Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “TRAVEL”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 721 records · Page 40Linked to original sources
PubMed2002

Environmental tobacco smoke exposure during travel among adults with asthma.

OBJECTIVES: In California, state law now prohibits smoking in most public places. We examined the prevalence and short-term health impact of environmental tobacco smoke (ETS) exposure during travel among adults with asthma. DESIGN, SETTING, AND PARTICIPANTS: A cohort of 374 nonsmoking adults with asthma recruited from a random sample of allergy, pulmonary, and family practice physicians in northern California underwent structured telephone interviews. MEASUREMENTS AND RESULTS: The prevalence of self-reported ETS exposure during travel in the past 12 months was substantial (30%; 95% confidence interval, 25 to 35%). Of the exposed subjects, approximately one third (34%) indicated no other regular source of ETS exposure. ETS-related cough, wheezing, or chest tightness during travel was the most common complaint (66%), followed by eye irritation (46%) and nose irritation (43%). After ETS exposure, many subjects indicated extra inhaled asthma medication use (55%). Subjects with no other regular ETS exposure reported a greater likelihood of eye irritation (58% vs 40%; p = 0.068) and nose irritation (58% vs 36%; p = 0.025) than persons with regular exposure. In contrast, there were no differences in respiratory symptoms, asthma medication use, or asthma exacerbation by regular ETS exposure status. CONCLUSIONS: In adults with asthma, ETS exposure is common during travel. For many subjects, travel is their principal source of exposure.

Adult↗
PubMed2005

Pharmacotherapy, vaccines and malaria advice for HIV-infected travellers.

Since the introduction of effective antiretroviral therapy (ART), HIV-infected individuals are travelling more frequently and international travel has become much safer. Specific concerns include the safety of ART during travel, drug adherence and interaction considerations, and effects of immunosuppression. This review describes potentially important infections, vaccine effectiveness, safety and special approaches for their use, and HIV-related issues regarding predeparture counselling. With advanced immunosuppression (CD4+ T-cell count < 200/microl or < 14%), the immunogenicity of several vaccines is reduced, complications could occur after live attenuated vaccines and certain infections acquired during travel may be more frequent or severe. Challenges include the best options for malaria chemoprophylaxis, standby treatment and medical follow-up of the increasing number of HIV-infected long-term travellers.

Anti-HIV Agents↗
PubMed2002

Risk attitude reversals in drivers' route choice when range of travel time information is provided.

Automobile drivers were recently found to be risk averse when choosing among routes that had an average travel time shorter than the certain travel time of a route considered as a reference. Conversely, drivers were found to be risk seeking when choosing among routes that had an average travel time longer than the certain travel time of the reference route. In a driving simulation study in which the reference route had a range of travel times, this pattern was replicated when thereference range was smaller than the ranges of the available routes. However, the pattern was reversed when the reference range was larger than the ranges of the available routes. We recently proposed a simple heuristic model that fit the relatively complex data quite well. Actual or potential applications of this research include the design of variable message signs and of route choice support systems.

Attitude↗
PubMed2006

Current and future developments in travelers' diarrhea therapy.

Diarrhea continues to be the leading health problem among international travelers to developing tropical and semi-tropical regions. Despite more than 50 years of research providing information about the etiology and pathogenesis of the disease, the rate of illness and consequences remain unchanged. An estimated 40% of travelers to developing nations will become ill with diarrhea. Although travelers' diarrhea is considered a self-limited disease, novel and effective approaches to disease prevention and treatment have been realized in recent years. Also, recent evidence has identified a potential for long-term complications of the illness, including postinfectious irritable bowel syndrome. With the advent of poorly absorbed (<0.4%) rifaximin, a treatment option for the common watery diarrhea syndrome equivalent to previously used absorbed antibacterial drugs has emerged. Rifaximin with an excellent safety profile and limited potential to induce coliform resistance, prevents most of the diarrhea that would otherwise occur. With further studies in different settings, new consideration should be given to the routine use of chemoprophylaxis for travelers to high-risk countries. Antibacterial drugs will continue to be the optimal treatment for travelers' diarrhea subjects for the most part caused by bacterial enteropathogens and shorten the duration of diarrhea by 1-2 days compared with no active drug treatment.

Bismuth↗
PubMed1998

Management of travellers' diarrhoea.

The most common health problem encountered in international travellers to topical and subtropical areas is diarrhoea. Even though it is not a life-threatening condition, it may influence deeply the quality of a vacation or the success of a business trip. The majority of cases of travellers' diarrhoea are due to bacterial pathogens, but viruses have also been implicated in a minority of patients. It is advocated that travellers with diarrhoea provide themselves with sources of salt (crackers or soup) and mineral water, to prevent and treat dehydration. Otherwise, treatment recommendations follow illness severity. For mild cases, symptomatic relief alone can be recommended. Loperamide is an effective agent improving diarrhoea and associated symptoms. For moderate diarrhoea (requiring a forced change in itinerary) combination therapy is advised using a fluoroquinolone together with loperamide. Severe diarrhoea [fever > 38 degrees C, dysentery (bloody stools) or incapacitating symptoms] should prompt the voyager to take an antibiotic alone for 3 to 5 days. Loperamide is relatively contraindicated in these cases. For the minority of patients receiving chemoprophylaxis to prevent travellers' diarrhoea, fluoroquinolones taken once a day while in the area at risk produce the highest protection rate (up to 95%). However, most authorities do not recommend routine prophylaxis for travellers.

Aged↗
PubMed2005

Rifaximin: a review of its use in the management of traveller's diarrhoea.

Oral rifaximin, a semisynthetic rifamycin derivative, is an effective and well tolerated antibacterial for the management of adults with non-invasive traveller's diarrhoea. Rifaximin was significantly more effective than placebo and no less effective than ciprofloxacin in reducing the duration of diarrhoea after treatment initiation for illness contracted during travel to diverse geographic locations. While rifaximin is effective in patients with Escherichia coli-predominant traveller's diarrhoea, it appears ineffective in patients infected with inflammatory or invasive enteropathogens. Rifaximin has a broad spectrum of antibacterial activity in vitro and undergoes negligible systemic absorption (<0.4%). In contrast to systemically absorbed antibacterials, such as the fluoroquinolones and macrolides, the acquisition of resistance to rifaximin would have limited consequences for global public health, as rifaximin has no role in the management of systemic infections. Rifaximin shows promise as chemoprophylaxis against traveller's diarrhoea and is a valuable new option for the management of traveller's diarrhoea caused by non-invasive bacterial strains.

Anti-Bacterial Agents↗
PubMedDate not supplied

Epidemiology of giardiasis in German travelers.

BACKGROUND: Giardiasis has been well characterized in individuals traveling from areas of low to high endemicity. METHODS: Clinical features, travel and medical histories in 352 patients with giardiasis who presented to a German outpatient clinic for Infectious and Tropical Diseases were investigated in order to identify common epidemiological factors and potential strategies of prevention. RESULTS: Compared to the total patient population of the outpatient clinic during the period of investigation (n=13, 566 patients), patients who presented with giardiasis traveled longer (median 28 days versus 19 days, p <.001). While only 19.2% of the total patient population had traveled to the Indian subcontinent prior to referral, 32.1% of the patients with giardiasis acquired the infection there (p <.0001). Similar results were obtained for West Africa: in contrast to 19% of patients with giardiasis (p <. 0001), only 5.4% of the total patient population traveled there. CONCLUSION: The risk of infection appears to be highest when making an extended journey to the Indian subcontinent. Short-time visitors to other parts of Asia and Latin America are apparently at a markedly lower risk. Risk factors such as type, duration and destination of the journey should be considered in pretravel counseling.

Adolescent↗
PubMedDate not supplied

Does the concurrent administration of an inactivated hepatitis A vaccine influence the immune response to other travelers vaccines?

BACKGROUND: Travelers seeking protection from hepatitis A also often need protection against other infections, prevalent at their destinations. METHODS: A total of 396 volunteers received not only a hepatitis A vaccine but also either a vaccine against polio, hepatitis B, diphtheria, tetanus, yellow fever, Japanese encephalitis, typhoid fever or rabies according to their individual needs. We investigated the potential influence of the hepatitis A vaccination on the immune response to the other travelers vaccines that were administered concurrently. RESULTS: With seroprotection rates of 100% for yellow fever, Japanese encephalitis and rabies immunization and tetanus boosters our data demonstrate that the concurrent administration of hepatitis A vaccine does not compromise the immune response of these vaccines. Also for oral typhoid, hepatitis B and diphtheria vaccination we did not detect a negative influence of concurrent hepatitis A vaccine administration as compared with respective vaccinations when given alone. Prior to vaccination, more than one third of our subjects lacked protective antibody levels against diphtheria and only 44% of initially seronegative travelers seroconverted to an anti-diphtheria titer > or = 0.01 mIU/mL, supporting a need for an additional dose. Furthermore, only two thirds of the vaccinees tested prior to vaccination were protected against polio type 3, and the seroconversion rate following the administration of oral polio vaccine, was lower for viral type 3 (80%), as has been previously demonstrated in settings without concurrent other vaccinations. CONCLUSION: No negative effect of concurrent travelers vaccinations on the immune response of a hepatitis A vaccine has been detected in a previous report, and, likewise our data suggest no impairment of the antibody response of these travelers vaccines by the concurrent administration of the hepatitis A vaccine.

Adolescent↗
PubMedDate not supplied

Traveling to Australia for the Sydney 2000 Olympic and Paralympic Games.

The modern Olympic Games, conducted only once every 4 years since 1900, will be held in Sydney, Australia, from September 15 to October 1, 2000. There will be approximately 35 competition venues, 5 villages, 100 training venues, a media center, and sponsor hospitality areas.1 There will be about 300 events for 28 sports, involving 10,300 athletes from 200 countries, 5,100 team officials, 50,000 volunteers, 15,000 media, a world wide audience of around 3.5 billion viewers and listeners, and up to several hundred-thousand spectators at any one time.1 The Paralympic Games will also be held in Sydney, after the Olympic Games, from October 18 to 29, 2000, with more than 4,000 athletes competing.1 This paper focuses on health and safety issues for travelers to Australia in general, although it makes specific references to advice for visiting Olympic and Paralympic athletes and team staff, who will be traveling to the games. It must be remembered that travel health advice can change, and that travelers should be advised to seek up-to-date travel health advice for Australia closer to their departure.

Australia↗
PubMedDate not supplied

A study of the incidence of accidents occurring during an Arctic expedition: another important aspect of travel medicine?

The number of expeditioners and independent adventure travelers to remote and physically demanding areas is increasing. Recent evidence suggests that trauma and accidents (resulting mainly from road traffic accidents and drowning) are the primary cause of mortality in travelers rather than infectious diseases.1,2 The risks and potential hazards faced on an expedition are likely to be different from those encountered by other travelers. An extensive literature search revealed little data concerning the incidence and nature of accidents on expeditions, or concerning the young adventure traveler. The objective of this study was to determine the frequency and type of accidents that occurred on a 6-week summer arctic expedition, undertaken by "young explorers" and their leaders. This information will be valuable in order to identify potential risks as part of the pretravel risk assessment, and consequently improve the medical briefing and training of expeditioners and adventure travelers.

Accidents↗
PubMedDate not supplied

Malaria chemoprophylaxis in UK general practitioners traveling to South Asia.

BACKGROUND: Imported malaria continues to be a significant cause of morbidity and mortality in the United Kingdom. Low uptake and poor compliance of chemoprophylaxis are thought to be contributory factors. Little information is available on how well health care physicians comply with malaria chemoprophylaxis when they travel to malarial areas. The aim of this study was to determine the usage and compliance of malarial chemoprophylaxis by general practitioners who have traveled to South Asia. METHOD: A telephone survey of 172 general practitioners practicing in the West Yorkshire area of the UK who have traveled to South Asia. RESULTS: Of the 145 (84%) responding to the survey, 50 (35%) took no chemoprophylaxis, 28 (19%) did not complete the chemoprophylaxis course, and 67 (46%) were fully compliant. The reasons for noncompliance were; the belief the area visited was free from malaria (34%), no wish to take prophylaxis (18%), previous side-effects (10%), the belief of possessing long-term immunity (10%), no time to obtain prophylaxis (4%), malaria is easier to treat than to prevent (2%), costs of purchasing prophylaxis (2%), went for a short period of time and took the risk (2%), and no specific reason (18%). CONCLUSIONS: This study has shown that a large proportion of general practitioners questioned did not take the recommended antimalarial prophylaxis. If they themselves do not keep to the guidelines, it is of concern that they may not reinforce the taking of chemoprophylaxis by their patients. Training in travel medicine may improve chemoprophylaxis uptake by general practitioners, but until then, such physicians should not be regarded as the main provider of pretravel advice. All travelers including health care physicians should be aware, and should comply with malarial prophylaxis guidelines, with emphasis on chemoprophylaxis compliance and mosquito avoidance.

Antimalarials↗
PubMedDate not supplied

Clinical features and epidemiology of tick typhus in travelers.

BACKGROUND: Epidemiologic features of tick typhus among German travelers has not been surveyed recently. METHODS: Clinical features, travel and medical histories in 78 patients with tick typhus who presented to a German outpatient clinic for Infectious and Tropical Diseases were investigated, in order to identify common epidemiological factors and potential strategies of prevention. Diagnosis was confirmed by serological detection of IgG- and IgM-antibodies to Rickettsia conorii by indirect immunofluorescence. RESULTS: The majority of patients (71.8%) had visited southern Africa prior to presentation. All patients presented with fever as the main symptom. An eschar was still present in 68 patients (87.2%) with regional lymphadenitis in 19.2%. However, only a minority of patients (17.9%) remembered a tick bite at the location of the eschar. CONCLUSION: Efforts to reduce the incidence of tick typhus in travelers should focus on preventive measures targeting behavioral changes. Avoiding tick bites during travel to endemic areas appears to be the single most important prophylactic action. Taking this into consideration, it should be possible to decrease the number of travelers returning with tick typhus significantly by adequate pretravel counseling.

Antibodies, Bacterial↗
PubMedDate not supplied

Malaria epidemiological situation in Italy and evaluation of malaria incidence in Italian travelers.

BACKGROUND: Malaria was endemic throughout the country until it was eradicated nearly 50 years ago. Since then, mainly imported malaria cases have been reported to the National Health Service, with an increasing trend. The aim of this study was to present a detailed analysis of the current epidemiological situation of malaria in Italy, and to make a first attempt to calculate the incidence of malaria in Italian international travelers. METHODS: An archive of confirmed malaria cases is available at the Istituto Superiore di Sanità (ISS), the National Institute of Health of Italy, based on the mandatory report system. Data from each case report reported to the ISS from 1989 to 1997 have been analyzed. An evaluation of malaria incidence in Italian travelers has been also performed for the same period, based on the statistics provided by the Ministry of Transport. RESULTS: From 1989 to 1997, a total of 5,898 microscopically confirmed malaria cases have been reported. Of these, 5,773 (97.9%) were imported cases, 106 cases (1.8%) were relapses of Plasmodium vivax or Plasmodium ovale infections, and 19 cases (0.3%) occurred in subjects who had never been out of Italy. During the period of study, 55 deaths due to Plasmodium falciparum malaria were reported, with a mean fatality rate of 1.2%. Malaria incidence in Italians who traveled to Africa was estimated to be 1.5/1000. These figures appeared to be 10-20 and 30-40 times greater than that recorded in travelers to Asia (0.11/1000) and Central-South America (0.04/1000) respectively. CONCLUSIONS: From 1989 to 1997, there has been a remarkable increase in the total number of imported malaria cases in Italy, which reached a peak of more than 800 cases/year in 1997. A constant increase in the number of cases affecting foreigners has been reported, while the cases among Italians have remained stable. From 1989 to 1997 the number of Italian intercontinental travelers has nearly doubled, but malaria incidence has remained quite stable.

Adult↗
PubMedDate not supplied

Bacterial removal from inexpensive portable water treatment systems for travelers.

BACKGROUND: There are many personal portable water treatment systems for travelers on the market, including chemical agents, iodine resin purifiers and filters. However, information on the real efficacy of these systems in the field is often lacking. We have therefore estimated the capabilities of several inexpensive personal portable water treatment systems for travelers to remove bacteria in various situations of water quality, using stressed indigenous strains of bacteria. METHODS: Four chemical agents (Drinkwell chlorine, Hydroclonazone, Aquatabs, 2% iodine in ethanol), two iodine resin purifiers (the straw PentaPure Outdoor M1-E, the PentaPure Traveler purifying and filtration system) and four filters (the flexible bottle Pres2Pure, the hand-pump filters Mini Ceramic, First Need Deluxe and WalkAbout) were evaluated in triplicate using both turbid and clear water at 25 degrees C. Bacteria were counted by conventional culturing techniques, colorimetric and fluorescent assays of coliforms and Escherichia coli enzyme activities (Colilert)/Quantitray method), and viable but not culturable bacteria were assessed quantitatively by 5-cyano-2,3-dilotyl-tetrazolium staining. RESULTS: The best systems were the three hand-pump filters, Mini Ceramic, First Need Deluxe, and WalkAbout. All had a submicron filtration element that completely removed 3 log (99.9%) or more of viable bacteria, and no coliforms or E. coli were detected in the effluent. The PentaPure Traveler removed more than 99.3% of the viable bacteria. The only chemical agents that gave a bacterial inactivation of over 2 log in clear water were the Drinkwell chlorine, the Aquatabs, and the 2% iodine in ethanol. The three other devices, Hydroclonazone, Outdoor M1-E, and Pres2Pure, performed poorly, as coliforms and E. coli were detected in the treated water by the Colilert method. The chemical agents and the iodine resin straw performed poorly on raw river water; coliforms and E. coli were detected in the treated water. CONCLUSIONS: These data demonstrate the differences between the systems tested. The effectiveness of other devices on the market should also be tested, so as to help travelers and hikers select the most appropriate portable water treatment system.

Bacteria↗
PubMedDate not supplied

Empiric immunization versus serologic screening: developing a cost-effective strategy for the use of hepatitis A immunization in travelers.

BACKGROUND: Older individuals and those born overseas are thought at increased risk of prior exposure and thus have naturally acquired immunity to hepatitis A. Whether these individuals or other groups of international travelers should be screened for acquired immunity or empirically immunized is not clear. Hepatitis A serology and risk factor data was obtained prospectively in patients presenting for hepatitis A immunization and used to develop a cost-effective strategy for the use of serologic screening and empiric immunization in our traveler population. METHOD: Candidates for hepatitis A immunization were routinely screened for total hepatitis A serum antibody. Risk factor data including country of birth, travel history, and history of jaundice was collected. Cost-effectiveness was assessed by comparing the cost of serology to screen all patients plus cost to immunize those found to be seronegative with, the cost of empirically immunizing all patients. RESULTS: Analyses were conducted comparing age, travel history, country of birth, and history of jaundice for significance in predicting seropositivity in a group of 115 subjects. Country of birth was statistically a significant predictor of positive results with 80.0% of foreign-born patients positive for total antibody against hepatitis A compared with 35.6% of patients born in the United States. Living outside of the United States (defined as greater than 30 days) was also correlated with a higher prevalence of hepatitis A positive serology. Age was not predictive for the group as a whole. A lower prevalence (24.3%) was noted in the group of US born individuals aged 30 to 60. Travel and prior history of jaundice failed to demonstrate significance. CONCLUSIONS: Employing a simple cost-effectiveness equation using cost of serological testing, cost of vaccine, and prevalence of acquired immunity in the community, a strategy was developed. In our population it was cost-effective to screen all foreign-born individuals and those who had lived outside the United States.

Adult↗
PubMedDate not supplied

Pneumonia among travelers returning from abroad.

BACKGROUND: Although respiratory tract infections represent a frequent cause of morbidity in travelers, and pneumonia a frequent cause of medical consultation among febrile travelers returning home, the etiologic spectrum of pneumonia in travelers has not been specifically studied. METHODS: We reviewed the medical charts of all travelers hospitalized during a 12-month period in our department with pneumonia after returning home. RESULTS: Seventeen patients (nine men, eight women, mean age 44 years, range 26 to 67 years) were included in this study. The etiology of pneumonia was established in 13 patients. Bacterial pneumonia was documented in 10 cases and was due to Streptococcus pneumoniae (n=2), Mycoplasma pneumoniae (n=2), Legionella pneumophila (n=1), Coxiella burnetti (n=1), Leptospira sp. (n=1) or Mycobacterium tuberculosis (n=3). Other etiologies included histoplasmosis, invasive schistosomiasis and dengue fever (one case each). CONCLUSION: These results show the wide range of causes of pneumonia among travelers returning from abroad.

Adult↗
PubMedDate not supplied

United States male students who heavily consume alcohol in Mexico are at greater risk of travelers' diarrhea than their female counterparts.

BACKGROUND: The relationship between alcohol consumption and travelers' diarrhea has not been well studied. METHODS: A cohort of US college students (n=171), who attended 2001 or 2002 summer educational sessions in Guadalajara, Mexico, were followed prospectively to examine the frequency of alcohol consumption and the development of travelers' diarrhea. RESULTS: More male students reported consuming >5 drinks/day of drinking while in Mexico compared to female students (p <.001). Males who consumed >5 drinks/day of drinking while in Mexico were more likely to develop diarrhea than their female counterparts who drank the same amount (79% vs. 46%; p=.035). No association was found between the development of travelers' diarrhea and the consumption of fewer than 5 drinks per day in Mexico. Non-drinkers accounted for only 8% of the population and had a relatively high attack rate of diarrhea (69%). CONCLUSIONS: This study suggests that males who drink heavily are at high risk for developing travelers' diarrhea and may be a group of people to target for education about the moderation of use of alcohol while traveling. Nondrinkers also deserve further study in larger numbers to confirm an apparently high attack rate of diarrhea and to explore what risk factors might be involved.

Adult↗
PubMedDate not supplied

Travel as a risk factor for malaria requiring hospitalization on a highland tea plantation in western Kenya.

BACKGROUND: Over the past two decades, endemic malaria returned to the western highlands of Kenya, a region that had been free of endemic malaria during the preceding 30 years. A study of malaria patients admitted to a tea estate hospital was conducted to estimate the risk of severe malaria when acquired during travel away from the tea estates compared with infections that had probably been locally acquired. METHODS: From May 1998 to March 2000, 1,296 patients were evaluated with a case-control design and standardized questionnaire during their hospitalization. Death certificates from the tea estates were examined from 1964 to 1972 and 1986 to 1999. RESULTS: Travel away from the tea estates during the 2 months prior to hospitalization (n = 432) was strongly associated with a diagnosis of malaria (odds ratio 2.7, 95% CI 2.1-3.5). The estimate of risk associated with travel was consistent with known malaria endemicity, the Rift Valley Province having a much lower malaria transmission than the area around Lake Victoria. The seasonality of malaria-related deaths indicates that many lowland-origin children probably contracted their fatal infection away from the tea plantation. CONCLUSIONS: Travel within Kenya is a significant risk factor for hospitalization owing to malaria on the tea estates; expatriate travelers need to be aware that the East African highlands cannot be regarded as malaria free.

Adolescent↗