Recommendations For Travel Research Articles

Prescribing hepatitis A vaccines in the UK

Hepatitis A is a liver infection caused by a virus that is spread by eating or drinking contaminated food and water or from direct contact (including some types of sexual contact) with an infected person. Hepatitis A virus infection causes liver inflammation that usually results in a mild illness. More rarely, severe symptoms with the potential to develop into liver failure can occur. UK health professionals involved in prescribing hepatitis A vaccines should make sure they are familiar with appropriate vaccine guidance and use current UK hepatitis A vaccine recommendations for international travel as part of their risk assessment. Although most people respond well to the hepatitis A vaccine, the importance of food and water hygiene should still be emphasised to all UK travellers visiting hepatitis A endemic areas.

EXPERIENTIAL TOURISM OF HANOI CITY RESIDENTS, VIETNAM

This research aims to analyze the experiential tourism needs of the residents of Hanoi city. Data for this study were collected by surveying 200 residents in Hanoi to understand their experiential tourism needs. The study uses two main methods: descriptive statistics and cross-tabulation analysis. The research results indicate that experiential tourism is a relatively new and trending form of tourism, especially among young people. Additionally, the study identifies the activities that customers wish to experience in a travel tour. Based on the analysis results, the research proposes some appropriate recommendations for travel companies to better meet the experiential tourism needs of Hanoi residents in the future.
 Keywords: Experiential Tourism; Hanoi City; Residents; Vietnam; Travel Preferences; Tourism Trends; Travel Experiences; Market Research; Tourist Activities; Recommendations.

Prescribing typhoid vaccines in the UK

Typhoid is a potentially life-threatening infection that is usually spread through contaminated food and water. Most typhoid cases reported in the UK are linked to overseas travel. UK health professionals prescribing travel vaccines, including typhoid vaccine, should ensure they are familiar with appropriate vaccine guidance and use current UK typhoid vaccine recommendations for international travel as part of their risk assessment. The importance of food and water hygiene should be emphasised to all UK travellers visiting typhoid endemic regions.

Flight After Stapes Surgery: An Evidence-Based Recommendation.

Recommendations for air travel after stapes surgery, specifically stapes surgery, vary, with no standard recommendation to guide patients and surgeons. According to our search, no previous article has explored the physics of middle ear changes during flight and its effects on poststapedectomy patients in a systematic way. The aim of this study is to bring together 2 arms of expertise, otology, and aviation, to produce an evidence-based recommendation for flight after stapes surgery. The database MEDLINE was searched during August 2022. The search strategy had the goal of identifying studies that discovered the effects of flying on stapes surgery patients and the effects of atmospheric pressure on middle ear structures. The articles yielded from the search strategy were transferred to the online citation manager Rayyan. Included in the review were those studies reporting patient outcomes after flying following ear surgery; additional studies included those reporting pressure changes in the middle ear and ossicular chain displacement whether in experimental or animal conditions. Modern-day commercial air travel is safe for patients who have undergone stapedotomy surgery, even very shortly after hospital discharge if they have to. If stapedotomy patients wish to fly after hospital discharge, otologists are to reassure them that it is safe to do so. Patients are to be reminded to perform a gentle Valsava maneuver about every 4 minutes during airplane descent.

Vaccinations in athletes

The prevention of infections is essential to athletes’ health and performance. Even mild infections can severely affect athletic performance and the eligibility to train and compete. One of the most effective means of avoiding severe infections are vaccinations. However, like the general population, athletes frequently do not receive the recommended vaccinations. This shortcoming is largely based on fear of adverse vaccine reactions, concerns about the efficacy, misinterpretations, negligence, and poor communication. As sports medicine physicians are involved in the regular screening of adolescent, adult, and senior athletes, they are in a unique position to advise on an individual basis about the risks and benefits of an athlete-specific vaccination schedule. Thus, every preparticipation physical examination should be used to check the vaccination status and, if needed, optimize and update the athletes’ vaccination profile. In this clinical review, recommendations for standard, travel, and specific-indication vaccinations in athletes will be given and their efficacy, timing, and administration in the sports context will be discussed. The review will be completed by recommended literature and useful apps for the sports medicine physician involved in the preparticipation physical examination of athletes. Key Words: Standard Vaccinations, Travel Vaccinations, Indication Vaccinations, Tetanus, Diphtheria, Pertussis, Measles, Mumps, Rubella, Hepatitis A/B, SARS-CoV-2, Influenza, Tick-Borne-Encephalitis, Sports

Survey and Analysis of Chemoprophylaxis Policies for Domestic Travel in Malaria-Endemic Countries.

The prevention of malaria in travelers with the use of antimalarials often occurs in connection with international travel to areas of significant risk of infection. Although these travelers sometimes cause outbreaks in their malaria-free home countries, the cardinal objective of prescribed chemoprophylaxis is to protect the traveler from patent malaria during travel. Here we consider the chemoprophylaxis of domestic travelers from malaria-free but -receptive areas within malaria-endemic countries. The main objective in this setting is the protection of those areas from reintroduced malaria transmission. In order to better understand policy and practices in this regard, we surveyed malaria prevention and treatment guidelines of 36 malaria-endemic countries and 2 that have recently eliminated malaria (Sri Lanka, China) for recommendations regarding malaria chemoprophylaxis for domestic travel. Among them, just 8 provided specific and positive recommendations, 1 recommended without specific guidance, and 4 advised against the practice. Most nations (25/38; 66%) did not mention chemoprophylaxis for domestic travel, though many of those did offer guidance for international travel. The few positive recommendations for domestic travel were dominated by the suppressive prophylaxis options of daily doxycycline or atovaquone-proguanil or weekly mefloquine. The incomplete protection afforded by these strategies, along with impractical dosing in connection with the typically brief domestic travel, may in part explain the broad lack of policies and practices across malaria-endemic nations regarding chemoprophylaxis.

Policy Recommendations for Green Travel in Medium - Sized Cities Based on Mobile Signaling Data

Policy Recommendations for Green Travel in Medium - Sized Cities Based on Mobile Signaling Data

Can Patients Travel by Air Less Than 1 Week After Lung Nodulectomy?

Objective: The study objective was to determine empirically based timing recommendations for safe air travel following lung nodulectomy. Methods: All patients who underwent pulmonary nonanatomic resection followed by air travel home immediately after discharge were identified at 2 institutions between 2014 and 2018. These patients were surveyed via telephone regarding any complications they may have experienced during their travel home and within the first week after discharge. These complications included shortness of breath, chest pain, drainage from their surgical sites, and evaluation by a health care provider in the interim, if they required. Results: Our study identified 27 patients who fit the inclusion criteria. The median number of days between surgery and flight home in the studied population was 4 days. The median number of days between chest tube removal and flight home was 2 days. None of the 27 patients reported experiencing shortness of breath, chest pain, drainage from their surgical sites, or need for evaluation by a health care provider within 1 week of discharge. Nine patients (33%) traveled by air with a small (<5%) pneumothorax documented on chest radiography after removal of thoracostomy tube. One (4%) patient successfully traveled without complication with a 10% pneumothorax. Conclusions: The findings of our study support the safety of air travel following lung nodulectomy in patients who have undergone uneventful wedge resection and have no significant pulmonary or cardiac comorbidities. It is not necessary for patients to wait the recommended 7 days prior to traveling.

Self-care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology.

Self‐care is essential in the long‐term management of chronic heart failure. Heart failure guidelines stress the importance of patient education on treatment adherence, lifestyle changes, symptom monitoring and adequate response to possible deterioration. Self‐care is related to medical and person‐centred outcomes in patients with heart failure such as better quality of life as well as lower mortality and readmission rates. Although guidelines give general direction for self‐care advice, health care professionals working with patients with heart failure need more specific recommendations. The aim of the management recommendations in this paper is to provide practical advice for health professionals delivering care to patients with heart failure. Recommendations for nutrition, physical activity, medication adherence, psychological status, sleep, leisure and travel, smoking, immunization and preventing infections, symptom monitoring, and symptom management are consistent with information from guidelines, expert consensus documents, recent evidence and expert opinion.

Assessing barriers to patient acceptance of pharmacist-provided recommendations for international travel

ObjectivesThe primary objectives of this study were to determine the percentage of travel recommendations accepted by individuals serviced at a university travel health clinic and to identify barriers to travel recommendation acceptance or implementation by travelers. A secondary objective was to use details regarding the identified barriers to refine travel clinic protocols. MethodsThis cross-sectional study utilized an 11-item questionnaire, conducted via telephone from February 2018 to April 2018. The survey was administered by a pharmacist employed at the travel clinic. The following data were collected: travel itinerary, content of pharmacist provided travel recommendation(s), acceptance of pharmacist travel recommendation(s) or reason for declining the recommendation(s), patient utilization of supplemental recommendations (e.g., traveler’s diarrhea treatment flowchart, over-the-counter travel items, accessing medical care abroad), perceived usefulness of travel clinic resources, and the status of patient health during travel and upon return. Data was evaluated using descriptive statistics. ResultsA total of 205 travelers were screened to participate in the study; 85 surveys were completed, resulting in a 41% response rate. Of 349 travel vaccination recommendations made, 242 (69%) were accepted by patients. The vaccine recommendations with the lowest acceptance were Japanese Encephalitis (18%, n = 2/11), rabies (27%, n = 15/55), and influenza (51%, n = 41/80). The top reasons for declining included cost (40%, n = 34), lack of perceived necessity (37%, n = 31), and timing (16%, n = 14). In addition, 68% reported using travel clinic advice if they became ill during travel. ConclusionThis study showed a positive response to recommendations provided by this travel clinic. Cost and ‘lack of perceived necessity’ were identified as barriers to acceptance of recommendations. Travel clinic protocols will be refined to provide further education to travelers about unfamiliar disease states that may pose an increased risk during travel, aiming to increase acceptance of pharmacist-provided recommendations.

Changes to country-specific hepatitis A travel vaccination recommendation for UK travellers in 2017—responding to a vaccine shortage in the national context

ObjectivesA routine review of hepatitis A travel vaccination recommendations was brought forward in June 2017 due to hepatitis A vaccine shortages and a concurrent outbreak in men who have sex with men (MSM). There were three objectives: first, to document the review process for changing the recommendations for the UK travellers in June 2017. Second, to study the impact of these changes on prescribing in general practice in 2017 compared with the previous 5 years. Third, to study any changes in hepatitis A notifications in June–October 2017 compared with the previous 5 years. Study designThis is an observational study. MethodsTravel vaccination recommendations for countries with either low-risk (<20%) or high-risk (>90%) status according to child hepatitis A seroprevalence were not changed. A total of 67 intermediate-risk countries with existing recommendations for most travellers and with new data on rural sanitation levels were shortlisted for the analysis. Data on child hepatitis A seroprevalence, country income status, access to sanitation in rural areas and traveller volumes were obtained. Information about the vaccine supply was obtained from Public Health England. Changes to the existing classification were made through expert consensus, based on countries' hepatitis A seroprevalence, sanitation levels, level of income, volume of travel and hepatitis A traveller cases. Data on the number of combined and monovalent hepatitis A–containing vaccines prescribed in England, 2012–2017, were obtained from the National Health Service Business Service Authorities. The number of monthly prescriptions for January–September 2017 was compared with the mean number of prescriptions for the same month in the previous 5 years (t-test, α = 5%, df = 4). The number of hepatitis A cases notified in June–October 2017 not related to the MSM outbreak was compared with the number of notifications in the same months in previous years. ResultsA total of 36 countries were downgraded based on good access (80+% of population) to sanitation in rural areas and the intermediate-risk status in terms of child hepatitis A seroprevalence. For these countries, vaccination would only be recommended to travellers staying long term, visiting friends and relatives or staying in areas without good sanitation. There was a significant decline in hepatitis A vaccine prescriptions in June–September 2017, and there was no increase in the number of notifications. ConclusionsHepatitis A vaccination recommendations for travel were revised in 2017 following a systematic approach to maintain continuity of supply after a hepatitis A vaccine shortage and increased hepatitis A vaccine demand related to a large outbreak. Improved access to good sanitation in rural areas and low seroprevalence estimates among children have led to 36 countries to no longer require vaccination for most travellers. These changes do not seem to have impacted on hepatitis A notifications in England, although further research will be needed to quantify the impact more precisely.

Trauma patients are safe to fly 72 hours after tube thoracostomy removal.

Current recommendations for safe air travel following traumatic pneumothorax are 2 to 3 weeks after radiographic resolution. These recommendations are based on several small observational studies and expert consensus, which cite a theoretical risk of recurrence and hypoxia because of decreased oxygen tension at altitude. We sought to systematically study the timing of chest drain removal after traumatic pneumothorax and risk of recurrence in relation to air travel. A retrospective cohort study of consecutively admitted patients who sustained a traumatic chest injury treated with tube thoracostomy over a 5-year period was undertaken. Adult patients with a postremoval expiratory chest x-ray demonstrating absence of pneumothorax and at least a 24-hour observation period before flight were eligible for study. All patients were transferred to a participating medical center for continued care. In-flight medical monitoring was available for all patients. Baseline patient characteristics, interval period from drain removal to flight, in-flight medical records, and incidence of radiographic or clinical recurrence of pneumothorax at the destination facility were recorded. Seventy-three patients who met the inclusion criteria were studied. All were male with a median age of 24 years (interquartile range [IQR], 22-26 years), injury severity score of 30 (IQR, 24-38), and chest abbreviated injury scale value of 3 (IQR, 2-4). The majority of patients sustained a penetrating injury (74%). The median duration of tube thoracostomy was 4 days (IQR, 3-6 days). The median period between thoracostomy tube removal and flight was 2.5 days (IQR, 1.5-4 days). Twenty-nine patients (40%) remained mechanically ventilated during transport. There were no reported in-flight medical emergencies for the entire cohort. There were no reported postflight radiographic or clinical recurrences during the subsequent 30 days. After a 72-hour period of observation, air travel after tube thoracostomy removal appears safe for both mechanically ventilated and nonventilated patients. Therapeutic, level IV.

P326 Physicians’ recommendations for travel in patients with inflammatory bowel disease

P326 Physicians’ recommendations for travel in patients with inflammatory bowel disease

Understanding interactions between beggars and international tourists: the case of China

ABSTRACTBegging exists in developed as well as developing countries and in many jurisdictions is regarded as a criminal activity. In a tourism context, it is not uncommon to see begging-type activities in areas where tourists are present. Surprisingly, the literature has largely ignored begging as an issue of concern. This study examined the reaction of international tourists to encounters with beggars in China with a particular emphasis on the impact that an encounter with beggars could have on trip satisfaction. The study found that (1) elder beggars are still the most common types of beggars encountered by respondents; (2) giving money but refusing further communication with beggars was the most common reaction; (3) begging did not have a significant impact on overall trip satisfaction and (4) begging did not have a significant impact on the likelihood of revisiting China or a negative impact on future recommendations for travel to China.

Ethical, Legal, and Administrative Considerations for Preparticipation Evaluation for Wilderness Sports and Adventures

Preparticipation evaluations (PPEs) are common in team, organized, or traditional sports but not common in wilderness sports or adventures. Regarding ethical, legal, and administrative considerations, the same principles can be used as in traditional sports. Clinicians should be trained to perform such a PPE to avoid missing essential components and to maximize the quality of the PPE. In general, participants' privacy should be observed; office-based settings may be best for professional and billing purposes, and adequate documentation of a complete evaluation, including clearance issues, should be essential components. Additional environmental and personal health issues relative to the wilderness activity should be documented, and referral for further screening should be made as deemed necessary, if unable to be performed by the primary clinician. Travel medicine principles should be incorporated, and recommendations for travel or adventure insurance should be made.

Ethical, Legal, and Administrative Considerations for Preparticipation Evaluation for Wilderness Sports and Adventures.

Preparticipation evaluations (PPEs) are common in team, organized, or traditional sports but not common in wilderness sports or adventures. Regarding ethical, legal, and administrative considerations, the same principles can be used as in traditional sports. Clinicians should be trained to perform such a PPE to avoid missing essential components and to maximize the quality of the PPE. In general, participants' privacy should be observed; office-based settings may be best for professional and billing purposes, and adequate documentation of a complete evaluation, including clearance issues, should be essential components. Additional environmental and personal health issues relative to the wilderness activity should be documented, and referral for further screening should be made as deemed necessary, if unable to be performed by the primary clinician. Travel medicine principles should be incorporated, and recommendations for travel or adventure insurance should be made.

Health recommendations for international travel: a review of the evidence base of travel medicine.

International travel is increasing, including travel to countries with emerging economies. Travel may pose health risks for the individual and contribute to the global spread of infectious diseases. The specialty of travel medicine is aimed at minimizing health risks associated with international travel. The field has emerged in the past 25 years, and the evidence base supporting its clinical practice is growing. This review will describe the evidence base underlying travel medicine, highlight recently updated travel medicine guidelines, and outline future research priorities. Recommendations for a number of common vaccines for travelers have been updated recently. More sophisticated detection methods are leading to the identification of a wider spectrum of pathogens associated with travelers' diarrhea, and antibiotic resistance is increasingly being identified. New treatment options for malaria are available, and a fifth Plasmodium species causing disease in humans has been identified. An evidence base for the practice of travel medicine is emerging. Expert opinion and consensus guidelines continue to play an important role in supporting clinical practice.

Is there an alternative to pre-flight hypoxic challenge testing in scoliotic patients?

Hypoxic challenge testing (HCT) is not readily available in all hospitals. It has recently been shown that resting oximetry does not reliably predict the results of HCT in patients with extrapulmonary restrictive lung disease. We assessed other clinical tests to see if they might be used as an alternative screen for HCT. People with primary thoracic scoliosis were recruited. Resting SpO(2), arterial blood gases (ABG's), lung function and shuttle walking test (SWT) were measured. All subjects underwent HCT breathing an inhaled oxygen fraction of 15% for 20 min, or until SpO(2) fell below 85%, when ABG's were taken. Fourteen people (5 male) with thoracic scoliosis, Cobb angle 93 (31) degrees , aged 65 (8.5) years, FEV(1) 0.86 (0.4) L, FVC 1.2 (0.4)L were studied. The resting SpO(2) was 96 (2) %, PaO(2) 9.2 (1) kPa and PaCO(2) 6.1 (0.4) kPa. HCT was positive in 11 subjects (PaO(2) <6.6 kPa). Eight of 11 HCT positive subjects had a resting SpO(2) > 95%. Positive correlation was found between SpO(2) at SWT termination and PaO(2) following HCT (r = 0.56, p = 0.02). Those with saturations of 92% or under at SWT termination had positive HCT. Despite normal resting SpO(2) subjects with thoracic scoliosis may have positive HCT. Current recommendations for air travel do not accurately identify these people. Desaturation following a SWT may provide a useful screening tool, however a low threshold for performing HCT on people with thoracic scoliosis prior to air travel is warranted.

Expansion of Postoperative Pneumothorax and Pneumomediastinum: Determining When It Is Safe to Fly

The possibility of expansion of pneumothorax (PTX) and/or pneumomediastinum (PMED) during commercial flights makes air travel after thoracic surgery particularly worrisome. Guidelines from the Aerospace Medical Association (AsMA) suggest delaying air travel 2 to 3 wk following uncomplicated thoracic surgery and 1 wk following radiographic resolution of PTX; they also state that PTX is an "absolute contraindication" to air travel. However, both AsMA guidelines and thoracic surgeons' recommendations for postoperative air travel require further examination. We reviewed the literature looking for evidence supporting official guidelines and conducted a survey of U.S. thoracic surgeons about their recommendations for air travel by patients with postoperative PTX and/or PMED. We found no experimental evidence supporting the AsMA guidelines. Of the 68 thoracic surgeons who returned our questionnaire, 44% recommended that patients wait variable periods of time of up to 42 d (13.8 +/- 11.6 d) following complete resolution of PTX prior to air travel, while 46% of them allowed their patients to fly with some degree of PTX. Following mediastinoscopy, 76.9% of the surgeons allowed their patients to fly without delay, even with PMED. The only adverse in-flight event reported was a case of thoracic pain during ascent. A wide variability exists among thoracic surgeons regarding their recommendations for air travel by patients with postoperative PTX and/or PMED. Both AsMA guidelines and surgeons' recommendations should rely more on scientific evidence. Studies of PTX and PMED expansion during simulated flight are needed to develop better guidelines.

A survey of public transport use by immunocompromised children in the United Kingdom

The advice given to immunocompromised children and their families on the use of public transport at our oncology unit has been inconsistent, with a lack of written or evidence based guidelines. We therefore carried out two surveys, one national and one local on this issue, to determine what advice is given to families. We also undertook an extensive literature search on this subject. The first survey was completed by the Paediatric Oncology Nurses Forum link member at each of the 22 United Kingdom Childrens' Cancer Study Group (UKCCSG) centres. We asked their current practice for use of public transport for hospital visits, school attendance, regular weekly use and holidays. We looked at recommendations for travel on holiday in the UK and abroad with reference to neutrophil and platelet counts. The second survey was completed by parents of 64 children attending our outpatient clinic over a 2-week period to ascertain whether the families comply with our verbal recommendations. There was a 100% response from UKCCSG centres. None of the centres had any written or evidence based guidelines. 55% of centres allowed public transport for hospital visits, 82% for school and 90% for holidays. Sixty-eight percent of centres allowed UK travel with a neutrophil count of 0.5-1 x 109/L and 18% if neutrophils <0.5 x 109/L. Eighteen percent of centres allowed foreign travel with a neutrophil count of 0.5-1 x 109/L but only 9% if <0.5 x 109/L. The second survey showed 2% used public transport to attend hospital, 5% for school, 17% for regular use and 50% travelled by plane for holidays. A Pubmed literature search revealed a lack of studies on immunocompromised patients. A certain use of public transport is necessary for patients to engage in as normal a life as possible. There is a need for further studies to produce sensible and consistent advice on this issue.