Referral of travellers from Australia by general practitioners for travel health advice

Scope and Predictors of Travel Medicine Practice among Primary Care Physicians in Qatar

In an era of globalization, travel-related illnesses have become a focus of public health concern. Pretravel consultation is an effective measure to promote healthy travel. This study aimed to assess the scope of primary care physicians' (PCPs) practice of travel medicine (TM) in Qatar and its associated predictors. This was a cross-sectional study design. A structured questionnaire was used to collect data from all PCPs working in the 27 primary healthcare centers in Qatar. Descriptive and analytic statistics were used as appropriate, and a multivariable logistic regression model was constructed. Three hundred sixty-four PCPs participated in the study (response rate of 89.2%). Most PCPs (91.1%) provided pretravel consultations of which 72.7% provided less than 10 consultations per month. Overall, pretravel advice content and frequency including vaccine and malaria chemoprophylaxis recommendations were inadequate. Significant predictors of high frequency of pretravel consultations (≥10/month) included male PCPs (AOR 1.78, 95% CI: 1.01, 3.18), PCPs who had postgraduate training or experience in TM (AOR 2.74, 95% CI: 1.59, 4.72), and multilingual (speaking ≥3 languages) physicians (AOR 1.96, 95% CI: 1.12, 3.45). Frequently encountered post-travel illnesses included travelers' diarrhea, respiratory diseases, and fever. While, most PCPs provided pretravel consultations, the frequency and content of consultations were inadequate. Male PCPs, past training or experience in TM, and multilingual physicians were important predictors of providing a high frequency of pretravel consultation. The findings of this study identified several gaps in PCPs' TM practice. Specific measures should be designed and implemented to reduce the burden of travel-related illnesses and promote healthy travel.

Primary care physicians’ knowledge of travel vaccine and malaria chemoprophylaxis and associated predictors in Qatar

Background

In an era of globalization, travel-related illnesses have become a focus of public ‎health concern, especially in the Arab region where travel health services are insufficient and ‎not well-established. This study was conducted to assess travel vaccine and ‎malaria chemoprophylaxis knowledge and associated predictors among primary care physicians‎ (PCPs) in ‎Qatar.

Methods

This was a cross-sectional study. A structured questionnaire was used to collect ‎data from all physicians working at all 27 primary healthcare centers from March 1^st to May 31^st 2020.‎ Knowledge scores were computed and a multivariable linear regression model was built to identify predictors of higher knowledge.

Results

A total of 364 PCPs participated (response rate of 89.2%). Participants’ mean ‎age was 44.5 (±7.8) with 59.1% being males. Their overall mean knowledge score was 9.54/16 (±3.24). Significant predictors of higher knowledge included: aged 40–49 years ‎(1.072; 95% CI: 0.230, 1.915)‎, had medical degree from non-Arab countries ‏‎(0.748; 95% CI: 0.065, ‎‎1.432)‎‏,‏‎ had training in TM ‏ ‏‎(1.405; 95% CI: 0.407, ‎‎2.403), and provided ≥10 consultations/ month ‎(2.585; 95% CI:1.294, 3.876)‎. Online information was the main reported resource of travel medicine consultation.

Conclusions

The overall PCPs’ mean percentage knowledge score of travel medicine was 59.6% (±20.3). A high volume of pretravel consultation, prior training, middle age group, and medical degree from non-Arab countries were significant predictors of higher ‎knowledge. Continuing ‎education and training provided by recognised international institutions for all PCPs is highly ‎recommended to narrow the gap in travel medicine knowledge.

Global mobility, travel and migration health: clinical and public health implications for children and families

Exponential growth of the world's population combined with increased travel has dramatically increased the spread of infectious diseases. Although there has been significant focus on migration, the major contributors to the transmission of communicable diseases are travel and tourism not migration. Given that children represent up to 10% of international travellers, it is critical to the health of all age groups to ensure that tailored guidance for children is considered in public health policy and guidelines, and pandemic responses. To further support pandemic preparedness, public health systems need to strengthen ties with communities and health systems. In addition, travel and migration issues need to be included as core competencies in medical education. Ensuring that clinicians who care for children have knowledge of travel and migration health will foster a better health outcome in an increasingly mobile population at risk of emerging infectious diseases.Abbreviations CDC: Centers for Disease Control and Prevention; DGMQ: CDC Division of Global Migration and Quarantine; EID: emerging infectious diseases; EU: European Union; VFR: visiting friends and relatives; IOM: United Nations International Organization for Migration; LPR: lawful permanent resident; US: United States of America; WHO: World Health Organization.

Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence

BACKGROUND

Travellers visiting friends and relatives (VFR travellers) in their country of origin are at increased risk of a range of preventable infections. Risks are broadly related to circumstances of travel, risk misconceptions and access to health services. Despite nearly two decades of literature highlighting these increased risks little impact has been made on their risk disparity.

METHODS

This review draws on evidence from travel medicine literature, supplemented by evidence from the broader field of immigrant health, and is structured to include strategies that aim to reduce barriers at the patient, provider and health system level.

RESULTS

For the travel medicine provider, tailored risk communication that is cognisant of the unique health beliefs and barriers to travel health for VFR travellers is needed, including enhanced communication through the use of interpreters and supplementary written communication. Primary care providers are uniquely placed to identify future travel plans among immigrant patients, however, greater awareness of VFR traveller risks and training in travel medicine are required. Community health promotion interventions that are culturally appropriate, translated into multiple languages and takes into account the cumulative risk of multiple return visits are key to normalizing travel healthcare seeking behaviours and improving awareness of VFR travel risks. Currently, there are few examples of novel strategies to engage migrant communities in travel health with no formal evaluations of their effectiveness. Best practice includes the use of community-consulted approaches in collaboration with government, primary care and travel medicine.

CONCLUSIONS

Multifactorial barriers related to health beliefs and access to health services require a range of strategies and interventions in both reaching and providing advice to VFR travellers. To improve the evidence base, future research should focus on the evaluation of novel strategies that address these barriers and improve access and provision of pre-travel healthcare to VFR travellers.

Preparation and Characterization of Loperamide-Loaded Dynasan 114 Solid Lipid Nanoparticles for Increased Oral Absorption In the Treatment of Diarrhea

The aim of the project was to assemble two optimum solid lipid nanoparticle (SLN) formulations for oral delivery of loperamide (LPM) to treat different types of diarrhea, and to evaluate their release profiles in vitro and pharmacokinetic properties in vivo. In this work, glyceryl trimyristate (Dynasan 114) nanoparticles containing the drug LPM and sodium cholate as a stabilizer were prepared using a modified solvent evaporation technique. Two LPM-loaded SLNs, namely LPM-SLN-1 (LPM-SLN with a high ratio rate of lipid to drug) and LPM-SLN-2 (LPM-SLN with a low ratio rate of lipid to drug), were prepared by the solvent evaporation method. A change in the lipid concentration affects the characteristics of LPM-SLNs. The average sizes of the LPM-SLNs were 303 ± 18 nm and 519 ± 36 nm, separately, as analyzed by dynamic light scattering. The LPM-SLNs were found to be round with a smooth surface, as observed using a transmission electron microscope and a scanning electron microscope. The average encapsulation efficiencies were 87 ± 3.78% w/w and 84 ± 5.17%, accordingly. In the in vitro release experiments, LPM-SLNs showed a continuous release profile of LPM without any burst release. The oral bioavailability of LPM-SLNs was analyzed using Wistar rats. The relative bioavailabilities of LPM-SLNs were 227 and 153%, respectively, as compared that of the LPM tablet. There was no difference in the T_max between LPM-SLN-2 and the LPM tablet. In conclusion, LPM-SLN-1 significantly improved the oral bioavailability of LPM, while LPM-SLN-2 having the same swift action as the LPM tablet. These results demonstrate the potential of LPM-SLNs in the oral delivery of LPM to treat different types of diarrhea.

International travel in the immunocompromised patient: a cross-sectional survey of travel advice in 254 consecutive patients

AIMS

Our primary aim was to determine the rate of overseas travel in immunocompromised individuals attending appropriate clinics at an Australian tertiary care hospital. We also aimed to characterise health-seeking behaviour prior to travel and investigated sources of pre-travel advice, compared travel patterns and activities between three specific immunosuppressed groups, and examined pre-immunosuppression patient serology.

METHODS

We implemented a cross-sectional survey of patients between February and August 2012. This survey was implemented among three outpatient populations at Monash Medical Centre, an Australian tertiary care hospital.

RESULTS

We recruited 254 immunosuppressed adults from three patient populations: human immunodeficiency virus-positive individuals, renal transplant patients and rheumatology patients requiring immunosuppressive therapy. No clinical intervention was performed. In the 10 years preceding the survey, 153 (60.2%) participants reported international travel. Of these, 105 (68.6%) were immunosuppressed at the time of travel. These patients were 47.6% male and 60% Australian born. Forty per cent were visiting friends and relatives as part of their travel. Fifty-four per cent of those immunocompromised at the time of travel were going to high-risk destinations. Pathology files indicated that serological screening was frequently not performed prior to immunosuppression in the renal transplant and rheumatology groups.

CONCLUSIONS

Immunocompromised patients often travel to high-risk destinations with limited or inadequate pre-travel preparations. Doctors caring for the immunocompromised should be aware of travel risks, suitable vaccination protocols and when to refer to specialist travel clinics.

Travel Medicine Encounters of Australian General Practice Trainees-A Cross-Sectional Study

BACKGROUND

Travel medicine is a common and challenging area of clinical practice and practitioners need up-to-date knowledge and experience in a range of areas. Australian general practitioners (GPs) play a significant role in the delivery of travel medicine advice. We aimed to describe the rate and nature of travel medicine consultations, including both the clinical and educational aspects of the consultations.

METHODS

A cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations was performed. Trainees contemporaneously recorded demographic, clinical, and educational details of consecutive patient consultations. Proportions of all problems/diagnoses managed in these consultations that were coded "travel-related" and "travel advice" were both calculated with 95% confidence intervals (CIs). Associations of a problem/diagnosis being "travel-related" or "travel advice" were tested using simple logistic regression within the generalized estimating equations (GEE) framework.

RESULTS

A total of 856 trainees contributed data on 169,307 problems from 108,759 consultations (2010-2014). Travel-related and travel advice problems were managed at a rate of 1.1 and 0.5 problems per 100 encounters, respectively. Significant positive associations of travel-related problems were younger trainee and patient age; new patient to the trainee and practice; privately billing, larger, urban, and higher socioeconomic status practices; and involvement of the practice nurse. Trainees sought in-consultation information and generated learning goals in 34.7 and 20.8% of travel advice problems, respectively, significantly more than in non-travel advice problems. Significant positive associations of travel advice problems were seeking in-consultation information, generation of learning goals, longer consultation duration, and more problems managed.

CONCLUSIONS

Our findings reinforce the importance of focused training in travel medicine for GP trainees and adequate exposure to patients in the practice setting. In addition, our findings have implications more broadly for the delivery of travel medicine in general practice.

General Practitioners' Perception of Risk for Travelers Visiting Friends and Relatives

BACKGROUND

General practitioners (GPs) are an important source of pre-travel health advice for travelers; however, only a few studies have investigated primary healthcare provider-related barriers to the provision of pre-travel health advice, particularly to travelers visiting friends and relatives (VFR). We aimed to investigate Australian GPs' knowledge, attitudes, and practices with regard to VFR travelers.

METHODS

A postal survey was sent to randomly sampled GPs in Sydney, Australia, in 2012. The questionnaire investigated GPs' perception of risk and barriers to the provision of advice to VFR travelers.

RESULTS

Of 563 GPs, 431 (76.6%) spoke a language other than English (LOTE) with 361 (64.1%) consulting in a LOTE. Overall, 222 (39.4%) GPs considered VFR travelers to be at higher risk than holiday travelers, with GPs consulting in English only [adjusted odds ratio (aOR) 1.65, 95% confidence interval (CI) 1.11-2.44, p = 0.01] and GPs considering long-term migrants as VFR travelers (aOR 1.86 95% CI 1.07-3.23, p = 0.03) remaining significant on multivariate analysis.

CONCLUSIONS

Multilingual GPs are a valuable resource to reducing language and cultural barriers to healthcare. Targeted education of this subgroup of GPs may assist in promoting pre-travel health assessments for VFR travelers. Awareness of the need for opportunistic targeting of migrants for pre-travel consultation through routine identification of future travel is needed.