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Reasons for seeking care and adherence to pretravel preparation in expatriate or long-term travelers' children in the tropics: A French prospective study. Travel Med Infect Dis 2021; 46:102184. [PMID: 34699957 DOI: 10.1016/j.tmaid.2021.102184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Studies on pediatric travelers' health rarely address expat or long-term travelers' children. METHOD To investigate reasons for seeking care and adherence to pretravel preparation, we prospectively enrolled French children 0-15 years old, either expatriates or staying >6 months in tropical areas, who attended a French health center in Africa, Central America or Southern Pacific regions from October 01, 2011 to October 31, 2012. A standardized questionnaire was completed by a general practitioner at each visit, then anonymized and included in our database. RESULTS 464 questionnaires were collected from 367 children (sex ratio M/F: 1:1). Median age was 6.4 years (IQR: 3.6; 10.3). Reasons for seeking care were mostly infections (n = 378), of which 12 (3.2%) were tropical. There were no deaths, but one child with tuberculosis was repatriated. Coverage was high for routine immunization, but less for travel-related vaccines. Personal antivectorial protection was significantly lower in children aged >5 y or in non-malarial areas. Where indicated, malarial chemoprophylaxis was prescribed to only one third of the children, of whom 60% were poorly compliant. Advice regarding measures against diarrhea and sunburn was followed significantly more for stays >2 yrs. CONCLUSION Mild cosmopolitan illnesses predominated but protection against tropical threats should be optimized before and during the stay.
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Sanftenberg L, Kramer M, Esser S, Schelling J. Insights into needs of business travelers to China from calls to a medical assistance provider. Heliyon 2019; 5:e01237. [PMID: 30815606 PMCID: PMC6378333 DOI: 10.1016/j.heliyon.2019.e01237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/24/2019] [Accepted: 02/11/2019] [Indexed: 11/24/2022] Open
Abstract
Background Although 17.5% of German travelers were business travelers in the years 2011–2013, little is known about their pathologies. Recent publications indicate that infections are the primary health issue in general travelers. Our aim was to investigate whether business travelers from Germany to China also primarily suffer from infections. Methods From 2011 to 2013, 587 calls for service of German business travelers to China were collected by a medical assistance provider. 482 of these calls were evaluated regarding demographics, reported diseases and conditions and the type of service provided by the medical assistance company. Results The most common reasons for calls for service were “factors influencing health status and contact with health service” (18.8%), “injury and poisoning” (16.0%) as well as “symptoms, signs, and ill-defined conditions” (13.7%). Most patients asked for “medical advice” (37.8%), referral to “outpatient care” (25.1%) or “inpatient care” (16.6%). “Evacuation and/or repatriation” was required mainly due to “injury and poisoning” (n = 12), “diseases of the circulatory system” (n = 5) or “mental disorders” (n = 3). Conclusion German business travelers to China are seeking primarily administrative support from a medical assistance provider and are mostly affected by non-infectious diseases. Pre-travel preparation of such travelers need to place more emphasis on non-communicable health risks and prevention.
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Affiliation(s)
- Linda Sanftenberg
- Institut für Allgemeinmedizin, Klinikum der Universität München, Germany
| | - Michaela Kramer
- Institut für Allgemeinmedizin, Klinikum der Universität München, Germany
| | | | - Jörg Schelling
- Institut für Allgemeinmedizin, Klinikum der Universität München, Germany
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Chen LH, Leder K, Barbre KA, Schlagenhauf P, Libman M, Keystone J, Mendelson M, Gautret P, Schwartz E, Shaw M, MacDonald S, McCarthy A, Connor BA, Esposito DH, Hamer D, Wilson ME. Business travel-associated illness: a GeoSentinel analysis. J Travel Med 2018; 25:4841826. [PMID: 29462444 PMCID: PMC5824651 DOI: 10.1093/jtm/tax097] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 01/02/2018] [Indexed: 01/23/2023]
Abstract
Background Analysis of a large cohort of business travelers will help clinicians focus on frequent and serious illnesses. We aimed to describe travel-related health problems in business travelers. Methods GeoSentinel Surveillance Network consists of 64 travel and tropical medicine clinics in 29 countries; descriptive analysis was performed on ill business travelers, defined as persons traveling for work, evaluated after international travel 1 January 1997 through 31 December 2014. Results Among 12 203 business travelers seen 1997-2014 (14 045 eligible diagnoses), the majority (97%) were adults aged 20-64 years; most (74%) reported from Western Europe or North America; two-thirds were male. Most (86%) were outpatients. Fewer than half (45%) reported a pre-travel healthcare encounter. Frequent regions of exposure were sub-Saharan Africa (37%), Southeast Asia (15%) and South Central Asia (14%). The most frequent diagnoses were malaria (9%), acute unspecified diarrhea (8%), viral syndrome (6%), acute bacterial diarrhea (5%) and chronic diarrhea (4%). Species was reported for 973 (90%) of 1079 patients with malaria, predominantly Plasmodium falciparum acquired in sub-Saharan Africa. Of 584 (54%) with malaria chemoprophylaxis information, 92% took none or incomplete courses. Thirteen deaths were reported, over half of which were due to malaria; others succumbed to pneumonia, typhoid fever, rabies, melioidosis and pyogenic abscess. Conclusions Diarrheal illness was a major cause of morbidity. Malaria contributed substantial morbidity and mortality, particularly among business travelers to sub-Saharan Africa. Underuse or non-use of chemoprophylaxis contributed to malaria cases. Deaths in business travelers could be reduced by improving adherence to malaria chemoprophylaxis and targeted vaccination for vaccine-preventable diseases. Pre-travel advice is indicated for business travelers and is currently under-utilized and needs improvement.
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Affiliation(s)
- Lin H. Chen
- Mount Auburn Hospital, Cambridge, Massachusetts, and Harvard Medical School, Boston, MA, USA
| | - Karin Leder
- Royal Melbourne Hospital and School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Kira A. Barbre
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Schlagenhauf
- University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers’ Health, Epidemiology, Biostatistics and Prevention Institute, Zürich, Switzerland
| | - Michael Libman
- Montreal General Hospital and McGill University, Montreal, Quebec, Canada
| | - Jay Keystone
- Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Philippe Gautret
- Aix Marseille Université, IHU—Méditerranée Infection, Marseille, France
| | - Eli Schwartz
- The Chaim Sheba Medical Center, Tel Hashomer, and Sackler Faculty of Medicine Tel-Aviv University, Israel
| | - Marc Shaw
- Worldwise Travellers Health Centres New Zealand and James Cook University, Australia
| | - Sue MacDonald
- Medicine and Quality, Interior Health, and University of British Columbia, Kelowna, British Columbia, Canada
| | - Anne McCarthy
- Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Bradley A. Connor
- The New York Center for Travel and Tropical Medicine and Weill Medical College of Cornell University, New York, NY, USA
| | - Douglas H. Esposito
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Davidson Hamer
- Center for Global Health and Development, Boston University School of Public Health, and Boston University School of Medicine, Boston, MA, USA
| | - Mary E. Wilson
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, CA, USA
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Fonseca AG, Dias SS, Baptista JL, Torgal J. Psychological well-being of Portuguese expatriates in Sub-Saharan Africa: a cross-sectional study. J Travel Med 2017; 24:4191319. [PMID: 29088477 DOI: 10.1093/jtm/tax061] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 08/01/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND Psychological health problems are highlighted among the most relevant disease patterns in expatriates. The purpose of this study was to determine the psychological well-being in Portuguese expatriates in Angola and Mozambique, considering the increasing expatriation wave. METHODS A cross-sectional self-administered web survey was conducted in a sample of 352 Portuguese civil expatriates in Angola and Mozambique. Clinically significant psychological distress was determined using General Health Questionnaire (GHQ)-12 and associated factors were studied using multiple logistic regression analysis. RESULTS GHQ-12 items showed good internal consistency as reflected by the Cronbach's alpha. One-third of the screened expatriates corresponded to cases of clinically significant psychological distress. Age, country of birth, self-reported psychological symptoms and self-perception of general health in the previous 3 months were identified as independent variables associated with psychological distress. CONCLUSIONS Increasing awareness and monitoring expatriates mental health should be in the health agenda, furthermore considering them a risk group in need of evidence-based mental health expatriate preparedness. The use of user-friendly validated tools, such as GHQ-12, allowing objective assessment and surveillance of these hard to reach populations should be reinforced.
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Affiliation(s)
- Ana Glória Fonseca
- Public Health Department, NOVA Medical School (Faculdade Ciências Médicas), Universidade Nova de Lisboa (NOVA Lisbon University), Campo Mártires da Pátria, 130. 1169-056 Lisboa, Portugal
| | - Sara S Dias
- Public Health Department, NOVA Medical School (Faculdade Ciências Médicas), Universidade Nova de Lisboa (NOVA Lisbon University) and UIS-ESSLei-IPLeiria, Portugal
| | - Joao Luis Baptista
- Faculdade de Ciências da Saúde (Faculty of Health Sciences), Universidade da Beira Interior (Beira Interior University), Portugal
| | - Jorge Torgal
- Public Health Department, NOVA Medical School (Faculdade Ciências Médicas), Universidade Nova de Lisboa (NOVA Lisbon University), Campo Mártires da Pátria, 130. 1169-056 Lisboa, Portugal
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Fonseca AG, Dias SS, Baptista JL, Torgal J. Portuguese expatriates' health in Angola and Mozambique-a cross-sectional study: increasing awareness and need for more surveillance. J Travel Med 2017; 24:3095988. [PMID: 28426116 DOI: 10.1093/jtm/tax020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Increasing numbers of expatriates are working in sub-Saharan Africa. There is little published data on the complex population and this survey aimed at understanding expatriate morbidity by accessing self-reported health problems and malaria preventive practices. METHODS A cross-sectional web-based survey was conducted targeting Portuguese expatriates in Angola and Mozambique. Logistic regression analysis explored factors associated with self-reported health problems and psychological symptoms in the previous 3 months. RESULTS A total sample of 352 adult Portuguese urban civil occupational expatriates was obtained. Median length of expatriation was 3 years. Considering a 3-month timeframe, one in five expatriates reported new health problems and need of medical assistance, 5% were hospitalized and 64% reported general psychological symptoms. Less than 2% of subjects were on malaria chemoprophylaxis. Having chronic health conditions doubled the reporting of new health problems. Increasing length of expatriation was associated with decreasing reporting of general psychological symptoms. Directors and executive managers and expatriates living alone tended to report more general psychological symptoms. CONCLUSION Expatriate communities deserve enhanced surveillance for the health issues that affect them. This will improve evidence-based preparation and intervention by public and travel health practitioners.
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Affiliation(s)
- Ana Glória Fonseca
- Public Health Department, NOVA Medical School, Faculdade Ciências Médicas, Universidade Nova de Lisboa (NOVA Lisbon University), Lisbon, Portugal
| | - Sara S Dias
- Public Health Department, NOVA Medical School, Faculdade Ciências Médicas, Universidade Nova de Lisboa (NOVA Lisbon University), Lisbon, Portugal.,UIS-ESSLei-IPLeiria, Lisbon, Portugal
| | - João Luis Baptista
- Faculdade de Ciências da Saúde (Faculty of Health Sciences), Universidade da Beira Interior (Beira Interior University), Lisbon, Portugal
| | - Jorge Torgal
- Public Health Department, NOVA Medical School, Faculdade Ciências Médicas, Universidade Nova de Lisboa (NOVA Lisbon University), Lisbon, Portugal
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Giorgi G, Montani F, Fiz-Perez J, Arcangeli G, Mucci N. Expatriates' Multiple Fears, from Terrorism to Working Conditions: Development of a Model. Front Psychol 2016; 7:1571. [PMID: 27790173 PMCID: PMC5062027 DOI: 10.3389/fpsyg.2016.01571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/27/2016] [Indexed: 11/25/2022] Open
Abstract
Companies’ internationalization appears to be fundamental in the current globalized and competitive environment and seems important not only for organizational success, but also for societal development and sustainability. On one hand, global business increases the demand for managers for international assignment. On the other hand, emergent fears, such as terrorism, seem to be developing around the world, enhancing the risk of expatriates’ potential health problems. The purpose of this paper is to examine the relationships between the emergent concept of fear of expatriation with further workplace fears (economic crisis and dangerous working conditions) and with mental health problems. The study uses a quantitative design. Self-reported data were collected from 265 Italian expatriate workers assigned to both Italian and worldwide projects. Structural equation model analyses showed that fear of expatriation mediates the relationship of mental health with fear of economic crisis and with perceived dangerous working conditions. As expected, in addition to fear, worries of expatriation are also related to further fears. Although, the study is based on self-reports and the cross-sectional study design limits the possibility of making causal inferences, the new constructs introduced add to previous research.
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Affiliation(s)
- Gabriele Giorgi
- Department of Psychology, European University of Rome Rome, Italy
| | | | - Javier Fiz-Perez
- Department of Psychology, European University of Rome Rome, Italy
| | - Giulio Arcangeli
- Department of Experimental and Clinical Medicine, University of Florence Florence, Italy
| | - Nicola Mucci
- Department of Experimental and Clinical Medicine, University of Florence Florence, Italy
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