Pre-travel consultation without injury prevention is incomplete

Japanese health and safety information for overseas visitors: a randomized controlled trial

INTRODUCTION

International travel to Japan increased steadily until the coronavirus disease 2019 (COVID-19) outbreak. Although international travel was curtailed worldwide due to the pandemic, the number of overseas visitors to Japan should increase again after the restrictions are lifted. We assessed the effect of a five-minute digital game on the knowledge of health information and the level of satisfaction with educational health resources of overseas visitors to Japan.

METHODS

We conducted a randomized controlled trial among 1062 previous and potential visitors to Japan utilizing an internet portal. We recruited previous and potential visitors to Japan from the internet portal sites of the UK, the US and Australia. We randomly allocated participants to two groups: an intervention group that played an animated game and a control group that viewed an online animation. All participants answered a self-administered questionnaire online from March 16 to 19, 2021. We assessed visitors' levels of health knowledge and satisfaction using the CSQ-8. We analyzed the data with a t test and the difference in differences test. Our RCT followed the SPIRIT guidelines.

RESULTS

Of the 1062 previous and potential visitors recruited via the three countries' internet portals (354 from each country), some had visited Japan previously (174 in the intervention group, 220 in the control group), while some were potential visitors to Japan (357 in the intervention group, 311 in the control group). Some had gathered health and safety information about Japan prior to this study (180 in the intervention group, 211 in the control group). Both groups improved their health information levels after the intervention. The level of satisfaction with health information in Japan was significantly increased in the intervention group (average difference of 4.5 points) compared to that in the control group (average difference of 3.9 points) (p < 0.05). Both groups' mean CSQ-8 scores increased significantly after the intervention (p < 0.001): from 23 to 28 in the intervention group and from 23 to 24 in the control group.

CONCLUSIONS

Our study introduced unique educational strategies using an online game to provide health and safety information to previous and potential visitors to Japan. The online game was a more effective way to increase satisfaction than the online animation about health information. This study was registered in the UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry) as Version 1, and the trial registration data are available as UMIN000042483, 17/11/2020.

TRIAL REGISTRATION

Trials UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry), UMIN000042483 (Japanese health and safety information for overseas visitors: A randomized controlled trial), 17/11/2020.

Risk of deaths due to injuries in travellers: a systematic review

BACKGROUND

Annual global travel reached an all-time high of 1.4 billion international tourist visits in 2019. It is estimated that injury accounts for close to 25% of deaths in travellers, most of which are theoretically preventable. However, there are limited data available on injury occurrence and outcomes in travellers. Our objective was to better understand the relative risk of dying from injury that arises from the novel environments and behavioural changes associated with foreign travel.

METHODS

A systematic literature review was conducted (PubMed, Embase and Scopus) according to PRISMA guidelines that included studies published in English since 1990 that reported injury deaths in tourists per 100 000-person years or as a proportion of total tourist deaths in comparison to a non-traveller population. We also included studies that reported data allowing calculation of these rates. Relative rates or proportions of overall injury mortality, mortality due to traffic accidents, drowning and homicide were summarized.

RESULTS

In total, 1847 articles were identified, 105 underwent full-text review, and 10 articles were suitable for data extraction. There was great variability of relative risk reported, but overall, travellers appear to have a higher risk of injury mortality than domestic populations, with relative rates of injury death ranging from 1.04 to 16.7 and proportionate mortality ratios ranging from 1.43 to 3.

CONCLUSIONS

Tourists should be aware of the increased risk of dying from road traffic hazards, drowning and homicide while traveling abroad. Specific geographies and activities associated with higher risk should be emphasized. Travel medicine practitioners and organizations that send people abroad should counsel travellers regarding these risks and seek ways to reduce them, including encouraging potential risk-mitigating behaviours. There is a need to improve systems of data collection and reporting on injury deaths in travellers and to study the impact of pre-travel and institutional interventions aimed at reducing this risk.

Drinking and Night-Time Driving May Increase the Risk of Severe Health Outcomes: A 5-Year Retrospective Study of Traffic Injuries among International Travelers at a University Hospital Emergency Center in Thailand

Road traffic injury (RTI) is a leading cause of death in developing countries. This burden affects not only locals, but also international travelers. Data on international travelers with RTIs in Thailand, especially from a medical perspective, are limited. This study aimed to analyze the factors associated with severe health outcomes following RTIs among international travelers at a university hospital emergency center in Thailand from January 2015 to December 2019. The retrieved data consisted of demographics, risks, preventive factors, and health outcomes. The severity of outcome was classified as fatality, hospitalization, or non-severe. A multinomial logistic regression model was used to identify the possible determinants of severity of health outcome among international travelers with RTI. A total of 720 travelers with RTIs (69% males; 82.5% were Southeast Asian) were included, with a mean age of 28.5 years. Of these, 144 (20%) had severe health outcomes: 64 (9%) fatalities and 80 (11%) hospitalizations. The level of severity of outcome was not associated with travelers’ demographics, but was associated with conventional risk factors, i.e., motorcycle use, alcohol/drug use, night-time driving, and less use of seatbelt/helmet. In a multinomial logistic regression analysis, alcohol drinking (adjusted odds ratio (AOR) 2.53, 95% confidence interval (CI) 1.41–4.55) and night-time driving (AOR 2.54, 95% CI 1.36–4.75) were associated with hospitalization. Patients who had a history of tetanus vaccination were less likely to die (AOR 0.37, 95% CI 0.17–0.81). In conclusion, one-fifth of RTIs resulted in severe health outcomes, and 9% were fatal. Road safety campaigns in Thailand should target travelers of all nationalities. Interventions that enhance travelers’ safety practices and proper preparation for road accidents should be explored further.

Japanese health and safety information for overseas visitors: protocol for a randomized controlled trial

BACKGROUND

Before the COVID-19 pandemic occurred in January 2020, the number of overseas visitors to Japan had increased threefold over the last decade. To minimize the risk of health problems, visitors should be able to access information on the health care systems of the places they visit. Most short-term overseas visitors are young adults. Although they are not very likely to get sick from noncommunicable diseases, they are at high risk for injury and often experience stomach ailments, fever, or nausea when travelling. The objective of this study is to evaluate culturally and linguistically appropriate health information on preventive health behaviours and the health care system in Japan. We will examine the level of satisfaction of overseas visitors to Japan with health care-related educational materials using a five-minute digital game named Sa-Chan Japan.

METHODS

Our study is a randomized controlled trial (RCT). We will assess both satisfaction and motivation before, during, and after the interventions and examine the changes over time. The intervention group will comprise overseas visitors who will view and answer questions in an animation named Sa-Chan Japan. The control group will comprise overseas visitors who will watch an English digital animation named Mari Info Japan. We will recruit 1002 participants through the Macromill Internet portal. We will contact overseas visitors who have either visited or wish to visit Japan from the United Kingdom, United States, and Australia. The participants will fill out a self-administered questionnaire online in the first quarter of 2021. We will determine the participants' levels of satisfaction with the CSQ-8 (8-item Client Satisfaction Questionnaire). We will analyse the median score of the overseas visitors with both the Wilcoxon rank-sum and the Wilcoxon signed-rank tests. Our protocol of randomized controlled trials follows the SPIRIT guidelines.

DISCUSSION

Our research will utilize unique digital education strategies in a game that promotes health and safety among overseas visitors to Japan. We believe the results of this study will be useful in overcoming the current challenges regarding pretravel health requirements for overseas visitors worldwide.

TRIAL REGISTRATION

Version 1 of this trial was registered in the UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry), and the trial registration data are available on UMIN000042483 , November 17, 2020.

Insights into needs of business travelers to China from calls to a medical assistance provider

Background

Although 17.5% of German travelers were business travelers in the years 2011–2013, little is known about their pathologies. Recent publications indicate that infections are the primary health issue in general travelers. Our aim was to investigate whether business travelers from Germany to China also primarily suffer from infections.

Methods

From 2011 to 2013, 587 calls for service of German business travelers to China were collected by a medical assistance provider. 482 of these calls were evaluated regarding demographics, reported diseases and conditions and the type of service provided by the medical assistance company.

Results

The most common reasons for calls for service were “factors influencing health status and contact with health service” (18.8%), “injury and poisoning” (16.0%) as well as “symptoms, signs, and ill-defined conditions” (13.7%). Most patients asked for “medical advice” (37.8%), referral to “outpatient care” (25.1%) or “inpatient care” (16.6%). “Evacuation and/or repatriation” was required mainly due to “injury and poisoning” (n = 12), “diseases of the circulatory system” (n = 5) or “mental disorders” (n = 3).

Conclusion

German business travelers to China are seeking primarily administrative support from a medical assistance provider and are mostly affected by non-infectious diseases. Pre-travel preparation of such travelers need to place more emphasis on non-communicable health risks and prevention.

Providing Japanese health care information for international visitors: digital animation intervention

Background

Over 24 million international visitors came to Japan in 2016 and the number is expected to increase. Visitors could be at a risk of illness or injury that may result in hospitalization in Japan. We assessed the effects of a four-minute digital animation titled Mari Info Japan on the level of anxiety experienced by international visitors to Japan.

Methods

We conducted a non-randomized, controlled study at Narita International Airport outside Tokyo in December 2014. On the first day, we recruited international visitors for the intervention group at predetermined departure gates and, the following day, we sampled visitors for the control group at the same gates. We repeated this procedure twice over 4 days. The intervention group watched the digital animation and the control group read a standard travel guidebook in English. After receiving either intervention, they completed a questionnaire on their level of anxiety. The outcome was assessed using the Mari Meter-X, The State-Trait Anxiety Inventory Form Y (STAI-Y), and a face scale, before and immediately after the intervention. We analyzed data with Wilcoxon rank sum tests.

Results

We recruited 265 international visitors (134 in the intervention group, 131 in the control group), 241 (91%) of whom completed the questionnaire. Most of them had no previous Japanese health information before arrival in Japan. The level of anxiety about health services in Japan was significantly reduced in the intervention group (Mari Meter-X median: − 5 and 0, p < 0.001 and STAI-Y median: − 3 and 0, p < 0.001). The face scale analysis showed no significant difference.

Conclusions

Watching a digital animation is more effective in reducing anxiety among international visitors to Japan compared with reading a standard brochure or guidebook. Such effective animations of health information should be more widely distributed to international visitors.

Trial registration

UMIN-CTR (University Hospital Medical Information Network Center Clinical Trials Registry), UMIN000015023, September 3, 2014.

Electronic supplementary material

The online version of this article (10.1186/s12913-018-3191-x) contains supplementary material, which is available to authorized users.

Road Traffic and Other Unintentional Injuries Among Travelers to Developing Countries

Injuries result in nearly 6 million deaths and incur 52 million disability-adjusted life-years annually, making up 15% of the global disease burden. More than 90% of this burden occurs in low- and middle-income countries. Given this burden, it is not unexpected that injuries are the leading cause of death among travelers to low- and middle-income countries, namely, from road traffic crashes and drowning. Therefore, pretravel advice regarding foreseeable dangers and how to avoid them may significantly mitigate injury risk, such as wearing seatbelts, helmets, and personal flotation devices when appropriate; responsibly consuming alcohol; and closely supervising children.

Travel itinerary uncertainty and the pre-travel consultation--a pilot study

Risk assessment relies on the accuracy of the information provided by the traveller. A questionnaire was administered to 83 consecutive travellers attending a travel medicine clinic. The majority of travellers was uncertain about destinations within countries, transportation or type of accommodation. Most travellers were uncertain if they would be visiting malaria regions. The degree of uncertainty about itinerary potentially impacts on the ability of the travel medicine specialist to perform an adequate risk assessment, select appropriate vaccinations and prescribe malaria prophylaxis. This study reveals high levels of traveller uncertainty about their itinerary which may potentially reduce the effectiveness of their pre-travel consultation.