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PubMed1996

Rural human immunodeficiency virus health service provision. Indications of rural-urban travel for care.

We studied the travel of rural individuals positive for human immunodeficiency virus (HIV) to urban areas for HIV diagnosis and for ambulatory and inpatient HIV-related health services. We surveyed all (N = 84) identified HIV-positive adults (aged 18 years or older) residing in rural central and eastern Kentucky. Sixty-three individuals completed the survey, for a response of 75%. Although 60 respondents (95%) were living in a rural area at 18 years of age, 23 (37%) of the survey sample lived in urban areas at the time of their initial HIV diagnosis. Of the respondents, 13 (21%) traveled from rural areas to urban areas for their initial diagnosis of HIV. Forty-seven respondents (74%) traveled outside their county for HIV-related ambulatory care, with 40 respondents (64%) traveling to an urban area. The mean travel time required to obtain care for those who traveled to an urban area was almost 2 hours. Primary reasons for travel for ambulatory care include confidentiality concerns, belief that their physician was not knowledgeable enough about HIV, and referral to an outside physician. Increased training of rural primary care physicians regarding the psychosocial and biomedical aspects of HIV is suggested.

Adult↗
PubMed1991

Analysis of Escherichia coli isolates from subjects with travellers' diarrhoea using DNA probes and serotyping.

Escherichia coli isolated from faeces of 54 healthy volunteers who visited Tunisia for eight days were examined. These volunteers participated in a randomized double-blind placebo-controlled study to establish whether ciprofloxacin could prevent travellers' diarrhoea. Escherichia coli strains isolated before travel, during episodes of travellers' diarrhoea, immediately after return and five weeks after return were serotyped and tested for the presence of virulence genes indicating diarrheogenic properties by hybridization with a set of four non-radioactively labelled DNA probes. Subjects receiving ciprofloxacin prophylactically to prevent travellers' diarrhoea were asymptomatic and no Escherichia coli could be cultured shortly after return home. Sixty-four percent of subjects (18/28) who did not receive antibiotic prophylaxis suffered from travellers' diarrhoea. Hybridization tests detected 8 enterotoxigenic Escherichia coli strains producing heat stable toxin, 13 enterotoxigenic strains producing heat labile toxin and 10 strains which produced both heat labile and stable toxin. Of the 31 probe positive strains, 29 (94%) were cultured from 11 volunteers with travellers' diarrhoea. A bacterial cause was thus determined in 61% of the volunteers who experienced travellers' diarrhoea.

Adult↗
PubMedDate not supplied

Traveler's diarrhea.

Travelers' diarrhea is common. Between 8% and 50% of travelers develop diarrhea; incidence depends on the country visited. The attack rate is highest for travelers from a developed country who visit a developing country. Children are at particular risk. Travelers' diarrhea is usually acquired through ingestion of fecally contaminated food and water. Most cases are due to a bacterial pathogen, commonly, Escherichia coli, and occur within the first few days after arrival in a foreign country. More than 90% of episodes develop within the first 2 wk of initiation of travel. Dehydration is the most common complication. Water and electrolyte replenishment is important and can usually be accomplished with an oral rehydration solution. Judicious use of an antimotility agent and antimicrobial therapy reduces the duration and severity of diarrhea. Pretravel education on hygiene and on the safe selection of food items is important in minimizing episodes. Dukoraltrade mark (Aventis Pharma Ltd., Auckland, New Zealand) vaccine should be considered for travelers who are 2 y of age or older and who will be visiting an area associated with risk of infection due to enterotoxigenic E coli or Vibrio cholerae. Typhoid vaccine is recommended for travelers who will be visiting areas with poor sanitation and hygiene.

Anti-Infective Agents↗
PubMed2003

Does air travel affect pregnancy outcome?

METHODS: To evaluate if air travel affects pregnancy outcome, all women with singleton, non anomalous fetuses, admitted for delivery at a gestational age >20.0 weeks over a 6-month period were asked if they traveled by airflight during pregnancy, including details of the destination and length of their flights and any complications during the travel. Pregnancy outcome was obtained by chart review. Statistical analysis included Student's t-test, Mann-Whitney U test, chi square, Fisher's exact test where appropriate, and linear and logistic regression analysis, with p<0.05 considered significant. RESULTS: Two hundred twenty-two women were studied. Of these, 53% ( n=118) traveled at least once during pregnancy (median 2 flights, range 1-12). The first flight was taken at a mean +/- standard deviation gestational age of 13.3+/-7.6 weeks with average flight lasting 4+/-2 h. There were no differences in gestational age at delivery (39.1 vs. 38.4 weeks, p=0.07), neonatal birthweight (3,379 vs. 3,273 g, p=0.24), or rates of vaginal bleeding (2% vs. 5%, p=0.26), preterm delivery <37 weeks (9% vs. 14%, p=0.29), preeclampsia (5% vs. 6%, p=0.76), neonatal intensive care unit admission (13% vs. 16%, p=0.56), or cumulative adverse obstetric outcome ( p=0.61) between those who did and did not air travel during pregnancy. Power analysis demonstrated that a sample size of 2,803 women in each group would be necessary to show that air travel has a protective effect against adverse pregnancy outcome (alpha = 0.05, beta = 0.80). There were no thromboembolic events complicating any of the pregnancies. CONCLUSION: Our findings suggest that air travel is not associated with increased risk of complications for pregnancies that reach 20 weeks' gestation.

Adult↗
PubMed2006

Vaccines against traveler's diarrhoea and rotavirus disease - a review.

Diarrheal diseases constitute one of the most important health problems worldwide, preferentially in developing countries with a morbidity of estimated 5 billion and a mortality of 5 million cases per year. Children less than 5 years are particularly in danger with respect to the incidence and severity of the gastrointestinal symptoms. Travelers to developing countries are also at risk to develop diarrheal disorders; around 30-50% of them acquire so called "travelers's diarrhea" caused by bacteria, viruses or protozoa. It has been estimated that approximately 30-70% of diarrhea are due to bacteria, of which the most frequently detected enteric pathogens are non-invasive, enterotoxigenic Escherichia coli (ETEC). Their exotoxins, the heat stabile (ST) and the heat labile (LT) toxins are in large part responsible for the pathogenicity of the bacteria. About 20% of cases of traveler's diarrhea are caused by LT producing ETEC. This heat labile toxin exhibits a 80% sequence homology with cholera toxin. The presently available vaccine against cholera (Dukoral) contains inactivated Vibrio cholerae bacteria and the recombinant non-toxic B subunit of cholera toxin. Consequently, this vaccine displays also some efficacy against traveler's diarrhoea with up to 25% of travelers being protected against this disease. Rotaviruses are the leading recognized cause of diarrhoea-related illness and deaths among infants worldwide in developing and industrialized countries. Based on the high incidence of this disease two oral vaccines have been developed and will be available in Europe in 2006. Due to the impact of rotavirus diseases also in Austria vaccination against this disease has been already suggested in the Austrian vaccination schedules for infants from 6-24 weeks of age. One of the two vaccines, Rotarix, is an attenuated monovalent vaccine with a broad cross-reactivity against the most frequent serotypes. The second one, RotaTeq, is a pentavalent attenuated vaccine containing 5 human-bovine reassortants. Both vaccines display 85-98% efficacy against severe rotavirus disease and an excellent tolerability with no difference in side reactions to the placebo controls, particularly with respect to intussusceptions. With respect to increasing travel habits with infants and small children, particularly when visiting friends and relatives, vaccination against rotavirus infections will also be important in international travel.

Adult↗
PubMed1992

Hepatitis A in Swedish travellers.

The incidence of hepatitis A is very low in Sweden. It has been shown that the prevalence of antibodies to hepatitis A virus is 6.6% in individuals < 40 years of age and 1% in those < 20 years old. The number of reported cases of hepatitis A infection has declined from 628 in 1985 to approximately 250 during the last four years. The attack rate per 100,000 inhabitants has thus declined from 7.3 to approximately 3 during this period. The number of cases in travellers has been stable at approximately 140 cases per year during the period 1985-1990. About one-third of the cases are associated with travel to either Europe or Asia. Immune globulin has been widely used as prophylaxis but use has declined. Based on travel statistics and estimation of the use of immune globulin, a risk ratio was calculated for the relation between the number of travellers not receiving immune globulin and cases of registered hepatitis A infection. This risk ratio was > 50,000 for travel to the Mediterranean part of Europe, approximately 100 for travel to Africa and approximately 300 for travel to Asia.

Hepatitis A↗
PubMed2005

Travel-related hepatitis B: risk factors and prevention using an accelerated vaccination schedule.

Rates of global travel and tourism are increasing dramatically, especially to regions with medium or high endemicity for hepatitis A and B, such as Asia, Africa, Latin America, and the Middle East. International travelers to these areas should be protected against both hepatitis A and B, regardless of their anticipated length of stay. However, many travelers depart within weeks of planning their trip (too late to complete the accelerated 0-, 1-, 2-month regimen for hepatitis B), and a majority of those traveling depart without being vaccinated. Although extended-stay travelers are at high risk for hepatitis B, short-stay travelers also are at risk. The most commonly encountered risk factors for travel-related hepatitis B are casual sexual activity with a new partner, medical and dental care abroad, and in the expatriate community, adoption of children who are hepatitis B carriers. Although efficacy studies of accelerated schedules for hepatitis B immunization have not been conducted, the results of immunogenicity studies in healthy volunteers who received an accelerated, 3-dose regimen on a 0-,7-, and 21-day schedule suggest that excellent, rapid, and long-term protection will be conferred. More data are needed to assess the efficacy of accelerated schedules in persons aged >40 years and to determine whether a fourth dose of hepatitis B vaccine is needed in all age groups.

Hepatitis B↗
PubMedDate not supplied

The elderly travellers.

As the population increases, older people have the opportunity to travel for longer periods and to destinations that are quite different from what they are used to. Older people do indeed have more ongoing medical issues and some limitations due to the aging process. Most of the time these chronic conditions are not a contraindication to travel. Preparing for travel frequently involves starting an exercise program, updating routine immunizations such as tetanus, pneumonia, and influenza as well as getting destination specific immunizations such as hepatitis, yellow fever and typhoid. Medications should be reviewed as they relate to altitude, climate and concurrent travel medications including malaria prophylaxis. There are many organizations and foundations that deal with travel and specific medical problems such as diabetes, asthma, dialysis and for those with spinal cord injuries. The traveler would be wise to seek the advice of specialists related to their specific medical condition as well as a travel medical physician. One should also be sure that their medical insurance would cover them in a foreign country.

Adult↗
PubMed2005

Sexually transmitted infections and HIV among travellers: a review.

Sexually transmitted infections are often acquired during travel. Infections are most often seen in young adults, travelling without a regular partner and among those who have higher numbers of partners while at home. Alcohol and recreational drug use may increase risk. The risks are highest from having unprotected sex with local partners in developing countries where the prevalence of infection can be many times higher than at home. The risks of acquiring HIV are highest in Africa, followed by South Asia. Special precautions are required by those going to work in health-care settings in high HIV prevalence countries. Travellers may benefit from advice about safer sex, condom use, emergency contraception and vaccination against hepatitis B. In special circumstances a starter pack for HIV post-exposure prophylaxis should be considered. Following return travellers should consider attending specialist services for a screen for sexually transmitted infections and HIV if they are concerned about exposure whilst travelling. A number of reports suggest that travel clinics need to pay more attention to the sexual health of travellers.

Adolescent↗
PubMed2002

Practical advice for perioperative travel nurses.

Travel nursing presents unique opportunities that permanent employees may never experience. Today's nursing shortage allows travel nurses to fill temporary staff positions while experiencing the sights, culture, and cuisine of a location of their choosing. This creates a beneficial situation for travel nurses, hospitals, travel companies, and, ultimately, patients. Knowledgeable, flexible nurses and traveler-friendly hospitals can extend contracts if mutually agreeable, thus prolonging the benefits. Before beginning the adventure, however, travelers must have realistic expectations. Many disappointed travelers may have been more successful had they done better research.

Contracts↗
PubMed2002

ACOG committee opinion. Air travel during pregnancy.

In the absence of obstetric or medical complications, pregnant women can observe the same general precautions for air travel as the general population and can fly safely up to 36 weeks of gestation. In-craft environmental conditions, such as low cabin humidity and changes in cabin pressure, coupled with the physiologic changes of pregnancy, do result in maternal adaptations, which could have transient effects on the fetus. Pregnant air travelers with medical problems that may be exacerbated by a hypoxic environment, but who must travel by air, should be prescribed supplemental oxygen during air travel. Pregnant women at significant risk for preterm labor or with placental abnormalities should avoid air travel. Because air turbulence cannot be predicted and the risk for trauma is significant, pregnant women should be instructed to continuously use their seat belts while seated, as should all air travelers. Pregnant air travelers may take precautions to ease in-flight discomfort, and although no hard evidence exists, preventive measures can be employed to minimize risks.

Aircraft↗
PubMed2005

Long-haul air travel before major surgery: a prescription for thromboembolism?

OBJECTIVE: To investigate the Incidence of postoperative venous thromboembolism (VTE) in patients who had flown long distances before major surgery. PATIENTS AND METHODS: Using the Mayo Clinic computerized patient database, we Identified patients who had flown more than 5000 km before major surgery (travelers) and had experienced an episode of clinically significant VTE within 28 days after surgery. Individual medical records were reviewed for the diagnosis of VTE, pertinent risk factors, and outcome. We compared the Incidence of VTE in travelers to the incidence of VTE in patients from North America (nontravelers) undergoing similar surgical procedures. RESULTS: Eleven patients met our criteria for long-haul air travel and clinically significant VTE within 28 days after surgery. Compared with nontravelers undergoing similar surgical procedures, long-haul travelers had a higher Incidence of VTE (4.9% vs 0.15%; P < .001). Compared with nontravelers who developed VTE, travelers were younger (P = .006), developed VTE earlier in the postoperative course (P = .01), had higher American Society of Anesthesiologists physical status classification (P = .02), and had higher prevalence of smoking (P = .007). Of the 11 travelers with VTE, 10 were of Middle Eastern origin. CONCLUSION: Prolonged air travel before major surgery significantly increases the risk of perioperative VTE. Such patients should receive more Intensive VTE prophylactic measures during the flight and throughout the perioperative period.

Adult↗
PubMed2001

Committee opinion: number 264, December 2001. Air travel during pregnancy.

In the absence of obstetric or medical complications, pregnant women can observe the same general precautions for air travel as the general population and can fly safely up to 36 weeks of gestation. In-craft environmental conditions, such as low cabin humidity and changes in cabin pressure, coupled with the physiologic changes of pregnancy, do result in maternal adaptations, which could have transient effects on the fetus. Pregnant air travelers with medical problems that may be exacerbated by a hypoxic environment, but who must travel by air, should be prescribed supplemental oxygen during air travel. Pregnant women at significant risk for preterm labor or with placental abnormalities should avoid air travel. Because air turbulence cannot be predicted and the risk for trauma is significant, pregnant women should be instructed to continuously use their seat belts while seated, as should all air travelers. Pregnant air travelers may take precautions to ease in-flight discomfort, and although no hard evidence exists, preventive measures can be employed to minimize risks.

Aircraft↗
PubMed2003

Travellers' diarrhoea.

Risk of travellers' diarrhoea is about 7% in developed countries and 20-50% in the developing world. Options for prevention include education and chemoprophylaxis. Vaccination is a promising but incomplete option. Achieving behaviour modification of food and water choices among tourists is difficult. Bismuth subsalicylate (BSS)-containing compounds are about 62% effective in the prevention of travellers' diarrhoea. Antibiotics are about 84% effective in preventing travellers' diarrhoea. Routine prophylaxis of travellers' diarrhoea, especially with antibiotics, should be discouraged. Oral rehydration is generally important in the treatment of diarrhoea, but travellers' diarrhoea is only infrequently dehydrating in adults. The addition of oral rehydration solutions confers no additional benefit to loperamide in the treatment of travellers' diarrhoea in adults. Presently, the most active of the antibiotics routinely available for treatment are members of the fluoroquinolone group. Antibiotics that are not absorbed such as aztreonam and a rifampicin-like agent, rifaximin, are both effective. The latter might become a therapy of choice once it is routinely available, due to predictably less adverse reactions with a non-absorbed antibiotic. Preliminary results with azithromycin look very promising. Less severe disease can be treated with a variety of non-antibiotic agents (e.g. BSS-containing compounds, loperamide and a calmodulin inhibitor, zaldaride). The combination of an antibiotic and loperamide is superior to treatment with either agent alone in a several studies and is arguably the treatment of choice for distressing travellers' diarrhoea.

Adult↗
PubMed2003

Travel epidemiology: WHO perspective.

International travel is undertaken by increasing, numbers of people for professional, social, recreational and humanitarian purposes, and this trend looks set to continue. Travellers are exposed to a variety of health risks of the unfamiliar environment of the area visited. Most such risks can be minimized by suitable precautions taken before, during and after travel. Furthermore travellers can introduce any infectious agents they may harbour to the visited area. Because of rapid air travel, no country is safe from infectious diseases and an outbreak in one country can easily and rapidly be transmitted across long distances to affect other countries through travel and trade. The main WHO strategies for minimizing the negative effects of expanding travel on global health security include developing the necessary strategies, rules and regulations, strengthening global communicable diseases surveillance and response, dissemination of related information throughout the world and strengthening national capacity for communicable diseases surveillance and response.

Communicable Disease Control↗
PubMed2004

The effects of travel on team performance in the Australian national netball competition.

The effects of travel on performance during six seasons of the Australian national netball competition were analysed. Pairs of games were grouped according to the travel required to reach the opponent's court. The four groups were local (< 1 h) travel (LT; n = 15), north or south travel without a time-zone shift (NS; n = 77), and east or west travel with either a < 2-h time-zone shift (EW1; n = 54) or a 2-h time-zone shift (EW2; n = 25). The combined change in performance was analysed by comparing the points difference (home margin-away margin) for each pair of games. In this way, each game acted as its own control. One-way ANOVA revealed no significant difference (P = 0.68) in the points difference (mean +/- SD) for LT (-1.3 +/- 8.8), NS (-3.3 +/- 4.2), EW1 (-3.8 +/- 4.9), or EW2 (-6.8 +/- 7.2). While the large variation in points difference diminished the power of the ANOVA to detect change, effect size (ES) calculations revealed a large effect on the points difference when EW2 was compared with LT (ES = 1.0) and a moderate effect when EW2 was compared with EW1 (ES = 0.5) and NS (ES = 0.6). There was however, a significant difference between points scored at home and away for EW2 travel only (P = 0.01). These results suggest that relatively brief air travel (across only two time zones) can influence team performance.

Adolescent↗
PubMed2005

Traveller's diarrhoea.

Traveller's diarrhoea affects over 50% of travellers to some destinations and can disrupt holidays and business trips. This review examines the main causes and epidemiology of the syndrome, which is associated with poor public health infrastructure and hygiene practices, particularly in warmer climates. Although travellers may be given common sense advice on avoidance of high-risk foods and other measures to prevent traveller's diarrhoea, adherence to such advice is sometimes difficult and the evidence for its effectiveness is contradictory. However, non-antimicrobial means for prevention of traveller's diarrhoea are favoured in most settings. A simple stepwise approach to the management of traveller's diarrhoea includes single doses or 3-day courses of antimicrobials, often self administered. The antibiotics of choice are currently fluoroquinolones or azithromycin, with an emerging role for rifaximin. In the long term, there will be greater benefit and effect on the health of local inhabitants and travellers from improving public health and hygiene standards at tourist destinations.

Anti-Bacterial Agents↗
PubMed2005

Typhoid and paratyphoid fever in travellers.

Enteric fever--a more inclusive term for typhoid fever and paratyphoid fever--is a systemic infection caused by Salmonella enterica, including S enterica serotype Typhi (S typhi) and serotype Paratyphi (S paratyphi). In developed countries there have been two major changes in the pattern of the disease: a marked decline in its incidence and its characterisation as a predominantly travel-associated disease. The risk to travellers appears to vary by geographic region visited, with travel to the Indian subcontinent accounting for the greatest travel risk. Although the most common cause of enteric fever is S typhi, the incidence of disease caused by S paratyphi among travellers may be more important, since the available vaccines only protect against S typhi. Descriptions of the clinical presentation in travellers are scarce but severe complications and death are rare, probably due to rapid access to readily available medical care. Drug resistance reflects the situation in endemic countries, and shows a steady increase in multidrug-resistance patterns. Currently, the recommendation for first-line therapy is ceftriaxone and, where isolates have been found to be quinolone sensitive, fluoroquinolones can still be given. Preventive measures are educating travellers about hygiene precautions and vaccination. With an increase in multidrug-resistant strains, a more effective vaccine for S typhi and S paratyphi is urgently needed.

Developing Countries↗