorable economic implications if the traveler is on business and may help the maintenance of a desired level of quality of life while a traveler is on holiday. An observational study of various medical complaints made by European travelers about their stay in areas outside Europe (Algeria, Egypt, Mexico, Morocco, and Tunisia) was conducted. Air travelers returning from these areas between July 15 and August 16, 1992, were interviewed upon arrival at Brussels airport by means of a standardized questionnaire written up in lay language. As shown in Table 1, the total number of complaints in the adult group (>= 15 years of age, n = 5373) was 4919 and 446 in the pediatric group (n = 818). With fever as an exception, there were fewer complaints in children. Only approximately 50% of the travelers did not suffer

Journal Article↗
PubMed1996

Age-Specific Anti-Hepatitis A Virus Seroepidemiology in Italian Travelers: Indications for Anti-Hepatitis A Vaccination.

Background: Hepatitis A virus (HAV) circulation in the environment is decreasing in most industrialized Western countries. This decrease has lead to low seroprevalence rates in adults. As a consequence, many nonimmune unprotected travelers from areas of low prevalence are considered at risk of acquiring HAV infection when traveling to high HAV endemic areas in developing countries. The recent HAV inactivated vaccine has proved safe and effective, and its use in different geographic areas should be guided by local age-specific HAV seroprevalence rates. The aim of this paper is to describe the age-specific sero-epidemiology of HAV infection in travelers from a highly industrialized region in Northern Italy (Lombardy). Methods: Seven hundred and forty-four consecutive travelers aged from 20 to 59 years, subdivided in 10-year age groups, gave blood samples in the collaborative Health Centers in the Lombardy region and sera were tested for HAV IgG antibodies. A questionnaire was given to travelers that investigated alimentary habits and a history of previous travel. Results: Anti-HAV seroprevalence was 18.0%, 58.0%, 75.8%, and 89.5% in the 20-29, 30-39, 40-49, and 50-59 age groups, respectively. Age was the single most important determinant of anti-HAV seroprevalence. The influence of previous travels, eating shellfish, or ingestion of self-cultivated vegetables was ruled out by multivariate analysis. Conclusions: In the Lombardy region (Northern Italy), age specific anti-HAV seroprevalence rates are much higher than those reported in other Western European countries. The cost-benefit analysis suggested that travelers born after 1960 do not need serologic screening before vaccination. Whenever possible, however, HAV serologic screening is advisable for travelers born before 1960. However, the severity of the disease in older subjects, and the proved safety of HAV vaccination in immune subjects, may advise d'emblée HAV vaccination without prior screening, when serologic investigation is unfeasible because of lack of time or the unavailability of testing facilities.

Journal Article↗
PubMed2003

Randomised controlled trial of site specific advice on school travel patterns.

AIMS: To evaluate the effect of site specific advice from a school travel coordinator on school travel patterns. METHODS: Cluster randomised controlled trial of children attending 21 primary schools in the London boroughs of Camden and Islington. A post-intervention survey measured the proportion of children walking, cycling, or using public transport for travel to school, and the proportion of parents/carers very or quite worried about traffic and abduction. The proportion of schools that developed and implemented travel plans was assessed. RESULTS: One year post-intervention, nine of 11 intervention schools and none of 10 control schools had travel plans. Proportions of children walking, cycling, or using public transport on the school journey were similar in intervention and control schools. The proportion of parents who were very or quite worried about traffic danger was similar in the intervention (85%) and control groups (87%). However, after adjusting for baseline and other potential confounding factors we could not exclude the possibility of a modest reduction in parental concern about traffic danger as a result of the intervention. CONCLUSIONS: Having a school travel coordinator increased the production of school travel plans but there was no evidence that this changed travel patterns or reduced parental fears. Given the uncertainty about effectiveness, the policy of providing school travel coordinators should only be implemented within the context of a randomised controlled trial.

Bicycling↗
PubMed2006

Correlates of distances traveled to use recreational facilities for physical activity behaviors.

BACKGROUND: Information regarding how far people are willing to travel to use destinations for different types of recreational physical activity behaviors is limited. This study examines the demographic characteristics, neighborhood opportunity and specific-physical activity behaviors associated with distances traveled to destinations used for recreational physical activity. METHODS: A secondary analysis was undertaken of data (n = 1006) from a survey of Western Australian adults. Road network distances between respondents' homes and 1) formal recreational facilities; 2) beaches and rivers; and 3) parks and ovals used for physical activity were determined. Associations between distances to destinations and demographic characteristics, neighborhood opportunity (number of destinations within 1600 meters of household), and physical activity behaviors were examined. RESULTS: Overall, 56.3% of respondents had used a formal recreational facility, 39.9% a beach or river, and 38.7% a park or oval. The mean distance traveled to all destinations used for physical activity was 5463 +/- 5232 meters (m). Distances traveled to formal recreational facilities, beaches and rivers, and parks and ovals differed depending on the physical activity undertaken. Younger adults traveled further than older adults (7311.8 vs. 6012.6 m, p = 0.03) to use beaches and rivers as did residents of socio-economically disadvantaged areas compared with those in advantaged areas (8118.0 vs. 7311.8 m, p = 0.02). Club members traveled further than non-members to use parks and ovals (4156.3 vs. 3351.6 meters, p = 0.02). The type of physical activity undertaken at a destination and number of neighborhood opportunities were also associated with distance traveled for all destination types. CONCLUSION: The distances adults travel to a recreational facility depends on the demographic characteristics, destination type, physical activity behavior undertaken at that destination, and number of neighborhood opportunities. Knowing how far adults travel to undertake physical activity will assist in designing supportive neighborhoods and designing future ecological research.

Journal Article↗
PubMed2006

[Hospitals in Hesse in the view of enlightened travellers].

The "Hohen Hospitäler", hospitals founded by landgrave Philipp dem Grossmütigen during the years 1533-1542, were seen as an expression of greatest caritas in Early Modern times. These protestant institutions for the poor and sick underlings of Hesse were appreciated as charitable shelters by noblemen and commoners. This situation changed dramatically at the end of the 18th century. The first critics were travelling philosophers of the Enlightenment, who visited the "mad houses" of Hesse as well as other oddities. They published their experiences in travel reports. Although the hospitals as integrated institutions still cared for both psychiatric and somatic patients, these authors only concentrated on the mad inmates. The fact that these were kept in "dark and dirty cloistral corridors" was the central point of criticism. This negative situation was confronted by the travellers not only with a demand for more hygiene but also with a call for an academically trained physician. Furthermore, they claimed for dissecting deceased patients in order to explore the nature of madness. A comparison of these travel reports with the first psychiatric publications of the early 19th century discloses a literary discourse. It leads from the reports of travellers with a general interest to specialist literature of early psychiatry. Obviously it had a formative influence on the self-conception of this new medical field, which benefited from the criticism concerning the allegedly inhumane conditions in the old hospitals. Three questions follow from this statement: 1. Which were the images produced or reproduced by the travellers in their reports? 2. Which were the standards against which the critics measured their reports? 3. In how far were the philanthropic aims of the enlightened travellers related to the self-conception of the hospitals and their inmates? Travelling reports are compared with the circumstances in the hospitals. This comparison throws light in the "invention" of the genre psychiatry. Furthermore, it makes clear how ambiguous the charitableness of the travelling philosophers of the Enlightenment was.

Germany↗
PubMed2001

Guidelines for malaria prevention in travellers from the United Kingdom for 2001.

These guidelines on malaria prevention are designed to aid health care workers who advise travellers, particularly those who will be overseas for less than a year. The present, and any future, revisions are the responsibility of the Advisory Committee on Malaria Prevention in UK travellers (ACMP; membership given at the end of the Guidelines). This has replaced the consensus meetings which produced earlier versions from 1980 to the the 1997 version. The guidelines are in three parts. The first part is a summary that emphasises modifications to the advice given in the last set of guidelines, published in 1997. The second part discusses the issues addressed in formulating the guidelines. Oversimplified lists of recommendations by country can be misleading. The second part also addresses the health care worker's consultation with prospective travellers. Doctors, practice nurses and pharmacists are asked to read this section to ensure that due attention is paid to the traveller's history and destination. The third part gives specific recommendations for travellers to specific destinations and some details of individual drugs. Fuller information on some drugs now less used was given in earlier versions of the guidelines. These guidelines reflect experienced professional opinion. Data are inadequate for unequivocal views to be given on several issues, but all available evidence has been taken into consideration. There is often a range of acceptable options, but to meet the requests of general practitioners the guidelines aim to give one recommended option and state the alternatives, suggesting when and how different regimens can be used to good effect. However, there are now several options for effective prophylaxis of highly chloroquine-resistant falciparum malaria, and the choice between them will depend on details of the journey and individual preferences. Decisions on the terms under which different drugs are licensed for use are the responsibility of the Licensing Authority, advised by the Committee on Safety of Medicines and not of the ACMP. The guidelines should therefore be read as a supplement to and not as a substitute for the relevant data sheets. In concept and practice, chemoprophylaxis lies somewhere between vaccinations (for which people expect governments to lay down schedules) and treatment of ill people (which is determined by individual clinical need and choice). The risks of malaria need to be balanced against the risks of the preventive measures, on the basis of the data available. Travellers may ask for an explanation of these risks and doctors and practice nurses need to be well informed and able to present this information to travellers. The second part of these guidelines may also be of use to prospective travellers who wish to read about the options themselves. All readers are recommended to read part two in its entirety to get a balanced picture.

Antimalarials↗
PubMed1994

Cost-effectiveness analysis of vaccination against hepatitis A in travellers.

Hepatitis A virus (HAV) infection is a substantial risk for travellers from low endemic countries to high endemic destinations. Costs and effects of alternative options for prevention were compared using formal decision analysis. General indications for the optimal prevention of hepatitis A were derived from a cost-effectiveness analysis. Various possible strategies for prevention of hepatitis A in travellers were compared to doing nothing: active immunisation using either the existing vaccine (HAVRIX 720) or the new vaccine (HAVRIX 1440); first screening for the presence of HAV antibodies and then vaccinating only susceptibles; and passive immunisation with immunoglobulin. Using a number of assumptions as baseline and for an average duration and frequency of travel from low to high endemic countries, threshold values were obtained for the choice between passive and active immunisation. Passive immunisation remains the most cost-effective prevention strategy for those expected to travel not more frequently than twice over the next 10 years and for short stays (7,000-9,000 pounds per infection prevented). For travellers expected to travel three or more times in 10 years or for trips exceeding a period of 6 months, active immunisation before the first trip is the most cost-effective option (7,500 pounds or less per infection prevented). When travel frequency increases to once a year in the next 10 years, costs per infection prevented decrease to about 3,500 pounds. Screening for the presence of antibodies before vaccination is only justified for older travellers or those leaving from countries with moderate endemicity, i.e., with an average HAV prevalence of at least 30%.

Cost-Benefit Analysis↗
PubMed2005

[Travel behavior of the Austrians -- review and future trends].

In the past decades, international travel has expanded exponentially and therefore its economic significance has increased. This development has been made possible purely by the enormous increase in scheduled and charter flights. Travel frequency has also increased among practically all age groups. The manifold travel destinations extend virtually to the whole globe. Europe has been able to maintain its status as premier destination for tourists. Europe has a 50% share of the global income from international travel. The clear up-swing of the travel branch in the year 2002 could not be continued in 2003. The desire to travel was present, but the trend to short travel has continued. Three years after the events of 11 September 2001, experts again expect an increase in travel frequency and intensity on the part of European tourists for the next years. The World Tourism Organisation prognosticates an enormous growth in international tourist arrivals up to 2020. Despite continuing globalization, international tourism will continue to take place primarily within the individual regions of the world.

Austria↗
PubMedDate not supplied

Psychiatric morbidity in travelers to Honolulu, Hawaii.

To investigate the phenomenon of acute psychiatric decompensation in travelers, charts of all psychiatric-emergency patients with a history of recent travel involving time-zone changes were reviewed at a major medical center in Honolulu, HI. Charts of a control group with no history of travel were also reviewed. Significantly more travelers than controls showed symptoms of depression and mania (P < .012). East-bound travelers were significantly more likely to show symptoms of mania than controls (P < .001). In an eastbound-versus-westbound comparison, significantly more eastbound travelers showed symptoms of mania, whereas significantly more westbound travelers showed symptoms of depression (P < .05). These findings support the phase-advance hypothesis of depression. Psychosocial and biologic factors that may contribute to psychiatric decompensation in travelers are discussed.

Acute Disease↗
PubMedDate not supplied

Travel medicine--prevention based on epidemiological data.

In travel medicine efforts should be concentrated on preventive measures that are necessary, and travellers should be spared the side effects, costs and stress of superfluous measures. Excess mortality abroad is mainly due to traffic and swimming accidents, indicating the need for appropriate control strategies. The morbidity in travellers to developing countries is high, and is primarily due to traveller's diarrhoea. As prophylaxis is ineffective or unrealistic, and as travellers often need fast relief, it is recommended to include loperamide and an antimicrobial agent in the travel kit. Recent studies have shown that the incidence rate per month of Plasmodium falciparum malaria in Africa may reach 24/1000. The most frequently occurring immunizable diseases are hepatitis A (3/1000) and hepatitis B (0.8/1000). For many tourists and some expatriates pre-travel advice (hygiene, measures against mosquito bites, etc.) as well as chemoprophylaxis and immunization can be limited to these infections, but those travelling or staying outside large centres need additional measures.

Developing Countries↗
PubMed2006

[Influenza and travelling].

There is a risk for the traveler to acquire an exotic disease when traveling and to introduce it in non-endemic areas after returning. Influenza is a good example of such a disease. The incidence of flu in travelers is unknown. However, numerous outbreaks of flu have been reported in groups of travelers: package tours, pilgrims, elderly people, and travel by plane or cruise ships. Nowadays vaccination against flu is not recommended in travelers unless they belong to groups at risk for flu. Nonetheless vaccination against flu is difficult to apply to travelers due to problems in vaccine availability and inadequacy between vaccine strains and strains responsible for ongoing outbreaks in the opposite hemisphere. This vaccination seems important to travelers because flu may impair their vacation. In addition, it is also interesting for the community if it limits the spread of flu worldwide.

Adolescent↗
PubMed2005

Running a travel clinic.

Annually, 1.5 billion passengers travel by air and 700 million travellers cross international borders, and around 50% of them can become unwell in some way. In today's world travel is important for business people as it is for humanitarian groups and immigrants, as it is also for holiday makers. All travellers need to be aware of potential health problems and consequences of their travel, and they need up to date authoritative advice. Travel health clinics provide this advice in a structured, practical and authoritative format. Such a format is discussed, and applied with the skills of medical, nursing and management practitioners. The four steps for giving travellers the foundation for healthy journeys are all explored: to assess pre-health, to analyse itineraries, to select appropriate vaccines, and to provide education about the prevention and self-treatment of travel-related diseases.

Ambulatory Care Facilities↗