Pretravel Education Research Articles

Pre-air travel health-seeking behaviour, prevalence of barotitis media, its knowledge and associated factors among recently travelled patients in Kano, Nigeria.

Existing evidence suggests that barotitis media (BM) is common among air travellers, and it has the potential to cause severe discomfort and sometimes permanent hearing and balance deficits. It has not been studied in Nigeria. This study aimed to assess the pre-air travel health-seeking behaviour, prevalence of BM, knowledge of BM and its associated factors among a cohort of outpatients with a history of recent air travel in Kano, Nigeria. This questionnaire-based survey involved 97 participants systematically and proportionately selected from adult patients or caregivers of children with recent air travel history attending two outpatients clinics over 7 weeks. Information on biodata, pre-air travel advice-seeking behaviours, air travel experience and BM knowledge were obtained. Data were analysed using the descriptive statistical methods, Chi-square or Fisher's exact tests and odds ratio (OR). Most participants were male (54.6%) with tertiary education (87.6%); the prevalence of BM was 44.3% (43/97). Only 2.1% (2/97) had ever sought pre-air travel advice from a doctor; 83.5% (81/97) had heard of BM before; 42% had adequate knowledge of BM. Employment status (Fisher's exact, P = 0.001), clinic at recruitment (Fisher's exact, P = 0.00008), duration of last flight (Fisher's exact, P = 0.0001) and persistent ear-pain after landing (Fisher's exact, P = 0.001) were significantly associated with participants' knowledge of BM. Persistent ear-pain after landing was the predictor of BM knowledge (OR = 0.04, 95% confidence interval [0.002-0.67], P = 0.025). The BM knowledge level of this cohort suggests the need for further studies to ascertain the complete picture and justify improved pretravel education of air travellers in our setting.

1659. Electronic Consultations Combined with a Video Supported Powerpoint-based Pre-Travel Education Is Equivalent to In-Clinic Face-to-Face Pre-Travel Consultations in Appropriately Selected Travelers

BackgroundPre-travel consultation involves an in-clinic face-to-face consult (F2F) with a Travel Medicine provider. F2F involves education/counseling which is time-consuming for both patients and providers. Although electronic consultations (synchronous and asynchronous) are well established in many subspecialties, pretravel eConsults are not well known. We compared pretravel education via F2F to an innovative hybrid electronic consultation (HeC) combined with a Video Supported PowerPoint (VSP) for selected travelers.MethodsWe conducted a prospective trial comparing HeC-VSP to F2F to determine the quality of pretravel education. Study was approved by the Mayo Clinic IRB. Patients were enrolled from May 2014 through May 2015. Patients in both arms were given pretravel and post-travel surveys. Exclusions included age less than 18 years, first trip to Africa, immunocompromised host, non-English-speaking traveler, or travel for longer than 4 weeks.Results194 patients were enrolled; 100 in HeC-VSP and 94 in F2F arm completed pretravel survey. Post-travel survey was completed in 54.2% (51/94) of the F2F, 67% (67/100) in the HeC-VSP group. The groups are similar in demographics and prior travel experience (Table 1). 36.2% of the F2F group felt that the consultation could have been effectively accomplished through a video-based education, while 33% felt that a F2F was needed; in contrast a majority (63.3%) in the HeC-VSP group would not have preferred a F2F consultation. HeC-VSP-based pretravel education was similar compared with that provided via the F2F consults. There were no statistically significant differences in the responses obtained in both groups to knowledge assessment questions (Table 2) except for one question. A higher proportion (76/100; 76%) in the HeC-VSP group compared with 55.4% (51/94) chose the correct response (P = 0.0018) regarding management of bloody diarrhea with fever. Self-reported change in behaviors to prevent travel-related illnesses was reported overall in 53% of the patients with no statistically significant differences between the groups.ConclusionNonsynchronous eConsultation combined with VSP provides a viable solution to provide pretravel education for a select travel population. Disclosures All authors: No reported disclosures.

Travelers' Diarrhea: A Clinical Review.

Background: Travelers’ diarrhea is the most common travel-related malady. It affects millions of international travelers to developing countries annually and can significantly disrupt travel plans.Objective: To provide an update on the evaluation, diagnosis, treatment, and prevention of traveler’s diar-rhea.Methods: A PubMed search was completed in Clinical Queries using the key term “traveler’s diarrhea”. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. Patents were searched using the key term “traveler’s diarrhea” from www.freepatentsonline.com.Results: Between 10% and 40% of travelers develop diarrhea. The attack rate is highest for travelers from a developed country who visit a developing country. Children are at particular risk. Travelers’ diarrhea is usually acquired through ingestion of food and water contaminated by feces. Most cases are due to a bac-terial pathogen, commonly, Escherichia coli, and occur within the first few days after arrival in a foreign country. Dehydration is the most common complication. Pretravel education on hygiene and on the safe selection of food items is important in minimizing episodes. For mild travelers’ diarrhea, the use of antibi-otic is not recommended. The use of bismuth subsalicylate or loperamide may be considered. For moder-ate travelers’ diarrhea, antibiotics such as fluoroquinolones, azithromycin, and rifaximin may be used. Loperamide may be considered as monotherapy or adjunctive therapy. For severe travelers’ diarrhea, antibiotics such as azithromycin, fluoroquinolones, and rifaximin should be used. Azithromycin can be used even for the treatment of dysentery whereas fluoroquinolones and rifaximin cannot be used for such purpose. Recent patents related to the management of travelers’ diarrhea are discussed.Conclusion: Although travelers’ diarrhea is usually self-limited, many travelers prefer expedient relief of diarrhea, especially when they are traveling for extended periods by air or ground. Judicious use of an antimotility agent and antimicrobial therapy reduces the duration and severity of diarrhea.

Blood sugar control among type 2 diabetic patients who travel abroad: A cross sectional study.

The dose adjustment of anti-diabetic drugs during traveling abroad remains an important issue for the diabetic patients. However, there are few studies exploring the changes in blood sugar in patients with type 2 diabetes mellitus (T2DM) when traveling abroad. The study aimed to investigate the hypoglycemic episodes, sugar control, and associated factors during travel among patients with T2DM.A questionnaire was administrated to T2DM patients visiting the family medicine clinic in a medical center from September 2016 to April 2017. The Chi-square test was used to examine the differences in risk factors of hypoglycemia between hypoglycemic group and non-hypoglycemic group. Multivariate logistic regression models were used to examine the risk factors for the hypoglycemia.A total of 65 males and 74 females completed the questionnaire. The mean age was 59.3 ± 12.1 year olds, the mean BMI was 28.1 ± 5.9 kg/m2, and the mean HbA1C was 7.4 ± 1.1%. There was 8.6% of diabetic patients reporting hypoglycemic episodes during travel. The hypoglycemic episodes were significantly related to the numbers of crossing time zones after adjusting for possible confounders. Only 21.6% of subjects told physicians their travel plan whereas two third of the physicians did not provide pre-travel consultation.The hypoglycemic episodes sometimes occurred and were related to the numbers of crossing time zones in diabetic travelers. The proportion of pre-travel consultation was low in patients with T2DM. Besides, most of the physicians did not offer pre-travel education when patients mentioned their traveling plan. The willing and ability of physicians to offer the pre-travel diabetic education deserved further investigation.

Epidemiology of Imported Infectious Diseases, China, 2005-2016.

Imported infectious diseases are becoming a serious public health threat in China. However, limited information concerning the epidemiologic characteristics of imported infectious diseases is available. In this study, we collected data related to imported infectious diseases in mainland China from the National Information Reporting System of Infectious Diseases and analyzed demographic, temporal, and spatial distributions. The number of types of imported infectious diseases reported increased from 2 in 2005 to 11 in 2016. A total of 31,740 cases of infectious disease were imported to mainland China during 2005–2016; most of them were found in Yunnan Province. The cases were imported mainly from Africa and Asia. As a key and effective measure, pretravel education should be strengthened for all migrant workers and tourists in China, and border screening, cross-border international cooperation, and early warning should be further improved.

Diabetes mellitus and travel-related illnesses

International travel, including patients travelling with diabetes mellitus, is predicted to increase in the coming decades. These patients will require pre-travel education regarding adjusting insulin and oral antidiabetic agents during their journey especially if they fall ill. The spectrum of travel-related illnesses includes food and waterborne diseases, airborne and vector-borne diseases, zoonoses, sexually transmitted and blood-borne diseases, and diseases transmitted by soil. This article reviews the pre-travel vaccines and immunisations and infectious diseases of potential risk to diabetic travellers. Furthermore investigation of fever in returned diabetic travellers with particular reference to physical signs of common tropical illnesses is also discussed.

Travelers’ diarrhea

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

Travel health knowledge, attitudes and practices among United States travelers.

Large numbers of United States residents travel each year to countries where malaria, hepatitis A, hepatitis B and other vaccine-preventable diseases are prevalent. However, relatively little is known about how United States travelers perceive risks associated with travel or how they prepare for their international voyages. This airport survey was therefore performed to determine the travel health knowledge, attitudes and practices (KAP) of United States travelers. Questionnaires were administered to international travelers, aged 18 years or more, departing from the John F. Kennedy International Airport in New York who were going to destinations that were high risk for malaria or hepatitis A. Overall, 404 questionnaires were completed, including 203 focused on malaria and 201 on vaccine-preventable diseases. Latin America and Asia were the most common destinations. Only 36% of travelers sought travel health advice, despite the fact that more than half prepared their trip at least a month in advance. Only 17% of travelers considered themselves at high risk for hepatitis A. Although the majority of travelers (73%) to a high-risk malaria-endemic region perceived malaria as a high health risk, only 46% of them were carrying antimalarial medications. Additionally, although the majority of travelers believed that vaccines were effective for prevention, few were vaccinated for their journey: 11% for tetanus, 14% for hepatitis A, 13% for hepatitis B, and 5% for yellow fever. This airport survey demonstrated important shortcomings in the travel health KAP of international travelers. A substantial proportion of the travelers were not adequately protected against malaria, hepatitis A or hepatitis B. Future efforts need to focus on improving the level of awareness of travelers regarding their risk of disease acquisition overseas and the importance of pre-travel education, immunizations, and malaria chemoprophylaxis.

West African Immigrants and New Patterns of Malaria Imported to North Eastern Italy.

With the settlement of increasing numbers of immigrants from tropical African countries into Italy over the last decade, the epidemiologic pattern of imported malaria underwent significant change. Italian immigrants originating from endemic areas who revisit their country of origin have exhibited an increasing incidence of malaria: the Italian Ministry of Health recorded an increase of from 14% in 1986 to 40.4% in 1991. This retrospective study reviews the epidemiology of all malaria cases recorded from 1988 to 1991 in a regional reference center in North Eastern Italy. Epidemiologic factors, including the details of their travel experience, were examined for all cases, and the relation of immigrants to Italian-born citizens were compared. Of the 100 cases recorded during this period, 36 were diagnosed in 1988-1989 and 64 in 1990-1991. Immigrants accounted for six times more cases during the latter than during the former time period. Compared to nonimmune short-term travelers, immigrants experienced significantly milder forms of the disease and lower levels of parasitemia (Plasmodium falciparum) on admission. Notably, 10 cases of malaria in immigrants were not recognized at first observation on microbiology. With the advent of this new risk group of immigrants that originate from endemic countries, especially those making occasional short visits to their native countries, this new epidemiologic profile of malaria imported into Italy shows the need for improvement in the areas of prophylaxis, pretravel education, and diagnostic services.

Specialized Travel Consultation Part I: Travelers' Prior Knowledge.

Studies have shown that more than one third of all travelers to tropical countries experience an illness while abroad. Naiveté about diseases, such as malaria, travelers' diarrhea, cholera, and HIV infections, appears to be the most crucial factor determining travel-related morbidity rates. A study was designed both to evaluate the level of disease-related, pretravel knowledge prior to a specialized travel clinic consultation as well as to correlate the level of knowledge with demographic and travel variables and previous travel experience. Using a self-administered questionnaire, data were collected from 167 clients who attended the Hospital for Tropical Diseases Travel Clinic, London, England, in June 1991. The questionnaire evaluated clients' knowledge and attitudes of travel-related diseases, their prevention and treatment, and the scores were analyzed using the Statistical Analysis System software, Version 5. Predictors for increased knowledge scores were examined by a one-way layout model comparing disease knowledge scores with variables such as sex, age, socioeconomic class, ethnic background, previous travel experience, type and duration of travel, destination, accommodation quality, and health insurance coverage. A step-down regression model was constructed to control for the effects of the many mutually confounding factors. Travelers' diarrhea and malaria risk at destination were acknowledged by more than 85% of the respondents, and 60% of the questions on travelers' diarrhea prevention, compared to 81% of those on malaria prevention, were answered correctly. Significantly, however, only one half of the respondents indicated that they would take appropriate measures concerning diarrhea while abroad. Stepwise regression identified previous travel experience, pretravel advice, traveling for work purposes, and using backpack overland tours as significant predictors of high knowledge. This study points out the necessity of pretravel education and that it should focus not only on malaria but also on other travel-related diseases like travelers' diarrhea. As well, target groups for whom more detailed information should be provided are identified, including inexperienced travelers, those using organized tours and sleeping indoors, those planning to visit friends or relatives, and those who have not received sufficient pretravel health advice.