1
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Potin M, Carron PN, Genton B. Injuries and medical emergencies among international travellers. J Travel Med 2024; 31:taad088. [PMID: 37405992 DOI: 10.1093/jtm/taad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 06/07/2023] [Accepted: 06/12/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Tropical infectious diseases and vaccine-preventable emergencies are the mainstay of pre-travel consultations. However, non-communicable diseases, injuries and accidents that occur during travel are not emphasized enough in these settings. METHODS We performed a narrative review based on a literature search of PubMed, Google Scholar, UpToDate, DynaMed and LiSSa and on reference textbooks and medical journals dedicated to travel, emergency and wilderness medicine. Relevant secondary references were extracted. We also aimed to discuss newer or neglected issues, such as medical tourism, Coronavirus Disease 2019, exacerbations of co-morbidities associated with international travel, insurance coverage, health care seeking abroad, medical evacuation or repatriation and tips for different types of travellers' emergency medical kits (personal, group, physician handled). RESULTS All sources reviewed led to the selection of >170 references. Among epidemiological data on morbidity and deaths while abroad, only retrospective data are available. Deaths are estimated to occur in 1 in 100 000 travellers, with 40% caused by trauma and 60% by diseases, and <3% linked to infectious diseases. Trauma and other injuries acquired during travel, such as traffic accidents and drowning, can be reduced by up to 85% with simple preventive recommendations such as avoiding simultaneous alcohol intake. In-flight emergencies occur on 1 in 604 flights on average. Thrombosis risk is two to three times greater for travellers than for non-travellers. Fever during or after travel can occur in 2-4% of travellers, but in up to 25-30% in tertiary centres. Traveller's diarrhoea, although rarely severe, is the most common disease associated with travel. Autochthonous emergencies (acute appendicitis, ectopic pregnancy, dental abscess) can also occur. CONCLUSIONS Pre-travel medicine encounters must include the topic of injuries and medical emergencies, such as the risk-taking behaviours and foster better planning in a comprehensive approach along with vaccines and infectious diseases advices.
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Affiliation(s)
- Mathieu Potin
- ISTM CTH (Certificate of Travel Health), Chemin des Croix-Rouges 12, Lausanne CH-1007, Switzerland
| | - Pierre-Nicolas Carron
- Emergency Department, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 46, Lausanne CH-1011, Switzerland
| | - Blaise Genton
- Policlinic of Tropical, Travel Medicine and Vaccination, Centre for Primary Care and Public Health, Unisanté, University of Lausanne, Rue du Bugnon 44, Lausanne CH-1011, Switzerland
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2
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Hüfner K, Falla M, Brugger H, Gatterer H, Strapazzon G, Tomazin I, Zafren K, Sperner-Unterweger B, Fusar-Poli P. Isolated high altitude psychosis, delirium at high altitude, and high altitude cerebral edema: are these diagnoses valid? Front Psychiatry 2023; 14:1221047. [PMID: 37599873 PMCID: PMC10436335 DOI: 10.3389/fpsyt.2023.1221047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/11/2023] [Indexed: 08/22/2023] Open
Abstract
Psychosis is a psychopathological syndrome that can be triggered or caused by exposure to high altitude (HA). Psychosis can occur alone as isolated HA psychosis or can be associated with other mental and often also somatic symptoms as a feature of delirium. Psychosis can also occur as a symptom of high altitude cerebral edema (HACE), a life-threatening condition. It is unclear how psychotic symptoms at HA should be classified into existing diagnostic categories of the most widely used classification systems of mental disorders, including the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) and the International Statistical Classification of Diseases and Related Health Problems (ICD-11). We provide a diagnostic framework for classifying symptoms using the existing diagnostic categories: psychotic condition due to a general medical condition, brief psychotic disorder, delirium, and HACE. We also discuss the potential classification of isolated HA psychosis into those categories. A valid and reproducible classification of symptoms is essential for communication among professionals, ensuring that patients receive optimal treatment, planning further trips to HA for individuals who have experienced psychosis at HA, and advancing research in the field.
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Affiliation(s)
- Katharina Hüfner
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marika Falla
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Neurology/Stroke Unit, Hospital of Bolzano (SABES-ASDAA), Bolzano, Italy
| | - Hermann Brugger
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Hannes Gatterer
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
| | - Giacomo Strapazzon
- Institute of Mountain Emergency Medicine, Eurac Research, Bolzano, Italy
- Department of Anesthesia and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Iztok Tomazin
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Mountain Rescue Association of Slovenia, Kranj, Slovenia
| | - Ken Zafren
- Department of Emergency Medicine, Stanford University Medical Center, Palo Alto, CA, United States
- Department of Emergency Medicine, Alaska Native Medical Center, Anchorage, AK, United States
| | - Barbara Sperner-Unterweger
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
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3
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Rainford Mb Candidate AC, Flaherty GT, Hallahan B. Vampire tourism and vampirism: the darker side of travel medicine. J Travel Med 2022:6827806. [PMID: 36377759 DOI: 10.1093/jtm/taac135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/21/2022] [Accepted: 11/11/2022] [Indexed: 11/16/2022]
Abstract
‘Dark tourism’ refers to travel by individuals to destinations and sites linked to death, tragedy and the macabre; with vampire tourism increasingly popular over the last 20 years. The capacity of travellers, especially those with mental disorder, to cope psychologically with travel to associated emotionally challenging destinations requires further investigation.
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Affiliation(s)
| | - Gerard T Flaherty
- School of Medicine, University of Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Brian Hallahan
- School of Medicine, University of Galway, Galway, Ireland.,Galway-Roscommon Mental Health Services, University Hospital Galway, Ireland
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4
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Anna G, Crom-Beer Susan D, Sabine H, Thomas H, Alexia A, Christoph H, Sven FJ. Ready-To-Go Questionnaire - Development and validation of a novel medical pre-travel risk stratification tool. Travel Med Infect Dis 2022; 47:102304. [DOI: 10.1016/j.tmaid.2022.102304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 02/07/2022] [Accepted: 03/03/2022] [Indexed: 10/18/2022]
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5
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Death as attraction: the role of travel medicine and psychological travel health care in 'dark tourism'. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2021; 7:24. [PMID: 34380578 PMCID: PMC8359045 DOI: 10.1186/s40794-021-00149-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/21/2021] [Indexed: 12/04/2022]
Abstract
Still an evolving field in travel medicine, psychological travel health has not yet been linked to tourist products that may affect travellers’ mental wellbeing. Dark tourism, the travel to sites linked to death, atrocities and suffering, is a product that, on the one hand, attracts people with a keen interest in death-related attractions and, on the other hand, may inflict psychological scars. Of particular concern are travellers with undiagnosed or diagnosed mental illness. This is the first article bringing travel medicine and dark tourism together. Understanding dark tourism is crucial to appreciate the wide variety of potential stimuli leading to anything from amusement to travel-related psychoses. Travellers’ motivations for and emotional responses to visits of ‘dark’ sites provide an important input into individually tailored psychological pre and post-travel health care. Relevant recommendations include suggestions for education, clinical practice and much needed further multidisciplinary research.
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6
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Autism Spectrum Disorder (ASD) and the Family Inclusive Airport Design Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137206. [PMID: 34281143 PMCID: PMC8297129 DOI: 10.3390/ijerph18137206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/30/2021] [Accepted: 07/04/2021] [Indexed: 11/17/2022]
Abstract
The literature on air travellers with psychiatric disorders is limited. This perspective article highlights various travel-related aspects of autism spectrum disorder (ASD). The airport experience can be stressful for families of children with autism spectrum disorder (FwASDs). The aim of this study was to explore the airport experience of FwASDs using the value co-creation process approach to assist airport managers in designing improved experiences for this specific passenger segment. This study responds to the current climate in which airports are developing awareness programmes in relation to children who require special assistance at airports. The prevalence of children with ASD is 1/68. While a number of airports throughout the world have adopted procedures addressing the needs of those with cognitive impairment, these advances are far from universal. As part of an academic-industry collaboration between Vueling airlines and the Spanish airport operator Aena, 25 FwASDs took part in an inclusive airport research project in the city of Barcelona from November 2015 to April 2016. Employing a qualitative methodology that incorporated focus groups, ethnographic techniques, and post-experience surveys, the study contributes to extending the body of knowledge on the management of the value co-creation process for challenging passenger segments within the airport context. The study explains how ensuring adequate resource allocation to this passenger segment can improve the family-inclusive design of the airport experience and offers managerial recommendations.
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7
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Abstract
For a person with mental illness, travelling abroad can be challenging but it can be easier when the traveller and healthcare practitioner have a clear understanding of the likely impact of travel on the illness and of the illness on the travel experience. Travel may also precipitate first presentations of mental illness or unmask previously undiagnosed mental disorders. We propose that mental health problems should receive greater recognition in travel medicine and that psychiatrists should collaborate more closely with travel medicine clinicians to ensure that their patients benefit from the opportunities afforded by international travel.
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Affiliation(s)
- Gerard Flaherty
- School of Medicine, National University of Ireland Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Shang Yuin Chai
- School of Medicine, National University of Ireland Galway, Ireland
| | - Brian Hallahan
- School of Medicine, National University of Ireland Galway, Ireland.,Galway Roscommon Mental Health Services, University Hospital Galway, Ireland
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8
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Migliore L, Braun L, Stucky CH, Gardner C, Huffman S, Jumpp S, Bell E. Considerations for Acute and Emergent Deployed Mental Health Patient Management and Theater Transports: A Scoping Review. Mil Med 2020; 186:e932-e942. [PMID: 33382426 PMCID: PMC8399236 DOI: 10.1093/milmed/usaa568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/09/2020] [Accepted: 12/28/2020] [Indexed: 11/14/2022] Open
Abstract
Background Although combat stress and psychiatric casualties of war have consistently contributed to the need for deployed patient transport to higher echelons of care, little is known regarding specific evidence-based strategies for providing psychological support and optimal transport interventions for warriors. Study Objective The purpose of this scoping review is to map existing literature related to considerations for deployed mental health patient transport. The review’s primary aims are to identify the existing scientific research evidence, determine research and training gaps, and recommend critical areas for future military research. Methods We used Arksey and O’Malley’s six-stage scoping review methodological framework (identify the research question, identify relevant studies, select studies, chart data, report results, and consultation). Using a systematic search strategy, we evaluated peer-reviewed literature from five databases (PubMed, CINAHL, PsycINFO, Web of Science, and Embase) and gray literature from the Defense Technical Information Center. All publications were independently screened for eligibility by two researchers during three review rounds (title, abstract, and full text). Results We identified 1,384 publications, 61 of which met our inclusion criteria. Most publications and technical reports were level IV evidence and below, primarily retrospective cohort studies and epidemiologic surveillance reports. Few rigorously designed studies were identified. Eight research themes and a variety of research and critical training gaps were derived from the reviewed literature. Themes included (1) characterizing mental health patients aeromedically evacuated from theater; (2) in-flight sedation medications; (3) need for aeromedical evacuation (AE) in-theater education, training, and guidelines for staff; (4) epidemiological surveillance of AE from theater; (5) mental health management in deployed settings; (6) suicide-related event management; (7) transport issues for mental health patients; and (8) psychological stressors of AE. Research is needed to establish clinical practice guidelines for mental health condition management in theater and throughout the continuum of en route care.
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Affiliation(s)
- Laurie Migliore
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | - Lisa Braun
- Nursing Research, Naval Medical Center, Portsmouth, VA 23708, USA
| | - Christopher H Stucky
- Center for Nursing Science & Clinical Inquiry, Womack Army Medical Center, Fort Bragg, NC 28310, USA
| | - Cubby Gardner
- Air Force Medical Readiness Agency, Falls Church, VA 22041, USA
| | - Sarah Huffman
- Airman Readiness Optimization Division, 711th Human Performance Wing, Dayton, OH 45433, USA
| | - Savannah Jumpp
- Clinical Investigation Facility, David Grant USAF Medical Center, Fairfield, CA 94533, USA
| | - Emily Bell
- TriService Nursing Research Program, Uniformed Services University, Bethesda, MD 20814, USA
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9
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Bonny-Noach H, Sagiv-Alayoff M. Cannabis tourist destinations: risk for vulnerable travellers with pre-existing mental disorders. J Travel Med 2020; 27:5671717. [PMID: 31821507 DOI: 10.1093/jtm/taz098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 12/04/2019] [Accepted: 11/05/2019] [Indexed: 11/14/2022]
Abstract
In recent years, more countries have decriminalized and legalized cannabis, and have become cannabis tourism destinations. Little has been published about individuals with pre-existing mental health disorders who use cannabis during travel. Health professionals should pay greater attention to cannabis use among vulnerable travellers before, during, and after their travel.
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Affiliation(s)
- Hagit Bonny-Noach
- The Department of Criminology, Faculty of Social Sciences and Humanities, Ariel University, Ariel, Israel
| | - Moran Sagiv-Alayoff
- State of Israel Ministry of Health, Northern district, Nof Hagalil, Israel.,Dr Sagiv Mental Health and Drug Casualties International Rescue, Had-Ness, Israel
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10
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Felkai PP, Marcolongo T, Van Aswegen M. Stranded abroad: a travel medicine approach to psychiatric repatriation. J Travel Med 2020; 27:5719611. [PMID: 32010953 DOI: 10.1093/jtm/taaa013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/12/2010] [Accepted: 01/30/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND The incurred mental alteration of a traveler abroad should be an alarming signal for patient, for family and for the local healthcare professionals alike. It is estimated that 11.3% of travelers experience some kind of psychiatric problem, with 2.5% suffering from severe psychosis and 1.2% requiring more than 2 months of therapy upon return from a trip abroad. Acute psychotic episode represents approximately one-fifth of travel-related psychiatric events. Yet, the travel-related mental problems have been a neglected topic till today. Now a good selection of literature is available to help further researches. METHODS Besides describing the most relevant literature of travel-related mental disturbances, authors present two key issues of dealing with psychiatric problems of travelers abroad: to identify the origin of the mental alteration and the process of the patient with psychiatric problems. RESULTS Identifying the origin and the nature of the mental symptoms of travelers is often difficult because of the language barrier, among extraordinary circumstances. A simple two-step three-branch algorithm could make the decision easier for the attending physician. Some of the brief psychotic disorder and organic origin of mental disturbance can be and often are treated in place. CONCLUSIONS Some mental problems probably originated from or triggered by the travel or a foreign environment itself. In these cases the full recovery will be expected if the triggering factor is eliminated. The solution is early repatriation. The repatriation for psychiatric reasons is highly different from repatriation for other medical emergencies. The authors describe a proposal of a step-by-step action of repatriation of a psychotic patient. By the help of this suggested protocol, the patient may successfully be taken home.
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Affiliation(s)
- Peter P Felkai
- Travel Medicine Faculty Group, Internal Medicine Chair, Medical Faculty, Debrecen University, 1039 Debrecen, Hungary
| | - Tullia Marcolongo
- International Association for Medical Assistance to Travellers, Toronto, ON, ON M6K 3E3 Canada
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11
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Abstract
OBJECTIVES To identify factors influencing successful international travel among patients with psychotic illness. METHODS Eight individuals participated in a semi-structured interview of 15-20-minute duration with a clinician in relation to their recent experience of international travel. Clinical files were reviewed and a case series was compiled. RESULTS Four individuals engaged in international travel without any adverse effects. Four other individuals experienced significant psychotic and/or affective symptoms while travelling. Treatment non-adherence, a lack of awareness of how to obtain support and limited or no pre-travel planning were noted in these individuals. CONCLUSIONS Pre-travel counselling, treatment adherence, provision of information packages relating to their mental illness and having contact details of their treating mental health team increase the likelihood of successful international travel in patients with psychotic illness. Travelling with a companion may reduce fear of relapse.
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12
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Kohl SE, Barnett ED. What do we know about travel for children with special health care needs? A review of the literature. Travel Med Infect Dis 2019; 34:101438. [PMID: 31233860 DOI: 10.1016/j.tmaid.2019.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Children travel with their families, including children with chronic illness. We know that adults with chronic illness who travel are more likely than their healthy peers to become sick while traveling. A review of the literature was undertaken to identify what is known about traveling with children with special health care needs and to identify gaps in our knowledge. METHODS An Online search of the PubMed, CINAHL and Google databases of English language literature was conducted June 2016, October 2017, June 2018 and April 2019 using the terms children and travel, air travel, travel health, disabled child, children with special healthcare needs, parents of disabled children, vacations, recreation, international, wheelchairs, planning techniques, asthma, diabetes, altitude, cystic fibrosis, inflammatory bowel disease, sickle cell disease, depression, food allergies, Attention Deficit Hyperactivity Disorder (ADHD), and seizures. The search was limited to years 2000-2019. A secondary search of relevant articles was conducted using the reference sections of articles identified in the primary search. RESULTS 185 papers were examined for travel health related outcomes for children and adults with chronic diseases. Articles were excluded if they addressed the educational needs of students with disabilities traveling abroad, did not directly address travel health (e.g travel skills, travel itineraries), contained outdated policy statements, or were case reports of a single patient. The remaining 84 papers were organized and reviewed by organ systems. The articles were primarily descriptive and did not lend themselves to a systematic review. CONCLUSION Children traveling with chronic and complex health conditions are a heterogeneous group of vulnerable travelers. Closing the knowledge gap about how to best help these travelers requires a multipronged approach. Research is urgently needed to identify best practices for five of the most common chronic childhood diseases: asthma, depression, ADHD, food allergies and autism. For less common illnesses, ones typically cared for in specialty clinics, expert consensus opinion and multi-center studies are needed. Families and disease advocacy societies should be included in the research as they may have already identified the most pressing travel-related health concerns and solutions for these problems.
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Affiliation(s)
- Sarah E Kohl
- University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15213, USA.
| | - Elizabeth D Barnett
- Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA
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13
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Zhi GYJ, Flaherty GT, Hallahan B. Final journeys: exploring the realities of suicide tourism. J Travel Med 2019; 26:5375415. [PMID: 30860264 DOI: 10.1093/jtm/taz016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/27/2019] [Accepted: 03/11/2019] [Indexed: 11/14/2022]
Affiliation(s)
| | - Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Brian Hallahan
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,University Hospital Galway, Galway Roscommon Mental Health Services, Galway, Ireland
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14
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Abstract
It appears that the El Camino pilgrimage route has become a long-distance trek and endurance test of the individual. The continuously increasing number of hikers demands more attention by travel medicine professionals. Analysis of the age groups of the pilgrims over recent years shows that the number of young pilgrims (< 30 years) is decreasing, but the number of middle-aged people (30-60 years) is slightly increasing, while the number of elderly people (> 60 years) is considerably increased. The leading cause of fatalities during the pilgrimage is ACS. The majority of the cardiac problems occur among the elderly people. The second most common cause of death is a traffic accident, and the third and fourth causes are a fatal exacerbation of the pilgrim's pre-existing disease and illnesses caused by the extreme temperature (hot and cold environment alike). The aforementioned data suggest that pre-travel advice should be an indispensable part of the preparation for the El Camino peregrination, especially for the patient with chronic disease and elderly people.
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Affiliation(s)
- Peter Felkai
- Travel Medicine Chair, Internal Medicine Faculty, Debrecen University, Medical School, Szentendrei ut 301, Budapest, 1039, Hungary.
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15
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Rousseau C, Frounfelker RL. Mental health needs and services for migrants: an overview for primary care providers. J Travel Med 2019; 26:5251755. [PMID: 30561687 DOI: 10.1093/jtm/tay150] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/13/2018] [Accepted: 12/17/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND The objective of this article is to present an overview of the burden, spectrum of diseases and risk factors for mental illness among subgroups of migrants, namely, immigrants, refugees and individuals with precarious legal status. This expert review summarises some of the implications for primary care services in migrant receiving countries in the global North. METHODS A broad literature review was conducted on the epidemiology of mental health disorders in migrants and the available evidence on mental health services for this population focusing on key issues for primary care practitioners in high-income countries. RESULTS Although most migrants are resilient, migration is associated with an over-representation of mental disorder in specific subpopulations. There is a general consensus that stress-related disorders are more prevalent among refugee populations of all ages compared to the general population. Relative to refugees, migrants with precarious legal status may be at even higher risk of depression and anxiety disorders. Persistence and severity of psychiatric disorders among migrant populations can be attributed to a combination of factors including severity of trauma exposures during the migration process. Exposure to stressors after resettlement, such as poverty and limited social support, also impacts mental illness. Services for migrants are affected by restricted accessibility and should address cultural and linguistic barriers to and issues in the larger social environment that impact psychosocial functioning. CONCLUSION There is substantial burden of mental illness among some migrant populations. Primary care providers seeking to assist individuals need to be cognizant of language barriers to and challenges of working with interpreters as well as sensitive to cultural and social contexts within the diagnosis and service delivery process. In addition, best practices in screening migrants and providing intervention services for mental disorders need to be sensitive to where individuals and families are in the resettlement trajectory.
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Affiliation(s)
- Cécile Rousseau
- McGill University-Division de psychiatrie sociale et culturelle, CLSC Parc Extension 7085 Hutchison, Local 204.2, Montreal, Quebec, Canada
| | - Rochelle L Frounfelker
- McGill University-Division de psychiatrie sociale et culturelle, CLSC Parc Extension 7085 Hutchison, Local 204.2, Montreal, Quebec, Canada
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16
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Marcolongo T, Valk T, Jones M. Mind the gap: building the psychological capital of travellers. J Travel Med 2019; 26:5231385. [PMID: 30517734 DOI: 10.1093/jtm/tay142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 12/03/2018] [Indexed: 11/12/2022]
Affiliation(s)
- T Marcolongo
- IAMAT, 67 Mowat Avenue, Suite 036, Toronto, ON, Canada
| | - T Valk
- VEI Incorporated, 6951 Hilltop Ln, Marshall, VA, USA
| | - M Jones
- Spire Shawfair Park Hospital, 10, Easter Shawfair, Edinburgh, UK
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17
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Sanford CA, Flaherty GT. The significance of non-communicable threats to travellers: time for a sea-change? J Travel Med 2019; 26:5199089. [PMID: 30476161 DOI: 10.1093/jtm/tay103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 11/14/2018] [Indexed: 01/01/2023]
Affiliation(s)
- Christopher A Sanford
- Family Medicine, Global Health, University of Washington, Seattle, Washington, DC, USA
| | - Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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18
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Lally L, McCabe E, Flaherty GT. Intractable itch in a Brazilian expatriate. J Travel Med 2019; 26:5198764. [PMID: 30476182 DOI: 10.1093/jtm/tay135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 11/21/2018] [Indexed: 11/14/2022]
Affiliation(s)
- Leona Lally
- Department of Psychiatry, University Hospital Galway, Galway, Ireland.,School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Evelyn McCabe
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gerard Thomas Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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19
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Airault R, Valk TH. Travel-related psychosis (TrP): a landscape analysis. J Travel Med 2018; 25:5067359. [PMID: 30085263 DOI: 10.1093/jtm/tay054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/10/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Travel-related psychosis (TrP) can be difficult for both the traveller and treating clinician. This review focuses upon a particular subset of TrP occurring during travel to destinations with high religious, spiritual, cultural or aesthetic value (high valence destinations) because it is both interesting and informative. METHOD Psychiatric, occupational and travel medicine literature was reviewed using PubMed with search terms of 'travel' AND 'psychosis' and 'international travel' AND 'psychosis' from 1998 to the present. Articles were included if they dealt with psychosis in travellers to high valence destinations. Articles were excluded if they dealt primarily with psychosis in travellers due to drug or medication usage. French literature was obtained using the CH St. Anne Ey Medical Library, Paris, France. RESULTS Literature on TrP to high valence destinations is lacking many details. The range of high valence destinations is wide. Incidence and prevalence figures for TrP of any type do not exist although rough calculations as to incidence of psychiatric problems and psychosis in travellers are made based upon the articles reviewed and are discussed. Findings lead to several hypotheses with both medico-legal, diagnostic and epidemiological ramifications. CONCLUSIONS TrP to a number of high valence destinations is a real phenomenon worthy of further study. It is not clear that TrP is more likely to occur with such travel than to non-high valence destinations or not. First episode psychosis during travel to high valence and other destinations is reported and has medico-legal ramifications. Some TrP episodes likely are brief psychotic disorders and this hypothesis should be rigorously explored in future reports. A number of suggestions concerning further studies are made.
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Affiliation(s)
- Regis Airault
- Psychiatre Hospitalier, Chercheur Associe au CNRS, Paris, France
| | - Thomas H Valk
- Publications Department, VEI, Incorporated, Marshall, VA, USA
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Flaherty GT, Caumes E. An analysis of international traveller deaths at the Cliffs of Moher in Ireland, 1993-2017. J Travel Med 2018; 25:4934913. [PMID: 29635642 DOI: 10.1093/jtm/tay019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/13/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Traumatic deaths, and more particularly suicides, during international travel receive a disproportionately low level of attention in the travel medicine literature. We describe the demographic profile of international travellers whose death occurred at the Cliffs of Moher along the Atlantic seaboard in Ireland. METHODS Coroners' files for the 25 years between 1993 and 2017 were interrogated. All cases of death on or at the cliffs were examined, and demographic data were extracted, including date of death, gender, age, nationality, whether the victims were alone at the cliffs prior to their death, whether the fall was witnessed, prevailing weather conditions, post-mortem examinations, toxicology reports and inquest verdicts. RESULTS Overall, 66 deaths occurred on or at the base of the Cliffs of Moher during the period 1993 through August 2017. In total, 18 (27.3%) of the victims were international visitors to Ireland, including 11 males (61.1%). The mean age of travellers (n = 17) was 34.2 years. Victims were nationals of 12 different countries, with 13 being European nationals. Most deaths occurred in summer (n = 7) or spring (n = 6), with eight deaths (44%) reported at weekends. In total, 15 victims (83.3%) had walked along the cliff path alone. A jump or fall from the cliffs was witnessed in only two cases (11.1%). Post-mortem examinations revealed multiple traumatic injuries consistent with a fall from a height. Four cases had evidence of alcohol intoxication. Suicide or open verdicts were returned in 50% (n = 9) of the cases. CONCLUSIONS Travelling alone to the site, purchasing one-way tickets, or depositing belongings on the clifftop support the possibility of suicidal intent, while being intoxicated could be a co-factor in suicidal jumps or support the possibility of an accidental fall. This knowledge could help to identify travellers at the greatest risk of death at cliffs.
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Affiliation(s)
- Gerard T Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
| | - Eric Caumes
- Department of Infectious and Tropical Diseases, Groupe Hospitalier Pitié-Salpêtrière, 45-83, Boulevard de l'Hôpital, Sorbonne Université, 75013 Paris, France
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Johnston N, Sandys N, Geoghegan R, O'Donovan D, Flaherty G. Protecting the health of medical students on international electives in low-resource settings. J Travel Med 2018; 25:4780173. [PMID: 29394388 DOI: 10.1093/jtm/tax092] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 11/22/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND Increasingly, medical students from developed countries are undertaking international medical electives in developing countries. Medical students understand the many benefits of these electives, such as the opportunity to develop clinical skills, to gain insight into global health issues and to travel to interesting regions of the world. However, they may be much less aware of the risk to their health and wellbeing while abroad. Compounding this problem, medical students may not seek advice from travel medicine practitioners and often receive inadequate or no information from their medical school prior to departure. METHODS The PubMed database was searched for relevant literature relating to the health of medical elective students. Combinations of the following key words were used as search terms: 'international health elective', 'medical student' and 'health risks'. Articles were restricted to those published in English from 1997 through June 2017. A secondary review of the reference lists of these articles was performed. The grey literature was also searched for relevant material. RESULTS This narrative literature review outlines the risks of clinical electives in resource-poor settings which include exposure to infectious illness, trauma, sexual health problems, excessive sun exposure, mental health issues and crime. Medical students may mitigate these health risks by being informed and well prepared for high-risk situations. The authors provide evidence-based travel advice which aims to improve pre-travel preparation and maximize student traveller safety. A safer and more enjoyable elective may be achieved if students follow road safety advice, take personal safety measures, demonstrate cultural awareness, attend to their psychological wellbeing and avoid risk-taking behaviours. CONCLUSION This article may benefit global health educators, international elective coordinators and travel medicine practitioners. For students, a comprehensive elective checklist, an inventory of health kit items and useful web-based educational resources are provided to help prepare for electives abroad.
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Affiliation(s)
- Niall Johnston
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | | | - Rosemary Geoghegan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Diarmuid O'Donovan
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Gerard Flaherty
- School of Medicine, National University of Ireland Galway, Galway, Ireland.,School of Medicine, International Medical University, Kuala Lumpur, Malaysia
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