Illness and risk behaviour in health care students studying abroad

Travel Health-Related Preparation Practices of Institutions of Higher Education and Occurrence of Health-Related Events among Undergraduate Students Studying Abroad, 2018-2021

Background

Knowledge of specific health-related events encountered by students studying abroad and the availability and use of pre-travel healthcare for these students is lacking.

Methods

Anonymous web-based questionnaires were sent to study abroad offices, student health centers, and undergraduate students after studying abroad at eight institutions of higher education in the United States and Ireland from 2018-2021. Analyses were descriptive; relative risks and 95% confidence intervals were calculated for health-related events.

Results

One study abroad office required a pre-travel consultation. All student health centers had pre-travel counseling available. Among 686 students, there were 307 infectious and 1,588 non-infectious health-related issues; 12 students (2%) were hospitalized. Duration of travel and timing of a pre-travel consultation impacted the risk of health-related events. Certain mental health conditions were associated with increased risk of alcohol and drug use.

Conclusion

Future studies should address the optimal timing and best practices to optimize health for students studying abroad.

Medical Trainees Abroad: Neglected Human Rights Considerations

Medical trainees (applicants, students, and house officers) often engage in global health initiatives to enhance their own education through research and patient care. These endeavors may concomitantly prove of value to host nations in filling unmet clinical needs. At present, healthcare institutions generally focus on the safety of the trainee and the welfare of potential patients and research subjects when sanctioning such programs. The American medical community has historically afforded less consideration to the ethics of engagement by trainees from the United States in nations known for serious human rights transgressions. This essay examines the ethics of such endeavors and argues for increased consideration of these broader considerations when trainees engage in global health work abroad.

Travel-related respiratory symptoms and infections in travellers (2000-22): a systematic review and meta-analysis

BACKGROUND

Respiratory tract infections (RTIs) are common in travellers due to the year-round or seasonal presence of respiratory pathogen and exposure to crowded environments during the itinerary. No study has systematically examined the burden of RTI infections among travellers. The aim of this systematic review and meta-analysis is to evaluate the prevalence of RTIs and symptoms suggestive of RTIs among travellers according to risk groups and/or geographic region, and to describe the spectrum of RTIs.

METHODS

The systematic review and meta-analysis was registered in PROSPERO (CRD42022311261). We searched Medline, Embase, Scopus, Cochrane Central, Web of Science, Science Direct and preprint servers MedRxiv, BioRxiv, SSRN and IEEE Xplore on 1 February 2022. Studies reporting RTIs or symptoms suggestive of RTIs in international travellers after 1 January 2000 were eligible. Data appraisal and extraction were performed by two authors, and proportional meta-analyses were used to obtain estimates of the prevalence of respiratory symptoms and RTIs in travellers and predefined risk groups.

FINDINGS

A total of 429 articles on travellers' illness were included. Included studies reported 86 841 symptoms suggestive of RTIs and 807 632 confirmed RTIs. Seventy-eight percent of reported respiratory symptoms and 60% of RTIs with available location data were acquired at mass gatherings events. Cough was the most common symptom suggestive of respiratory infections, and the upper respiratory tract was the most common site for RTIs in travellers. The prevalence of RTIs and respiratory symptoms suggestive of RTIs were 10% [8%; 14%] and 37% [27%; 48%], respectively, among travellers. Reporting of RTIs in travellers denoted by publication output was found to correlate with global waves of new respiratory infections.

INTERPRETATION

This study demonstrates a high burden of RTIs among travellers and indicates that travellers' RTIs reflect respiratory infection outbreaks. These findings have important implications for understanding and managing RTIs among travellers.

Mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use among students who intend to spend a semester abroad - a cross-sectional study

Aim

Our aim was to investigate potential differences in mental health, self-rated health, risky sexual behaviour, alcohol use, and drug use between (1) Prospective exchange students and campus students separated by sex, and (2) male and female students as a group.

Method

Comparative cross-sectional design using an online survey containing the following instruments: Knowledge, Attitudes, and Sexual Behaviour in Young People in Sweden; Self-Rated Health Questionnaire; and General Health Questionnaire 12. One-hundred and fourteen prospective exchange students and 451 campus students participated in the study.

Results

Male prospective exchange students rated their mental health as being better and had used cannabis more often compared with female prospective exchange students. Male prospective exchange students also rated their mental health as being better than male campus students. Female students, in general, rated their mental health as worse than male students. A larger proportion of male prospective exchange students had sex together with alcohol compared with male campus students, and a larger proportion of female prospective exchange students had sex with a new partner and drank more alcohol compared to female campus students.

Conclusion

The result shows that risky alcohol use and sexually risky behaviour is prominent amongst prospective exchange students. It is possible that they will continue, and even increase their risky behaviour whilst abroad as they find themselves in a new social context, and free from influence of the rules and restrictions that they might have at home. With limited knowledge of the local culture, native language, and in an unfamiliar environment, it is possible that the risks will be enhanced and possibly decrease their health. This highlights the need for proactive interventions, conceivably with some variations in content between sexes.

International University Students' Pre-Travel Preparation, Knowledge and Practices towards Travel Health in Thailand: A Nationwide Cross-Sectional Study

International university students are vulnerable travellers due to their unpredictable schedules and lifestyles. As Thailand continues to see an increase in international students, evaluating their pre-travel preparation and preventive behaviours is crucial to identify areas for improvement. For this purpose, an online survey focusing on pre-travel preparation, knowledge and preventive practices related to travel health was distributed to 324 eligible international students from 14 Thai universities, with the majority being from Asia and Oceania (79.0%; n = 256). The results showed that half of the respondents (53.7%; n = 175) received professional pre-travel advice, mainly because of the mandatory health examination and vaccination requirements of the host university. The study also revealed inadequate knowledge about infectious and non-infectious health risks, with only one-third being aware that Japanese encephalitis is transmitted by mosquito bites, and less than half of the students recognising Thailand's emergency services number. Poor preventive practices were also observed, with less than half of those with new sexual partners consistently using condoms and less than half of those riding motorcycles always wearing helmets. These findings highlight the need for a new strategy to improve the standard of travel health preparation among this group of young adult travellers, particularly those from resource-limited countries.

Diarrhea and related personal characteristics among Japanese university students studying abroad in intermediate- and low-risk countries

Despite an increasing number of students studying abroad worldwide, evidence about health risks while they are abroad is limited. Diarrhea is considered the most common travelers' illness, which would also apply to students studying abroad. We examined diarrhea and related personal characteristics among Japanese students studying abroad. Japanese university students who participated in short-term study abroad programs between summer 2016 and spring 2018 were targeted (n = 825, 6-38 travel days). Based on a 2-week-risk of diarrhea (passing three or more loose or liquid stools per day) among travelers by country, the destination was separated into intermediate- and low-risk countries. After this stratification, the associations between personal characteristics and diarrhea during the first two weeks of their stay were evaluated using logistic regression models. Among participants in intermediate-risk countries, teenagers, males and those with overseas travel experience were associated with an elevated risk of diarrhea; the odds ratios (95% confidence intervals) were 2.42 (1.08-5.43) for teenagers (vs. twenties), 1.93 (1.08-3.45) for males (vs. females) and 2.37 (1.29-4.33) for those with overseas experience (vs. none). Even restricting an outcome to diarrhea during the first week did not change the results substantially. The same tendency was not observed for those in the low-risk countries. Teenage students, males and those with overseas travel experience should be cautious about diarrhea while studying abroad, specifically in intermediate-risk countries.

University students' travel risk perceptions and risk-taking willingness during the COVID-19 pandemic: A cross-sectional study

BACKGROUND

Student travellers are recognised as a group at high risk of travel-related morbidity, but few previous studies have evaluated students' perceptions of or willingness to take risks during travel. Individual risk propensities may influence travellers' engagement in pre-travel healthcare and can therefore inform strategies in pre-travel risk communication. This study aimed to describe the factors influencing risk-taking willingness, risk perceptions and future health-seeking intention among student travellers.

METHOD

We conducted a cross-sectional online survey (June-August 2021) among students enrolled at Monash University, Melbourne, Australia. Primary outcomes were travel-related risk-taking willingness and risk perceptions, measured using the health/safety items of the validated Domain-Specific Risk-Taking (DOSPERT) scale.

RESULTS

Four hundred and eighteen students completed the survey. The mean age of respondents was 25.61 years, 78% were female and 46% were born outside Australia. Greater willingness to take risks was predicted by younger age (<25 years), being Australian-born, greater travel experience (3+ trips), having previously sought PTA, and perceiving oneself at low risk of severe COVID-19. We found no significant predictors of risk perception. Increased intention to seek pre-travel advice in the future was associated with greater risk perception, younger age, and perceiving oneself at high risk of severe COVID-19.

CONCLUSION

These findings support the rationale for a greater role of risk communication in travel medicine promotion strategies. We recommend that this could be achieved through 1) increasing risk perception by emphasising potential travel-associated risks, 2) personalising information about travel risks, 3) addressing perceived benefits of engaging in risky behaviours, and 4) reinforcing self-efficacy.

Perceptions of travel-related health risks and pre-travel health-seeking behaviour among students: A qualitative analysis

BACKGROUND

The impact of the COVID-19 pandemic on travel risk perceptions and pre-travel healthcare attendance is unknown. We aimed to explore barriers and enablers to engagement in and uptake of pre-travel advice (PTA) among university students, a recognised at-risk group for travel-related morbidity and poor PTA uptake. Additionally, we aimed to explore whether the COVID-19 pandemic has influenced attitudes towards future PTA.

METHODS

Semi-structured interviews were conducted with university students (October-December 2021). Thematic analysis of the data was conducted using the Health Belief Model (HBM) framework.

RESULTS

We interviewed 18 students (11 male, median age 24). Students' risk perceptions relating to travel-related illnesses were influenced by past experiences, travel destination, vaccination status and knowledge. Barriers to seeking PTA included a lack of perceived need and concerns about accessibility/availability, whereas potential benefits included reduced health risks, vaccine-induced protection, and knowledge gain. Cues to seeking future PTA were perceived risks of travel-related illness, perceived high-risk destination, itinerary-related vaccine requirements, perceived benefits of advice and concerns about COVID-19 infection. COVID-19 risk perceptions did not consistently align with those of other travel-related illness. We used findings to inform recommendations.

CONCLUSION

The current COVID-19 pandemic offers an opportunity to increase students' risk awareness and promote preventive travel health behaviours. Recommendations to improve students' future engagement in PTA include: 1) increasing awareness of risks associated with travel, 2) emphasising PTA benefits, and 3) ensuring PTA is convenient, accessible and affordable.

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.

Sex at Sea: Undergraduates' Perceptions of Sexual Relationships During Their Semester at Sea Voyage

Often viewed as right of passage in emerging adulthood on college campuses, most undergraduate students participate in casual sex during their undergraduate career. Sexual exploration typically continues during study abroad programs; however, these programs have previously been associated with an increase in risky sexual behavior due to a lack of familiar social norms and community. The current study examined the casual sexual relationships of 302 undergraduates participating in Semester at Sea, an eleven country, 106-day voyage which incorporates aspects of a traditional college campus combined with the novel experience of studying abroad. The purpose of this research was to explore students' casual sexual relationship perceptions and behaviors in the context of a structured and community-oriented study abroad environment. Over half (52%) of the student population completed a series of open-ended questions regarding their uncommitted sexual activity during the Semester at Sea voyage. Results indicated that 16.9% of students engaged in at least one casual sexual relationship over the course of the trip. Casual sex relationships on-board the Semester at Sea voyage were less prevalent than those on traditional college campuses, but casual sex relationships at sea appeared to focus more on the importance of communication and boundaries during the sexual relationship and concluded on a more positive note. It is likely that these decisions were influenced by the established communal culture on-board the ship, which encouraged students to maintain harmonious social relationships and a high level of awareness of others.

Bacterial travellers' diarrhoea: A narrative review of literature published over the past 10 years

Travellers' diarrhoea (TD) is the most frequent illness experienced by international travellers to lower-income countries with bacterial agents considered to account for 80-90% of cases. In this review, we summarise evidence published on bacterial TD over the past 10 years, focusing on the epidemiology and aetiology of TD. Diarrhoeagenic Escherichia coli (DEC) continue to be the most commonly implicated bacteria in TD, although Enteropathogenic E. coli (EPEC) and Enteroaggregative E. coli (EAEC) now appear to be predominant where Enterotoxigenic E. coli (ETEC) was previously considered most prevalent globally. Where fluroquinolone resistance had primarily been documented for Campylobacter in Southeast Asia, widespread resistance has been observed in most regions of the world for multiple enteropathogens, including Shigella, Salmonella, ETEC and EAEC. Implementation of novel molecular methods for pathogen detection has led to identification of bacterial pathogens, including Clostridium difficile (with and without the use of prior antibiotics), Arcobacter species and Bacteroides fragilis, as aetiological agents in TD. The widespread resistance to first-line antibiotics in multiple bacterial enteropathogens warrants continued surveillance and re-evaluation of current treatment practices. Further investigations are required to determine the prevalence and geographical distribution of bacterial enteropathogens that have been more recently implicated in TD.

Patterns of diseases in health students abroad: A systematic review

BACKGROUND

Different health risks are associated with international electives among medical students, including the transmission of infectious diseases and non-communicable diseases. This review aims to summarise the evidence for illnesses associated with travel in medical students taking part in electives abroad.

METHODS

Articles were identified through a literature search in two databases (until 30 July 2020) - PubMed and Web of Science.

RESULTS

Sixteen articles were included in the systematic review. The results were classified into two broad categories: communicable diseases and non-communicable diseases. Gastrointestinal infections including travellers' diarrhoea were the most common infectious diseases reported by medical students abroad, followed by respiratory tract infections and skin infections. Blood-borne and sexually transmitted infection and systemic febrile infections due to vector-borne pathogens were rarely reported. Only six of the 16 studies addressed microbial carriage. The acquisition of resistant bacteria appeared to be frequent. Traffic accidents and mental health problems were also reported.

CONCLUSIONS

One of the lessons learned from this review is the requirement for large-scale epidemiological studies to evaluate the burden of infectious diseases such as gastrointestinal, respiratory and blood-borne infections with microbiological documentation. In particular, the emergence of the acquisition of resistant bacteria may lead to a theoretical risk of spread to the community and hospitals. Studies addressing mental health issues in the context of medical electives abroad are also needed.

Travel preparation and health risks in Dutch and Belgian medical students during an elective in low- or middle-income countries: A prospective self-reporting cohort study

BACKGROUND

Medical schools offer students the opportunity to perform international electives. This study aimed to assess health risks among medical students, to tailor institutional guidelines.

METHODS

Multicenter study at Dutch and Belgian universities, among medical students who visited low- or middle-income countries. Students completed four questionnaires: once before the elective and two weeks, three- and six months after return.

RESULTS

Data was complete for 479 students (follow-up rate 84%). Most traveled to Surinam (29%) and South-Africa (14%). Half of the students encountered difficulties in adapting to local culture. Almost 40% visited malaria endemic countries. Nearly all (87%) used chemoprophylaxis as prescribed. Definite needle-stick or splash injuries were reported by 7%. All were dealt with adequately in accordance with national guidelines. However, less than half of 24 possible incidents were handled adequately. Two-and-a-half percent had unprotected sex with a new partner. The incidence of travelers' diarrhea (TD) was 46%. In those with TD, the incidence of post-travel new-onset abdominal complaints was 3%. Three percent were involved in a minor traffic accident, 18% were injured during leisure activities, 5% were threatened or experienced physical violence. Only half of the students visiting a highly endemic country were screened for tuberculosis post-travel. For schistosomiasis this was 6%.

CONCLUSIONS

Students abroad are exposed to medical and non-medical challenges, which should be addressed during pre-travel counseling. Contact details of a professional back home should be provided, so students can confer in case of problems while abroad. Lastly, we recommend a centrally organized post-travel health check.

Lifestyle Practices, Satisfaction with Life and the Level of Perceived Stress of Polish and Foreign Medical Students Studying in Poland

The adaptation of foreign students to a new country can be complicated due to different cultural values, language barriers and the way university courses are structured. The aim of the study was to analyze the lifestyle practices, satisfaction with life and the level of perceived stress of Polish and foreign students studying various medical disciplines in Poland with regard to chosen sociodemographic characteristics. The study included 231 foreign and 213 Polish students (n = 444) taking different medical disciplines at the medical university in eastern Poland. Three research tools were used: Fantastic Lifestyle Questionnaire (FLQ), Satisfaction with Life Scale (SWLS), Perceived Stress Scale (PSS-10). Additionally, students' sociodemographic data was collected. Two-factor analysis of variance (ANOVA) was performed and correlations between variables were also examined. Our research indicated that Polish students obtained higher results in FLQ than foreign students. It also demonstrated a significantly higher level of stress among Polish students in comparison to foreign students. The self-assessment of their health condition, lifestyle, and rank associated to being healthy correlated with FLQ, SWLS and PSS-10. The present research can aid the development of support programs for foreign students so that the cultural adaptation processes would more positively influence their lifestyle and an education environment.

Are you ready? A systematic review of pre-departure resources for global health electives

BACKGROUND

There has been an exponential increase in the offering of short-term international field experiences in recent years in response to student demands for global health opportunities. Pre-departure preparation is an essential component to equip trainees with the adequate safety, wellness, and cultural competence needed to engage in a meaningful and mutually beneficial elective. This review seeks to quantify the plethora of pre-departure preparation training available to public health, clinical, and undergraduate trainees across the continuum of education for short-term experiences in low-and middle-income countries (LMICs).

METHODS

We performed a systematic review of Pubmed, Embase, Web of Science, Scopus, and Ovid Global Health in February, 2018. A three-concept search was employed and included "global or international health"; "education or preparation of personnel/students"; and "field programs or travel." The study teamed used PRISMA reporting guidelines to conduct title and full-text reviews and conduct data extraction and analysis.

RESULTS

The search returned 2506 unique articles. Of these, 55 met inclusion criteria and were included in the final review. Ninety one percent (91%) of articles focused on pre-departure trainings for medical students and residents. Nine thematic domains for short-term international field experiences emerged; culture, safety, and project-specific knowledge were the most frequently covered domains while mentorship, professionalism, and emotional wellness and culture shock were least common. Approximately half (53.3%) of studies specifically evaluated the pre-departure component of the international experience using a survey or evaluation form. Recommendations emerged from these evaluations including early engagement with international partners, inclusion of self-reflection exercises and site-specific content, and utilization of interactive approaches in learning. Some institutions face barriers to conducting pre-departure preparation such as lack of dedicated faculty, finances, and institutional support.

CONCLUSIONS

Interest in pre-departure training for international experiences is growing but few programs conduct and publish evaluations of these trainings. Pre-departure trainings should be developed in partnership with receiving institutions and faculty and incorporate critical self- reflection throughout the experience. In addition to the experience itself, institutions need to evaluate these curricula to better understand how they influence trainees' capacity to effectively engage in LMIC settings.

Healthy, safe and effective international medical student electives: a systematic review and recommendations for program coordinators

Background

Thousands of medical students undertake international medical electives each year. These students face potentially substantial health and safety risks as well as educational and ethical challenges and therefore should undertake their electives within well-structured and coordinated programs.

Methods

We conducted a qualitative systematic review based on a pre-determined protocol. Relevant publications and guidelines relating to international medical electives were identified through a review of the literature using on-line search engines, principally PubMed. We then conducted a systematic qualitative synthesis to extract relevant publications. Finally, the literature was organized according to themes, with the aim of developing a structured set of Recommendations for Implementation for program coordinators.

Results

A wide range of important issues were identified which were categorized into seven themes upon which recommendations were made principally for the benefit of program coordinators: Responsibilities; General policies; Travel advisories; Occupational risk assessment; Funding & finances, Pre-departure training programs; and Post-return debriefing and screening.

Conclusions

Recommendations for program coordinators on the health and safety of medical students while on international medical electives have been sourced from existing guidelines and relevant publications. There was considerable consensus from the literature and as such these synthesised recommendations could form the basis for internationally accepted standards for elective placement program coordinators.

Electronic supplementary material

The online version of this article (10.1186/s40794-019-0081-0) contains supplementary material, which is available to authorized users.

A meta-analysis and systematic literature review of factors associated with sexual risk-taking during international travel

BACKGROUND

International travel facilitates global spread of sexually transmitted infections (STI). Travellers could contribute to onward transmission of pathogens rarely encountered at home and export new strains to the destination. The aim was to systematically examine evidence regarding determinants of travel-related sexual risk-taking and identify knowledge gaps and areas for targeted interventions.

METHOD

Articles published in peer-reviewed journals from 2000 to 2017 were screened in 6 databases and assessed for relevance against criteria. Data was extracted for factors associated with travel-related STI or proxies. Meta-analyses estimated pooled prevalence of casual sex and non-condom use. Adjusted odds ratios of predictors were pooled to generate a combined estimate.

RESULT

Forty-nine articles qualified for inclusion. A heterogeneity test indicated variation across studies. The pooled prevalence of casual travel sex was 35% and prevalence of non-condom use 17%. Expectations of casual sex strongly predicted sex with a new partner when travelling abroad. Planning to have sex indicated condom use.

CONCLUSION

The studies largely represented sub-groups of risk-taking populations from a European context, indicating substantial knowledge gaps. Studies investigating migrants travelling to visit friends and relatives, older travellers, and female travelers are needed. Post-travel harm reduction activities may serve as a focus for future interventions.

Environmental factors influencing the development and spread of antibiotic resistance

Antibiotic resistance and its wider implications present us with a growing healthcare crisis. Recent research points to the environment as an important component for the transmission of resistant bacteria and in the emergence of resistant pathogens. However, a deeper understanding of the evolutionary and ecological processes that lead to clinical appearance of resistance genes is still lacking, as is knowledge of environmental dispersal barriers. This calls for better models of how resistance genes evolve, are mobilized, transferred and disseminated in the environment. Here, we attempt to define the ecological and evolutionary environmental factors that contribute to resistance development and transmission. Although mobilization of resistance genes likely occurs continuously, the great majority of such genetic events do not lead to the establishment of novel resistance factors in bacterial populations, unless there is a selection pressure for maintaining them or their fitness costs are negligible. To enable preventative measures it is therefore critical to investigate under what conditions and to what extent environmental selection for resistance takes place. In addition, understanding dispersal barriers is not only key to evaluate risks, but also to prevent resistant pathogens, as well as novel resistance genes, from reaching humans.

Protecting the health of medical students on international electives in low-resource settings

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.

Illness among US resident student travellers after return to the USA: a GeoSentinel analysis, 2007-17

Background

The number of US students studying abroad more than tripled during the past 20 years. As study abroad programmes' destinations diversify, students increasingly travel to resource-limited countries, placing them at risk for infectious diseases. Data describing infections acquired by US students while travelling internationally are limited. We describe illnesses among students who returned from international travel and suggest how to prevent illness among these travellers.

Methods

GeoSentinel is a global surveillance network of travel and tropical medicine providers that monitors travel-related morbidity. This study included the records of US resident student international travellers, 17-24 years old, who returned to the USA, had a confirmed travel-related illness at one of 15 US GeoSentinel sites during 2007-17 and had a documented exposure region. Records were analysed to describe demographic and travel characteristics and diagnoses.

Results

The study included 432 students. The median age was 21 years; 69% were female. More than 70% had a pre-travel consultation with a healthcare provider. The most common exposure region was sub-Saharan Africa (112; 26%). Students were most commonly exposed in India (44; 11%), Ecuador (28; 7%), Ghana (25; 6%) and China (24; 6%). The median duration of travel abroad was 40 days (range: 1-469) and presented to a GeoSentinel site a median of 8 days (range: 0-181) after travel; 98% were outpatients. Of 581 confirmed diagnoses, the most common diagnosis category was gastrointestinal (45%). Acute diarrhoea was the most common gastrointestinal diagnosis (113 of 261; 43%). Thirty-one (7%) students had vector-borne diseases [14 (41%) malaria and 11 (32%) dengue]. Three had vaccine-preventable diseases (two typhoid; one hepatitis A); two had acute human immunodeficiency virus infection.

Conclusions

Students experienced travel-related infections, despite the majority having a pre-travel consultation. US students should receive pre-travel advice, vaccinations and chemoprophylaxis to prevent gastrointestinal, vector-borne, sexually transmitted and vaccine-preventable infections.

Health and sexual behaviour among exchange students

AIM

The objective was to describe the exchange students' health and sexual behaviour associated with their exchange studies, and examine the extent to which they had received preventive efforts against human immunodeficiency virus (HIV)/sexually transmitted infection (STI) and safer sex before departure.

METHODS

A cross-sectional study was conducted based on a web survey with questions about sexual behaviour, self-esteem and psychological well-being. Data were analysed using descriptive and analytical statistics.

RESULTS

A total of 136 outgoing exchange students from a Swedish University participated. Most of the exchange students rated their health as good, had psychological well-being and rated their self-esteem as being high. Approximately half of the exchange students had sex with a new partner during the exchange semester, and 87% of them had sexually risky behaviour. More than half (61%) of the exchange students had received preventive efforts before departure. No statistically significant difference regarding preventive information was found between those who reported sexually risky behaviour and those who did not. The group that had sexually risky behaviour desired free condoms and access to clinics for sexual health.

CONCLUSIONS

Exchange students rated their health as good, and the majority of them participated in information sessions that addressed preventive efforts on HIV/STI and safer sex before departure. Sexually risky behaviour during exchange studies was reported and highlights the need for more effective preventive measures; for example, a recollection of reading STI information.