Impact of traveling to visit friends and relatives on chronic disease management

The Prevalence of Non-infectious Diseases Among Overseas Chinese Workers in 2018

Background

With the "Belt and Road" initiative, more Chinese citizens have gone abroad to engage in overseas labor activities. Few studies have investigated the prevalence of non-infectious diseases among Chinese overseas workers. This study seeks to fill the gap and illustrate the relevant diseases in a population of Chinese overseas workers.

Methods

The health records of 13,529 Chinese migrant workers (12,917 males, mean age 41.3 ± 8.7 years, and 612 females, mean age 33.1 ± 10.2 years) who visited the International Travel Health Care Center in Anhui province were obtained. Chi-square test and binary logistic regression models were used to analyze the associations between the prevalence of non-infectious diseases and sex, as well as the association between non-infectious diseases and length of stay abroad.

Results

In this study, 34.6% of overseas workers were found to have one or more types of non-infectious diseases. Hypertension had the highest prevalence (9.58%). Hypertension, fatty liver, renal disease and abnormal liver function tests were more prevalent among male workers than among female workers, while anemia and abnormal urinalysis were more prevalent among female workers. The prevalence of hypertension, renal diseases, liver diseases and gallbladder diseases increased with the length of stay abroad.

Conclusion

Non-infectious diseases including cardiovascular diseases, diabetes, and chronic respiratory diseases were highly prevalent among Chinese overseas workers. Hence the monitoring of non-infectious diseases needs to be enhanced to reduce China's overall disease burden in the future.

Children with chronic health disorders travelling to the tropics: a prospective observational study

BACKGROUND

The number of trips to the tropics taken by children with chronic health disorders (CHDs) is increasing.

METHODS

All of the children with CHDs who attended two international vaccination centres in France before travelling to the tropics were included in a prospective, exposed/unexposed study. Each child was age-matched with two control children and followed for 1 month after returning from the tropics.

RESULTS

Fifty-six children with CHDs and 107 control children were included. The children's median age was 6 years old (IQR 2-11). Of the study participants, 127/163 (78%) travelled to West Africa, mainly to visit relatives. The median duration of the stay was 42 days (IQR 31-55). The age of the children, the destination and the duration of the trip were similar between the two groups. Sickle cell disease (23/56) and asthma (16/56) were the most common CHDs. Overall, the children with CHDs experienced more clinical events than the control patients did (p<0.05); however, there was no difference when chronic disease exacerbations were excluded (p=0.64) or when only the period abroad was considered (p=0.24). One child with a recent genetic diagnosis of atypical haemolytic uraemic syndrome died from a first disease exacerbation.

CONCLUSIONS

Health problems among children with CHDs travelling abroad are mainly related to chronic disease exacerbations, which mostly occur after the children return. Patients with diseases that require highly specialised care for an exacerbation should avoid travelling to resource-limited tropical countries.

Pre-travel advice seeking from GPs by travellers with chronic illness seen at a travel clinic

PURPOSE

Travellers are ageing and frequently report chronic illness. Pre-travel health advice is crucial, particularly in this subgroup, and general practitioners (GPs) are first in line for treatment adjustment before departure. Our aim is to evaluate pre-travel health advice seeking from GPs by travellers with chronic illness seen at a travel clinic.

METHODS

A cross-sectional observational survey using a questionnaire was conducted between August 2013 and July 2014 in travellers attending the travel medicine clinic of a tertiary university hospital in France.

RESULTS

During the study, 2019 travellers were included. Mean age was 39.4 years (±18.8). Three hundred and ninety-one (19.4%) travellers reported a history of a chronic illness. Arterial hypertension and diabetes mellitus were the most frequently reported illnesses, affecting, respectively, 168 (8.3%) travellers and 102 (5.1%). Hajj pilgrims were more likely to report a history of chronic illness than other travellers. Only 810 (40.1%) travellers sought pre-travel advice from their GP. Six hundred and fifty-two (40.1%) healthy travellers and 158 (40.5%) travellers reporting chronic illness sought pre-travel advice from their GP (P = 0.96).

CONCLUSION

Travellers with a history of chronic illness do not seek pre-travel health advice from their GP more frequently than healthy travellers. Travel health specialists are generally not the best practitioners to manage the care of underlying medical conditions presenting risks during travel. However, GPs offer continuity and disease management expertise to improve the specificity of pre-travel planning. Thus, ongoing collaboration between the traveller, GP and travel health specialist is likely to yield the best outcomes.

Health risks of young adult travelers with type 1 diabetes

AIM

International travel has become popular among young adults. This study evaluated the rate and characteristics of travel-associated health risks among young adults with type 1 diabetes mellitus (T1DM) compared with healthy same-aged individuals.

METHODS

A retrospective study was conducted of 47 young adults with T1DM and 48 without (controls). Structured questionnaires accessed information regarding 154 international trips during the preceding 5 years and lasted 7 days and longer.

RESULTS

Mean ± SD ages of the diabetic and control groups were 26.6 ± 5.0 and 26.9 ± 2.6 years, respectively. Mean trip durations were 80.0 (range 7.0-390.0) and 87.6 days (range 7.0-395.0), respectively. The number of trips per person was 1.5 ± 0.6 and 1.7 ± 0.8, and the proportion of trips to developing countries 64 and 61%, respectively. There were no differences between the groups in rates of travel-related diseases that required medical consultation (11% vs 15% for all trips). No patient sought medical attention for acute problems related to diabetes management. Prior to 71% of their trips to developing countries, respondents with diabetes consulted their diabetes physician; prior to 26% of their trips they switched from an insulin pump to injections; during 41% of the trips they increased glucose monitoring; and for the period of 11% of the trips they defined their metabolic control as poor. Self-reported mean hemoglobin A1c (HbA1c) levels before and after trips were 7.65 ± 1.45 and 7.81 ± 1.23%, respectively (p = 0.42, paired t-test).

CONCLUSIONS

Young adults with type 1 diabetes did not report more travel-related diseases than did healthy individuals. Most reported reasonable to good glycemic control during the trip without severe consequences.

Pharmaceutical care model to assess the medication-related risks of travel

BACKGROUND

People are at greater risk of health problems when travelling and a significant number of travel-related health problems are associated with the effects of travel on pre-existing chronic diseases. Medications play a key role in the management of these conditions. However, there is a notable lack of research evaluating the potential medication-related risks associated with travel.

OBJECTIVE

To apply a systematic pharmaceutical care model developed to evaluate potential pharmaceutical risks (PPRs) and pharmaceutical care issues (PCIs) in travellers.

SETTING

Adult travellers leaving Cairns International Airport, Australia, for an international destination.

METHOD

A cross-sectional survey using semi-structured interviews, including a systematic medication history, followed by the application of a pharmaceutical care model to evaluate each participant for PPRs and PCIs.

MAIN OUTCOME MEASURE

Evaluation of standard clinical and travel-related PPRs and PCIs.

RESULTS

Medications for chronic diseases were being taken by 47.7% of the 218 travellers interviewed. Although 75.2% of participants presented with no PPRs, a total of 274 PCIs were identified across 61.5% of the participants, with an average of 2.04 PCIs per participant. The most prevalent PCIs related to the inadequate precautions taken by some travellers visiting malaria-endemic regions. Although 91 participants recognised that they were travelling to malaria-endemic regions, 65.9% of these participants were not using malarial chemoprophylaxis, and only 16.5% were using chemoprophylaxis that fully complied with standard recommendations. The second most prevalent PCI was the need for 18.8% of participants to be educated about their medications. Other PCIs identified have the potential to increase the risk of acute, travel-related conditions, and complicate the care of travellers, if they inadvertently became unwell while overseas.

CONCLUSION

PPRs and PCIs were not identified in all participants. However, the impact of many of the identified medication-related issues could be substantial to the traveller. This study represents the novel application of a pharmaceutical care model to identify potential PPRs and PCIs in travellers that may not be identified by other pre-travel risk assessment methods.