Travel Abroad Research Articles

Surgical Tourism: Some US Patients Travel Abroad for Less Costly Surgery

a large randomized trial might be able to achieve, she said. However, she said, an observational study might be preferable to a randomized trial under certain circumstances: when patients are too ill to be randomized, when no acceptable alternate therapy exists, when patients or their families decline to participate in a randomized trial, or when a disorder is so rare that it affects too few individuals to randomize. In such cases, an observational investigation might not produce the best data, she said, “but it gives you larger numbers of patients, so you don’t base decisions on 1 or 2 patients.” Sedrakyan suggested that a good combination of observational and randomized trials is essential. “We need to do a really good job of identifying those questions in surgery that are pragmatically good candidates for clinical study using randomized trials and those that are good candidates for observational investigations,” he said.

Mission to Nowhere: Putting Short-Term Missions into Context

International Bulletin of Missionary Research, Vol. 33, No. 4 S missions have experienced explosive growth in the past two decades.1 In addition to the many parachurch organizations promoting such trips, for many congregations this sort of “mission” has become a key component of youth group activities. In the United States short-term mission trips are widely promoted as a key means through which average church members can become involved in mission outreach and by which they can make a direct, even sacrificial contribution in the foreign missions work of the church. Today more than 1,600,000 adults and young people from the United States travel abroad yearly on short-term mission trips, most for two weeks or less duration.2 A phenomenon of this scope certainly merits social-scientific observation, as well as missiological reflection. My expertise is as an anthropologist. Over a two-year period I observed a high school mission team in their preparation and visit to the Dominican Republic. My research uncovered multiple ways in which the group’s preparation, travel, and return narrative served to minimize the contextual specificity of the trip’s destination in favor of a more generic “short-term mission” Mission to Nowhere: Putting Short-Term Missions into Context

Vie quotidienne, grossesse, qualité de vie après transplantation hépatique

It is now accepted that patients with a liver transplantation regain the ability to lead a normal life within months of surgery, but at the price of lifetime immunosuppressive treatment and specific regular surveillance. A balanced and diversified diet, together with regular physical activity is necessary to prevent, limit, or delay the development of the cardiovascular complications that determine the prognosis for long-term survival. Attenuated live vaccines are contraindicated in patients treated with immunosuppressants to avoid the risk of reversion of the attenuation of the virus or bacteria. Travel abroad is possible to places with good sanitary conditions, if the patient increases his or her vigilance for any contagious infection. The global incidence of cancer is higher than in the general population, justifying specific and regular testing and clinical monitoring. A planned pregnancy is possible in patients stabilized after liver transplantation, and prognosis is most often good for mother and child. Early multidisciplinary management is essential because of the elevated risks of fetal growth restriction and preterm delivery. The global perception of quality of life increases after liver transplantation, but remains lower than in healthy subjects.

Sickle Cell Children Traveling Abroad: Primary Risk is Infection: Table 1

Pediatricians taking care of sickle cell children in France are concerned about giving travel advice. Very few articles are published and no study has been done about it. A lot of pediatricians are using their own experience to decide if sickle cell children can travel abroad. Studying the consequences of such travel for sickle cell children is important to discuss common recommendations. We conducted a prospective study from June 2006 to December 2007 on desires to travel expressed during our consultations with sickle cell children. We studied notable events that occurred during travel and at least 2 months after return. Of 52 desires to travel, 10 were cancelled. All of the 42 trips were to Africa. Median duration of travel was 1.29 months (0.5-3). Median age at travel was 7.6 years (0.2-17.7). Events during travel were two hospitalizations (4.8%), a transfusion (2.4%), and four paramedical or medical examinations (9.6%). After return, four events occurred: two SS children had Plasmodium falciparum malaria (4.8%) and two had digestive bacteremia (4.8%) in SC and Sbeta+ children. No event occurred during plane travel. None of our patients died. The primary risk for sickle cell children traveling to Africa is infection: malaria first and digestive septicemia second. These risks are increased by long travel and poor sanitary conditions. Each travel should be prepared a long time before departure, and each pediatrician should insist on malaria prophylaxis and sanitary conditions, especially for young children. Trips should be shorter than 1 month when possible. A longer prospective study will be done to confirm these results.

Panzytopenie, Fieber und Splenomegalie bei 2-jährigem Jungen

Suspected of having a systemic malignancy a 22-month-old boy was admitted to hospital with fever, pancytopenia and hepatosplenomegaly. The boy was of ethnically German origin and no travel abroad was reported. Intensive search for a focus of infection, laboratory tests and bone marrow microscopy failed to be diagnostic. Serological findings and detection of Leishmania DNA in bone marrow by polymerase chain reaction (PCR) led to the diagnosis of visceral leishmaniasis. On explicit questioning the child's parents reported a stay in Greece 18 months before onset of symptoms. On the fourth day of i.v. therapy with liposomal amphotericin B, 3mg/kg/d for 10 days, the fever subsided. Platelets and leukocytes regained normal levels. The child was discharged after 10 days of treatment and received two more doses on days 14 and 21. Negative results on microscopic bone marrow inspection do not rule out visceral leishmaniasis. Detection of anti-Leishmania antibodies may support the suspected diagnosis and provide the indication for PCR technique.

A case of Crimean-Congo haemorrhagic fever in Greece, June 2008

A 46-year-old woman with disseminated intravascular coagulation (DIC) died in a hospital in Alexandroupoli, in north-eastern Greece, in the end of June 2008. The woman was admitted to the hospital four days earlier, with fever, malaise, myalgia, chills and abdominal pain. One day before death, her condition deteriorated rapidly and she developed heavy hemorrhage from the genital tract, DIC and multi-organ failure. The patient reported a tick bite four days before admission, and that she had tried to remove the tick herself. No travel abroad was reported. She was engaged in agricultural activities in a rural area near the town of Komotini, in Rhodope prefecture, south of the Greek-Bulgarian border.

The present situation of prophylactic vaccination in Japan for travel abroad

The current situation of vaccination in Japan is reviewed from a viewpoint of overseas travelers. Vaccinations before travel to developing countries, where the risk of infection is high, are recommended for two reasons: "individual protection" and "prevention of communicable disease importation". However, there are problems in Japan; some vaccines available commonly in foreign nations are not approved in Japan and the vaccination schedule is not convenient for travelers. Vaccination is sometimes needed also for travel to Europe and North America. This is because certain vaccinations are required for entering school or studying abroad. In Japan, there is no regulation which recommends vaccination as an entrance requirement. Compared with other nations, Japanese children receive fewer vaccines routinely. On the other hand, there are different features from other industrialized nations, such as routine childhood BCG vaccination and immunization against Japanese encephalitis in Japan. Compared with foreign nations, awareness as regards "travel medicine" is lower in Japan. Recognizing this situation will lead to improvement of vaccination of travelers.

Cross/intercultural training. A one‐day seminar in preparation of travel abroad

Cross/intercultural training. A one‐day seminar in preparation of travel abroad

Interns at an International, Humanitarian Organization: Career Pathways and Meaning Making

This qualitative study examined the career shaping experiences and related meaning making processes of 12 interns at The Carter Center, an international, humanitarian organization. Experiences shaping participants' careers were grouped into the following themes—academics and intellectual curiosity; travel abroad; religion; relationships—family, friends, and mentors; and transformative life events. The following themes illustrated the meaning making processes of the participants: Diversity and privilege, interconnectedness, meaningful work, and sense of home. This study suggests that student affairs educators can play an important role in fostering the complex meaning making required of international, humanitarian work.

Determinants of Malaria Prophylaxis Among German Travelers to Kenya, Senegal, and Thailand

Malaria chemoprophylaxis is a mainstay of malaria prevention in travelers. Adequate pretravel advice forms the basis for efficient malaria prophylaxis. This study assessed the determinants for seeking pretravel advice and evaluated the quality of advice from each source and its influence on the patterns and outcome of malaria prophylaxis intake. In March and April 2004, a self-administered questionnaire was distributed by cabin crews to passengers flying back to Germany from three popular tourist destinations: Kenya, Senegal, and Thailand. To evaluate the quality of advice and actual intake, figures were assessed against the official recommendations of the German Society of Travel Medicine and International Health (DTG). A total of 1,001 passengers were included in the study (Kenya, 492; Senegal, 131; and Thailand, 378), of which 81% had sought any kind of pretravel health advice. Travelers' age and time of pretravel consultation were associated with the source of information consulted. Seventy-five percent of travelers from Senegal and Kenya received DTG compliant advice compared to only 17% of travelers from areas with low malaria risk in Thailand. Travelers returning from Kenya and Senegal had used correct chemoprophylaxis in only 65 and 47% of trips, respectively. In multivariate analysis, the factors determining correct intake among Senegal and Kenya travelers were receiving pretravel advice (from nonmedical professionals: OR 4.4, 95% CI 1.9-10.0 and from medical professionals: OR 15.4, 95% CI 7.3-32.4), a correct risk perception (OR 2.9, 95% CI 1.9-4.5), 2 to 3 weeks of travel abroad (vs a duration >3 wk: OR 2.2, 95% CI 1.3-3.8), and travel to Kenya (OR 1.9, 95% CI 1.1-3.1). Malaria prevention among a large proportion of German travelers to tropical destinations is inadequate. Public health efforts should be made to raise awareness among travelers, travel agencies, and medical institutions in Germany.

Compliance with Atovaquone-Proguanil against Malaria of Korean Travelers Abroad

Background :Recently, many Korean people travel abroad where malaria is prevalent. However, in Korea, relatively little is known about compliance of chemoprophylaxis against malaria. This study was performed to determine the factors influencing compliance of chemoprophylaxis against malaria in Korean travelers. Materials and Methods : Face to face interview, telephone interview and e-mail correspondence were performed to 241 people who were prescribed with atovaquone-proguanil at the international travelers' clinic of National Medical Center between February 2007 and October 2007. Results : Total of 55 people out of 235 reported one or more events of adverse reactions after chemoprophylaxis (total 76 events). However, in 38 adverse events the link between chemoprophylaxis and adverse events were very weak. Compliance of malaria chemoprophylaxis with atovaquone-proguanil was 53.9% in the study group. The predictive factors for non-compliance were package tour, travel of business affair and young age group. Conclusions :Compliance of malaria chemoprophylaxis in Korea travelers was low compared with Dutch and French studies. More efforts to increase compliance are needed, especially in travelers on package tour, business travel and people under age 40.

Education unbound

PurposeThe rapid rise of Multi‐User Virtual Environments (MUVEs) or Metaverses, presents opportunities and challenges for the societies in the physical world and a particular challenge for education. This work aims to identify the key issues confronting education as it moves from its cohort model, K‐16, to an evolving life long experience, P‐to‐Gray, decoupling certification from knowledge acquisition.Design/methodology/approachExperimentation with MUVEs in education are combined with a review of the critical literature to yield an analysis of the current situation.FindingsEducation is evolving, and the MUVE's are also evolving both technically and culturally. Thus we will see significant changes in both current, brick space, education as well as e‐learning.Practical implicationsEducation will be life‐long learning, often ungraded, and blended between brick spaced learning and participation in virtual cultural experiences.Originality/valueMirror worlds, or simulations, will be important, not just in the current “brick‐space”, but also in the virtual worlds which will be accepted as one accepts “travel abroad”.

Restless minds: South African students and the brain drain

This article reports the results of a 2002 survey of emigration potential among a representative sample of 4784 postgraduate and final-year undergraduate students at South Africa's tertiary educational institutions. The authors created a valid and reliable index of emigration potential and found slightly higher levels than those measured by identical questions in previous surveys of skilled adult South Africans. Multivariate regression analysis revealed that the factors that most increase emigration potential among South Africa's future skills base are logistical ones, including family encouragement and financial resources. Next in importance are students' prospects of a better life for themselves and their families in their target countries than in South Africa. Finally, the study showed that patriotism and strong national identity decrease emigration potential while previous travel abroad and access to information about life abroad increase it. It also found that a range of possible government attempts to make emigration more difficult would only increase students' probability of leaving the country.

Diagnostic value of endoscopy for the diagnosis of giardiasis and other intestinal diseases in patients with persistent diarrhea from tropical or subtropical areas

Objective. Upper endoscopy has been suggested as a valuable tool in the diagnosis of giardiasis. The aim of this study was to compare two methods based on endoscopy, i.e. microscopy of duodenal fluid and histology, with a fluorescent-antibody assay for the detection of Giardia lamblia cysts in stool specimens. The role of endoscopy in the identification of other causes of chronic diarrhea acquired during travel abroad was also evaluated. Material and methods. Thirty-one patients (9 F, 22 M, median age 39 years, range 19–63 years) with persistent diarrhea after returning from tropical or subtropical areas agreed to undergo upper gastrointestinal endoscopy before and after treatment. Lower gastrointestinal endoscopy was subsequently performed. Three stool samples from each patient were examined using the direct fluorescent-antibody assay (DFA) for the detection of G. lamblia, and by routine methods for other protozoal and bacterial enteric pathogens. Each patient underwent upper endoscopy and biopsies and duodenal fluid samples were taken. In 12 patients a further lower endoscopy was performed. Results. In 16 patients G. lamblia was detected in stool samples by DFA (relative sensitivity: 100%). Histology of duodenal biopsies and microscopy of duodenal fluids allowed diagnosis of giardiasis to be made in only 8, and 3 patients, respectively (relative sensitivities: 21% and 44%). Besides giardiasis, upper endoscopic examination revealed an alternative diagnosis (tropical sprue), whereas six additional diagnoses were made by colonoscopy. In six patients the cause of chronic diarrhea remained unclear. Conclusions. Compared to stool examinations using DFA, upper endoscopy is less sensitive for the diagnosis of giardiasis. In patients with negative stool examinations, lower endoscopy yields relevant diagnoses more often than upper endoscopy.

Risk of Exposure to Hepatitis B and Other Blood‐Borne Viruses Among Australians Who Travel Abroad

European studies indicate that up to 67% of travelers traveling abroad participate in activities that put them at risk of exposure to hepatitis B. Australians are increasingly traveling to destinations where hepatitis B is highly endemic, such as Asia, and are likely to have similar levels of involvement in activities with an associated risk of hepatitis B exposure. A series of annual telephone surveys of approximately 500 randomly selected Australian overseas travelers have been conducted under the auspice of the Travel Health Advisory Group over the years 2001 to 2003. The surveys examined the extent to which travelers seek pretravel health advice, what immunizations they receive and what risks they are exposed to during travel including the risk of hepatitis B and other blood-borne virus acquisition. In the 2003 survey, 281 (56%) of the 503 people interviewed had visited at least one country with high or medium hepatitis B endemicity on their most recent overseas trip in the past two years. Approximately a third of travelers undertook one or more activities that were considered to be associated with increased risk of potential hepatitis B exposure. Less than half the travelers (46%) had been vaccinated against hepatitis B. The results have implications for the individual traveler, as well as to the broader community. Infected travelers can be an important source of hepatitis B into their own home communities. Improved advice and clear recommendations for hepatitis B vaccination are needed to avoid infection.

Incidence and precipitating factors of morbidity among Israeli travelers abroad.

During recent years international travel, including visits to the developing world, has become increasingly popular. Many of these travelers suffer from some sort of health problem during their trip or after their return. Travelers clinics that give pretravel immunization and counseling have emerged. This study analyzes the incidence and risk factors for health problems among Israelis traveling abroad. The study surveyed by telephone 200 people who visited the traveler's clinic at Soroka Medical Center in Beer-Sheva during the years 1998 to 1999. The travelers were questioned after returning from their journey about the type and duration of the trip, compliance with medical advice given in the travel clinic, and health problems during the trip. The mean age was 26.4 +/- 9.4 years, 7% went on an organized tour, 23% traveled alone, and 77% traveled with a friend. The mean duration of the trip was 14.7 +/- 13.4 weeks. Of the travelers, 70% reported some health impairment. Problems reported most frequently were gastrointestinal tract diseases (43%), respiratory tract diseases (25%), and injuries (10%). Only 4% were admitted to a hospital during their trip. After their return, 19.5% consulted a physician. Comparing the group of travelers who were sick with the rest, a correlation between noncompliance with the keeping of food hygiene and illness was found (p =.008). Additional risk factors for illness were long duration (p <.001), solitary trip (p =.04), and young age (p <.001). Of the people who were advised to take antimalaria chemoprophylaxis, 55% reported regular use of these drugs. Compliance with treatment correlated with older age (p <.001), short duration of stay (p =.01), previous experience, and travel to Africa (p <.001). Most of the travelers to developing countries are young, travel for long periods, and live in basic conditions during their stay abroad. For these reasons travelers are at increased risk for morbidity. High risk travelers should be identified and counseled in order to increase their compliance with the medical advice and immunizations. A screening program for returning travelers should be considered.

High-Risk Travel Abroad Overtook Low-Risk Travel from 1999 to 2004: Characterization and Trends in 2,622 Spanish Travelers

Travel medicine in Spain is provided by a few specialized centers that do not come under the auspices of the main health system. Some kind of reform is required to avoid common summer collapses and postponements of the service. In contrast to other European countries, neither the exact role nor the responsibilities of general practitioners and primary health care in travel medicine are clearly defined. An observational study was performed with retrospective data concerning 2,622 travelers from 1999 to 2004. Although the study was performed at a third-level travel medicine center, continuous contact with and support to general practitioners was maintained throughout the period. International travel was a steadily increasing reality between 1999 and 2004 despite well-known tragic events involving world safety. The number of high-risk travels (53.4%) also increased and even overtook low-risk ones (46.6%). This trend was explained as the result of an increasing number of journeys to sub-Saharan Africa (14.9%) and those made by traveling immigrants (64.1% of those journeys), which represented a significantly higher proportion of high-risk travels compared with those made by autochthonous subjects (52.1%; p < .001). Moreover, traveling immigrants tend to consult more frequently in periods < 15 days prior to travel than do autochthonous travelers (p < .0001). A substantial number of highly vulnerable travelers, such as pregnant women, infants, elderly people, and immunosuppressed subjects, was found (1.8%). Low-risk travelers who could have been advised and vaccinated by general practitioners were 1,139 (43.4%). Given the increasing number of travelers undertaking high-risk travels abroad, any kind of reinforcement of travel medicine provision in Spain should be considered essential. General practitioners could attend to a significant proportion of low-risk travelers.

The History of a Novel's Travels Abroad: Foreign Editions of Frances Burney's "Cecilia"

The History of a Novel's Travels Abroad: Foreign Editions of Frances Burney's "Cecilia"

Mefloquine Increases the Risk of Serious Psychiatric Events During Travel Abroad

Psychiatric events during travel abroad account for a large percentage of medical repatriations arranged by insurance companies. Several risk factors have been proposed for such events, one of these being use of mefloquine. We investigated the risk of psychiatric events during use of mefloquine. We performed a nationwide case control study using medical records from 4 large alarm centers in the Netherlands. Cases were patients contacting the alarm centers because of psychiatric events, according to International Code Primary Care code P (all psychiatric symptoms) or International Classification of Diseases, Ninth Edition, codes 290-319 (all psychiatric syndromes). To every case we matched up to 6 controls by alarm center, calendar time, and continent of travel. All controls had contacted the alarm centers because of nonpsychiatric medical reasons. Shortly after the anticipated day of return, cases and controls received a questionnaire regarding travel characteristics, gender, age, marital status, education, weight, height, general health, history of psychiatric diseases, use of medicines, smoking status, alcohol intake, coffee intake, and use of malaria prophylaxis. Dates of travel for the source population were between September 1, 1997, and June 1, 2000. The study population consisted of 111 cases and 453 controls. The risk of psychiatric events during the use of mefloquine was 3.5 (95% CI = 1.4 to 8.7). In females, the risk was strongly increased, with an odds ratio of 47.1 (95% CI = 3.8 to 578.6). Stratification for history of psychiatric diseases showed that the risk of psychiatric events during use of mefloquine in cases without a history of psychiatric diseases was 3.8 (95% CI = 1.4 to 10.1), whereas the risk in cases with a history of psychiatric diseases was 8.0 (95% CI = 1.8 to 35.8). The use of mefloquine is associated with an increased risk of psychiatric events in females and in patients with a history of psychiatric diseases.

Infectious Disease Prevention for Children Traveling Abroad

Infectious Disease Prevention for Children Traveling Abroad