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Kitro A, Ngamprasertchai T, Srithanaviboonchai K. Infectious diseases and predominant travel-related syndromes among long-term expatriates living in low-and middle- income countries: a scoping review. Trop Dis Travel Med Vaccines 2022; 8:11. [PMID: 35490249 PMCID: PMC9057062 DOI: 10.1186/s40794-022-00168-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 02/22/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Expatriates working in low-and middle-income countries have unique health problems. Migration leads not only to an increase in individual health risk but also a risk of global impact, such as pandemics. Expatriates with no prior experience living in tropical settings have expressed greatest concern about infectious diseases and appropriate peri-travel consultation is essential to expatriates. The objective of this review is to describe infections and travel-related syndromes among expatriates living in low-and middle-income countries. Methods MEDLINE database since the year 2000 was searched for relevant literature. Search terms were “long-term travel”, “expatriate”, and “health problems”. The additional references were obtained from hand-searching of selected articles. Results Up to 80% of expatriates suffered from gastrointestinal problems followed by dermatologic problems (up to 40%), and febrile systemic infection/vector-borne/parasitic infection (up to 34%) Expatriates living in Southeast Asia were at risk of vector-borne diseases including dengue and non-Plasmodium falciparum (pf) malaria while expatriates living in South Asia had a high prevalence of acute and chronic diarrhea. Staying long-term in Africa was related to an elevated risk for pf malaria and gastrointestinal infection. In Latin America, dermatologic problems were commonly reported illnesses among expatriates. Conclusion Certain health risks for expatriates who are going to depart to specific regions should be the focus of pre-travel consultation. Specific health preparations may reduce the risk of disease throughout their time abroad. Disease and symptom awareness is essential for screening, early diagnosis, and better health outcomes for ill-expatriates.
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Fleischer SH, Freire AK, Brown K, Creer A, Eggett DL, Fullmer S. Association of Short-Term Changes in Menstrual Frequency, Medication Use, Weight and Exercise on Bone Mineral Density in College-Aged Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10363. [PMID: 36011999 PMCID: PMC9408413 DOI: 10.3390/ijerph191610363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
To evaluate if experiencing a short-term exposure (18-months) to factors such as menstrual irregularities, dieting, changes in exercise or body weight, and medication usage is associated with bone mineral density (BMD) in college-aged females. A retrospective survey assessing health behaviors during a recent 18-month time period and a DXA scan were completed in 641 females. A total of 45.5% of participants reported amenorrhea during the 18-month time period. Those who experienced amenorrhea had lower femoral neck BMD (p = 0.018), trochanter (p = 0.018) and spine BMD (p = 0.022) compared to eumenorrheic women. Lifetime oral contraceptive usage longer than six months was negatively associated with BMD at femoral neck (p = 0.018) and total hip (p = 0.021). Women who lost weight trended towards having the lowest BMD at all sites compared to women who gained weight. Following a very-low calorie diet during the time period was negatively correlated with spine BMD (p = 0.001). Time spent in vigorous and very vigorous activity was weakly correlated with some hip BMD sites but time spent in extremely vigorous activity was not. In conclusion, females who experienced weight loss, amenorrhea, or a very low-calorie diet within an 18-month period of time in young adulthood had lower BMD. Additionally, oral contraceptive usage for longer than six months during their lifetime was associated with lower BMD.
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Affiliation(s)
- Stacie H. Fleischer
- Department of Nutrition, Dietetics and Food Science, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA
| | - Annalisa K. Freire
- Department of Nutrition, Dietetics and Food Science, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA
| | - Katie Brown
- Department of Nutrition, Dietetics & Food Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA
| | - Andrew Creer
- Department of Statistics, College of Physical and Mathematical Sciences, Brigham Young University, Provo, UT 84602, USA
| | - Dennis L. Eggett
- Department of Exercise Science & Outdoor Recreation, College of Science, Utah Valley University, Orem, UT 84058, USA
| | - Susan Fullmer
- Department of Nutrition, Dietetics and Food Science, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA
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Jensen MJ, Brown KN, Turley JM, Graf MI, Dyckman J, Creer AR, Fullmer S. Nutritional Concerns among Female International Volunteers Based on the Income and Development Status of Their Country of Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084846. [PMID: 35457713 PMCID: PMC9026757 DOI: 10.3390/ijerph19084846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 12/10/2022]
Abstract
This study aimed to determine the prevalence of female athlete triad risk factors among female international volunteers based on the development and income status of their country of service. A total of 2164 past volunteers completed a retrospective survey. Countries’ income and development statuses were coded using the respective annual United Nations World Economic Situations and Prospects reports. Independent t-tests, ANOVAs, and Pearson’s Chi-Squared tests were used to assess group differences; corresponding odds ratios were calculated. Volunteers in nondeveloped (OR = 2.25, CI = 1.85–2.75) and non-high-income (OR = 2.17, CI = 1.75–2.70) countries had over twice the odds of experiencing secondary amenorrhea. More volunteers who served in nondeveloped countries reported an increase in exercise while serving (p = 0.005). Those who served in a nondeveloped (OR = 1.52, CI = 1.16–1.98) or non-high-income (OR = 1.45, CI = 1.08–1.94) country had higher odds of weight loss. However, volunteers serving in nondeveloped (OR = 0.52, CI = 0.44–0.63) and non-high-income (OR = 0.50, CI = 0.4–0.61) countries were less likely to report food insecurity compared to those in developed and high-income countries. Bone mineral density was within the expected range regardless of income and development status. Female volunteers who served in nondeveloped and non-high-income countries experienced higher odds of secondary amenorrhea, which was likely influenced by an increase in exercise and higher odds of weight loss.
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Affiliation(s)
- Megan J. Jensen
- Department of Nutrition, Dietetics and Food Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA; (M.J.J.); (M.I.G.)
| | - Katie N. Brown
- Department of Nutrition, Dietetics and Food Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA; (M.J.J.); (M.I.G.)
- Correspondence:
| | - Jennifer M. Turley
- Department of Exercise & Nutrition Sciences, Moyes College of Education, Weber State University, Ogden, UT 84408, USA;
| | - Marlene I. Graf
- Department of Nutrition, Dietetics and Food Sciences, College of Agriculture and Applied Sciences, Utah State University, Logan, UT 84322, USA; (M.J.J.); (M.I.G.)
| | - Jenna Dyckman
- Utah State University Extension, Utah State University, Logan, UT 84322, USA;
| | - Andrew R. Creer
- Department of Exercise Science & Outdoor Recreation, College of Science, Utah Valley University, Orem, UT 84058, USA;
| | - Susan Fullmer
- Department of Nutrition, Dietetics and Food Sciences, College of Life Sciences, Brigham Young University, Provo, UT 84602, USA;
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Prevalence of Female Athlete Triad Risk Factors among Female International Volunteers and College Age-Matched Controls. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031223. [PMID: 35162245 PMCID: PMC8834590 DOI: 10.3390/ijerph19031223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 12/04/2022]
Abstract
This study retrospectively compared the prevalence of factors related to the female athlete triad (low energy availability, secondary amenorrhea (SA), low bone mineral density (BMD)), and post-study BMD of female college students and female international volunteer missionaries (volunteers). Female college students (21–26 years) completed a survey that retrospectively assessed an 18-month study period (volunteer service or first 18 months of college); Diet History Questionnaire III (DHQ III) and Dual-Energy X-ray Absorptiometry (DXA) scan were optional. One-way ANOVAs and chi-squared distributions assessed group differences. Logistic regression assessed covariates of SA and BMD; corresponding odds ratios (OR) and confidence intervals (CI) were calculated. Statistical significance was set at p < 0.001. 3683 participants (58.8% volunteers, 31.5% non-volunteers, 9.8% others) provided complete survey data; 246 completed the DHQ III, and 640 had a post-study DXA scan. Volunteers had higher metabolic equivalent (MET) hours than non-volunteers and others (p < 0.001), and higher prevalence of food insecurity (p < 0.001) and SA (p < 0.001). Volunteers had higher odds of SA (OR = 2.17, CI = 1.75–2.62) than non-volunteers. Weight loss, body satisfaction, “other” weight loss methods, increased MET hours, and vomiting during the study period increased participants’ odds of SA. Participants’ average BMD Z-scores were within the expected range at all sites, with no significant group differences. Volunteers’ higher MET hours and higher prevalence of food insecurity and SA did not result in significantly lower post-study period BMD.
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Bauer IL. Healthy, safe and responsible: the modern female traveller. TROPICAL DISEASES TRAVEL MEDICINE AND VACCINES 2021; 7:14. [PMID: 34090539 PMCID: PMC8180038 DOI: 10.1186/s40794-021-00141-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
One-half of all travellers are women; yet, there is a distinct lack of detailed travel health knowledge on topics of unique relevance to women. While there is medical advice relating to stages in the female lifecycle, it neglects women-specific practical aspects despite their ability to harm travellers’ health and cause inconvenience. This paper discusses comprehensively three major aspects of travel as they relate to women. First, it suggests the management of personal hygiene, bodily functions, menstruation and sexual behaviour, and alerts to the limited knowledge on travel mental health issues. Second, apart from travelling in a female body with its specific demands, being a woman requires special attention to safety and security. Within various travel contexts, women have many opportunities for minimising potential risks. Finally, guided by travel medicine’s acknowledgment of its role in the concept of responsible travel, this article goes beyond the usual general statements and broad advice and offers detailed and practical suggestions on how the female traveller can contribute to the overall goal of minimising any potential harm to fellow humans and the natural environment. Recognising the scarcity of women-specific travel information, pathways to better education, and a range of suggestions for urgent research facilitate the provision of high-quality travel health care tailored specifically to women’s needs.
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Affiliation(s)
- Irmgard L Bauer
- College of Healthcare Sciences, Division of Tropical Health and Medicine, James Cook University, Townsville, QLD, 4811, Australia.
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Allyn J, Angue M, Corradi L, Traversier N, Belmonte O, Belghiti M, Allou N. Epidemiology of 62 patients admitted to the intensive care unit after returning from Madagascar. J Travel Med 2016; 23:taw023. [PMID: 27147730 DOI: 10.1093/jtm/taw023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/14/2022]
Abstract
BACKGROUND To our knowledge, there is no data on the epidemiology of patients hospitalized in intensive care unit (ICU) after a stay in Madagascar or other low-income countries. It is possible that such data may improve transfer delays and care quality for these patients. METHODS In a retrospective study, we reviewed the charts of all patients admitted to ICU of the Reunion Island Felix Guyon University Hospital from January 2011 through July 2013. We identified all patients who had stayed in Madagascar during the 6 months prior to ICU admission. RESULTS Of 1842 ICU patients, 62 (3.4%) had stayed in Madagascar during the 6 months prior to ICU admission. Patients were 76% male and the median age was 60.5 (48.25-64.75) years; patients were more frequently residents of Madagascar than travellers (56.5%). In most cases, patients were not hospitalized or given antibiotics in Madagascar. The most frequent causes of hospitalization were infections including malaria (21%) and lower respiratory infection (11%). Carriage and infection with multidrug resistant (MDR) bacteria on ICU admission were frequent (37% and 9.7%, respectively). The mortality rate in ICU was 21%, and severity acute physiological Score II was 53.5 (37-68). CONCLUSIONS Patients admitted to ICU after a stay to Madagascar are mainly elderly patients with chronic illnesses, and often foreign residents. The admission causes are specific of the country like malaria, or specific to the population concerned such as cardiovascular accidents that could be prevented.
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Affiliation(s)
| | | | | | - Nicolas Traversier
- Bacteriology laboratory, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis cedex, France
| | - Olivier Belmonte
- Bacteriology laboratory, CHU Félix Guyon, La Réunion, Bellepierre 97405 Saint-Denis cedex, France
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Teneza-Mora N, Lumsden J, Villasante E. A malaria vaccine for travelers and military personnel: Requirements and top candidates. Vaccine 2015; 33:7551-8. [DOI: 10.1016/j.vaccine.2015.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 09/23/2015] [Accepted: 10/02/2015] [Indexed: 10/22/2022]
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Pavli A, Smeti P, Spilioti A, Silvestros C, Katerelos P, Maltezou HC. Vaccinations and malaria prophylaxis for long-term travellers travelling from Greece: A prospective, questionnaire-based analysis. Travel Med Infect Dis 2014; 12:764-70. [DOI: 10.1016/j.tmaid.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Revised: 03/14/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
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Travelling with medications and medical equipment across international borders. Travel Med Infect Dis 2014; 12:505-10. [DOI: 10.1016/j.tmaid.2014.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/08/2014] [Accepted: 07/22/2014] [Indexed: 11/17/2022]
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Schutze GE, Ferris MG, Jones DC, Wanless RS, Calles NR, Mizwa MB, Schwarzwald HL, Kline MW. The Pediatric AIDS Corps: a 5-year evaluation. Pediatrics 2014; 133:e1548-54. [PMID: 24864179 DOI: 10.1542/peds.2013-2938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children's Hospital created a global health corps named the Pediatric AIDS Corps (PAC) in June 2005. This report provides descriptive details and outputs for PAC over its first 5 years. METHODS Demographic data were gathered about PAC physicians employed from July 2006 to June 2011. A 21-question survey was used to query PAC physicians about their experiences in the program. Data concerning clinical experiences and educational programs also were reviewed. RESULTS A total of 128 physicians were employed with PAC. The median duration served was 22.7 months. Eighty-seven percent indicated that experience affected their future career choice, with half continuing to work with children and families living in resource-limited areas after they left PAC. Patient care was identified as the most rewarding part of their work (73%), whereas deaths (27%) were the most difficult. Baylor College of Medicine International Pediatric AIDS Initiative enrollment of HIV-infected children and adolescents into care and treatment increased from 6107 to 103 731 with the addition of PAC physicians. Approximately 500 local health care professionals per quarter benefited from HIV clinical attachments that were not available before PAC arrival. PAC physicians visited outreach sites providing in-depth HIV mentoring of local health care professionals, leading to 37% of the sites becoming self-sufficient. CONCLUSIONS The positive evaluation by the PAC and the scale-up of clinical and educational programs support the recent calls for the development of a national global health corps program.
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Affiliation(s)
- Gordon E. Schutze
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, Texas
| | - Margaret G. Ferris
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, Texas
| | - David C. Jones
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, Texas
| | - R. Sebastian Wanless
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, Texas
| | - Nancy R. Calles
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, Texas
| | - Michael B. Mizwa
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, Texas
| | - Heidi L. Schwarzwald
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, Texas
| | - Mark W. Kline
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Baylor International Pediatric AIDS Initiative at Texas Children’s Hospital, Houston, Texas
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Shepherd SM, Shoff WH. Vaccination for the expatriate and long-term traveler. Expert Rev Vaccines 2014; 13:775-800. [DOI: 10.1586/14760584.2014.913485] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pierre CM, Lim PL, Hamer DH. Expatriates: special considerations in pretravel preparation. Curr Infect Dis Rep 2013; 15:299-306. [PMID: 23784665 PMCID: PMC7089152 DOI: 10.1007/s11908-013-0342-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Expatriates comprise a diverse set of travelers who face unique medical, psychiatric, and non-health-related risks as a result of increased exposure to host country environment and associated lifestyle. Expatriates have an increased risk of developing malaria, gastrointestinal disorders, latent tuberculosis, vaccine-preventable infections, and psychological disorders, when compared with other travelers, yet the majority of existing pretravel guidelines have been designed to suit the needs of nonexpatriates. Although greater interest in expatriate health issues has led to improved characterization of illness in this population, expatriate-specific risk mitigation strategies-including modifications to chemoprophylaxis recommendations, limiting tuberculosis exposure, and prevention of occupational or sexual blood-borne virus transmission-are poorly described. Occupations and destinations affect travel-related disease risk and should inform the pretravel consultation.
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Affiliation(s)
- Cassandra M Pierre
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 1 Boston Medical Center Way, Boston, MA, 02118, USA,
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Lim PL, Han P, Chen LH, MacDonald S, Pandey P, Hale D, Schlagenhauf P, Loutan L, Wilder-Smith A, Davis XM, Freedman DO. Expatriates ill after travel: results from the Geosentinel Surveillance Network. BMC Infect Dis 2012; 12:386. [PMID: 23273048 PMCID: PMC3546948 DOI: 10.1186/1471-2334-12-386] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 12/13/2012] [Indexed: 11/29/2022] Open
Abstract
Background Expatriates are a distinct population at unique risk for health problems related to their travel exposure. Methods We analyzed GeoSentinel data comparing ill returned expatriates with other travelers for demographics, travel characteristics, and proportionate morbidity (PM) for travel-related illness. Results Our study included 2,883 expatriates and 11,910 non-expatriates who visited GeoSentinel clinics ill after travel. Expatriates were more likely to be male, do volunteer work, be long-stay travelers (>6 months), and have sought pre-travel advice. Compared to non-expatriates, expatriates returning from Africa had higher proportionate morbidity (PM) for malaria, filariasis, schistosomiasis, and hepatitis E; expatriates from the Asia-Pacific region had higher PM for strongyloidiasis, depression, and anxiety; expatriates returning from Latin America had higher PM for mononucleosis and ingestion-related infections (giardiasis, brucellosis). Expatriates returning from all three regions had higher PM for latent TB, amebiasis, and gastrointestinal infections (other than acute diarrhea) compared to non-expatriates. When the data were stratified by travel reason, business expatriates had higher PM for febrile systemic illness (malaria and dengue) and vaccine-preventable infections (hepatitis A), and volunteer expatriates had higher PM for parasitic infections. Expatriates overall had higher adjusted odds ratios for latent TB and lower odds ratios for acute diarrhea and dermatologic illness. Conclusions Ill returned expatriates differ from other travelers in travel characteristics and proportionate morbidity for specific diseases, based on the region of exposure and travel reason. They are more likely to present with more serious illness.
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Affiliation(s)
- Poh-Lian Lim
- Department of Infectious Diseases, Institute of Infectious Disease & Epidemiology, Tan Tock Seng Hospital, Singapore, Singapore.
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Neuberger A, Klement E, Reyes CMG, Stamler A. A cohort study of risk factors for malaria among healthcare workers in equatorial Guinea: stay away from the ground floor. J Travel Med 2010; 17:339-45. [PMID: 20920056 DOI: 10.1111/j.1708-8305.2010.00436.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Nonimmune long-term travelers to sub-Saharan Africa are at a high risk of contracting malaria. Most previous studies described risk factors and spatial distribution only in short-term travelers. This study describes the epidemiology and spatial distribution of malaria cases among expatriate healthcare workers in Equatorial Guinea. METHODS We conducted a cohort study evaluating the risk factors for malaria among healthcare personnel working in a hospital in Bata, Equatorial Guinea. Demographic data were recorded for all workers, and the spatial distribution of malaria cases within the hospital perimeters was determined. RESULTS During 2008 noncomplicated falciparum malaria was diagnosed in 13/102 workers (12.75%). On univariate analysis, the factors negatively associated with the risk of contracting malaria were living above the first floor and being older than 30 years. This association remained significant in multivariate analysis [hazard ratio (HR) = 0.24, 95% confidence interval [CI] = 0.06-0.91 for subjects living above the first floor and HR = 0.14, 95% CI = 0.04-0.52 for subjects above 30 years old]. Males and smokers had increased risk of contracting malaria on univariate analysis. However, this association was not significant in multivariate analysis (HR = 3.37, 95% CI = 0.87-13.1 and HR = 3.12, 95% CI = 0.83-11.75, for univariate and multivariate analysis, respectively). Low compliance with malaria prevention guidelines was observed in the study cohort. CONCLUSIONS Living on the ground floor of apartment buildings in sub-Saharan Africa, as opposed to living on the top floors, confers an increased risk of acquiring malaria in long-term travelers with low compliance to prophylaxis. These findings should be discussed in advance with people intending to stay in sub-Saharan Africa for an extended period of time. The association between belonging to a younger age group and an increased risk of acquiring malaria, and the marginally significant increased risk of malaria in males and smokers, can probably be explained by increased exposure to malaria vectors. The compliance of healthcare workers with malaria prophylaxis is extremely low, as was previously described for other long-term residents.
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Affiliation(s)
- Ami Neuberger
- Unit of Infectious Diseases, Rambam Medical Center, Haifa, Israel. a
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Chen LH, Wilson ME, Davis X, Loutan L, Schwartz E, Keystone J, Hale D, Lim PL, McCarthy A, Gkrania-Klotsas E, Schlagenhauf P. Illness in long-term travelers visiting GeoSentinel clinics. Emerg Infect Dis 2010; 15:1773-82. [PMID: 19891865 PMCID: PMC2857257 DOI: 10.3201/eid1511.090945] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Length of travel appears to be associated with health risks. GeoSentinel Surveillance Network data for 4,039 long-term travelers (trip duration >6 months) seen after travel during June 1, 1996, through December 31, 2008, were compared with data for 24,807 short-term travelers (trip duration <1 month). Long-term travelers traveled more often than short-term travelers for volunteer activities (39.7% vs. 7.0%) and business (25.2% vs. 13.8%). More long-term travelers were men (57.2% vs. 50.1%) and expatriates (54.0% vs. 8.9%); most had pretravel medical advice (70.3% vs. 48.9%). Per 1,000 travelers, long-term travelers more often experienced chronic diarrhea, giardiasis, Plasmodium falciparum and P. vivax malaria, irritable bowel syndrome (postinfectious), fatigue >1 month, eosinophilia, cutaneous leishmaniasis, schistosomiasis, and Entamoeba histolytica diarrhea. Areas of concern for long-term travelers were vector-borne diseases, contact-transmitted diseases, and psychological problems. Our results can help prioritize screening for and diagnosis of illness in long-term travelers and provide evidence-based pretravel advice.
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Affiliation(s)
- Lin H Chen
- Harvard University, Boston, Massachusetts, USA.
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Abd El Bagi M. Imaging of Parasitic Diseases of the Gastrointestinal Tract. IMAGING OF PARASITIC DISEASES 2007:73-102. [DOI: 10.1007/978-3-540-49354-9_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Abstract
The term "expatriates" refers to professionals and their families who live abroad for several months or years. Owing to potential prolonged exposure, and living conditions that may be closer to those of the local population, they are at higher risk of acquiring infectious diseases that are endemic in their new place of residence. They often have reduced access to medical services, putting them at higher risk of complications and more severe outcomes. Vaccination is probably one of the most effective means of preventing expatriates from acquiring endemic or epidemic diseases. Incapacitation or sickness in the field may cause serious disruption to project activities and impose an extra workload on the local team. It may also result in repatriation, with further extra direct and indirect costs for the organization. Predeparture advice and preparation, to promote risk reduction behavior, coupled with adequate support in the field are key ingredients to ensure effective and successful activities of collaborators. Institutions and organizations sending expatriates to developing countries have a clear responsibility, and it is in their own interests to promote the health of their employees working abroad.
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Affiliation(s)
- Jan A Dijkstra
- Hôpital Cantonal Universitaire, Unité de Médecine des Voyages et des Migrations, Geneva, Switzerland
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