Overseas Travel Research Articles

'A Happy Holiday': English Canadians and Transatlantic Tourism, 1870-1930 (review)

Reviewed by: 'A Happy Holiday': English Canadians and Transatlantic Tourism, 1870-1930 Jane Nicholas (bio) Cecilia Morgan . 'A Happy Holiday': English Canadians and Transatlantic Tourism, 1870-1930. University of Toronto Press. xxiv, 462. $90.00, $37.95 In this richly detailed and finely argued book, Cecilia Morgan reveals the intersections of identity, nation, and empire in English (and largely Protestant) Canadians' experiences with transatlantic tourism in the late nineteenth and early twentieth centuries. Morgan argues that tourism is 'useful in exploring a range of issues, the most central and recurring one being the role it played in forging and sharpening middle-class identities and perceptions.' Morgan is careful, however, to tease out the fractured nature of this group's identity along gender, race, class, and regional lines, and pays close attention to ambivalences. The intersections of gender and other aspects of identity are especially well documented. Male tourists, for example, more frequently ventured into London's East End where they gazed upon the English working classes and reaffirmed their own classed and racialized identities, although women were not wholly excluded from these activities on East End streets. Morgan also notes that women could perform the lost, solo female tourist and appeal to masculine authority for assistance, while simultaneously revealing a distinct sense of autonomy and self-sufficiency in their travels and writing. Despite the multiplicity of reactions to various places and sites among tourists, overseas travel, especially to Britain, provided this privileged group of Canadians an opportunity to contemplate wider issues of identity, nation, and empire as modern subjects. In a section on imperial pageants, for example, Morgan contrasts the experiences of two Canadians, one who brims with optimism thinking about the events, while another experiences an acute sense of disappointment watching the 1911 Festival of Empire parade. Experiences were just as varied inside the Crystal Palace where the Canadian exhibits could be satisfying [End Page 591] or disconcerting in their representation of Indigenous performers or portrayal of aspects of the Canadian landscape. More than just events, however, Morgan shows how these experiences and reactions formed an important avenue where travellers could reflect upon, criticize, and potentially shore up modern subjectivities. Embroidered with first-person accounts from almost fifty unpublished sources, including travel diaries and letters home, as well as published reports appearing in Canadian newspapers and periodicals, Morgan's 'A Happy Holiday' teases out aspects of the sensuous history of tourism - what travellers saw, smelled, heard, and even tasted. This forms part of what Morgan calls the 'theatre of tourism,' which engages with the performance of tourism and the sensuous pleasures (and perils) tourists encountered, from theatres and shopping to the experience of London traffic and 'noisy' Italian cities. Taken together, then, Morgan's study of tourism is also about modernity and how English Canadians sought to make sense of their typically welcomed, but often dislocating, experiences with it. Travellers found that their overseas experiences could challenge or confirm their stereotypes about other people (the English working class, orphans, and 'degraded' European women, for example) as well as their own notions of Canadian or imperial progress. As English-Canadian men and women maintained and eschewed stereotypes about the people and places they visited, they often found themselves confronted as (and sometimes offended by) being seen as 'colonial cousins' unable to meet white, British, middle-class standards. Despite, perhaps, feeling a sense of belonging to a great 'white' empire, travellers were often confronted with contradictions and disappointments, and these are well documented throughout the book. 'A Happy Holiday' is divided into nine chapters organized by destination, theme, and chronology. The first eight deal with transatlantic tourism to places in Great Britain and Western Europe from the 1870s to the First World War. The ninth chapter discusses the changes and continuities in English Canadians' experiences overseas in the 1920s. Although Morgan finds the balance in favour of continuity in the 1920s, there were changes, and a significant one was the automobile, as it allowed tourists largely to dictate their own travel schedule, afforded them more privacy, and had them speeding through the landscape as highly mobile flâneurs, at least until they ran out gas, blew a tire, or steered off...

Reducing the risk of respiratory disease in overseas travellers

Reducing the risk of respiratory disease in overseas travellers

Reducing the risk of respiratory disease in overseas travellers

This article addresses the risk of respiratory illness for those travelling overseas. It considers emerging disease risks, particularly the influenza virus, as well as vaccination and vulnerable populations. Resources to help practitioners provide pre-travel advice in line with best practice in travel health are discussed.

How Consumer Ethnocentrism and Animosity Impair the Economic Recovery of Emerging Markets

ABSTRACT Many developed nations have reportedly turned to protectionism to speed up recovery from the recent global financial tsunami. Emerging economies that rely on exports and tourism have been particularly hard hit by these barriers. This study analyzes a conceptual framework that captures the effects of product image, country image, ethnocentrism, and animosity on consumers’ attitudes for imports and overseas travel. The results offer a fresh perspective, beyond that which has been explained by literature on product evaluation and country-of-origin. The findings imply that an export-dependent nation will need a linkage strategy to defend against protectionism. Strategic implications are discussed.

Comparison of serine-rich protein genes of Entamoeba histolytica isolates obtained from institutions for the mentally retarded in Kanagawa and Shizuoka Prefectures, Japan

In Japan, amebiasis has been observed in homosexual men, in institutionalized persons, and in overseas travelers. We have previously reported an outbreak of amebiasis that occurred from 1986 to 1994 in institutions for the mentally retarded in Kanagawa and Shizuoka Prefectures in Eastern Japan. Entamoeba histolytica but not Entamoeba dispar was identified in Entamoeba cultures obtained from cyst passers in four institutions located in different municipalities in this region. In the present study, serine-rich protein genes of eight isolates from the four institutions were sequenced, and their polymorphism was analyzed. The results showed that all the sequences from the E. histolytica isolates were identical. This retrospective study led us to conclude that the outbreak of amebiasis in different municipalities was derived from a single source of E. histolytica.

Prevention of pandemic influenza after mass gatherings – learning from Hajj

Shortly after Hajj 2009 ended on 30 November, less than 100 pilgrims with confirmed pandemic influenza A H1N1 09, including five fatalities, had been reported by Saudi officials in the media.1 Since the elderly and others with influenza risk factors were discouraged from attending Hajj, this case fatality rate of 5% is inconsistent with that expected (less than 0.5%) and suggests there were many more undetected surviving cases. It is known from earlier pandemics that the ‘percentage of the recognised sick, who seek medical advice does not represent the total of the afflicted’.2 To date Saudi Arabia has the largest number of influenza A H1N1 09 cases (9355, 20% of all cases) and the third largest number of fatalities (81, 14% of all fatalities) reported from the World Health Organization (WHO) Eastern Mediterranean Region.3 Further, a Saudi hospital has claimed that about one-fifth of hospitalized patients had the influenza A H1N1 virus infection after returning from travel abroad,4 so publication of Hajj 2009 realtime influenza surveillance data (with PCR confirmation, if possible) by the Saudi Ministry of Health would be useful and welcome to inform global pandemic influenza control. A large number of pilgrims stay in Saudi Arabia for a month. If as few as 10 arrived with H1N1 09 influenza, and assuming a low basic reproduction number (R0) of 1.5, a serial interval of 3 days and a susceptible population,5 nearly 1000 cases will have occurred within that month. Up to 60% of Hajj pilgrims suffer symptoms of respiratory infection,6 and the attack rate of influenza among symptomatic pilgrims has been estimated as 10%,7 so that extrapolating for 2.5 million pilgrims attending this year's Hajj 150,000 cases of influenza would be expected. It is a tradition in Muslim communities that as well as pilgrims being visited by friends and relatives on arrival in Mecca, many travel after Hajj in the Middle East and Indian subcontinent, and recent returnees attend congregational prayers at mosques. These activities increase the risk of infections such as the influenza spreading among pilgrims' vulnerable contacts including the elderly and children. Also, Hajjis' travel and return coincided with the 2009 Christmas and New Year holiday period and associated overseas travel and contact in airplanes, airports and other sites. Useful recommendations for the prevention and control of influenza A H1N1 at Hajj 2009, published in both Science and the Lancet in mid-November,8,9 summarized the advice from an expert consultation undertaken by the Saudi Arabian Ministry of Health. These included good surveillance at Hajj by realtime electronic reporting, rapid laboratory confirmation via the healthcare system at Hajj, compliance with WHO advice, particularly that on the control of infectious diseases during mass gatherings and reporting of infection as required by the International Health Regulations 2005.10,11 The latter assumes surveillance in the country of origin to be adequate for recognizing and reporting post-Hajj infections. However, experience is of delay in recognizing Hajj-associated cases and outbreaks. It is less than a decade since the Hajj-associated worldwide outbreak of meningococcal W135 disease following Hajj 2000 when 87% (78/90) of the Hajj-associated cases in Europe were in contact with those who had returned from Hajj; there were 14 deaths which may have been avoided by quicker recognition of the association.12 Risk events for pandemic influenza A H1N1 09 include the continuing Umrah and other mass gatherings subsequent to and soon after Hajj 2009, such as the December UN conference on Climate Change expecting 15,000 delegates, world leaders and politicians in Copenhagen, the winter Olympics in Vancouver early in 2010, and the FIFA World Cup later in 2010. Post-event surveillance is just as important for these in the control of respiratory infections. Health services around the world need reminding of the importance and means of surveillance, which may need strengthening or construction. Therefore, we set out here recommendations for post-event surveillance, diagnosis and treatment: Vigilance and questioning about recent travel abroad, including attendance at Hajj or other mass gatherings; Reporting suspected cases locally and to WHO; Confirming H1N1 09 flu by PCR; Continuing preventive action: respiratory etiquette, mask use by symptomatic cases and their contacts, maintenance of hand hygiene, voluntary isolation of cases, antivirals for cases and for prophylaxis in vulnerable contacts, vaccination of unvaccinated Hajjis and their at risk contacts against seasonal and pandemic influenza, pneumococcal vaccination of at risk pilgrims; We also urge WHO to develop a post-event surveillance scheme and directive for immediate electronic reporting of travel-associated influenza and its complications, during the current pandemic influenza A H1N1 09 and in preparation for the future.

Lessons Learned from Non-Pharmaceutical Public Health Responses to Pandemic (H1N1) 2009 in Japan

Public health responses in mitigating influenza pandemics include enhanced surveillance, quarantine, patient management, and social distancing. This manuscript summarizes non-pharmaceutical public health responses in Japan and identifies 10 lessons learned from pandemic (H1N1) 2009. Pandemic (H1N1) 2009 can be classified into five phases: I) prepandemic; II) overseas, when swine influenza A (H1N1) was identified in Mexico and the United States; III) early localized, when domestic clusters of patients were identified in Japan; IV) smoldering; and V) widespread. Ten lessons were learned and identified: in the prepandemic phase, 1) the initiatives of high-level decision-making bodies must be enforced effectively and comprehensively, and 2) planning must be flexible and based on a range of scenarios. In the overseas phase, 3) difficulties in decision-making and require the public's trust, 4) human rights must be protected, especially for infected individuals, and 5) efficient response operations are essential because of limited resources. In the early localized phase, 6) acceptance of local governments' initiatives, 7) assumption of the identification of the first domestic patients without overseas travel, 8) strategic public communication for minimizing anxiety, and 9) timely resource allocations with termination of unnecessary responses are necessary. In the widespread phase, 10) criteria for school closures are essential. The implementation of these measures could create greater efficiency in public health responses in the face of another epidemic.

Attitude and practice of medical students studying in Hungary and India toward health during overseas and domestic travel

It is presumed that medical students are travelers who can take care of their health, and thus the present study was conducted to elicit the attitude and practice [AP] of medical students from two different countries toward travel health issues. To elicit the attitude and practice of medical students from two different countries toward travel health issues and identify the reasons for any variations. An anonymous pre-tested structured questionnaire consisting of socio-demographic details, travel aspects, travel health issues, and precautions [medicines carried, vaccination history, and pre-travel consultation] adopted was distributed to 250 foreign medical students studying at the University of Debrecen, Hungary [Group I] and another 250 native medical students in India [Group II]. Data were analyzed by simple descriptive statistics and Student t-test. A total of 428 students responded among total eligible population of 500; 228 [90.2%] in group I and 200 [80%] in group II. In 2008, 188 [82%] of the former and 33 [16.5%] of the latter groups traveled to international destinations. Among groups I and II, health problems were experienced by 73 [32%] and 65 [32.5%] students, respectively. During hospitalization, students of group I were admitted for one of the following illnesses such as severe asthma, dehydration, malaria, and tibial fracture, while two other students were admitted to the hospital with deep vein thrombosis [DVT]. During travel, the category of medicines carried by students belonging to group I/II were anti-diarrhoeal [75/19], anti-emetics [53/39], anti-giddiness [49/7], anti-histamines [55/12], anti-pyretics plus analgesics [197/70], anti-spasmodics [55/11], antibiotics [33/10], vitamin pills [84/0], and laxatives [47/6]; supportive items such as adhesive plaster [64/3], and thermometer [37/1]; personal protective materials viz., mineral water [165/88], hygienic food [100/132], insect repellents [86/14], special clothes such as full sleeves and cap [150/0], sun screen [160/14], and items against sexually transmitted diseases [159/0]; health documents such as medical insurance card [161/3], previous health records [40/0], immuno-prophylaxis [127/0], family physician's phone number [43/9] and pre-travel advice [57/2]. Students studying in Hungary were better informed about travel-related issues than native students from Indian medical colleges. The probable reasons for such variations were cultural differences, variation in their pre-medical curricula and teaching, frequent travel, a previous university degree, military training, maturity, and staying away from parents. The overall attitude and practice of medical students toward travel health issues were sub-optimal, since the subjects taught did not focus much on travel and health-related issues. Hence, there is an urgent need to initiate standardized teaching in the field of travel medicine for the students of health sciences for the benefit of the community.

The Making of a Medical Entomologist

This article describes the childhood of Mike Service, his very early interest in insects, his time at Imperial College, London University, and his career in Nigeria studying the taxonomy and biology of anopheline malaria vectors. On his return to England he became increasingly interested in the ecology and population dynamics of hematophagous insects. After almost eight years undertaking only research, he joined the Liverpool School of Tropical Medicine, where he was involved in lecturing as well as research and engaged in frequent overseas travel mainly to Africa, Central and South America, and Asia. On retirement he retains an active interest in medical entomology. Although he undertook a considerable amount of taxonomic work on mosquitoes, he believes his most important, and possibly influential, work was introducing ecological methods that were used by agricultural scientists to the study of mosquitoes. For example, the construction of life tables, calculating the percentage mortality of pre-adult mosquitoes, and the identification of predators by serological methods.

An Imported Case of Echinococcosis of the Liver in a Korean Who Traveled to Western and Central Europe

Echinococcus granulosus, an intestinal tapeworm of dogs and other canids, infects humans in its larval stage and causes human echinococcosis or hydatid disease. In the Republic of Korea, 31 parasite-proven human echinococcosis cases have been reported, most of which were imported from the Middle East. We recently examined a 61-year-old Korean man who had a large cystic mass in his liver. ELISA was negative for tissue parasitic infections, including echinococcosis, cysticercosis, paragonimiasis, and sparganosis. The patient underwent surgery to remove the cyst, and the resected cyst was processed histopathologically for microscopic examinations. In sectioned cyst tissue, necrotizing protoscolices with disintegrated hooklets of E. granulosus were found. In some areas, only freed, fragmented hooklets were detected. The patient had traveled to western and central Europe in 1996, and had no other history of overseas travel. We report our patient as a hepatic echinococcosis case which was probably imported from Europe.

Mefloquine chemoprophylaxis against malaria in Japanese travelers: results of a study on adverse effects

Although Mefloquine is commonly used as a prophylactic drug for travelers to malaria endemic areas, there are only limited reports about its adverse effects in Japanese travelers. We carried out a prospective observation study of 107 travelers who were prescribed mefloquine as chemoprophylaxis against malaria prior to their departure from November 2004 to October 2006. We carefully sought the appropriate prescription for each client according to the guidelines for Japanese overseas travelers. The clients consisted of 71 men and 36 women of whom we were able to follow 65 travelers until the end of their prophylactic procedure. Of the 65, 47 travelers completed their full course of chemoprophylaxis. Different adverse effects were reported in 19 travelers of them such as fatigue (n=9), dizziness (n=6), headache (n=3), nausea (n=3), drowsiness (n=2), strange dreams (n=2), anxiety (n=2), fever (n=1) and skin rash (n=1). Three travelers were incapable of continuing chemoprophylaxis due to the adverse effects, but no serious events were noted. Through our study, mefloquine chemoprophylaxis seemed tolerable for Japanese travelers. We believe that our detailed consultation and careful monitoring reduced the incidence of severe adverse effects and maintained the high rate of adherence to chemoprophylaxis.

한국 귀금속산업 활성화 방안분석(CAD/CAM을 중심으로)

1980년대 이전의 한국귀금속산업은 전통 공예와 디자인의 발달사를 제외하면 마케팅 및 사업적인 측면에서는 의의는 거의 없었다. 재화의 가치에서 장신구의 가지로 변화 되어온 국내 주얼리 시장은 1980년대 이후 해외여행자유화 및 86아시안게임과 88서울올림픽을 계기로 주얼리 제조 산업에 중요한 전환점을 맞이하게 되었다. 1990년대 이전 제품의 대량 생산을 가능하게 정밀 주조기법의 도입으로 급성장하게 된 주얼리 시장은 1990년대 이후 CAD/CAM의 도입과 함께 주얼리 제조 산업은 새롭게 변화하기 시작하였다. 주얼리 제조 산업은 과거 핸드메이드라고 불리던 수 가공 작업에서 대량 생산을 위한 마스터를 기본으로 하는 정밀 주조 산업으로 변화되어 왔다. 이에 마스터의 개발은 디자인 개발과 함께 주얼리 생산업체에 중요한 과제로 제시 되어 왔고 CAD/CAM의 도입으로 디자인과 마스터 개발에 다각화를 가져오게 되었다. 본 연구는 먼저 국내 주얼리 시장의 현주소와 CAD/CAM에 대한 이해와CAD/CAM의 장점 및 활용 방법을 알아보고 이를 통해서 주얼리 시장의 활성화 방안을 제시해 보고자 한다. Except for traditional industrial art and history of design development, Korea jewelry industry before 1980's, had little meaning in the aspect of marketing and business. Domestic jewelry market which have changed from the value of goods to value of ornaments, faced important transition point for jewelry industry by the chance of in Asian Game held in 1986, and money of overseas traveler after 1980s. The rapidly-grown Jewelry field by the introduction of detail casting method to make it possible mass-production of the products before 1990's, began to change into new system, with introducing CAD/CAM after 1990's. Jewelry industry has changed from manual work called handmade to the detail casting industry based on master for mass-production. For this, the development of master, with the design development, have been suggested as important task to jewelry industry firms, and by the introduction of CAD/CAM, the diversification of design and master development has been made up. In this study, we would try to find out current status of domestic jewelry field and to understand CAD/CAM, and advantage of CAD/CAM, and through this, suggest good solution to precipitate domestic jewelry market.

How Motivations, Constraints, and Demographic Factors Predict Seniors' Overseas Travel Propensity

This study investigates the influences of travel motivations, travel constraints, and demographic variables on seniors' overseas travel intentions. A survey of Taiwanese seniors was conducted for the purpose of identifying the significant predicators of overseas travel. Using factor analyses, four motivations (relaxation, novelty, escape, and socialization) and three travel constraints (perceived risks, time commitments, and personal reasons) are delineated. The results from the logistic regression analysis suggest that the main factors predicting seniors' overseas travel propensity include age, income source, employment status, relaxation motive, novelty motive, socialization motive, and personal reasons constraint.

The Third Wave—Medical Tourism in the 21st Century

The high number of uninsured or underinsured Americans and the spiraling cost of healthcare in the United States has spurred growth in patients traveling abroad for affordable healthcare, which has become known as medical tourism. It is projected to become a $21 billion a year industry by 2011. Overseas prices for most procedures, including airfare, are often half the cost of those performed in the United States; some procedures are 80% less. International facilities in India, Thailand, and elsewhere are obtaining Joint Commission International (JCI) accreditation and aggressively marketing to Western customers and insurance agencies and advertising high quality standards and personalized service. The acceptance of medial tourism is growing, with a recent poll showing more than 40% of US healthcare consumers willing to travel abroad for care. Insurance companies have begun to integrate foreign care into their coverage, offering discounts to patients agreeing to overseas travel. Physician groups have been slow to respond, even though estimates are that medical tourism may represent $162 billion in lost spending in America by 2012. Some experts think the continued US healthcare cost crisis will drive an increase in medical tourism and international competition, significantly impacting domestic physicians and hospitals.

Plasmid-Mediated Quinolone Resistance in <i>Salmonella</i> Isolated from Patients with Overseas Travelers<i>'</i> Diarrhea in Japan

Twenty-eight of the 302 Salmonella strains isolated from patients with overseas travelers' diarrhea who were examined at Kansai Airport Department Station during the 6-year period between 2001 and 2007 showed decreased susceptibility to both nalidixic acid (NA) and ciprofloxacin (CPFX) (MIC of NA, 16-64 μg/mL; MIC of CPFX, 0.064-2.0 μg/mL). These 28 strains revealed no variations in the quinolone resistance-determining region; however, 25 of the strains showed retention of the qnr gene. The qnr-retaining Salmonella belonged to 6 serotypes, and 21 and 4 of the 25 strains showed qnrS1 and qnrS2, respectively. The most common serovar was S. Corvallis (17 strains).

Overseas Visitor Deaths in Australia, 2001 to 2003

The health and safety of international visitors remain an important issue for Australia and other tourist destinations. The death of visitors remains an important indicator of safety. The aim of this study was to provide updated figures on deaths of overseas travelers in Australia. Data were sourced from the Australian Bureau of Statistics concerning deaths of overseas visitors for the years 2001 to 2003. There were 1,068 overseas visitor deaths (701 males, 66%) during the study period 2001 to 2003. Death by natural causes increased with age, while deaths associated with accidents were more frequent among younger age groups. The majority of deaths were from natural causes (782, 73%), particularly ischemic heart diseases (26%). There were a total of 247 accidental deaths (23% of all deaths) with the main causes being transportation accidents (14% of all deaths) and accidental drowning/submersion (5% of all deaths). The countries contributing the most deaths were the UK (247, 23%), New Zealand (108, 10%) Melanesia/Micronesia (95, 9%), and the United States (57, 5%). Australia remains a relatively safe destination for international travelers, at least in terms of fatalities, which appear to be declining. Most deaths of overseas tourists in Australia are due to natural causes with cardiovascular disease being the predominant cause of death in this group. Accidents remain the most common preventable cause of death of travelers, with road and water safety being the major issues. It is important that tourism and travel medicine groups continue to advocate for improved health and safety of international travelers visiting Australia.

Transmission potential of the new influenza A(H1N1) virus and its age-specificity in Japan

On 16 May 2009, Japan confirmed its first three cases of new influenza A(H1N1) virus infection without a history of overseas travel, and by 1 June, 361 cases, owing to indigenous secondary transmission, have been confirmed. Of these, 287 cases (79.5%) were teenagers (i.e. between 10 and 19 years of age). The reproduction number is estimated at 2.3 (95% confidence interval: 2.0, 2.6). The average number of secondary transmissions involving minors (those under 20 years of age) traced back to infected minors is estimated at 2.8. That is, minors can sustain transmission even in the absence of adults. Estimates of the effective reproduction number Rt moved below 1 by 17 May. Active surveillance and public health interventions, including school closures most likely have contributed to keeping Rt below one.

Curriculum as an International Text: Evaluation of Global Education from Junior High School Students' Knowledge and Attitude in Taiwan

This study is interested in understanding curriculum as an international text and evaluating the connections between junior high school students’ global knowledge and attitudes and the required national curriculum in Taiwan. The study also examines whether the global knowledge and attitudes vary by demographic variables. By using the Global Knowledge Scale and Global Attitudes Scale, data were collected from 1,017 students in central Taiwan and analyzed by descriptive statistics, chi-square and one-way MANOVA. The results of this study revealed that, first, the global knowledge of the junior high school students was insufficient, but their global attitudes were positive. Second, there was no gender difference in global knowledge but there was a difference in global attitudes. Third, ninth graders held significantly the highest knowledge and attitudes than eighth graders and seventh graders. Fourth, there was a socioeconomic status difference in global knowledge and attitudes. Finally, students with overseas travel experience have better global knowledge and attitudes. This study suggests that practitioners and researchers need to find practical ways to improve global education including curriculum design and implementation, teacher preparation, school environment, and students’ assessment.

A tale of two parasites: the comparative epidemiology of cryptosporidiosis and giardiasis

New Zealand has a higher reported incidence of cryptosporidiosis and giardiasis than most other developed countries. This study aimed to describe and compare the epidemiology of these infections in New Zealand, to better understand their impact on public health and to gain insight into their probable modes of transmission. We analysed cryptosporidiosis and giardiasis notification data for a 10-year period (1997-2006). Highest rates for both diseases were in Europeans, children aged 0-5 years, and those living in low-deprivation areas. Cryptosporidiosis distribution was consistent with mainly farm animal (zoonotic) reservoirs. There was a dose-response relationship with increasing grades of rurality, marked spring seasonality, and positive correlation with farm animal density. Giardiasis distribution was consistent with predominantly human (anthroponotic) reservoirs, with an important contribution from overseas travel. Further research should focus on methods to reduce transmission of Cryptosporidium in rural areas and on reducing anthroponotic transmission of Giardia.

PR29P COSMETIC MEDICAL TOURISM: ITS TRUE COST

Cosmetic tourism has been enjoying unprecedented public attention of late. Enticing New Zealanders with the promise of low cost, overseas travel and the advertised exotic adventure, its popularity grows steadily amongst consumers.We report four cases of complications that had arisen from cosmetic tourism presented to our unit within the last 18 months.With each case presentation, we aim to identify the pitfalls of such practice and thus reasons that lead to these devastating and costly complications for the consumers and health system.Finally, a literature review on the impacts and responses to cosmetic medical tourism from our region and other developed countries including the UK and the US will be presented.In summary, outsourcing health care in our current climate subject our patients to uncertain quality of care, which could seriously threaten their wellbeing. If legislation is to be proposed to limit agents in the advertising and purveyance of medical tourism in New Zealand, it is imperative that accurate account of the adverse events and cost to the taxpayer are recorded. The cost and challenge this global phenomenon poses to our practice warrant prompt study of its extent and impact to the New Zealand plastic surgical community.