Anxiety and health problems related to air travel

A Conservation of Resources schema for exploring the influential forces for air-travel stress

Effective air-travel stress management is increasingly crucial in determining tourist satisfaction and travel choices, particularly in a time of intensive fear about virus, terrorism, and plane crashes. However, research about air-travel stress, particularly what and how various influential forces shape passenger stress levels, is still in its infancy. The current research proposes the adoption of Conservation of Resources (COR) theory as a holistic schema to identify through resource dynamics the potential influential forces for air-travel stress across leisure travel stages. The findings, based on surveying passengers at the gate of multi-country international and domestic airports, demonstrates the capability of COR schema to predict and explain the influences on air-travel stress from an array of personal and situational/trip-specific factors. The theoretical advances from COR-based cross-stage stress analyses, and the guidance for customized airline/airport stress-soothing service strategies are discussed.

Hypobaria-Induced Oxidative Stress Facilitates Homocysteine Transsulfuration and Promotes Glutathione Oxidation in Rats with Mild Traumatic Brain Injury

Background:

United States service members injured in combat theatre are often aeromedically evacuated within a few days to regional military hospitals. Animal and epidemiological research indicates that early exposure to flight hypobaria may worsen brain and other injuries. The mechanisms by which secondary exposure to hypobaria worsen trauma outcomes are not well elucidated. This study tested the hypothesis that hypobaria-induced oxidative stress and associated changes in homocysteine levels play a role in traumatic brain injury (TBI) pathological progression caused by hypobaria.

Methods:

Male Sprague Dawley rats were exposed to a 6 h hypobaria 24 h after mild TBI by the controlled cortical impact. Plasma and brain tissues were assessed for homocysteine levels, oxidative stress markers or glutathione metabolism, and behavioral deficits post-injury in the absence and presence of hypobaria exposure.

Results:

We found that hypobaria after TBI increased oxidative stress markers, altered homocysteine metabolism, and promoted glutathione oxidation. Increased glutathione metabolism was driven by differential upregulation of glutathione metabolizing genes. These changes correlated with increased anxiety-like behavior.

Conclusion:

These data provide evidence that hypobaria exposure after TBI increases oxidative stress and alters homocysteine elimination likely through enhanced glutathione metabolism. This pathway may represent a compensatory mechanism to attenuate free radical formation. Thus, hypobaria-induced enhancement of glutathione metabolism represents a potential therapeutic target for TBI management.

Airport user experience unpacked: Conceptualizing its potential in the face of COVID-19

Given the unprecedented challenges imposed on the aviation industry by the COVID-19 pandemic, this paper proposes a new perspective on airport user experience as a field of study to unlock its potential as a basis for strategic roadmapping. Through an integrative literature review, this study points out a dominant focus, in practice and research, on customer experience and service quality, as opposed to user experience, to help airports gain a competitive edge in an increasingly commoditized industry. The review highlights several issues with this understanding of experience, as users other than passengers, such as employees, working for the airport and its myriad stakeholders, as well as visitors, are largely omitted from study. Given the complexity of the system, operationally, passengers are generally reduced to smooth flows of a passive mass, which this study argues is both a missed opportunity and a vulnerability exacerbated by the COVID-19 pandemic. Major events apart from COVID-19 are used to show the negative effects this simplification of user experience has had. Based on solutions and models proposed in previous studies, a conceptual model has been developed to illustrate the postulated potential of a deeper and more holistic study of airport user experience to make airport systems generally more agile, flexible and future-proof. As such, the paper advocates to utilize the user experience as a basis for strategic planning to equip airports with the know-how to manage not just daily operations more effectively but also the aftermath of and recovery from major events like the COVID-19 pandemic. Moreover, with the user experience at the center of the strategic roadmap, airports can plan ahead to mitigate the impact of future scenarios. The importance of future research and the use of existing research are discussed.

Stranded abroad: a travel medicine approach to psychiatric repatriation

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.

Lost in the Black Belt South: health outcomes and transportation infrastructure

The importance of transportation infrastructure to health outcomes has been increasingly recognized. However, the relationship between transportation and health is underexplored in rural areas. This study fills the gap by investigating rural health outcomes in association with two transportation infrastructures-highways and airports-in the Black Belt counties of the USA, a region characterized as predominantly rural and black and as having high poverty and unemployment. Spatial regression models are applied to analyze the 2010 data. The results suggest Black Belt counties have poorer health outcomes than their non-Black Belt counterparts, and the difference increases as the percentage of blacks increases. The results also show that the higher accessibility to an airport a county has, the better its health outcomes. Highways, however, do not have a statistically significant association with health outcomes. The poor health outcomes in the Black Belt counties are also influenced by poverty, rurality, unemployment, and low educational attainment. This research was the first to study transportation, especially airports, in the rural US South with relation to health outcomes. Our findings shed new light on removing the health disadvantages accumulated in the Black Belt.

Severe mental illness and airports – the scope of the problem

Aims and Method

Mental illness may cause specific problems in the environment of an international airport. The aim of our study was to assess frequency, presentation and safety implications of mental disorders requiring formal admission at an international airport. We performed a retrospective study over 4 years including patients who were detained by the police and admitted.

Results

The frequency of admissions was one per million passengers, the frequency of incidents raising safety concerns was four per 10 million passengers. An in-flight disturbance occurred in 1.4 per 10 million arriving passengers. Most common were schizophrenia or schizotypal disorder (46.8%) and mania (22.6%). Twenty per cent of patients presented with wandering.

Clinical Implications

Emergency admissions and incidents causing safety concerns were rare. Airport wandering was a frequent presenting sign that should be recognised.

Air travel considerations for the patients with heart failure

Context:

Prevalence of patients with heart failure (HF) is increasing in worldwide, and also the number of people with HF traveling long distances is increasing. These patients are more prone to experience problems contributed air travel and needs more attention during flight. However, observational studies about problems of HF patients during flight and appropriated considerations for them are limited.

Evidence Acquisition:

We evaluated the conditions that may be encountered in a HF patient and provide the recommendations to prevent the exacerbation of cardiac failure during air travel. For this review article, a comprehensive search was undertaken for the studies that evaluated the complications and considerations of HF patients during flight. Data bases searched were: MEDLINE, EMBASE, Science Direct, and Google Scholar.

Results:

HF patients are more prone to experience respiratory distress, anxiety, stress, cardiac decompensation, and venous thromboembolism (VTE) during air travel. Although stable HF patients can tolerate air travel, but those with acute heart failure syndrome should not fly until complete improvement is achieved.

Conclusions:

Thus, identifying the HF patients before the flight and providing them proper education about the events that may occur during flight is necessary.

Older adult falls at a metropolitan airport: 2009-2010

INTRODUCTION

We investigated falls at a metropolitan airport to determine fall incidence, identify potential causes of these falls, and suggest opportunities for mitigation.

METHODS

We used deidentified incident reports of all falls requiring EMS response that occurred at the airport during 2009 and 2010.

RESULTS

On average, one fall occurred every 2.3days. Ninety-six percent (96%) of falls occurred in terminals. Of all falls, 44% occurred on escalators, making escalators the most common location. Seventy-two percent (72%) of fallers were females; 43% were ≥65years; 92% of all falls resulted in a documented injury; 37% of falls resulted in transport to hospital emergency departments. Escalator fall risks include carrying bags (due to changes in baggage fees), using cells phones, not using handrails, and compromised strength and balance.

CONCLUSIONS AND IMPACT

Diverting at-risk passengers to elevators could significantly reduce the overall falls. Interventions targeting escalator falls have the greatest promise for reducing falls at this airport.

Travel Recommendations for Older Adults

Older age is an important factor in preparing travelers owing not only to physiologic changes and the increased probability of underlying medical conditions and prescription medications but also to immune status with regard to naturally acquired immunity versus immunization for vaccine-preventable diseases. Cardiovascular events (including myocardial infarctions and cerebrovascular accidents) account for most deaths abroad, followed by injuries. To plan for healthy travel, international travelers should be advised to seek care at least 4 to 6 weeks before departure. Travel medicine is a dynamic field because conditions worldwide are subject to rapid change. Clinicians must maintain a current base of knowledge if they will be regularly advising travelers or must set a threshold for referral to a travel medicine specialist.

Psychological factors in airline passenger and crew behaviour: a clinical overview

Air travel places unique physical and psychological demands on the traveller and air crew. This paper presents a general overview of the psychological aspects of air travel and specifically how air travel affects airline passenger and crew behaviour. It covers travel and stress, the effects of travel on behaviour, fear of flying, disruptive passenger behaviour and crew mental health, highlighting what insights clinical psychology can offer in relation to these.

HEALTH-RELATED LIFESTYLE AND PATTERNS OF BEHAVIOR RELATED TO HEALTH EFFECTS OF LEISURE TRAVEL

Whether or not leisure travel might have positive effects on personal health was investigated. During a short leisure trip, saliva samples were collected from 40 females. Levels of salivary cortisol and chromogranin A (CgA) were evaluated by enzyme-linked immunosorbent assay (ELISA). To quantitatively evaluate the health-related lifestyle and the patterns of behavior of the subjects, we also administered written questionnaires. For samples taken during the trip, there was a significant increase in the levels of CgA. Meanwhile, there was a significant increase in the levels of cortisol after the tour. These tendencies were more pronounced in individuals who scored well for health-related lifestyle. These findings suggest that the effects of travel were more beneficial for persons with positive characteristics related to health-related lifestyle.

Medical problems encountered among travelers in Bahrain International Airport clinic

BACKGROUND

The Middle East is one of the most rapidly growing destination for travelers. Objective. The aim of this study was to determine the medical conditions affecting travelers needing medical assistance in Bahrain International Airport (BIA).

METHOD

Logbook documenting medical conditions of travelers presenting to the BIA clinic from January 1 till the end of December 2004 was reviewed.

RESULTS

A total of 3,350 travelers attended the clinic, constituting 0.12% of the disembarking and transit travelers. Most common conditions faced were respiratory problems (24.4%), followed by headaches (19.2%), trauma, musculoskeletal pains (12.9%), and gastrointestinal problems (11.0%). Only 2.1% of all complaints were referred to secondary care. The majority of cases were handled by the nurse.

CONCLUSIONS

Majority of the patients examined had acute minor medical problems. Ninety-eight percent of conditions affecting travelers were handled in the airport clinic by the nurse and the family physician. Airport clinic could serve as an efficient emergency triage system for filtering serious illnesses needing urgent management.

Medical conditions affecting well-accommodated travelers in Lebanon

There are no data on the prevalence of common diseases affecting travelers to Lebanon. Between 2001 and 2002, one among nine physicians was consulted on guests who needed medical attention in a five-star Beirut hotel. Physicians were consulted 114 times. The mean age of the patients was 36.6 years. Gastroenteritis (50.9%) followed by respiratory problems (25.4%) were the leading causes for consultation.

Medical Assessment of the Health Effects of Short Leisure Trips

Using responses to questionnaires and results of saliva samples from 40 women, the authors assessed the effects on health of participation in a short leisure trip (2 nights, 3 d) to Kyushu Island in Japan. They addressed transportation, sightseeing, and group activities during the tour, which might differ from participants' usual activities. Levels of the salivary endocrinological stress markers cortisol and chromogranin A (CgA) were determined by enzyme-linked immunosorbent assay (ELISA). In each of the groups with characteristics considered healthy and related to lifestyle, patterns of behavior, perceived stressors, and stress reactions, a decrease in the cortisol levels and an increase in the CgA levels were apparent during the tour. The baseline for stress hormone changes was the levels on awakening on Day 1 (i.e., immediately before the tour). These findings suggest that even short periods of travel can bring about a reduction in di-stress and acquisition of eu-stress, experienced as feeling uplifted or fulfilled.

Travel epidemiology--a global perspective

In order to have a rational approach to necessary preventive measures it is essential to know the health risks. The 80 million travellers each year with destinations in Africa, Asia, Latin America, Pacific Islands and remote areas in Eastern Europe are exposed to a broad range of pathogens that are rarely encountered at home. The risk depends on the degree of endemicity in the area visited, the duration of stay, the individual behaviour and the preventive measures taken. Travellers' diarrhoea (TD) is the most frequent ailment of visitors to countries with poor hygiene. The incidence rate is 25-90% in the first 2 weeks abroad. The risk of TD is far less in travellers originating in a high risk country, as some immunity develops. Malaria is an important risk for travellers going to endemic areas. Without chemoprophylaxis, the monthly incidence is high in some destinations, among them frequently visited tropical Africa where 80-95% of the infections are due to Plasmodium falciparum. The incidence rates are lower in most endemic areas of Asia and Latin America where Plasmodium vivax predominates. The risk is nil in all capital cities of South America and SE Asia, as well as in many frequently visited tourist destinations. The diseases preventable by immunization will be discussed in a separate paper (Vaccination priorities; page 175). Sexually transmitted diseases occur frequently, as some travellers (5% of Europeans) engage in casual sex, approximately half of them without being protected by a condom. The prevalence for HIV-infection, syphilis, gonorrhoea, etc. often exceeds 50% in prostitutes. In some European countries, a major proportion of heterosexuals with newly acquired HIV-infection have acquired it while abroad.

Pre-travel advice: an overview

The message of the pre-travel provider is necessarily paradoxic. First the provider lists a score of causes of illness and premature demise, and then states, "But it sounds like a great trip and I think you'll have fun." Pre-travel providers need to walk a fine line: they must encourage patients to be cautious but not paranoid, optimistic but realistic. This discussion is complicated further by the fact that risk reduction is not the only consideration; if it were, practitioners would advise patients to remain in the developed world and foray from their homes only to visit health clubs and the fruit-and-vegetable section of grocery stores. A tacit assumption in travel medicine is that some degree of acceptance of heightened risk is tolerated for the benefit of improved quality of life offered by travel abroad. The amount of risk that is reasonable to accept for a given benefit in quality of life yielded by travel cannot be quantified, however. Providers must render judgments on what is "reasonable" and what is not, and this complex decision is based on equal parts medical knowledge and intuition. At one extreme, mountaineers in Nepal have been found to have a 2.4% mortality rate per expedition [83,84]. The travel provider might make the reasonable decision to counsel these travelers to avoid that activity. These travelers most likely will ignore that advice, at which point the provider must endeavor to reduce risk to the extent possible. Other situations in which the provider should advise a change in itinerary or activities include counseling parents who plan to take an infant to high altitude or a pregnant woman who plans to scuba dive. If travelers remain cloistered in their hotel rooms, eating all meals from room service and watching CNN, then it could be suggested that they are overly risk-adverse and might consider foraying out of the hotel, despite the potential associated increased risks to health. Conversely, if travelers find themselves on motorcycles after a few drinks with a new love interest, they are perhaps not sufficiently risk-adverse; however, the "point of optimal risk acceptance" between these two extremes is a matter of conjecture. Risks associated with travel can never be eliminated; however, appropriate advice and immunizations can tilt the odds in travelers' favor.