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At least 55 records · Page 3Linked to original sources
PubMed1997

Travels with HIV: the compliance and health of HIV-infected adults who travel.

We examined the effects of travel on the health of a group of HIV-infected adults (n = 89) cared for in a public hospital HIV clinic. In a period of 2 years, 45% travelled to a median of 3 US destinations for at least one week and 20% travelled to at least one international destination for a mean duration of 20 days. At the time of completion of the survey, the majority of these patients were severely immunosuppressed (median CD4+ count, 120/mm3). A physician was consulted concerning travel before 53% of the trips, but only one person consulted a travel medicine expert. All but one patient (98%) who was receiving medical therapy carried sufficient supplies of medication; 95% estimated their compliance with medication at 75% or better. None of the travellers to developing countries received gamma globulin, but one received yellow fever vaccine. Fifteen travellers (43%) became ill either during their trip or immediately thereafter; 3 required hospitalization. While most illnesses were not severe, 4 patients developed potentially life-threatening infections including coccidioidomycosis, cryptococcosis, PCP, and bacterial pneumonia. This survey provides information by which the clinician can anticipate the health care needs of HIV-infected patients who travel. HIV-infected patients should be more aware of the necessity for medical counsel prior to travel.

AIDS-Related Opportunistic Infections↗
PubMed1991

Travel medicine and travel clinics.

In response to the vast number of American travelers to the developing world, the discipline of Travel Medicine has become an emerging specialty. There are presently no formal Board or other requirements to practice Travel Medicine, but bona fide practitioners of this field, who also usually direct travel clinics, should at the least be well-trained and experienced in tropical medicine and medical aspects of travel, and have had considerable overseas work experience. The concept of travel medicine and the need for travel clinics operated by well-qualified physicians are discussed. The areas of involvement of travel clinics in protecting the health of the traveler are described.

Ambulatory Care Facilities↗
PubMed1998

Incidence and risk factors of diarrhoea in Dutch travellers: consequences for priorities in pre-travel health advice.

A cohort of 743 Dutch short-term travellers (1-6 weeks) to various (sub)tropical areas was studied to assess incidences of travellers' diarrhoea (TD) and risk factors to guide prevention policies. The occurrence of TD was ascertained retrospectively by questionnaire; independent risk factors were identified by logistic regression analysis. The overall attack rate (AR, 95% CI) of TD was 52% (49-56); 11% (9-14) reported two or more episodes. The overall incidence rate (IR) per 100 person weeks of travel (pwt) (95% CI) was 22 (20-24). IRs were highest for travellers to the Middle East (48, 33-71), lowest for South-east Asia (17, 15-20) and East Africa (18, 14-24) and intermediate for South America and West Africa (both 26, 19-36), Central America (29, 23-37) and the Indian subcontinent (32, 26-39). Compared to first episodes of TD, subsequent episodes were of longer duration and more frequently accompanied by faecal blood loss, abdominal cramps or systemic symptoms. After adjustment for travel duration and destination, independent risk factors (OR, 95% CI) for TD were recent treatment for gastrointestinal (GI) disorders (4.6, 1.2-17.2), history of GI surgery (3.9, 1.4-11.1) and, possibly, current use of medication reducing gastric acidity (6.9, 0.7-67.4). The risk was reduced for extensive travel experience (0.4, 0.3-0.7) and organized travel (0.7, 0.5-0.9). Regarding prevention and/or antibiotic self-treatment of TD, priority should be given to travellers who may suffer major health or other consequences from TD and to those with pre-existing GI disorders, particularly when visiting a high or intermediate-risk area on individual journeys with limited travel experience.

Adult↗
PubMed1991

Overseas fatalities of United States citizen travelers: an analysis of deaths related to international travel.

STUDY OBJECTIVE: Studies of travel-related mortality and morbidity have been limited to nonfatal events. Causes of travel-related mortality may differ significantly from morbidity and thus have different prevention strategies. DESIGN: We examined the overseas fatalities of US citizen travelers for the years 1975 and 1984. The death certificates were abstracted; all deaths under age 60 and a 20% sample of deaths 60 and older were examined. SETTING AND TYPE OF PARTICIPANTS: All overseas travel fatalities of US citizens were examined excluding those occurring in Canada. INTERVENTIONS: None. RESULTS: Cardiovascular events (including myocardial infarctions and cerebrovascular accidents) and injuries accounted for 49% and 25% of the overseas deaths of US citizen travelers, respectively. Infectious diseases other than pneumonia accounted for only 1% of the deaths. Eighty percent of injury deaths occurred outside of hospitals. Injury death rates for male travelers were greater than US age-specific death rates. CONCLUSIONS: Greater emphasis on the prevention of fatal events, especially those resulting from injury, must be given by physicians and other individuals and organizations who advise travelers. Further studies are needed to explore the issues of preventable injury deaths, emergency medical services, and overseas travel.

Accident Prevention↗
PubMed2006

[Travel advice for special travellers].

The increase in the hope and quality of life, along with the greater rapidity and comfort of the different means of transport have made possible that travellers with chronic diseases, pregnant and kids makes tourist trips to tropical or subtropical zones. On the other hand the increase of the international cooperation has caused the appearance of long stay travellers who live in conditions such as the local population. These travellers have special characteristics due to their physical training conditions, chronic treatments, or the way of life during the travel that them makes more susceptible to suffer problems of health during the travel. For this reason the usual recommendations for travellers are insufficient in these groups and is necessary to make an individualized travel advice that considers these factors. This revision shows the most important warnings that must be made in these groups of special travellers.

Disease Management↗
PubMed1997

[How to plan travel vaccinations when they are numerous or the traveler is pressed for time?].

Deciding on the best immunizations and their best sequence of administration for some travellers may be wavering. Numerous resources documents and tools are available to help the travel medicine expert in his or her decision making process. Still, many factors are to be considered and weighed. These include time, money, uncertain itinerary, health status, fears and beliefs of the traveller and the number of available injection sites. The specific needs of the traveller should be assessed with minutia. The evaluation will look at the type of accommodation planed, the purpose of the travel, the distance covered, the mode of transportation, and previous travel experience. Inevitably, some travellers will leave the country without receiving all recommended immunizations. They should be part of the decision process when some are to be sacrificed. Information is essential for an enlightened choice, and it is the responsibility of the travel medicine expert to provide it.

Drug Costs↗
PubMed2005

Challenging scenarios in a travel clinic: advising the complex traveler.

With adequate preparation and in consultation with a travel medicine expert, most travelers today can travel safely regardless of their age and health status. The few instances when it is prudent to alter travel plans or postpone travel altogether are not to be taken lightly. For the most part, however, most complex travelers can enjoy a healthy and rewarding travel experience.

Adult↗
PubMedDate not supplied

Rabies antibody seroprotection rates among travelers in Nepal: "rabies seroprotection in travelers".

BACKGROUND: Rabies preexposure immunization is recommended for international travelers who are at risk for exposure to rabid animals, especially in areas where postexposure treatment may be limited. Rabies antibody seroprotection rates among international travelers has not been previously investigated. OBJECTIVE: To assess preexisting rabies seroprotection among travelers presenting to a health clinic in Nepal. METHODS: A prospective convenience sample of international travelers evaluated at a health center in Kathmandu, Nepal during a 2-month period. Subjects were eligible for inclusion if they had received rabies preexposure vaccination within the previous 5 years. Demographic information and vaccination records of rabies preexposure prophylaxis were obtained. Consenting subjects provided serum for rabies antibody measurement measured using the rapid fluorescent focus inhibition test. A dilution greater than or equal to 1:5 (0.5 IU/mL) was considered positive. Data were analyzed using chi-squares and two-sample t-tests with unequal variances. RESULTS: A total of 43 patients consented to enroll. Complete data were available for 38 patients. Subjects had received human diploid cell vaccine (HDCV) or purified Vero cell rabies vaccine (PVRV) vaccine, either via the intradermal or intramuscular route. All patients had adequate antibody titers except one, who had a titer below 0.5 IU/mL. There was no statistically significant relationship between antibody titer and type of vaccine, route of administration, time since vaccination, number of vaccinations, or patient age. CONCLUSIONS: Among 38 travelers to Nepal who had received documented preexposure rabies HDCV or PVRV vaccination series, 37 demonstrated adequate titers of > or =0.5 IU/mL and would be considered boostable if exposed to rabies virus. One traveler had a titer of <0.5 IU/mL. Type of vaccine, method of administration, number of vaccinations, and time since vaccination did not influence rabies antibody titer. Rabies vaccination with HDCV and PVRV vaccine was effective in stimulating adequate seroprotection in this sample of travelers.

Adolescent↗
PubMedDate not supplied

Travel counseling for the elderly traveler.

As the baby boomer's generation retirees, many will have the time and money to travel abroad to see the world's exotic wonders or visit family and friends. When the travelers are elderly, they are particularly vulnerable to the effects of travel. Healthcare professionals are responsible for counseling elders on travel health based on their medical history, destination, method of transportation, and exposure risks. Important areas of travel counseling include preparing for travel, air travel, safety, sun and heat, insect precautions, food and water precautions, and vaccinations.

Aged↗
PubMed1999

Travel-related morbidity in travelers with insulin-dependent diabetes mellitus.

BACKGROUND: To assess whether there are clinically significant problems in patients with insulin-dependent diabetes mellitus (IDDM) traveling to tropical countries regarding metabolic dysregulations, infectious complications and general health problems. METHODS: A retrospective, descriptive cohort study by telephone interview of all IDDM patients who had received pretravel health advice at our travel clinic during a 12 month period. Data were collected on IDDM related problems: hypo-/hyperglycemic dysregulation, infectious complications, practical difficulties, exploring risk factors, as well as on general health problems. RESULTS: Of the 19 respondents, 13 (68%) reported any metabolic dysregulation, including all but one respondents with Type 1 diabetes. Fifty-five percent of Type 1 diabetics reported to have dysregulated more often than in the preceding period at home. Critical dysregulations occurred in 2 of the 19 study patients. Only 4 out of 11 (36%) type 1 IDDM patients increased frequency of blood glucose monitoring while traveling. Three travelers reported a febrile illness which resulted in hyperglycemic dysregulation. Five study patients experienced difficulties in the adjustment of their insulin dosage to the unfamiliar circumstances of traveling in the tropics. CONCLUSIONS: Metabolic dysregulation was a clinically significant problem, thus IDDM travelers to tropical destinations probably run extra health risks. Fever, easily acquired in the tropics, appeared to be an additional, serious health problem for this study population. As the number of diabetic travelers will increase, more research on the importance of risk factors possibly leading to dysregulation is necessary.

Adult↗
PubMed1996

Cardiology and Travel (Part I): Risk Assessment Prior to Travel.

Traveling has always been a distinction of man. In Homer's Odyssey, we find a narrative description of the astonishing and long-standing adventures of Odysseus returning to Ithaca from Troy, and later on Thoukedides and Herodotos described different civilizations and historic events based on personal experiences obtained from traveling. At that time, the only available means of transportation were animals and ships. Therefore the trips were time consuming and frequently accompanied by unpredictable events. Nowadays, the use of modern means of transportation has made traveling much more enjoyable and faster; however, it can occasionally become stressful and, as a result, can be associated with a variety of medical problems both in healthy patients and in subjects with cardiovascular diseases. Previous epidemiologic studies have consistently demonstrated that cardiovascular events (including myocardial infarctions and cerebrovascular events) are one of the leading causes of morbidity and mortality among adult travelers.1-6 Since the population of many industrialized countries shows aging trends, the potential problems occurring in elderly passengers, many of whom are more likely to have cardiopulmonary problems, are anticipated to increase. Assessment of the risk of cardiopulmonary problems prior to travel in a mobile society becomes an issue for the public and, in particular, for physicians. The data regarding the cardiovascular risks prior to traveling are limited because of the lack of a central registry for the collection of information regarding health problems or emergencies among travelers. However, review of the literature provides us with important observations in which we can make specific recommendations for assessing cardiovascular status and risk prior to travel during a pretravel medical consultation.

Journal Article↗
PubMedDate not supplied

Potential cost-savings and quality improvement in travel advice for children and families from a centralized travel medicine clinic in a large group-model health maintenance organization.

BACKGROUND: Cost, as well as accuracy and quality of medical care, is an important factor from the perspective of the health care payer. We evaluated the potential pharmacy cost savings, appropriateness of recommendations, and patient satisfaction associated with a proposed centralized travel medicine service in a large group-model health maintenance organization (HMO). METHODS: From computerized pharmacy records, we identified 101 children 18 years of age or younger from six different facilities of Kaiser Permanente in northern California who obtained malaria prophylaxis, typhoid vaccine, or yellow fever vaccine for international travel from their primary care practitioner. We obtained records of all vaccinations and prescriptions provided to each patient and interviewed their parents concerning medical services they received in preparation for travel. We compared what vaccinations and prescriptions were actually given to expert recommendations, and compared total pharmacy costs for actual versus recommended care. RESULTS: Travel advice obtained from primary care practitioners in this system was often inefficient and varied from expert recommendations. Primary care practitioners frequently overestimated risk, leading to unnecessary prescribing, especially of mefloquine and typhoid vaccine. This created potential cost-savings of US $12 per patient (17% of total pharmacy costs per patient). We were unable to quantify additional savings that could result from improved efficiency of providing care. CONCLUSIONS: A travel medicine clinic staffed by practitioners who provide expert and current advice may provide savings in pharmaceutical costs as well as improvements in quality of care compared to primary care practitioners without expertise in travel medicine.

Adolescent↗
PubMed2001

Traveller's thrombosis: a review of deep vein thrombosis associated with travel. The Air Transport Medicine Committee, Aerospace Medical Association.

There is an increasing suspicion among the travelling public and the international media of an association between the occurrence of deep venous thrombosis (DVT) and air travel. It was noted by the UK House of Lords Select Committee on Science and Technology that up to 20% of the total population may have some degree of increased clotting tendency. It follows that some air travellers are at risk of developing DVT when, or soon after, travelling. There have been no epidemiological studies published which show a statistically significant increase in cases of DVT when travelling in the absence of pre-existing risk factors. The literature was reviewed. Current evidence indicates that any association between symptomatic DVT and travel by air is weak, and the incidence is less than the impression given by recent media publicity.

Aircraft↗
PubMed1993

[Epidemiology of traveler's diarrhea in Spanish tourists travelling in developing countries].

BACKGROUND: Travellers' diarrhea (TD) is the most frequent problem in travellers going to the developing countries. This paper analyses the prevalence of the syndrome by geographical areas as well as the risk factors in 2209 Spanish travellers to 3 continents. METHODS: Epidemiological data were gathered through a personnel interview filled by the travellers during their return trip. Those were introduce in a DbaseIII plus computer program and were evaluated through the Epi Info program. RESULTS: The overall prevalence of TD found was 41%. The Indian subcontinent, the Middle East and Moghreb countries showed a higher prevalence of TD. Trekkers and people on boat cruises (Nile and Amazon) had the highest prevalence of TD. The consumption of non-carbonic drinks and ice creams was significantly associated to TD. Travellers with previous gastrointestinal illnesses suffered more TD than others. CONCLUSIONS: Despite the fact that Spain in considered an area of intermediate risk for TD we found no significant differences in the prevalence of TD in Spanish travellers when compared with other published series from developed countries.

Adolescent↗