Travel and health status: a survey follow-up study

Unleashing the link between the relaxation of the COVID-19 control policy and residents' mental health in China: the mediating role of family tourism consumption

Objective

COVID-19 has negatively influenced industrial development, family consumption, and residents' mental health. Unfortunately, it has not yet been studied whether this adverse situation can be alleviated after the relaxation of the COVID-19 control policy (RCC). Therefore, this study aimed to analyze the effect of the RCC on the resident's mental health and the mediating effect of family tourism consumption.

Methods

By using the PSM and mediating effetc model to research the panel data of two periods (April 2021 and April 2023) for Shaanxi province, China.

Results

The RCC negatively inhibited the mental health severity of residents, and the mental health severity decreased by 0.602. In particular, the RCC showed the most substantial negative effect on residents' stress, followed by anxiety and depression. Meanwhile, it is found that the impact of the RCC on the mental health of residents is highly heterogeneous. The RCC indicates a linear significant effect on the mental health of residents under 60 years of age, while the results were found insignificant for residents above 60 years of age. Meanwhile, the RCC's improvement effect on urban residents' mental health is greater than that of rural residents. In addition, mechanism analysis showed that tourism consumption plays a mediating role in the influence of the RCC on the mental health of residents, and the mediating effect accounted for 24.58% of the total effect.

Conclusion

Based on the findings, the study proposes that government and policymakers should strengthen mental health intervention, improve access to mental health counseling, stimulate economic development, expand the employment of residents, and track the mutation of the novel coronavirus.

Fever in the Returned Pediatric Traveler

Global mobility has been steadily increasing in recent years. The assessment of the febrile child returning from international travel is a diagnostic challenge. The COVID-19 pandemic has profoundly affected international travel and made evaluation and management of the sick returned traveler more challenging. Children visiting friends and relatives abroad remain at higher risk of infection compared to tourists. This review presents a guidance on the initial assessment of a traveling febrile child including interpretation of medical history, physical examination, and laboratory findings. Important clues to etiology include exposure to different infectious agents, incubation periods of pathogens, and prophylaxis regimens and vaccines received. Early identification of potentially life-threatening and highly contagious infections is essential. In this article, we discuss the epidemiology, evaluation, and management of specific travel related infections such as malaria, typhoid fever, dengue fever, viral hemorrhagic fever, rickettsiosis, leptospirosis, schistosomiasis, gastrointestinal, and respiratory infections.

Predicting morbidity in older travellers during a short-term stay in the tropics: the ELDEST study

BACKGROUND

Older persons may suffer more from travel-related health problems because of ageing and underlying chronic disorders. Knowledge on who is more likely to have these health problems helps to tailor travel health advice more specifically. This study aimed to determine predictors of travel-related morbidity in older travellers by assessing their pre-travel characteristics and performance using physical and cognitive functioning tests.

METHODS

Multicentre prospective cohort study among older travellers (≥60 years) who consulted one of the participating Dutch travel clinics. Handgrip strength and cognitive performance were measured pre-travel. Participants completed questionnaires before departure and 1 and 4 weeks after return. A diary recorded health complaints during travel until 2-week post-travel.

RESULTS

In total, 477 travellers completed the study (follow-up rate of 97%). Participants' median age was 66 years. The most visited regions were South-East Asia (34%) and South Asia (14%). Median travel duration was 19 days. Polypharmacy (≥5 medications per day) was not uncommon (16%). The median Charlson Comorbidity Index (CCI) score was 0. Self-reported travel-related infectious diseases concerned primarily respiratory tract infections (21%) and gastroenteritis (10%) whereas non-infectious complaints were injuries (13%), peripheral edema (12%) and dehydration (3%). Medical assistance was sought by 18%, mostly post-travel from their general practitioner (87%). Self-reported physical and mental health-related quality of life significantly improved during and after travel. Predictors for an increased risk of travel-related morbidity were higher CCI score, more travel experience, longer travel duration, higher number of daily medications, visiting northern Africa or South-East and East Asia, and phone and social media use.

CONCLUSION

Older Dutch travellers are generally fit, well-prepared and suffer not only from common infectious health problems, but also from injuries. Travel improved their self-perceived health. The predictors could be used to identify the more at-risk older traveller and to decrease travel-related morbidity by optimizing pre-travel advice.

Travellers' risk behaviors and health problems: Post-travel follow up in two travel medicine centers in Italy

OBJECTIVES

We examined the association between travellers' characteristics, compliance with pre-travel recommendations and health problems.

METHODS

Volunteer travellers were enrolled and data collected using a questionnaire between 30-60 days after returning home. We analyzed the associations through bivariate and multivariate models.

RESULTS

Of the 468 enrolled travelers, 68% consumed raw food and 81% food containing milk and/or eggs. 32% consumed street vendor food and 30% drinks containing ice. 24% used the recommended mechanical prophylaxis measures. 46% got sick during and/or after travel (gastrointestinal symptoms most frequently). Factors predisposing to health problems were female gender, youth/middle age, intermediate travel duration and profession. The American continent and staying in hostels and tents were significantly associated with febrile illness. Street vendor food was significantly associated with skin reactions.

CONCLUSIONS

Adherence to behavioral recommendations remains low. Travellers must be informed of health risks during and after travel.

Retrospective clinical case series study in 2017 identifies Plasmodium knowlesi as most frequent Plasmodium species in returning travellers from Thailand to Germany

Febrile illnesses are common in travellers returning from south-east Asia. However, malaria is a rare diagnosis in this population. A series of Plasmodium knowlesi infections was noted in German travellers returning from Thailand since 2012. Infectious disease and tropical medicine facilities registered by the German Society for Tropical Medicine and International Health were contacted in March 2017, and asked to report previous P. knowlesi cases. In addition, surveillance data from the Robert Koch-Institute were analysed. The facilities reported a total of six P. knowlesi-positive cases, all were returning travellers from Thailand. The P. knowlesi-positive cases made up 6/9 of all diagnosed malaria cases imported from Thailand in the time period 2012 to 2017. In 4/5 of cases where a malaria rapid diagnostic test had been applied it revealed a negative result. P. knowlesi is an important differential diagnosis in travellers returning from south-east Asia with itineraries that include Thailand. This study highlights the importance of this Plasmodium species in this patient subgroup. Whenever malaria is suspected in a returning traveller from Thailand, P. knowlesi should be taken into consideration and a differential PCR be executed as currently the unequivocal diagnosis of P. knowlesi is based on nuclear amplification techniques.

A closer look at travellers' infections abroad: Finnish nationwide data with incidences, 2010 to 2012

BACKGROUND

Although infections represent the most common health problem of travellers abroad, data on morbidity and incidences of various infections are scarce.

METHOD

Data on infections of Finnish travellers during 2010-2012 were retrieved from the database of SOS International, an assistance organization covering 95% of Finns requiring aid abroad. The study included 30,086 cases. For incidence calculation, the data were linked to the numbers of Finns visiting these regions during the same period as recorded by the Official Statistics of Finland.

RESULTS

The incidence of infections was particularly high in Africa, southern Europe plus the eastern Mediterranean, and Asia plus Oceania. The most frequent diagnoses were acute gastroenteritis (38.0%) and respiratory-tract infections (RTI) (34.5%), followed by infections of the ear (12.6%), skin or subcutaneous tissue (5.1%), urogenital tract (4.2%), eye (3.1%), and systemic febrile infections (2.2%). Vaccine-preventable diseases (VPD) accounted for 0.8% of cases, with varicella as most (49%) and influenza as second-most (27%) common.

CONCLUSIONS

Incidence of infections was higher in southern than in eastern and western Europe. Gastroenteritis and RTI proved the most frequent diagnoses, whereas systemic febrile infections were uncommon. Despite pre-travel immunizations, VPDs still occurred; pre-travel consultation should cover both varicella and influenza.

Travelers' health problems and behavior: prospective study with post-travel follow-up

Background

The annual number of international tourist arrivals has recently exceeded one billion, yet surprisingly few studies have characterized travelers’ behavior, illness, and risk factors in a prospective setting. Particularly scarce are surveys of data spanning travel, return, and follow-up of the same cohort.

This study examines behavior and illness among travelers while abroad, after return home, and at follow-up. Patterns of behavior connected to type of travel and illness are characterized so as to identify risk factors and provide background data for pre-travel advice.

Methods

Volunteers to this prospective cohort study were recruited at visits to a travel clinic prior to departure. Data on the subjects’ health and behavior were collected by questionnaires before and after journeys and over a three-week follow-up. In addition, the subjects were asked to fill in health diaries while traveling.

Results

The final study population consisted of 460 subjects, 79 % of whom reported illness during travel or on arrival: 69 % had travelers’ diarrhea (TD), 17 % skin problems, 17 % fever, 12 % vomiting, 8 % respiratory tract infection, 4 % urinary tract infection, 2 % ear infection, 4 % gastrointestinal complaints other than TD or vomiting, and 4 % other symptoms. Of all subjects, 10 % consulted a doctor and 0.7 % were hospitalized; 18 % took antimicrobials, with TD as the most common indication (64 %). Ongoing symptoms were reported by 25 % of all travelers upon return home.

During the three-week follow-up (return rate 51 %), 32 % of respondents developed new-onset symptoms, 20 % visited a doctor and 1.7 % were hospitalized.

Factors predisposing to health problems were identified by multivariable analysis: certain regions (Southern Asia, South-Eastern Asia, and Eastern Africa), female gender, young age, and long travel duration.

Conclusions

Despite proper preventive measures like vaccinations, malaria prophylaxis, and travel advice, the majority of our subjects fell ill during or after travel. As the symptoms mostly remained mild, health care services were seldom needed. Typical traveler profiles were identified, thereby providing a tool for pre-travel advice. The finding that one third reported new-onset illness during follow-up attests to the importance of advising clients on potential post-travel health problems already during pre-travel visits.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-016-1682-0) contains supplementary material, which is available to authorized users.

Travel risk behaviors as a determinants of receiving pre-travel health consultation and prevention

BACKGROUND

An estimated 30-60 % of travelers experience an illness while traveling. The incidence of travel-related illness can be reduced by preventive measures such as those provided by the Traveler Health Clinic (THC) in Kuwait.

METHODS

The present study is an analytical comparative study between groups of travelers visiting the THC during the study period (May 2009 - December 2010) and an age- and gender-matched control group of non-visitors (800 people). Both groups completed a modified pre-departure questionnaire.

RESULTS

Bivariate analysis revealed that Kuwaitis (68.2 %), those traveling for work (25.3 %) or leisure (59.5 %), those living in camps (20.4 %) or hotels (64.0 %), and those with knowledge of the THC from the media (28.1 %) or other sources (57.3 %), were more likely to be associated with a high frequency of visits to the THC (p < 0.001). Additionally, travelers heading to Africa (47 %) and South America (10 %) visited the THC more than did others (P < 0.05). Multivariate analysis revealed that nationality, followed by purpose of travel, duration of stay, and choice of travel destination are independent predictors of receiving pre-travel consultation from the THC.

CONCLUSION

Nationality, purpose of travel, length of stay, and travel destination are predictors for receiving a pre-travel consultation from the THC.

Illness and injury of travellers abroad: Finnish nationwide data from 2010 to 2012, with incidences in various regions of the world

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Travel risk behaviours and uptake of pre-travel health preventions by university students in Australia

Background

Forward planning and preventative measures before travelling can significantly reduce the risk of many vaccine preventable travel-related infectious diseases. Higher education students may be at an increased risk of importing infectious disease as many undertake multiple visits to regions with higher infectious disease endemicity. Little is known about the health behaviours of domestic or international university students, particularly students from low resource countries who travel to high-resource countries for education. This study aimed to assess travel-associated health risks and preventative behaviours in a sample of both domestic and international university students in Australia.

Methods

In 2010, a 28 item self-administered online survey was distributed to students enrolled at the University of New South Wales, Sydney, Australia. Multiple methods of distributing links to the online survey were utilised. The survey examined the international travel history, travel intentions, infection control behaviours and self-reported vaccination history.

Results

A total of 1663 respondents completed the online survey, 22.1% were international students and 83.9% were enrolled at an undergraduate level. Half had travelled internationally in the previous 12 months, with 69% of those travelling only once during that time with no difference in travel from Australia between domestic and international students (p = 0.8). Uptake of pre-travel health advice was low overall with 68% of respondents reporting they had not sought any advice from a health professional prior to their last international trip. Domestic students were more likely to report uptake of a range of preventative travel health measures compared to international students, including diarrhoeal medication, insect repellent, food avoidance and condoms (P < 0.0001). Overall, students reported low risk perception of travel threats and a low corresponding concern for these threats.

Conclusions

Our study highlights the need to educate students about the risk associated with travel and improve preventative health-seeking and uptake of precautionary health measures in this highly mobile young adult population. Although immunisation is not an entry requirement to study at Universities in Australia, large tertiary institutions provide an opportunity to engage with young adults on the importance of travel health and provision of vaccines required for travel, including missed childhood vaccines.

Self-reported symptoms of infection among travelers departing from Sydney and Bangkok airports

BACKGROUND

Data on the burden of illness in travelers departing from both developing and developed countries within the Asia-Pacific region is scarce. We conducted a survey to assess symptoms of infection among travelers within the region.

METHODS

A self-administered questionnaire was distributed to travelers departing Sydney airport, Australia, for destinations in Asia and departing Bangkok Airport, Thailand, for Australian destinations during the respective winter months of 2007. A two-stage cluster sampling technique was developed to ensure representativeness and a weighting was applied to the Sydney sample. Travelers were assessed for symptoms of infection (fever, sore throat, diarrhea, rash, and myalgia), travel activities, and social contact in the 2 weeks prior to departure.

RESULTS

A total of 843 surveys was included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, 45.6% of respondents were Australian residents and 26.7% were residents of countries in Asia. At least one symptom of infection was reported by 23.8% of respondents and 5.4% reported two or more symptoms of infection in the 2 weeks prior to departure. The proportion reporting symptoms was higher in those departing Bangkok compared to Sydney. Significant risk factors for the reporting of symptoms differed between residents and visitors departing each study site. Activities resulting in high rates of social contact prior to travel, particularly contact with febrile persons, were found to be independent predictors of reported symptoms.

CONCLUSIONS

Self-reported symptoms of infection were common in our sample of travelers. Infectious diseases in travelers can result in spread across international borders and may be associated with the frequency of social contacts and reported illness among travelers.

Descriptive epidemiology of travel-associated diarrhea based on surveillance data at Narita International Airport

BACKGROUND

Although travelers' diarrhea is one of the most common health problems among international travelers, current findings depend largely on hospital and clinic-based information. To better understand the disease epidemiology and to identify specific subpopulations with increased risks, denominator data covering a large traveler population are needed.

METHODS

We conducted a questionnaire survey of all travelers at the quarantine station, Narita International Airport, and retrospectively reviewed records from January 2001 to December 2005. The Immigration Bureau database was used as denominator data on travel patterns during the same period. To elucidate the risks of contracting diarrhea, we estimated incidence according to age, sex, month of travel, and travel destination.

RESULTS

A total of 7,937,654 people voluntarily submitted questionnaires; 9,836 had travelers' diarrhea. Travelers of both sexes aged 20 to 29 years reported the disease most frequently. Men aged 20 to 24 had the highest estimated incidence compared with any other age and sex group. The incidence was higher in March, August, and September than other months, mainly due to the influx of young adult travelers. Travel to south-central Asia, Southeast Asia, and North Africa was associated with higher risks than that to other areas.

CONCLUSIONS

Risks of contracting travelers' diarrhea are dependent on age, sex, season, and destination of travel. Incidence of diarrhea in all four seasons varies with age. Some destinations are associated with increased risks regardless of age. To prevent travelers from contracting diarrhea, adequate measures should focus on specific subpopulations.

Aeromedical transport after acute myocardial infarction

BACKGROUND

No guidelines exist for the planning of aeromedical repatriation after acute myocardial infarction (AMI). In 2004, we employed a risk evaluation-based decision-making system for repatriation of patients after AMI. The objective was to evaluate the safety of transports during 2005 managed by this system.

METHODS

A total of 116 patients were transported according to the algorithm, 64 unescorted and 52 escorted. The decision-making system was based on the recommendations given by the European Society of Cardiology. Whenever possible, patients were evaluated by coronary angiogram or exercise electrocardiogram. Patients at high risk were treated locally if appropriate facilities were available or evacuated to the nearest heart center. Patients at low risk were allowed to fly unescorted home if no other concomitant diseases needed the attention of a physician. The composite end point of death of any cause during transport or departure from the planned repatriation due to worsening of the condition was registered.

RESULTS

No patients reached the end point. Patients who were not risk evaluated more often needed escort (p < 0.04). Escorted patients were older (p < 0.001) and had more post-AMI complications (p < 0.04).

CONCLUSIONS

Patients can safely travel unescorted after AMI if their risk of ischemia is low as determined by risk stratification examination prior to repatriation.