Ease Of Travel Research Articles

Imported Chikungunya Virus Infection

To the Editor: Chikungunya is a disease caused by an arboviral alphavirus transmitted to humans by Aedes mosquitoes (Aedes aegypti, Ae. albopictus). Symptoms include fever, myalgia, rash, and joint pain (which can last for several months) (1). During the 2005–2006 epidemics on Reunion Island, clinical manifestations such as severe hepatitis, severe maternal and fetal disease, and meningoencephalitis not described previously were observed (2). Occurring in an immunologically uninfected population, this outbreak spread quickly, infecting approximately one third of the population (266,000 of 775,000 inhabitants) (2). The case-fatality rate on Reunion Island was estimated to be 1/1,000 cases, with excess deaths observed mainly among persons >75 years of age (3). Chikungunya disease is endemic to western, central, eastern, and southern Africa; on Indian Ocean and west Pacific Ocean islands; and in Southeast Asia (1). Before 2005–2006, no outbreak of this disease had been described on islands in the Indian Ocean (Comoros, Mayotte, Madagascar, Reunion Island, Mauritius, and Seychelles). Since the epidemic on Reunion Island, many imported cases caused by this arbovirus have been reported elsewhere in areas where the disease is not endemic, particularly in Europe and the United States. The main competent vector of chikungunya virus, a mosquito, Ae. albopictus, is indigenous to Southeast Asia and some islands of the western Pacific and Indian Ocean. The mosquito spread to the eastern Pacific, the Americas, Central Africa (Nigeria, Cameroon, Equatorial Guinea and Gabon), Europe, and the Middle East (4,5). Entomologic studies have shown that Ae. albopictus mosquitoes can now be found in the southeastern part of the United States, Mexico, Central and South America, the Caribbean, the Middle East, Japan, and southern Europe (Spain, Italy, Bosnia-Herzegovina, Croatia, France, Greece, the Netherlands, Serbia and Montenegro, Slovenia, Switzerland, and Albania) (4,6). This mosquito has also been intercepted in Australia’s seaports and is now established in northern Queensland (7). Ae. aegypti mosquitoes are indigenous to Africa and disseminated around the tropical and subtropical regions. The southeastern United States, the Middle East, Southeast Asia, Pacific and Indian islands, and northern Australia are also infested by this mosquito. In continental Europe, it has been documented in southern regions but today seems to no longer to be present there (8). Climate change, increasing globalization, and ease of travel could favor the continuing spread of mosquitoes to nonindigenous habitats, expanding the number of regions in the world where local transmission of vector-borne disease could occur. In these countries where competent vectors are present, patients coming from disease-endemic areas at an early stage of infection may import the virus and be responsible for locally acquired mosquito-transmitted cases of chikungunya. The risk for local transmission in these countries is not simply theoretical, as shown by the epidemic of chikungunya in the county of Emilie-Romagna, Italy, in which 205 cases were identified between July 4 and September 27, 2007 (9). In the United States, such secondary transmission of vector-borne disease has also been observed with malaria (10). To determine regions of the world at risk for an epidemic of chikungunya virus, we first listed the imported chikungunya cases (i.e., cases diagnosed in nonendemic areas) reported around the world. A literature review was undertaken on Medline by Pubmed and websites provided by the World Health Organization, Eurosurveillance, European Center for Disease Prevention and Control, Health Protection Agency (United Kingdom), Institut de Veille Sanitaire (France), and the Centers for Disease Control and Prevention (United States) were searched for information on imported chikungunya cases. Data were then mapped and compared with the known and theoretical geographic distributions of Ae. albopictus and Ae. aegypti mosquitoes around the world (Appendix Figure) (4–8). This figure shows that imported cases were reported in many countries where mosquito vectors for chikungunya virus are well established. These facts underscore the need for clinicians to consider the possibility of chikungunya disease in patients who experience acute unexplained fever with joint pain and live in regions where mosquito vectors are established. The presence of imported cases and well-established vectors also confirms the need for an active surveillance system; early detection of unexpected new diseases by physicians will enable the timely implementation of suitable control measures that can interrupt the transmission chain.

Child exploitation in the 21st century

Child exploitation has been a problem throughout history. While newer technology has been responsible for many positive changes in society, it also has changed the way in which adults can take advantage of children. With the tremendous technological advances made in the 20th century, a variety of new tools are available to those who prey on children. As we begin the 21st century, this victimisation has taken on important new characteristics. The Internet, digital photography and the ease of travel all have had an impact. We will look how some of these advances have been used by those who prey on our children.

Rhinoplasty

Rhinoplasty

Using satellite images of environmental changes to predict infectious disease outbreaks.

Recent events clearly illustrate a continued vulnerability of large populations to infectious diseases, which is related to our changing human-constructed and natural environments. A single person with multidrug-resistant tuberculosis in 2007 provided a wake-up call to the United States and global public health infrastructure, as the health professionals and the public realized that today's ease of airline travel can potentially expose hundreds of persons to an untreatable disease associated with an infectious agent. Ease of travel, population increase, population displacement, pollution, agricultural activity, changing socioeconomic structures, and international conflicts worldwide have each contributed to infectious disease events. Today, however, nothing is larger in scale, has more potential for long-term effects, and is more uncertain than the effects of climate change on infectious disease outbreaks, epidemics, and pandemics. We discuss advances in our ability to predict these events and, in particular, the critical role that satellite imaging could play in mounting an effective response.

On Southbound Ease and Northbound Fees: Literal Consequences of the Metaphoric Link between Vertical Position and Cardinal Direction

Consumers are influenced by the metaphoric relationship between cardinal direction and vertical position (i.e., is up). People think it will take longer to travel north than south (Study 1), that it will cost more to ship to a northern than to a southern location (Studies 2 and 6), and that a moving company will charge more (Studies 3a and 3b) for northward movement than for southward movement. Furthermore, people have greater intention to visit stores advertised to be south (vs. north) of a reference point (Study 4), especially when ease of travel is important (Study 5).

Radiology and Public Health

An article by Mollura et al in this issue of JACR relates how radiologists could join with other specialists, medical informaticists, and researchers to broadly participate in the field of public health. It’s an idea whose time has come. The combination of worldwide terrorism and the ease of travel have made obsolete the old ways of dealing with outbreaks of disease. Now, our best weapon to contain naturally occurring and criminally initiated epidemics is access to early and accurate information. As Mollura and his colleagues relate so well, radiology could play a critical role in keeping our citizenry safe if only we could link the product of our expertise—our radiology reports—to other clinical information and smart systems that could determine patterns of disease occurrence and spread.

A Large Cluster of Imported Plasmodium falciparum Malaria among Nigerian Expatriate Students

Singapore reported the elimination of malaria in 1982, but this country remains vulnerable to imported malaria. We describe a large cluster of 16 cases of imported Plasmodium falciparum malaria in visiting Nigerian students. More than half were asymptomatic and diagnosed only on screening. Although early diagnosis and treatment of patients averted local transmission of disease, our report illustrates the vulnerability of malaria-free countries to the introduction of malaria in this age of increasing globalization and ease of travel.

On Southbound Ease and Northbound Fees: Literal Consequences of the Metaphoric Link Between Vertical Position and Cardinal Direction

Abstract Consumers are influenced by the metaphoric relationship between cardinal direction and vertical position (i.e., “north is up”). People believe that it will take longer to travel north than south (Study 1), that it will cost more to ship to a northern than to a southern location (Studies 2 and 6), and that a moving company will charge more (Studies 3a and 3b) for northward than for southward movement. Furthermore, people have greater intention to visit stores advertised to be south (versus north) of a reference point (Study 4), especially when ease of travel is important (Study 5).

Medical migration and Africa: an unwanted legacy of educational change

The opportunities given for medical staff to travel, work and remain in countries other than that of their domicile or graduation have led to the phenomenon of medical migration. This has been supported by ease of travel, improved technology and a drive to share good examples of medical education through improved communication.Whilst these opportunities create positive advantages to the individuals and countries involved, through the transfer of knowledge and medical management, the situation does not always lead to long term benefits, and clear disadvantages begin to emerge. The gulf between the developed and developing countries becomes pronounced, leading to a general drift of resources away from the areas where they are most needed and subsequent profound effects upon the indigenous population.This paper suggests that it is a responsibility of medical educators throughout the world to recognize this effect and create opportunities whereby the specialty of medical education positively effects medical migration to the benefit of the less fortunate areas of the world.

Linking services

The world has become a global village thanks to high speed communication and ease of travel, we hear. but do these platitudes apply to dispensing healthcare? Margaret Ryan reports on how video conferencing has been integrated into gynae-oncology services in the north west

Attitudes to transport modes for shopping purposes in Singapore

A review of the retailing and transportation literature shows that there is an apparently large research gap in the understanding of shoppers’ attitudes towards transport modes for shopping purposes. In particular, not many studies have been done to examine shoppers’ detailed and disaggregated attitudinal image structures of the various transport modes for shopping purposes. Using Singapore as a study area, this paper has attempted to investigate shoppers’ image structure of transport modes and their comparative perception ratings for the various modes of transportation for shopping purposes. Using principal component analysis, the research has unveiled the perceptions of five transport modes for shopping purposes. While some of the factors are unique to certain transport modes, other factors, namely ‘suitability’, ‘practicality’, ‘ease of travel’ and ‘cost’, are common to all modes of transportation. By way of the weighted‐factor rating, the study found that the car recorded the highest overall perception rating while the bus rated the lowest. In addition, the shoppers have reasonably good perception of public transport modes in Singapore.

Parasitic and fungal disease of bones and joints.

Among the musculoskeletal infections, fungal and parasitic diseases are infrequent and may have a nonspecific imaging factor. The incidences of fungal and parasitic bone infections are related to geographic distribution, ethnic and nutritional factors, and occupation. Immunocompromise and ease of travel can lead to increased incidence. These are a group of chronic disorders, and delayed diagnosis is common because radiographs, computed tomography, isotope studies, and magnetic resonance imaging are useful but often do not have specific signs for determination of the causative infective fungal or parasitic organism. Definitive diagnosis is possible with a high index of clinical suspicion and aspiration.

Recurrent acute rheumatic fever: a forgotten diagnosis?

The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.

Women, the Internet, and sexually transmitted infections.

To assess the relationship between Internet use and sexual risk behavior among women. A cross-sectional survey, with 64 items, seeking sex partners online was posted on the Internet. Respondents were targeted through e-mail list serves and bulletin board postings. However, the majority of responses were gathered after national media coverage of the survey. Of the 4444 eligible participants, age >18, from North America who completed the online survey, 29% (n = 1276) were women. Of the 1276 women, 544 (43%) reported having sex with a person they first met on the Internet. These women were more frequently white, older, and more experienced with testing for sexually transmitted infections (STI) than women who never had a sex partner they first met online. They also had a higher number of total lifetime partners and more frequently used condoms. However, these women also reported high rates of STI, are not regularly using condoms, and are engaging in anal, oral, and vaginal sex with Internet partners. Many of the women say they would appreciate receiving STI prevention information via e-mail, and those with Internet partners more frequently stated they would participate in chat room discussions about prevention (p < 0.02). The Internet is a flourishing sex venue, and women too are using this new vehicle to seek out sex partners. The wide pool of potential sex partners found online coupled with ease of travel and an increase in partners has the potential to spread an STI or HIV with greater efficiency than ever before imagined. Although women with Internet partners may engage in protective behavior more frequently than women with no Internet partners, they also engage in higher risk behaviors. This population, therefore, needs to be recognized and targeted with STI and HIV education and prevention efforts.

Sexually transmitted infections and human immunodeficiency virus infection in Europe: the way ahead?

The incidence of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) infection is increasing in Europe. The reasons for this are multifactorial but ease of travel is one of them. This is worrying in view of the established role of STIs in facilitating HIV transmission. Care of this group of infections is provided by a variety of doctors, often not following agreed guidelines. It is vital that doctors and their specialist societies engage in setting standards, in ensuring that STIs and HIV infection are moved up the healthcare agendas of all European countries and in making sure that access to care is rapid. Surveillance should be enhanced, interventions evaluated and the media engaged.

Tick paralysis presenting in an urban environment

We report the case of a 17-month-old female with tick paralysis presenting to an urban Los Angeles emergency department. The tick was later identified as the North American wood tick, Dermacentor andersoni, and was likely obtained while the family was vacationing on a dude ranch in Montana. We discuss the epidemiology of tick paralysis, a differential diagnosis for health care providers, and methods of detection and removal. Given the increasing popularity of outdoor activities and ease of travel, tick paralysis should be considered in cases of acute or subacute weakness, even in an urban setting.

Recurrent pyogenic cholangitis

Recurrent pyogenic cholangitis or hepatolithiasis is prevalent in Southeast Asia and is characterized by the finding of pigmented calculus within the intrahepatic bile ducts proximal to confluent of right and left hepatic duct. Cholangitis occurs primarily in bile ducts, which subsequent resulted in pigmented stones and stricture formation. Only with the help of radiological imaging we can stamp the diagnosis of recurrent pyogenic cholangitis. Ultrasonography and computed tomography (CT) played key role in defining this condition. Although recurrent pyogenic cholangitis rarely seen out side Southeast Asia in the past, ease of travel and migration have mean that this condition is now encountered in western countries more regularly. We described a case of extensive hepatolithiasis due to recurrent pyogenic cholangitis.

PERCEPTIONS OF “Nursing” and “Nursing Care” in the United States by Dutch Nursing Students

Abstract THE INTERNATIONALIZATION OF NURSING IS HERE. Ease of travel, advances in communication technology, and international health care journals and conferences have resulted in an increase in cross-border contacts with our nursing colleagues. In its most recent “Essentials” document, the American Association of Colleges of Nursing (I) included the understanding of global health care as a component of “core knowledge” for nursing practice into the 21st century. Selected European schools of higher education are permitting health professional students to take up to 25 percent of their required courses outside their home country (2). To meet the challenge of internationalizing the nursing profession, professional education programs have developed various learning strategies, including international courses and student and faculty exchange programs. Few studies have examined the outcomes of these visits. What are foreign nurses and nursing students observing about nursing and nursing care in the United Stat...

Glucose-6-Phosphate Dehydrogenase Deficiency: A Worldwide Potential Cause of Severe Neonatal Hyperbilirubinemia

After completing this article, readers should be able to: 1. Explain methods of preventing the hyperbilirubinemia caused by glucose-6-phosphate dehydrogenase (G6PD) deficiency. 2. Compare and contrast the correlation between hemolysis and serum bilirubin levels in healthy infants and those who are G6PD-deficient. 3. Describe the role of deficient bilirubin conjugation in the pathogenesis of G6PD deficiency-associated neonatal hyperbilirubinemia. 4. Define the risk for neonatal hyperbilirubinemia in female G6PD-deficient heterozygotes, G6PD-deficient homozygotes, and hemizygote males. Glucose-6-phosphate dehydrogenase (G6PD) deficiency, a commonly occurring X-linked genetic enzyme defect, is notorious for its association with acute hemolytic crises occurring in response to a frequently identifiable trigger (favism). Another potentially devastating danger of this condition is severe neonatal hyperbilirubinemia with its accompanying bilirubin encephalopathy, kernicterus, and death. Far from being a condition limited to historical time epochs and developing countries, G6PD deficiency-associated kernicterus still is seen in modern times. Indeed, among 80 infants from 21 states in the United States documented in a pilot Kernicterus Registry between 1984 and 1998, 18 (22.5%) were reported to have G6PD deficiency. Furthermore, Maisels recently listed G6PD deficiency among the 10 factors that are associated most commonly with an increased risk of nonhemolytic jaundice. Because of the association with favism, G6PD-associated hyperbilirubinemia traditionally has been regarded as hemolytic in origin. However, recent research has shown that although acute hemolysis does play a role, its contribution in many cases may be smaller than previously thought. The emphasis now has been placed on decreased bilirubin conjugation, with promoter polymorphism for the gene for the bilirubin conjugating enzyme, UDP glucuronoslytransferase 1A1 (UGT1A1), being a major factor in production of the icterus. In this review we highlight key aspects of the pathogenesis of this type of hyperbilirubinemia, explain the relevance of the condition, and describe a particularly problematic group that has a recently recognized high incidence of …

Rare bone infections "excluding the spine".

Bone infections are usually due to haematogenous spread from distant infected organs. Spread of local sepsis or contamination of open wounds are less frequent routes of infection. The commonest cause of osteomyelitis is Staphylococcus aureus. The term rare bone infections refers to diseases where only a few percent affect bone or diseases which are essentially rare; these include bacteria, fungi, parasites and non-specific conditions. Common examples are tuberculosis, salmonellosis, brucellosis, hydatidosis, madura, actinomycosis, aspergillosis and American fungal infections. Certain bone infections have become exceedingly rare, particularly atypical mycobacteria, viral embryopathies and spirochaetes. Rare bone infections are encountered in many parts of the world commonly in the tropics and in the U. S. Immunocompromise and ease of travel can lead to increased incidence. A high index of clinical suspicion is necessary for diagnosis. Specific laboratory diagnosis is not always possible. Radiographs, computed tomography, isotope studies and magnetic resonance are useful but may not make the diagnosis. Aspiration or biopsy is necessary. Rare bone infections may simulate non-infective bone lesions.