1
|
Linares-Rufo M, Bermudez-Marval H, García-Bertolín C, Santos-Galilea J, Balsa-Vázquez J, Pérez-Tanoira R, Santos-Larrégola L, Cuadros-González J, Rojo-Marcos G, Ramos-Rincón JM. Perspectives of primary care physicians in Spain on malaria: a cross-sectional survey and retrospective review of cases. Malar J 2024; 23:7. [PMID: 38178126 PMCID: PMC10768253 DOI: 10.1186/s12936-023-04826-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND In Spain, the risk of imported malaria has increased in recent years due to the rise in international travel and migration. Little is known about the knowledge, information sources, clinical practice, and specific needs of primary care physicians (PCPs) concerning malaria despite the pivotal role played by these professionals in managing the health of tourists. The objective of this study was to assess the knowledge, attitudes, and practices of PCPs in Spain regarding malaria. METHODS This research analyses data from (1) a cross-sectional nationwide survey assessing the knowledge and attitudes of PCPs regarding malaria, and (2) a retrospective review of 373 malaria cases appearing in primary care medical records (PCMRs) in the Madrid area over the past 15 years to determine how cases were documented, managed, or characterized in the primary care setting. RESULTS The survey findings reveal a modest level of self-perceived familiarity with malaria (221/360, 57.6%), even though 32.8% of the practitioners reported having delivered care for confirmed or suspected cases of the disease, these practitioners had greater knowledge of malaria (80.4%) compared to physicians who reported not having delivered care for malaria (19.6%, p < 0.001). Ten percent of the survey participants did not know the name of the mosquito that transmits malaria, and only 40.7% would promptly request malaria testing for a traveller with symptoms after a trip to an endemic area. Responses provided by younger PCPs varied to a greater extent than those of their more experienced colleagues regarding prevention practices and patient management. A review of PCMRs showed that only 65% of all patients were recorded as such. Among those registered, only 40.3% had a documented malaria episode, and of those, only 16.6% received proper follow-up. Only 23.7% of the patients with a PCMR had a record that specifically indicated travel to an endemic country or travel classified as visiting friends and relatives (VFR). CONCLUSIONS The findings of this study underscore the critical role of PCPs in the field of travel medicine, particularly given the increase in imported malaria cases. These results highlight the need for targeted training in travel medicine and the need to ensure optimal patient education in care settings.
Collapse
Affiliation(s)
- Manuel Linares-Rufo
- Microbiology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain.
- Foundation iO, Madrid, Spain.
| | - Harold Bermudez-Marval
- Microbiology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Carlos García-Bertolín
- Microbiology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | | | - Javier Balsa-Vázquez
- Internal Medicine Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Ramón Pérez-Tanoira
- Microbiology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
- Biomedicine and Biotechnology Department, University Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | | | - Juan Cuadros-González
- Microbiology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
- Biomedicine and Biotechnology Department, University Alcalá de Henares, Alcalá de Henares, Madrid, Spain
| | - Gerardo Rojo-Marcos
- Internal Medicine Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - José-Manuel Ramos-Rincón
- Clinical Medicine Department, Miguel Hernández of Elche University, Elche, Alicante, Spain
- Internal Medicine Department, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| |
Collapse
|
2
|
Nucci D, Santangelo OE, Provenzano S, Fatigoni C, Nardi M, Ferrara P, Gianfredi V. Dietary Fiber Intake and Risk of Pancreatic Cancer: Systematic Review and Meta-Analysis of Observational Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111556. [PMID: 34770068 PMCID: PMC8583332 DOI: 10.3390/ijerph182111556] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/21/2021] [Accepted: 10/30/2021] [Indexed: 12/24/2022]
Abstract
The burden of pancreatic cancer varies greatly across countries, with the number of deaths, incident cases, and disability-adjusted life years more than doubling in recent years, and with high-income countries having the highest incidence and mortality rates. We conducted this systematic review with meta-analysis with the goal of summarizing the current evidence on dietary fiber intake and its role in reducing the risk of pancreatic cancer, given the importance of identifying risk factors. This systematic review followed the guidelines of the Cochrane Collaboration and the Meta-analysis of Observational Studies in Epidemiology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. The structured literature search was conducted on PubMed/Medline and Scopus, combining free text words and medical subject headings. Our review contained 18 records at the end of the process. Our results show that dietary fiber intake reduces the risk of pancreatic cancer. When the analysis was differentiated according to the type of fiber considered, sub-grouped by gender (reduction of around 60% among women), and when case-control studies were conducted, the strength of the association increased. Clinicians and policymakers should improve interventions to raise the population's awareness regarding the consumption of high-fiber diets, both in practice and in terms of public health policy.
Collapse
Affiliation(s)
- Daniele Nucci
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (D.N.); (M.N.)
| | | | | | - Cristina Fatigoni
- Department of Pharmaceutical Sciences, University of Perugia, 06122 Perugia, Italy;
| | - Mariateresa Nardi
- Nutritional Support Unit, Veneto Institute of Oncology IOV-IRCCS, 35128 Padua, Italy; (D.N.); (M.N.)
| | - Pietro Ferrara
- Center for Public Health Research, University of Milan—Bicocca, 20900 Monza, Italy
- Value-Based Healthcare Unit, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy
- Correspondence:
| | - Vincenza Gianfredi
- School of Medicine, University Vita-Salute San Raffaele, 20132 Milan, Italy;
- CAPHRI Care and Public Health Research Institute, Maastricht University, 6211 Maastricht, The Netherlands
| |
Collapse
|
3
|
Rothe C, Rosenbusch D, Alberer M, Bühler S, Burchard G, Erkens K, Feldt T, Grobusch MP, Köhler C, Kapaun A, Löbermann M, Meischner K, Metzger W, Müller A, Nothdurft HD, Ramharter M, Rieke B, Schlaich C, Schönfeld C, Schulze MH, Siedenburg J, Steiner F, Veit O, Weitzel T, Boecken G. Empfehlungen zur Malariaprophylaxe. FLUGMEDIZIN · TROPENMEDIZIN · REISEMEDIZIN - FTR 2021. [DOI: 10.1055/a-1520-3764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Camilla Rothe
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Deike Rosenbusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
| | - Martin Alberer
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Praxis Dr. Frühwein und Partner, München
| | - Silja Bühler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Infektionsepidemiologisches Landeszentrum und Impfzentrum, Institut für Hygiene und Umwelt der Freien und Hansestadt Hamburg
| | - Gerd Burchard
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
| | - Kai Erkens
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Kommando Sanitätsdienst der Bundeswehr, Dez. VI 2.2, München
| | - Torsten Feldt
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Tropenmedizinische Ambulanz, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Düsseldorf
| | - Martin P Grobusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Department of Infectious Diseases, Center of Tropical Medicine and Travel Medicine Division of Internal Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Carsten Köhler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Annette Kapaun
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Universitätsklinikum Heidelberg, Zentrum für Infektiologie, Sektion klinische Tropenmedizin
| | - Micha Löbermann
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Universitätsklinikum Heidelberg, Zentrum für Infektiologie, Sektion klinische Tropenmedizin
| | - Karin Meischner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Environmental Protection, Health Management and Safety, Health Management, Siemens AG
| | - Wolfram Metzger
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Impfzentrum, Landratsamt Tübingen
| | - Andreas Müller
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Tropenmedizin Missioklinik, Klinikum Würzburg Mitte gGmbH
| | - Hans Dieter Nothdurft
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
| | - Michael Ramharter
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
- Sektion Tropenmedizin, I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf
| | - Burkhard Rieke
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Deutsche Fachgesellschaft für Reisemedizin (DFR)
- Tropen- und Reisemedizinische Praxis, Düsseldorf
| | - Clara Schlaich
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Deutsche Gesellschaft für Maritime Medizin (DGMM)
- Hafenpraxis Hamburg Dr. Schlaich & Dr. Beyer
| | - Christian Schönfeld
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Charité – Universitätsmedizin Berlin, Institut für Tropenmedizin und Internationale Gesundheit
| | - Marco H Schulze
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Institut für Krankenhaushygiene und Infektiologie, Universitätsmedizin Göttingen
| | - Jörg Siedenburg
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Regionalarztdienststelle Nairobi, Kenia
| | - Florian Steiner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Praxis für Innere Medizin und Tropenmedizin, Hausärztliche Versorgung, Tarmstedt
| | - Olivia Veit
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Schweizerisches Tropen- und Public Health-Institut, Basel, Schweiz
- Institut für Epidemiologie, Biostatistik und Prävention, Zürich, Schweiz
| | - Thomas Weitzel
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Travel Medicine Program, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Gerhard Boecken
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin, Reisemedizin und Globale Gesundheit e. V. (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Regionalarztdienststelle Buenos Aires, Argentinien
| |
Collapse
|
4
|
Rothe C, Rosenbusch D, Alberer M, Bühler S, Burchard G, Erkens K, Feldt T, Grobusch MP, Köhler C, Kapaun A, Löbermann M, Meischner K, Metzger W, Müller A, Nothdurft HD, Rieke B, Schlaich C, Schönfeld C, Schulze MH, Siedenburg J, Steiner F, Veit O, Weitzel T, Boecken G. Empfehlungen zur Malariaprophylaxe. FLUGMEDIZIN TROPENMEDIZIN REISEMEDIZIN 2020. [DOI: 10.1055/a-1204-1496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Camilla Rothe
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Deike Rosenbusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
| | - Martin Alberer
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Silja Bühler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
- Institut für Hygiene und Umwelt, Freie und Hansestadt Hamburg
| | - Gerd Burchard
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Bernhard-Nocht-Institut für Tropenmedizin, Hamburg
- Institut für Hygiene und Umwelt, Freie und Hansestadt Hamburg
- Ständige Impfkommission am Robert Koch-Institut (STIKO)
| | - Kai Erkens
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Kommando Sanitätsdienst der Bundeswehr, Dez. VI 2.2, München
| | - Torsten Feldt
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Tropenmedizinische Ambulanz, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinik Düsseldorf
| | - Martin P. Grobusch
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam
| | - Carsten Köhler
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Anette Kapaun
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Universitätsklinkum Heidelberg, Sektion klinische Tropenmedizin
| | - Micha Löbermann
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Tropenmedizin und Infektionskrankheiten, Zentrum für Innere Medizin, Universitätsmedizin Rostock
| | - Karin Meischner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Environmental Protection, Health Management and Safety, Health Management, Siemens AG
| | - Wolfram Metzger
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Innere Medizin VII, Institut für Tropenmedizin, Reisemedizin, Humanparasitologie, Universitätsklinikum Tübingen
| | - Andreas Müller
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Tropenmedizin Missioklinik, Klinikum Würzburg Mitte gGmbH
| | - Hans Dieter Nothdurft
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Abt. für Infektions- und Tropenmedizin, Klinikum der LMU München
| | - Burkhard Rieke
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Deutsche Fachgesellschaft für Reisemedizin (DFR)
- Tropen- und Reisemedizinische Praxis, Düsseldorf
| | - Clara Schlaich
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Deutsche Gesellschaft für Maritime Medizin (DGMM)
- Praxis HafenCity Hamburg Dr. Schlaich & Partner
| | - Christian Schönfeld
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Charité – Universitätsmedizin Berlin, Institut für Tropenmedizin und Internationale Gesundheit
| | - Marco H. Schulze
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Institut für Krankenhaushygiene und Infektiologie, Universitätsmedizin Göttingen
| | - Jörg Siedenburg
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
| | - Florian Steiner
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Praxis für Innere Medizin und Tropenmedizin, Tarmstedt
| | - Olivia Veit
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Schweizerisches Tropen- und Public Health-Institut, Basel, Schweiz
- Institut für Epidemiologie, Biostatistik und Prävention, Zürich, Schweiz
| | - Thomas Weitzel
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Travel Medicine Program, Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Gerhard Boecken
- Ständiger Ausschuss Reisemedizin (StAR) der Deutschen Gesellschaft für Tropenmedizin und Globale Gesundheit (DTG)
- Auswärtiges Amt – Gesundheitsdienst, Berlin
| |
Collapse
|
5
|
Utzinger KS, Held U, Hanscheid T, Gültekin N, Fehr J, Grobusch MP, Schlagenhauf P. Self-diagnosis and self-treatment of Plasmodium spp. infection by travellers (1989-2019): A systematic review and meta-analysis. Travel Med Infect Dis 2020; 38:101902. [PMID: 33132136 DOI: 10.1016/j.tmaid.2020.101902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/23/2020] [Accepted: 09/27/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Standby emergency self-treatment (SBET) is often recommended as an anti-malaria strategy for travellers to low-risk endemic areas. This self-treatment enables competent malaria therapy, if medical assistance is unavailable. The World Health Organization (WHO) recommends performing reliable diagnostic tests before starting antimalarial treatment. For the self-diagnosis of malaria in travellers, rapid diagnostic tests (RDT) can be used to confirm the infection before SBET is used. The aim of this research is to assess the use of RDT and/or SBET in travellers. METHODS We searched the databases (PubMed, Scopus, Embase, CINAHL) using terms and synonyms for 'self-diagnosis' and 'self-treatment' combined with 'malaria' and 'travel'. Articles in English, French and German were included. Potential articles were screened and extracted by two authors (KU and PS). Only original articles and case reports documenting the self-use of RDT and/or SBET in travellers were included. Data were extracted using a standardised approach. We defined 'correct use' of RDT and SBET. Data on number and performance of RDT and SBET use, as well as malaria verification were collected in an Excel table. Five meta-analyses were performed using a random effects model and calculating pooled proportions. This systematic review was conducted according to the PRISMA guidelines and registered in PROSPERO (CRD42018108874). RESULTS The research resulted in 867 articles of possible relevance on RDT and 955 articles on SBET. After screening, a total of 4 articles on RDT use and 17 articles for SBET use in travellers were included in the systematic review. Most of the RDT were performed and interpreted properly by the travellers (pooled proportion 88%, 95% confidence interval (CI) from 64% to 97%), whereby the proportion of correct performance was increased after a pre-travel test run (97%). Major problems in the implementation such as pricking finger, placing blood drop, identifying lines and interpreting results could be discovered. We found data on 1025 SBET uses in studies of travellers to high-risk African countries. In these studies, the pooled proportion of SBET uses was 6% (95% CI from 2% to 13%). We found 545 SBET uses in studies of travellers to countries of mixed malaria risk. In these studies, the pooled proportion of SBET uses was 2% (95% CI from 1% to 7%). Furthermore, the evaluation showed a high proportion of correct SBET use (pooled proportion 69%, 95% CI from 35% to 90%). As a cause for incorrect use, errors in dosage (under- or overdose), disregard of minimal incubation period (< 7 days since first possible malaria exposure) and absence of fever were identified. Four cases of post-SBET severe adverse events were documented. In a third of travellers who used SBET, a Plasmodium spp. infection could be detected (pooled proportion 31%, 95% CI from 16% to 51%). CONCLUSIONS This systematic review and meta-analysis showed that the majority of travellers were able to use RDT and SBET correctly. Standardised pre-travel instructions and specific training are indicated to increase the proportions of correct RDT and SBET use. With improved and user-friendly technology, RDT may become an integral part of SBET malaria recommendations for travellers. Combined use of RDT and SBET could be an appropriate strategy for selected subgroups of travellers to low-risk, remote malaria areas. Future research should focus on combined RDT and SBET strategies.
Collapse
Affiliation(s)
- Khyra S Utzinger
- University of Zürich, WHO Collaborating Centre for Travellers' Health, Travel Clinic and Department of Public & Global Health, MilMedBiol Competence Centre, Epidemiology, Biostatistics and Prevention Institute, Switzerland
| | - Ulrike Held
- University of Zürich, Biostatistics Department at Epidemiology, Biostatistics and Prevention Institute, Switzerland
| | - Thomas Hanscheid
- Instituto de Microbiologia, Faculdade de Medicina da Universidade de Lisboa, Portugal
| | - Nelja Gültekin
- Centre of Competence for Military and Disaster Medicine, Federal Department of Defence, Civil Protection and Sport DDPS, Swiss Armed Forces, Switzerland
| | - Jan Fehr
- University of Zürich, WHO Collaborating Centre for Travellers' Health, Travel Clinic and Department of Public & Global Health, MilMedBiol Competence Centre, Epidemiology, Biostatistics and Prevention Institute, Switzerland; Division of Infectious Diseases & Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Amsterdam University Medical Centers, Location AMC, Amsterdam Public Health, Amsterdam Infection & Immunity, University of Amsterdam, Amsterdam, the Netherlands
| | - Patricia Schlagenhauf
- University of Zürich, WHO Collaborating Centre for Travellers' Health, Travel Clinic and Department of Public & Global Health, MilMedBiol Competence Centre, Epidemiology, Biostatistics and Prevention Institute, Switzerland.
| |
Collapse
|
6
|
Ferrara P, Masuet-Aumatell C, Ramon-Torrell JM. Pre-travel health care attendance among migrant travellers visiting friends and relatives (VFR): a 10-year retrospective analysis. BMC Public Health 2019; 19:1397. [PMID: 31660916 PMCID: PMC6819640 DOI: 10.1186/s12889-019-7722-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/09/2019] [Indexed: 01/29/2023] Open
Abstract
Background Travellers visiting friends and relatives (VFR) define a specific population of travellers exposed to higher risks for health and safety than tourists. The aim of this study was to assess differentials in pre-travel health care in VFR travellers compared to other travellers. Methods A retrospective cohort study was performed including attendees of the Travel Medicine Clinic of the Hospital Universitari de Bellvitge, Barcelona, Spain, between January 2007 and December 2017. Results Over the 10-year period, 47,022 subjects presented to the travel clinic for pre-travel health care, 13.7% of whom were VFR travellers. These showed higher rates of vaccination against yellow fever and meningococcus, but lower rates for hepatitis A, hepatitis B, influenza, rabies, cholera, polio, typhoid IM vaccine and tetanus vaccine boosters. Regarding malaria prevention measures, results highlighted that VFR travellers, when compared with tourists, were more likely to be prescribed with chemoprophylaxis, particularly with mefloquine, than with atovaquone/proguanil. Conclusions Findings from this large-scale study indicated differences in vaccination rates and completion, as well as in chemoprophylaxis for malaria, between VFR and non-VFR travellers, fostering specific interventions for promoting adherence to pre-travel health advice among migrant travellers.
Collapse
Affiliation(s)
- Pietro Ferrara
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", 5 Via Luciano Armanni, 80138, Naples, Italy
| | - Cristina Masuet-Aumatell
- Bellvitge Biomedical Research Institute (IDIBELL), Preventive Medicine Department, University Hospital of Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Catalonia, Spain. .,Clinical Science Department, School of Medicine, University of Barcelona, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Catalonia, Spain.
| | - Josep Maria Ramon-Torrell
- Bellvitge Biomedical Research Institute (IDIBELL), Preventive Medicine Department, University Hospital of Bellvitge, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Catalonia, Spain.,Clinical Science Department, School of Medicine, University of Barcelona, Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Catalonia, Spain
| |
Collapse
|
7
|
Del Prete V, Mateo-Urdiales A, Bueno-Cavanillas A, Ferrara P. Malaria prevention in the older traveller: a systematic review. J Travel Med 2019; 26:5562848. [PMID: 31509199 DOI: 10.1093/jtm/taz067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 12/15/2022]
Abstract
Older travellers are at higher risk of malaria-related morbidity and mortality compared with younger people. Yet, prevention of malaria in this specific group of travellers is a long-standing issue in travel medicine. The aim of this research was to synthetize the existing evidence about this important topic, highlighting older travellers' attitudes and practises toward malaria prevention. Searches were performed on PubMed, Embase, EuropePMC, Web of Science, WHOLIS and LILACS databases for relevant studies reporting malaria prevention measures in older travellers. To measure malaria prevention in the older traveller population, the main information outcomes were obtained from the ABCD framework that included travellers' 'Awareness' towards pre-travel health advice, their utilisation of 'Bite-prevention measures' and adherence to 'Chemoprophylaxis'. Data on 'Diagnosis'-related outcomes were excluded for not being measures of malaria prevention. Three evaluators independently selected studies, extracted data and assessed the quality of the included articles. The research protocol was registered with PROSPERO (protocol number CRD42019124202). Out of the 899 titles and abstracts screened, 13 articles were included in this review synthesis. These studies included a wide range of interventions for malaria prevention: no relevant differences in pre-travel healthcare attendance were found depending on age; older travellers were found to be less likely to comply with bite-prevention measures; three high-quality studies reported that adherence to chemoprophylaxis significantly increased with age, while three studies did not find age-related differences in travellers' adherence. Overall, prevention of malaria in the older traveller has received limited attention from the scientific community. Older travellers seem to be less likely to comply with bite-prevention measures, but there was high heterogeneity across the reports. This population group demands particular attention and tailored health advice before travelling to malaria endemic areas. More research is required on how to improve malaria prevention in the older traveller.
Collapse
Affiliation(s)
- Viola Del Prete
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alberto Mateo-Urdiales
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
- School of Public Health, Health Education North West, Manchester, UK
| | | | - Pietro Ferrara
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| |
Collapse
|
8
|
Tan R, Elmers J, Genton B. Malaria standby emergency treatment (SBET) for travellers visiting malaria endemic areas: a systematic review and meta-analysis. J Travel Med 2019; 26:5475009. [PMID: 30995308 DOI: 10.1093/jtm/taz027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 04/11/2019] [Accepted: 04/11/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Malaria prevention methods for travellers to low or moderate malaria risk areas vary and remain controversial. Standby emergency treatment (SBET) for malaria is one possible strategy increasingly recommended since 1988 with little evidence on its effectiveness or how it is truly being used. METHODS A systematic review and meta-analysis were performed based on a structured search in Embase, Medline, PubMed, Cochrane and Web of Science on 7 September 2018. The primary outcome was the overall prevalence of SBET use in travellers, and secondary outcomes were the proportion carrying SBET, the response to fever [use of SBET, health facility attendance and use of malaria rapid diagnostic test (mRDT)], adverse events to SBET and the proportion using SBET incorrectly (incorrect dosage/duration). The pooled SBET use prevalence was analysed using a random effects model. A descriptive summary was done to present secondary outcomes. The study protocol was registered with PROSPERO CRD42018103703. RESULTS A total of 11 studies were eligible for inclusion among the 1027 titles identified by our search. The studies included 7/11 prospective cohort studies that recruited pre-travel clinic attendees in Europe and 4/11 cross-sectional studies, of which 3 recruited travellers at airports before their return home from Southeast Asia and Africa and 1 from an employee registry including long-term travellers. The overall pooled prevalence of SBET use among the 26 403 travellers was 2.5% (95% confidence interval, 1.1-4.3%; range, 0.4-10.8%). There was significant variation in the proportion of travellers carrying SBET medication (40-100%), the proportion of travellers with appropriate response to fever (23-100%), adverse events (0-33%) and incorrect dosage/duration of SBET (0-100%). CONCLUSION Adherence to the proposed recommendations for SBET use, notably the response to fever, was poor. If the use of SBET is to be pursued, modifications to the current SBET strategy should be considered, such as better selection of travellers at higher risk for malaria and the potential addition of mRDTs.
Collapse
Affiliation(s)
- Rainer Tan
- Travel Clinic, Department of Research, Innovation and Training, Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland
| | - Jolanda Elmers
- Medical Library, Research and Education Department, Lausanne University Hospital, Rue du Bugnon 46, Lausanne, Switzerland
| | - Blaise Genton
- Travel Clinic, Department of Research, Innovation and Training, Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.,Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
| |
Collapse
|