Travel medicine research priorities: establishing an evidence base

Travelers' knowledge, attitudes, and behavior related to infectious diseases in Italy

The objectives of this investigation were to examine the travelers’ knowledge, attitudes, and behavior about travel-related diseases and to evaluate the factors that influence their knowledge, attitudes, and behavior. A cross-sectional study was performed between May and September 2018 among a random sample of individuals attending randomly selected travel agencies in the geographical areas of Caserta and Naples, Italy. One fourth of participants (25.6%) had a poor level of knowledge, 50.2% a moderate, and only 24.2% a good level about the most common infectious diseases in the destination country. Those who had received information from physicians about the most common infectious diseases in the destination country and who do not need additional information were significantly more likely to have a good level of knowledge. A large majority (91%) showed no concern about the risk of getting an infectious disease during the travel. Almost half of the respondents had received information concerning the most common infectious diseases in the destination country and the related prevention measures. This information was more likely acquired by those graduated, those who know the foods that can cause the infectious diseases, and those who self-perceived a well health status, and less likely by those who had a poor level of knowledge about the most common infectious diseases in the destination country and who were going to Asia and South America. Education and communication activities regarding all aspects of travel-related diseases are needed to increase the knowledge and the access to preventive measures.

Pharmacists' scope of practice in travel health: cregulations

OBJECTIVES

The primary objective of this study was to assess pharmacists' authority to provide travel health services in each state and Washington, DC. Secondary objectives were to determine the need for collaborative practice agreements (CPAs), protocols, or prescriptions for this type of pharmacy practice and to identify jurisdictions where pharmacists are able to practice as travel health providers independent of CPAs or individual physician protocols.

METHODS

An online survey was developed to assess pharmacists' authority to administer travel immunizations, furnish travel-related medications, and order travel-related laboratory tests. Open-ended items on scope of practice, training requirements, and pending legislation or regulations were also included. The survey was distributed to state pharmacy association executives. A member of the research team searched pharmacy laws to clarify missing or inconsistent responses. Data were analyzed using descriptive statistics.

RESULTS

The survey response rate was 76.5% (n = 39). Missing (n = 12) or conflicting (n = 6) response issues were resolved. Thus, data were available for 100% of jurisdictions. In most jurisdictions, pharmacists were able to provide one or more components of this service. In 44 jurisdictions (86.3%), pharmacists were allowed to administer travel immunizations. Twenty-seven jurisdictions (52.9%) allowed pharmacists to furnish travel medications. Pharmacists in 23 jurisdictions (43.1%) could order travel health-related laboratory tests. Pharmacists can practice independently in 1 state, but CPAs or individual physician protocols are required elsewhere.

CONCLUSIONS

To the authors' knowledge, this study represents the first national pharmacists' travel health scope-of-practice analysis. While pharmacists in many jurisdictions can provide some components of travel health services, only one, New Mexico, currently allows pharmacists to practice all aspects independently. Thus, pharmacists continue to have an opportunity to expand scope of practice in travel health. Additional research may help to drive increased access to and use of travel health care.

Multistate US Outbreak of Rapidly Growing Mycobacterial Infections Associated with Medical Tourism to the Dominican Republic, 2013-2014(1)

Infections in 6 states were linked to persons traveling to undergo cosmetic surgical procedures.

During 2013, the Maryland Department of Health and Mental Hygiene in Baltimore, MD, USA, received report of 2 Maryland residents whose surgical sites were infected with rapidly growing mycobacteria after cosmetic procedures at a clinic (clinic A) in the Dominican Republic. A multistate investigation was initiated; a probable case was defined as a surgical site infection unresponsive to therapy in a patient who had undergone cosmetic surgery in the Dominican Republic. We identified 21 case-patients in 6 states who had surgery in 1 of 5 Dominican Republic clinics; 13 (62%) had surgery at clinic A. Isolates from 12 (92%) of those patients were culture-positive for Mycobacterium abscessus complex. Of 9 clinic A case-patients with available data, all required therapeutic surgical intervention, 8 (92%) were hospitalized, and 7 (78%) required ≥3 months of antibacterial drug therapy. Healthcare providers should consider infection with rapidly growing mycobacteria in patients who have surgical site infections unresponsive to standard treatment.

Bibliometric analysis and curriculum mapping of travel medicine research

Evidence-based travel medicine requires that research priorities reflect the wide knowledge base of this discipline. Bibliometric analysis of articles published in Journal of Travel Medicine yielded the following results: epidemiology (6%, n = 105); immunology/vaccinology (8.5%, n = 148); pre-travel assessment/consultation (30.5%, n = 533); diseases contracted during travel (48.3%, n = 843); other clinical conditions associated with travel (6.8%, n = 119); post-travel assessment (5.2%, n = 91) and administrative and general travel medicine issues (6%, n = 105).

Closing the gap in travel medicine: reframing research questions for a new era

BACKGROUND

Travel medicine needs are changing. New patterns of travel, including greater travel by individuals from emerging economies with different values in costs, risks and benefits, must be considered. This review aims to (1) highlight selected studies that have been published that address previously identified gaps in knowledge; (2) propose possible ways to consider questions regarding travel medicine practice for travelers from emerging economies, underscoring priorities for research focusing on these important populations; (3) highlight potential deficiencies in relevance of current international guidelines as they pertain to travelers from emerging economies; (4) frame research questions for travelers from emerging economies and (5) consider roles for ISTM in closing the gap.

METHODS

We reviewed past travel medicine research priorities published in 2010 to identify publications that responded to some research questions posed. We also reviewed CDC and WHO recommendations and assessed their applicability to travelers from emerging economies.

RESULTS

Recent publications have responded to some research questions, but gaps remain and new questions have emerged. Re-framing of several key research questions is needed for travelers from emerging economies.

DISCUSSION

A new challenge looms for traditional travel medicine fields to identify and attend to knowledge and guideline gaps, particularly to rethink questions regarding travel medicine to make them relevant for travelers from emerging economies. The International Society of Travel Medicine is well positioned to assist emerging economies assess their resources and needs, formulate research priorities and tailor the development of travel medicine into a framework aligned to their requirements.

How much is too much? (Part 2) International Olympic Committee consensus statement on load in sport and risk of illness

The modern-day athlete participating in elite sports is exposed to high training loads and increasingly saturated competition calendar. Emerging evidence indicates that inappropriate load management is a significant risk factor for acute illness and the overtraining syndrome. The IOC convened an expert group to review the scientific evidence for the relationship of load—including rapid changes in training and competition load, competition calendar congestion, psychological load and travel—and health outcomes in sport. This paper summarises the results linking load to risk of illness and overtraining in athletes, and provides athletes, coaches and support staff with practical guidelines for appropriate load management to reduce the risk of illness and overtraining in sport. These include guidelines for prescription of training and competition load, as well as for monitoring of training, competition and psychological load, athlete well-being and illness. In the process, urgent research priorities were identified.

Phenomenological analysis of going home in Caribbean-American international travelers

BACKGROUND

In travel health risk assessments visiting friends and relatives (VFR) travel status is often used as an indicator for high-risk travel behavior. VFR travelers have been associated with increased risk of travel-associated illnesses due to poor adherence to travel guidelines and lack of pre-travel health consultations. For travelers to dengue endemic regions, guidelines include compliance with mosquito avoidance practices (MAP). The goal of this study is to understand the meaning of travel experiences to the home country for immigrant and first generation American VFR travelers in the United States (US).

METHODS

A phenomenology study was conducted on VFR travelers to identify social and physical environmental factors associated with travel health behaviors, and determine how 'going home' influences compliance with recommendations for dengue prevention. Purposive sampling identified participants for semi-structured interviews on travel behavior with iterative collection and analysis until data reached saturation.

RESULTS

Interviews revealed five themes that defined the experience of going home: connectedness; control of the experience; two different experiences at home; seeing what home has to offer; and there is no place like home. Moreover, risk perception of health and disease risks in the travel destination influenced travel behavior and compliance with guidelines.

CONCLUSIONS

VFR travel status does not fully capture the experience of international travel. Behavior was associated with the emergent concept of Cultural Embeddedness when traveling home and to new destinations. More research on improving terminology for travel health risk assessments is needed to improve prevention strategies in VFR travelers.

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.

Health recommendations for international travel: a review of the evidence base of travel medicine

PURPOSE OF REVIEW

International travel is increasing, including travel to countries with emerging economies. Travel may pose health risks for the individual and contribute to the global spread of infectious diseases. The specialty of travel medicine is aimed at minimizing health risks associated with international travel. The field has emerged in the past 25 years, and the evidence base supporting its clinical practice is growing. This review will describe the evidence base underlying travel medicine, highlight recently updated travel medicine guidelines, and outline future research priorities.

RECENT FINDINGS

Recommendations for a number of common vaccines for travelers have been updated recently. More sophisticated detection methods are leading to the identification of a wider spectrum of pathogens associated with travelers' diarrhea, and antibiotic resistance is increasingly being identified. New treatment options for malaria are available, and a fifth Plasmodium species causing disease in humans has been identified.

SUMMARY

An evidence base for the practice of travel medicine is emerging. Expert opinion and consensus guidelines continue to play an important role in supporting clinical practice.